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Home My WebLink About0012 SOUTHWINDS CIRCLE - Health 12 Southwinds Circle, Centerville mell�0 2J �i� UPC 12543 No. 53LOR •o�°OST.�pNS��o- HASTINGS. MN r Commonweafth of Massachusetts Q s Executive Office of Environmental Affairs PI EIVEO Department of FEB 2 4 1997 Environmental Protection TOWN OF a HULTHOEPT. Wllllam F.Weld Trudy �J Governor Arpm Paul Celluccl ®�' s U.Governor 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION property Address: Southwinds Cir, Craigville Address of Owner. Plonowski Date of Inspection: A- -g '7 (If different) 3015 Riverdale Ave Name of Inspector. W.E. Robinson SR Apt 51 Company Name,Address and Telephone Number. ( 5 0 8 ) 7 7 5-8 7 7 6 Riverdale, NY 10463 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA 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 • t, a Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails O Inspectoe's Signature: e<;e 1 ✓ _ Date: Dq�- 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 and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A,B,C,or D: A) SYS PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or snore 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,cracked,structurally unsound,shows substantial infiltration or enfiltration,.or tank failure is 4 imminent.ent. The system will pass inspection if the existing septic tank is replaced with a Fonforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292.3500 40 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 10/11 Southwinds Cir, Craigville Owner. Plonowski Date of Inspection: Bl 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): 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) THER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2 SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND AFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for ooliform 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. 3 OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 10/11 Southwinds Cir, Craigville Owner. Plownowski Date of Inspection 1 a D) SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the 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 distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. El LARD SYSTEM FAILS: e 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: 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 U of a public water supply well) The r or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program require eats of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST P..'s—yAddress: 10/11 South winds Cir, Craigville Owner. Plownowski Date of Inspeodon: Check if the following have been done: ✓Pumping information was requested of the owner, occupant, and Board of Health. _d*one 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. 't p in plans have been obtained and examined. Note if they are not available with N/A. VThe ty or dwelling was inspected for signs of sewage back-up. system does not receive non-sanitary or industrial waste flow e site was inspected for signs of breakout. it system components, excluding the Soil Absorption System, have been located on the site. , e 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. he ' e and location of the Soil Absorption System on the site has been determined based on existing information or :,, p ted by non-intrusive methods. The 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 SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 10/11 Southwinds Cir, Craigville Owner. Plownowski Date of Inspection: ;-—19.—cT I - FLOW CONDITIONS RESIDENTIAL: Design flow: y'-/® gallons Number of bedrooms:� Number of current residents:-A�A Garbage grinder(yes or no): fig _ Laundry connected to system(yes or no) Seasonal use(yes or no):_Yy.-'S Water meter readings,if available: 1995 - 1 3 7 , 0 0 0 g a 1 s 996 - 36, 000gals. Last date of occupancy: COMMERCIAL/INDUSTRIAL. Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes 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 pudped as part of inspection: (yes or no) ,,6 If yea,`volume pumped: eallons Reason for pumping: TYPE 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) Other(explain) APPROXIMATE AGE of all components, date installed(if known)and source of information: A S 13 8 Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/95) b i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10/11 Southwinds Cir, Craigville Owner. Plownowski Date of Impaction: SEPTIC TANK: ✓ (locate on site plan) Depth below grade; � � Material of construction: l�oonc:+ete_metal_FRP_other(e:plain) Dimensions: -k Sludge depth: 9- Distance from top of sludge to bottom of outlet tee or baffle:3 S Scum thickness: 3'` , Distance from top of scum to top of outlet tee or baffle: , Distance from bottom of scum to bottom of outlet tee or baffle:- Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) C 6 rs cd l 6 -6 D a J d s jam, G E TRAP:_ (loca on site plan) Depth low grade: Mete ' of construction:_concrete_metal_FRP_other(ezplain) Dime ions: thickness: from top of scum to top of outlet tee or baffle: from bottom of scum to bottom of outlet tee or baffle: Comm ts: (repo ndaticn for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evide ce of leakage,etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddreaa: 10/11 Southwinds Cir, Craigville Owner. P l ownow s k i Date of Inspection: ;L, OR HOLDING TANK:_ ( on site plan) Depth grade: Mate ' of construction:_concrete_metal_ "_other(esplain) Ca gallons Design flow: gallons/day Alarm evel: Co nts: (co on of inlet tee,condition of alarm and float switches,etc.) DI3 BUTTON BOX: V (loca on site plan) De of liquid level above outlet invert:_( Co ents. / ( if,level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP CHAMBER (/ (locate n site plan) Pum in working order:(yes or no)�' ts: (note co t'on of pump ber,condition of pumps and appurtenances,etc.) 6 1 (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) propertyAddrew 10/11 Southwinds Cir,. Craigville Owner. Plownowski Date of Inspeotion.�Z-) SOIL ABSORPTION SYSTEM(SAS):z (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits,number:_ leaching chambers, number: leachin6 galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Comments:(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.)� FXATo z S JTd Imo- i1 -C1 CM9P LS:_ (locate on ite plan) Number an configuration: Depth-top liquid to inlet invert: Depth of so ids layer: Depth of layer: Dimensions of cesspool: Materials construction: Indication f groundwater: ow(cesspool must be pumped as part of inspection) Cowmen :(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.) PRIVY: (locate on plan) Mate ' of construction: Dimensions: Depth. f solids• Co :(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) PropertyAddrese: 10/11 Southwinds Cir, Craigville Owner. Plownowski Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' pGl r ° 10 DEPTH TO GROUNDWATER Depth to Vuundwater:_�,_feet method of determination or approximation: 6 1J � J (revised 11/03/95) 9 TOWN OF BARNSTABLE �O�'�"� G V LOZATION. S� rY�/�it�.5 C/R SEWAGE # `"��-7 VILLAGE C R A 1 G V 4 L Le ASSESSOR'S MAP & LOT O", INSTALLER'S NAME & PHONE NO. .-1�-'An A C o A410 Co' t--'a SEPTIC TANK CAPACITY /, O LEACHING FACILITY:(type) f A fiD A .-f (size) 1Af NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT-ISSUED: A;' `r— P14r- DATE COMPLIANCE ISSUED: ��•"'�� VARIANCE GRANTED: Yes No r ®� �4001, si FIzs...... ....3.0 ..0.0 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / TOWN OF BARNSTABLE 1 Applirn#iun fur Uhi-puuttl Wurkw Tonstrnr#iun rrmit OU✓� Application is hereby made for a Permit to Construct ( ) or Repair PM an Individual P Sewage Disposal System at: , C hwin Circle Crai ville ...Sx x�-�� S 9 L ....... ............ ---------------------------------------------------- .--- e - Location-Address or Lot No......................................... o. "' Mark B. Plonowski ......................-.......................................................................... •-•-•-'-----------------•-------•••---'-...•-----------"'-'---.......-----'------......-----'--- W J .P.Macomber Jr. Owner Address Installer Address UType of Building Size Lot............................Sq. feet Dwelling-X No. of Bedrooms-----------4______________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) d 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........................ Gr Test Pit No. 2...............minutes per inch Depth of Test Pit.................... Depth to ground water..............._........ a --------------------------------------------------•--------........................................................................................ 0 Description of Soil...Sand....................................................... V W UNature of Repairs or Alterations—Answer when applic able-------Low--_prof_ile septic tank pump_______._ chambzr dump light alarm 1-box 6 infiltrators . ---••------••--•--"----•------------- -----------------------------------------------------------------••--............ Agreement: The'undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the.State Environmental Code—The undersigned further agrees not to place the ,system in operation until a Certificate of Complia ce has b n 'ssu by the oar of health. Signed -----............................. . ....... ................ .r------------- ............ ------l.0./_.1..7../..9-4------ ^ ° Date Application Approved By �; . -- .. .......................... '° .', s .............. ....... .. ._...------------------------------ Date / Application Disapproved for the following re'asonr- -- --------------- ---- ----------------- -- --. ................. ........ -- ................. ............. ........................................I...... .... . .. .... .._................................._.... .. --------- ..................... / �j 9 -Pe n.rm No.� __:...:�..,�..�`... `......1...........:.... Issued -�� p�.�°' ..... Dace I No...!.=J' `� Fas......�. 30__00 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH + �. , TOWN OF BARNSTABLE /l //� I V.- Appliratiou for Uiripuuttl Workri Tomitrurtiun Firmit I� Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal System`at: &..1 .�,.:.S ou tkwi n drC-irc1 e C r a i q.v i 11 e.................................................................................................. ---• ---- Location=Address or Lot No. Mark B. Plonowski ......................_.......................................................................... --••••-----•-----------------------------------•-•---•----------•..-..-....-----•---.......------. W J.P.Macomber Jr. owner Address ,-a ........................................,......................................................... •---•--•---••----------•-----•-----•..........--------•--•--•---.......-----------..........-•---- Installer Address UType of Building Size Lot............................Sq. feet I-. Dwelling-X No. of Bedrooms._.-.-_.-.--- ------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons-------------------.-------- Showers ( ) — Cafeteria ( ) dOther fixtures .--•-••-•--------------------------•----------------...--------------------------------- --------------------....------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------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. I................minutes per inch Depth of Test Pit.------............. Depth to ground water....---------.--..------ ° Get Test Pit No. 2.................minutes per inch Depth of Test Pit-------------------- Depth to ground water....--------.---........ 1:4 --------------------------•-------••---•--•-------•------•---•-••-•--------------------•-------------------------------------------- -•••--------------------- 0 Description of Soil...Sand.......................................................................................................................................................... W -----------------=------- ----------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable....-.Low profile septic tank pump chamber pump light alarm___1-box 6 infiltrators Agreement:.4 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b e issued by the oar of health. Signed -- --- 4 -v'i/�/- - ........... ............................... ------1 -011..71"a4...... Date Application Approved By .... vx �.... ..... ...... ........................ ) .. Date Application Disapproved for the following reasons: - - -Vi/....... ------.'....................... ....... .---.......--------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ' Date Permit No. 1� ...G .. 7------------- Issued -----., ..�" ✓..��.. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cfer#ifira e of C�omplianare THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX) J P.Macomber Jr. by ------------------------- -------------_.........................-------------------------------- --------------------......----------------------.----------------------------------------......-------------------------------.--------- Instller 11 & 11A Southwind Circle Craigvi.alle at ........ .. ............_......................... ... .......... .. ---------_------------------------------------------------------------.---------- ------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 f The State Environmental Code as described in the application for Disposal Works Construction Permit No. ...� j.. ....• .._ �L.. dated . 7_4...Zf THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUN- TION SATISFACTORY. DATE - f -... - - Inspector .<- l THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No��1.f..�`�.�� FEE----�-.. Dispaasat Worse Tunutrurtilan "rrnuit. J.P.Macomber Jr. Permissionis hereby granted........ ------------------•-----••-•----------------------------------------.....-----------------.......---------------------..-----•------ to Construct ( or Re air ,X an Individual Sewage Disposal System 11 & l�A So third Circle Craigville at No. ------------------------------------ -------------------- ------------ ••------ ---- ----------- -........ ....... Street Cps as shown on the application for Disposal Works Construction Permit Nd-_ `�/:�Dated-._� .... /..'' /O: e �g Board of ealth / DATE .------1---------•-••... ---•--------------------------•---- rf FORM 36508 HOBBS&WARREN-INC.,PUBLISHERS ll S outhwinds Cottage Lao CATION SEWAGE PERMIT NO. .ldraigville Beach Rd. 80-398 V1ILLAGE Craigville, MA I N S T A LLER'S NAME i ADDRESS A & B Cesspool Service l PR Ri chci=c Tarrar:a,Tjganni c MA 02001 t UILDE R OR OWNER ii Mnhi 11 o i DATE PERMIT ISSUED 8 f 1/80R DATE COMPLIANCE, ISSUED 8/ 1/80 i 1 r 1 . q 1I� i at �3 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town ----.....OF........Barnstable .................. .. ............................................. Appliration for Biiipwial Workii Tomitrurtion Prrutit . Application is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal System at:Craigville Beach Rd. , Craigville ............................................................................-------•---•--- Location-Address or Lot No. ...Mobilio Main St.,� Worcestert MA ....--- - .... ..•. ............................. Owner Address a A & B Cess •ool Service 128 Bishops Terraces Hyannis,._.MA...___ F ................................................ Installer Address Q Type of Building Size Lot------------------•-•-------Sq. feet U Dwelling—No. of Bedrooms.............................__...________.Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons.................3........ 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-----------.............. fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' ---•-•-•--•--•--------------••-•--•-•--•----•-••---••••--•••-•-••••-----•••-•••................-•••-•----•........•......................................... ODescription of Soil Sarxl--•--•-•-•--•••••....••-•••••--••.......:.....••-••-------•-•----•-------•----------••-• ............................................................ x --------•------------------------------------------------- UW ---•---••-••----------------------------•...._._.....--•..._---------------------------•-------------------• ------------------------------------------------------------------------------------------- Nature of Repairs, or Alterations—Answer when applicable...installation--of--a•_flowdifussor,....$tone.... .._paagd.--•••-•--•••-•--•••••-••--•-••••-••••••••-•••--•----•--•--•......--•-•..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ii`:I p 5 of the State Sanitary Code= The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of 1 ealtl • r Sign .-- •...... r - 8, 1�80............. Application Approved B � ... 8 l 80 PP PP Y , ------------------ ...............................Date Application Disapproved for the following reasons:.......................... .............. ..........................•------------•-----•--------•------•-•----------•-----------.......-------------••-------•----•--•----•--------••----•--•------------•-------•-•••--•••----------•-•-•---•---- Date Permit No.80.-------------------------------------------------- Issued...........8� 1(/80 Date THE COMMONWEALTH OF MASSACHUSETTS .��,� BOARD OF HEALTH ....................T.oW.Rl .........OF................Bamtable.......................................... �r�if irtt#le oaf (�u�t�li�a�trr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (x) by..._.4. _8.. �s QQI..Serra,�e...�.�$.. a,sY�Q� .T.exxa�e� annis► M----026Q1.....-.....77_5-6264-------- Installer at...... ...........................Craigyill-e_.Reach_Rd-.:,.._0raig_ville............. has been installed in accordance with the provisions of TITLE; r of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.-89- �>_.......... dated_8/_1/80--..---._.-__________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......8. ..�180......•..•-------------------•------•--•--.....----...•.. Inspector.................................................................................... .... FRs......$...... ..00... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................T.o�...........OF........BOrnstable ApplirFa#tun for BiupugFal Workg Tunutrurtivat 11amit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System atdraigville Beach Rd., Craigville 3nsi..Cs�ttage..--•---------•----•-•---...---•---------------------------------------------------•--------- Location-Address or Lot No. --Mobilio Main St. , forcester:-..M......................................... -.-.... - Owner Address A-& B Cesspool Service 128 Bisbpp! Terrace t...H-yannis '` ..... Installer Address QType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................•..._2....................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons....._----------3......... 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 ( ) Percolation Test Results Performed by•---------------•----•--•-••......---•---••-••-----•......--•-••-•--•-... Date------•--------------------------•---- Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ <s., Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ...-•--•••-•--------•--•-•----•------•-------•--•--••--•-•-••-•....••-•••--•..............••-•---••-......................................................... D Description of Soil........sa x .................................................-................................... V ........••••••••----•••-•-•--•----•-----••••----.....••-•---•---•---•-•-•••----•........................•...•--•-•••-•-•--•----•-----•-------•-••----•••---••••••---•---•-•••-•----••-••--•---•--••..... ---•-------------------------- ------------ -------------------------------------------------------.................................................................................. Nature of Repairs or Alterations—Answer when applicable__in8te,llation.-of-a-•flowdifltsggK,...S_tOn2.... p �...Ad-f----------------•--------------------------------------------------...-------------------------------.._......------------------------------------------------------------.....----' Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the, rovisions of TTTLE p 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 W_ealt �iig/nipd7r '8 1 80 = l l Application Approved By......... y- - L 1 -------------------_-- -------- 8/ :L Date Application Disapproved for the following reasons:................................................................................................................ .....-----•---•-----------------------------------------------•-•------•-----------.....---•----------•--•-•--•-••-••-------•-•---••-••----••---•------------------------------------------------------ Permit Nos9 . ................Date...._. � Issued 8/ 1�80 Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T own...........o F................Barnstable.................... ................................. Trrtifiratr of ToaatpliFatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Re aired (X ) by A•& B Cess-pool_-Service, 128_Bfahops 2'errace,. Hyannis, _1�A 02601 -- 77?1. 64 ....•--- Installer at.....11_-Southwind__Cottages ...........................................................rgville Beach Rd . Craigville has been installed in accordance with the provisions of TITLE j of The State Sanitary ode s described in the -.application for Disposal Works Construction Permit No.. 0......Z_j�=............ da.ted_$_._1��0 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......8L11/80................•-•--------..........•--................ Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 0. Town...............oF......................Barnstable.................._................. .00 No80.`.� = FEE....--..5..:.0...... �iu�ruu�al orku `�unu�ratr�ion praati� Permission is hereby granted....A_fie•B._Cesspool. Service _ _ to Construct ( ) or Repair (X) an Individual Sewage Disposal System at No...11--aOuthwind_-Cottaea Crdigville Beach Rd., Cigvillet --Mobilio - Street as shown on the application for Disposal Works Construction Pemmt !/Ngr8 0�_---_�_ _ �_-____ _ Dated...;•$I_O _ -----•----------------------------- $/ 1/80 � Board of Health DATE...... ---- ------. = FORM 1255 HOBBS & WARREN. INC., PUBLISHERS