HomeMy WebLinkAbout0036 MADDAKET LANE - Health 36 Maddaket Lane
Centerville P
A =
UPC 10259 4a
No. H 163OR
11�••Mq! YM
TOWN OF BARNSTABLE c
l
^'ACATION ��� !l�� ��T �L' SEWAGE #
'VILLAGE C �N��tOlLLL`� ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. ��� /�C®
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) .SQa 0�' (size) qL-,
NO.OF BEDROOMS
BUILDER OR OWNER ��6"7—
PERMTTDATE: I I—1-07- COMPLIANCE DATE: —
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
/� rr
63 �SW4LK WAY
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2oo�=5C
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
•� Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
01ppricatton for �Diopooal 6p$tem Cunotruction VCrmtt
Application for a Permit to Construct( . )Repair( pgrade( )Abandon( ) O Complete System O Individual Components
Location Address or Lot No. / �-E— O erv�p S�,Addrees and Tel.No.
'fUif la(lf} PIC)
Assessor's Map/Parcel / O
Installer's Name,Address, /and el.No. Designer's Name,Address and Tel.No.
�3n C o
Type of Building:
Dwelling No.of Bedrooms 7 3 Lot Size sq.ft. Garbage Grinder( )
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
Size of Septic Tank &VITO Type of S.A.S. i JA S
- Description of Soil 1 IA-AY
Nature of Repairs or Alterations(Answer when applicable) l
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Enviro tal Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this B d of alth.
Signed Date &
Application Approved by Date & /—D
Application Disapproved for the following reasons
Permit No. Date Issued
` f, .. •�A a ..... ., '
�- No. Fee
' 4 THE COMMONWEALTH OF MASSACHUSETTS " Entered in computer: g
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Yes
2pplication for ;h6pool 6petem Construction Permit
Application for a Permit to Construct( )Repair( pgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. O]ers Name,Address and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,angel.No. Designer's Name,Address and Tel.No.
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 1:�2 gallons per day. Calculated daily flow 2, c) gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 1660 .tom% ,-� Type of S.A.S. /,,� ! S
=.:
Description of Soil l+4 r�
Nature of Repairs or Alterations(Answer when applicable) 1
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 Enviro "ntal Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this B i d of alb th.
Signed Date 4,
Application Approved by Date
Application Disapproved for the following reasons
Permit No. 2-002 ( � Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired('Upgraded( )
Abandoned( )by
at 1 /7'?a" 4 Lw,- 4!: 1✓i/. e,4 7PC4/1/ has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.7-602—SI`l' dated I
Installer _Designer
The issuanc of th+is permit shall not be construed as a guarantee that the sy fe—. will function ds designed.
Date 11 a 1 Inspector XI�
r"
---------------------------------------
No. ?_bO� � ��� Feed
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Migogal bpttem 196ifttruction Permit
t Permission is hereby granted to Contest/ru t( )Re air) -(grade( ))Abandon( /
t System located at l / �/�/ i �
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 must be completed within three years of the date of this
Date: 11- 1 — U2 Approved by
TOWN OF BARNSTABLE
LOCATION�[&l /-/�� � � C' SEWAGE #
VILLAGE �N� ���L _ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. � 9 C41JCO 77S c� �
SEPTIC TANK CAPACITY YrcS��f Id6'
LEACHING FACILITY: (type) e d 5-0 s (size) �X
NO.OF BEDROOMS its11+r .0
BUILDER OR OWNER
PERMTTDATE: P I-I-D COMPLIANCE DATE: -de — 9
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
L
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"31 f r� •' �'.
63��s�'
T I i
W,4LK WAY
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M4PP1 07 Z
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=_ CO 01 'E ALTH OF MASSACHU SETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF FiNMONMtNTAI'.'PROTECTION
ONE WINTER STREET, BOSTON ILA 0210E (617) 292-5500
TRUDYCOXE
Secretary
ARGEO PAUL CELLUCCI DAVID B. STRUHS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address:36 Mad.d.aket Lane Nameofowner Roberta Hayes
Centerville , MA Address of Owner:
Date of Inspection:
Name of Inspector:(Please Print) Wm. E . Robinson S r.
1 am a DEP approved sy a rtis O�%u rt 1 Section e r V l4C o f True 5(310 CMR 15.000)
Company Name: WII1 li A
Mailing Address: P 0 Box 1069, Centerville- , MA
Telephone Number: 8 7 76
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:
L' Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails/ / Q
Inspector's Signature: (.-J rx Date:
The System Inspector shall 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 to the
system owner and copies sent to the buyer, if applicable, and the approving authority.
NOTES AND COMMENTS
RED EO
TOWN OFSAMSTABLE @V
HEALTH DEPT.
S �
revised 9/2/98 Page Iof11
H
;� Pr,.nled on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
'rap"Address: 36 Mad.d.aket Lane , Centerville
Jwner: Roberta Hayes
Date of Inspection:
INSPECTION SUMMARY: Check 9 A C, of D:
A. S�YPASSES:
I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure
criteria not evaluated are indicated below.
COMMENTS:
B. YSTEM 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 s, no, or not determined(Y, N, or NO). 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.
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
revised 9/2/98 Page 2of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Prop"Address:36 Mad.daket Lane , Centerville
Owner: Roberta Hayes
Date of Inspection: 9_,,_Q j
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 WITH 310 CMR 15.303(1)(b)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 surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2 SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS
FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH 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 50 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 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. 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 fcontinued)
Property Address:
36 Maddaket Lane, 'Centerville ",�
Owner: Roberta Hayes
Date of Inspection:
D. SYSTEM FAILS:
You mus indicate either "Yes" or "No to each of the following:
have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this
etermination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes N
Backup of sewage into facility-or system component due to an overloaded or clogged SAS or cesspool.
_ Discharge or panding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6" below invert or available volume is less than 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. RGE SYSTEM FAILS:
You ust 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
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 tl of a public
water supply well)
The wner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
offic of the Department for further information.
revised 9/2/98 Page 4ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Prop"Address: 36 Mad.d.aket Lane, Centerville
Owner: Roberta Hayes
Date of Inspection:
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 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. f
V _ As built plans have been obtained and examined. Note if they are not available with N/A.
f/ _ The facility or dwelling was inspected for signs of sewage back-up.
v _ The system does not receive non-sanitary or industrial waste flow.
The site was inspected for signs of breakout.
_ All system components, excluding 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 on the site has been determined based on:
V/ _ 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)
(15.302(3)(b)]
The facility owner (and occupants,if different from owner) were provided with information on the propermaintenaacj�-0f
SubSurface Disposal Systems.
revised 9/2/98 Page 5of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Irop"Address: 36 Maddaket Lane , Centerville
owner: Roberta Hayes .[' r' e
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL:
Design flow:33"0 g.p.d./bedroom.
Number of bedrooms(design): Number of bedrooms(actuaq,7
Total DESIGN flow3rC
Number of current residents: C�
Garbage grinder(yes or no):1.is
Laundry(separate system) (yes or no):"; If yes, separate inspection required
Laundry system.inspected (yes or no)
Seasonal use (yes or no):/L o 1998 3 r 000 gal.
Water meter readings, if available (last two year's usage (gpd):
Sump Pump(yes or no):kU 199� 84, 000 gal.
Last date of occupancy:_-7—
COM ERCIAL/INDUSTRIAL:
Type o establishment:
Design flow: qpd ( Based on 15.203)
Basis o design flow
Grease rap present: (yes or no)_
Industr al Waste Holding Tank present: (yes or no)_
Non-s nitary waste discharged to the Title 5 system: (yes or no)_
Water meter readings,if available:
Last ate of occupancy:
O ER:(Describe)
La date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and so ce of information:
A
System pumpe6 as part of inspection: (yes or no) d
If yes, volume pumped: gallons
Reason for pumping:
TYPE OF/SYSTEM
(/ Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records,if any)
I/A Technology etc. Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components, date installed(if known) and source of information:
Sewage odors detected when arriving at the site: (yes or no)A'd
revised 9/2/98 Page 6of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Yroperty Address: 36 Mad.d.aket Lane, Centerville
Owner: Roberta Hayes
Date of Inspection:
BUILDING SEWER:
(Loca on site plan)
Depth elow grade:_
Materi 1 of construction:_cast iron_40 PVC_other(explain)
Dista a from private water supply well or suction line
Diam ter
Co ants: (condition of joints, venting, evidence of leakage,-etc.)
SEPTIC TANK:_
(locate on site plan)
Depth below grade: F
Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain)
If tank is metal,list age_ (sage confirmed by Certificate of Compliance_ (Yes/No)
p�
Dimensions: /'ff °- `� o `°
Sludge depth: 3—6/''
Distance from top of sludge to bottom of outlet tee or-baffle:
Scum thickness: 0
Distance from top of scum to top of outlet tee or baffle: `l,
Distance from bottom of scum to bottom of outlet tee or baffle:L
How dimensions were determined: Cj i? d a-`
'omments:
(recommendation for pumping, condition of inlet and outlet tomes or baffles, d th of liq id level in relation to o let invert, structural integrity,
evidence of leakage, etc.) AiD ®
GREASE P:
(locate on ite plan)
Depth belo grade:_
Material of onstruction:_concrete_metal_Fiberglass _Polyethylene_other(explain)
Dimensions:
Scum thickn ss:
Distance fro top of scum to top of outlet tee or baffle:.
Distance fro bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments
(recomme dation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity,
evidence o leakage,etc.)
revised 9/2/98 Page 7of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
'rop"Address: 36 Mad.d.aket Lane , Centerville ti
Owner:R oberta Hayes
Date of Inspection: S
TIGH OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection)
(locate on site plan)
Depth b low grade:_
Material of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain)
Dimensi ns:
Capacit gallons
Design ow: gallons/day
Alarm resent
Alarm evel: Alarm in working order: Yes_ No_
Date f previous pumping:
Com ents:
(con 'tion of inlet tee, condition of alarm and float switches,etc.)
DISTRIBUTION BOX: o
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equ�evidence of solids carryover, evidence of leakage into or out of box, etc.) -
PUMP CHA ER:
(locate on sit plan)
Pumps in wo king order: (Yes or No)
Alarms in w rking order(Yes or No)
Comments:
(note condi ion of pump chamber, condition of pumps and appurtenances, etc.)
revised 9/2/98 Page 8of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
'rop"Address: 36 Madd.aket Lane , Centerville
owner:Robertapfa es
Date of Inspection: 7
SOIL ABSORPTION SYSTEM(SAS):_
(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:_
leaching chambers,number:_
leaching galleries, number:_
leaching trenches, number, length:
leaching fields, number, dimensions:
overflow cesspool, number:_
Alternative system:
Name of Technology:
Comments:
(note condition of soil, sins tof by raulic failure, levey of ponding, damp soil, condition of vegetation, etc.)
L La G ry ' f_ lL rri) �V �LS a W C'i s, �P �` ��d �. Y+-1
dVLn asr �
CESSP LS:_
(locate o site plan)
Number a d configuration:
Depth-top of liquid to inlet invert:
Depth of olids layer:
)epth of cum layer:
Dimensi ns of cesspool:
Materia of construction:
Indica on of groundwater:
inflow (cesspool must be pumped as part of inspection)
Comment
(note con ition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY:
(locate o site plan)
Material of construction: Dimensions:
Depth f solids:
Comrq nts:
(note co dition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
revised 9/2/98 Page 9of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
'roperty Address:36 Madaket Lane , Centerville
jwrwRoberta Hayes
Jete of Inspection:
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)
� 1 J
L
revised 9/2/98 Page 10ofII
' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
rop"Address:36 Mad.d.aket Lane, Centerville
owneRoberta Hayes
Date of Inspection: C/7-//9j/
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
J�+
Estimated Depth to Groundwater 12--Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observed Site (Abutting property, observation hole, basement sump etc.)
Determined from local conditions
(//Checked with local Board of health
Checked FEMA Maps
Checked pumping records
Checked local excavators, installers
Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
Of 6 n av3, Yyfa s,
�qr9 0/
revised 9/2/98 Page 11of11
L G;C A 3� S E W A G E PERMIT NO.65
t- , + L4 36
VILJLAGE
INSTA LLER'S NAME & ADDRESS
,Y4iMI'S 1+C-lyoepsnAf
B U It D E R OR OWNER
DATE PERMIT ISSUED 5- 1-7 �
DATE COMPLIANCE ISSUED S-, -- 7g-
y
.. .31
(�b
THE COMMONWEALTH OF, MASSACHUSETTS
BOARD OF HEALTH
,.
y TOWN BARNSTABLE
fnr- Uhipos al Works Tomitrurtiun Errant
Application is hereby made•for, a.Permit to,Construct., ( x)-or'Repair ( ) an Individual Sewage Disposal
System at: e ,
=-Maddake`ts Lane Lot 4 `�"
�.� " Location-Address or Lot No.
••. - I�ssZ7T .... a�,Z, ,l lP-� ?4_T.! r..lit! s- ----------------------
-. caner Address
> W
Installer �- � Address
dType of But ding Size Lot.... .......Sq. feet
Dwelling—No. of Bedrooms........:....................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ....:....................... No. of persons............................ Showers ( ) — Cafeteria ( )
a
Other fixtures =--------------------------- -------------- ----------------
W Design Flow.......:..................::5.5...........gallons per person per.day. Total daily flow____.._...._._... ...0_________..........gallons.
9 Septic Tail—Liquid capacity...I Q.Q Rallons Length.8 6,��_Widt1A'-.1Q" Diameter..._.. ..... Depth 5':r 4".
x FI®w 13if' use N.o. .__.__...' _3 Wldths ..9'.._.::_.. Total Length__.._21........ Total leaching area..__ ._2 49___sq. ft.
.i .
Seepage Pit No..................... Diameter.................. Depth below inlet.................... Total leaching area...................sq. ft.
Z Other Distribution box ( Dosing tank ( )
'-' Percolation Test Results Performed byCAPe- COA..Sur-vast-._Consult.antEDate..Jan.....L---_1978....
as Test Pit No. I........ ......minutes per inch Depth of Test Pit-----$4....... Depth to ground water.......8__Q___--•__.
f= Test Pit No. 2........2_.....minutes per inch Depth of Test Pit_._..8.-.g...... Depth to ground :pF. .0__:
LPL ..... y
............................................... ........ .�.. ............
Description of Soil------------ -8 C(? ---hand---su..gravi l..••••••-•••-••-•-•••••••••••-••-----•---•- =_-RENWICK_--
............................................................................................ .�........._..I..........._..V c� CHAPMAN
W -
U Nature of Repairs or Alterations—Answer when applicable....................................................... .�.. ��........ �
STD
Agreement: AL
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordan e 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 b sue by the board of kie
Signed - //
g �/ZVte
Application Approved By.... DlC-_-••••.......................•----•.......... �...... ----------- =-� .7
Application Di proved fo t follow' g y sons: `f�3..-7� a•-�'� ---- °�� -.lZat��, ir�rz�.
�fif i Date
PermitNo..... .............................................. Issued.......F...............--..................=...........
Date
c.
4t^
No........... ......... Fim..............................
§ THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
mOWN...0 F.........BARNSTABLE
......................................................................
rp iration for Di-epos al Works C>zuatstrur#ilau
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at:
Maddaket Lane................... ......_.. �tot...4. -
--.. ...----••-----..._... .. ..... ....--•--•••••• .... -- ---•-•---•------............ ...................
- L cation-Address or Lot No.
........ - / Zi¢T .. z T_............................... .........SO�{7.E .V.1 +odT!`�_ ! MIR4............
caner Address.
a ....................' a<r�G' ...................... ....._......
Installer Address
d Type of Bu ding Size Lot.....L7.,.2.i2------Sq. feet
U Dwelling—No. of Bedrooms.................3........................Expansion Attic ( ) Garbage Grinder ( )
`4 Other—T e of Building ____________________________ No. of ersons_...______.____.________.__. Showers
a Other—Type g p ( ) — Cafeteria ( )
dOther fixtures _.._.._..-•------•................•-•-..._..---------••-----•-------..._..----•-•-----------•-----•--...-----
W Design Flow.............................$_5..........gallons per person per day. Total daily flow.................3.3.0...................gallons.
R; Septic Tank—Liquid capacity.__1LlflOallons Length._$°_-_6!° Widtha_'._-_LL?-'-"Diameter________________ Depth_.5!_=4_1'
x ��OW- Dlffu No___________ __ _ Width '.g:4:"___._ Total Length...... Total leaching area..........2_4.9..sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( xl Dosing tank ( )
aPercolation Test Results 'Performed by_CApe._.'"coo ,._.Swrvey___.CO,r).sUltaatdDate__2a11_1-_ 31-_--19 7-$••.
,,•a Test Pit No. I........2_.....minutes per inch Depth of Test Pit......$••d_____. Depth to ground wat _ _8_._0___._.__.
Li, Test Pit No. 2......... .....minutes per inch Depth of Test Pit...... ...... Depth to ground _, � ._0.__
s
O Description of Soil.............. '____C_O-arae...S.c' nrl...&...gravel......................................... ��°----RENICUCK.__. _
rn
V ....-----••--------•--....._...-•--------------•----•--•---•------------------------------._...----•---------•-----------•--..------------....._------•....... A•...........8=............
W CHAPMAN w
U Nature of Repairs or Alterations—Answer when applicable......................................................
� ........�F F`'/STEM � -----
••--•-•••--•--•••••-•---•••-•••---------------=------•-•--•-••••••--•••---•--•--•--••-•----•----•-•-•-------------------------••----•.................. _T ........
Al:
Agreement: r
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accord ce with
the provisions of TITLT Z 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has pbeiAuey t eand of hea tSigrled.•• •-- ..................... ........................ ..._
ApplicationApproved By........................•-------------...........----------...............................-_-_...• ........................ ...............
Date
Application Disapproved for the following reasons-----------------------••------•-----•--•-----.._._.....------.....------------------....._...--•••••....-----•--
-----------------------••••••--•••••••-•-------•••------•-----••••••---••••-•-•••---•••---•--•----•-••-•---••••-_-•---
Date
PermitNo......................----------------------•--•--•••... Issued......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........ .s. ........................OF.....................................................................................
Trrfifiratp of TuutpliFana
THIS IS TO CERTIFY, t the I�•dual,'Sewage Di osal System constructed (-,,� ) or Repaired
by G Q......---•-----•-•----•--• -------------- `. .......................................................................----•---------•--
Installer
-- ----•------- ......................................................
Code as described in the
application for Disposal Works Construction Permit No.__............ .. ...................... dated-.......... -___-__.____
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......:........................................................................... Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No....: ..•..... FEE........................
M1,11rruatl dal .5 Taatt atr#ryi tit rrutit
.4A..R
k ermission is hereby granted........................ ..:_.
........_;.......................................................
to Construct ( or Repair �jl l n ii v�1 a1,S��a�ge Dispgc o f Sfy�s s r'
at No •... .t•- �
street
as shown on,the application for Disposal Works Construction,/PerLi iNo C----------------- Dated..........................
x
z' _---- r -r - .
'!k t - ---
/Mj r/ 1 Board of Healt ?+ r..,
DATE / (f
, •
FORM 1255 HOBBS ,& WARREN. INC., PUBLISHERS. _jr _
�T1 _ •
S0I L. LOG 7E,SrRr •
S s`
f
4 C.I. BOX o a o n o f #
10 00 ' v
MIN. GAL.
SEPTIC a
TANK U
S� FLOW DIFFUSOR Q
20` MINIMUM -I �`�•o
FOUNDATION
SCALE: I"= 4'
ELEVATION SKETCH o PERC. RATE
SCALE I = 4� TEST BY: .ti/rG'lyl�Cc �T .a..s
TOWN INSPECTOR
BACKHOE OPERATOR 'Q 401" -'N54--r"2r• —Ile {
.x b� TEST MADE ON : _7, 11974,
zc qaj
l�Es"mtic ON
go .�, J � tea. •
lb
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p
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8 4.
X17
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7zcsTf?T
APPROVED BY BOARD OF HEALTH �� a
DATE 19—
.t t RENWICK
CHAPMAN
p No.27654 O
4
�rfi cJSTV—
NAL ENS
ELEVATION SCHEDULE
• PROPOSED SITE PLAN,
I. INV. AT FOUNDATION = 87o a
2. INV. INTO SEPTIC TANK = 8 ,7,r SEWAGE SYSTEM DESIGN
3.- INV. • OUT -OF SEPTIC TANK = $ ,���.- � �y ya r
4. INV. INTO DISTRIBUTION BOX SCALE, I"=Zo' 197$
t 5. INV. OUT OF DISTRIBUTION BOX = 13G33C—Sc3
6. INV INTO LINES BG. g, CAPE COD SURVEY "CONSULTANTS
.. ROUTE 132
E
a. HYANNIS, .MASS 7.• END OF LINES _ c9G•�C? •
8. BOTTOM OF BED
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ASSESSORS MAP : (�o TEST HOLE LOGS
v / NOTES:
f Gj PARCEL : 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH
tt
FLOOD ZONE: SOIL EVALUATOR :Dh►R-pf,:: Mw �Ae�er2 P-S- �T"HIS PLAN, _J995 MASSACHUSETTS TITLE V & TOWN OF
V WITNESS�I: N I '- i y�►2AJ� � BOARD OF HEALTH REGULATIONS.
REFERENCE: �`L 133ZZ DATE: 067 ev— ?-- 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES,"
PERCOLATION RATE: L '-MIN p N(A4 SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO
pc¢p 101 C L L poi� �
INSTALLATION.
9 ASS - �'O I� L�12 U,7
D TH- I TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION
ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE
FILL DETERMINATION.
A U)P�tA,1 IO'��3� 4) ALL P I OTHERWISE)
TO BE " SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS
LOCATION MAP 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A
GARBAGE DISPOSAL.
S �FB.Z�t 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED)
1Gr')I vtq MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON
A BASE OF 6"OF CRUSHED STONE.
7 _ k_ 7?.._ err G
I��} `� , 7Y �_art,c,;�a�_-D�IL__��'c_�/_`R�-y?t�1R ,���'f3 •:- -
. �Y& _/Soot- pled ,S0)
tv__76,11vb> w//^/ i2QUS
SEPTIC SYSTEM DESIGN _V_ ;p� ;✓�e5 j l 7z.� v Dvp�
FLOW ESTIMATE
l3i,s'7 BI=DROOMS AT f Iy GAL/DAY/BEDROOM - '�, OGAL/DAY
SEPTIC TANK
(or(9 / -- 3301SAL/DAY x 2 DAYS - '�'J GAL
USE 1.,.Ca) GALLON SEPT I C TANK ��pL,tKC
SOIL ABSORPTION SYSTEM
iu 01Ut -s w of sS 0
✓ram K r'
S/ G )
SIDE AREA: l�.S�7 t- (tZ)2 x `�� �r U ?�� /U �j , J 2_ o
BOTTOM AREA: 2 - r �. REcisI���
a t SEPTIC SYSTEM SECT ION
7-0
cs U
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y_� h I� ly, �ly''j.�sp�cfloh FC,�j
,,. 2 � ` o �cXt siry �
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D-BOX
{1+�7TA3/4 I \ l000 GAL �;� C � � a�v � �• ,�. l I �r �L, /- �'U
' SEPTIC TANK
(")0r &I,( �l! l_ r V ElIS77rt1� � ,, ���, 1 S
1J�- �' 2
7s � 2- ` /�/,S7
x Z l
�, Z 1
r :,i joy sTl Z� 3q,
014 Zl/V cis SITE AND SEWAGE PLAN ,
LOCATION :i�kf
B:pig 1�1 r'�rZ s� - ���// �VI LLE / -r
-TOP of f�uNpA-7to►�I PREPARED FOR : Y+/� �fi� i'-OS
( �L�Vr4TlvN
a r �G S 1 �*TVM 4SS>ME D. I--
_ D 1
DARREN M. MEYER, R.S.
SCALE :
/
43 VINE STREET DATE' y
Z
DUXBURY, MA 02332
W
3 DATE HEALTH AGENT (781) 585-0293
Z