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HomeMy WebLinkAbout0052 HARRISON ROAD - Health 52 ffARRISON RD, CCNMRVILLC A= 229-074 Y 1 No. 42101/3 ORA ESSELTE 10% 0 0 0 0 i 4 / e ' C) t 'f'.J t/4� ...�, V i •, AF,L i 2 'l6 MAPN 16 r"'N 16 ISION .O;OZ .E;6 ,.B;S lfA �I co� -07 LLJ � n O woovpaqT7 oN o 'tea xoov 6.r�n-Q O q N Woovpaq .O:b .L L;L N N O .E-.L —.OL9£6 Vld VOTH BI 9NUSIX3 —' I�t11 �vr PROPOSED CHANGES TO FIRST FLOOR PLAN f 7,-3" V 5'-1'—� —9'-7" 3'-7 3'-2" 15'_7• �. r-11" 0" A vv�^' ® &owey boom �- _ � `��J/✓� 3'_ 10= 'r — 2- -- - -77 pH`i �o m Cam'— 7 A 20'-0" l PROPOSED 2N0 FLOOR MASTER SUITE FLOOR PLAN o �I - -� DECK i � 5'-4 1-8" o 1 �rer� aste�c bed oom ' a Town of Barnstable Vi�-c3 . t1act1� c�.r Department of Health, Safety, and Environmental Services sARrrsreeLe, MAW � Public Health Division i639 367 Main Street, Hyannis MA 02601 Office: SOS-790 6265 ASSE$SORB MAP Na Thomas A McKean FAX: 508-775-3344 �apn�NA. j.� 5..A—7 Director of Public Health January 23, 1996 Donald Miller 52 Harrison Road Centerville, MA 02632 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 52 Harrison Road, Centerville was inspected on December 6, 1995 by Robert Saben a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Leakage out of distribution box You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within, thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health ti IV [Installer letter] Sl TO:` J?Q#A (Date) ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. ',�R�' �'�i'� �I A The septic system owned by�'ou located at was inspected on /.r-J<-- 5t0y W,& �V;;7 _a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean,R.S., C.H.O. Agent of the Board of Health Town of Barnstable BARNSTABLE COUNTY SYSTEMS INSPECTORS 25 MID-TECH DRIVE WEST YARMOUTH, MA 02673 LDEC EWLED December 12, 1995 3 1995 DEPT.RNSTABLE Town of Barnstable Barnstable Health Department South Street Hyannis, MA 02601 Dear Health Department: Enclosed please find a Subsurface Sewage Disposal System Inspections for property located at 52 Harrison Road, Centerville, owned by Donald Miller. If you have any questions, please do not hesitate to call me at (508) 778-0101. Sincerely, Robert W. Saben, Jr. Certified Systems Inspector C ��� �f r �� /`� . - , a __ !6. s ASSESSORS MAP NO, PARCELNO: Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of RECEIVED • Environmental Protection DEC 13 1995 William F.weld H�EALTH DEPT. Governor ^C MAD'E Trudy Coxe Vf V 1ADLG Secretary,EOFJ1 David B.Struhs Comminioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 52 Harrison Road, Centerville Address of Owner: Date of Inspection: December 6, 1995 (If different) Name of Inspector: Robert W. Saben Company Name, Address and Telephone Number: Barnstable County Systems Inspectors 25 Mid—Tech Drive West Yarmouth, MA 02673 CERTIFICATION STATEMENT (508) 778-0101 1 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: _ Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority X Fails J , Inspector's Signature: % � �_29 '2� Date: December 6, 1995 The System Inspector shall submit a copy of this inspection report to the Approving Authority 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 to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, oro A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. 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, 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 conforming septic tank as approved by the Board of Health. (revised 8/15/95) One Winter Street a Boston,Massachusetts 02108 a FAX(617)SW1049 a Telephone(617)292.5500 �, Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART A CERTIFICATION (continued) Property Address: 52 Harrison Road, Centerville, MA Owner: Donald Miller Date of Inspection: December 6, 1995 B] SYSTEM CONDITIONALLY PASSES (continued) 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 The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed 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 THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: the system has a septic tank and soil absorption system and is within 100 feel to a surface water supply or tributary to a surface water supply. _ The systen, hay a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The systen has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm• DJ SYSTEM FAILS:. I have determined that the system violates one or more of the following failure criteria as defined 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. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 I. A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 52 Harrison Road, Centerville, MA Owner: Donald Miller Date of Inspection: December 6, 1995 D] SYSTEM FAILS (continued): X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 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. 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: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 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: the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 52 Harrison Road, Centerville, MA , Owner: Donald Miller Date of Inspection: December. 6, 1995 Check if the following have been done: X Pumping information was requested of the owner, occupant, and Board of Health. X 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. . N/A As built plans have been obtained and examined. Note if they are not available with N/A. — Sketch only showing locatio X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow X The site was inspected for signs of breakout. X All system components, excluding the Soil Absorption System, have been located on the site. X 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. X The size and location of the Soil Absorption System 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 Sub- Surface Disposal System. (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION. Property Address: 52 Harrison Road, Centerville Owner: Donald Miller Date of Inspection:December 6., 1995 FLOW CONDITIONS RESIDENTIAL: Design flow: gallons Number of bedrooms:_ Number of current residents: Garbage grinder(yes or no):N6 Laundry connected to system (yes or no):_,Y&s Seasonal use(yes or no):No Water meter readings, if available: 1993-11,000 gal..; 1994-71,000 gal. . Last date of occupancy: Current COMMERCIAUINDUSTRIAL: Type of establishment: N/A Design flow: allons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary Waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Last day pumped 05/09/90 System pumped as pan of inspection: (yes or no)_ If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM X 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) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: 08-10-86 Sewage odors detected when arriving at the site: (yes or no) No .(revised 8/15/95) S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 52 Harrison Road, Centerville Owner: Donald Miller Date of Inspection: December 6, 1994 SEPTIC TANK: (locate on site plan) Depth below grade: 12 iY Material of construction:X concrete _metal _FRP—Other(explain) Dimensions: 4 x5 x5' Deep Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 3'2" Scum thicknessl" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 1'4" 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:_ (locate on site plan) N/A Depth below grade: Material of construction: concrete _metal _FRP—other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom nt«un, t- bottom of outlet tee or battle: 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.) (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 52 Harrison Road, Centerville, MA Owner: Donald Miller Date of Inspection: December 6, 1995 TIGHT OR HOLDING TANK:_ (locate on site plan) N/A Depth below grade: Material of construction: _concrete_metal _FRP—other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: X . (locate on site plan) Depth of liquid level above outlet invert: 211 Comments: (note if level and distribution is equal, evidence of solids cars,-over, evidence of leakage into or out of box, etc.) Leakage out of Distribution Box around inlet pipes Static 1igiiid level chows evidenra of potential problem with S.A.S. ; further investigation will be necessary to determine cause and extent of problem. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order.(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 y. s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 52 Harrison Road, Centerville, MA Owner: Donald Miller Date of Inspection: December 6, 1995 SOIL ABSORPTION SYSTEM (SAS):X (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, number: 1 leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Co a is: (note pri ltion of Soil signlof hydraulic failure, level of ponding, condition of vegetation,etc.) ��gg static iqui Ieve in Distribution box show evidence of S.A.S. not working properly soil was and compact material, some clay is evident in this area. CESSPOOLS: _ (locate on site plan) N/A 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 part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY._ N/A .(locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 8/15/95) 8 e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 52. Harrison Road, Centerville Owner: Donald Miller Date of Inspection: December 6, 1995 SKETCH OF SEWAGE DISPOSAL SYSTEM: r . include ties to at least two permanent references landmarks or,Whchmarks L locate all wells within 100' z> _. LU _U i a Uj �9 DEPTH TO GROUNDWATER Depth to groundwater: /d feet 1 method of determination or approximation: �OL�/�1'i/r/b�T r Uf .� O�fPK✓�ti (�� AAA 9q (revised 8/15/95) . 9 o/ TOWN OF BARNSTABLE r LOCATION CE+.rl 2►.i l IC- SEWAGE # 25 tr7F VILLAGE SZ ASSESSOR'S MAP & LOT .- 4 7 INSTALLER'S NAME & PHONE NO. CJ& SEPTIC TANK CAPACITY I Uc�o f LEACHING FACILITY:(type) G f S (size)3 m�i �`SI�►�� NO. OF BEDROOMSPRIY ELL R P 1LIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 2I�9/9 {• . r I ,. VARIANCE'GRANTED: Yes No(z Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Private Water Supply Well and Leaching Facility flit t Q. W® o _ o t 6 r • A HSSORI'S MAP NO. PARCEL LOCATION SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME i ADDRESS BLS �.A A.-e a tQ BUILDER OR OWNER / /-z DATE PERMIT ISSUED 41Ocsr— G D%ATE COMPLIANCE ISSUED I r 1�sw t Y / ® i 7i 6 l� l J \ i t f s� L v2.No. 9 0 7 Fee 30.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zipplication for Mt!5pool *psAem Cow6truction 3dErmit Application is hereby made for a Permit to Construct( )or Repair(x )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 52 Harrison Rd David Cole Centerville 420 South St Hyannis 428-6787 Installer's Name,Address,and Tel.No. 775-8776 Designer's Name,Address and Tel.No. W.E. Robinson Septic P.O. Box 1089 Centerville Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder(no Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) install 3 stonepacked HD gallies & connect to existing d—box 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 t o of Health. /) Signed i �-�a, /� Date Application Approved by Application Disapproved for the RlowinV reasons Permit No. .(�_ 1 0 7 K Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS r Certif irate Of CompY ante THIS IS Tq RTrFY,that the On-s't Sewage Dis osal System installed( )or re aired/replaced( )on by W-. Robinson Sep c Servic� for 52 Harrison m Centerville as Cole has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Use of this system is conditioned on compliance with the provisions set forth below: No. Fee 30.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migozaf *p$tem Conelrurtion Vermtt Permission is hereby granted to W.Er Robinson Septic Service to construct( )repair( x}an On-site Sewage System located at 52 Harrison Rd Centerville 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. All construction must be completed within two years of the date below. Date: f c. — 12 Approved by�� 30.00 • No. 71 23 e / Fee $ THE COMMONWEALTH OF MASSACHUSETTS F PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Tipptication for Migogal *pgtem Construction 3permit yr Application is hereby made for a Permit to Construct( )or Repair(X )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 52 Harrison Rd David Cole Centerville 420 South St Hyannis 428-6787 Installer's Name,Address,and Tel.No. 775-8776 Designer's Name,Address and Tel.No. W.E. Robinson Septic P.O. Box 1089 Centerville Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder(M) Other Type of Building No. of Persons Showers( ) Cafeteria( ) a Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) install 3 stonepaeked HD gallies & connect to existing d-bo2 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- cateof Compliance has been issu d by t ' o of Pealth. Signed Application Approved by Application Disapproved for the ollowin reasons .a Permit No. C-- g 7 K Date Issued l a- 1�-77 t 5�.5 CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUC17ON PERMIT(W1T11OU'F DESIGNED PLANS) I, lei , hereby certify that the application for disposal works construction permit signed by me dated %�Z 7— 9 ✓ , concerning the property located at n R I S meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED : DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. I f I � y� v I L l J Q �� O No.. ..:_. Fus......sa........... THE COMMONWEALTH OF MASSACHUSETTS J BOARD OF HEALTH T©WYl...................OF.......1 1. nziliv...---------------------............•................. Appliration for Disposal 3 oxkii Tontrurtion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair (- .) an Individual Sewage Disposal System at: ....:......S z .t.C� ngrus ��,. - ... .... .... . ............. Loca ion-Address '/ r Lot No .........../)')!/�erl...,�sz�atoAr..�----...-------•--....--------........_._.... .... :1_Itt-� 4naac�Y..Ccysr...voile...................••---- Owner Ad ress __Q. ... .!cQ . 36a /!/lain S,..ieg.' ¢ . 16t)&u . •............... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling '�No. of Bedrooms.........................................Expansion Attic ( ) Garbage Grinder ( ) p`4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) p" 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 ( ) Percolation Test Results Performed by---------------------------------•-•---•--------------. ----------------- Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit........._._.._._._. Depth to ground water........................ G= Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----................... �+ •-••-----------------------------------------------•-----•--......-----.............._......-----....----•-•-----------•--•-•-----•-•----••-•••----....•---- ODescription of Soil.............................................................................................--........................................................................ "4 U ............................•••••----•-•------•..._.....•-•------------------•••-•••-•--•......._._......-----•--•---•••--••. ••.....-••-----•••....--•------•-•----------...----•-------------•._...... W 7 UNature of Repairs or Alterations—Answer when applicable_-4nb _•_---i kJ • .. ►.n14...__D- k...... A taQII C oro i 4 1--p!!- ....------•----------------------------•-•-•----•----•---•-------------------------•-----•-----------------------•------------------•---------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLL 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. Signed--- Q_ ..4......1.6.....&to l ' Date Application Approved BY----•------•.................•--------•-•-••-•-•----------.�......................... .. �"'�a...... .... .............. ..•--'Date Application Disapproved for the following reasons:-------•--------------•--------•----•--•----------------------------------------•---------....•••----•-•••------ -••--------=----------•-••-------------•----•--------•••---••-------•-•-------•----••-------------•....._----•••-----•-----•---••••--••-••--••-••-•---•--•---••-----•--•...---••-••---•.._...---._...... -�,�-p Date PermitNo.----- Q. `- ------------------ Issued-....................................................... Date No._o�P....= v , Fps..... ' _. ........ THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH ^� 1 ` II GI�Jn OF. ,rrrr?5T"t?le, Appliratiun for Disposal Works ( onstruetion jrrutit Application is hereby made for a Permit to Construct ( ) or Repair (=) an Individual Sewage Disposal System at: •---••-•--`�•z�p ct_r r l a r s - nr; t__t i r r c 3 i ;4.-•-•-•...... ....... / .... ...._ --••---..._.....................---...... o ... ...... ....Yr...... ... t Location-Address ' �o r Lot No. .....-------•---------•-----•-------------•• ...............................•.. . r rt ar �O.ri. yr/l e------•--------...._..._. Owner Address ( yr .... W ( �M C�.,,cc� 350 /ffGIn i���s tl�Pr�?rlt ►l a ... -------------------------------------------------•-----....... •--••-. ............. Installer Address r Type of Building Size Lot............................Sq. feet Dwelling`~No. of Bedrooms............... ...........................Expansion Attic ( ) Garbage Grinder ( ) a"4 Other—T e of Building No. of persons............................ Showers YP g ---------•--------------•-•- P ( ) — Cafeteria ( ) QOther fixtures ------------------------•-•----.....------------.........---------•-•----------------•-.......----•-----•-----•-..............-------•-••-------...... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic 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 ( ) 0.4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -------------•-•-•••••••---•......----•.....•--•-.....--•••-•.....................------......--------....----...........-----•-- : ----------- .... .----- 0 Description of Soil...-••--...----•--•-•••-•-••--••••••..............••••---•--...........----..........----•-•••••••-•--••••......._........••--...------••-••........-•--......--...... ---•------•-------- r�r .... -•---•-----------•-•-•---••••--•--•--••-•-•-••--•--•----••---•-•--•-•-•••-•.................................• a .......... ;-------------------•----•- U Nature of Repairs or Alterations—Answer when applicable-A•11cr�....1.0©n Grc ' 5��;I c_ �L 1 k U...jv.. ..��� Clrt .....PCRC�t_()l...................................................•-^------.....------•---•-------••----..--......-----•-••---......•-----.............................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of TITLE 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. Signed.-•-................ --............................................................. .._..-�••-•----.........._.... Date Application Approved B ....... - . ------- Date Application Disapproved for the following reasons:-------•-------------------•-------•----...----------...............--------•-•----................--....___ ..............................................•---.....................................----.....---------..............-•---------•---------•-----------------------.............................._------ Date PermitNo.... .'' ............ Issued........................................................ Date �r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a QttltaiC� 1e. OF..................................................................................... (Irrtif utttr of Toutplianrle THISA TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by............... n l............................................................................................................-................................._.._...._ r nstaller at............==e?A4. ._ML .�_(ac .... .... ` ............................................... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Codeas described in the application for Disposal Works Construction Permit No..... .. .0.— ....... dated......L/. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA A EE THAT THE SYSTEM Ir F CTI N�SATISFACTORY. DATE .... --......---•--••------••-•------•-•--...... Inspector. ------------------------------------------------•---•--..-_.----- THE COMMONWEALTH OF MASSACHUSETTS f" BOARD OF HEALTH N ..: `. -��t1.uY.'...........................OF....1:..p s ... ..................----................................... FEE.. �w0.............. �iu�rou .� urku �ons#rnrtion �rrntit Permission is hereby granted..--..---- •0r.,,AP.�--�........................................................................................................__.. to Construct ( ) or R ur ( ) an Individual Sewa isp System atNo.---... ............ ..------��-- -...............: ............. Street -as shown on the application for Disposal Works Construction Permit No ? . Dated..._411zp 6............. ......................... r� ---- -- Board of Health DATE........'4101�._ .....L_�V`k'�G--...FORM 125�.5 1IN, INC., BOSTON r Ir . - �'• �llt °J i '•t :�' .., i� �..J-of,_ £Z vd tzn �Yooq U,' paap P14V `L8 a&d In �yooq yr vno d v vo u,"oyv " lyg 7a0 �xrra� -ka???Yv pruo *06 lo9zo -vld `v?sn'vhly I99 �vJ" r n��z btu ----_ __— - J ?7d ? -- - .: If y• � 1Y V aP? 0£ = 7o0 ( Prod / -- ool .1 43'10' 15'-T' T 3„ BO N CV CV OD 4'--0" _ dedwoot Cl c„ aixg /tOom N - p Closet �4 2, 2„ I cn ' in Carey /toot 2, 0.. 5'-6" 1► r 3_9" C. c i. 3'-1 cv 2-1" bedwolpt ------ co bothoom ; - c N 13=5" �ftC�ea c' LO bathoo�st C oset ZO j d CY) 3.3" 3_7,.N -10'-�;' ,, 8„ 2-0„f 6, 0„ t3�2„ 10=5" 6. T' WPC UPQa . pw5 , OD day A)OW ul�-b & PAt2-l7rr&j 7.,oq wew_f, R-11 tpKou� , � -_ Gyrsvm t-A CO L�su =7Uc+ fb 5 20'--0" 1.