HomeMy WebLinkAbout0049 HYDE PARK ROAD - Health HYDE PARK, CENTERVILLE _I
A=173-016.006 _ _ -
r
RECERV
Commonwealth of Massachusetts APR 4 199�
Executive Office of Environmental Affairs
HEALTH DEP"i:
Department of TOWN OFSARNSTAUE
Environmental Protection
M INUM F.MIMd Trudy Core
80MIw a.weury
Arpo wPattl CMiuocl David SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
�. CERTIFICATION
Pr Address: HY,aC i°/9� `,' -e 444r.[v14e-.-c Addeeas of Owner. �l,Q. �t-E vi✓ 11�.�is
Date of Inspeation: (If different)
Name of Inspector. /y/G1rll�:-,i✓ /NiGLf
Company Name.Address and Telephone Number.
4L, "ri!,f ,E
CERTIFICATION STATEMENT
I ratify that I be"po nally inspected the sewage disposal system at this address and that the information reported below is true, aoettrste
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
. ointeft—ce of on-site sewage disposal systems. The system:
_ Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
✓aiL
Inspector's Signature: �2'� Date:
'Plea 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
ter m to tba approprists regional office of the Department of Environmental Protection.
The arigi W should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Chsck A,B, C,of
Al SYSTEM PASSES:
I hm not toand any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any lailare criteria not evaluatad are indicated below.
B] SYSTEM CONDITIONALLY PASSES:
One or sore systam components need to be replaced or repaired. The system,upon complation of the replacement or repair,pesees
iftepectim
Indicete yes,no,or not determined(Y.N,or ND). Describe basis of determination in all instances. If"not detamined",explain,why am)
"w septic tank is metal,cracked,structurally unsound.shows substantial infiltration or enfltration,or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a Conforming septic tank as approved
by the Board of Health.
(revised 11/03/95) 1
One MlUttat Street a Soaton,Massachusetts 02108 a FAX(617)SW1049 s Telephone(617)2t12•SS00
Proved on Reevckd Gape, .
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: yy All
Owner. /y!t'. K/P v�� di9sirs
Date of Inspection: 3/� /9G
B)SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution boa is due to broken or obstructed pipe(s)
or due to a broken,settled or uneven distribution boa. 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] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
Public health,safety and the environment.
1) 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.
_) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER.IF APPROPRIATE)
DES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETY 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 coliform bacteria and volatile organic compounds indicates that the well is free
ilom Pollution from that heility and the presence of ammonia nitrogen and nitrate nitrogen is squsl to or Les than 6 ppm.
a) OTHER
(revised 11/03/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: qq /-IYO.: �in�r. GE',r�lr?viLL�
Owner. M/t'.
Date of Inspsction:
D1 SYSTEM FAIL:
I haw determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for
tba dstsrmiastion is identified below. The Board of Health should be contacted to determine what will be necessary to oorrecc the
fathnre.
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
onspool.
Static liquid level in the distribution bo: above outlet revert 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 1,12 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 oesepool 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 LARGE SYSTEM FAILS:
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 aignificant threat to pubbe
laaa)th 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 II of a public
wassr supply well)
The cores,as operstor of any such system shall bring the system and facility into full compliance with the groundwater treatment program
�uiremesrta of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for Anther information.
(revised 11/03/95) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
Owner. /"/ie
Date of Iaspootiona 3
'Check if the following have been done:
t'—Pumping information was requested of the owner, occupant, and Board of Health.
�Noae of the system components have been pumped for at least two weeks and the system has been receiving normal flow rate
during that period. Large volume of water have not been introduced into the system recently or as part of this inspection.
A built plans have been obtained and examined. Note if they are not available with N/A.
j,:�`The facility or dwelling was inspected for signs of sewage back-up.
G'The system does not receive non-sanitary or industrial waste flow
jz he site was inspected for signs of breakout.
✓All system components,excluding the Soil Absorption System. have been located on the site.
!!The septic tank manholes were uncovered, opened. and the interior of the septic tank was inspected for condition of baffle or
tees,material of construction, dimensions, depth of liquid, depth of sludge,depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
ZThe facility owner(and ooc upants, 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 Addres., y9 //YpE f�0,e - � -X
Owner. h 4 ftF!/Ioel
Dace of Inspection: 3/W/k-
FLOW CONDITIONS
RBSMZNTIAL-
Design lbw: 33J pllon.
Number of bodroams: 3
Number of omrent residents:
Garbage Qinder(yes or no): pJ0
Laundry aonnetted to system(yes or no):6s
Seesonal on(yes or no): Aoo� a/I �y0 G,s+< y— /S7 ono Gi9G
Water meter readings, if available:
Last date of occupancy: Y
COMMERCIAL/INDUSTRIAL-
Type of establishment:
Design flow: - P110".1day
Grasse trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)_
Non-swiitaty waste discharged to the Title 5 system: (yes or no)_
Water meter-readings, if available:
Last date of occupancy:
OTHER(Describe)
Last date of oomgwncy:
GENERAL INFORMATION
PUMPING RECO S and of information:
System pumped as part of inspection: (yes or no)Z-1�1
If yea,volume pumped: gallons
Beason for pumping:
Septic tanlrMistnbrttioa box/soil absorption system
_._. Smss cesspool
Overflow oampool
Privy
Shared system(yes or no) (if yea,attach previous inspection records, if any)
Other(arplain)
APPROXD"TE AGE of all components,date installed(if known)and source of information:
Sewage odoeeodoa detected when arriving at the site: (yes or no)
(revised 11/0/95) 5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (oontinued)
Property Address: 419 11'YV pi15Ci: c,G.vT�2v/GL,f
Owner.
Date of Inspection:
SEPTIC TANK;
(locate an site plan)
Depth below grade:
Material ateoosbVcbon:L/aoncete_metal_FRP_other(esplain)
Dimamsioms• x S' d� oo y9" o�,to
Shidge depth.
Distance from top of ahtdge to bottom of outlet tee or baffle: Tfi/✓K Hi90 (� // /gih%1c7 I� DF�S L.l
Scum thickness: O Tv
Distance from top of scum to tap 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.) T/f 4.04 /u i9/���/ /L�L�T //✓.%�.�1 Th'l� Cot.G.�CTC
_(Zr✓I&.f T 7,6 E /9PP�Ai?Etr TU !3E (,QO!'��/ off S% D.£Grxy Tl�E yoiFy�
FLaar/ 4-14,,6
GREASE TRAP:
(locate on site plan)_
Depth below grade:
Material of COast:vction:_concrete_metal_FRP_otheeexplain)
Dimensions:
Scum thickasas:
Distance frtm top of act-to top of outlet tee or baffle:
Distance fiom 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.)
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
property Address: .
Owner.
Date of Inspection:
TIOW OR HOLDING TANK_
(looms an site plan)
Depth blow prde:
Material of contraction:_concrete_metal_FRP_other(e:plain)
Dimensions:
Capacity: gallons
Design ilo.v: gallons/day
Alan level:
Comments:
(condition of inlet tee,condition of alarm and float switches, etc.)
DISTRIBUTION BOX -
(locate on site plan)
Depth of liquid level above outlet invert:_
Comments:
r evidence of 1 into or out of box, etc
(cote if level and distribution is equal,evidence of solids carryove `leakage v C3� �L��lef1�
P/,0� .5tf�!%i'�" '-•per' Lg�kS Ga�o 1'HE ",b , �3®a' �/�fi ��°r> C�'.�',y .��•F �9Pi:�r�:.rr�Te'`.j'
PUMP CHAMBER:_
(locate an sits plan)
Primps in working aQder:(yas or no)
Comments:
(now condition of pump chamber,condition of pumps and appurtenances, etc-)
(revised 11/03/95) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .
PART C
SYSTEM INFORMATION(oontinued)
Property Addeesm yq HioE f'r9,,e,t-
Owner.
Date of Inspection: 31a��yG
DOTE ABSORPTION SYSTEM (SAS):_
(boats Cn Arta plan,if posst3le:excavation not required,but may be approximated by non.intrusive methods)
If not dstesmined to be preomt,explain:
Type:
Caching pits, number:_
Caching chambers, number: 3
Cschtrug galleries, number:
lft h 8 trenches, number,length:
Caching fields, number, dimensions:
overflow Cesspool, number:
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.)
T11 L/d�- ;G !�//c� 6" �l�r/ Tffl' �i� of TIf.E �Lyr.�/
SAS A S?le L AGtfiyy e¢iT ,Gd�T AT
Tf��
CFBSPOOLS:_
(locate on site plan)
Number and Configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scam layer.
Dimensions of cesspool:
Materials of construction: j
Indication of groundwater:
iafiow(Cesspool must be pumped as part of inspection)
Comments:(note Condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.)
11WY._
(beats an site plan)
materiels of ocost on:
Depth of solids: Dimensions:
Cam(note Condition of soil,signs of hydraulic Lilure, level of ponding,condition of vegetation, etc.)
(revised 11/03/95) 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner. �i/r �j��//,d Of�d1S
Date of Inspection:
SIUMB OF SEWAGE DISPOSAL SYSTEM:
ierlude ties to at least two permanent references landmarks or benchmarks
Towle all wills within 100'
� I
t �
I
FRorvT
DZrM TO GROUNDWATER
Depth to P
sesthod of dsterminadon or appr imation: (/a/yEE� �L A,e/ SfiyC✓S T/7 E �9D��5/ o G.S�r�'�.Ho�r+>El
j9t kLEy/9Tlo/✓ 58D� �9yD TftE L(zTIra OF fi/E SAS f9r G ypT��i .�`
(revised 11/03/") 9
t �7
ASSESSORS MAP
No. ._. ..__._.�....... PARCELbVO: L�--- Fps...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Diripwml Workri Tonotrnrtion Errant
Application is hereby made for a Permit to Construct ( ) or Repair ( L-)'an •Individual Sewage Disposal
System at
.... a........ int � -----------. ....................................................................................
.Lo t �d r•s r Lot No.
Opener Address
Installer Address
VType of Building Size Lot..........................Sq. feet
,.., Dwelling—No. of Bedrooms......... _._ __________________Expansion Attic ( ) Garbage Grinder (Il1C�
aOther—Type of Building ............................ No. of persons.-.-----_----•.---_-----___- Showers ( ) — Cafeteria ( )
04 Other fixtures ............................... . .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length---------------- Width---------------- Diameter................. Depth................
x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area............._......sq. ft.
3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-..--------.._._...._...
a •-•-•-----•---------------•-••-••-••--••--•------••----•--•--•-----.......-••-...------'-•-•'--'_.......................................---•....
_...........
..
0 Description of Soil........................................................................................................................................................................
x •••-••••••••-------------- ................................................. ---•...........------------ ..----- f
U ature of a airs lter 'o — e icabl .----• .......
- •--'--• .............. ....... . . .. • . ............. . ... ...... ......
�`-�
Agreement: r'og E,. F-LAW 0\V-in>401 w S TOw t-
74_0
k)
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordan with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a tificate of p is has b n issue y the board of health.
Signe ........ �-- ------------- ....... .... .... .......A....................... .......... ......................
�
Application Approved By .. . ... .................................... ........... le
Application Disapproved for the following rea ...............................
......................................... ........................................
.�
Da.
Permit No. . .. .......... ................-.. Issued .-------------------..............................
..--.
Dare
THE COMMONWEALTH OF MASSACHUSETTS
- BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of U-IImplianre,
THINS TO GEyR ' That the Individ 1 Sewage Disposal System constructed ( ) or Repaired ( L-'
by .............._ ... ............ .... ... -...... -- - -- ------- ....................
.......
..- ................-----------------
Insr,J lcr -�..
at ............ y.Q...... .... ......-J. . ... U....1.1.. ...1........................................................... .....................
has been installed in accordance with the provisions of TITLE�CONSTR
f The State Environmental Coe as described in
the application for Disposal Works Construction Permit No. - ......�. .:_. dated Jj�._. ..5..
.... ......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT �7�� A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.� i
DATE.......... . ". .....`` _� ..-...... Inspector .r.� ... I. . `' r
------------- — ------------------«_-----_,—_,----------------------
THE COMMONWEALTH OF MASSACHUS.ETTS
46OARD OF HEALTH
TOWN OF BARNSTABLE
No....................31�.... FEE......-...................
Bilivo , Workg mitrudWayrrmit
Permissionis hereby granted•--- ----.. '\\�,,......... ...... ................. ..........................................-.........................
to Con t i�}}F.t ( ) Of Repair. an Individu uewag isposal S stem
at N0.. "� �•-- ---. .�L ,.'.. .:------- ' y ----. ...........
-
Strcet
as shown on the appli tion for Disposal Works Construe 'off Permit No_ U�_ ated4
(� 4� ... n
B(vg�/�of Health
DATE..............° � ��? n t- l
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS -
� a
No.r �! Fis q..(9........
:,..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
AVVV iration for Diripwial Works Tomitrurthitt ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( L-)'an Individual Sewage Disposal
System at
......Q.\4.
Loc itin - 1d r•ss or Lot No.
� .�l . ... --------------------------- -•----------•------- X71 ....•---_-................
......................Oa ner Address
WQ����....�� -��`rn �------------------------- ---------------------------
Installer Address
UType of Building Size Lot............................Sq. feet
., Dwelling— No. of Bedrooms._....... _____________________________E�pansion Attic ( ) Garbage Grinder
aOther—Type of Building ---------------------- ----- No. of persons--_.-_-__--_____-_--_.---. Showers ( ) — Cafeteria ( )
a Other fixtures ................................. .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter................ Depth................
x Disposal Trench--No. .................... Width.................... .rotal Length-__----_-___-._ --- Total leaching area....................sq. ft.
Seepage Pit No........... ...... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
1"4 Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. I................minutes per inch Depth of Test Pit---_--..---__._-____ Depth to ground water........................
fZq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a
0 Description of Soil.........................................................................................................................................................................
U .................... .-. --•---------------.......--••--•-•-----•---•--•-----•--•--•-•----•----------•-••-•-------------------------•----•----...--------•----•-•-•-••--------------................-•-•-
W ---------------------------------------------------------------------------------------------------------------------- ,
UNature of e�alrs Alteratto —A ,- •—w e p licabl ......T*' !�---s s�......�.......t�_s_, ..._...... ....... �.`�
._.... -.- ......... .. .............' ,-�- ..._.a.. -- ��� -----•-�-
Agreement: 41'�OV �W l��E �15 ►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 tificate of Co p is has b n Issue y the board of health. ( _
Signed ..... /..... >—c -.............. .3.......I
le
�- r
Application Approved B ........................... ..e......... /1./.... .// ,�:...................... ....:. C" -�:
PP PP y lu V �.4.. ..�. ..... IV.. ....
Application Disapproved for the following rea.`� .. ...... ...... ................................................ ........... .........................
...... ......................................................:....................
Permit No. ... ... --... Issued ........................................................ate......
Date
1 '
0.
i'
.04
I-Z oc->
�n4 _
nLl. i SITE ' .- PLAN
LOCUS: loT.. S -1rrb� p�•�I�i
• ��lN OF. ILA. _ p✓'/L�hT�.-�1.
ARM G REF:. ,
down cape engineering N .. :�d�ISM) curl
p H PREPARED FOR:
CIVIL ENGINEERS
LAND SURVEYORS
0�M�Ifs18t, ►. fp$ p' ..SCALE
YMIt�.MK •, , _'`�''^ DATE ' 8 I-I a
TOWN OF BARNSTABLE �
LOCATION l PfW p-LeC_ SEWAGE#
VP_LAGE LE_N"T&ZVd/C�� ASSESSOR'S MAP
INSTALLER'S NAME&PHONE NO. e12—OM
•.J
SEPTIC TANK CAPACITY 1 j ad o
LEACHING FACILITY: (type) (size) .3 �� y
NO.OF BEDROOMS
BUILDER 0 OWNER / blkd r_S
PERMTTDATE: �®' �t '�` � 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) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet_of leaching facili ) Feet
Furnished by 1-1�^�'t C� p dopt 4-1L J
t
3
�L(
n
o
No. `3 ' Fa; S .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD_ OF HEALTH
�2?C.U..VI..... .OF............t� ` c l.`a`z-! tit- _.
Appliratiun for Biopnsttl Wurkii Tonstrudinn Permit
Application is hereby made for a Permit to Construct � or Repair ( ) an Individual Sewage Disposal
System at:
--... ...........................
`{� r, li....`.. �:�''�`� [- -% cr�5:.............:..
...... � a//��Locati r�JTi2 UC_7 ......................................................or Lot No..........................»..............
.... ............ ..... .....
Owner Address
W .........::...
Installer Address /' ���
Type of Building Size Lot.......,c...................Sq. feet
aDwelling—No. of Bedrooms.......... ........................:.Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building .........:.................. No.. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures ............................................. ------
Design Flow............,�1C?....................gallons per person per day. Total dailyflow........�. ®........ ......gallons rf
_ �
Septic a k—Li uid capactt gallons Length.+.......... Width:-/.._.... Diameter................ Depth-.�..g.
Disposal�' ,T�u� gth f leaching 2�/'6 o q.
—. o. ____. ......_.. Width... .......... Total Len ..��.....Total leach area._.._.......r_......s ft.
3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area.................sq. ft.
x Other Distribution box PO Dosing tank
Percolation Test Results Performed by..T.t..FA.I....... k. .................... Date......l
S 8S
,.a Test Pit No. l.G 2-...minutes per inch Depth of Test Pit....Y2.Ef?7 Depth to ground water.... �t -
Li. Test Pit No. 2..5 ._minutes per inch Depth of Test Pit...Viz. Ti Depth to ground water......&...1GT
I-f-F>`1®. aP.n'`...i....��J.FT....... io �,eP.:. ! ...J.2.. T
....
O -]��escription of Soil....2.17:...1? .._ f... .. r1 .........5 r—-----P ...�/hl� 5/�L. �;..........
--- -------
Tc...(2,C .... '..,;....:Z51.. ..._GL 1...,. l�-/ z�, cam[ •p
U .............................................A....••••..
? 7�7A
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.LITLZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation u><tii ertiticate of pliance has b n issued bey- tboard of health. '
Signed J. ..... ...........•-•...............••• . ........._....
....-. ... ... .. .. ......
ate
pplication Approved By............. ............ .... ... ..,....�...I g. .........
ate
Application Disapproved for the f 7 owing reasons:.............:
....................... ...............................••••-••-••..................................................................................•••••-••••••••......-•-...•.... ..............
Date
PermitNo......................................................... Issued-.......................................................
Date
..-
ASSESSOR'S MAP NO. )7 PARCEL I(2
_l0 C T ION S SEW AGE PERMIT NO.
6-q3
VILLAGE
� INSTA LLER'S NAME L ADDRESS
V4rl JLO I i C� s® n
1.
d U i L D E R OR OWN ER
"3ay��c�e �;.s; Ic�erS
C e ✓1e
DATE PERMIT ISSUED
-DATE COMPLIANCE ISSUED
j
W
I'
�� III
P/%
eK F(q OWN OF BARNSTABLE
LOCATION %"l IIY,O-' /'2 /C SEWAGE#
VILLAGE C-fa(�% osl,"/ L,r ASSESSOR'S MAP&LOT i 16 r�c
INSTALLER'S NAME&PHONE NO.. cT ✓. 1�aPiSrd[L .�
SEPTIC TANK CAPACITY /,:E'�� ��
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS
BbM-DER OR OWNER /1/l 1,ra'1, 1
PERMITDATE: P�s- COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility V Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet f 1 a hing cili ` Feet
Furnished by ��� � ' 3��-�'1fc
I
Il
a � �
6- �_
�h 35 3,
F/Pa�vf
No...................:..... Fizz..............?........._ .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Appiiration for Disposal Works Tons#rudion Vern fit
Application is hereby made for a Permit to Construct`('') or Repair ( ) an Individual Sewage Disposal
System at:
I:,ocatiou-Address / or Lot No.
............... � ......���L?N �T�IJGT="lG�Jt.._ .._........................._.._..._....... --
.._ ........_.................-..........
W Owner Address
............................................... . 'i-er....•••••--------------• .............
...............••-•------- ... ........
•......
_......
.....................
Instaler Address
Type of Building Size Lot_........4............_Sq. feet
V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
►+
`4 Other—Type of Building ............... No.. of ersons......_____........_.._._.__ Showers
p., yp g ............. p ( ) — Cafeteria ( )
p Other fixtures
Design Flow............. /�-J.........................gallons per person per day. Total daily flow....... ..............gallons.
�� r .. e .r .. 'Diameter. Depth.
Septic Tank—Liquid capacity,- ......__..gallons Length_��...�..... Width._�.�b.:_
W k.r-n/,�l fi�I�=� i �
x Disposal Trench—No.___.......... Width... Total Length...::�_�..__,_ Total leaching area g6:.Q..sq. ft.
3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area.................sq. ft.
Z Other Distribution box`O) Dosing tank ( )
Percolation Test Results Performed by...�_.... ... '_- 1- ...................... Date.....Z.2....%�.../�:....-
,.1 Test Pit No. 1::°•=•-Z....minutes per inch Depth of Test Pit.... 2-F7;• Depth to ground water....`! .' -•
Test Pit No. 2. ...minutes per inch Depth of Test Pit...�?,. Depth to ground water....- 7-7 !.
Gw '7 E�a7 serf•alp. ..G •m r►� / r�, P—r,.._...P �T'e e n, tamer � /2_ FT,
07 Description of Soil...��_ T•t
.............................................................�17��%._._....-.
._........._. ...........
"►d �T �? �' � -r" '�l b5 G i<=c�t`/ ti?E�, . ...
v ---------------- ... ......• ...--, ..............,.......,----_..:..
---------•..... Gva- tilc.ou... T /��Z� �-r /z s=T �.....-�,L
VNature 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:ITLZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation(`until a Certificate of Compliance has been issued by the board of health.
Q ` Signed---_..Ct ........\�.....................................................z.7 .. ... .............._....
' •Date
Application Approved By.................r AA LI ( l / / ..........
I........ _. :. ...................................................... ........ __......
f iDate
Application Disapproved for the following reasons:.............:....................................................................t_...._...__.........._-_---
V %-,
--------------•-•--..................----•-----------....._..................................---..._.........------...----------.._._._..----.._...._...._.__.._............_..••-••-•...•••.............
Date
t
PermitNo.. .......................... Issued.......................-................................
Date
w. .....wanwwn x3.:
THE COMMONWEALTH OF MASSACHUSETTS -
it Y BOARD OF HEALTH
............... "...................OF............. ................. _..............
t
(Irr#if irate Lit f anutphitnrr jr .1 A, , f 7 r
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (�") or Repaired ( )
by............................................................ :A Attic rt>......:(.0' ...............................................�.••- �.. .......................
Installer
�r-)7 V S Hyl F �r,2K
at.............. .._........._•--•--•-••-••-••-........_. ..•••--•••-••........ ..... .................
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as,described in the
application for Disposal Works Construction Permit No......................................... dated_.........._....._.I...._...._.................
THE ISSUANCE OF THIS CERTIFICATE,SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. y �.
DATE.................` . . ..... � ............................ Inspector.....-f ._....... ...................
w r:+wwr¢sa.awwsa-.'w mx.e,m..+.e��*«.%.u•w �.0 w s�s.,nw.��e cse n!woman woe•_!..wr we wa;s..,.�r-e..wncr,wr wec•wwo pe��w e-..�u esa as n!e e e c w.rr a.aw n orrr we+.--.
fJJa I IV uug r -.9cp- THE COMMONWEALTH OF MASSACHUSETTS FttNA f
�`�E cDv`r57f2,.�rt,aN! �qc�1 r) tjL. .:iry tti�I`1 t tv
cC,� r � 1 �+ 1C A5l�u :r5�£rr. BOARD OF HEALTH ;E 9V•` .
Disposal18arks Tuna#rur#iart f rrntit
Permission is hereby granted.................. bti(.!...:_-`_'..._..........._.....i.SCt.-•.........................................................................
to Construct (>/) or Repair ( ) an Individual Sewage Disposal System
atNo.............LD7.........P4..... --•---•-- .... ILr. ...bA., e.........0 u' ------.. _..............--•----. .... .. .........
Street <�?(- i-3 1.122 /
as shown on the application for Disposal Works Construction Permit No.........!........... Dated......:... ......................
DATE...................
/ )'iard of Health
ev a
362-4541
926 mein street
yarmouth
mass. 02675 down cape engrineerin�
civil engineers& land surveyors
structural design
Arne H.Ojala P.E.,R.L.S.
land court Richard R.Fairbank P.E.
surveys
site planning
August 5, 1986
sewage system
designs
Barnstable Town Hall
Board of Health
inspections South Street
Hyannis, MA 02601
permits Gentlemen:
Please be advised that on June 12, 1986 Down Cape Engin-
eering inspected the septic system installation located
at Lot #5 on Hyde Park Road, Centerville. We. hereby
certify that the installation complies with Massachusetts
Environmental Code Title V, Town of Barnstable Health
Regulations, and our approved site plan # 84-198-5 revised
February 10, 1986.
Sincerely,
��jtT 1
Arne H: Ojala, P.E., R.L.S.
AHO/amp
Inspected by Timothy Covell & Carol Young
O
77
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roll�+
31
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CpµG Fp.1NDA -
�
1
127.00 -- -"
- JOB # -84-198
C EP T I F I ED PL 0 T PL A N -S;iolAi,.l"W. Bu'LT'
PREPARED FOR:
LOCATION: LOT-5 BARNSTABLE
SCALE: 1 "=40 ' DATE: 05/16/86
REFERENCE:
PB 383 .PG 39 BAYSIDE CONSTRUCTION
I HEREBY CERTIFY THAT THE BUILDING -
SHOWN ON THIS PLAN IS LOCATED ON THE OF M,�s�
GROUND AS SHOWN HEREON
ARiNE yG�
down cape engineering oJAu N
CIVIL ENGINEERS / �"os A SST
LAND SURVEYORS
ROUTE 6A YARMOUTH MA DATE REG. LAND SURVEYOR
21*
pp-
362.4541
926 main street
Yarmouth mass. 02879' down Cape en1ineeri01
civil engineers.&land surveyors
structural design
Ame H.0jala P.E.,RLS.
land court Richard R.Fairbank P.E.
surveys
site planning
June 13, 1986
sewage system
designs
Barnstable Town Hall
Board of Health
inspection: South Street
Hyannis, MA .02601
permits Gentlemen:
On June 12, 1986 Down Cape Engineering inspected the
installation of the sewage system on Lot 5,' Hyde Park
Road and find that it meets the intent of our design
#84-198-5 revised Feburary 10, 1986.
Very truly yours,
Arne H. Ojala, P.E., R.L.S.
Inspected by: Carol Young
Timothy Covell
AHO/amp
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EL 44.11(j>my,
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127.00 -
JOB # 84-198
CEP T I FI ED PLOT PLAN -sHowit.►r�'�s c�ui�s' *�pnc.s zEM is/�� G,
LOCATION: LOT-5 BARNSTABLE PREPARED FOR:
SCALE. 1 =40 ' DATE: 05/16/86
REFERENCE:
PS 383 .PG 39 BAYSIDE CONSTRUCTION
HEREBY CERTIFY THAT TH I E E BUILDING
SHOWN ON THIS PLAN IS LOCATED ON ,THE tiN OF
GROUND AS SHOWN HEREON 3 fit'
ARNE yG�
o _ K .
down cape engineering
CIVIL ENGINEERS / �,��,A IST
LAND SURVEYORS
1._.
ROUTE 6A YARMOUTH MA DATE REG. LAND SURVEYOR
AA 5
,
SECTION SEWAGE
SEPTIC TANK- 4+ _ „D"BOX - 4 .
- 1
TOP OF FDN
�?
y
(MSL)r ..2..Op I/aT0�h
WASHED STONE a `r .
v r-� all
-
a
kH : •v.
--_ 5—
IN-
OUT.
fC�f
G. t OUT• IN• s
3; — \
TANK C��Jr3�Jl
ELEV. 1-
ELEV. ELEV.
ELEV
'pp
ELEV. ELEV.
/n
. �r OF ors I�h".
�i�r L .�i
'MASHED STONE
,
SO
Ww
7 AD
`.���L1S"T,: i-1 Sly 3 ! �•I ` >'.J�
TEST HOLE LOGAyc
,q,�
TEST BY fs7 WITNESS 3
,•,
TEST DATE � Cv''G BEDROOM HOUSE
T.H.- r 1 T.H: +� 2
ELEV/: 4 Cl LEV.6J �j
L�Z DISPOSER DISPOSER Lo', SLL$ PERC RATE MIN/IN.
�� lJr3 FLOW RATE 33c� (GAL./DAY)
D. SEPTIC TANK 3'30 N•SL=_
6dT 714 0
G( � 5 Oav" REQ'O SEPTIC TANK SIZE
W /coo o
P' �4 LEACH FACILITY
t7� SI.DE WALL�2�+� '72! (Z;S) 'I�rOC/D. + k q-►Gi; , . /
' BOTTOM :?fix ='ZZ ,O '� s. re) G/D. I_7► /�'S ���5 SOo .;
1� ! 1321' S 5213 1
'TOTAL 2.' •.t� a
USE: T7 C'I� F�1� '^ ®.pl�'V—o
WATER ENCOUNTERED -
N®TES': (UNLESS OTHERWISE NOTED) y..�
1.DATUM(MSQ:TAKEN FRO f.C/'��" QUADRANGLEMAP a p� �oilq' e�,e�l►1!�LC� fG O.I l�il
2.MUNICIPAL WATER AVAILABLE
3.PIPE PITCH:4i"PER FOOT J�
4.DESIGfFLOADING FOR ALL PRECAST UNITS:AASHO• r' � •44.' y' �L� `� � ,_ _ _._. ���
S. IN.GROUND COVER OVER ALL SEWAGE FACILITIES:(1)FT. -
6 PIPE90lNTS SHALL BE MADE WATERTIGHT
7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF
STATE rJ�,01 OJk(µ -
STATE ENVIRONMENTAL CODE TITLE 5 po�usT. .! _
,. C - -
T�-itb
8. wc'+c�c c...a�e a._►a.,:�..u�„_'p , ;- ..... . ,� <s3 (7 1-dT�#-�I•�-orb AN
�K
-
-
r
Focus
l r llr. fl REG:P F4Li 5S A> :. GINEEf
:. tvV D.. G�L�Z=1^-D.• a:: _ r�1�.� ♦{2D .. 4 ARNE �, REF p
: .
.. , � rz +t .
gA,N.la .
down ca a e ineerin
i�.l� .�-�'-Est , _ l'�! ',.._• ;`.(�.H PREPARED FOR:.
zoo.+ nis�D GcK _ 5or9.
�a LAND:URVIEYORS
►���
ARDOFH , �YS ,Y R.
., BOARD EALTH . ,.
PROPOSED-- --O-O-O- OA �t� k iM�O ILIA 8t. i'. glya
CONTOURS (PROPOSED)
APPROVED TE f�"��7TAPSL.E MA i,•' �. SCALE
`
DATE
6