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Home My WebLink About0339 MAIN STREET (CENT.) - Health (2) 339 Main Street (Cent.) Centerville A = 208 118 0 i i I IN UPC 12534 ` O.2-153LOR K"Twes,YN Health Complaints 20-Aug-03 Time: 3:45:00 AM Date: 8/15/03 Complaint Number: 4233 Referred To: DONALD DESMARAIS Taken By: JOAN AGOSTINELLI Complaint Type: GENERAL MAR 2- Article X Detail: UNSANITARY CONDITIONS PARCEL - Business Name: LOT ' Number: 353 Street: MAIN STREET CATS ARE IN A PEN WHICH IS UP AGAINST THE COMMON FENCE. PLEASE CALL WITH FINDINGS ON THIS ISSUE TO COMPLAINTANT. Actions Taken/Results: SPOKE WITH COMPLAINTANT AND COULD SMELL THE CATS. WENT TO THE HOUSE NEXT DOOR AND SPOKE WITH KAREN QUINN, MATTHEW PISANO (HOME OWNERS)AND FOUND A 26'X 14' PEN WITH UP TO 20 CATS IN IT. THEY TOLD ME THAT THEY POWERWASH THE PEN 1 X WK. I TOLD THEM THAT I COULD SMELL IT NEXT DOOR. THEY SAID THEY HAD SPENT$6000 TO ERECT PEN IN PRESENT LOCATION. THEY DID SAY HOWEVER THAT THEY WERE GOING TO MOVE IT TO THE BACK OF THE PROPERTY BY THE END OF SEPTEMBER. THEY WILL CALL ME WHEN THE JOB IS COMPLETE OR I WILL CALL THEM AND DO AN INSPECTION ON 1 OCT 2003. THEIR PHONE# 1 771-1678 AND ARE LOCATED AT 351 MAIN ST 1 Health Complaints 20-Aug-03 CENTERVILLE. Investigation Date: 8/18/03 Investigation Time: 10:30:00 AM 2 No: Z� Fee VYe THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Application for Migo!ml *pgteut Cow6truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. 33 Owner's Name,Address and T 1.Noo.+/� Assessor's Map/Parcel )%A f��/ Instaalle�r's Name,Address,and Tel.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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of He It Signed C-• r Date Application Approved by Date 6—�L 7^ 7 Application Disapproved for the fol ing re ons Permit No.o. — Le j�?( Date Issued TOWN OF BARNSTABLE LOCATION 3 g A,,I sT SEWAGE # VILLAGE_ �.�-r<o ��,(/� ASSESSOR'S ZMAP & LOT tl D INSTALLER'S NAME&PHONE NO. jr COW SEPTIC TANK CAPACITY l S c'T EJ;r,:4,,r- LEACHING FACILITY: (type) t of r,, fi6+ttr,,a!r ("-,/i (size) /z. x 3 o' NO.OF BEDROOMS _ BUILDER OR OWNER and PERMPTDATE: 9 I 6'1q,7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 gQ O z C� .0 Iry R oh IU -�NN c G 97 No. 6, Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[pplication for Mi000gaf *potem Con5truction Vermit Application.for a Permit to Construct( )Repair( ;Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3 3 9 Owner's Name,Address and T 1.No n Assessor's Map/Parcel A s4 Installer's Name,Address,and Tel.No. ~� Designer's Name,Address and Tel.No. Type of Building: E` Dwelling No.of Bedrooms ' / Lot Size sq. ft. Garbage Grinder( ) Other Type of Building t" 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 Type of S.A.S. 4 ,Description of Soil i Nature of Repairs or Alterations(Answer when applicable) Date last inspected: ' Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of He lth. Signed Date Application Approved by DIte &-a 7_ Z Application Disapproved for the fol ing re"Alons h S Permit No. - �e to/ Date Issued ———j 4;———————————————-———————————————-—— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired l ' Upgraded( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system wil func as designed. Date -- Inspector --------------------------------------- No. . ---------- No. - / Ady5 .1c>C3�s - 11 b- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mwiopogar 6potem Conotruction Vermit \ Permission is hereby granted to Construct(%,/)Repair( )Upgrade( )Abandon( ) System located at ?;t?? 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 t e t. Date: - - 9 7 Approved by'\ t rip 4r� JgAlki ,h TOWNOF BAANSTABLE LOCATION .�� SEWAGE VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE SEPTIC TANK CAPACITY i'1�d LEACHING FACILITY:(type) i NO. OF BEDROOMS PRIVATE WELL BLIC WATER BUILDER O 0 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: y - 9 VARIANCE GRANTED: Yes No � y IL31 . cif k s t, .. .4, K e NOTICE: This Form is to be used for the Repair of Failed Septic Systems Only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL 1VOJMS CONS11WG ION I'E1Z( 1FL OV1'1'l1UU'1' llESIGNEll PLANS) 1, hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at meets all of the following criteria: There are no wetlands within 300 feet of the proposed septic system There are no private wells within 1 SO 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 now 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). NOV (; �;;� .. BORTOLOTTI CONSTRUCTION,INC. 765 WAKEBY ROAD, MARSTONS MILLS, MA 02648 508-771-9399 508-428-8926 FAX: 508-428--9399 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property rl Address: Date of Inspection: Inspector's N•Ate: J, 0 Owner's Name and Address: 5j d hn CERTIFICATION STATEMENT* I certify that I have personally inspected the sewage disposal system at this address and that the infornia- tion reported below is true,accurate and complete as of(lie time of inspection. The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site sewage disposal stems. The System: . Passes Conditionally Passes Needs Further Ev ualion By Local Aproving Authority Ins Fails - r�Q pector's Signature: Date:---~� `� The System Inspector shall submit a opy of this inspection report to the Approving authority within thir- ty(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: A)SYST M.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 comple- tion of the replacement or repair, passes inspection. Indicate yes, nor,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 sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup 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): - 1 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four times a year duc 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 11EALTH: 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 TIIAT THE.SYSTEM IS FUNCTION- ING 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 Feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with 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 system 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 the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D)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 efluent 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 clog- ged SAS or cesspool. Liquid depth in cesspool is less than G"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOI'due to clogged or obstructed pipe(s). Number of times pumped -2- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 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 coliforn►bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design flow of a 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 sw face 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 11 of a public water supply well. The owner or operator of any such system shall bring(lie system and facility into full compliance with the groundwater treatment program requirements of 314 CN R 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART 11 CHECKLIST Check if the following have been done: t✓Pumping information was requested of the owner,occupant, and Board of Health. &--7N.one of the system components have been pumped for atleas(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. v/As-built plans have been obtained and examined. Note if they arc 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,excluding the Soil Absorption System, have been located on site. __&�fhe septic tank manholes were uncovered,opened,and the interior of the septic tank was in- spected 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 existing information or approximated by non-intrusive methods. -3 - SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART I) CHECKLIST(continued) ✓ if different from owner were provided with information on The facility owner(and occupants, d ) the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART(: SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL: ✓ n Design Flow: 4Vqr gallons Numbcr of Bedrooms: % Numbcr of Current Residents Garbage Grinder: NO Laundry Connected To Systcm: _�e Seasonal Use: D Water Meter Readings, if ailable: Last Date of Occupancy: COMMERCLAI,/LNDUSTRIAL• (] Type of Establishment: _ Design Flow: gallons/day Grease Trap Present (yes or Rio) - Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings, If Available: __ _ Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION PUMPING RECORDS and source of informa"' n:d System Pumped as part of inspection:/Y 0-- -- If yes, volume-pumped: - gallons Reason for pumping: TYPE, F SYSTEM: 1/ Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes, attach previous inspection records, if any) Other(explain): "PROXIMATE AGE of all components, date installed(i known)and sourcg of iformation: Sewage odors detecte hen arriving at the site: -4- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: Depth below grade: �� Material of Construction: ✓concrete metal FRP_Otlier (explain) Dimisions:/D,5AAX r Sludge Depth: 6:�) Scum Thickness: ' Distance from top of sludge to bottom of outlet tee or baffle:_ 6 , Distance from bottom of scum to bottom of outlet tee or baffle: Comments;(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of li lid r level in relatio to outlet invert, structural integrity, evidence f leakage,etc.�`S a- /Sw'Mallon Z�Q 0 GREASE TRAP: Depth Below Grade: Material of COJISISllclioll: concrete metal FRP Other (explain) Dimensions: Scum Thickness: Distance from top of scum to top of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) .TIGHT OR HOLDING TANK: Depth Below Grade: Material of Construction:_coucrete_metal—FRP_Other(explain) Dimensions: Capacity: gallouis Design Flow: gallons/day Alarm Level: _ Comments: (condition of inlet tee,,condition of alarm and float switches, etc.) DISTRIBUTION BOX: 1/ Depth of liquid level above outlet invert:�r4hl` Comments: (note j qyel nd distribution is equal,cvi nce of solids carryover, vidcn of leak4ge into or olit of box, etc ( C, 'loafP ` PUMP CHAMBER:. Pump is in working order: Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) -5- SUBSURFACE SEWAGE,DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM (SAS): ✓ (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: Leaching chambers, numbcr: Leaching galleries,number: Leaching trenches, number, length: Leaching fields, number,dimensions: Overflow cesspool, number: Comments: (note conditi n of soil, signsppf hydraulic failure level of ponding,condition of vegetation, etc.) /'° Ore' �6A/_ /-S, CESSPOOLS: 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 soilk, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) _ PRIVY: Materials of construction: Dimensions: _ Depth of Solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) -G - i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permancut references, landmarks or benchmarks. Locate all wells within 100 Feel. Fn f�• :U] w o I/ q 30' Z17- .DEPTH TO GROUNDWATER: Depth to groundwater: / Feet Method of Determine ion o Ap ro, 'oration: ✓�i1��? � ! 'c'��rl �'J• dl' �`pjr TOWN OF BARNSTABLE LOCAT ON 3 5 i"LJ S`T SEWAGE # q P1 41 C/ 7-0V aD V & i,x V`LLAG ASSESSOR'S MAP & LOT -*AP P STALLER'S NAME&PHONE NO. C3 P—,:A) SEPTIC TANK CAPACITY I S e, c°S-r LEACHING FACILITY: (type) 10 P, f4ftAr CY 1 (size) I L Y 3 e,' NO. OF BEDROOMS Y BUILDER OR OWNER UAA 1244 C d Q R--r PERMIT DATE: 9 16-17°j COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 r Tl �19 , ti pPro STb TOWN OF BARNSTABLE LOCATION 2139 Arn /�/'Coe SEWAGE # `ALLAGI3 ,L-- ASSES /MAP & LOT�� t3 NAME&PHONE NO � �` SEPTIC TANK CAPACITY 460 C 6 S LEACHING FACILITY: (type) rS (size) NO.OF BEDROOMS II,^ BUILDE OR OWNER �h/? PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 lea n cili ) Feet Furnished by �' q,, Our r3 0 OL a y, y,, ` w r TOWN OF BARNSTABLE LOCATION -?-39 /M-0t,-,J 6-7j&£z? SEWAGE V;';_LLAGE ASSESSOR'S MAP & LOT :Pd INSTALLER'S NAME & PHONE NO.,:�-04eW ajA;yT ,Z$F-- RX)g SEPTIC TANK CAPACITY %moo Ad i�� LEACHING FACILITY:(type) 1,t �e74om� 6J (size) 71,,e NO. OF BEDROOMS PRIVATE WELL OR UBLIC WA—T—�ER------) BUILDER OR OW �^j DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ��a� c�� . � s3�. �� 0 ,. � .f �—, __ �.� -- 4 � NO...... `/- Fizz.............................. , APPROVED THE COMMONWEALTH OF MASSACHUSETTS SarnswW ration Ocpsnme,It BOARD OF HEALTH OWN OF BARNSTABLE Appliratiutt for Dbipuiiitl Wurlt,i Tattstrurtiun Permit Application is hereby made for a Permit to Construct ( ) or Repair t>C) an Individual Sewage Disposal System at: --_...• --------•------ ----------- ---------•-•-------••--•---•------•-••--•••--••-••••--•.._........_...........-•---- oc- :\ddrrss --•----•--'o Lot No. .....................................- ! -------------•-T-'-=`�--------...��__-�----- ----- .....--- .-- . .....----•-------�.:_......?....:_--- owner Address LD l �P12oi�Tati➢ G ,Q >t.L -----------------------------------•-•-----.•--•-- -•-•------•.......... i�.-----.�---�- ---, . Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling— No. of Bedrooms...................�._---_-_.-.-_-_Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 0., 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......7--------- Total Length_....v?1...... 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.....................__. (? Test Pit No. 2................minutes per inch Depth of Test Pit................... Depth to ground water---I.................... Q+' --------------------------------------------------------------- -..... ------------ -.-----•--•••----------------- -------- •........ ........ .......... Descriptionof Soil........................................................................................................................................................................ W U Nature of Repairs or Alterations—Answer whn applicable/6AS .. ._l � � j__D.✓�G 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 b n i u dd by the board of health. y p p . � f Signed ------------- - ........-....... 1� Application"Approved By .................. ) ..... .. ... . . ................................................................ ...,C°�.-..31..:-..9. .. mw Application Disapproved for the following reasons: ..................................... . ......................................................................................... .......... ................................................. .. ............... . .......................................................... .-- . .....----. ........................................ p / _ Dare PermitNo. --------.L..a..�..(�.. - �........................ Issued .......................... ....... ......................... Dare No...... ................ THE COMMONWEALTH OF MASSACHUSETTS 3`� ��BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinn for Biripwial Wor1w Tnnitrnrtiun. rumit Application is hereby'made for a Permit to Construct ( ' ) or Repair (�<) an Individual Sewage Disposal System at: •---•.................... ....•--•---••-------•---•-•-...........---- •-•-•--•---...-----•-•--- Location-Address or Lot No. ---- /\ ... ----••- O�sner� _ Address . ... •-•-- _ .. .....................................................2.....------ � - = Installer Address UType of Building Size Lot............................Sq. feet .� Dwelling— No. of Bedrooms....................L,,_..._-_______-__-__Expansion Attic ( ) Garbage Grinder ( ) aOther—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./-560.gallons Length................ Width................ Diameter---............. Depth................ x Disposal Trench--No. .........../__... Width......7......... Total Length.....__-2_`1_...... 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 b Date........................................ Test Pit No. 1................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........................ ODescription of Soil........................................................................................................................................................................ ----•-•------------------------------•-----------....------------....._.._...-----•----•-------------------------------------------------------------------------------.._...._.._••--.._---............ U Nature of Repairs or Alterations—Answer when applicable.z±�t-r�-L4 /. ?zb ....-�. 1_�.._74a .,�..! .abY- --------.. -----•--w ` %-_.__._-.5771F 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 h/as been issued by,the board o_fhealth. / Signed ...........v...,s ..................... r Application Approved B ,. - . Application Disapproved for the following reasons: ...................................................... .. ................ ........ ........................................ ............................. ............. . . .............................................................. ........ . .............................................. ................................... p / _ Dace PermitNo. .........../...a..� C2.. ---------------------- Issued ------------- .........-----------------......................... Dm THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Q'IErtifirate of (1:11-orap1t21nre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ('C ) by ..... ......... _,� ��' � � ........_ .r�. 1Tr��a.J. ....... ............................ • " Insr 7 .- 'i at ................._............. ... ...........33.�......_....�J1 9 ..1.......... :%Y----------------------------------------------------------------- ---------- 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. ------P.o? e^..y_5....... dated .__..._.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE . ..._.......... .........�. .. .._ ` ...... Inspector Inspector ......_........................... . ....._.... . ......... ........................ i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE q — No. / =-•�'•./S- FEE .............. Bisposal Worbi Tonarurtiorn Vamit Permission is hereby granted------------ --------- - �7-------- c � _.. f.:�1C.T/0 ............................... to Construct ( ) or Repair (X_ an Individual Sewage Disposal System atNo.... �. �.�1��------- �ST/ftsET-----•--------•---•----•----------------------•---............ — Street as shown on the application for Disposal Works Construction Permit No._�_-.��___ Dated........................................... � / / Board of Health DATE------ ----------------------••-••---••---- FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS