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HomeMy WebLinkAbout0041 ARBETA ROAD - Health 41 �ArbetaRoad ; � J l r f o a pe y Oo TOWN OF B STABLE LOCIAUON SEWAGE # Zko i VU,LAGE _ASSESSOR'S MAP &LOT 77 L4 INSTALLER'S NAME&P NE NO. SEPTIC TANK CAPACITY �nn�� LEACHING FACILITY: pe) � 1� (size) NO. OF BEDROOMS BUILDER OR OWNER PERMIIDATE: COMPLIANCE DATE:_ r 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 facility) Feet Furnished by / o . . �, O n m • � �� .� ���� ��� a, �"� -�► 6- ��J-- No. /'11/(/ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC.HEALTH DIVISION — TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pprtcatiou for ]tgpogal *pgtem Cougtructiott permit Application for a Permit to Construct J( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components yLocation Address or Lot No. l /`rct 5— 114 9W O�y� ,Name,Are sOandjel.�. .41 Assessor's Map/Parcel # 040/Y s .��8-y2o—9738 ln�45e��Na4eA C814andr�� Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided -- gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) RE /QC -' — 6ax L te last inspected:reement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in ordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of mpliance has been issued by this oard of He Ith.Signed 4_%4�� Date l&, / ,—/oatJ plication Approved by Date plication Disapproved by: Date the following reasons Permit No. a O o— —Date Issued h 142 S No. a 1 i t / ` P / \Fee THE COMMONWEALTH OF MASSACHUSETTS Hntered in computer:�� 4 Yes = s PUBLIC HEALTH. ®li/ISION - TOWN OF BARNSTABLE, MASSACHUSETTS., s �Zfpplicatfo.n for Mtg o of ,6 kem Com5truction Vermit YW Application for a Permit to Construct /( ) Repair( )) Upgrade( ) Abandon( ) [!] Complete System ❑Individual Components Location Address or Lot No.y/ /7 r ��'7 Owner's Name,Addre s,and.Tel.No. ahrhmx(6 Cori ��.Q14 Assessor's Map/Parce 410V Installer's Name,Addre s and Tel No.) )S— y Designer's Name,Address and Tel.Noi +'={. f G .S ass � -• ,.. Type of Building: v Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Buildin r,t; No.of Persons Showers t YP g (` ) Cafeteria( ) Other Fixtures Design Flow(min.required) �;; sVF gpd Design flow provided , t; gpd Plan Date i„f• i,3 - � rx� , Number of sheets �. Revision Date s Titlewr ?f Size of Septic Tank y,' ,'(`.r(j Type of S.A.S. Description of Soil -3. � 4 Nature of Repairs or Alterations(Answer when applicable) 15,�,,JC U//f -Sant=- Z-ac:20Ti014 /f- �D Date last inspected: Agreement:. 'The.undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in . accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been.issued by this Board of He lth. Signed Gc/ _ Date l Application Approved by �' Date ` Application Disapproved by: Date for the following reasons W, r Permit No. a 0 Date Issued /Q 6 7 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Corry Yi nce Zoe 14r7�� THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructkd ( ) Repaired ( ) Upgraded ( ) Abandoned( )by at L has been constructed in accordance with the provisions of Title 5 and the for Disposal/System Construction Permit No. sir o- L� dated / kQ Installer ids& Designer #bedrooms Approved design flow gpd The issuance of this permit shall not•be construed as a guarantee that the system will urrt ti-o al d signed. Date �T))•��o InspectorFee - ��1� t, THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACRUSETTS 1=tgPoga1,,*pgtem Congtructtott 3"Iermtt Permission is hereby granted to Construct ( . ) Repair ( ) Upgrade ( ) ' Abandon ( ) System located at Ilk and as described in the above Application fdfDisposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S<and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date Approved by ��— COMMONWEALTH OF MASACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY CORE Secretary ARGEO PAULCELLUCCI DAVID B.STRUHS Govemor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 41 ARBETA RD. HYANNIS, MA 02601 ala nL4 L Name of Owner DONNA SCHNEIDER Address of Owner: 194 HIGHLAND ST.TAUNTON MA.02780 Date of Inspection: 311100 Name of Inspector: JOHN GRACI I am a DEP approved system Inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) 4 Company Name: TITLE V INSPECTIONS Mailing Address: P.O.BOX 2119,TEATICKET MA.02636 11000 Telephone Number: 608-664.6813 CFRTIFICATION STATEMENT at I have personally Inspected the sewage disposal system at this address and that the information reported,below is true'Naccura"te I certify that p ly p and complete as of the time of Inspection.The inspection was performed based on my training and experience in the proper functionand maintenance of on-site sewage disposal systems.The system: X Passes _ Conditionally Passes _ Needs Further Evaluati n By the Local Approving Authority Fails Inspector's Signature: Date:319100 The System Inspector shall s mit a copy of this inspection report to the Approving Authority(Board of Health or DEP)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. NOTES AND COMMENTS "The Inspection Is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system Is performing at the time of inspection.My Inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life:" THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 41 ARBETA RD. HYANNIS, MA 02601 Name of Owner DONNA SCHNEIDER Date of Inspection: 311100 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are Indicated below. B. SYSTEM CONDITIONALLY PASSES: One or more system components 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all Instances.If"not determined",explain why not. n1a The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)indicating that the tank was Installed within twenty(20)years prior to the date of the inspection;or the septic tank, whether or not metal,is cracked,structurally unsound,shows substantial Infiltration or exfiltration,or tank failure is Imminent.The system will pass Inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. nla 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 n& 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 revised 912198 i Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 41 ARBETA RD. HYANNIS, MA 02601 Name of Owner DONNA SCHNEIDER Date of Inspection: 311100 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 IN ACCORDANCE WITH 310 CMR 16.303(1)(b)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 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 ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has.a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS Is less than 100 feet but 50 feet or more from a private water.supply.well,unless a well water analysis 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,Method used to determine distance nfa(approximation not valid). 3) OTHER n/a revised 9/2198 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 41 ARBETA RD. HYANNIS, MA 02601 Name of Owner DONNA SCHNEIDER Date of Inspection: 3/1100 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is Identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ X Backup of sewage Into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet Invert due to an overloaded or clogged SAS or cesspool. X Liquid depth In cesspool is less than 6"below invert or available volume Is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped 0. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. _ X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X 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. E. LARGE SYSTEM FAILS: 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: r ' The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more.of the following conditions exist: Yes No _ X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. .t revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 41 ARBETA RD. HYANNIS, MA 02601 Name of Owner: DONNA SCHNEIDER Date of Inspection: 3/1100 Check If the following have been done:You must Indicate either"Yes"or"No"as to each of the following: Yes No X - Pumping information was provided by the owner,occupant,or Board of Health. X - None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this Inspection. X As built plans have been obtained and examined.Note if they are not available with N/A. X - The facility or dwelling was Inspected for signs of sewage back-up. X - The system does not receive non-sanitary or industrial waste flow. X _ The site was inspected for signs of breakout. X - All system components,excluding the Soil Absorption System,have been located on the site. X - The septic tank manholes were uncovered,opened,and the interior of the septic tank was Inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X _ Existing information,For example,Plan at B4O,H, X _ Determined in the field(if any of the failure criteria related to Part C is at Issue,approximation of distance is unacceptable)1 5.302(3)(b)) X - The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal Systems. ry revised 9/2/98 Page 5 of 11 t I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 41 ARBETA RD. HYANNIS, MA 02601 Name of Owner DONNA SCHNEIDER Date of Inspection: 311/00 FLOW CONDITIONS RESIDENTIAL; Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual): Total DESIGN flow: 330 gpd Number of current residents:4 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system Inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a COM MERCIALlIN13USTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.If available: n/a Last date of occupancy:nM OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: 11-6-99 System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a TYPE OF SYSTEM X 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) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:Na APPROXIMATE AGE of all components,date installed(if known)and source of information: ORIGINAL 30 YEARS,WITH A NEW PIT IN 1996 Sewage odors detected when arriving at the site:(yes or no): NO revised 9/2198 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 41 ARBETA RD. HYANNIS, MA 02601 Name of Owner DONNA SCHNEIDER Date of Inspection: 3/1100 BUILDING SEWER:X (Locate on site plan) Depth below grade: 18" Material of construction: _ cast iron X 40 Pvc _ other(explain) Distance from private water supply well or suction line: n/a Diameter: 4" Comments: (condition of joints,venting,evidence of leakage;etc.) THERE IS TOWN WATER SEPTIC TANK: X (locate on site plan) Depth below grade: 12" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 1000G L 8'6"H 6'7"W 4'10"" Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 32" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 16" How dimensions were determined: MEASURED 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.) THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING THE SYSTEM NOW AND EVERY TWO YEARS. GREASE TRAP: _ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a 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.) n/a i revised 9/2198 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 41 ARBETA RD. HYANNIS, MA 02601 Name of Owner DONNA SCHNEIDER Date of Inspection: 311100 r TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n/a ' Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a ' Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallonstday Alarm present: NO Alarm level:WA Alarm In working order:NO " Date of previous pumping: n/a Comments: (condition of Inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:X (locate on site plan) Depth of liquid level above outlet Invert: LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) THE DISTRIBUTION BOX IS STRUCTURALLY SOUND. PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO ` Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a ` revised 9098 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 41 ARBETA RD. HYANNIS, MA 02601 Name of Owner DONNA SCHNEIDER Date of Inspection: 311/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(2)1000 GAL 6 X 6 leaching chambers,number: (n/a)n/a leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (n/a)n/a Alternative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PITS ARE STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT HAD X OF WATER IN IT AT THE TIME OF THE INSPECTION.THE PIT HAS NOT HAD MORE THAN 3'OF WATER IN IT. CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet Invert: n/a Depth of solids layer: n/a Depth of scum layer. nla Dimensions of cesspool: nla Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 9/2/98 Page 9 of 11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION(continued) Property Address: 41 ARBETA RD. HYANNIS, MA 02601 Name of Owner DONNA SCHNEIDER Date of Inspection: 3/1/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes Into house) ( 01� o g PA �g8 Ag 3) p . AC �g a6g �o bl6 revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 41 ARBETA RD. HYANNIS, MA 02601 Name of Owner DONNA SCHNEIDER Date of Inspection: 3/1/00 NRCS Report name: n/a . Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 12 Feet+ Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions _ Checked with local Board of health Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-12+FEET revised 9/2/98 Page l l of 11 9� TOWN OF BARNSTABLE �;«; 7,3 0, / LOCATION `� �Z Lie J'Q' 12d SEWAGE # V'LLAGE, ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. -4 6 O�� YIj�✓' 'iZ -LYE SEPTIC TANK CAPACITY I(D LEACHING FACILTTY:'(type)a ��4 3 (size) _(000 NO.OF BEDROOMS BUILDER OR OWNER���tirly�On� PERMITDATE: ZQ6 -/,i- jCOMPLIANCE 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 facility) Feet Furnished by i Isi /r \ NIZG I I THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratiou for Di-nVotittl Worltg C oustrurtiurt f rrmit Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at: •-4-1....Ar-bs ta-•-1t-©-ad... ra -,-I�la s ---•-••------------- ---------------------------•---------•-•--------•-----------.................-------•-•-•--••---- Location-Address or Lot No. SCHNEIDER ..................-......................................................................•--- 0" er Address a ----:g-:-Ma-eomberr•-J-r-------------------------------------------------- •--•--............ Installer Address UType of Building Size Lot............................Sq. feet ►. Dwelling—XP4o. of Bedrooms.----___-_-_--__-------------------------Expansion Attic ( ) Garbage Grinder (T0) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures W Design Flow..._.55..................................gallons per person per day. Total daily flow.........33Q--------------------,......gallons. WSeptic Tank—Liquid capacity.--1.QQCkallons Length._.g.�. j.tt__ Width:4...1-0..... Diameter................ Depth5..�.7........ 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. 1................minutes per inch Depth of Test Pit-.--.--____----_-_- Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 R: ............................••--•------..........------.........._.......----------••-------••------......................................................... Description of Soil......................................................................................................................................................................... v ------------------------•--•----Sand--&---Gravel.--------------------------...--•-----•--- W U Nature of Repairs or Alterations—Answer when applicable........Adding an additional 1 -100.0____ __ allon leach 1 ng �?i t t°...an....e x s t n g...t ank . p 1-t --------------------------------------------------------------•----- 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 Complian e has bee is ed by he board f he th. Sign ..... . .. ...9./...1_.�. ..9..5...... ............. Application.Approved By .....:... .......... ... ............................ ....8...... .. ...... ------- ............ .. ........ .............. ......9.... ..,..... Dace Application.Disapproved for the followingasonr: .........................................................................................................................I......... Permit No. r....... .3/.. .................. Issued ........................................................�f....... Due �. 7 -�Z( THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HEALTH TOWN OF BARNSTABLE .1 pphration for D `5}agaf Works Cno strnrtinn F umit •.. ' Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at., � d..�l...^r-) r v^ ;__y?1 fit.. SCHNEID.. .. .-•------------------•••-•-•-•--------•-•--- -••-•---••-------••- W O�cncr Address 1610 n •rr.,_ ee.. .T-....................•-------•-----------------•---••- -•----•--•-----------•--------•--•-•------•---------••- � �-�•i'�i'iui.'�Siiu`r,JtcT"1"""v i !Installer Address Type of Building}� Size_Lot............................Sq. feet 0-4 Dwelling-x4o. of Bedrooms........... ........:........ Ex i Attic aOther—Type of Building J -. . P'anson c ( ) Garbage Grinder (�t0) ............................ No. of persons-_....-..-....-_-.........-- Showers ( ) — Cafeteria ( ) Other fixtures ----••----•-----•--- W Design Flow!e.5.5..................................gallons per person per day. Total daily flow...--..--DR-------------------......gallons. WSeptic Tank—Liquid capacity-.1.0.0�'gal Ions Length...--..• ,,-. Widthkv.0u:. Diameter................ Depth5.'_7........ z 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........................................ ,a Test Pit No. I----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water..................--.... 0-4 Test Pit No. 2................minutes per inch Depth of Test Pit--_-.._-.-_--_.--_. Depth to ground water........................ tx Description of Soil------------------ ........................... •--------------------•--- ad R' Gxve W •-----••----••..............•••••--••-•-----•••-••--•••-•••--•--•••------... x --- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable......._ACl44El-_-An addl -1 000 .......................................................... _allon..Leac i.-n.u•••P t...:k,A_._oxt-®x**tina,...tank_ 4 pit.. 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 Compliance has bee iss;ed by he board f hea th. Sign ! .. .�.............. ....9.../...1.1. ...9.5....1jl 4. Application Approved By ...... .. . ... ... ..... .. .. ...... .......... A...... . ....../............. ..._.. ... - C �" ApplicationjDisapproved for the following reasons: .... t ........................... ............. ..................... ....................... ........................................ .... Dare -10� Permit No. ...., ........I......t..._. Issued ..........Um....................................... .'Y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE %LI'EXtifi ate IIf Tamplitinre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repairedg(-XXX) by ...J P.sTie.c.omb.er.---Jr...................................................................................................................................................................................... Ins�allcr .-.--- at ...41 Arbetta Road Hyannis,Mass. ............................................... ................................................................................................ . has been installed in accordance with the provisions of TITLE 5 T,h*S t to Envkro mental Code as described in the application for Disposal Works Construction Permit No. ........ ........... .. dated ............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B CONSTRU?� GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................. �-. q .// .......��..................... ... Inspector .�:,... ...: . THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH _ ' TOWN OF BARNSTABLE No.-y ........... FEE - 0_.OQ.... i Disvosal Workii Tomitrnrtion "rrntit Permission is hereby granted......S.P. Comber Jr. ---------------------------------------------• -------------------------............. to Construct ( ) or Repair (XX)Xan Individual Sewage Disposal System �? {•. at No............... °.1.-- 1.aS a. - str• t rr f as shown on the appli lion for Disposal Works Construction Per it NP. . � I_.... . ed_�_.._Q--- ........ ._LJ Board of Hea tli'_._.r..............:.... /...... DATE....................... /r I ------------------------ p.. FORM 36508 HOBBS Q WARREN.INC..P BLISHERS r Cor 00 / ,,. I FOR F (`j CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I J.P.Macomber Jr.. , hereby certify that the application for disposal works construction permit signed by me dated 9/11 /9 5 , concerning the property located at 41 Arbetta Road Hyannis Mas, meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is;J4 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED : DATE: 9/1 1 /9 5 LICE SEPTIC SYSTEM INSTALLER IN THE OWN OF BARNSTABLE NUMBER I [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted].. 1 a 1 Arbetta Road Hya.nnisjMass . -New 1000` Existing 1000 gallon pit. Existing Distribution box. Exi ting 1000--ga] ] Qnp L'OCAT10N ' SEW&CtE PERMIT -MO. INSTALLER 5 UWE kDDRESS BUILDER'S 1.1 &MF- ADDRESS DA E PERNAVT 15SUED DATE COMPLI &&ACE ISSUED : id �" dO � � frJ . � r- � w : " Wc,.jx � �, � � � � _ o cr, � �- � � � � . � n � � -� � �� �- I , �. r � o � ��, O r`� -___ - - No.. ---••-•••_..... FE$......1D............._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH r C��.......OF.... ...... .............. Appliration for 3isvag tl Works Cnutuarnrtion Vrrniit Application is hereb made for a Permit to Construct or Repair an Individual Sewage Disposal PP Y ( ) P ( ) b P System at,: , - �Loe�_ - #.Y.,O. _ on Add s or t. _ -------------- / / /J1 O ress Installer Address Type of Building Size Lot..... r. . lI Sq. feet Dwelling o. of Bedrooms..........3............................Expansion Attic ( ) Garbage Grinder ( ) aOther—'type of Building ____________________________ No. of persons----------6-------------- Showers ( ) = Cafeteria ( ) Otherfixtures .n................................ :----------------------------------------------------------------------------•----------------------- W Design Flow........................ !!------------gallons per person per day. Total daily flow....._..____ ..................gallons. WSeptic Tank+.iquid capacity.). gallons Length---------------- Width.._.._._....._.. lliameter........_._..... Depth................ x Disposal Trench—No. .................... Width..................__ Total Length....................�Total leaching area....................sq. ft. 3 Seepage Pit No.... Diameter-1 -•-•- Depth belo inlet-------=yl- �✓t _...sq. ft. Other Distribution box ( ) Dosing tank � Percolation Test Results Performed by.......................................................................... Date----------------------------------._.... Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water------------:........... f4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---------- ---- . ............................................................. .-•_.. O Description of Soil �_" �..?.... •• -_._ ...1i1� •-••••• -- ------9....... :� -- — 2— l-i W V 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 Article XI of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' ed by the board of heal Sig e �0`" • . -• . -----•••••• ••. ................................ e Date Application Approved By..... " ; ---••• •••• ,_• Date Application Disapproved for the following reasons---------------------------------- ------------------------------------------------------------------------------ .............••.......---.-----------........._....... ..-------•-•------. Date PermitNo................... --••---•----•-----•-•••--•----------• Issued........................................................ Date 700 g. 4► No.-- ............ Fs$......AQ....i THE COMMONWEALTH OF MASSACHUSETTS B/OARD1 OF HEA1 TH .7 . ........OF..../.. ................ Ap.pliratiun -fur Di,gpugttl Works Tomitrurtiun Pumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syste/at: • f .............. .............A-A Lo io Add or t Owner o ress 104 Installer., ` Address UType of Building t Size Lot.. eh j........Sq. feet 0­4.4 Dwelling o: of Bedrooms--_______�----------------------------Expansion Attic ( ) G�irbage Grinder ( ) Pa. Other—Type of Building ............................ No. of persons.........16.............. Showers ( ) — Cafeteria ( ) dOther fixtures/.�.. .----------•......................•---------:-:----._....------•----------------•---•---•----------------------...._.._.......--•-.-•--- W Design Flow_:............. ____. 3 u.___..___ gallons per pet son per day. Total daily flow____..__._.__--__________________gallons. WSeptic Tank Liquid capacity1 gallons Length................ Width................. Diameter................ Depth................ x Disposal Trench—No. .................... Wi th_._. ...._..______ Total Length..................... Total leachin area....................sq. ft. 3 Seepage Pit No.._(;7kt.------ Diameter.1.a. ._... Depth below inlet C y �� 5-1 Seepage ft. Z Other Distribution box ( ) Dosing tank ( ) p��- /6)-1 2 G Percolation Tesf,Results Performed by...................... Date-----------•----....------. Test Pit.yNo.{ 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth'to ground water........................ (Z4 Test Pit.No.,-2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------------------ O - //��r ��R --------- — G 2 Description of Soil------6 ._... �� ` !_....0.......................••------------------- x r2t -ice " !..���.. x .........................................................................................................................................................................................:.............. 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 Article LI of the State Sanitary Coder— The undersigned further agrees-not to place the system in operation until a Certificate of Compliance has been i4ued by the board of heal . y - Sig = •----- -------------------------------- Date Application Approved By.. � .::...�; .................... . . .....= /...'%., .-7-�----- Date Application Disapproved for the following reasons:................................ .............................................................................. a ----•------------------------------------------------•--•-•-----------------------------------------------•-------------•--•-----•-----••--•----•--...:.------------------•---------...-------------•--- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . r ....�.. ........................o F...... ,.. .r . "' , .4_U e........................ Tntif irntr of Tilutp innrr TH�iIS IS TO C�fIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by....... I................1--�''A...------.. .I----- -------------------------------- ------------------------•--- ................................... ` - .�' Installer at.... .........................../----•-----•• � '" ...............'�i�e...---.._....------�'� �1L!��- has been installed in accordance with the provisions of Article XI of The Stat Sanitary Code as described in the application for Disposal Works Construction Permit No..._ dated..._!___-' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.{ ? Ins ector. � DATE::. f ��= 4 �yF --•----------------------•--------------------•- D �f 1 THE COMMONWEALTH OF MASSACHUSETTS r _ BOARD O/F2 HEALTH' ................ /Yl.t...:O F............. .Q/t t .................. No..4U.............. FEE...10..�! U •, �i��u�ttl �rk� � nstr�trfiuHt �rrmi#. Permission is hereby granted______________________ _ to Construct( ✓j"oi rr Repair ( ) an Individual Sew ge Disposal System at No. .. `.. `' Street ....... :: street as shown on the application for Disposal Works Construction Permit No._._�U.___..... Dated_____��?�'__7�............... ------------------------------------- ....... Y3.1--- - --------------- y/ 1Board of Health ' DATE .J: /;(� ' FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS r {.-+.et-.�^z.Yr• 4•«4^,�r+. .i f r�: P ir_,R 'i. + �', _•.. _ _ � ,. . !vw u_}•_h•\%4 �'pbTr����..,,c��"¢� tit • +� i �:`r a T sue', � i i. t_ - f ._y ^ Y. 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