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HomeMy WebLinkAbout0600 PHINNEY'S LANE - Health 600 PHINNYS LANE, CENTERVILLE A= �llln J��CYC(gp�o UPC 12534 No.2� 153LOR HASTINGS,MN JUN. 8. 2006 3; 04PM NO. 164 P. 2 Town of Barnstable Health Inspector Office Hours "'�T° o Regulatory Services 8:30—9:30 Thomas F.Geiler,Director 1:00—2:00 BA&NYr& Public Health Division' PoA. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 COPY Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT - SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: Address: 'S `� �1� Map Parcel Name: U 6 C�r I Phone#: 2a. How many bedrooms exist at your property now? 2b. Are you planning-to add any bedrooms? If yes,how many? 2c. How many bedrooms total are proposed at this property(including the amnesty unit)? 2d.Please include a copy of the floor plans for the entire property- showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or NO i,.t �+ ,. { v., .aw t' 'AJ e oP i r.,H-°.w•: Y'' ati:v:•; +v' ,i+ e, .p..,sir,, y... r�-� ,.F`, + '> �' 1'�tF'1� �l•1 b � t� •tb' iiy,1-d; +.. � t �; � E ��':��d�"G.�:�+(+:.,:�:+r i, ir1, C''1::;; "�:, `� ,{�}�'_r �,��k$-'.�' ntl.G .� ;g,D�,`SI�C�,;,(�,,,p;,Cq,�e819 ',�F�:@�b�4•� �.'�, S;�d•:,.,,�',.'F^..,:,. ,,. a,.�..r;iw..t;at,v`'{,":;�i'r 4. Location of dwelling is INSIDE �OUTSIDE a Zone of Contribution to public supply wells? 5• Is the dwelling connected to an NSITE WELL or to P �W; 6_ Is a disposal works construction permit on file? YES or NO 6a. If yes,how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES or ND 8, is there an engineered septic system plan on file at the Health Division? YES or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO POP,OPFICE USE ONLY The Public Health Division has no objection to bedrooms at'this property. Special Conditions: Signed: Date: Cqftoc Q,1healzh/wpfzles/amaaszyapp ) Message Page 1 of 1 McKean, Thomas From: McKean, Thomas Sent: Wednesday, June 07, 2006 5:01 PM To: Taylor, Madeline Cc: Desmarais, Donald Subject: RE: Amnesty Septic Updates Here are the updates: 3 Franbill Road-Approved for 5 bedrooms. 23 Fortes Way- The"sitting" areas/rooms shall not contain privacy-a minimum 5 feet opening to the room shall be provided (a door shall not be provided at the main doorway). Also, an up-to-date inspection report is requested; the report on file is nine years old. No more than 3 bedrooms are allowed onsite. '600 Phinney's Lane-There is a questions regarding the submitted floor plan: - Is the family room totally open or does it have a door? -The current floor plan shows 4 bedrooms as follows (office, master bedroom, upstairs bedroom, family room). Only three bedrooms are allowed. I will ask Judith to FAX that information over to you. -----Original Message----- From: Taylor, Madeline Sent: Wednesday, June 07, 2006 12:52 PM To: McKean,Thomas Subject: Amnesty Septic Updates Importance: High Hi Tom Can you let me know as soon as you have any update for me. I need to get site approval letters issued asap for the applicant for the July hearing as I will be on vacation shortly. Also, I have sent Judith numerous emails over the last few weeks regarding 87 Suffolk Ave in Hyannis and have had no response. If there is a recent septic report on file for that proeprty can you please have someone fax it to me. I would really appreciate it. My fax is 862-4782. Thanks as always for your assistance, Madeline 6/7/2006 D VV\ O ROD" e , 1ALL. i 5-111 p6, "L>tarvc Sf C a tv - �►vT Boa . ®ram_-___ i . LOO G D _ ► q l y I PO/ 1Z S' �S 1 1s %A I Iyo a oo�C55�1It1 � 1 LA LL� ly io LAAAL E�-V)�L4�q ZAa: F6(5�5- 6AJX be, " 0� PLO r 1 Li LC !/ 1 �� J i� ��-? � . � ✓� ��-- �.s�.-lam � d� 5� � _ a — nro�i�.r 1�Q - � g�sr ; � �� ` � , �� COMMONWEALTH OF.MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART A CERTIFICATION �r '`l Property Address: Name of Owner l Address of Owner: ,4/V G7 � �/°y(/� I(e Date of Inspection: hp� S Name of Inspector:(Please /`F l�fl/ 1 am a DEP approved syate inspector pursuant to Section 15.340 of Title 5 1310 CMR 15.000) Company Name: /,F—60 C_ . , f Malting Address: 0 n a 5 O S' C'0­1u+ P Telephone Number: e:�Z�2 X 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: Passes _ Conditionally Passes _ Needs Further Eysluation Fm the Local Approving Authority _ F Inspector's Signature: ® Date: a 6 The System Inspector shall submit a copy of this inspection report to the Approving Authon y(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-Enviironmental Protection. The original should be sent to ttte system owner and copies sent to the buyer,if applicable, and the approving authority. . NOTES AND COMMENTS R:EtARNSTABLE RECEIVED a JA001 TOWN .HT. revised 9/2/98 page 1or11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(contirwed) Property Address: �p 00 P�1 hh/ S �AIVA,- Ceh t/°Y!/r t e Owner: Date of Inspection: ® INSPECTION SUMMARY: A; B, C, or A A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 16.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. 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 ye ,no,or not determined IY,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty 120)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 y the Board of Health. Sewage be up or breakout or high static water level observed in the distribution box is due to broken or obstructed pipes) or due to a roken, 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 r quired pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if it approval of the Board of Health): broken pipe(s)are replaced obstruction is removed q revised 9/2/98 j:�;; }, Page 2ofII f "J n�hhf`• �J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Prepert„Address: d o y nn� IA"ry` ®�► Pr vi`l� Owner: A1v )77 Date of Inspection: A010 / 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) 4YSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM 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) STEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS NCTIONING 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 oliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the p se ce mmonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance approximation not valid). 31 OTHER y revised 9/•2/98 Page 3orii SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PP !/9/7( C ^A/I/ Property Address: Y OG �/ Owner: `.T Data of Inspection: ° D. SYSTEM FAILS: �i_ You must indicate either"Yes" or No to each of the following: 1 'eve determined that dne4r more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this d termination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. f Y s N j Backup of sewage intofacilitylor system component-due to an overloaded orelogged-SAS or-cesspool. _ Discharge or ponding o effluent to the surface of the ground or surfac9 waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distr ution box above outlet invert due o an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less t an 6" below invert or available volume is less than 1/2 day flow. _ Required pumping more than 4 time in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. _i Any portion of the Soil Absorption Syste ,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 0 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a ne I of a public well. _ Any portion of a cesspool or privy is/thin 50 fe of a private water supply well. Any portion of a cesspool or pr v'y is less-than 100 fe t but greater than 50 feet from a private water supply well with no acceptable water quality oneysis. If the well has been nelyzed to be acceptable,attach copy of well water analysis for +coliform bacteria,volatile organic•compounds, ammonia itrogen and nitrate nitrogen. E LARGE SYSTEM FAILS: Y"k must indicate either"Yes" or"No""to each of the following: Th following criteria apply large systems in addition to the criteria abo Th�system serves a f ciilliity with a design flow of 10,000 gpd or greater(Lar a System)and the system is a significant threat to public has and safety and the environment because one or more of the following c ditions exist: Yes No / !� the/system is within 400 feet of a surface drinking water supply. 1 t6 system is within 200 feet of or tributary to a surface drinking water suppl 1 the system is located in a nitrogen sensitive area(Interim Wellhead Protection A a=IWPA)or a mapped Zone II of a public water supply well) The owner or�oporator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further inforgiation. revised 9/2/98 Page 4of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: (�0 0 p�;n N t y s �.A NC Owner: P:' Alue, 1 $ Date at 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 havabeen puffgw orat.least two week*and-the system hasbeewnceivingvermal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. y _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components,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: _ Existing information. For example, Plan at B.O.H. _ Determined in the field Of 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 infounatioaon.tha.propermaintansars.-0f SubSurface Disposal Systems. A 1 , revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C p /+ SYSTEM INFORMATION Property �� Address. Owner: Date of Inspection: ®ol FLOW CONDITIONS RESIDENTIAL: Design flow: a.p.d.'/bedroom. Number of bedrooms(design):_ Number of bedrooms(actual):_ Total DESIGN flow Number of current residents:.?_ Garbage grinder(yes or no):-Aza Laundry(separate system) (yes or no)- If yes,separate inspection.required Laundry system inspected (vp or no) Seasonal use(yes or no):, 1, ,o p� Water motor readings,if.av tlable(last two year's usage(gpd): Sump Pump(yes or no):- a. Last date of occupancy:- aC� COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: aad Based on 15.203) Basis of design flout Grease trap present:(yes or no)_ Industrial Waste Holding Tank present:(yes d)_ . Non-sanitary waste discharged to the Title yste as 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: System pumped as part of inspection:(yes or no) B 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 installed4if known)-and source of information: -- Ur TI Sewage odors detected when arriving at the site:(yes or no) revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued Property Address: �a7-o Owner: g Data of btspection: BUILDING SEWER: (Locate on site plan) Depth below grade:_ Material of construction:_cast iron_40 PVC_other(explain) Distance from private water supply well or suction line Diameter Comments:(condition of joints,venting,evidence of leakage,-etc.) - SEPTIC TANK•_ (locate on site plan) Depth below grade:_ Material of construction: oncrote_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age_ ls.age_confwmed-by Certificate of Compliance_(Yes/No) Dimensions: et/ Sludge depth: d` Distance from top of sludge to bottom of outlet tee orbeffler-2G Scum thickness:,_ Distance from top of scum to top of outlet tee or baffle:_ Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: �1 Air j�r�gv&%e Comments: • (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural-integrity, evidence of1eakage,etc.) GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass ,Polyethylene_,other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, ndition of inlet and et tees r baffles,depth of li uid level in rglation to outlet invert,structural integrity, evidence of leakage,etc.) ,g 's, r �v � � � stiff revised 9/2/. 98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART I tPe, SYSTEM WI�RMATION(corrtira�gd)_h �. A/r l- Crs) ��U 1 Property Address: .�- Ownw: 12J If/� Date of Inspection: / Zt ®TIGHT OR HOLDING TANK: (Tank e pumped prior to, or at time of,inspection) (locate on site plan) !/ Depth below grade:_ Material of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order:Yes._ No_ Date of previous pumping: \ Comments: \ �' (condition of inlet tea,condition of alarm and float switches.,etc.) \ i 1 DISTRIBUTION BOX:_ !f� (locate on site plan) 1 Depth of liquid level above outlet invert: l Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of I kage into or out of box, etc.) - PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: �7 (note condition of pump chamber, ondition of pumps and appurtenances,etc.) • i 1 1 i revised 9/2/98 Page 8of II i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION_FORM PART C d� ��r✓� / /� SYSTEM WFO(iMATI 'nuede... Property Address: ^ Wf— Owner: Date of Inspection: SOIL ABSORPTION SYSTEM(SAS) (locate on site plan,if possible;excavation not required,location may be approximated by non-intr sive 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,signs of hydraulic failure,level o ponding, damp soil Condition of vegetation, etc.) i CESSPOOLS-_ (locate on site plan). i 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 inspection) Comments; (note condition of soil, signs of hydraulic fail re,level of ponding, condition of vegetation, et PRIVY:— (locate on site plan) Materials of construction: Dimensi s: Depth of solids: Comments: (note condition 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) � c eo Property Address:. �bo Ownar: V Data of Inspection: j /A/a� 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) `w� b t l _ , Q reL ell ® � 7 revised 9/2/98 Page 10or11 /'1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM W-ORMATION c Prape ty Address: Owner /P1 l�J 5 Data of Inspec*m: NRCS Report name Soil Type_ Typical depth to ground etsr USGS Date webehe visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slops Surface water Check Cellar Shallow wells Estimated Depth to Groundwater/.?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.) ermined from local conditions Checked with local Board of health Checked FEMA Maps Chocked pumping records Checked local excavators,installers Used USGS Onto Describe how you established the High Groundwater Elevation. IMust be completed) revised 9/2/98 page nofti TOWN OF BARNSTABLE LOCATION O ;`%y�P SEWAGE # , VIL'`tAGE ; ASSESSOR'S .MAP & LO 0 a� INSTALLER'S NAME 6z PHONE NO. SEPTIC TANK CAPACITY 1:06 he 5 LEACHING FACILITY:(type) © U //'X (size p 5� NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER p Vel5 �— DATE PERMIT ISSUED: s� DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No Zz, �e e ...................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Divi-pniial lVar1w Tomitrur ' 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Y S stem at t ........... .................... :.. r. .�__.._..._ ............-- ocati'. -_\ddress or Lot No. h-. ._-- -�: �n -------------------------• ------......---....-------------•.---------------•••-----------•-•----------.....--------......... vner r Address CMG S = Installer Address UType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms..........................._-._---.___-Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures d -- --------.--------------------------------- ------------------------------------------------ ••---- W Design Flow............................................gallons per person per day. Total daily flow............................................ 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........................................ Test Pit No. I----------------minutes per inch Depth of Test Pit---.------.--.-----. Depth to ground water.........--.... 44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 04 -----------------------------------------------------------•------------------------...._......-----........................................................ 0 Description of Soil........................................................................................................................................................................ U --------------------------•---------....------------------------------------------------------------------------------------------------•-•-...---- .................................... UW ------ ----- Nature of Repairs or Alterations—Answer when applicable._. i:--. .-.- ..��-_---//......... ........ .......................... 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 undersi ned further agrees not to place the system in operation until a Certificate of Compliance h b iss d y e and o alth. 9. fL Signed ----- ��;... .... ..... / /....� Date... Application.Approved By --------------O -_--t,�'..''---`-1......_.......- - Application Disapproved for the following reafon . ............... ...._..._........_. -:._....................... ... ... .. . ....... --------------------------------------------------------------------------------------------------------------- ----- ----------------------------------------------------------------------------- ........................................ Dare Permit No. ..........�,_ �'---�-0-..�------------- Issued e TOWN OF BARNSTABLE -- LOCATION 0, SEWAGE #ffv � VILLAGE : � i� ASSESSOR'S MAP & LOU o/Y INSTALLER'S NAME & PHONE NO. . .SEPTIC TANK CAPACITY v0 /f-A, `St;`h� LEACHING FACILITY:(type) (size S NO. OF BEDROOMS 73 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED• VARIANCE GRANTED: Yes No O 1 � Y - �5-6 o i p 9 y Fme�.:..................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratilan for Bi-nVu!3ul Workri Towitrurtifan Permit s Application is hereby made for a Permit to Construct ( ) or Repair (-»^') an Individual Sewage Disposal SystemKV ......... .. 0; 0q ... . ..... ..................................... ' g�f� la \ddr`�s ». •... aS� or Lot No. .- f �! ..._. ........... -•--••......---•--.... ••-•---••-----------•-•••-•...-•••-•.................................•-- e a --- caner .p Address Installer Address UType of Building Size Lot............................Sq. feet .., Dwelling— No. of Bedrooms._I--------------------------------------Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ---------------------------- No. of persons-------.-------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------------------- --------- 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...................................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Teit Pit No. 2................minutes per inch Depth of Test P it Depth to ground water........................ a .---'-•----•-----------------'-----•'---••••----•••••••-'-'----•••••----•-•••-•-•-•--••-•-••..........•--••---•---•-••••-•••••-•-'--•'--•-.....----•-..•..... 0 Description of Soil........................................................................................................................................................................ V ........................................... x -�" - r� a U Nature of Repairs or Alterations—Answer when applicable._ _ _._ .. : ... - - ---�4 s - ..............••... 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 undersi ned further agrees not to place the system in operation until a Certificate of Compliance.hag beef►issued byrthe e and of" a1th. Si ned ... � ' �� - "-- - g t.... .., .. Application.Approved BY ................ �' ..� -"`--" -t--------------------------------------------------------------------- -----?... .. ._,/.S. Dace Application Disapproved for the following reasons: ------------------------------------------------------------------------..........---------------......------------------------------ ..._....------........................................:.............................................----------------------------------------------------......................------------------- -- .... -- ................. !✓ Dace Permit No. - ........- Issued ...---�1--�... _"a.`r.... Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C er#ifirate of C amplianre THIS IS T,9.(2,,MTIFY, Tha�e Individual Se �aPe Disposal System constructed'(� ) or Repaired by � � '�'- � .. - _ .... . ... .. ... mr.li � ` has been installed in accordance with the _to, ons of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction PermitNo. ........ — 5 dated ----- :.:-_%... 4.`--------- PP P -......�.-.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...........................�a ....... ...... , Inspector ---------- -----.�.---:-- ------ ------------------------ r .---......- ---. ---- -j" a- U -0 1 L/ THE COMMONWEALTH OF MASSACHUSETTS / BOARD OF HEALTH TOWN OF BARNSTABLE No....... .. FE ..-,:::.................. i n�tt1 r. uns- rnstion Permit Permission is hereby granted---- to Construct ( ) or a. Repair n 'Individual Sewage Disposal System at No.--y��( �' -.. 1_ I »...�r. 4?rz ./' �� ' ................ l� r ty` # StreetF ' as shown on the application for Disposa tforks Construction Permit No.':-A:__- Dated.._ �............. -•_ �. .. . - -- ---- Board of Health------------------------------------------ DATE-------------------------------------------------------------------------------- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS LOCATION a, f SEWAGE PERMIT NO. 14, ,VILLAGE I N S T A LLER'S NAME i ADDRESS JOHN A. AA!_T0 RA('KNnE SWA dl6E 1.50 street WeSt Rarnctah(A1 92668 R UILDER� OR OWNER ,( rf r. r7e ;41) ATE PERMIT I ' SUED,, DATE COMPLIANCE ISSUED --- Z� ,� ,,,, ,'�, f d_� • e � Y 7/ �� � / a1`` ` I�� t \\ �- .�p_ � �" 0 i i � � � � 1 � `�s_ � i ��� � �� iSSFSSORS MAP NO: 'RROEL N'0.. No................ Fxs... , ...6........ ` THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ----..��......"ly� ...............OF_.......� �...�.... .....---•---------.---------- Appliratioo for Uiipogal Works Tomiuurtion Vamit Application ds hereby made for a Permit to Construct ( ) or Repair (,X an Individual Sewage Disposal System at: &b 13 (P � n 3 Z- 1� ................_--.........---- ------•-•----•---•--- ............................. ---•-•----•-------------......-•-...----•-•----•...------•---.._...-•----......-----........------ ^ -1 Location: d re�ss or Lot No. SIX -----------•-----..... --------... $ -.-....... a ------•-•---------•.:� ...._ -LIT...................................`` '' re 1�,5 �........_..•••--- tn�_ xl+ -... .._.... Installer Address- Pq d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) aOther—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........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water-__.--._-__-_-_._______. fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ---•-•. ® Description of Soil.................. . x W x -•-•--------- U Nature of Repairs or Alterations—Answer when applicable._.____-____I�' _-___-__:� ---------------------------- ---._ Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i T_j,u '5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has iss ed by the board of hea.h. Signed•- ...............�. 7 �3—N6 �, ._........_ Dade ApplicationApproved By-•-•-••----•---•--•---•--•-•-••. ---• •- ---------- ------------ -----•--....----- to Application Disapproved for the following reasons:---------------•--......------------------------------•-------••----------------•---------------------•--•------ ---------•----•--------------•-----•---•--------------------•--------•-•--------------•---------•-•--...---•.........._...-•---•-•--•••-•---•-•---•---•-•----•---•--•----• ............................. Date PermitNo......................................................... Issued...............................-----•--•-----------•. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ��J OF........ ......................... ................................................... Appliratiun for Disposal Works Tonstrurtiun Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (X an Individual Sewage Disposal System at: ...................................... ---•--•-•-••-----••----•----•- ------•----•-----...-•----•••-•••-•--••----•------•------•--••---•------•--•-•------••......•---•- Location• dress ...... Lot.No ^^•- Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) pa., Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) G" Other fixtures . W Design Flow____________________________________________gallons per person per day. Total daily flow...._._____..............._...._.._.......__gallons. 0� Septic Tank—Liquid capacity------------gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—NTo. .................... Width.............._..... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by........................................................... -•----••--•••• Date---------------------------------------- Test Pit No. I................minutes per inch Depth of Test Pit-----............... Depth to ground water........................ i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil___...•.....-_ ter_.. x U ---------------------------------------------•-•----------------.......-•-•------••----------•---•--......----------------------------•----------------................................................ W U Nature of )Repairs or Alterations—Answer when applicable----------J.Gt`TS'�� _ ............t`�d---------� `'J-------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Ti , of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has e iss ed by the board of health. Signed � 7 ....--•-•......•-••........�- --------------------•----•--•-•--••--•--- 7atee Application Approved By-•••---•-•-•--•-•---••••..__... ..... G' == •----•-•---= .....•.................. ------- Application Disapproved for the following reasons_________________________________________________________________________________________________________•._..._ --------------------•--.....-----------...------•-••---------------------•--------........-•-------------....................---...----------------------------------------------------------------•-•--- Date PermitNo--------------------------------------------------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1-0 w ..... ......n.............L................................ Trdif iratr of Toutpliaurr THIS IS TO CLRTIFY, That tJ:>re Individual Sewage Disposal System constructed ( ) or Repaired } by---•----•---......•---•--------- '---.PQNLQ.. __.._..---•-•--••-•-----••......... •••••..... ....... --...................................................................... Installer - *...- at--••-••---••--•-•• ' �-------- ) .1.rb'- • . .....-•••••••l.N. ---•-•-••e__1Q. .I-------------------------------------------------------------------•------ has been installed in accordance with ie provisions of TITLE 5 of The State Sanitary Code Xs3 scribed in the application for Disposal Works Construction Permit No......... dated----- ................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT rHE SYSTEM WILL FUNCTION ATISFACTORY. l DATE................................... ... 31 Inspector...---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...^.�. ..............oF.........�i..�...... �� Z v �? Z NO......................... FEE........................ Disposal Works .Tonstrurtion Prrmit Permission is hereby granted.............. •---•......a...••---••••.. -••••-•-•••-...-•--•••--•-••-•--•.....••••--••-•----•............................. to Construct ( ) or Repair (x ) an Individual Se ,age Disposal System atNo............... ---------•��� �-N�`��5..---•--j`:L- .....C���-----'........................................................................ Street as shown on the application for Disposal Works Construction Per 't No.................. ---------------------------------------- -- --- --• - 1 Board of Health TDATE................. .......:�------..... ......-•--•--- FORM 1255 How & WARREN. INC.. PUBLISHERS