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HomeMy WebLinkAbout0018 SOUTH EAST LANE - Health (2) 18 South East Lane Centerville P A = 189 044 i F r 12543 I'STINGS,MN i I 6 f lfE No. 3 Fee 16_10 7AW THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for Zi.5po.5a1 *p5tem Construction 3permit Application for a Permit to Construct( . )Aepair( v,� pgrade Abandon( ) )<Complete System O Individual Components,- Location Address or Lot No. Owner's Name,Address and Tel.No. NEAL Me-AULIFFC Assessor's Map/Parcel '�y q i9 $ourm owr—L.4-6' �j VI d Installer's Name,Address,and Tel.No.S�A" ��'de9�`7/j� Designer's Name,Address and Tel.No. S ADt/ANI�D �2fI. SaG�T10NCS ccws,ULrf� Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 4+0 gallons per day. Calculated daily flow Naf,04(W V D gallons. Plan Date 5-30-03 Number of sheets I Revision Date Title Size of Septic Tank 1500 go-1 Type of S.A.S. LO" C H 01 Description of Soil, O-4" t�.aw� _ 4° -L�3 L ►y ,,,a v Z3° —SB" /1&d SAS/D r Aolop Nature of Repairs or Alterations(Answer when applicable)��-_)�$ .M toZ *QQ17 .-4 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 Me 5 of the E ' onmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss ealth. Signw Dad Application Approved by �/ Date Application Disapproved or the following re o s Permit No. Date Issued - No41 ..A_— P G r x Fee ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .. _ Yes a I PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS max. ... ZIpplication for Migpogal *pgtem Couttructip Permit Application'for a Permit to Construct( )Repair( of r pgrade VfAbandon( ) J Complete System ❑Individual Components Location Address or Lot No. ° Owner's Name,Address-and Tel.No. ylc. Assessor'sMap/Parcel U� qq ��} $ouTLl SST' G.�/vt• U Q-Wr� Vl 62.l3 Installer's Name,Address,and Tel.No.%�r/on Designer's Name,Address and Tel.No." �w� �- �.r)VUnvNs cc�vsU�7� V� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( r ) Other Fixtures Design Flow 4.-o gallons per day. Calculated daily flow IVo7" P2v111124 D gallons. Plan Date �- 30-03 Number of sheets I Revision Date Title --,EWi46-E _sY57�M Q F S 1(,-^( Size of Septic Tank 1 SOO (i G 1 . Type of S.A.S. LC# H C H4M RFJZ (3) Description of Soil' n—'4' _ Lh114W1 -^Z L,0,/<MY �'�7�/i� ? S 7 /✓l" f ifN!� to (paP j 1 Nature of Repairs or Alterations(Answer when applicable) ­5 S ? '% 4�.;�k' 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 b this o 04A''ealth. �"/' 4`' Signed,,2, _ n ,�,x_, Dam= ''� Ar' Application Approved by rJCl������� 1J�;-,�l f k, /�' ' �.f.-i �� Date Application Disapproved for the following reasons 4 `� Permit No. Date Issued ————— —, -q ----------- �S SpP�'� tt k► HE COMMONWEALTH OF MASSACHUSETTS box, BARNSTABLE, MASSACHUSETTS 4 sA s , ` 112jo 3, I_vk 1,e 4 f9e Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by c" )i Z C/.?®4r` ,_ !n K� � t e� ✓'d vim' -,4Lr;' G C'" h2,/be constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �'�Y ated Installer Designer The issuance of thhris permi shall not be construed as a guarantee that the system flI ncti'off design Date Inspector — ------ ------------------------------ No. � Fee v� h THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLE., MASSACHUSETTS Mood *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at afZ,41' 44C!! '::f Aa G 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 mu t be completed w' 'n Pree years of the date of 2 this ermi LA P(—s Date: / , D 3 Approved by /� /. 11 �e t S s%&e_k ?lq lo I TOWN OF BARNSTABLE o �� �,a r 'TZ ti L )CATION SEWAGE # .� VILLAGE wT�sc ASSESSOR'S MAP & LOTS-P-,V- INSTALLER'S NAME&PHONE NO. C72' �'E`'�oc�`6✓f'' �� ��Oj SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) _I-,rod g c I. COw/OR N0.OF BEDROOMS "BUILDER OR OWNER PERMITDATE: —;Z /--o` COMPLIANCE DATE: Y Separation Distance Between the: r ' 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 J ` Feet Furnished by tom// G�`�OG��J� A ,D ,A. Alz g e, C 0 •1 - d �� 3 TOWN OF BARNSTABLE LOCATION SEWAGE # va..LAGE �'wTra �iG��` ASSESSOR'S MAP & LOTZ"-4fJ`f` INSTALLER'S NAME&PHONE NO. CT/tea SEPTIC TANK CAPACITY � � J LEACHING FACILITY: (type) -,'071�fZ,0 (size) NO.OF BEDROOMS �) �vo�q.�1 to,✓�,g BUILDER OR OWNER '�L/f/r�' /y PERMTTDATE: —'� --o'� COMPLIANCE DATE: Separation Distance Between the: Maximum AdjustedG'roundwater 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 J Feet Furnished , lam/ G �OG��'JC I Q � r o . � o 41 A 1% I i Z do t` Commonwealth of Massachusetts Executive Office of Environmental Affairs OCT �' 3 I `;0 Department ofyf : �Hvironmental Protection T udy Coxe - David B. Struhs U. C.ortvNtsbMr • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION PropertyAddresa: 18 South East Lane Centerville,MA Add. of Owner. Date of Inspection: 1 0/3/96 (If different) Name of Inspector- Joseph P.Macomber Jr. Company Name,Address and Telephone Number. J.P.Macomber & Son Inc. Box 66 Centerville ,Mass . 02632 508-775-3338 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 Evaluation By the Local Approving Authority _ Fails X , Inspector's Signature:/A Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner.u,d copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A) SYSTEM PASSES: t S I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, era:ked, structurally unsound, shows substantial inMtration or exfiltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a Conforming septic tank as approved by tLe Board of Health. (revised 11/03/95) 1 One Winter Street • Boston, Massachusetts 02108 a FAX(617) 556-1049 • Telephone (617)292-5500 �� Printed on Recyckd Paper f �1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) P:opertyAddresa 18 South East Lane Centerville,Mass . 02632 Owner. Beatrice Chandler Date of Inspeotion: 1 0/3/9 6 B)SYSTEM CONDITIONALLY PASSES (continued) AP Sewage backup or breakout or hob static water level observed in the distribution boa is due to broken or obstructed pipe(s) or due to a broken,settled or unsm distribution boa. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution bout is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: 4� 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 ENVIRONMENTS EJ Cesspool or privy is within 60 feet of a surface water Cesspool or privy is within 60 feet of a bordering vegetated wetland or a salt marsh Z) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENTS '&_)O 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. ti4� The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. Az The system has a septic tank and soil absorption system and is within 60 feet of a private water supply well The system has a septic tank and soil absorption system and is less than 100 feet but 60 feet or more from a private water supply vrell,unless a well water analysis for colVorm bacteria and volatile organic compounds indicates that the wall is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm. 9) OTHF4t N4, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontinued) P,,pertyAddress: 18 South East Lane Centerville,Mass . 02632 Owner. Beatrice Chandler Date of Inspewt4on:1 0/3/9 6 D) SYSTEM FAILS: e A165 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.swage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box abov outlet invert due to an overloaded or clogged SAS or cesspool. 1 l Ptr A-r 1-2 dw-) Liquid depth in oesspeel is less than 6"below invert or available volume is less than IN day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped &41 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 60 feet of a private water supply well. 40 Any portion of a cesspool or privy is less than 100 feet but greater than 60 feet from a private water supply well with no acceptable water quality analysis. If the well has been analysed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: 1 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.: &2d the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 6.00 and 6.00. Please consult the local regional office of the Department for Anther information.. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 18 South East Lane Centerville,Mass . 02632 Owner: Beatrice Chandler Date of Inspection: 10/3/9 6 Check if the following have been done: ` ,k�umping information was requested of the owner,occupant, and 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. built plans have been obtained and examined. Note if they are not available with N/A 2The facility or dwelling was inspected for signs of sewage back-up. -iL 'ne system does not receive non4anitary or industrial waste flow - The site was inspected for signs of breakout. system components,Zuding the Soil Absorption System, have been located on the site. jzThe 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. ZThe size and location of the Soil Absorption System on the site has been determined based on ezurtuig information or approximated by non-intrusive methods. ZThe facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 �5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAdd,oaa: 18 South East Lane Centerville ,Mass . 02632 Owner. Beatrice Chandler Date of IndpoUtiQL:: 10/3/96 FLOW CONDITIONS RES I D ENTUl: JJ Design Aow: ons�QY'd Number of bedrooms: Number of current residents: Garbage grimier(yes or no): Laundry connected to system (yes or no Seasonal use (yea or no):-&D l WUtr /rea4ings if aya4blejQQe5 � AN fi Last date of occupancy: �K CO-MMERCIA.L/INDUSTRIAL• Type of establishment: 'o4 Design flow:_,&2/j_ga1lons/day Grease trap present: (yes or no).L/g Industrial Waste Holding Tank present: (yea or no) 1 jt4 Non-sanitary wasta discharged to the Title 5 system: fives or no)A& Water meter readings, if available: �� -- yl-T Last date of occupancy: A)fi OTHER (Describe) 6 _ Last date of occupancy:_ GENER kL INFORMATION PUMPING FECORDS d urceo�tnforrration: 1, -1� TreA ZXI"'>' J ��'' �ti 0 tc � YYL`%T CKty System pumped as part of inspection. tyes or no) /jO Lf yes, volume puruped: A�j al;ulj Reason for pumping: .J TYPE 07 SYSTEMM - Septic tau.Vdlatrlbutlon bo:/soil absorption Y)'Ytem A/D S iagl Cv: l ti"J Overflow cc�aspwl '0 Privy AJL� Shared system (yea or no) (if yes, attach previous inspection records, if any) Other (ezpliin) APPROXIP1ATE AGE; of aall comP�n�ent�s date u:.+ of (if known) and source of information: _ �� �Y/l�i�y' i :_USURFACE SEWACE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION (continued) Property Address: 18 South East Lane Centerville,Mass . 02632 Owner: Beatrice Chandler Date of Inspectional 0/3/96 SEPTIC TANK: AOM{ 9 �'V (locate on site plan) Depth below grade:_r Material of construction: kconcrete _metal _FRP _other(exp—l-ain) Dimensions:pr Sludge depth. y� Distance from top Judge to bottom of outlet tee or Scum thickness:_//' e— Distance from top of scum to top of outlet tee or baffler Distance from bottom of scum to bonom of outlet tee or bafflr. Comments: (recommendation for pumping, condition of inlet and outlet tees or baffle. depth of liquid IPvel in relation to outlet invert, structural �rity, evidence of leakage, etc.) Pump tank annually:I. nlet &• gull!Pt tees ,j- 1 n _Liquid, level is 51 It to at ih-L- inir- esent time. CREASE TRAP.�pv� (locate on site pran) Depth below grade:;4U/; Material of consin­66Z,Al�:oncrete _metal _FRP __utneriexplain) Dimen;ions• Scum thickness: Distance from top yr scum to top of outlet tee or bafile:•/Vl Distance from bottom nl 5rom in bottom or outlet tee or uon:,• Comments: (recommendation for pumping, condii-rt of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, et �Grease trap is not present. k tzevised 8/1$/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) picp.ih,AAd.. 18 South East Lane Centerville,Mass . 02632 Owner. Beatrice Chandler Date of Inspection: 10/3/9 6 TIGHT OR HOLDING TAME•>if/(!�, (locats on site plan) n • Depth below grade: 101 Material of construction:�JAooncreta_metal_FRP_othet{esplaia) Al� Dimensions: ►V 4 Capacity: ID4 p1lons Design flow: onslday Alarm level:A)A Comments: (condition of inlet tee,condition of alarm and float switches, etc.) Ti.ght. nr hnl cii ng Lanka are not =raaent._ DISTRIBUTION BOX:-Ie/ (locate on site plan) Depth of liquid level above outlet invert: Q) Comments: ante if kvsl aid di, u� a is equal, dance Lsolids over,evidence of leakage into or ut of box tc.) bx is evel; as single flow pipe; NO evidence of solids carry over, No evidence of leakage in or out of the distrbution box. Nn ranairg naar3ad at the present time PUMP CHAMBER:_a4'1 (locate on site plan) Pumps in working order.(yes or no)—A29 Comments: (Rota P tipa of pum�c)s o pr e S e rn and appurtenances, etc.) um c am�e (revised 11/03/95) 7 . .,,SU&FACE SEWAGE DISPOSAL SYSTEM INSPECTION PART C SYSTEM INFORMATION (oontinuod) pivj:<rty 18 South East Lane Centerville,Mass . 02632 Owuar. Beatrice Chandler Date of 10/3/96 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if poss11ls;excavation not required, but may be approximated by non•intru4ve methods) e If not determined to be present, explain: leaching pits, number. l •-� leaching chambers, number., leaching galleries, number. leaching trenches, number,length: leaching fields, number, ions: overflow cesspool, number: Comments: (note condition of soil signs of hydraulic failure, level of ponding, condition of v tatiop,�tc.) Loamy sand to mealumm fine sand;No signs of hy�raullic Taliure or puliftt , All vegetation is normal. No repairs needed at the 32resent time , The I enChing ; ,Q rl-ry CESSPOOLS: ,'tf,� (locate on site plan) Number Lad oori4uratiow /1Jfti~ Depth•top of liquid to inlet invert: AIX Depth of solids layer: Depth of scum layer: Dimensions of ocuapiol: M.atariaL of coustruct:on: .4)/4 Indication of grouadwat.r: '6W inflow(ooaspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Cesspools are_noWpkesent. PRIVY: (local on site plan) Materials of oo n: �!� Dimensions: x� Depth of solids:-Alli— Comments: (note condition of soil, signs of h�•draulic failure, level of ponding, condition of vegetation,etc.) Privy is not present. j.,j12FACE SEWAGE DISPOSAL^SYSTEM INSPECTION ,l'U1 r1 PART B SYSTEM INFORMATION continued `r SKETCH OF SEWAGE E SPOSAL SYSTEM: � include ties; to at least two permanent references landmarks or benchmarks locate all 4lells w thin--100 ' C nterville Osterville blarstons Mills Watp& Company 428 6691 I - I_ I' C\ \ r.� DEPTH TO GROUNDWATER 20► + depth to groundwater rethod of determination or a roximation: PP Ins aI1�: _ _ _ ,lip-.-water enc-6un ere at. 'T .-- . V �s Y Jos �C Sbyy 3�'1�1 THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. Ih June 8, 1995 Acting Director of the �' -ion of Water Pollution Control TOWN OF Barnstable HOARD OF HEALTH SWIS(1RFACF SFHAGF DISPOSAL SYSTEM INSI'F:CTIUN FORM - PART U - CF,RrIF1CATION 1 F••'—•••-T""'•-�.•::••.��'1.T.��ll'�:T:�T.��1••-T-•T-•••�:.��....._. .�TTTCTrt'STTSSTT-fLTS'iT}RTRC�C�{. LTQT7Si}SI'T'RTTTfT -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS I .Sola:.h Faot Tana nantarvl11 e Mass 02632 ASSESSORS MAP , DLOCK AND PARCEL # 1'�9—,!IYy OWNER' S NAME Beattr,�� Chandler PART U - CEI?TIFICATION C NAME OF INSPECTOR -Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Son Inc. COMPANY ADDRESS Box 66 Centerville,Mass . 02632 Street Town or City State tip COMPANY TELEPHONE (508 1 775 3338 FAX ( 508) 790 - 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the i►ifor►nation reported is true , accurate , and _ complete as of the time of .inspection . The inspection was performed and any recommendations regarding Upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one ; (XXXXXXXXX System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have conducted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date 10/21 /96 One copy of this certification must be Drovidptrl t.n t.hA nwNT?p 4-1,,, n„��� LOCATION SEWAGE PERMIT NO. ZZE V I L L'AG E y— / s, INSTA LLER'S NAME i ADDRESS A JOHN A. ,AALTO BACK140E SER`:IC'E, 150 Walnut Street West Barnstable, Mass. 02.663 48 U 11 D E R OR OWNER / k'rwe I OAT-E PERMIT ISSUED _ g26 ^ DATE COMPLIANCE ISSUED �`� � X� J-7 it No.._........ Fmc.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD- O HE T .......... ...........OF.......... ........-- ----------------L-........ Appliration for Uiipnaal Worse Tomitrnrtiun ranfit Application is her y made for a Permit to Construe ( L or Repair ( an Individual Sewage Disposal System at• - . . . . ... . --..&_O&Z --...-•.............•-_: .............-•-------------........--..-- Loc 'o -Add ess or Lot No. ..... . ....................... .......•-•-...........•--•-..................._•---••---------••-................................. ne Address Installer Address Q Typ of Building— Size Lot............................Sq. feet V Dwelling—No. of Bedrooms................... ......... .. .....Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building __- _ No. of ersons____________________________ Showers Pa YP g ---------------------- P ( ) — Cafeteria ( ) Q' Other fixtures ...................................................... W Design Flow............................................gallons per person per day. Total daily flow----........................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter______--__._.. Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. " 3 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........................ fa, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ w ......................................................... 0 Description of Soil..........•---- ----------••-- ........................................................................ . ............................. U ................................................ .......... 1•-- .. •-------- -•••...----•---------•---. W - ----------------------------- U Nature of Repairs or Alterations—Answer hen applicable.--------- -- •--/- �- .......=------ --- -----------------------------........................................ Agreement: Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of I I p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b is by.the o rd o health Signe . . .. --• .......... ...---- Dat 1 Application Approved By........ f •... -•••-•-------• e...- ....... ...- C�- Date Application Disapproved for the following reasons----------------------------------------------------------------------------•---•---•------ ------------....... .............•••-----••--•-•-•----••--•....--•---•-------•-----•••---•---•-----•-•--••••------•--••---•••--•------•-•---•-•....----•---------------•----•-----------------•------------...--•---....---- Date Permit No......................................................... Issued--_-7-- �.. - Date .,3 1.+W✓"' ....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD O F l--I E T t..... Appliration for DigpnsFal Works Tnnitrnrt,ion Viernfit Application is hereby made for a Permit to Constructs ( ) or. Repair ( ' ) an Individual Sewage Disposal System at: ._..., _ ...... .., ..... - .. . .. ... _ ............. ...... Loca o -Add ess or Lot No. .. ........................ .•----•-•-----•••••-•-••••---..................----•.......----•-.................___.____......_. C� ner Address a -•-•• A--•---•-•-.... ----------------- Installer Address Typ of Build Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other...—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a - 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........................................ M Test Pit No. I................minutes per inch Depth of Test Pit-_____-_------_____ Depth to ground water......................... (X4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ----------------------------------------•• ................................................................................................................ O Description of Soil............... ----------------------------------------------------------------------••-•-•••....... x -----------•---- ------ •------------ ------- U Nature of Repairs or Alterations—Answer vhen applicable.!—__ * -....... r ' - - ---------------------------------•-------•--------------------------------------------------------•----------------------.....---.....--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i i'1-17, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b is by t�erd, o healthf Signe ? _.- + Application Approved BY•---•-• ' � d -'' -- -j---•-- Application Disapproved for the'f ollowing reasons:---------------................... -= Date ----------------------•-------•-•--•-••-•••--•-•-•--•••-•------••--- Date PermitNo......................................................... Issued_....................................................... Date s THE COMMONWEALTH OF MASSACHUSETTS`x r~ z, BOARD O H ={ a f .......... .............OF........ Z Tnrtifiratr of Toutph anre " ' N TH IS TO C. IFY, at the Individual Sewage Disposal System constructed ( ) or Repaired bY------- - � -- -------•----•--------- I staller Xe...&49A�A.l has been installed in accordance with the provisions of 4�� .......5 f State Sanitary Co eas describe inthe application for:Disposal Works Construction Permit N _._ ........ dated_----- "----9'` ... THE ISSUANCE OF"THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. `t DA h Inspector-- _ •------------------•---•---•-------•-------.---u THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALT 0.......{.. ' FEE...0............... Disposal 'k T . 15 ` -wit amit Permission is hereby granted.. ........... - :-----"'•-----------------------------••-•-• ------.--------•-•---------•-- to Constrt ( or Rep ( an d Idual ewa Dis Systprn at No.. '15s� G'' �- 5 -:- .Pcta----------- -- .................................... Street pp p orks`Construction Perrn"?t No ------ __... . ated.......as shown on the application for Disposal �'�-r . ..•._•,.-••.•-••- a DATE. ......................................... Board o �Hea lth ........FORM 1255 HOBBS & WARREN. INC., PUBLISHERS No...BQ-J-.[-- Fps....$...5-..QO....... THE COMMONWEALTH OF MASSACHUSETTS BOARD Off` HEALTH ------ Town.....OF....Baz�istable......... .:........................................... .1 1 Applira#ilan for Diipu,ial Workii Tilnuitrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair(x) an Individual Sewage Dis�osal System at: s....MA,....026Q1........... .................................................................................................. Location-Address or Lot No. ...RF�l --•--•--•--••-------•--•-•--•--•-----•-------•---------- --i-Q4-_Pine__St..�..HY�?v;?is,-- .....02601 --...-•--... Owner Address aA & B Cesspool Service .......................8 psTerrace,-__Hy MA 02601 -_ __ _ _. __________________________________„___,__ _ Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.............2.............................Expansion Attic ( ) Garbage Grinder ( ) pa., Other—Type of Building ____________________________ No. of persons.......?.................. Showers ( ) — Cafeteria ( ) Q' Other fixtures __________________________________ w Design Flow...................._.......................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 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........................ a ...................................=---••------....._._...--------------...----••--------------••------....-•---------------•--------------..........------. 0 Description,of Soil---------------- and x --•---....------------------......-----------------------------------------------•-------------------------------•-----------•----......... w U Nature of Repairs or Alterations—Answer when applicable._._.MStallatl_Ori__.o __1__1{OQS?..gs3�7.lQIL_.gxe-�;�St ...zt_or a__packed-_leach..pit...(.Oxerfl_nw)_;...•---------------•--------------------------------------------------------------------------------•----•----..._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T L_ y g g p y 5 of the State Sanitary Code—The undersigned further agrees not to lace the system in operation until a Certificate of.,Compliance has been issued by the board of health. — :. D to Application Approved B 4� � Qy l 58 Date Application' Disapproved for the following reasons:--------•• -----........................................................................................... -----------------------------•----------...------••-------•---•--•-_.._._....-------••......---•--------------------------------..................................................-------------------- Date Permit No...............80-------------------------------•-.. Issued--_...----..4�1 I80-------------------------- Date ,r 4 Fxs.... .f1p........ THE COMMONWEALTH OF MASSACHUSETTS j BOARD OF HEALTH ------. ... _.. -.-.T.own..._OF...lia Istaue............................................................ Appliratinn for Disposal Works Tnnstratrtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: ...1.Q?l:.kl»ne..5Jt=.q.t,...iiyann la,-?:'It1....026a........... ....••-----•------....._.......---••--------•-----•---------•--------------------••--•••........_. Location-Address or Lot No. Robsx �.Q4... ;tAx$-}iy�ar�nz��y ' .....()?6.1-----------•---•- Owner Address A& $ espolSsy ? Hn ts.'..A...026 --- . .. . Fa Installer Address � Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.___.______.^4_____________________________Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building ____________________________ No. of persons....... ____________._...__ Showers ( ) — Cafeteria ( ) P4 Other fixtures -------------------------------- - W Design Flow............................................ 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 ( ) a Percolation Test Results Performed by.......................................................................... Date........................................ 04 Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-______-_______________ ---------------•--••--•....----•--•••••------------------------------._.....--••--••------••------•........................................................ 0 Description of---•-----------------------------Soil----------••-••-Sand-------•--------------------------------------------------------------------------••--•••-•----•-•-••- +J ----................................................................................................................................................................... W UNature of Repairs or Alterations—Answer when applicable___instal"Lat'1_an__o ---store--pac., __laach---p.1t,.__ _werfI.°W.)-t.................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with f-1 T f`��•-• the provisions of 'T:L.i., 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. ! C ate Application Approved BY . ........................... 1---••--- - ................ Date Application Disapproved for the following reasons:.......... -••_______________________________________•.---_____-_-__------__--________.__.._____________._..__ -----------------------------------------------------------------------------------------•----------•-•----------------•------.---------------------------------------------------------------...._.... v Date Permit No------------- y--- ----- --------•------------ Issued-. ---A/151.80..._..__•--•----•---•-•---- t Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................TQW.n...OF........... C7CYiSt ? ................................................ Tnfif irttte of toutplianre T�yI S IS TO CERTIFY, Tha he I dividual ewa e Dis-osal S-stem ons red X A & I3 Cesspool 6ervice, tl t3 bishops 'I�err�ce, �lyann�s, :�`u� �01 -- — by....................................................................................... --------------------------------------------------------------•-------•------:=-- Installer at 04-F aae__ t.,_.__H3rann. 1 A<-...4 6�2�. -------PkQbe -F !"l!_n -----------------------•----------------•---------'-------------------------- has been installed in accordance with tle provisions of TITLE: 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit'No______________8Q-_::I_ An.... da.tea_.....4 1 /8.0......................... THE ISSUANCE OF THIS CERTI'FI'd TE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.........``180 = ------••-•---=-_.._.. Inspector........:.:...: ... C .......................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ....................................OF..................................................................................... No.--$ •••- 0- .7_.._ FEE. _-5.00 Displas al Works %'Dnntrndion prrmff Permission is hereby granted_A & B Cesspool SexyiCe,-_128••I3ishcps...`J_'erraC2-,...HyannisMA....02601 to Construct ( `) :or Repair (X ) an Individual Sewage Disposal System at No!Q'_.Pine:Street,.__4yaa.nnis, l'`A 02601 -- Robert Flin' .....-----.--•- Street / as shown on the application for Disposal Works Constructio A rmit 080_' ____ Dated_.__.__4!-��l$�.................. s ------------------------- /,`r/80 Board of Health DATE.............4/,r/80 FORM 1255 HOBBS & WARREN, INC., PUBLISHERS - � rr d4- ,gin +- 5K� 3°X6 303 10 — 1 I Sys ��oOl Ifs L- 5fAk2 OF LX of 0 AA \1\ G AOU FA ti f`-FI x-Ea ovc 2 i -4eELFGTP2iG B� C-UE, \3 V ux.�i'to � : . tc GA 10 L5 6 — 131E .5 ppc rz L a�.c , Suz�IJ — r c�!)s P-4Et►,) •r L> 1 — GJ_.-. . - D Gl & - -._H.. Sf� k7� - t�JExTt �O1�9+�f „ W/oX.Te1,)31 7J 3 t� . i x. X&8 UG4 LT OtJ (2,OOM. FwG__ g iiur. AW'G sO63 im—re¢lo2 . p U N 2C��M JAC,uzz.-t Jz©o nA C-A--t / 5 H-E D So oFA-PJ fW Ao�JL cT a g y a- a8x6gaN FAA.) 1NriR1 Fu o p E Ri v GLE �. LT, W�SG ���► 18a .rb -- - Vol - a Fwl�.�o PY ya- G ,3 G G L o c tK _-" �- C- L. i o�.o —" k i zx CF E�vrl L ><Lv - fiirJ.G� EL tcIS�INGGZ. EL ,ocf3 C(,�11 ('�t s � S—__s__--- �r l6 SLopE , ACCESS w 11v 6 0► GR. z t` , ,oZ� — Ft eu� t-- -- 6 M 1 �3 MAX C OV� QUp, 0 ACCESS Pb S PEN%rb Jf- R c, ccwc. 9 6 H to •o ',a K C ASBAFF�C. 95•g ��` .moo 95.7 t).a b S\\ 3 l 1 o \\\ '� /4`�01 Yy pax,23-k — lJ w nsr�r-n sip+•+`; �L - L C)G U D C T N C)f- 9vI'> . ),,LIT rEtipe�r�� - 10 el-I 0 F Jul OTES: �Q,Ct-Y-1 Et - I�/ 1 , 01 -)POSAL SYSTEM ro aZ CO \ASJKUCTED ►,� SiRI CT I�CCL�RDANCE or- C 0I�IIV1. or NI ASS . E IA VIRDJ. CODE - T V. . f_ SURVEY Y!�)A7A 1- l)olti LAND CLURT- PLAN LATEU IZ- 8- 65 PRofl L_E of DISPOSAL S`C STE j�� 13AkN57,11ELE RT- Co , di� )�)EEUS. (Nor ro SU�tE) 3 A SS ES S C� ' S M t\P 1. 8 9 P Q� O q4 . BENLH )MARK - /VJ--ML )wTRLL AS SHOWJ c,l PLAN , 5, C ONTR}\CT OfZ CALL DI Cl SAFE Q LEAST 72 1-10VR S 13EF0RF- TBM: "MAG" NAIL SET I STARnIV G IN TRUNK OF 12" t10LLY. (o_ PVMP A FILL LXIST ) NG l- I 'SAtiD `�LP,rII MmK, ELEV. = 100,00 (ASSUMED DATUM) 7, F )E LL7 CIA\, PL V IVl P I Q 3 F-x) 1 J N G Y: 8J K)TI aN A J � W A!CK ro DWLLL INCH. S. USE 1, 5 a0 GAL SEP1C 7ANk ' PI A CE ''T"s ,a,�n GAS I 1=F LIE T j"\tJ K Pi% T J 1-L C -1I �. V S-f 3 -S 'x5'xt' I? G_ C�1C- LE3\G?A LH AYAM'=.RS. w);,, -4 ' or 314" l „4,v ) '/z" 1�C�VBLE W AS}1 ED SToWL )�Ll A ROVND w t� Z r� W Y'\S I-\E P LA ST-�1JE c,..(-7 c� / p EXIST. COVER EXIST. COVER ELEV.S 9f3.3 �o �vl G�i ELEV. = 99 s� 20 � 0 Op �Y'1 \ tp�M� EXIST. TANK �s 5 / oil R�5�� S OVER. raj WOOD -DECK I STY. WOOD FRAME \ IT. CONC ❑ DRIVf LOT 7 N.► '� AREA = 15,G70-±- SF O L_75.7 Gl r.0 2 r. L=20.U r��ciT LAN E °�, 1 I-1Er7T TE St P,Q r £ P_PC.TEST - � a AMASS i EX I ST/N '.� q0 26 ,XDL ��'' RICHARD H �Fh( Z 61 S— — 5 Ncl J.LO(a)`� I €S.Z HOOD cn HARRY �G o No. 35031 EARL m 3 c O fvv,y 5 A 'A b po p O LANTERY, 1R.�� v 9 7•Z — — 5 9 Fss�0/S T E���J ��No.26575 O Q P f I - �cNA 5 �� ��STeE''e, DE 51 fly S IT I -� l / i — �ro�t ! D"Ljuk1 03 L GRAPHIC SCALE � In)G>`t i-"A 'DWEL!1NG W/`i f3EDRD0M5 �'e ►��it -- 30 0 15 30 80 120 M)Qys/1 N_ 5�1,,1,�GE 5Y� , E , , Doi c o� tS sn, D A I LEI F L 0 'vv = 1 I a x 4 = '+ 4 G. P.IJ. ____ .,,...__ . , m_._._ +1� ' 1=�aR SF- PT I c rA I'ylf, cY L. -REQ' ua IN FEET )VI l m N f-A L 1VI C AU L I FF L --- 4�!- a (�. P. U. X 2 .O = `d E3 0 GAL 5 . 1 inch = 30 1t. I a S C)UTN C ASS- L MYFL C rl V� - 0 , �.. �.T/'S�3�V I L LEA )V1 A c�2�3z 1 ,5 � uAL T - � - � — 5 . �. 5.�------ — ��-�24� - PhZOt'05CD COtiTnV� _ L 0\C I-, I l`l_G 1\R JX � I 1 �, S I�UT J�l lr JA5T t l" NT- U S E 3 C. t Y s--m j E 10 CXt51lN G COlVT��KP\ SS E S.S oa' S M NIP f 8� Pe. �44 CV- C= ECTIVL JC-PTM = 2 . 0 ' CEJJT- rR\J tL1L MA d2G3�. L L G ► Z 6 x 0.7 4 = 13 3 - paw C:\-/Ay --- ADW\NCE❑ T; CI-I . SOLU-TI ON S 13), 3Zx U. T4 348 F)r�M �oN�. -47,2 T OT' 1>L CA?AC)TV - Lt`t I GALS . Q,. r� sTED: `� 29-c1� CocvsvL7 CI�1G'r� . � . St;Nt�.�M�. — -.-----_._._-- - � - ---- DI•�TE s 5 - S �-(13 DW G.� 5 3o c�3