HomeMy WebLinkAbout0022 BUTLER AVENUE - Health 22 BUTLER AVE., CENTERVILLE
A = 226 016
t
UPC 12534No. 2-153LOR
erg'
HASTINGS, MN
DATE- •2/2/99
PROPERTY ADDRESS:a2 Bu'rizr Ave
Craigv'ill ,Mass.
02636 . 41
On the above date, 1 Inspected the septic systom avte`the aoyidresa.
This system consists of the following: p
91� FES 1 2 1999 >>1 . 1-1500 gallon tank. ,
2/ 1-Distribution box . TOI°NOFE RM^T^,BLF
3. 4-4 ' x4 ' gallies in series .
Based bn my Insc�actlon, 1 certlly the following condltl
L .✓
4. This is a' title' five septic system. '("•17EP Code ) • ��� r
5. The septic system"is in• proper• wdrking order
at the present time. ---- -
6:-The -house• has`not - been occupied for two years.
7. The gallies are dry and the sand is clean.,
81GNATURr7 ,
Name• J P.rKacomber Jn,____`_� ; ,•
Company•_J• P_Macorgber. & on"Tnc • •; ,
Addresa•_,g4.x_66_: ------
__C e n�,a�r v,�1 L e �H.�.�.i_Q�b 3.2• •'
Phone:
THIS CERTIFICATION DOES NOT CONSTrrUTE A GUARANTY OR WARRANTY
JOSEPH P. MACOMBER '& SON; INC,
Tanks-Ce s4pools-Le achf lelds
.PUmp*d 4 Initillyd '
Town Sewer Connections
P.O. Box 6G' Centerville, MA 02632.0066
77.6-33U 775-6412
COMMONWEALTH OF 1VIASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON MA 02108 (617)292-5500
TRUDY COXE
Secretary
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commisswner
PART A
CERTMCATION
Property Address: 22 Butler Ave Name of Owner Thomas Greene
Craigville ass . AddressofOwner:210 Ran dolt ve
D�of�wctk 2/99 Milton ,Mass . 02186
Name of Inspector:(Please Pri no J.P.Macomber Jr .
I am a DEP apaoved system Inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
ny compa Narre: J.Y.Macomber & Son Inc .
Mating Address: Rnsr_ fife f:Pntarvi l l a -Macg 02632
Telephone Number: 5 0 8-7 7 5-3 3 3 8
CERTIFICATION STATEMENT
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 Inspection. The Inspection was performed based on my training and experience In the proper function and
maintenance of on-site sewage disposal systems. The system:
ZPasses
- Conditl6nally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fail
4sspectoes Signature. / Data: _
The System Inspect all submit a copy of this Inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection. The original should•be sent 1oVat
system owner and copies sent to the buyer,If applicable,and the approving authority. .
NOTES AND COMMENTS
revised 9/2/98 Page Iof11
A
i,Primed on Regckd Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
prop,wtyAddrww;22 Butler. Ave Craigville ,Mass .
Owner. Thomas Greene
Date of k-P--don: 2/2/9 9
INSPECTION SUMMARY: Check A, B, C, or A
A. SYSTEM PASSES:
1 have not found any information which indicates that any of the failure conditions described in 310 CMR 16.303 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.
Indicate yes, no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If "not determined",explain why not.
The septic tank Is metal,unless the owner or operator has provided the system Inspector with a copy of a Certificate of
Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the Inspection:or
the septic tank, whether or not metal,is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank Is replaced with a complying septic tank as
approved by the Board of Health.
yd Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health).
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
Thu system required pumping-more than four dmes-a yeardue to broken or obstructed pipe(s). The system wi(Fpass--
inspection if(with approval of the Board of Health): - --
broken pipe(s)are replaced
obstruction is removed
revised 9/2/98 Page 2of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
P.opwtyAddre":22 Butler Ave Craig ville ,Mass .
owner: Thomas Greene
Date of Inspection: 2/2/9 9
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 the
public health,safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WRH 310 CMR 15.303(1)(b)THAT THE SYSTEM
IS NOT FUNCTIONING IN A MANNER WHICH.WILLPA03ECT THE PUBLIC HEALTH.AND SAFETY AND THE EN VMONMENITz
Cesspool or privy is within 50 feet of surface water
Cesspool or privy is within 60 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 PROTEC rS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 60 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS Is less than 100 feet but 50 feet or more from a
private water supply well,unless r, well water analysis for coliform bacteria and volatile organic compounds indicates that the
well is free from pollution from that facility and the pres rice of tammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm. Method used to determine distance (approximation not valid).-
3) OTHER
revised 9/2/98 Page 3of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
PropettyAddress: 22 Butler Ave Craigville ,Mass .
Owner: Thomas Greene
Data of Inspection: 2/2/9 9
D. SYSTEM FAILS:
You must Indicate either"Yes" or"No" to each of the following:
_-10- I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this
determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
L/ Backup of-sewage irrloiecilitywr•*/atem component•dus�to an overloaded orcloggsdSAS-or-ceaspod.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
/ cesspool.
V/ Static liquid v I
a distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in se9spool is less than!6"-below invert or available volume is less than 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a 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 I of a public well.
f� 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
»coliform bacteria, volatile organic compounds, ammonia nitrogen-and nitrate nitrogen. -
E. LARGE SYSTEM FAILS:
You must indicate either "Yes" or "No" to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
Yes No
'A
41C7 the system is within 400 feet of a surface drinking water supply
the system-is-witWn 200 feetof-4-it+butarir40e8urfao"4r*king water-supply•••• - —• --•- - -
the system is located In a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone 11 of a public
water supply well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
office of the Department for further inforination.
revised 9/2/98 Page 4of11
i
I
i SUBSURFACE SEWAGE DI$POSAI,SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 22 Butler Ave Craigville ,Mass .
Owner: Thomas Greene
Date of inspection: 2/2/9 9
Check if the following have been done:You must indicate either "Yes" or"No" as to each of the following:
Yes No
Pumping information was provided by the owner, occupant, or Board of Health.
_ None of the systemcompowants haw:baon pua►ped4acatJeast tawo•awseka and`the'uystem hasbaeaascaiaiwg wasnoW flow
rates during that period. Large volumes of water have not been Introduced into the system recently or as part of this
inspection.
_ As built plans have been obtained and examined. Note if they are not available with N/A.
_ The facility or dwelling was Inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow.
_ The site was Inspected for signs of breakout.
_ All system components,•ZfCcluding the Soil Absorption System, have been located on the site.
_ 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 Soil Absorption System orrthe site has been determined based on:-
_ Existing information. For example, Plan at B.O.H.
_ Determined in the field(if any of the failure criteria related to Part C Is at Issue,approximation of distance is unacceptable)
115.302(3)(b)j
The facility owaar.(and,co�nts if difiarant fronn oAm&r),3wara4n4auid&d with inf�A*oacn t"pun str m=inr f
SubSurface Disposal Systems.
I
revised 9/2/98 page sorii
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
PropertyAddreu: 22 Butler Ave Craigville ,Mass .
Owner Thomas Greene
Date of Inspection: 2/2/9 9
FLOW CONDITIONS
RESIDENTIAL:
Design flow: //() g.p.d./bedro
Number of bedrooms(desi ) Number of bedrooms(actual):
Total DESIGN flow
Number of current residents:
Garbage grinder(yes or no):
Laundry(separate system) (yes o o :_ . If yes,separate Inspection,required --.
Laundry system Inspected yqs or d
Seasonal use(Yes or nol:•
Water meter readings,If ava'!�ble(last two year's usage(gpd): /� U
Sump Pump(yes or no):A)C1
Last date of occupancy: ) Cowi� �j�i� G' 6;�91 r�
COMMERCtAL/WDUSTRIAL: ee�� O'
Type of establishment:
Design flow: 1114 gpd ( Based on 16.203)
Basis of design flow
Grease trap present: (yes or no)
Industrial Waste Holding Tank present:(yes or no).4),4
Non•sanhary waste discharged to the Title 6 system: (yes or no"-4
Water meter readings,If available: -
Last date of occupancy:
OTHER:(Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RE ORDS and o ce of Inform on:
System pumped as part of inspection. (yes or no)
If yes, volume pumped: gallons
Reason for pumping:
TYPE OF YSTEM
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)
I/A Technology etc.Attach copy of up to date o ration and maintenance contract
Tight Tank Cop .of DEP Approval
Other " X`e
APPROXIMA A E of II comp Hants, da a InstaHe {If known)•and Bourse of4Rforrnation: -•�+ � 5 d
Sewage odors detected when•arriving at the site:(yes or no)/-to
revised 9/2/98 Page 6of11
• � n
FFT
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF (HEALTH
�
TOWN OF BARNSTABLE j $ 30.00
No. .r�..... ;° FEE.......... ....._..
Ve
yg J.P.Macomber. Jr.
Permission is hereb ranted................................................
to Construct ( ) or Re air )Q an Individual Sewage Disposal System
r^_
at No..f22...Butler Apveraiwille
............................................._...........----_. ......... ..............
Stree
as shown on the application for Disposal Works Construction Permit f Dated..
`" �� ,,,�J
.................... .... ' .._.. ...._
DATE........ Board of Health
.............��. ...
iORM 36506 HOBBS 6 WARREN.INC..PUBLISHERS
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Olert'ifivi>tle of ('gumplizinve
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed
by........ ..................................:............ ( ) or Repaired)CXX )
• .............
at ...........2._Butler Ave Craigville
...... ..... .............................:.............................................................................................................:...................................................................
has been installed in accordance with the provisions of TITI.E 5 of The State Environmental Cod as descri d in
the application for Disposal Works Construction Permit No.�
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS .........
AS A GUARANTEE�
SYSTEM WILL FUNCTION SATISFACTORY. ANTEE THAT THE
- DATE....................... ...1 _ `
........... .
............................... Inspector ................
,.. .........................................................
' r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 22 Butler Ave Craigville ,Mass .
Owner: Thomas Greene
Data of Inspection: 2/2/9 9
BUILDING SEWER:
(Locate on site plan) �r
Depth below grade:,-
Material of construction:_cast Iron Z0 PVC_other(explain)
Distance fro .private water supply well or suction line Id
Diameter
Comments: (condition of joints,venting,evidence of lsak"o,-etc.)
Joints appear tighj- Nn avi dPnriz of 1 aalenl; i V.
,-
SEPTIC TANK:
(locate on site plan) r
Depth below grade:L
Material of construction:Zoncrete_metal_Fiberglass _Polyethylene_other(explain)
If tank Is(natal,list age is.age•confumed by Certificate of Compliance AA> (Yes/No)
Dimensions:
Sludge depth: y�
Distance from top of sludge to bottom of outlet tee yr t affle%(�rC-��
Scum thickness:_
Distance from top of scum to top of outlet tee or baffle:_
Distance from bottom of scum to b2Wm of outlet t e or baffle:
How dimensions were determined
Comments:
(recommendation for pumping, condition of inlet and outlet tees or-baffles,depth of liquid level in relation to outlet invert, structuroHntegrity,
evidence of leakage,etc.) Pump tank every 2-3 years • Inlet R Outlet
tees are in place ; The tank iG Gtrnrtnrall3; ennnd - 4hnvc
(locate on site plan)
Depth below grader
Material of constructionyVA concrete metal yFiberglass/,[gPolyethylene&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:/_
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,etc.)
Grease trap is not present .
revised 9/2/98 Page 7orii
SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(conthwed)
Property Address: 22 Butler Ave Craigville ,Mass .
Ownw: Thomas Greene
Date of kmpection:2/2/9 9
TIGHT OR HOLDING TANK;&bL/fATank must be pumped prior to, or at time of, Inspection)
(locate on site plan)
Depth below grade:
Material of construction:/,V,-9concretoV-imetalaFiberglasvtyPolyethylenq4aother(explain)
� I
Dimensions:
Capacity: 44 gallons
Design flow: gallons/day
Alarm present
Alarm level: Alarm in working order:Yes j!d NoA/!
Date of previous pumping:A_
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
light or hoiding tanks are not present
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: AA
Comments:
(note-if level and distribution Is equal,evidenoe of solids carryover,evidence of leakage Into or out of box, etc.) — -—
Distribution box has one lateral ; No PvidPncP of solids rarry
„e; ug Q,,; d9^0o 9i leafage li;49 er- eels of the bear :
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(Yes or No))
Alarms In working order(Yes or No)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
umD Chamber is not present .
revised 9/2/98 Page 8of11
SUBSURFACE SEWAGE(DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION Icontkwed)
PropertyAaaress: 22 Butler Ave Craigville ,Mass .
Owner: Thomas Greene
Date of kupection:2/2/9 9 ``))
SOIL ABSORPTION SYSTEM(SAS):'T'� ��
(locate on site plan,if possible;excavation not required,location may be approximated by non-Intrusive methods)
If not located, explain:
Type:
leaching pits,number.Q
leaching chambers,number: "G}
leaching galleries,number:=
leaching trenches,number,length:
leaching fields, number,dimension
overflow cesspool,number: 0
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.)
Loamy sand to clean sand ; No signs of hydranlir fail „ra
or p„.,ding , Cgils Ave—Qr-yr•beeehiRg—e£ee is d£y . Ve-gebe-t�6
CESSPOOLS: )e'er
(locate on site plan)
Number and configuration: 0
Depth-top of liquid to inlet invert: A»
Depth of solids layer: 41A
Depth of scum layer: 'jl.d
Dimensions of cesspool: 4 A
Materials of construction: 424
Indication of groundwater: A4
Inflow(cesspool must be pumped as part of inspection)
essnools are not present
Comments:
(note condition of soil, signs of hydraulic failure,.level of pending,condition of vegetation, etc.)
Cesspools are not present .
PRfVY:2LVe,
(locate on site plan)
Materjals of construction: y� Dimensions:
Depth of solids: AIW
Comments:
(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation;etc.)
Privy is not present ,
revised 9/2/98 Psee9orn
j
r `
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
prop,rtyAd&*&s: 22 Butler Ave Craigville ,Mass .
Ownw: Thomas Greene
Date of Irupoction: 2/2/9 9
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes Into house)
ae
dr/
,.�/ L
V
revised 9/2/98 Page 10of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
PropertyAddreas: 22 Butler Ave Craigville ,Mass .
Owner: Thomas Greene
Date of Inspection: 2/2/9 9
NRCS Report name
Soil Type_
Typical depth to groundwater
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
1
Estimated Depth to Groundwater Feet
Please indicate all the methods used to determine High Groundwater Elevation:
--,/Z/Obtained from Design Plans on record
Observed.Site(Abutting propert bservation hole, basement sump etc.)
,Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
Zhecked pumping records
: Checked local excavators,installers
Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
Installed System 4/15/93
House is on Bluff overlooking Lilly Pond .
Permit # 93-141
revised 9/2/98 Page iiorii
v_
a•.nsnr+.-nrr�rzrrrnrmr•ms.r.s-+n rnrrernr.-R+rRri�sm�rn mra�u sa�ssvrn �r'v�+r-:,.�..r'�
TOWN OF Barnstable BOARD OF HEALTH
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION
F.^•m^T•'.•::.-T.itf.^.T.Tr1.1•ITRI'R.Tri TT�.4'nflR'*RT•r^\'IT11RTf 7R1Of-TR1l/R�It►Rt1RIR�}lf9tT7 7ZT VTy'I'r'1"^1r-r•�
-TYPE OR PRINT CI.EARLY-
PROPERTY INSPECTED
STREET ADDRESS 22 Butler Ave Craigville ,Mass .
ASSESSORS MAP, BLOCK AND PARCEL #
OWNER' s NAME Thomas Greene
PART D - CERTIFICATION Y
NAME OF INSPECTOR Joseph P.Macomber Jr .
COMPANY NAME J. P.Macomber & So-,f 'Inc .
COMPANY ADDRESS Box 66 Centerville ,Mass . 02632
Strevt Town or City State EIP
COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 790 ) 1578-
R
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 maintenance of on-
site sewage disposal systems ;
Chec/kk one:
L:L2 System PASSED
The inspection which I have conducted has 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.
System FAILED*
The inspection wilich I have con tcted has found that the system fails to
protect the public health and 'the environment in accordance with Title
51 310 CMR 15 , 303, and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form .
Inspector Signature 1111. Date
One copy of tills certification must be provided to the OWNER the BUYER
( where applicable) and the 130ARD OF HEAL1'11. '
* If the inspection FAILED, thb owner or"operator shall upgrade '
within o'ne year of the date of the inspection, unless allowedorthe requiredm
otherwise as provided in 3.10 CMR 16 . 306 .
partd.doc
� , C 1
TOWN OF BARNSTABLE LOCATION .22 &Re.-Ae SEWAGE # /q
i3- / / Z
VILLAGE Cdc,%�e� /�e ASSESSOR'S MAP & LOT 224. DI(O
INSTALLER'S NAME & PHONE NO. (J,h
SEPTIC TANK CAPACITY -00 ja 4
LEACHING.FACILITYAtype) (size)
NO. OF BEDROOMS_PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER P �
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: f — �
VARIANCE GRANTED: Yes No V
afoot
2J
b
•. 1 �/ $ 30.00
FEs...................
THE COMMONWEALTH OF MASSACHUSETTS APPROVED
BOARD OF HEALTH Barnstable Conservation Department
TOWN OF BARNSTAB E
Ilk
Alirtiun fnrirpnal 3nrkii Cnomrnr#t n rruti
Application is hereby made for a Permit to Construct ( ) or RepaiiX�X� an Individual Sewage Disposal
System at:
22 Butler Ave Craiville
....---•-----•--....--•------•--------------------•-•---•-•-•------------------.....--•.....------ ----•-•-•--------•••-•---••-••--.........---•--•-•--•-----.........------•--•-•------...........--
Birdsall Location-Address or Lot No.
......................_.......................................................................... -•-------------•...•-•-•-•--••-••••--••---•----••.....---.....----•-•-------------.....---•----...
opener Address
a J.P..Mac_oLeab.ex.- Jr...----------------------------------------------•----•- ---------------------------------------------------------------------.............---•---------•--
Iustaller Address
d Type of Building Size Lot............................Sq. feet
Dwelling No. of Bedrooms..........�----------------------------Expansion Attic ( ) Garbage Grinder ( )
p`4 Other—Type of Building `----------------- ----- No. of persons-------------.-------------- Showers ( ) — Cafeteria ( )
Q, 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.
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........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.-:-........--...... Depth to ground water........................
04 ----•----•----------------------•-----....-•----•-•--•-••....--••-••-•-••-••----•-------•--..................................................................
O Descri tion f ssoi ------------------- .....................
W fang & Gravel
v ....--•--------••------•--••----•--•-....••••........--•--•••---•••-•-••-••-•-•--•----••••••-•-------•--•-••--•----•-••......-----•-----
W --•-••---------------------------------------------------------------•---------.....---•--••-------•--------. --------------------------------------------------•-------------------------.........
x 1-1
V Nature of Repairs or Alterations—Answer when applicable... 500 gallon tank four Gallies
.....................:......................................................................
Packed in stone.
•----•--••---------------------------------------- ........................................................-----.....--------------------------------------------------------•-••......---.......--••--
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 has been issued by the oar of health.
Signei
.- - -------a.61--- . .................... ---t--------------------------- ------3/2.5/93..:......
Dare
Application Approved By .....��-.....-.................................... ................................ ... !'Dar e
Application Disapproved for the following reasons: ................................................................
.....................................................................................
te
Permit No. -" .... .... -------------- Issued --------------a....-...��....�........
Dace
r '
62
. 30.00
............................
THE COMMONWEALTH OF MASSACHUSETTS
f
BOARD OFF HEALTH
TOWN OF BARNSTABLE
App hiation for .Diripmml lVorlto Tomitrnr#inn rrinit
Application is hereby made for a' Permit to Construct ( ) or RepairXTX�' an Individual Sewage Disposal
System at:
22 Butler Ave Craiville
......................•------•--------.......---....--------•----------•-------••••••-•...••_..... •---•••••---•--•••••----•----•-••--•---••---•---•-----...--•-•-----.....---•-•--•---....--------•
Location-Address or Lot No.
Birdsall
.................................................................................................. •---•------•-------•--••-•-••._._.._..---••------•-•-•-----•-----..............-__---.---------•--
Own cr Address
aJ=P aMa�_c?�bP r_..rTD::s--•--•--•-•-------•-•------•----•-•---•----.._...--•- ----•---------------•---•---------••-----•---....-----------•----••--•--------••---------•-•-----•
Installer Address
of
eet
V TypeDwelling IX No. of Bedrooms........... ......................._...Expansion Attic ( ) Size Lot__Garbage Grinderq(f )
Other—Type of Building ____________________________ No. of persons__.______.___________-_-.-. Showers 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.
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....................._..
ri, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 .............•--------------....._...•---••-•--•-----..._._..•-•--••--•-•--•••-•••-••----•---_-•_............................................................
0 Description of Soil.............
---------------------••--------•----------------•--•-••....._..-•-••__•-•--
� nand & Grave --------------------- -
v ..............•---•--•-•••-•-•---•••.......•---•---••---•--------•--•-••••-----•-•--•-------••--•----•-•--•-•--•-••••-•---•-------
W
---------------------------------------•••••-•...........---------------------......-•-----------•--- --•---•---------------------•-------••--•-----•••••--••--•••----•---••-•-•----••-._............_.
U Nature of Repairs or Alterations—Answer when applicable----1-1500 gallon tank four Gallies
.................---•--••-•-•--••-------•••--•-••••--._..._..-••-•---
_•Packed-- in.._stone..--•----------------------------------------------------------•----------------------------------------.._..-----------------------------•-•----
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 has bee issued by the board of health.
Signed .t . ---------- .-. . 3........5/S 3..:..-._
/.,
Dare
Application Approved By -...... ...... -.. c- �� `L% ( ............................... ... `�. ',,"� `-.r�✓�
Application Disapproved for the following rearonr: ...................................................Y...................................................................................
.............................................- .............. . ................................. .. .................................................................... ........................................
Permit No. ..........�.......... Issued ................ .....-.....�.��........--y_ !
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
C�Erttftrate of C�IIZItlatia TCE
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired!(;XX )
by.......J-..P..Macomber.... r.............................................. .. ..................----------.-------.----------------.--------.--- ... ......................................... --
i."aii
at .......22 _Butler Ave Craigville----- --
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application,for Disposal Works Construction Permit No.! - '.�.......... dated e......... --`- -----------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE .............._- .. ..� ..-.....Q��� .-............. Inspector --- .... _...-._.........................._.... -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE $ 30.00
No :.. FEE...............-----
�i��nottl nr�� ,�nitntr�rtinri �rrmit
Permission is hereby granted-------J.P.Macomber Jr.
------------•--------------•-•-------------------•---...-•--------•-•--•-------•••---•---••--•••---••-•-•-..._..-....
to Construct ( ) or Re airX X) an Individual Sewage Disposal System
at No.__22... utler Apveraigville
Street
as shown on the application for Disposal Works Construction Permit� ._f� Dated._.��._..'.....Q.
A. _.....
Board of Health
DATE-------`__..---......--................•- . .................................
FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS