HomeMy WebLinkAbout0096 SEAN'S CIRCLE - Health 96 SEAN'S CIRCLE, CENTERVILLE
A= 170 057
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cQcO�o
UPC 12534
"r 153LOR
HASTINGS,MN
DATE:§/30/9:8
PROPERTY ADDRESS: .96 S-9ari' s Circle •
Centerville,Mass. R I'V�
7 �f9S
'02632 JUL 07 -
TOWN OF BARNSTASLE
HEATLH DEpr, `.
On the above date, 1 Inspected the septic system at the abov8 `a•d-d.re,s'&.1
This system consists. of the following: £
1 . 1 -1 00*0 gallon 'septic tank.
2 . 1 -Distribution box.
3 . 1 -1000 gallon precast leaching pit.
Based bn my Ingractlon, I certify the following conditions:
4 . This is a title five septic system designed for a three
,.bedroom house under the 1978 code.Note This is not designed
for a -.four. bedroom house.
5 .. The present septic system is in proper working order
at the- present time'.
6 . Pumped septic tank due to ..a heavy scum and solids layers in
the septic tank. Pump every 2-3 years.
51GNATURr-:
Name: J. P.Racomber Jr...
-------,---------------
Company:_j. P_Macomber_ & Son-`Inc
Address:_-Sax-bb------ -- --
__Centgrville , Mass__02.632 '
Phone: '
___548--1'75_3338-----__
3
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
•
JOSEPH P. MACOMBER & SON, INC.
Tanks-Css.spools-Leachf lelds
Pump+d & Installed
Town Sewer Connectlons
P.O. Box 66' Centerville, MA 02632-0066
775-3338 775-6412
COMMONWEALTH OF MASSACHUSETTS
UqEXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON, MA 02108 617.292•5500
TRUDY CO
WILLIAM F.WELD Sccrct
Governor
DAV1D B.STRU
ARGEO PAUL CELLUCCI Commissio
Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 96 Sean' s Circle Centerville Address of Owner:
Date of Inspection:6/3 0/9 8 Mass. (If different)
Name of Inspector:Jospa h P_Macomber & Son Inc.
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name: J P Macomber & Son Tnc--
Mailing Address: RoX 66 f'pntprvi 1 1 p Maac 0 632
Telephone Number:
'CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accuratc
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:
Zpasses
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fails /
Inspector's Signature:
Date: ^bl<----t--
The System Inspecto 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 own
and copies sent to the buyer, if applicable, and the approving authority.
INSPECTION SUMMARY: Check A, B, C, or D:
AI SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303
Any failure criteria not evaluated are indicated below.
COMMENTS: T p t rpSpnt- cWctem i c nol IT d.eSJ 9MQa for a t-hrpp
BI SYSTEM CONDITIONALLY PASSES:
_ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, up
completion of the replacement or repair, as approved by the Board of Health, will pass.
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, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection;
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltrdtion, t tag
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
(sevia•d 04/25/97) Daq• 1 01 10
DEP on the World Wide Web: http:Uwww.mapnet.state.ma.uvoep
Printed on Recycled Paper
U
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 96 Sean' s Circle Centerville,Mass .
Owner: Steve Capuzziello
Date of Inspection: 6/3 0/9 8
B) SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the
Board of Health). Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
4'6 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:
UD Cesspool or privy is within 50 feet of a surface water
W Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT 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 to 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.
Vd 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 (or coliform bacteria and volatile organic compounds indicates that
the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method used to determine distance _(approximation not valid).
3) OTHER
(swised 04/25/97) Y&y• 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 96 Sean' s Circle Centerville,Mass.
Owner: Steve Capuzziello
Date of Inspection: 6/3 0/9 8
DI SYSTEM FAILS:
You must indicate ei;i,er "Yes" or"No" as to each of the following:
1 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.
Yes No
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the disc ibution box above outlet invert due to an overloaded or clogged SAS or cesspool.
nouxl r
Liquid depth in Fe� is less than 6" below invert or available volume is less than 1/1 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped _.
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
O/ 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.
1Z Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
EI LARGE SYSTEM FAILS:
You must indicate either "Yes" or "No" as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
/0 the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone II of a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 04/25/37) Page 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 96 Sean' s Circle Centerville,Mass
Owner: Steve Capuzziello
Date of Inspection:6/3 0/9 8
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.
ZNone 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.
ZAs 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.
ZThe system does not receive non-sanitary or industrial waste flow.
_ The site was inspected for signs of breakout.
_ All system components,IeKlucling 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:
The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of
Sub-Surface Disposal System.
f� Existing information. Ex. Plan at B.O.H.
_ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is
unacceptable) (15.302(3)(b))
(revised 04/25/97) Pay• 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Properly Address: 96 Sean' s Circle Centerville,Mass .
0"ner: Steve Capuzziello
Date of Inspection:6/30/98
FLOW CONDITIONS
RESIDENTIAL:
Design flo%. 5a p.dJbedfoom for S.A.S.
.umber of bedrooms: y
Number of current (esidents:uA
Caroage gander (yes or no).A)Q
Laundry connected to system (yes or no). '�
Seasonal use (yes or no).A ) .. /e74�
% ater meter readings, if available (last two (2) year usage (gpd): / < y l'
Sump Pump tyes or no):&!O— /T Z b ??Plm 019h Id 19,1119
;ast date of occupancy --50
COMMERCIAUINDUSTRIAL•
Type of establishment:
Design flow:f_gallons/day
Crease trap present: (yes or no)4V_11L
industrial V%taste Holding Tank present: (yes or no)IVO
�on•sanitary %ante discharged to the Title 5 system: (yes or no)r l/
water meter readings, if available._
Last date of occupancy: /IJN
OTHER: :DescribeI
Last date of occupancy: IVIt
CENERAL INFORMATION
PUMPINC RECORDS and source of information:
System pumped as pan of inspeclton: (yes' or no)
If yes. volume pumped: 1� gallons /1
Reason for pumping yv .F>yf r SD�IAf� �igsytetssr
TYPE OF SYSTEM
Septic tank/distribution box/soil absorption system
A_ Single cesspool
Aln Overflow cesspool
A70 Privy
,AID Shared system (yes or no) (if yes, anach previous inspection records, if any)
I/A Technology etc. Copy of up to date contract(
Other
APPRpXIMATE ACE of aI c mponents, date installed (if known) and source of information: �?_, ��
Yr
S{..age odors detected when arriving at the site: (yes or no)/0
(r.vi..d 04/25/17) ➢.y. 5 o1 10
�^I
SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 96 Sean' s Circle Centerville,Mass .
Owner: Steve Capuzziello
Date of Inspection:6/3 0/9 8
BUILDING SEWER:
(Locate on site plan)
Depth below grade:
Material of construction: _cast iron /0 PVC_other (explain)
Distance from private water supply well or suction line 4/D
Diameter 4
n
Comments: (condition of joints, venting, evidence of leakage, etc.)
Joint
is vented through the houGP vent
SEPTIC TANK:�Oj� 9,4CLW 4'
(locate on site plan)
Depth below grade:
Material of construction: -concrete _metal _Fiberglass _Polyethylene _other(explain)
If tank is metal, list age A Is age confirmed by Certificate of Compliance 4L,,t_(Yes/No)
r Dimensions: 5)Vr ffr4 6T?,Af zh 41 / rr N14
Sludge depth: O
Distance from top of sludge to bottom of outlet tee or baffle: a
Scum thickness: 6
Distance from top of scum to top of outlet tee or baffle: d a
Distance from bottom of scum to bono of outle tee or baffle:
How dimensions were determined:
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.) Pump tank Pvpry 2-1 )4Pa r 4 I n l a t k n1-j t 16 t
tees are i n pl acp, The tank is strur-tnra 1 11), Gniunrl and shazgs
no signs of 1Pakagp
GREASE TRAP:AVM/°tom.
(locate-on site plan)
Depth below grader
Material of construction-AM concrete*W metal VAFi berg]ass othPol yet hyl ene4*tother(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:-dZV
Distance from bottom of scum to bottom of outlet tee or baffle:-A/&
Date of last pumping:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage,-etc.)
Grease trap is not present.
(revised 04/25/97) Pegs 6 of 10
Ub
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 96 Sean' s Circle Centerville,Mass.
Owner: Steve Capuzziello
Date of Inspection: 6/3 0/9 8
TIGHT OR HOLDING TANK:,VM (Tank must be pumped prior to, or at time, of inspection)
(locate on site plan)
Depth below grade:,
Material of construct ion:A2$concrete,U,1metalW&iberglassAm Polyethylene,�&ther(explain)
Dimensions: A)A
Capacity: AJAR gallons
Design flow:_A1,_gallons/day
Alarm level:_Alarm iq working order Yes;/L& No
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
Tigh t or holding tanks are not present
DISTRIBUTION BOX:,
(locate on site plan)
Depth of liquid level above outlet invert:_0
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or,,out of box, etc.)
Distribution box has one lateral .Slight sign of solids carry over;
Nn pvi dpnopp of 1 apkage in nr niif- f the distribution bLZX
PUMP CHAMBER:A20le,
(locate on site plan)
Pumps in working order: (Yes or No)
Alarms in working order (Yes or No)
Comments:
(note condition of pump chamber, condition of pumps and appunenances, etc.)
Pump chamber is not present.
(r.vl..d 04/25/97) P.g. 7 of 10
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:96 Sean' s Circle Centerville,Mass.
Owner: Steve Capuzziello.
Date of Inspection: 6/3 0/9 8
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:,_1,_
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 of ponding, condition of vegetation, etc.)
Loamy sand to medium sand; No signs of hydraulic failure
or pondina;egPtatinn is nnrmal �
CESSPOOLS:
(locate on site plan)
Number and configuration:_
Depth-top of liquid to inlet invert: A)d
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)
Cesspools are not present
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
Cesspools are not present.
PRIVY:d /Q�
(locate on site plan)
Materials of construction: Dimensions:
Depth of solids:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
Privies ar_p not prespnt
(revised 04/2S/97) Pay• 8 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Propeny Address: 9 Seans Circle Centerville,Mass.
Owner: Steve Capuzziello
Date of Inspection: 6/3O/9 S
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
�►szt�
(r.vi••d 0�/21/97) P.y• 9 or 10
SUBSURFACE SEWAGE DISK;:--,L SYSTEM INSPECTION FORM
P�itl C
SYSTEM INFORI.', .rION (continued)
Property Address:.96 Seans Circle Centerville,Mass.
Owner: Steve Capuzziello
Date of Inspection: 6/3 0/9 8
t
Depth to Groundwater Feet
Please indicate all the methods used to determine High Groundwater Oevation:
Obtained from Design Plans on record
f bservation of Site (Abuttin roe bservation hole, basemtr�t'sum etc.)
gp p
_eSetermine it from local conditions
Check with local Board of health
Check FEMA Maps
Check pumping records
_zcheck local excavators, installers
Use USGS Data
Describe in your own words how you established the High Groun&a*efElevation. Must be completed)
Used water contours map.
Gahrety Miller Model
12/16/98
(revi.ed 04/25/97) P�g� 'Qof 10
k,•,�.,�,.-n„-.r-r.-..,..-.�•...r„o-,,...,,..,•..,.,:,.•.,.a...,,.n..�...,�,,...,•.a-.,-.�>R•.. r-.r,-r-r-.,a—,_-:,.�,.r-•1
TOWN OF Barnstable BOARD OF HEALTH
I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION
`� 1:^•rn^�••.-:: -�.ttr.^.rrnmr.+n•rtrn r��astt+nrrrr-terzvsn�mmf'.-vm.�wrrts•m*.s.�a•m� mnntmrnRrv+�r.r.•.rrr'-•r.-ter •-..
-TYPE OR PRINT CI.EARL -
PROPERTY INSPECTED
STREET ADDRESS 96 Seans Circle Centerville,Mass .
ASSESSORS MAP, BLOCK AND PARCEL
OWNER' s NAME st•PVP rapoi.zziallo
PART' D - CERTIFICATION
NAME OF INSPECTOR Joseph P Macomber jr
-
COMPANY NAME J•P.Macomber. & Sof1`inc.
COMPANY ADDRESS Box 66 rpot pry il1P MARA n2Al9
Street Town or City State LIP
COMPANY TELEPHONE ( 508d 775 - 3338 FAX ( 508 790 - 1578
q
A
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposaj system at
this address and that the information 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 :
v 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 con toted 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 .
7 1 -
Inspector Signature Date
One copy of this certification must be provided to the OWNER, the BUYER
( where applicable ) and the 130ARD OF IMAL'I'll.
* If the inspection FAILED, th`e owner or operator shall upgrade ' the eyetem
within o'ne year of the date of the inspection, unless allowed or required
otherwise as provided in 3.10 CMR 16 , 305 .
partd •doc
TOWN OF BARNSTABLE
LOCATION 1 SEWAGE #
..A. VILLAGE LZ; . /' ASSESSOR'S MAP & LOT
ell
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS -41
BUILDER OR OWNER C) eky, �ZZ' /!
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) / 7 S Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 fee leaching fac'� Feet
Furnished b
i
4
C04Tz 1.
5 �
W 1
In
y
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.
lunc X. 199',
Acting Director of the L) iun ul Water Pulititiun Control
• A
_a r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town...............:.....OF..........Barnstable---.............................................
Aliptiration for Uiipnii al Workg Tomitrurtion ramit
Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal
System at:
...............Lot...1.....S.ean.!•s...Gir-cle,...C entarxilia..---------------...------------------------..................-•--•---•--..............---
- Location-Address or Lot No.
Own, Address
W ..........................................................rr c s---........ ------ Sz s�T-N-b�c...
------------------------••----•---•---•••
Installer Address 17,011
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.__.......•................................Expansion Attic ( ) Garbage Grinder ( np
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ---------=----- •--•-
W Design Flow________________55__..:._._____________._gallons per person per day. Total daily flow____._._.__.._._............._.__.........._gallons.
WSeptic Tank—Liquid capacit3jM)..gallons Length$t_611.._. Width...4.!.10"Diameter................ Depth...1+ Err
x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area---------sq. ft.
Seepage Pit No--------1-.._-_-__-_ Diameter•______1D.f______ Depth below inlet.._._b.!.......-_ Total leaching area__2 '7------sq. ft.
Z Other Distribution box (X) Dosing tank ( )
Percolation Test Results Performed by._Qape.--God---$urua3T----ConsLlltant$ate_...._6./].1/`79•---.--.----
a Test Pit No. 1......,2.......minutes per inch Depth of Test Pit____1.Z!......... Depth to ground water..none.._-_--.--
(i Test Pit No. 2................minutes per inch Depth of-Test Pit.................... Depth to ground water........................
a -------------•---------.-----
O Description of Soil...p•,0Q Q.b...WC-o-d--,loam.,__..O.b--2,Q...sub5Qi1,...2..Q!M6.-0.
U ---------------•------------------rackX...sand,---b..Q-12.0---clean-_med.-•-•sand. •-•---.... � � M ---------....
W ------------------------------------------------------ . . ---•••......•.... .. ••----•-
U Nature of Repairs or Alterations—Answer when applicable............................................ .o ....THOMAS_._.... .
E. VA
------------------------------•-•--••---._...-----------•-----------------•---------.......--•----------•---------•--•--•-•••--....-•-•_...••--•---. - .........
Agreement: No. 20945
The undersigned agrees to install the aforedescribed Individual Sewage Disposa A t with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees F g st_e
operation until a Certificate of Compliance has been issued by the board of health. ��I ,.101
S- ne __... .--•---------------•---------------------.........._-----
Date
Application Approved By..... - 1 ............................. .............-......
Date
Application Disapproved for the following reasons_............._..................................................______ --1 Z-•__.__.____......_..._...
�.
Date
o
No............. `...... Fss.. .................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Tom.. . .............O F..........Barr_u tab le..............................................
Appfiration for Disposal Works Tanstrurtion Vrrmit
Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual .Sewage Disposal
System at:
...............Lot...l......Lk:anls---f$T_r.?: 3...�enter.,z lle....---................._.._._....--------.._..----...----------------•--..........------.
Location-Address or Lot No.
•.............. �5......4 L_N -1----....---•----•----......----......_.... ....... 't _ 71 .---..._........._......-------•--•---.......................------.
_ Owner
Wa {.•.
Address
SR
.......................................�.--•-•• 2qC25t-------------
^-•-••
Installer AddresPQ s 0.y
Type of Building Size Lot.--.__...l..................Sq. feet
U Dwelling .--..Expansion Attic ( ) Garbage Grinder ( gip
a g—No. of Bedrooms.--------- —
p, Other—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( )
a' Other fixtures ......................................................................................................
W Design Flow............................................gallons per person per day. Total daily flow--.......:3..�.........................._..gallons.
WSeptic Tank—Liquid'capacity,('fOtl--gallons Length,,r.6?!'..__. width...1y!10Diameter................ Depth...ta:.. t_..
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No........I----------- Diameter......104°_... Depth below inlet.....0............ Total leaching area...67......sq. ft.
Z Other Distribution box (X) Dosing tank ( )
Percolation Test Results Performed by..Ga.p !Gird .. IrM.ey...L'am 311t ritDate-_ ..6/' _'?o.-__--•-_--..
aTest Pit No. 1......2-------minutes per inch Depth of Test Pit---la.......... Depth to ground water.-T1d✓ftf1..........
Test Pit No. 2................minutes per inch Depth of Test Pit............--...... Depth to ground water----....................
a •-••---••••••----•--•...••---•---••-•-•••----••-•••-----•--•..............•--•--•-•••.....--••••---•.........................................................
O Description of Soil... ...c ?ax'azf....-•-•----•--------
W •-••••--------- ------------------------------------------------•------•----------•-----•----•----•--••-----•••---•----......--.........---•--•--•••--•-•-•...........................................
U Nature of Repairs or Alterations—Answer when applicable................................................................................................
---------------------------•--------------------------.....•---•-------••-----••----••.....-•--------•-•-•-•------•----••------•••••-•-•---------•...--•--------•--•--••--•----•--•-----•-•---•-•--•-•.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT .;. y g g p y
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.
�� Signed :...--•-----•----------------------------------------•-•••-•--•---------••-•-- ................................
� Date
Application Approved BY---- •---•-•..................•..-- -----------------•-- --•-•---------
/I Date
Application Disapproved for the following reasons:................................................................................................................
......................•--.....------•-------•------•---••--••---•--------------•------......----------------•-•--------•-•-••----•-•---------•--••--------•----••••----••-------•......----••••••-•••-•-
Date
PermitNo......................................................... Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. .............. ! ........OF.........b`a.KN57.A AJE.....................................
Tnrtifiratr of Tomplionrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( )
byT Li..._." 4T. -----------------••-------•-------.........._............--•-•------........-.....---•-•--------....-•----•---•---
-�• Installer -
at. ..._.. D.-t_• 4 -��' �`� l.r'4 - JJ 1EkV1_L.`--�..•--••------------••--•-•......•--------------•-••----•-
has been installed in accordance with the provisions of T)r j of The State Sanitary Code as descr be in the
application for Disposal Works Construction Permit No.-- . --.'`��.��.............. dated-_... . ..�-_-... .............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
-� BOARD OF HEALTH
b_77(� f ............. .. 0.V.)..Q......0F........1_� ��;;.TIC.��._-(,..........--------.............. ' t: %
No......•-__-•-„t FEE........................
Disposal Works Tonotrudion rrmit
Permission is ereby granted----- ........
---- T1 - -=---------------------------------•----------...._.....------•---
to Construct ( Vor Repair ( ) an Individual Sewage Disposal System
atNo........... =O-'T.....------- 5F-OkICJ-z)...... -•----..--------------------------•----------•------------•-------------------------------------------
Street
as shown on the application for Disposal Works Construction Permit No...�. .....�1. Dated.....7__�1..�-�:.....•........
Board of Health;rl
DATE................................................................................
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
=
LOCATION SEWAGE PERMIT NO.
VILLAGE
INSTALLER'S NAME & ADDRESS
z"9 6iK&9
R UILDER OR OWNER
M lI"
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
f
tr
3
a�
J
r
SOIL LOG
7 4x•- ir`1f.< !L iL LL✓.L'.. yam.Ji•.N .......a..._..�
LOAM
F^r-^S.T•;'— _I2 NA ��p�j ,h
r4�"C.I. OISTI,�,,:; e ,1000 O (,,••: 1000 GAL. a T• r
o'FnIN. GAL. i•• PRECAST OR • , j , 24
TANK ,
SEPTiC BLOCK MIN
6 �SE E PAGE
( i• �s�e PIT • , . 1
20, MIN. _jam.;..`•
. �.•�•a' j� i
" FOUNDATION {` 1 %2° WASHED STONE
I I ,
ELEVATION SKETCH 10, PERC. RATE:�,,�rQ &t&,Z
SCALE 1„ 4. e TEST BY :
TOWN INSPECTOR A�IIIs_M(L1. ' Y"
BACKHOE OPERATOR:
TEST MADE ON
Z r5/��e'�8 C"G� YA'y �'Mi+I 7• T 76't,
/9?
_ V ,}
r .TAMES
Pz at,
I.AME'Y .
No.22f57
a
r.
th
�Y t *, I
SA
-
--S/?4$r2?w
`�
G
E"s9Ati
\'sse
r�
A r� .l (�-iS�•7q
640
' }J�S1�•�! �i�17'��•IA
,P3;Ktkr2aaM s y /ra Gal.�l.�Fzr�13. 7V 33G1 Grs/ta�/Jrt
kIs
ELEVATION SCHEDULE.
PROPOSED SITE PLAN
I. 1NV. AT FOUNDATION
� � SEWAGE SYSTEM DESIGN
2, I N V. INTO SEPTIC TANK - IN
3. INV OUT OF SEPTIC TANK ° 97•67 C•E'NT_cRI l,,6,
4. 'INV. INTO DISTRIBUTION' BOX '17,47 SCALE; I"=2D" 41,4y,197F
5. INV, OUT OF DISTRIBUTION BOX = 2.30 C
S 4 ,,gip CAPE COD SURVEY CONSULTANTS
6, INV. INTO SEEPAGE PIT = _.__
` ROUTE 132
7 BOTTOM OF PIT 911z HYANNIS ,MASS.
�, :