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Home My WebLink About0047 MARBLE ROAD - Health 47 Marble Road Barnstable A= 316—031 0 Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: STUDIO 360 f BUSINESS LOCATION: 4-1 tr1/1 AP—gLe, AD 869AISTA &,E a00 INVENTORY MAILING ADDRESS: s TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: ��il p�� MSDS ON SITE? TYPE OF BUSINESS: IWODWMkl^j(� INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers 'Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables (5P1'AN/ Ait47) hydrochloric acid, other acids) Floor&furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers k (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS d Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 47 MARBLE RD Property Address` BLANCHARD Owner Owner's Name information is required for BARNSTABLE MA 8121/07 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information forms on the lyputer,use key1. Inspector: only the tab to move your DOUGLAS A. BROWN ' y5 ZZ cursor-do not Name of Inspector use the return 03 key. D.A. BROWN Company Name r. r� P.O. BOX 145 , Company Address c]I =a CENTERVILLE MA z0?632 { , " CitylTown State Zip Code " 508-4204534 S14297 Telephone Number License Number B. Certification I certify that I.have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 01 X�4-v—, 8/21/07 ns Ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection..If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title V Inspection Form.doc•08106 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '( 47 MARBLE RD Property Address BLANCHARD Owner Owner's Name information is BARNSTABLE required for MA 8/21/07 every page. Cltylrown State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed Title V Inspection Form.doc•08/f>6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 47.MARBLE RD Property Address BLANCHARD Owner Owner's Name information is BARNSTABLE required for MA 8121/07 every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and!the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The,system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Title V Inspection Form.doc•08/06 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 47 MARBLE RD Property Address BLANCHARD Owner Owner's Name information is BARNSTABLE irequired for MA 8/21/07 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *" This s stem asses if the well water Y p to analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 47 MARBLE RD Property Address BLANCHARD Owner Owner's Name information is gARNSTABLE required for MA 8/21/07 every page. Clty/Town State Zip Code Date of Inspection B. Certific ation (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes" to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title V Inspection Form.doc-08108 Title 5 Official In Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments '^ 47 MARBLE RD Property Address BLANCHARD Owner Owner's Name inf ormation is required re wired for MA 8/21/07 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if t " »he following have been done. You must indicate es or no as to each of the following : Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] Title V Inspection Form.doc•08108 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 6 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ,•''` 47 MARBLE RD Property Address BLANCHARD Owner Owner's Name information is gARNSTABLE required for MA 8/21/07 every page. rty/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 252-06/243-05 Sump pump? ❑ Yes ® No Last date of occupancy: CURRENT Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design.flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): Title V Inspection Form.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 47 MARBLE RD Property Address BLANCHARD Owner Owner's Name information is BARNSTABLE required for MA 8/21/07 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1990 OFF ASBUILT CARD Were sewage odors detected when arriving at the site? ❑ Yes ® No Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 47 MARBLE RD Property Address BLANCHARD Owner Owner's Name information is BARNSTABLE required for MA 8/21/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene y ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No ------------------------------------------------------------------------------------------------------------------------------ Dimensions: 1000 Sludge depth: TRACE Distance from top of sludge to bottom of outlet tee or baffle Scum thickness TRACE Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Title V Inspection Fonn.doc•08tG6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 47 MARBLE RD Property Address BLANCHARD Owner Owner's Name information is gARNSTABLE required for MA 8/21/07 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK LOOKS PRETTY CLEAN NO HEAVY SOLIDS Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene y ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Title V Inspection Form.doc•08/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System+Page 10 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments y< 47 MARBLE RD Property Address BLANCHARD Owner Owner's Name information is BgRNSTABLE required for MA 8/21/07 every page. Cityfrown State Zip Code Date of Inspection D. System Information (Cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes El No Alarm-level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened)(locate on site plan): Depth of liquid';�,evel above outlet invert Comments(note if box is level and distribution to.outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 47 MARBLE RD Property Address BLANCHARD Owner Owner's Name information is BARNSTABLE required for MA 8/21/07 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): OPENED NEWEST PIT IT WAS DRY AT THIS TIME STAIN LINE AT 3 FT Title V Inspection Form.doc•08106 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 47 MARBLE RD Property Address BLANCHARD Owner Owner's Name Information ti is BARNSTABLE required for MA 8/21/07 every page. CiiyRown State Zip Code Date of Inspection D. System Information (cont.) Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Tide V Inspection Form.doc•08/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 • Commonwealth of Massachusetts ROOM Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 47 MARBLE RD Property Address BLANCHARD Owner Owner's Name information is BARNSTABLE required for MA 8/21/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. o �r -,� 0Pe acv O Title V inspection Form.doc•06/06 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal _g posal System Form Not for Voluntary Assessments 47 MARBLE RD Property Address BLANCHARD Owner Owner's Name information is BARNSTABLE required for MA 8/21/07 every page. C1tylTown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: i 0 Title V Inspection Form.doc•OS/06 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Town of Barnstable OF I 1p� Regulatory Services saxtvsrns Thomas F. Geiler, Director b 9 r Public Health Division ArFD MA'S A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original%copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. ASSESSOR'S MAP'N0. PARCEL 7 " -'. 9 ice'.L A aF IONS SEWAGE PERMIT N Q. -VILLAGE t IN A LLER'S - NAME i A0D.R.ESS B U I L D E R OR OWN Ell - D A T PERMIT D y E ISSUE r D A T E COMPLIANCE ISSUED _� � ,F ,j�� ,� fir' �` � r t �-'-=�. � � _ _ _ _ _ Tt^ f f .r�� i�k�i,Y' � �� .Z dry sw�"�fg ,r��/ ,l' ��C"" I" ✓�� d a�ssF,��y'�"�ti+' d r +�s�',y♦.�y,E'�f°-�� -d _. ! c � .��' o(}� �� 0 � :3�. 0 �® TOWN OF BARNSTABLE Fv t�C;.�TtO'; _ SE,WAGEo 6 "ILLAGt (ZASSESSOR'S MAP & LOT �:� ( INSTALLER'S NAME PHNE NO. v .dull-o�lz SEPTIC TANK CAPACITY LEACHING FACILI'I'Y:(typeL _ ,p_ r (size) NO. OF BEDROOMS_ RIVATE W}ELL OR�FUBLIC WATER BUILDER OR OWNER P DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No Lam' S9' 01 I i sq L i THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Allp iratiun for Dispustti 10orkii Tonstrur#iun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .............. � .r.�. . .. ......------.........--------- ......---.........................------. ...... Locatio Add` -•....................................•---or Lot No. .........••••.. ....._........ .. ...... ._... .... --------- - ...........------- Wn — Add a - .._... fir:.. .. . . ..--- staller Address UT of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms..... ..................................Expansion Attic ( ) Garbage Grinder ( ) '. Other—Type T e of Building ............... No. of ersons......................_..... Showers — Cafeteria Pa yP g ------------- P ( ) ( ) Q' Other fixtures -------------------.-------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank Liquid capacityA"d.0___gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area------_-------------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet_:_................. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..:..................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------- ----- ....................................................................................................... Description of Soil......._. +J ---••--•------------------------------------------ ------------------ W --------------------------------------------------------------------------------------------------------------- . -------- -------- -- V Nature of Repairs or Alterations—Answer when applicable....__..___ .................... .......... ..... ' -•--------------------------•--••----------•-------------•-•---•----•--••---.........-•-----------------•-------------------------------------••------•---- ........................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance as been issued A board of ealth. Signed ---------- � .................. ---- ------................ ----------------------------------- Dace Application Approved By -------------- - -- -- ..-----------.-- ---3 ~ ... � Date Application Disapproved for the following reasons- ---------- ------ -------------------------------------------------------------------------------------------------- -- ---- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- Permit No. ............../ �.......- ..7 Issued ------------------------ --..--...........-.--.. ...._.....- -....-.......... fe---- Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinn for Disposal Works Tunutrurtiun Verutit _ Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �, �� 117 , .. ...�.�........... .��.�.'�.� [X�.-------------------------- -----------.---- Locatio -Addr'-s - or Lot No. �....._�.._.. .......... - ---------------•-----------•--� .,+-.... caner �7 '/J_ Addres p nstalf'er Address W T e of Building 22 Size Lot............................Sq. feet V Dwelling—No. of Bedrooms._....J.................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building ._...___.._. No. of persons............................ Showers — Cafeteria QI Other—Type g --------------= P ( ) ( ) Q' Other fixtures ....................... W Design Flow............................................gallons per person per day. Total daily flow................_................._.........gallons. WSeptic Tank—Liquid capacity.nn V_gallons Length................ Width---------------- Diameter---------------- Depth................ xDisposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft; Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f3, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil.......,, .___ _ ._ . ._ -------- ........................---- x ---- a. U ...............•------------------------.....---......_.... W ----------------------------------•-------------------•-•--------------•---------••------------•----------- U Nature of Repairs or Alterations=Answer when applicable.------- -- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance as been issued by the board of .ealth. Signed ............. .. ........................................ Dare Application Approved BY `.... j--------------------------------------------------------------------- Dare � . � Application Disapproved for the following reasons: -- ------ ---------------- ---- - ------------------------------- . .............................. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ....................................... t 'r Permit No. � - �-7 . ---- Issued ..................................-------------------------- --- Dare THE COMMONWEALTH OF MASSACHUSETTS t # BOARD OF HEALTH TOWN OF BARNSTABLE Cex#ifira e of (fumpCianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( �) by.............................. .---:---------- . tp tmat .................Lyl... ........�VI.,--.4 (..!.�.-----......�....------........l.�Y�$Q-i�);!c.�.,P {...----......-.----------------------..........................-.----.......................-..--.-------.------------------------- has been installed in accordance with the provisions of TITLE 5 pt The State Environmental Code as described in the application for Disposal Works Construction Permit No. ....... 1). ....... -7........... dated -------7 .- � �a ------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. r 7 �" DATE.......... ---- ��" . -....o------------------------------------ inspector .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No TOWN OF BARNSTABLE Disposal Iforks Tlinufrndiun rrutit Permission is hereby granted------------- --r-r--- 4`Jr � -----•--------•----•---------------------------.......-----•---........................ to Construct ( ) or Repair (j an Indivvidual Sewage Disposal System atNo.................t1-!...7...... =>. 0................ -ti `D�, ................................................................... Street as shown on the application for Disposal Works Construction Permit No._ � _._.. _?Dated.......................................... ..................................... Q_-r ...................................................... DATE. Board of Health FORM 36508 HOBBS✓4 WARREN.INC..PUBLISHERS ASSESSOR'S MAP NO.--' PARCEL D I LOCATIONR �-1 SEWAGE PERMIT NO. 'rZ2T �y VILLAGE IN A LLER'S r NAME A ADDRESS I! B U I L D E R OR OWNER i DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED ' ��K fry'.'.� 5 f � �.✓ 1 4 1 ,n 1 No..........Y.,!Vh.... Fimic.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TA .. OF...... . .Z.e. �Zf9 C. ..................•----................ Appliration for Dispasal Works Tonstrrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: q ....... e-...�.flD. ... ............ ............................................... Location-Address or Lot No. ....---....._..•.CjM.4u0 ...�.r:-�?/�c.��.. .... ..0,e/,---•- - .............. ---...---...--•------------------..........-•---- Owner Address ---•--...---_.-U . ---------•--.._............................ ........................•.................. a __....... Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms..._._ � .Expansion Attic Garbage Grinder ( ) pai Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other f�xWres -------------------------------- - . W Design Flow............._ ...............................gallons per person per day. Total daily flow...........6.+_6...................gallons. WSeptic Tank—Liquid capacity/PP O.gallons Length---------------- Width................ Diameter................ Depth................ x Disposal Trench—No...__.. �__,_ 1•------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..__��`?Q(?___ dame er _______________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed bv.......................................................................... Date......:................................. aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a . ......................................................................................................................................:..................... 0 Description of Soil.................................................................. ---..-----------------------------------------------•-----.................................. W UNature of Repairs or Alterations—Answer when applicable................................................................................................ -------------------------------------------------------------------------------------------------•-------------•--------------------------------------------------------------------...--------------•-• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of heal . / J 9�3- 73 Signed ............. ---....... ----•---------•--••------ Date .._.Application Approved BY/ = <---- .-•-•--------�---�-C �-----------------•-------- --------- / Date ApplicationDisapproved or the following reasons:.............................................................................................................. ------•-•---•.........................•.................--------.......--•------•--------•-••------------•-•••-----••.......-•-•----•--••...•••.....•-••••---------•-----•-_-•••• --------------- /� 5 Da� Permit No.------..al.. -•--•---------------•-•------...... Issued-- � �......._.. 1 Date / -- - ..a�..�._►.u.- ..�..��. ....._ . + Z14 No......... �-.... FEE.._.......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........74'-�...........OF...... ��°��'! ; " 1: ....................................... Appliratiun for lioprronl Works Ton#rurtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal I ,. System at: .......... .......... -. .. ......%�' ... r 1. t'............................................... Location. Address ; or Lot No. ..............- Cif l .:�.�-4.•..- .....•.== ��.!A"//--------. Il Installer AddreOwner Address >"� _ • ' ...............................•----•--- --•--------------•------------•------•-•-•.._.. dress------------------------------........_...... dType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms „ ............ Expansion Attic ( ) Garbage Grinder ( ) Other -,Type of Building. No. of ersons :' Showers — Cafeteria 4. Other �x�ures -•-- -----------------------•--- --•--- ..._--•---•----- -•------------------•---. W Design"Flow ...::� ..4 .gallons per person per day. Total daily flow....... . .... gallons. WSeptic ,Tank—Liquid'capacity, W_.gallons Length................ Width................ Diameter....__................ Depth................ x Disposal'Treilcfi No. & Id ! ................. Total Length.................... Total leaching area.................... ft. Seepage Pit No.._., _ lame er Depth below inlet.................... Total leaching area.................. ft. Z Other Distribution box ( ) Dosing tank ( ) W Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of i.Test Pit.................... Depth„.Q,.ground water........................ (z, Test Pit No.�,-20-!.. :__.._...minutes per inch 'Depth of Test Pit.................... Depth to ground water........................ Phicx':•: ................... ------..... .-------•••••---•-------••-•--............---•----......................................................... O i Description of Soil W . a UNature of Repairs or Alterations—Answer when applicable...................................................._........-__....._....._...._...._.__._..... -----•---•----------•------ ------------------------------------ -------------=---•-_--:............................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with } the provisions of Article;XI of the State,Sanitary Code The undersigned further agrees not to lace the system in P Y g g P Y operation until a Certificate of Cornphanceaas been ) seedy the board of heal 73- -Signed : : " �. .------ Date Application Approved By_,J:-A<---. t --- ................................................... Date the following"reasons:...... .:........................................................ --•--........ Application Disapproved�0r :...................... '' ........................•----....-•-------•-------------------.........---...--•-•--•-------•----------•-------....---------------•---•---------------------•-------------------•----•-••--••--•-...... Date . Issued.-_ Cf 3 Permit No.---- .. .� �........• `---..•--- :. THE COMMONWEALTH OFx MASSACHUSETTS BOARD -OF HEALTH:`, Tntifiratr of Tomptiam' THIS IS TO C . F That the In idual Sewage Disposal System constructed ( ) or Repaired ( ) b � e_ y - -------•••-- -- -----.._ ------------------------------------- • --• Installer = has been installed in accordance with the provisions of Article XI of The State Sanitary Cod�i as desc d in the application for Disposal Works °on'struction Permit No.: `. __? ..�.. dated---------- -- . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WI F NC ION SATdSFACT,ORY % DATE--- .. .. h Inspector......... ... .;4r �r.3 x THE COMMONWEALTH OF MASSACHUSETTS �4, w ..BOARD OF HEALTH ....... .......OF..... ...................................................:.. No�7 ............ �.�. ............ FEE....................... Eltopood Works %T1unfrurtion ranfit Permission is hereby ranted... �". to Constrct ( ) or Repair ( ) a n i I wag3lo1 System atNo. .. ....................................... .. - 13 .. as shown on the applicationjor Disposal Works Construction_Permit No..................... Dated.......................................... w 4 .�.b n .... ..... ... .rt_Z1 //DATE ... -••---------------------------••-.-�.FORM 1255 HS & WARREN. INC{-PLIBLISEIERS x. I ! ! I I } 7T t ! t t + +---- -t -{ - -+ -+ + t T 1 -+- 1 } + -' + r .+ +_Y.- + + +- .•- t 4-1 t I , -r-4--+ I 1 ' , I !iL fi. Jr- 6-3 1 4- -- � 1 ; f-._�.. F-- i �---+--+-�-+----�:---7--h -�•---t-V=-�--'Y--1....-'+----t-�-+ � -:�—i- r _f---r_ .1- t - .+..-�.> -t--+-�--f--•--•{----!--''"".+----r--h h—�--T_ 1 c �---+---*—�t4)--� -I +—rt IT---i----1- -F +-�-t- I—r= '-t -�'---k }---f._-+--+-+-_r��'-`{. _--• --t-._t---t- -+-+ �.'�.� �. T .}.__.t—.�. ...+.-} 1 _�1 ! 1 I I 1 } 1 I I 1 I 1 — I 1 I I +- 4 I i - -�--+ ♦ rt }41 ♦ 1 f i i