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HomeMy WebLinkAbout0197 BARNSTABLE ROAD - Health 197 Barnstable Road Sewer Acct # 4211 Hyannis A = 310— 156 TOWN OF BARNSTABLE LOCATION 0? �P �r� SEWAGE # VII.,LAGE,T e4lk&r ASSESSOR'S MAP & LOT..��� INSTALLER'S NAME&PHONE NO. D SEPTIC TANK CAPACITY G0 LEACHING FACELITY: (type) mall ZJ (size) NO.OF BEDROOMS BUILDER OCOW>N�� PERMTTDATE: 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 facility) Feet Furnished by 20 6 rm.1 cs P) � /Y � '. �� \I I � �� �JJ i '� �� f � �� � Ss O ` 4� ' \ t �1 �� e. R . .a o � X r ti. s TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops _ 0 unsatisfactory- 4.Manufacturers COMPANY i'✓�Rd ����'(/ (see"Orders") 5.Retail Stores f' 6.Fuel Suppliers ADDRESS 19 .7 (3 a--Wl fro tL l� � Glass: 7•Miscellaneous 4v✓� W7 QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS unls IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil(C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: ( qc+ K GJ�S r/2 i„ rye �K DISPOSAURECI AMATION REMARKS: 1. Sanitary Sewage 2.Water Supply 154c,a(2a-eh > 44,4 D Lad 02 W O Town Sewer public �, �• •� a 0j,h �' { Ca /,�,,�, dQ On-site OPrivate 3. Indoor Floor Drains YES NO ✓ O Holding tank:MDC_ O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ✓ ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Desti�ation' 1. �`t�-�"/-�yG��. S '' r �F-�"e.((%l.i��G'✓ .S`1`w�-� �`l�.c,�jt�j YES NO 2. `3iu -VASq Person(s) Interviewed In pector Da e �a t ��► r Commonwealth of Massachusetts b ,\ Executive Office of Environmental Affairs , De artment of F ® Ir� Environmental Protection � C,^ William F.Weld Trudy Coxe'." Goamor Argao Paul Celiucci 0 -Davld B SUuhs LL Goremor :r+ Ff eminlaloner ry SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 9/ G'fk5 f/1 Zle— IRV PART A CERTIFICATION //"" Property Address- Address of Owner. p rc�t )/`ze0/n140 Date of Inspection: ^,3©_<� (If different) Name of Inspector. W.E. Robinson SR Company Name,Address and Telephone Number. ( 5 0 8 ) 7 7 5—8 7 7 6 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: d�asses Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inapeotor's Signature: l(/. 1 Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd of greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A,B, C,or D: A] 7tPA.SSES: e not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. I CONDITIONALLY PASSES: or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes ection. no,or not determined(Y,N,or ND). Describe basis of determination in all instances: If"not determined",explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a Fonforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Tekphons(617)M-5500 i�Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART At � CERTIFICATION( ntinued) Property Address: Owner. p2o6�/' y�eeorn.�r� Date of Inspection: —3 O — , BJ SYSTEM CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C1 FUR , ER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1 SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) YSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) ETERMINES 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 ooliform bacteria and volatile organic compounds indicates that the well is$gee from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or lea than 5 ppm. 3) O (revised 11/03/95) 2 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Aaareaa: Owner. f O,b�/`f' Frz et,11nz917 Date of Inspection: -7 3 6.-Cg Dj SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be neossaM to correct the failure. _ Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than W day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for ooliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El GE 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 significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into bill compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST r Property Address: Owner. Dateof Inspection: Check if the following have been done: /Pumping information was requested of the owner,occupant,and Board of Health. _eNone 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. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. (/The system does not receive non-sanitary or industrial waste flow V The site was inspected for signs of breakout. !'All system components,excluding the Soil Absorption System, have been located on the site. F/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. TThe size and location of the Soil Absorption System on the site has been determined based on existing information or apprommated by non-intrusive methods. /The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub. Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMA ON Property pbrty Ada,roa / ? jfrn�Sx7 19/(J Av Owner. Date of Inspection: Z_3 0 FLOW CONDITIONS RESIDENTIAL- Design flow: Ilona Number of bedrooms:_a_ Number of current residents: 0 Garbage grinder(yes or no):_Lt,0 _ Laundry connected to system(yes or no): Seasonal use(yes or no): A-0 Water meter readings,if available: Last date of occupancy:d i q �! COMMERCIAL/INDUSTRIAL t ' Type of establishment: A- « Design flow:gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)-LP Non4anitary waste discharged to the Title 5 system: (yes or no) 4- Water meter readings,if available: Last date of occupancy: OTHER(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and urce of information: A.- A System pumped as part of inspection: (yes or no)_Ys If yes,volume pumped: gallons Reason for pumping: TYPE 9P SYSTEM Septic tanWdistribution box/soil absorption system Single oesapool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: e3 S Sewage odors detected when arriving at the site: (yes or no)h- O (revised 11/03/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 9 TEM FORMATIO (continued) q 7 Property Address: Owner. Date of Inspection: SEPTIC TANK_J (locate on site plan) � 1 Depth below grade: Material of construction:_concrete_metal_FRP_other(e:plain) Dimensions: Shidge depth: 0 7 I Distance from top of sludge to bottom of outlet tee or baffle:4-1__ Scum thickness:_ Distance from top of scum to top of outlet tee or baffle:_ e Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlgt and outlet tees or baffles,depth of liquid level in relation to Outlet invert,structural integrity, evidence of leakage,etc.) 49 ® a ® ;> t+� '� ® t' GREAS _ (locate on si plan) Depth below Material of co n:_concrete_metal_FRP_other(e:plain) Dimensions: Scum thicL : Distance fro top of scum to top of outlet tee or baffle: Distance m bottom of scum to bottom of outlet tee or baffle: Comments: (recommen tion for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence o leakage,etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFFORnMATION(continued) � Property Address: � /'/1 �✓3G� /�1�/ Y�� �/� S Owner. lq®j elm e e U/ylr9/7 Data of Inspection: 7,_3 ®—0, TIG OR HOLDING TANK:_ (locate site plan) Depth grade: Material of n:_concrete_metal_FRP_other(explain) Dimensions: Capacity: ons Design I gallons/day Alarm le- e Comments: (condition of tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: —LZ (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) v PUMP BER:_ (locate on plan) Pumps in wo ' order:(yes or no) Comments: (note oonditi n of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / 9YST;M INfE`Q#tMATION(oontiqu�d) Property Address: i 7 3: P? Ile y k t Owner. a /t� �/^e Q e Date of Inspection: SOIL ABSORPTION SYSTEM(SAS):_ (locate on sits plan,if possible;excavation not required,but may PP be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits,number:_ leaching chambers,number: A leaching galleries,number: leaching trenches,number,length: leaching fields,number, dimensions: overflow cesspool,number:— Comments: (note condition of soil,sips of hydra c failure, level of ponding, ndition of vegetation,etc.) 76 o'-o it CESS LS:_ (locate on 'te plan) Number and tion: Depth-top of ' to inlet invert: Depth of solids r. Depth of scum Is r: Dimensions of pool: Materials of co a: Indication of water: inflow(cesspool must be pumped as part of inspection) Comments: ( condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) PRIVY: (locate on si plan) Materials 'co n Dimensions Depth of so Comments:( condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) (revised 11/03/95) g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C TEM INFORMATION oo e�/ S Property Address: owner: Date of Inspection: _3 D "1 SBL+'!'CH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' I I ^ s e I FC. DEPTH TO GROUNDWATER Depth to groundwater 12 ± feet method of determination or approximation: h 4 r � (revised 11/03/95) 9 Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: C_1r_"AMeA Dn12P-1 rory, e BUSINESS LOCATION: - TZC1r/ % MAILINGADDRESS: Mail To: TELEPHONE NUMBER: 7-W— D') Board of Health CONTACT PERSON: mzy bAr'C r�.� Town of Barnstable P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: z)0'9 y Hyannis, MA 02601 TYPEOFBUSINESS: D nV�a_I 01C114ILQ Does your firm store any_of f the toxic or hazardous materials listed below, either for sale or for you own use? YES � NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: `?I , �X� TELEPHONE: 0 0 LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixer Diesel fuel, kerosene, #2 heating oilSNEV l' ISED Other petroleum products: grease, Photochemicals (Dev�eyper) lubricants, gear oil q NEV0- USED Of Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids �i �y- 6' (dry cleaners) f y CvniG"a i n" V v ,rJ`L�I Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS r j Date: `�� •� TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: `Yc2 Y)'I�Y1 0-4 1 y . i r BUSINESS LOCATION; r,*,4d / MAILINGADDRESS: l n -� l� hr)l Mail To: Board of Health TELEPHONE NUMBER: -7'7)- Dy Town of Barnstable CONTACT PERSON: ���• �� L Z r�' MaAl P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: -7-7)")Q'Y y Hyannis, MA 02601 TYPE OF BUSINESS: orl'je Does your firm store any f the toxic or hazardous materials listed below, either for sale or for you own use? YES, NO, This form-must-be returned to the Board-of Health regardless of a yes or no answer-.Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: S l TELEPHONE: dd 0-26 0 LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity ' Antifreeze(forgasolineor coolant systems) Drain cleaners }NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oilsa Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixeep ,Diesel fuel, kerosene, #2 heating oil L �(SNEV1( 4USED Other petroleum products: grease, - Photochemicals (Developer) f f lubricants, gear oil 1� L NE\/A1 -U9ED ,4 Degreasers for engines and metal Printing ink ,Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar f�— Fertilizers Paints, varnishes, stains, dyes PCB's „Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids Le) (dry cleaners) �►3 �, vo Cyariai n os Vv Other cleaning solvents Bug and tar removers WHITE COPY-HEAD-aH DEPARTMENT/CANARY COPY-BUSINESS l'AU � _a � - `/L_�' No.. ! .� ...---•--• ? Fizs....11 .................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .........................................OF..........................._.......... ......_...........•----...................... Appliration for Uhip sal Workti Tonstrur#iun ramit Application is hereby made for a Permit to Construct ( X) or Repair (X ) an Individual Sewage Disposal System at: ..._1..97... ..........................•• ------------------------------------------------------.....---•--...........--•--................. Location-Address or Lot No. Robert A Freodaan. 0,0,5,....--•-----------A --------- ••---•••••------•••---------•-------........-•----------•---•---------------_...---....------•---- ..........e t.. �----• Owner Address -KV We a ..................•.---��... .... . = Installer Address Type of Building Size Lot.........8 913-------Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building Dental C1 1 n 1 c No. of persons............................ Showers 1 — Cafeteria a Other fixtures --- 2 1N..c...,..2..1au........1.1...dental...si.nks----------------------------------------------------------- --- W Design Flow............................................gallons per person per day. Total daily flow____._......._...._....493.............gallons. WSeptic Tank—Liquid ca.pacity..l_,QQ( allons Length p 'th__$_'_-_6-'-'-- Width_____ ________ Diameter__.____..____._. De th__5___-4_.__. x GalW;is nch—No.................... Width•....__......__._... Total Length..._._........•..... Total leaching area..._............___.sq. ft. gz No.__..6_......_.__.W r.Length 4'DPpth below inlet... . Total.leaching area....41.2.......sq. ft. Z Other Distribution box ( X) 5 outl etDosing tank ( ) aPercolation Test Results Performed by..... ..... Date____$/29l2.7................... ,a Test Pit No: 1........2.....minutes per inch Depth of Test Pit.....1.C.m . Depth to ground water_._None...encountered 44 Test Pit No. 2................minutes per inch Depth of Test. Pit.................... Depth to ground water........................ ►x --••--------------------------------------------------•----------........-•--•...-•-•-•--•••-..............---••------•-------------------•---......--....-- u i u i u i u O Descri tion of Soil...9__-- --�.._-4-- 1 oam..&_.topsoi-1.,..1--_-4••_---___3__-0.---oarse._,.ravel...&...Sand.,................. v3'-�' - 7'-0" .coarse sand_, trace--of_gravel-,___7- 0"_..-.__l4'-0" ..�Q_drse._sandx-----------------•-----••_--. w O.R Gunn Architect, Douglas L McIntyre,---Inspector- _-•--------------------•---•-_- ----------------------------------- U Nature of Repairs or Alterations—Answer when applicable......... ......... ......... ......... ............................................. J��z t; 7 ............................................ .... Agreement: & an The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code=The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n issued bye e b `health. Si ----- -------•---•--•-----•----- ----- � (Application Approved BY ...............••-•-.. - 1 Dat Application Disapproved for the following,reasons:...... ......Z�", ! �- �_ _ -_ -------------------------••-••--......•-•••-•--••-••---------••---•-........-------------•-••-----------•- ....................... ............................................................... Date Isstied..._.f__�-- .�'Permit No.....-•---••-------------•------...------•----------- -- -------•--•-•--...--•---.._..---- Date # , t s ,�•� 4 9�...................: FEs, d'� ^ THE COMMONWEALTH OF MASSACHUSETTS J BOARD OF HEALTH , dOF.................... ...... ................................................. 'Appliraation for Bi-opwi al ork� C on0 rttr ion f ermi# , Application ishereby made for a Permit to Construct (X ) or .Repair ( X) an Individual Sewage Disposal System at: 1.97_Barnstable 'Road, Hyanni s ........ ............. .................................................... •-•--- ........................... r s or I:ot,No. ' L atio Robert A. Freedmai, ` ................................- WKarn ons ' Address ........_.. --_-_... --•••-•----•--••----------- -------------•-------____e_........-- ------ ---------•--•--._.... ..... � Installer Address as 8 913 U Type of Building Size Lot............... ... ;!...Sq. feet Dwelling-No. of Bedrooms__________________ ...-----_---_Expansion Attic ( "") Garbage Grinder ( ) Other'. Type of:Building -Ile11tal...C_1_lnl o; of persons............................ Showers (1 ) — Cafeteria ( ) s Other fixtures 2 Y�I C..,_2: 1_au_•- --1 ___den_ta:1: s_i,nk • - - W Design Flow._.._ ;, -____.___ .gallons per person per day. Total.'daily flow............................49.3.........gallons. W Septic Tank=,I squid capacity].QDQ__gallons Lehgth._8.1 .--6". Width.....5_........ Diameter............... Depth.5-'.-4"---- Gal is osah rencli o .: YVentShth 4_t...nr__ Total Length.................... Total leaching area....................sq. ft. No: __... 1zAC Depth.below inlet__4'.-0........ Total leaching area......412_.._sq: ft. Other Distribution'box ( X) 5, outlelDosintank est Ma�ved coarse sand 8 29 77 Percolation Test Results Performed:by- ___ _____ __------------------------- is: �_________. Date._-.____�_____�..__________________.. a Test Pit No 1 t 2 .___.minutes per inch Dept of Test Pit.---14 C.-Q".. Depth to ground water..N.0.ne...eAro.untered Test Pit No 2'.:.__� �� nimutes per inc `Depth of Test Pit.................... Depth to ground water------------------------ Test A a Description of S --------- ..........................................................--........----------------------•-----....._...---'------ O - O11 I II I ' orl__---_-- �: 4 ]_Qaln__& tQpsRll:,.:.1:__-4._____.-___3---.Q-----coar_sE--grave_1---&--sand-,---------.-- 3' 0 ' 7' 0"_.coarse lCld __ r ce Qf : ravel_,...Z'_-Il"_.._-.-l4'-0".....cn-ar_se---sand................................ W 0 R Gunn�_.,Architect, � :�.a5...L.---Mcl tyre.,. Inspect-nr. ----------•--•-------------------------------------•----...----------- U Nature of Repairs or Alterations—Answer wheri applicable.-.............................................................................................. Agreement: The Yundersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITS 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 b ar f health. r. Si"" e A lication Approved B ------------- i ' APP lication Disapproved for the following reasons:_ Yat�e ........ . .. { F' Date } Permito....... ............ :: ----• Issued-----------------•------ Date THE'COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ........: .OF....:........ .. TatifirFatr of TootpliFattr TRH"WC IF 61, qtie Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ` /7 ' o � at .................................... ----•--- '-.--'-' ---------------------------------•'---''- ---'----•--'--'...---'----•--•---- has been installed in accordance with the provisions of pf�The State Sanitary Cif��s bed in the application for Disposal Works Construction Permit No���....................................... dated--...._j . .---------.-----.---_-- TFIEASSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARA TEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY DATE...:..._.1 .."..1`d..`'..... _? ._._..:.. Inspector .--C----- -- --- ----'-'- . ..: THE COMMONWEALTH OF MASSACHUSETTS y BOARD kHE H .....................................OF..... ------------- -- .................................. /�°' • No......................::: . FEE........................ s _ �t��to� c► ,� �tr�ton �erntt� , Perinissio reby granted_.__ tcaonst/ItIri Sestem atNo.................................................................... ...: ... ...- ... -----•--- --•---'---•-•'-------------'-'--/-,� a A•Street `�.yr,.w 7 as shown on the application for Disposal Works Construction P`''z N Dated.--_/. --- -- ------- Board of Hea DATE ...................................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS F (- 2AK\ ALGER AND GUNN 'A ARCHITECTS STANLEY F. ALGER. JR. • ARCHITECT P O B O X 3 6 9 OWEN RUSSELL GUNN • ARCHITECT 3 9 6 MA IN S T R E E T - HYANNIS. MASS. 02601 7 7 S 2 3 2 4 April 12, 1977 Re: Proposed Alterations & Addition for Dr. R. Freedman 197 Barnstable Road, Hyannis, Mass. WATER USE ANALYSIS (new building will create 5 examining rooms) Dr. ,Ringer - Rte. 6A 3 chairs 40,000 gal/yr.* 3 _ 5 X = 66,666 gal/yr. 183 gal ./day 40,000 X Apartment 100 gal ./day 283 gal ./day Dr. ,Freedman -. Barnstable Road 2 chairs & Apartment No meter - tabulated 75,000 gal/yr. 2 _ 5 X = 96,250 263 gal ./day 38,500 X Apartment 100. gal ./day 363 gal ./day Mr. Nault - Barnstable Water Dept. said figure -- 180,000 gal/yr 493 gal/day Information furnished by Tom Mullen T ALGER AND GUNN ARCHITECTS STANLEY F. ALGER, JR. • ARCHITECT D . O . B O X 3 6 9 OWEN RUSSELL GUNN • ARCHITECT 3 9 6 MA I N S T R E E T HYANNIS, MASS. 02601 7 7 9 2 3 2 4 April 12, 1977 Re: Proposed Alterations & Addition for Dr. R. Freedman 197 Barnstable Road, Hyannis, Mass. WATER USE ANALYSIS (new building will create 5 examining rooms) Dr. Ringer - Rte. 6A 3 chairs 40,000 gal/yr.* 3 _ 5 X = 66,666 gal/yr. 183 gal ./day 40,000 X Apartment 100 gal ./day 283 gal../day Dr. Freedman Barnstable Road 2 chairs & Apartment No meter - tabulated 75,000 gal/yr. 2 _ 5 X = 96,250 263 gal ./day 38,500 X Apartment 100 gal ./day 363 gal ./day Mr. Nault - Barnstable Water Dept. said figure -- 180,000 gal/yr 493 gal/day Information furnished by Tom Mullen I Co-�2 1 KA V- C 2 7 Q Z)Lr la 38.0 ZKG 7. 0 4q exlvr- -Fm TO 37.Z Ou 2w-a- b-.0, FEUCE: E'T, 6. 57.7 CEDAk PLYVV 5E-7 5 7 141 IklVeZ7FD BAT 0 . � _ 37.S Gz )CVE a, o.Tc. GA,LLLYMlT� % \ CUT iki i4ALr- 02 "It 0 2-4 Ca Imv, �512 121,1- DItT, 150%, I + _rE_=51 ]RIT I NIJ, 2,2 -57 ,rl IWV. 3Z.79' o ' EP7IC TAV (10G,L\ 41 L 2KG tosl�:W_ '5 b C. BOLTSol 4 4 Po-.,T 39 .0 3a CID PLYWC), -rknA,7 EA�7T, 4z--).4 ZL/ :5 wl PleNTA. \f UJI P05T5 BLDG. TO 11 -3 cl . 0 CUT F120M if BE Rnmoveo 0 z D -7 E ------ w Tx b- sc:A- L_r: Yz" . 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GuKIIIl-AI2CI4ITF_-('_-T TtLN-C ALGEV_ 4 GUKJNI -%,2CI4lTEC-,�S it colklz�u__ sAwir w0:A�7HE-P. - '5UwQ"I 4 WAZM 01-Nif)L rlaAc_F-: QA,7-, r-. - LCS-f TII 2 I0lWij-re_-5 Pu!!�LIC w At"y ort cr-Av�:-L- 7 S E: k�' S C-A,,LF-'- 1(::;- 0" s LEIBAW_oki ze I Z E-L, _57, 5715' i cY \\/A:TC-P_ C�QCOUQ7C-Q M-0 .4: l L E�A�ZOt4 zs'Z�D I _F_5^RoN R62c� LEWGIN R6zo C-L 57.715 C:"-. 5 7.Q Z95 WIT AL, RUP- 5 yz 151LIC-1,_ f5KICK MA'S,3 3/Z- SE PT i-C 495 Y, 1.S 7 5'15 1 000 KICK eL 29, MANHOLE E-C TIV C_ eL.15Z,79' F20M SIMP7 Aim BoTTok,4, (2, 2-G NV.EL -51, v.F-L."S 87' ­!�tr_.__'4 Z' T, Vt!' /i' WA-5tlE_o QALLIE,11' ALL PIPE 4+ CKU5HED TONS' TO AL_ -F- _;p u'l a� _4 _PF_-i;_>C0LATI0kl VATF--' L)11J 0 F_-P_ 2 K41 M, Z'WALu�_ I ­_ ­ -I -- 7" r=1 r-= 5 00TLeT"!2; r= Z��. r= t:--- l=j -1 =73 1=7 r-.73 r�__ tE!\/'5Tr_M cAPNC_lTy 41-Z 2 8Z4. c;AL/oA�j, (1.7 FAcl-oc,.) t:::l --:3 17-1 =1 t7l i -I t-Z.1 — t:=I T:-73 10 tj ;=--j 1_-4 rz-4 r--1 r-A r__j FZ:j =1 14 r---z =i I DETAILe.-) AIN ALGER AND GUNN ARCHITECTS D15T. 5OX 5EPTIC TA,. N K 10 00 (�AL ) JOB NO. 396 MAIN STREET HYANNIS. MASS. 02601 PROP05ED ADDIT!ON X-71FR�710 For f ) D 3 Lr--RT A\- f=R E E D?"IIIIIIIIIII A�N i,97 f3#\R57,^j15LE ROAD, HYANNi,5 , MA4),r?ACHU!5t",T5 I RE C/4% 5 7 N T5 .5 If C"I'l" 10 IN 7 H R J D15F. 5Y457 L= W� ".-, P� SCALE: ^15 NOTED REVISIONS: SHEET P own 3 7/2O�E .k' DATE: I ;q77 DIMECNTRACTOR SHALL VERIFY ALL IOSIONS AND CONDITIONS AT SITE DRAWN BY:0PCj/AC OF