Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0289 SALT ROCK ROAD - Health
289 SALT ROCK RA BARNSTABLE � . ._ w.. A = 316 023 ti T x • 4 e d � , .y p i a y.. G L u 1 U,t - • ' _ 9• > 1,- L :) .. � -. .. �' xx _. 1 L , -,$' "t"�t''-1'xi-�a''trx.lid� `''` �' r� -��, r. a.. avu�- ` x.� :._e. ��rt c^'.x as'�4. .'q � ;• -� ,_ ' _' !,' �' �:� .�`�a4q..; qq D. n:TOWN OF BARNSTABLE �w .a: LOCATION�. O`� U b t�Zo/�� SEWAGE'# Zdyf-7 Z"10 VILLAGE/Ji iZN,����;o ASSESSOR'S MAP & LOT I/G '0"L 3 t INSTALLER'S NAME,&.PHONE NO. � �� —7 5 '2 FOO SEPTIC TANK CAPACITY CX&s7 �'g %G73D LEACHING FACU- ITY: (tyP� Qt3c�a4� �'I�AH�72rS (size) �� *Y/,3 A''Z' .. NO. OF BEDROOMS BUILDER OR.OWNEk _ Koh PERMITDA TE '. S —9,-O 1. ,., COMPLIANCE,D:. ATE: Separation Distance Between the: Maximum_Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Welland Leaching Facility.(If any wells.exist 7. onsite or within 200 feet o.faeachiri facility) _ Feet g _ Edge of Wetland and.Leaching Facility(If any wetlands exist wtthtn 300 feet of leaching facility) Feet I Fturushed by 11 1� 1 1 t t � O , i �V{ No. w� — Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes PUBLIC HEALTH DIVIS iN='`OWN OF BARNSTABLE., MASSACHUSETTS Application for Mi.5pont *p5tem Cotittruction Permit Application for a Permit to Construct( )Repair( pgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.o[U C' A- Cx 1 Owner's Name,Addre s and Tel.No. Bwd Assessor's Map/Parcel � /� ... O Installer's Name,Add xs„and.TelaliNeo Designer's Name,Address and Tel.No.- 350 Main Street Type of Building: , Dwelling No.of Bedrooms .S Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persot Showers( ) Cafeteria( ) Other Fixtures \ Design Flow gallons per day. Calculated dai�ly�flow gallons. Plan Date Number of sheets �R vision Date ----- Title Size of Septic Tank MOO 6eL Type of S.A.S. Description of Soil 4-- 1 Nature of Repairs or Alterations Answer when applicable) _ ?s 1�4-� �/ • Q o S00 IF_s (_J j 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 Certifi- cate of Compliance has been issued by this Board of 1 Signed Date -S ' y Application Approved by Date Application Disapproved for the following reasorif t: Permit No. Date Issued No. Zt Fee 15 ✓ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISIONN='IOWN OF BARNSTABLES MASSACHUSETTS Yes ZIPPrication for �Digpozal 6potem .Cow5truction Permit Application for a Permit to Construct( )Repair( ,�<pgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. O wner's Name,Add and Tel.No. l Assessor's Map/Parcel r ' r N" ' '` ,,vs Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. A & B CAS , ' g 350 Main Str-1-1 Type of Building;. Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated dailyrflow gallons. if Plan Date Number of sheets t...`:t Revision Dae t Title Size of Septic Tank 000 Type of S.A.S. Description of Soil r t Nature of Repairs or Alterations(Answer when applicable)_.1"S 1 A-( I Q'a,),e t 'Lo `f` Date last inspected: +` f 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 Certifi- III cate of Compliance has been issued by this Board of He t Signed J Date S— S ' U Application Approved by Date S' 'U Application Disapproved for the following reason Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS , 1 BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( -rUpgraded( ) Abandoned( )by at G ,v has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �UrZ7 U dated_ Installer Designer The issuance of this pernpt shall not be construed as a guarantee that the syst 11 func =asigne Date S ,Z, ; Inspector cI � d �d,/� No.�,�`��� 3e6'oz3 ---------Fee f�D THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS MOOSSar 6pOtem Construction permit Permission is hereby granted to Construct( )Repair( grade( )Abandon( System located at 1 �^7 C'a[?[ (,4 / (� _�6 j n 114�, 4 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction u be ompleted within three years of the date of this p t. eeDate: U/ Approved by �% 1/6/99 NOTICE: This Forri<:i Isjo Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT:DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated S - - O ( , concerning the property located at a��j c5 rQ �7C-�o��.l d1�1 . c3q 1. ;J. meets all of the following criteria: 'This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system / There are no private wells within 150 feet of the proposed septic'system / There is no increase in flow and/or change in use proposed ere are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum.adjusted groundwater table elevation, Please complete the following:A) Top of Ground Surface Elevation(using GIS information) 99. .2 7 B) G.W.Elevation 94 +the MAX. High G.W.Adjustment.3. DIFFERENCE BETWEEN A and B yc �• SIGNED : DATE: [Please Sketch proposed plan of system on back]. NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert �,� �l o � rc o TOWN OF BARNSTABLE LOCATION AF7 SA—:r fzacA-- Z7j . SEWAGE #� VILLAGE-A A ASSESSOR'S- MAP 6i LOT? a -- INSTALLER'S NAME & PHONE NO. f Ctu-, �StLs+S • Cc�,�� ,�'_ SEPTIC TANK CAPACITY ov LEACHING FACILITY:(type) (size) boo NO. OF BEDROOMS PRIVATE WELL ,OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No d � � � � C` � � v ` � � �, �, «� �" G`* � ' �� �.. f: .! No THE COMMONWEALTH OF MASSACHUSETTS " BOARD OF HEALtk ' Appliration fur 3� � u tt1' urk�, C��ari r�tr#turi rant# Application is hereby made for a Permit,to Construct O or, Repair (✓) an Individual Sewage} Disposal System at - --. .. . Locati : Address� `' - or Lot No.— �•- + .. , W ,Z f JlC'Y�Q OWC�S7 •: '�"'G l/d v/L!�/ 1 Address• �.. .. --........--••---. �..,./... ..................... ------•-----------^.........................I... ...............•.................. ..........t F.1 Installer - r Address Type of Building + Size Lot.......:... .Sq. feet < =' , 0_4 Dwelling—No. of Bedrooms............. .......................:..Expansion Attic ( °)' Garbage Grinder ( ) p, -Other—Type of Building ____,_______________________ No. of persons.........._.:.__._._.._.._.. ) 04 Showers ( ') — Cafeteria ( dOther fixtures .::._.. ........---•--........-•••--•----------••.....-------•--------------••----......-•-•.....•---•..........r.......... WWDesign Flow...................................7..........gallons per person per_day...Total daily flow.._........:'.................._._......•gallons. WSeptic Tank—Liquid capacity............gallons Length.................. Width.................,Diameter................ Depth................ Disposal Trench—No.............. Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage,Pit No..................... Diameter....... Depth below inlet....:..:........... Total leaching area..................sq. ft. Z Other Distribution box {, ) Dosing tank( ) Percolation Test Results Performed.by.........................................r...................................... Date......................................... Test Pit No. 1................minute`s per'inch Depth of Test Pit........ ..., Depth to ground water........................ LL, Test Pit No. 2................minutes"per inch Depth of Test Pit..:...........__... Depth to ground water.................:__._.. x ::............•-------• :.: --------- - ---- O Description of•Soil................. :_.. ............. V ........^.................................... ..:.:........................................................................................... .................................................... x ......................................---•-•••••._....................................:...------•.....---•--------•-•-_. .......................... U Nature of Repairs or Alterations Answer whenr applicable..___�� � � %�/.............:.,hG���'_ -��....49W.Ac&- Agreement: r; a The'undersigned agrees-to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITU 5 of the State Sanitary Code k• The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' ed by the bo d of health.-' Signe .._ .;. " • ,' " Date E i"Application Approved B - ...... Application Disapproved for the following re s.:........................................... -- _..:..... .. ' .•--- --•�.j .... ....-----• ........................... ---------- . •--------------.------•-----.- --.-----• -- , ` ' ��. _:3✓.1..".S.l..�1... r ,r' '-------; .. _ .Date j• . Permit No.. -`_---._.... "Issued......... .. • a . . I Date a. •- w � No.-We--------_..-.... / 0...._ r THE 1_ T COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............... - ---.`. Appliration for Disposal Works Tutuarurtiorc f rrutit Application is hereby made for a Permit to Construct ( ) or Repair (V) an Individual Sewage Disposal System at: . Ajo Locatio -Address, or-Lot No. �// Owner Addre_ .. .--i7ivS� � c���<</✓r9�t Installer Address Type of Building Size Lot............................Sq. feet U Dwelling— No. of Bedrooms............:3..........................Expansion Attic ( ) Garbage Grinder ( ) p., Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other 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. 3 Seepage Pit No--_---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by----------............................................................... Date........................................ ,.� Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... L� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ A+' •-••••••-•-•---••---•---••--•••--••••••-••.................•••••----•................------------............................................................ ODescription 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 TIT1Z- 5 of the State Sanitary Cod The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bZT�_ is died by the board of health. Signe . •--••-- - S �3-'•... /'Date Application Approved By... .r � a.......--.. ........�'�"'/. Application Disapproved for the following reasons:.............................................................................................................. -•..................•-•-----..•..----•--••-•----•----------------•--...............---.......-----------..__...----------------------------------.....--- ............................................... 17 a Permit No... ..0..._...&:a.L&:al.................. Issued-.-•----------------•-------------------.... .. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... � OF...... fl �-1T�,1� ........................ ....................................................... Trrtifiratt of ftomphanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (V) /S /Lv S �ii/1 . /�--�--:------------------------------•----..................-------•-•--... by ........ ---- _ Insta r at.•••-••.'n == .4- /1��`="I(- 4"e= �i.��x�c/71.fl�1�.............................................................. has been installed in accordance with the provisions of TITLE 5 oaf The State Sanitary Code as descr'bed in the a lication for Dis oral Works Construction Permit No.__ ___ '"} �!f dated.............. �� PP P ::� — . --.•-• L .ter.... = THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE... ............. �. ./i Inspector... 7---'-----�----- -----_-::--'?....._..,. �!�............... .... .Z. . ............................. 1 ----------E--------------------=----- - ---- ------�----------------_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 131 .............OF...f... 1 : G�................................ �No...- FED..-.-t ................ Disposal Iforks Tunotrudion ramit r Permission is hereby granted...... _ .__T" •!!?. _.����'�� --�.... to Construct ( ) or Repair'(V)an Individual Sewage Disposal System at No.: ate`" - Z d.�'�:��.2.X.....A.nl...........�'� �''�G=' ' /�'jJ1:�:IA.... ---_ -I.......... s i Street as shown on the application for Disposal Works Construction�-e m. No.__....___.__�.. D'ated_. _.__._. .AM��O.-..�.. Board of Health DATE------... -••----••-----••••................••-- r / • S►3y co r } SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property a%q 5AI-T -K� 3RR�s bCE r�q, owner's name ��u9(R S /-A Vl��OS i/ Date of Inspection PART A a' CHECKLIST Check if the following have been done: k/ Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced- into the system recently or as part of this inspection. _t,-' As built plans have been obtained and examined. Note if they are not available with N/A. _k-' The facility or dwelling was inspected for signs of sewage back-up. _y The site was inspected for signs of breakout. � All system components, excluding the SAS, have been located on the site. _P,"' The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of .baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. _ The size and location of the SASilon the site has been determined based on existing information or approximated by non-intrusive methods. _v"' The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. 9 10JON dd 1995 { r 8 SUBSURFACE SEWAGE DISPOSAL; SYSTEM . INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential _3 number of bedrooms 3 number of current residents ND garbage grinder, yes or no YF5 laundry connected to system, yes or no 0 seasonal use, yes or no If nonresidential, calculated flow: Water meter readings; . if available: 9a-g3 l;0060 9AC. Q3-4 13Scoo 94 L 9N-9.5 (0r'o E5 Last date of occupancy - GENERAL INFORMATION Pumping records and source of inf rmation: FLLc.s �v System pumped as part of inspection, yes .or ,.no if yes, volume pumped Reason for pumping: Type of system usF-6 45 AAJ EtBOW3e _ -/ Septic tank/ /soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach .previous inspection records, if any) Other (explain) Approximate age of all components. Date installed, :if known. Source of information: _6 05 QL-D AK)d A"jtjo�v4 S4S jmstq ed s-a3-88 �[� Sewage odors detected when arriving at the site, yes or no SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: YF5 (locate on site plan) depth below grade• material of construction: concrete _metal= ` FRP other(explain) dimensions:- � � X � l X�. �a�T = l�oa yy.� FXrFitJs�a12 BP�ss=,�S /,�T �iv��T sludge depth AT ov'ri,eT Sn>a ©n/Lyj p n1- J ULFT- 6 -d .4n.d ruiddlA ate" distance from top of sludge to bottom of outlet tee or baffle 4i v o��lEi o�x " scum thickness _e�> distance from top of scum to top of outlet tee or baffle O' distance from bottom of scum to bottom of outlet tee or baffle Comments : (recommendation for pumping, condition. of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, recommendations for repairs, etc. ) yd 0 /ti E 4vl,P ,l, 6//3/4S Gli.S�7`E,P LE/�,�/ fiPyyr� *Is u&� J DISTRIBUTION BOX: � ES (locate on site plan) �•E U E � depth of liquid level above outlet invert .Comments : (note if level and distribution is equal, evidence7of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc. ) r�it3yy`rD�1 3oX PUMP CHAMBER;_ (locate n site plan) pu s in working order, yes or no Comments: (note conditio of pump 'chamber,. condition of pumps and appurtenances, recommendations or maintenance or ,repairs, c. ) 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM• INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : � F 5 (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type leaching pits and number -R GA leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions ' overflow cesspool, number Comments: �I 1 S t�l�Y� XTFNS �ISCr2S '� lut f� �'ni la�� - gpC14�C ctvuGL •(note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) 'C 0 AaWq AS A grUn ti ;:rA 1�r. od' CUTLET- .71F E N Cr3eE (ter i 0d,- t G.t Le i ' a C PrPE. 6 i 9S 16AM �' - i5 �.' ticw DIET�°i�E. lul4��j2 LE�4-k� FR�wt d 6 S /wX&J,7 &45 Fixes CESSPOOLS (locate on site plan) : numbe and configuration depth- op of liquid to inlet invert depth o solids layer depth o scum layer dimension of cesspool materials f construction , indication f groundwater inflow (ces pool must be pumped as � part of insp ction) Comments: - (note condition f soil, signs of hydraulic failure, leve of ponding, condition of vege ation, recommendations for maintenance o repairs,etc. ) PRI Y: (loc e on site plan) mater\aoruction dimen depthComme(note soil , signs of hydraulic failure, l el of ponding, conditation, recommendations for maintenance or repairs,etc. ) 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATIONcontinued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' w3 i s 9 .17SAL- Roc K (1� DEPTH TO GROUNDWATER SD I depth to groundwater method of determination or approximation: � lt--E re( � O a 1 c'( �'OR�/`c4 I'?1`A IO CA1'P_ C6J COMM9SSCF4/ Ova 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined" , explain why not) 1116 Backup of sewage into facility? NO or Discharge ondin, of effluent -to p g to the surface, of the ground or surface waters? Static liquid level in the distribution box above outlet invert? _ Liquid depth in cesspool <61' below invert or available volume< 1/2 dayi flow? Required pumping 4 times 'or more in the last year? number of times pumped Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy: (� below the high groundwater elevation? _ within 50 feet of a surface water? within 100 feet of-;a surface water supply or tributary to a surface water supply? within a Zone 'I of 'a public .well? within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? AQ within 50 .feet of a private water supply well? AL less than 100 feet but greater than 50 feet from a .private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analy: for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. I Address of property `oZ e i SALT IZ• .00 tc. N• 13QRY�-,JTA B� V��• S 13 y owner' s name poUg(_A.S LA V iA/VA Date of Inspection 13 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector AN7-11my E, 3oSwo,,)- Company Name /U ir:N l//?Dfv SS/=9V)CC- S, . Company Address f�0 7.,5- fOc�SS�"r A,4,4 OdSr Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, "accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade; maintenance and repair are consistent with my training and experience in the proper function and manitenance of on-site sewage disposal systems.:: Check one: have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15. 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of.,this form... I have determined that the system fails to protect- public health and the environment as defined in 310 CMR 15. 303 . The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector' s Signature Date Original to system Q==r/?V4 ,1/O1&11S /- Copies to: QGv/LE� Buyer (if applicable) /->Approving authority .1 7 SUBSURFACE SEWAGE DISPOSAL• SYSTEM INSPECTION FORM 3. Address of property P P Y . SA7`�. Owner's name �t L"4s � ,qv Z4w� Date of Inspection %, q_ g�- PART A CHEd,KLI ST Check if the following have been done: ~' Pumping information was, requested of the: owner' P #occu ant,..`r,andf Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water Ihave not; been introduced, intoFthe System recently or as art of this i s l/ P n pection. - As built plans have been obtained and examin ed. Note if they, are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The site was inspected for sig J,i:; of breakout. All system components, excluding the SAS, have been located on'the Slteg. The septic tank manholes were uncovered: opened, and' th interior of .the septic tank was inspected for condition of baffi'es 'or'tees material of construction, dimensions, depth of liquid, pep - sludge, depth of scum. l� The size and location of the SAS on the 'Site has been determined based on existing information or approximated by non-intrusive.,methods x -- The facility owner (and, occupants, if different from owner)-;were. provided with information on the proper maintenance of f a- 2. } SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART B SYSTEM^' , INFORMATION FLOW CONDITIONS ;4 t . If residential i . L number of bedrooms .� number of current residents �_ .garbage grinder, yes or no q.,t; Zg�z .laundry connected to system, yes or no dLCZ_ seasonal use , yes or no If nonresidential, calculated flow: w:, '.a�'. Y � .7 rat-::�•. .. Water meter: readings, if available :" 138 oo0 Last date of occupancy 9% 9s' /moo GENERAL',, INFORMATION Pumping records and source of information: System pumped as art if yes, volume pumped p or inspection, yes or no �Do_ Reason for �----- E Pumping: `Type o.f,x•Sys tem a Septic tank/distributio:, box soil t! Single cesspool absorption system Overflow `•'a "r- cesspool - - Privy , Shared system (yes or no) (ir yes, attach previous in records, if any) pection Other (explain) Approximate age of all components. Date installed, if known. information: S.ource. of Sewage odors detected when arriving at •k,.he site, yes or' no 1 C . SUBSURFACE SEWAGE DISPCSAL SYSTEM INSPECTION FORK ;PART B If SYSTEM INFOP.MATION continued SOIL ABSORPTION SYSTEM (SAS! : i, (locate on site plan, if possible ; excavation not required, but may be approximated by non-intrusive meth:--als) If not determined to be present, explain: ,. Type leaching pits and number eaching c a ers and number ' leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions. overflow cesspool , number s Comments: (note`'.condition of soil , signs of hydraulic ;failure, level •of ponding`, condition of vegetation, recommendations for; maintenance or'=r`epairsetc. ) _CESSPOOLS (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 (cesspool must be pumped as', pa"rt . of inspection) Comments: (note, condition of soil , signs of hydraulic failure, level.'of+-'ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) PRIVY: (locate on site plan) materials of construction dimensions depth' of solids Comments: i (note condition of soil , signs of hydraulic failure, - level. of-~ponding, condition of vegetation, recommendations for maintenance or repairs;etc. ) i 9 i ! BUHSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIONUFORM'. r., PART B ' SYSTEM INFOTION continued SEPTIC TANK: (locate on. siteplan) f below grade: depth q p material of construction: concr(,te metal FRP other(explain) ! dimensions:- x ✓� sludge depth 2 < distance from top of sludge to bottom of' outlet 'tee or baffle t scum .thickness �_.. distance from top of scum to top of 2 outlet tee or ba'f.fle;;,.' = �distance from bottom of scum tc) bottom Of outlet tee .or`baf:fle, Comments: (recommendation for pumping, condition of inlet and outlet tees or...baffles, depth,. of liquid level in relation to outlet invert, structural,' irite 'ff evidence ;of ,leakage, recommendations for repairs, etc. ) ` a ,aw ",g,`rity� M. i � �.�ti �' F>x G��� jam✓ til�� DISTRIBUTION BOX: ; (-locate on site plan) depth of liquid level above outlet invert Comments: ..(no e',*if level and distribution is equal , evidence of solids carryover, evidence of leakage into or out of 'jox, recommendation for 'repa' rs;. etc. j PUMP CHAMBER: (locate on site plan) pumps in working order, yes or no Comments: " ,(note condition of pump chamber, condition of pumps and appurtenances,, recommendations for maintenance or repairs, etc. ) a.f' 12 SUBSURFACE SEWAGE DISPOBAL SYSTEM INSPECTION FORM PART C a FAILURE CRITERIA Indicate• yes, no, or not determined, (Y, N, or ND) . Describe basis of determination in all instances. If "not determined",. explain"-4hf'Ot)-• : Backup of sewage into facility? 4. iv Discharge or ponding of effluent to the " surface of the ground or surface waters? Static liquid level .in.• the distribution box above outlet invert?. Liquid depth in cesspool <611 below invert s flow? n ert or available volume< 1/2 day 3 i Required pumping 4 times or more in the last number of times pumped, year. t . Septic .tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration?,tank failure imminent? Is any portion of the SAS , cesspool or privy: ' below the high groundwater elevation? 4, _ within 50 feet of a surface water? IL within . 100 feet of a surface water supplytributary water supply? or tart' to a surface within a Zone I of a public well? within 50 feet of a bordering "vegetated wetland or salt (cesspools and privies only, ? It marsh riot the SAS) . Al within 50 feet of a private water supply • pp y well. less than too feet but greater than 50 feet from a private water. ... supply well with no acceptable .later quality analysis?.__ ,,Lf.,.the:.,.wel1 has been analyzed to be acceptable, attach co for coliform bacteria, volatile organic`compoundsf. ammoniatnitrogensis and nitrate nitrogen. ti ,, 11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM j PART B {` SYSTEM INFORMATION continued SKETCRiPF,SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarksor benchmarks locate all wells within 100 , a, J6 DEPTH TO GROUNDWATER depth to groundwater method of determination or approximat2on: 7 Ns r $e Wit. :r�-, ,.i t. - «..;y„ X'�*'' ....• _ j t •' . � 1 13 SUBSURFACE SEWAGE DISPO'cAL SYSTEM INSPECTION FORM' PART D CERTIFICATION Name of Inspector Company Name Company Address Certification Statement I certify that I have personally inspected the' sewage disposal system at this -address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was per and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and manitenance of on-site sewage disposal systems. Check one: I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15. 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails 'to protect public health and the environment as defined in D10 CMR 1:: . 303 . The basis for this determination is provided in the. FAILURE CRITERIA section of this form. Inspector' s Signature :Q —` �� Le v Date — r C"s- Original to system owner Copies to: Buyer (if applicable) Approving authority i iCY5'ST:{li pp y1'Yi&R i4yt\ } R-1.2-95 WED 03 :08 ' P. 01 DISTRICT f BARN STABLE P.O' BoX 646 Barnstable, MA 02630 Phone: (508) '362-6498 Fax: (506) a62-9616 - April 5 , 1995 D I f I + R I a Douglas Lavians ' 89 Salt Rock Road V0 '`Barnstable MA 02630 W, RE: Service #1167 289 Salt Rock Road � . To Whom It May Concern, `3 .'. . The water usage for the above named propLrty is as follows �• 1992 to 1993 41.20 ,000 gallons 12 month-,,period .��.., 1993 to 1994 ; 138 ,000 gallons 12 month period r. .., 1994 to 1995 68 ,000 ciallons 6 month period If you need further jnformation. please feel free to call the office. c ,. •. V�f.ry traly Yours , / Margue /i'_e M. Freeman Collec. t a SEPTIC SERyI = Y I A . "sue x I P.O. B0X '59 , 23 ENTE } RPRISE Rd ' �r a b r^ ro i YARMOUTH PORT, 362=6237 `OR 800— I 696 `K ; r rw x STATEMEN ,t H!t v+.ik'F4• 'SS�a, ro-. ... 4.... -, n, a- + C^2 r n. a} tj73 DATE ? }�, r:= •c_�•��f� / PHONE 3 ' ' ' 4 ou NAMES ADDRESS �' S s r M2 CITYj� ., :,��.� TATE J POOL TITLE 5 .SEPTIC $, DESCRIPTIO z N OF WORK � r fke I C Ali ` ' 4 SUB k 7 l `• TOTAL `$��D� •4 YOUR CHECK IS YOUR RE'.0 I' P ro N a `S�i*n: .4 1 TOWN OF'BARNSTABLE? LOCATION_ �� SBWArM:. 00 VILLAGE wst21�1S'�PklS ASSESSOR'S t INSTALLER'S NAME_ & PHONE NO. g lS RsS. s � .: SEPTIC TANK CAPACITY lrtJ� , 7tIIC,; e V rL; l.Ocl �. '^,}R w... LEACHING FACILITY:(type) p $(g ) �'r'ta/E{ r' eAr�F�9x+�h b p �4' tnt ;f NO. OF BEDROOMS PRIVATE WELL OR P,UBLIC'WATBR BUILDER O OWNER VIA ' DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED-- VARIANCE GRANTED: Yes No 3 , a Y A _ tad y L? s 61, Y r•. 'r .n t r s�"• y x `r 4 q it tt � F y • fir . qf LOCATION $ [WAGE PERMIT NO. VILLAGE INSTA LLER'S NAME i ADDRESS _y G}�i. /y1 /�• fr Ad V��r� N U1LOE R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED � �- r N I a jjV-- s MV V 4 r D :.w TOWN OF BARNSTABLE v LOCATION 019 .��r 2oC.k 2a4% SEWAGE # 7-801- Z't 0 VILLAGE� s ASSESSOR'S MAP & LOT f �023 INSTALLER'S NAME&PHONE NO. Cl'�� edf'A CO 77 57'Z 8',00 SEPTIC TANK CAPACITY f dW QW a LEACHING FACILITY: (type 5'd6ga�(.1514M&rS (size) V2 X 2 .NO. OF BEDROOMS S BUILDER OR OWNER VO�KOS PERMIT DATE: S-%-0 COMPLIANCE DATE: ��Z-t-d I Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private.Water Supply Well and Leaching Facility (If any wells exist on site or.within 200 feet of leaching facility) Feet' Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by CIA r 2 P . N q a 30 �`� N0AC7.-111....... w ,� Fizs....... ... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH' . _116.w.Y`...............O F........ �j............... abI-�,................................. Appliratiou for Uhipoii al Works Tonatrurtinn Vanfit Application is hereby made for a Permit to Construct ()<) or Repair ( ) an Individual -Sewage Disposal System at: .e.... ....1..A...----19...................................................................... Location-Address or Lot No. a[±_ .......... A&v/.4 ------------------•-------•-- .................................................................................................. Owner Address aA,CtTK_4!A. 4`! ..__. .SONS.---------•-----•-•----•-. ...........-----...... ------------- Installer Address Type of Building Size LogeM.S........Sq. feet Dwelling—No. of Bedrooms.......i.'•.................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons___-•_--_-_-__-_.-_.•-__-__- Showers ( ) — Cafeteria ( ) P4 Other fixtures ___________________________ __ _ ---- -----------------------------------------------------------•--------- W Design Flow_.-_ _�?___________________________•-..gallons p4son per day. Total daily flow----------- ..................gallons. WSeptic Tank—Liquid capacity�.A�.gallons Length,6.'�o_"... Width.4-`1.C?'_ Diameter________________ Depth_ n 4". x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter-_-_.1-0........ Depth below inlet......4P......_.. Total leaching area.2 �....sq. ft. Z Other Distribution box ( ) Dosing tank ( 0 - 1 Percolation Test Results Performed bY---------- - __ an -------------------------------------------------- Date_._.3'_ '_'__ .______.. a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GTo Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----._-.----_ 3 C.Z �--------------..................................... o ..................................... --- -• ---- --- Descr�'ption of So'1 D"-.--4-Za"-----l0 X .---'sib ? `���� -------.....2 o��- 3 - G` !�1...._..__.. C2---c�MQ 13 „_ � Vie" �'�- �.Y� U --t--------------- -----.........------------...-----------------------------------------------------•------. 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;_T T y g g p y 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 health. ined.--••-•-----•----------------------------------------------------•-•--•...---=--•=•--- ................................ Date Application Approved By.... xt: j `D�4 �/ d� Date, Application Disapproved for the following reasons-------------•-•---------•-------------•--------------------•••-•--------------•--......---•••-•-----•-••-•---- .......... PermitNo......................................................... Issued....................................................... Date pp _. r NO.A-.Xn1ll..... FER310 ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH WN............:...OF.......... ..-. S .. Appliratilan for Buyviial Works Tnnitrurtinn thrutit Application is hereby made for a Permit to Construct (X) or Repair ( } an Individual Sewage Disposal SSa atR Xk...4 .:.. ate, a�.n. �. ... ...�..�.o�'_....19------------------------------------------------------------•-------- . Location-Address —or Lot No. lt.� r_S. t!LAN ............................. •-'--•------•.....•------•-•-•--•-••••................ Owner Address' a --•............................•••-•...... Installer Address �t Q Type of Building Size Lot-4 92-5....Sq. feet U Dwelling—No. of Bedrooms-------3---.---_--___ _---_Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers a g --------••-----•--------•--• P ( ) — Cafeteria ( ) Other fixtures ..---•••......---•-•--•••--- Qi1`L�d -------------- - -- -------•-•------------------------------•------------...... Design Flow........ l;;............................gallons per per day. Total daily flow____-__••_-_;ZZJC................gallons. W WSeptic Tank—Liquid capacity.IP�gallons Length&-W.. Width4-..k0."_ Diameter................ Depth._�7A.. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter-------1.0........ Depth below inlet......4.1........ Total leaching area.Z.4_77......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '� r= Percolation Test Results Performed b ._ ___ ____________________________________ Date... W y..- = 6-0------------ ,� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water__________--__-_--__-_-- Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water----- ......_.. I t. .. 3 L z 4. t. t. 1. 11 i / a t D Description of Soil --• ............. Q- ....5 `'�t, r =3� ...... ...... `tea n x ea.�u:. .,_.�rca......cc� ".._-t 5.tm"....��_ea► ..... a�r U b-_-__Elba.__E�_r....�'fIGL)�.1!1 ��r� . 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:T'T L E 5 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 health. ned...................................................................................... .......................... Date Application Approved BY-•• CJ!�!!d �t/ �• Date Application Disapproved for the following.reasons:---•-•••------••---•-••-••-•-••••-••••-•••--•--••-••••-•....--•-••-••-•---•---•-••------•--••--••--------••'.... ----------------•----'•---••-----•-----------------•----••-••------•-----••-•-------------•------------------------------•---------------------------------•---------- ............................... Date PermitNo..................................-----•••--••--•-••_.... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH LJ': .JV.............O F....... ..�!�.&1.V1 r'.!"A.P4. .................. . . Currtifirate of (9lantpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) ,- . , Installer a SY has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No----SA"✓1'1-_______________•- dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.--•---••••. I ...................................... Inspector•. THE COMMONWEALTH OF MASSACHUSETTS ..+ BOARD OF/� HEALTH .............OF... �* +. L{1 !+ .. FEE.......... �i��rn��1 nrk� ��an�#rnr#Uan rrnti� Permission is hereby granted......... .4.0-4.. ±P4'__.---.....IMAJ---------------------------------•-•------.....--------...........--••----.... to Construct ( U-f or Repair ( ) an Individual Sewage Disposal System at No...<d•'`� 1 ............. '�t `_._. d+ .r '..�' 7J �+ 22...... 0..--------�.1.S�R.Jk �.. ....... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... n n ► '� = ,4-1- 1 Board Health DATE1— ------................-•------------------------------- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS i - _J o Pr � ,�' - � _ spy 13�;q-r) ' •, , 3 41 11a JI 9q Jp / I CAM Coal 9 z'' UT rl ,r i > 9 5 j I ;,i , �' Via. -� ,.. % � � � J �=` !�` �. Q'1�TF-pST 1�• ' ® n� ., ,,:, Ana. 4 Y 4-z99<s 4wt, 2 , Pl4f.114 ^f� /p\1t1�FFX. r+��s RICHARD 4 a0 RICH.ARD G r,6A w cyl' fir,,1E5 \ , �` JAh5E5 Q'H£.aRN v O'HE�.RN. 27871 ° LEGEND EXISTING. .SPOT... ELEVATIONS O,A 'sj" EXISTING CONTOUR- -- 0 - — ` FINISHED SPOT ELEVATIONS 0:0 „. FINISHED CONTOUR 0 PROPQSED PLOT PLAN APPROVED= BOARD OF- HEALTH .f1S MASS.{ DATE AGENTS At. Ak aaJ I CERTIFY THAT THE PROPOSED R. ✓. 0 HEARN.. INC., RL5, 83 y� BUILDING SHOWN ON THIS PLAN 1348 ROUTE. 134 CO FORMS TO THE ZONING LAWS . EAST DENNIS , MASS.: M. . OF A hASS. DATE _Z ° A 1_ 3_ SCALE / / y., A7tr� EGlS ERE EY I_l�NQ SUiVQR L SHEET ._, OF .�— SOIL TEST INVERT ELEVATIONS NOTES= DATE: OF SOIL TEST IZ Z-7" ?9 INVERT AT BUILDING' FT: ALL WORKMANSHIP AND MATERIALS WITNESSED BY Grp ffM INLET SEPTIC TANK �3r d FT. SHALL CONFORM TO D.E.O.E. TITLE 5 PERCOLATION RATEe-z -MIN./INCH OUTLET SEPTIC TANK 9-Z•5 FT AND: THE TOWN OF l6+eh4-TA5ur_- RULE- . AND REGULATIONS FOR SUB.SURFACE OBSERVATION HOLE I OBSERVATION HOLE 2 INLET DISTRIBUTION BOX FT ELEVATION ELEVATION OUTLET D.ISTRI•BUTION BOX: 9 FT DISPOSAL OF , SANITARY SEWAGE —o o INLET LEACHING PIT' %}2-40:FT. F. tE�-_V�AT 16l"1 [oam BOTTOM LEACHING" PIT FT. JaTE • �-4- 8D E5`1� GPI T oa rn � , suso► i . s��:b�� ( DESIGN CALCULATIONS ! NUMBER OF BEDROOMS saw c�cr �Iear� �i``I� GARBAGE DISPOSAL UNIT noFl e_-\ TOTAL ESTIMATED' " FLOW {L1�..GAL./BR./DAY x BR.).•• 330 GAL/DAY +o ►"ne .fin REQUIRED SEPTIC TANK CARACI:TY. . .. . 4195 GAL. - mx ACTUAL SIZE. OF SEPTIC TANK TO BE INSTALLED... . 10042 GAL. LEACHING AREA REQUIREMENTS SIDE: WALL AREA 2 S GAL./S-F. BOTTOM AREA:1.0_ GAL.'/S.F.: LEACHING CAPACITY' ( BOTTOM S1-DEWALLA.. .... . . . . . . GAL. RESERVE LEACHING CAPACITY. .' . . . . 549 GAL. TOP OF e� rni FOUND. ELEV.=1v= -- !a' minCONCRETE 4 SCH. 40 CLEAN SAND COVERS PVC PIPE MIN� PITCH _ CONCRETE I/8 PER:-FT COVER �4--� ' • - .',5S Tc �. , 1 J. 2 MIN. PITCH ; p `. 12�� MAX. cto P ��r� Nq�\ Z ,Ln L /gu i/2, c7 JA'Cl�sS ^RiCHARD i (V — - ! C?H_.�.2:4 ! RICH G. f FLOW ::LINE ONE , Na. z»7t >�1Fs M .' 4 JA AVER OF S $ fir~ 4 1 � O'HEARN r- o A 1 H n T , tic tF U No.694 c' `t W ED 4 CAST IRON -� 3/4- 1 1/2 WASHED STONE s ' . ` PIPE�- MIN. PITCH o w o `�„� ,•--.��' ° '- ..:'. •`;, !�' I/4 PER F`T. �I:ST o. �H PRECAST LEACHING f- ' '�-rZ; QD� \9 �� i4l'-1 BASIN 0R EQUIV. ... M -. BOX . . . o` n L= 00o GAL s_� MASS.. SEPTIC F3,onon �. Lam. TANK" . io' .� 0 HEARN; INC., RLS; RS . R. E. " 1348' ROUTE I34 NN13 ' .M:AS,S; EAST DE . , PROFI"LE OF GROUND WATER TABLE _ OB" WAGE DISPOSALSYSTEM . NO!79 G2,<!• CLIENT SE �'..,,, ,, NOT. TO . SCALE .H - i • DATE Z•'?•�o'P�_ " SHEET_Z„OF Z _'... n=n :' 4}�' ,r .. .< -,. ..'.. _ ._ tic-- e - •*•-azca•. .r.F r4-...:^s r;,- ,v -