HomeMy WebLinkAbout0500 HUCKINS NECK ROAD - Health (2) 508 Huckins Neck Road.
Centerville 1=
A= 233 029
� SIII ® J��,cr`tFa�Oy..
UPC 10259
No.H_ 1630R ,. ��
HASTINGS.UN
DATe;6/19/01_____
PROPERTY ADORI?SS 500 Huckins Neck Road -
-- 02632---- ------------
On the aboye date, I Inspected the septl0 eyst®M at the above address.
Thls system conslsls of the following;
1 . 2-6 ' X8 ' bloc cesspools.
6a3ed on my Inapectlon, I cortify the following oonditlonu
2 . this is not a title five septic system.
3. This isKsewage system.
4 . The sewage system is in failure.Cesspools are heavily
rooted. Blocks have been spread.Cesspools are less than
50 ' from the wetlands. A new title five septic
system needs to be installed. SIGNATURE:-A
Company; Jo, •Qh_P__ N•comber_b Son , Inc ,
FA
Cent errl l le Na_-02632-OO��D INSPECTION
Phone ;___
THIS CCATIFICATION 00eS NOT CONSTITVTC A OVARANTY OR WARRANTY
•
JOSEPH P. MAOOMBER & SON, INO.
T+nkIC�+tpool� l richll�ld+
PVmPjd 4 In+tillid
Town Slwl! Conntotlons
P,O, Box 66 Contiry13330 775 6 A 2632-0066
RECEIVED
JUL 5 2001
TOWN OF B BLE
H DEPT.
I
!1
.\ COMMONWEALTH OF M.ASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
i
TITLE 5
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 500 Huckins Neck Road
Centerville,MasG _
Owner's Name:Edna McManus
Owner's Address: Same
Date of Inspection: 01
Name of Inspector: (please print) Joseph p_Macamher Jr.
Company Name: J.P; Macomber San Inc.
Mailing Address: Box 66
• 02632
Telephone Numbe08-775-33 8
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 the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
Passes
_ Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
_
Fails
Inspector's Signature: Dater
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 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
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page I
5 ► Nee 2ofII '
OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: :500 Huckins Neck Road
en ervi e, asss
(Owner: Edna McManus
Date of lnspection: 6 1 9 01
Inspection Summary: Check A,B,C,D or.E/ALWAYS complete all of Section D
& System Passesk.L
I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or
to 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
Cesspools are sverely rooted and to close to the wetlans.
A new i e ive sep i r, a 7 bedrount hante needs—te
. be installed.
B. ' System Conditionally Passes:
_42d One or more system componen.0 as described in the"Conditional Pass"section need to be replaced or
repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass.
Answer yes, no or not determined (Y,N,ND) in the for the following statements. If"not determined"please
e xpl a in.
,fdy,A0j'he e tic tank is metal and over 20 years old' or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
'A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
X-j��Observation of sewage backup or break out or high static water level in th istribution bo ue to broken or
obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 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 ,r^
ND explain:
2
Page 3 of I I
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: . 500 Huckins Neck Road
en ervi e, ass.
Owner:Edna McM nu
Date of Iaspection:
C. Further Evaluation is Required by the Board of Health:
40 Conditions exist which requu•e further evaluation by the Board,of Health in order to determine if the system
is failing to protect public health,,safety or the environment.
I. SYstem Hill pass unless Board of Health determines In accordance with 310 CMR 15.303(1)(b) that the
system is not functioning in a manner wbich will protect public bealtb,safety and the environment:
yam. Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is witbin 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 any) determines that the
system is functioning in a manner that protects the public health,safety and environment:
V0 The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
-V6 The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply.
Zl¢ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 199 feet but 50 feet or more from a
private water supple well". Method used to determine distance Gd /yt
"This system passes if the well water analysis, performed at a DEP certified laboratory, for 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, provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other'
System consists of two 6 'X8 ' block cesspools.The
cesspoo s are in series. The cesspoo s are are ess tnan
50 from the wetlands. A new title five septic
system should be installed.
3
4
' Page 4 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 500 Huckins Neck Road
en ervi e, ass.
Owner: Edna McManus
Date of Inspection: 01
D, System Failure Criteria applicable to all systems:
You must indicate 'yes" or"no"to each of the following for all inspections:
Yes No
a//(kup of sewage into facility or system component due to 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
VLiquid depth in cesspool is less than 6"below invert or available volume is less than 'f,day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
-Zof times pumped �.
Any portion of the SAS, cesspool or privy is below high ground water elevation.
Any portion of cesspool or privy is within 100 feet of a.swface water supply or tributary to a surface
water supply.
_ y portion of a cesspool or privy is within a Zone I of a public well.
y 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. (Tbis system passes if the well water analysis,
performed at a DEP certified laboratory, for 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, provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.)
It—cz(Yes/No)The s stem fails. have determined that one or more of the above failure criteria exist as
descri ed in 310 CMR 15.303. therefore the system fails,The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either'yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no/
the system is within 400 feet of a surface drinking water supply
tthe system is within 200 feet of a tributary to a surface drinking water supply
_ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA)or a mapped
Zone 11 of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered
eves" in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
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Page 5 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT$
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 500 Huckins Neck Road
Centerville,Mass.
Owner: Edna McManus
Date of Inspection: 6/19/01
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
_ Pumping information was provided by the owner,occupant, or Board of Health
�/ Were any of the system components pumped out in the previous two weeks ?
Has the system received normal flows in the previous two week period?
Have large volumes of water been introduced to the system recently or as part of this inspection?
Zwere as built plans of the system obtained and examined?(If they were not available note /A)
Was the facility or dwelling inspected for signs of sewage back up?
Was the site inspected for signs of break out?
Were all system components,�luding the SAS, located on site?
Were the se tic anholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge and depth of scum ?
Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has been determined based on:
Yes no
/ Existing information. For example, a plan at the Board of Health.
l✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) (310 CMR 15.302(3)(b)]
5
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Page 6 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 500 Huekins Neck Road
Centerville-,Mass.
Owner: Edna McManus
Date of Inspection: 6 1 9 01
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):_L Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15,203 (for example: 110 gpd x# of bedrooms):
Number of current residents:
Does residence have a garbage grinder(yes or no):
Is laundry on a separate sewage systemes or no): [if yes separate inspection required)
Laundry system inspected(yes or no):
Seasonal use: (yes or no):11A.0 Ajr Pr aY(?#rs'
Water meter readings, if available (last 2 years usage(gpd)): AW yevtts, .
Sump pump(yes or no):V
Last date of occupancy:/
�7
COMM ERCLAL/INDUSTR.IAL
Type of establishment:
Design now(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.): &
Grease trap present(yes or no):_7
Industrial waste holding tank present(yes or no):ALA
Non-sanitary waste t.dischar-gtd to the Title 5 system (yes or no):
Water meter reading's Pf available: ;/Ji9
Last date of occupancy/use:
OTHER (describe):
GENERAL INFORMATION
Pumping Records
Source of information;,.
Was system pumped as part of the inspection(yes or no): Q:�
If yes, volume pumped: _gallons -- How was quantity pumped determined? �q(
Reason for pumping:
TYPE OF SYSTEM
4,�6 Septic tank, distribution box, soil absorption system
7- Single cesspool
ZOverflow cesspool
d� Privy
.0 Shared system(yes or no)(if yes, attach previous inspection records, if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Night tank /fj:L Attach a copy of the DEP approval
�( Other(describe):
A proxi ate age of all co vents, date installed(if known)and source of information:
Were sewage odors detected when arriving at the site(yes or no):,10
6
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Page 7 of 1 1
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:500 Huckins Neck Road
Centerville,Mass.
Owner: Edna McManus
Date of Inspection: 6/19/01
BUILDING SEWER(locate on site plan)
•- �t'
Depth below grade:
Materials of construction: ast iron .UA40 PVC other(explain): y
Distance from private water supply well or suction line:
Comments (on condition of joints, venting, evidence of leakage, etc.):
Joints appear tight.No evidence of leakage.System is vented
N through the house vent.
SEPTIC TANK (locate on site plan)
Depth below grade:
Material of construction: concrete meta]N�fiberglass4J!Qpolyethylene
A other(explain)_
If tank is metal list age: t& is age confirmed by a Certificate of Compliance(yes or no)•r(%!a? (attach a copy of
certificate)
Dimensions: Z/I*
Sludge depth: A)/4
Distance from top of sludge to bottom of outlet tee or baffle: _
Scum thickness: 4M
Distance from top of scum to top of outlet tee or baffle:_�lA
Distance from bottom of scum to bottom of outlet tee or baffle:
How were dimensions determined: A,4
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of.leakage, etc.):
Septic tank is not present
GREASE TRAP4�W(locate on site plan)
Depth below grade: AI
Material of construction:Voconcrete-AmetaW.4 fiberglass./4polyethyleneAAother
(explain): A1,4
Dimensions: 4A
Scum thickness:M
Distance from top of scum to top of outlet tee or baffle: _
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping: A1,4
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage,etc.):°
Grease trap is not nrpspnt_
7
Page 8 of I 1
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 500 Huckins Neck Road
Centerville,Mass.
Owner: Edna McManus
Date of Inspection: 6/1 9/01
TIGHT or HOLDING TANKA,6—/f—,(tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: 104
Material of constructi : 4concrete&14 metal fiberglass polyethylene A44 other(explain):
Dimensions:
Capacity: ;114 gallons
Design Flow: 'gallons/day
Alarm present(yes or no): A)A
Alarm level: dql Alarm in working order(yes or no):&'
Date of last pumping: -V14_
Comments(condition of alarm and float switches,etc.):
Tight or holding tanks are not present.
DISTRIBUTION BOXIJlWe,(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: AIA
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of
leakage into or out of box, etc.):
Di-tri hiiii nn hnx i s not nrpspnt
PUMP CHAMBER &A (locate on site plan)
Pumps in working order(yes or no): 4154
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Pump chamber is not present
8
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Page 9 of I I
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SU$SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 500 Huckins Neck Road
en ervi e, ass.
Owner: Edna McManus
Date of Inspection:
SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
r.or;4 -Pr7 _ q)Z-C;tpm consists of two 6 'X8 ' block-k cesspools
in cari ecz f'-y— broken in pieces on #1 pnn1 Cesspools are dry
and sverely rooted. Cesspools are to close the wetlands.
Type
_Q leaching pits,number:
leaching chambers, number:D
,dLe> leaching galleries,number:
V leaching trenches,number, length:1
leaching fields,number,dimensions:
overflow cesspool, number: L
innovative/alternative system Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,
etc.):
T.c)am)4 sand t-o medium fine sand_CPsspools arP in fail up- They are
severely rooted- arid- tQ Gl-QSe tQ thQ 1AXQt1-a.n.ds--cz-J-1--- aXe dry.
Vegeation normal.New title five septic system should be installed
gg hha en vacant for 12 ye rs.
CES�S��bLS: Cesspool must be pumped as part of�inspection)(locate on site plan)
Number and configuration:
Depth—top of liquid to inle vert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no): 10
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.):
Same as above.
PRIVY4A . locate on site plan)
Materials of construction:
Dimensions:
Depth of solids: Yy
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
Privy is not present
9
Page 10 of 1 I ;
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Add ress:500 Huckins Neck Road
Centerville,Mass.
Owner: Edna McManus
Date of Inspection: 6 1 9 01
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
w ,—� vo�s
I � �
I
W
10
Page 1 1 of 1 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 500 Huckins Neck Road
Centerville,Mass.
Owner: Edna McManus
Date of Inspection: 6/19/01
SITE EXAMM,,
Slope /1AN17�f u�ST
Surface waterg �3��'
Check cellar V
Shallow wells 4Z
Estimated depth to ground water feet
Please indicate (check)all methods used to determine the high ground water elevation:
b e�� ar
nson record- Ifchecked, teof design plan reviewed:observation h le within 1SO feet ofSAheckelth-explain: 4
Checked with local excavators, installers-(attach octunentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Used; Water Contours Mazy.
Gahrety & Miller Model
1 2/1 6/94
11
I
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TOWN OF Barnstable BOARD OF HEALTH 1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION I' rr•s•r...•...—>.in.-.-rrmrm-rr.•rr'r+ams+rrnTn-rn�+-turn-�annsr'�'*n++awrrR+w�+�w'rer7 tsm ..T,re-r•r--n,—..A
-TYPE OR PRINT CI.EARLY-
PROPERTY INSPECTED
STREET ADDRESS 500 Huckins Neck Road Centerville Mass.
ASSESSORS MAP, BLOCK AND PARCEL #
OWNER s NAME
Edna McManus
PART D - CERTIFICATION r
NAME OF INSPECTOR Joseph P.Macomber Jr.
COMPANY NAME J.P.Macomber & Son In5`.
COMPANY ADDRESS Box 66 Centerville,Mass. 02632
Strevt Town or City State LlP
COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 ) 790 - 1578
R
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at
this address rand that the information reported is true , accurate, and
omplete 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 :
System PASSED ,
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
hea lth or the environme
nt as defined in 310 CMR 16103 . Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
his form .
System FAILED*
The inspection which I have con acted 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 " w�
Dne copy of this c ification must be provided to the OWNER, the BUYER
where appl ioable ) and the 130ARD OF HEAL1'lt.
* If the inspection FAILED, the owner or"" "Perator shall upgrade system
wit}iin one year of the date of the. inspection, unless allowed or required
otherwise as provided in 3,10 Ch1R 16 . 306 ,
partd .doc
is _^_ _ _ _
=ASSESSORS MAP N0: Z> ,
tNo �--t �� r",. PARCEL.NfF j Fee
THE COMMON EALTH OF MASSACHUSETM—
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETT
0(ppliCation for �Dtopozal *pMem Congtruction VCrmtt
Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No. Owner's Name,AJdddress and Tel.No. '7)J— i -D
tiv�G�Av.3 ivVC 4�, 10 t-1 4' to r��Yr Z���-�2 �' �-(( �i' _�3 L
if 1"b&- I L 7 VLF ,tL o
Installer's Name,Address,and Tel.No. �� 2��� Designer's Name,Address and Tel.No.i N i
o �- ,��--
Type of Building:
Dwelling No.of Bedrooms ",' -n Garbage Grinder(/W
Other Type of Building kAje. k;L ;G�l', No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow I to(Vo gallons per day. Calculated daily flow 3 a U gallons.
Plan Date Number of sheets Revision Date e ai v
Title
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) `�-
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to plac e stem in operation until!Ce ifi-
cate of Compliance has been issued by this Boar° H t "/ ���
Signed ate -
Application Approved b
Application Disapproved for the following reasons
Permit No. ��? � � Date Issued �4 —If
s
F e
THE COMMON EALTH OF MASSACHUSETTS
-' 'PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,, MASSACHUSETTS
Z(pplicattou for Migpogar *pgtem Con.5truction permit
Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No. aa Owner's Name,Address and Tel.T4, p� 7��,5 ( �
�t)S UG{CINJ N � ��l lot
I(/f.�• �i l L
Installer's Name,Address,and Tel.No. � 2y' Designer's ame,Address and Tel.No.
vA- -T V JVy& (34CV� ee
Type of Building:
Dwelling No.of Bedrooms Garbage Grinder( "
.Other Type of Building K. 71` No.of Persons Showers( ) Cafeteria( )
Other Fixtures
1.
Design Flow` low gallons per day. Calculated daily flow 3 U gallons. j
Plan Date — 9af Number of sheets Revision Date
- Title
C`"'_^" Description.df Soil
40 Nature of Repairs or Alterations(Answer when applicable)
• r --4....-mot -
Date last inspected:
Agreement:
o ensure the construction and maintenance of the afore described on-site sewage disposal system
The undersigned agrees�t
in accor_dance,with the provisions of Title 5 of the Environmental Code and not to plac he s stem in operation until a Certifi-
cate of Coinpliance has been`issued by this Boar H t
1
Signed' ate
r Application Approved b -
Application Disapproved for the following reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
.PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
- Certatftrate of (compliance,
THIS IS TO C RTIFY,that the On-site Sewage Disposal System installed(V�or repaired/replaced( )on
y U for_ -%An
as PS (K/ has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. ted /6/7
'Use of this system is conditioned on>compliance with the provisions set forth be ow:
No. ,L J 6 Fee v�
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS -
1wi,5pozaY *p5tem Construction Permit
,+ Permission is hereby granted to llhn D to r
to construct( repair( )an On-site Sewage System located at a<1 mi
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.
All construction mu t be co pleted within two years of the date below.
Date: � Approved by
BAXTER &. NYE, INC.
Professional Land Surveyors and Civil Engineers
812 Main Street •Osterville,'Massachusetts 02655 Tel. (508) 428-9131
FAX(508) 428-3750
WILLIAM C. NYE, P.L.S.-President PETER SULLIVAN, P.E.-Vice President-Engineering
RICHARD A.BAXTER, P.L.S.-Vice President
4
October 25 , 1995
Town of Barnstable
Board of Health
367 Main Street.
Hyannis , Ma 02601
Re: James Poon
505 Huckins Neck Road
Map 233 Parcel 50-2 "� 17
Dear Mr . Barry:
This letter is a follow-up to our phone conversation .
As discussed the sewage pump is to be sized by the supplier and
approved by engineer .
The selected pump will be in compl'iance. with Title 5 latest
revision .
I trust that this meets your present needs . If you have any
questions please feel free to call .
Very truly yours ,
ax r & N Inc
PEE
Peter Sullivan P. E . SULLsI �
V. P. Engineering . 7 3
MEL �
cc : Gary Blazis `QUA�
PS:.slg
MEMBERS OF
CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS I AMERICAN CONGRESS ON SURVEYING AND MAPPING
MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS
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