The URL can be used to link to this page

Home My WebLink About0146 MARBLE ROAD - Health 146 Marble Lane A= 316-044 Barnstable f ul21 1411:43p p.1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not.for Voluntary Assessments 146 Marble Road Property Address Karen Williams Owner Owner's Name information required for every Barnstable MA 02630 7-21-14 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.Please see completeness checklist at the end of the form. Important:when filling out forms A. General Information _ ```�gpHufnpryrirr' on the computer, \�� •(H OF •••...., ..• use only the tab �.RX , p 1. Inspector: ,; key to move your I U�/ O:• . G cursor-do not James D.Sears co/ JAMES ';m use the return = key. Name of Inspector = :W _: a CapewideEnterprises,LLC '*�'.,e o e6 Company Name 153 Commercial Street', �'F/sr;N SPtEG````�� Company Address ' Mashpee MA 02649. Cilyrrown State Zip Code 508-477-8877 S1623 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 graining and experience in the proper function and maintenance of on site sewage disposal systems. I am a 13EP approved system inspector pursuant to Section 16.340 of Title 5 (310 CMR 15.000).The system: ' p ® Passes . El Conditionally Passes �_ ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority �►� 7-21-14 spectors Signature Date " y The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 dars 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. !Sins•S�113 Thie 5 official Ins F Subsudece Sewage Disposal System.•Page t of 17 Jul 21 1411:44p p.2 r , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 146 Marble Road Property Address Karen Williams Owner Owner's Name information is required for every Barnstable MA 02630 7-21-14 page. City/Town wState Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I 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: f i 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. Check the box for"yes", "no' or"not determined"(Y, N, ND)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. ❑ Y ❑ N ❑ ND (Explain below): 15ins•3113 Title 5 Official Inspection Form:subsu teoe Sewage Disposal Syslem•Page 2 of 17 ' i Jul 21 1411:44p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 146 Marble Road Property Address Karen Williams Owner Owner's Name information required for every Barnstable MA ' 02630 7-21-14 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (coat.): ❑ 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` ❑ Y ❑ N ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑- N ❑ ND (Explain below): ❑ '.::. distribution box is leveled or.replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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' ❑ Y ❑, N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 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 t5i,13•W 3 Thle 5 Official Inspection Fom Subsurface Sewage Dispesd Sptom•Pogo 3 of 17 Jul 21 1411:44p p.4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form- Not for Voluntary Assessments 146 Marble Road, Property Address Karen Williams Owner Owner's Name informations required for every Barnstable MA 02630 7-21-14 Page. Cityrrown State Zip Code Date of Inspection B. Certification (coat.) 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. ❑ 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 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 must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"Nor'to each of the following for all inspections: Yes No Q 0 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool 0 ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Q Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in qjWMW is less than 6" below invert or available volume is less than %z day flow oO t5ins-3173 Tile 5 ORidel hrspectiun Fwm:Subsurface Sewage Disposal System•Page 4 or 17 Jul21 1411:45p p.5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 146 Marble Road ' Property Address Karen Williams .Owner Owner's Name information Is every Barnstable required for eve }. MA 02630 7-21-14 page. Cityfrown _ State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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. ❑ ® 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,) 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 E3, ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ nthe system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—.1WPA) 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. t5ins-3113 Tile 5 Official Inspection Form;Subsurface Sewage Olspow System-Page 5 or 17 e r Jul 21 1411:45p p,6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voiuntary Assessments 146 Marble Road Property Address Karen Williams Owner Owner's Name information is required for every Barnstable MA 02630 7-21-14 page. CitylTown State Zip Code Date of Inspection C. Checklist ' Check if the following have been done. You must indicate"yes"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 NIA) ® ❑ 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? Q ® 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)] Q. System Information Residential Flow Conditions: Number of bedrooms (design):' NA Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (forexample: 110 gpd x#.of bedrooms): 330 t5ft•3113 Title 5 Offirial Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 l Jul21 14 11:45p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 146 Marble Road Property Address Karen Williams Owner owner's Name information is required for every Barnstable MA 02630 7-21-14 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal.Tank D Box and pit_ ' r Number of current residents: Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system?(Include laundry system inspection Yes ® No information in this report.) 4 Laundry system inspected? ❑ Yes ® No P Seasonal use? y ❑ Yes ® No 2012-31,000Gals Water meter readings, if available (last 2 years usage(gpd)): 2013-35,000Gal's Detail: Sump pump? ❑- Yes ® No Last date of occupancy: Present Date CommerciaUlndustrial Flow Conditions: Type of Establishment: Design now(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatstpersons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? - ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? t. 0 Yes ❑ No Water meter readings, if available: l5ris-3113 Title 5 0lriaal In spection Form:Subsurface Sewage Disposal System•Page 7 of 17 Jul21 1411:46p p•g commonwealth of Massachusetts' _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 146 Marble Road Property Address Karen Williams Owner Owner's Name information is required for every Barnstable MA 02630 7-21-14 page. City(Town state Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): i General Information Pumping Records: Source of information: NA Was system pumped as partof,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 J Privy ❑ Shared system(yes or no)jif 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)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t51ns•3113 M11e 5 Offidd l'tspedion Form:Subsurface Sewage Dispcsal System-Page 8 of 17 Jul21 1411:46p _ p.9 Commonwealth of Massachusetts Title 5 Official 'on Form Inspection a P Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 146 Marble Road Property Address Karen Williams Owner Owner's Name Information is required for every Barnstable_ MA 02630 7-21-14 page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1982 Permit# 82-656'/New D Box 7-14. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: t 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.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): ` Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑polyethylene El 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: 1500 Gal. Precast Sludge depth: 211 t5ins-3/13 - ! _ - Title 5 Official Enspection Form:Subsurface sewage Disposal Syetem-Page 9 of 17 Jul21 1411:46p p.10 X Commonwealth of Massachusetts'' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments v 146 Marble Road Property Address Karen Williams Owner Owner's Name information is required for every gamstable MA 02630 7-21-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont) Distance from top of sludge tq bottom of outlet tee or baffle 28" Scum thickness T. Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom'of outlet tee or baffle 17" How were dimensions determined? Asbuilt-Tape i Sludge Judge 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 at working level. Tank at 18"below grade wlcover's at,V. In and outlet tee's. No sign of leakage or over loading. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ 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 15ne•3H3 Milo 5 Of6dal Inspection Form,Subwaace sexege Disposal System•Page 10 of 17 Jul 21 1411:47p p.11 Commonwealth of Massachusetts Title 5 Official, Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 146 Marble Road Property Address Karen Williams Owner Owner's Name information is required for every Barnstable MA 02630 7-21-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: i . ❑ Yes ❑ 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 -'`I^g'3113 .. TIHe 5 Official Inspection Form:Subaurlece Sawa"Dlapwal 9yotem-page 11 a`1 i r Jul 21 1411:47p p,12 Commonwealth of Massachusetts . Title 5 Official Inspection Form _ V= Subsurface Sewage Disposal System Form -Not for VoluntaryAssessments Es "• 146 Marble Road Property Address Karen Williams Owner Owners Name information is Barnstable required for every MA 02630 7-21-14 page. City/Town State rp Code 'Date of Inspection D. System Information (cont.) ; Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 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.): D Box is 16"x 16"-8" below grade.Box is new 7-14 w/one line out Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No` Comments(note condition of pump chamber,condition of pumps and appurtenances, etc_): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS) (locate on site plan, excavation not required): t If SAS not located, explain why: t5ins•3/13 Title 5 Olflclal Inspedion Form!Subsurface sewn ge Disposal System•Page 12 of 17 Jul 21 1411:47p p.13 Commonwealth of Massachusetts . Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary As 146 Marble Road Property Address M Karen Williams Owner Owner's Name - information is required for every Barnstable MA 02630 '7-21-14 page. Cityrrown State Zip Code Date of Inspection - D. System Information (cunt.) Type: ' ® leaching pits number_ 1 ❑ leaching chambers number.+ ❑ _ leaching galleries - number ❑ leaching trenches' ` number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool _ number s ❑ 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.): Leaching is a 1000 Gal. Precast Pit. Pit at 4' below grade w/cover at 1'. !'water in pit No sign of over loading or solid carry over. No hi h stain line,wall's clean. 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 x Dirierisions of cesspool " Materials of construction _ Indication of groundwater inflow - ❑ Yes`. ❑'-No , 151ns•3/13 Title 5 Official kupecWh Form:Subsurface Sewage oisposal System•Page t 3yof 17 _ w Jul21 1411:48p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Forrn Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 146 Marble Road Property Address Karen Williams Owner Owner's Name informationis required for every Barnstable MA 02630 7-21-14 page. City/Town state Zip Code Date of Inspection D. System Information (cont.) 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, signst of hydraulic failure, level of ponding, condition of vegetation, etc.): s i91ns•3/18 Ttie 5 014dei b-pac Il Forrte •Page 14 017 - Jul21 1411:48p p.15 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 146 Marble Road Property Address Karen Williams Owner Owner's Name information required for every Barnstable MA 02630 7-21-14 page. CiVrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area below a FF Iq S 4 ❑ drawing attached separately A-I.23 13-a = 9� El I G° R A N rT L IV rs'^S'3113 Me 50fffdal Inspedfon Form:Subsurrace Sewage Disposal System•Page 15 G 17 Jul21 1411:48p p.16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 146 Marble Road Property Address Karen Williams Owner Owner's Name g fired f n is 7 required for every Barnstable MA 02630 7-21-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 18+' Estimated depth trrhigh 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: Abutting area and lot hi h.No G.W.problem seen_ Before filing this Inspection Report, please see Report Completeness Checklist on next page. ISina-3h3 Y - Title 5 Official Wpwion Form:Subsurface Sewage Disposal System•Page 16 of 17 s , Jul21 1411:49p p.17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 146 Marble Road Property Address Karen Williams Owner Owner's Name information required for every Barnstable MA 02630 7-21-14 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Inspection Summary: A, B, C. D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater - ® Sketch of Sewage Disposal System either drawn on page,15 or attached in separate file s l5;ns-3/13 Tdle 5 Official hspecGon Form Subsurface Sewage Disposal System•Page 17 of 17 e No. 6- �1 �. Fee QV i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:-Y PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftPliLation for Disposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. %4(lp NJAA13 cE Ra Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 316 ® �.TvT-rL.E sL 4'm&J NA Installer's Name,Address,and Tel.No. SO9-q7?—F877 Designer's Name,Address,and Tel.No. Ca4jr6w(1>6 6LYr( ZP&16ES LX� &I11A ly 0014"'CI r Pd0c- Type of Building: -P Dwelling No.of Bedrooms Lot Size 3<o sq.ft. Garbage Grinder( ) Other Type of Building (bi!5 ?l f}L, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) RQ?L,+C€ o-wy- F a6t 0-6 n)c V)—L 1U&P c l- Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed C C Date '7—1 q P;1.o t4 Application Approved by Date 7-1 7 '/ Application Disapproved by Date for the following reasons Permit No. )—ol Date Issued 7— �� No. �— Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ,, { - . ftPlicatlon for Disposal *patent Constritrtion Permit Application for a Permit to Construct( ) Repair()o Upgrade( ) Abandon( ) ® mplete System Individual Components Location Address or Lot No. (q(p MAA1B(.F, Rt) Owner's Name,Address,and Tel.No. WARF,-iJ W1vL1R45- Assessor's Map/Parcel 3 �� ✓ �r3� "TV'r'rG.E ¢Tj -5Lj Z'a&J Mr4 Installer's Name,Address;and Te.No. 508--q7 7—8667 7 Designer's Name,Address,and Tel.No. / l 00 .K r S-r MA94Pl9 Type of Building: fi Dwelling No.of Bedrooms Lot Size 3G, (SS-- sq.ft. Garbage Grinder( ) Other Type of Building R15 fbEW 1 j4l,. ' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided ' gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil r Nature of Repairs or Alterations(Answer when applicable) -" ZE�e L*cTc- a r&,Ox A4g;b 5;7 f g Leib Date last inspected: 1 _ Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been�issued by this Board of Health. • Signed Date `1 ;1.014 `{6 Application Approved by Date? / 7 /�✓ Application Disapproved by Date for the following reasons Permit No. O/ 7 — a �" Date Issued --------------------------------------------------------------------------------------------------------------------------------------- Th E COMMONWEALTH OF MASSACHUSETTS "r BARNSTABLE,MASSACHUSETTS Certificate of Compliance' THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(x) Upgraded( ) Abandoned( )by `_419e/. f p& u1 C. at 1�& (1IAP—L�L - MAD e&S't`- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No��/ `Z3Z dated 7 -� 7 � �v 1 Installer (2 PF_W( LS' Ctr— Designer #bedrooms A-1 4 Approved design tiow �(J�� J gpd The issuance of this pohnit shallnot be construed as a guarantee that the system will function as designed. Date �`�, � Inspector --------- ------------------------------------------------------------------- - - - - No. ( (I �— , Fee b U THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction 3permlt Permission is hereby granted to Construct( ) Repair(X) Upgrade( ) Abandon( ) System located at 14L . MAR and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction most be/completed within three years of the date of this permit. Date -7 h —7// j Approved by /1- t� / r i/ ! I pp Rd LOCATION J � SEWAGE PERMIT NO. VILLAGE INSTA LIER'S NAIRE A A00RESS 8UIL0ER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED -1-,, �X2, �yv a - ter= Y t NO.__ .-�e 5 . ... ............ w- THE COMMONWEALTH OF MASSACHUSETTS C(� BOARD OF HEALTH I ............. ----OF....................................... Xpp iraftn a for Di"mi al lVorkg Tvaa,strurtijan ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ocatiotif iddress /�, y� I t N �,,y y( f- --.._ rl .6C�t.. i ------•--------•----•----•------------- -----j--�/1•� f .(_... .o�.C�!Q.t. .!�... ......--- Owner Add ,Wa •• •... •--••--• ....V_,�]r.l.�.........Ljolv.s�e.................. /9 Y'� ®! ! .... .��5..../��1 .... Installer dress Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............... -----•----------------.Expansion Attic Garbage Grinder ( ) aOther—Type of Building ---rA�9 ze.�..> ,tag lo. of persons............................ Showers (1 ) — Cafeteria ( ) dOther fixtures ------------------------------•---.•--•-•••-•------------------------------------••---------------------..... -------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.....--.....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-••--------P-------•-----------•..............••--••-•-••-•-•-- .--••- �te••-•-•-•----------•---•------•----•----- a Test Pit No. 1................minutes per inch Depth of Test Pit.--.--.............. Depth to ground water..-----..............--. f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..--.------------------. a' •---•----•--------------------------•-•--•-••-•----------•-••---•----.............................--.-...---•-•••----•-•--•..........................--.-••-- 0 Description of Soi --•. .........Vol••--•--•-•--•••••--•-••••-•-•................•-•--•------•-•--•---------------••---••---•-- +. ...........�t % $.- t, ''� � _--.. ------... ------------------------------------------------------------------------ .� U Nature of-'Repairs or Alterations—Answer when applicable...---.......................................................................................... t. ----------------- ----------•-------------------•--------------•---------------•-------....--•-••----------....------. ------------------------------------------•--•--------------------..........•---- Agreement: The undersigned agrees'to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL iE 5 of the State Sanitary Code j The undersigned further agrees not to place the system in f operation until a Certificate of Compliance has bee ued board o ealth. Signe !i .. .... .. . ................•. .. -� D s Application Approved B --• •.... .... .- v ----------- Date Application Disap ve f o following reasons: ------------------------•-•----------------•----------------------------------------------------------•------------ --------....••--- Date Permit No............................ ................ Issued ....................................................... Date r ,,No.. . ... S •_ i FEa ...:................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH --•.................. ..........:.........OF.............................;...............------....---..__.....__.._........._....._. Apli iration for Uhipos al Works Toatstrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: {f ..... .__ � l.:t'..:. ...---•-------------•--••--•---------- .......................................'' Q.................................................. ;o•cationt ddress y f t No. y _. .A14V.dILIA..--• --- /- G°feat./.�♦�. ._....�,��.��'�"2 S!.��......-- W '�f"1 � v _ l �(O�wnet X..Se9. _.Y++-/._...-•-------••- 1/_.f a�31f_ r 2d�d <1/5 ------•-•• Installer ress dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............___............_..........Expansion Attic (koe Garbage Grinder ( ) Other-,Type T e of Building rs9 ti te. ..1�Jat9 lo. of persons____________________________ Showers (I ) — Cafeteria ( ) aI YP g -------- dOther fixtures -----•----------•--------------•------------------------•-•-••-•••••-••••••••-----••-•. ----•--•--•-•-----------•---------•-------------------------• W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity_.____.__._.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_____________________ Width_______.__.__*..... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.:.4_.__.__..___..__ Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank Y ----�••----••------------------------------ --••---•---- Date......-................................. Percolation Test Results Performed b ______________ _ Test Pit No. 1________________minutes er inch De tla of Test Pit.__c___....__.__.:__ De th,to round water........................ P P�;: � P g (s, .Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 01 ............................................................................................................................................................. 0 Description of Soil.................0--------------------------- (xj ___--•--------------'------"'n....t .+ ....... --------------------------------•----------------------------••-•------- N- F W ...........................................................=----------------------=7----- . . ----- 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 TIT1Z- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be ued h board IXealth. Signe _ _ -. .... . a.la- --- .............. Application ApproveJB . , mac!` " J�LC Date Application Disapfp of ved for following reasons:---- _-------- --- -------------------------- ---------- ---------- ............---------- -•------------------------- ---• -----•-----------------•--•--•-•-•••-....•-•--•---•---- -••••-•---••-•---------•-------•-------•---------------------•------•----•-•-••••------------ �-�'� Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD DF HEALTH ....:1... `�i.........................OF...... ... '�� ....................................... (9rrtifiratr of Tootpliattre M.'44�� IS CERTIFY, That the Individual Sewage Disposal System constructed (��r Repaired ( ) by • • -•------•-•--------- _.... u ✓ installer fl __ `_..... ;at has ' been installed in accordance with the provisions of TITLE. 5 of The State Sanitary Code s dp4cribed in the application for Disposal Works Construction Permit No.__ Z" _,S'�_______________ dated_/e_ _-._�/. ........................ THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE C UE® S A UARANTEE THAT THE SYSTEM WIL F CTION SATISFACTORY. DATE..... ............................................................... Inspect - --------------------------------------------------•-••--•-----••--•-••••-- THE COMMONWEALTH O M SSACHUSETTS BOA OF TH ' 11-4 �-- 6 ........................OF. : C ---. -----....___..------......._.-----........ No .l�.......�j FEE._,?...•••..... Bill I rko oa tt Wrafit Permissioni Y granted__ ::-+ ._.._ ---• -•-------•---•-••----•-•-•-----••---••...............•-••-..._................ r e r ( ) an ivldua1 ea e f posal System to Constr��rq atNo. ----•-- ......................................................... - --------•--•-----•-••----•-- Street � as shown on, a application for Disposal Works Construction Permit No--_ tee /rig_ ________________ L r '�y od of He h DATE. - ----------------•------•••----...•-- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS SEwAG� DisPbsAc SYS-TEm Oeslaw �• PSTPIi s t PePC -Fe Sis -- �o r 3 Cx�s� rn9 Henry K- Jv, nrNi1Q Grade -7 4 -7 Me G I I I St — m,c0 ' ForeSL �tt�,y W or ce Si erg Mq , "on _ p� Su 6 s°1 L Gad Lot 9 o/Gr a n:t c,►ie sC, ►,a .,,th Ir4cts of C V) s+C, ble V) IJA9Qj Nia. 5.ao RDim - R�t� = Legs L 1�f.1-rc R Y Ass 0C_ thaw 'two -. OWC- 1C)27Z -R<w 14,00 — y�o 11�0 }fol�Zp r- �ct.00 r e si td 1111$1 82 al.A.°.,AA O 1 v S.ZS I 6' HARRY tiN �C _ �RsSv >tic� E RL No.265 %off oi VC,LX � q aZ.So NAL vN Ce11 G r fLodr -L 97.25" e. L . 9l, So inw9s.ZS k x rnv. 95 r,� I�2S� CnL. 6 r� x r r��' �. Come. sec.�� Imo' )O��'�N $e p1�c ` to 1", D iSG� A N o K-e. j ,Y\k 3/9 Z �s— ��ny� r an �oC'• �L. 54L�7 o0 a dsr.4 Sys i E M I\/ott: fJl5PO3Q,c S\1'5 fio he Congtcu C_ted In VCCord®,tiee -0 Cornm a ron dc -TitI S- ',4ST�PA AND Henq -F\, .3unn0q 1r`laree Ste r, mo, P)ar) 5ca�e : I � = f ' 30 ' �S e a--t-t ached sate p) n ; r i i �ZN OF M o HARRY; G� EARL +` N JR. v? O,r G/s-r FSSJONAL EN6 j i t DE s i y r� n sir'4e� -rarnily 6we[)fnq w /fo gorbaJe o�lspoSo � Dal l� -NoW = �10 X 3 = 330 GP. p, se -Fic lank cvoI. ice- e ' c) 3 3 O Cs �. D, x 1 , _ 'f 9 5 G-A L, 1 2s-D GR L. rt>4/VK -go , , Di sposoI 91-+ Des i9 Heel b y � - U se (5,' Dia • x 4�' 6" D P t P- ' S+one LANTE>Zy fFSSOC , - TecJive de P`h , � , Soodvv ch1A1 , Cap ty �' x D x 4 2 0 x 3-77 -rt X 5 � X , p 7`8 �0, 27�g2 9 io z � To`TP L c AP' -r y � `f 5.5 Gff L�, D''v -7 z pz r �.A411 Ivb {�SSoc• r : sit,U o w w : Z4 A ° Go �' + N,LSO y Q�.• � ,N/U. _, , , f \ vrvl P %asr 1 '� OF AR GfrI f t A g , E R L •' •N P r11,., i � T y IST /e Z s.00 /0 SS UAL G (� —777 0T #� - 13.E-. �ew^�-�..'qs 13r•��.�a � r3 A i3 LC V l.L�, A' G� o.��45-Q Co uTovA.. 7 m G44 ��,l '