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HomeMy WebLinkAbout0098 BETH LANE - Health oe 98 Beth Lane Hyannis CP A = 272 155 o � YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which your' - must do by M.G.L.-it does not give you per to operate.)"You must first obtain the necessary signatures on this format 200 Main St., Hyannis. Take'the completed form to the Town Clerk's Office,-1st Fl., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. - J io Fill in please DATE: 1 - ,: APPLICANT'S YOUR NAME/$: BUSINE _ YOUR HOME ADDRESS: TELEPHONE # Home Telephone Number fl { :..,.,:..,. IS NAME OF CORPORATION: NAME OF-NEW BUSINESS V _ - TYPE OF BUSINESS IS THIS A HOME OCCUPATION? NC' -YES . NO 15 _ ADDRESS OF,BUSINESS- _ MAP/PARCEL NUMBER [Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. —"(corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in'this town. 1. BUILDING COMMISSIONER'S OFFIf''E ` This individual ha b pe' in o.rmed�of ny er it require ents that pertain to this type of business. MUST COMPLY WITH HOME OCC 1PATiON �" )�'"�J � 7� -� ' i RULES AND REGULATIONS. FAILURE TO t Authbriz i natu * i U -- ^ COMPLY MAY RESU C0MENTS:( LT IN FINES. i9 �, h4 2. BOARD OF HEAT H This individual has been informed of t' e rm' r uireme s that rtain to this type of business. MUST COMPLY WITH ALL HAZARDOUS MATEPLA! e PEGI ILATIONS Authorized Signature COMMENTS:' 3. 'CONSUMER-AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature COMMENTS: Date: 601 a31 � (P ,.� TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: ���� \iV BUSINESS LOCATION: (� ���� ��� \-�,���\ �1�� � O��(�1 VENTORY MAILING ADDRESS: S4J\��, �jn��F TOTAtAMOUNT. TELEPHONE NUMBER: % CONTACT PERSON: S4k T EMERGENCY CONTACT TELEPHONE NUMBER: rn 3 \y 0 3 0 MSDS ON SITE? TYPE OF BUSINESS: INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Cai wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's IcPaints,varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison"labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug,and tar.removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applica t' ,Sl ature Staff's Initials YOU WIS14 TO OPEN A BUSINESS? For Your Information. Business certificates (cost 40 0af rrsl A-business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to.operate.) You'must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take,the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601. (Town Hall) and get the Business Certificate that is required by law. ' DATE: '� Fill in please:: _( APPLICANT'S YOUR NAME/ t _BUSINESS YOUR HOME ADDRESS: ��� -� �lv� `5Oa L:_:r�,.�ti�-it,,Y�E,• .ti,5ii'•Sliy4�;<I 1 \l - -�+o"''` TELEPHONE # Home Telephone Number U AL NAME OF CORPORATION: NAME OF-NEW BUSINESS�� TYPE OF BUSINESS IS THIS A HOME OCCUPATION? ES NO ADDRESS OF BUSINESS- Cl — J' MAP/PARCEL NUMBER (Assessing) When starting a:new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of.;:; Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yatftiouth ' Rd. & Main Street) to make sure yo.0 have the appropriate permits and licenses,required to legally operate your'business in this town." 1. BUILDING CO I SID ER'S OFodf This individ 1 ae infor jh �pdri�dire uirem s that pe ain to this type of businessMUST COMPLY WITH HOME OCCUPATION 'Au horized S* nature** RULES AND REGULATIONS. FAILURE TO 'COMPLY MAY RESULT S OMMENTS- v jY 1 2. BOARD OF HEA TH - � �s-mk vwS(100 v This individual has been informed f e er t requirements that pertain to this type of business. I, �- � . . Authorized Signature** _ MUS'f`COMPL `W COMMENTS: KNZARDOUS MATERIAL— 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements-that pertain to this type of business. Authorized Signature" COMMENTS: YOU WISH TO OPEN A BUSINESS? = For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which 1} you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1 FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) RED DATE: - o2D" Fill in please: APPLICANT'S YOUR NAME/S: �A�ls, -C, F FF'4 KFI Rat P CYF l BUSINESS YOUR HOME ADDRESS:�� � TELEPHONE # Home Telephone Number NAME OF CORPORATION: - S NAME OF NEW BUSINESS TYPE OF BUSINESS e\F r-Om\) Sz IS THIS A HOME OCCUPATION? NO ADDRESS OF BUSINESS - GU MAP/PARCEL NUMBER (Assessing) . When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - corner of Yarmouth make sure you have the appropriate ermits and licenses required to legally operate your business in this town. Rd. &Main Street) to ma yp 1. BUILDING COMMISSIONER'S OFFICE f This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS:, 2. BOARD OF HEALTH This individual has en i�e f the e mit requirements that pertain to this type of business. thorized Signature* Y° COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual ha een informed of the licensing requirements that pertain to this type of business. 11 Authorized Signature** COMMENTS: - TOWN OF BARNSTABLE Date: TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS- \ ) 622 L P\�A�► ��\C� S`��V���C BUSINESS LOCATION: 0\% INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: , �� ��► CONTACT PERSON:? EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) _ Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED a _Z �. _- - z. Any other-pro ducis with"poison" abels _. Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) x Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers & cleaning fluids oSS• b.4 e a C Q L.C,a n J') V/X1--3 (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS COMMONWEALTH OF MASSACHUSETTS EXECUTIVE;OFFICE OF ENVIRONMENTAL AFFAIRS Z DEPARTMENT OF ENVIRONMENTAL PROTECTION y i TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM RECEIVED t l PART A CERTIFICATION ' FJUL 2 5 2002 Property Address: 9$ BETH LANCiHYANNIS, MA 62601 Z� L I S J Lo22 Owner's Name: MRS. KEEFE i' f �' TOWN OF BARNSTABLE HEALTH DEPT. Owner's Address: 98 BETH L`ArNE,HYANNIS,MA 02601 Date of Inspection: 7/3/02 Name of Inspector: (please print) �JOHN GRAC1 Company Name: SEPTIC INSPECTIONS l n tr Mailing Address: P.O. 6OXT119 TEATICKET, MA.02536 Telephone Number 508-564-6813 FAX 508=564=7270 CERTIFICATION STATEMENT 1 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`ofthe time of the inspection.The inspection was performed based on my training and experience in the proper functi6h,and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340"of Title 5(310 CMR 15.000). The system: 4. _ Passes X CJ�'akl. es, Neuation by the Local Approving Authority Fa Inspector's Signature: Date: 7/3/02 The system inspector shall suis inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inystem is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shal`l`siibn:it the report to the appropriate regional office of the DEP. The original should be sent to the system owner and''copies sent to the buyer, if applicable,and the approving authority. Notes and Comments SYSTEM CONDITIONALLY PASSED TITLE V INSPECTION. D-BOX IS STRUCTURALLY UNSOUND. RECOMMEND PUMPING EVERY,TWO'YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. a. 'Page 2 of 1 I r OFFICIAL INSPECTION'FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SIJWAGI; DISPOSAL SYSTEM INSPECTION FORM is hi t� PART A CERTIFICATION(continued) Property Address: 98 BETH,LANE:HYANNIS, MA 02601 Owner: MRS. KEEFE Date of Inspection: 7/3/02 Inspection Summary: Check A,B,C,D,or E/ALWAYS complete all of Section D A. System Passes: - ))' - i�if pit hf 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure ci iter a not evaluated are indicated below. Comments: SYSTEM CONDITIONALLY PASSED TITLE V INSPECTION. D-BOX IS STRUCTURALLY UNSOUND. RECOMMEND PUMPING EVERY TWO�YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. B. System Conditionally Passes: a X One or more system components as dt scr`ibed in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replaceipent or.repair,as approved by the Board of Health,will pass. l Answer yes,no or not determined(Y,N,ND)infthe for the following statements. If"not determined" please explain.Ir . a n/a The septic tank is metal andover.20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration oi-tank failure is imminent. System'will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is£available. it ND explain: n/a n/a Observation of sewage backup or,break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced obstruction'is removed distributi6ri,box is leveled or replaced ND explain: n/a " > n/a The system required pumping more than'-4,times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): _ okenpipe(s)are replaced _,obstruction isremoved ND explain: n/a Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM s# PART A ' RTIFICATION(continued) r Property Address: 98 BETH LANE HYANNIS, MA 02601 Owner: MRS. KEEFE Date of Inspection:.7/3/02 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 public health,safety or tlje envir gnlent: 1. System will pass unless Board',of.Health determines in accordance with 310 CMR 15.303(1)(b)that the system is . not functioning in a ma iier,.,which will protect public health,safety and the environment: _ Cesspool or privy is within 50!feet of a surface water _ Cesspool or privy is with'n r5b feet of-a bordering vegetated wetland or a salt marsh , 41' 1 . 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 heath y safet and 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 SAS and the SAS is within a Zone I of a public water supply. _ The system has a septic tank and SkS''and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**,. Method used to determine distance n/a ' yz **This system passes if the weit,mater analysis; performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to.this-form. �y, f 3. Other: y. sr n/a 7i. `ii.. 4 . r `, . x Page 4 of n OFFICIAL IN,SPECTIONrYORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ;r, a PART A ` CERTIFICATION(continued) Property Address: 98 BETH L•ANEi-HYANNIS, MA 02601 Owner: MRS. KEEFE Date of Inspection: 7/3/02 D. System Failure Criteria applicable fo'all systems: You must indicate"yes"or"no"to each of the following for alLinspections: Yes No X Backup of sewage into facility or'sysiem component due to 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 '/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 NO PUMPING INFORMATION. X Any portion of the SAS,cesspoolgor privy is below high ground water elevation. X Any portion of cesspoo[`or pn y i I ' ithin 100 feet of a surface water supply or tributary to a surface water supply. _ X Any portion of a cesspool on 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. IThis system passes if the well water analysis,performed at a DEP certified laboratory, for`cohforni bacteria and volatile organic compounds indicates that the well is free from pollution frompthiffacilitytand the presence of ammonia nitrogen and nitrate nitrogen is equal to or ,, r less than 5 ppm,,provided tli,' o other failure criteria are triggered. A copy of the analysis must be attached to this form t :? _ (Yes/No)The system fa�s have:determined that one or more of the above failure criteria exist as described'in 310 CMR 15.303,therefore the system fails:The system owner should contact the Board of Health to determine what will be necessary to correct the failure. : " E. Large Systems: To be considered a large system the,system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"40,each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is wrthm,200 feet,of a tributary to a surface drinking water supply ;0 a: X the system islocated in a nitrogen seiisitive area(Interim Wellhead Protection Area—.1 WPA)or a mapped Zone II of a public water supply well 4i If you have answered yes':to any question in Section E the system is considered a significant threat, or answered . "yes" in Section D above the large syslelu has lailcd. The owner or ollcralor of any Ln`ge system Considered n `ngnlf laid Ihl'eal under Section E or failed under§potion D shal,l upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 5 t3i Page 5 of I 1 0 }' 3 a' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:.98 BETH LANE'HYANNIS, MA 02601 Owner: MRS. KEEFE Date of Inspection: 7/3/02 Check if the following have been done.You must indicate"yes"or"no" as to each of the following: Yes No r �y X Pumping information was provided`by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks X Has the system received normal flows in the.previous two week period ? X Have large volumes of water,been introduced to the system recently or as part of this inspection'? f theisystem obtained and examined?(If they were not available note as N/A) X Were as built plans'o X _ Was the facility or dwellfingsrnspecied for signs of sewage backup'? X _ Was the site inspected for,sign.s of break out'? X _ Were all system components;excluding the SAS, located on site'? X Were the septic tank mahlioles uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions;depth of liquid,depth of sludge and depth of scum ? { X _ Was the facility owner'(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems;'4 ,. . The size and location of the Soil Abso ption System (SAS)on the site has been determined based on: �. , Yes no X _ Existing information. For example,a plan at the Board of Health. X _ Determined in the field i(if any ofthe failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3J(b)]" ;� l :J. Page 6 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE`SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C + SYSTEM INFORMATION Property Address: 98 BET H LANE HY'ANNIS, MA 02601 Owner: MRS.KEEFE Date of Inspection: 7/3/02 FLOW CONDITIONS RESIDENTIAL ! �' Number of bedrooms(desig�kl15,203*.(fdr : 3 Number`of bedrooms(actual): 3 DESIGN flow based on 310 example: 110 gpd x#of bedrooms): 330 Number of current residents: 2� - Does residence have a garbage grinder(yes-or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no),:.,NO . Seasonal use: (yes or no): NO t'< Water meter readings, if available"(last,,2 years usage(gpd)):*o(a— 0() Sump pump(yes or no): NO + Last date of occupancy: n/a L4 S 1 LJ®O COMM ERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR, l5.203)}';n/agpd Basis of design flow(seats/persons/sgft;etc,): 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/use: n/a OTHER(describe): n/a y+' � .'GENERAL INFORMATION Pumping Records + ; Source of information: NO PUMPING INFORMATION Was system pumped as part of the4inspecticn.(yes or no): NO If yes,volume pumped: n/agallons,-- How was quantity pumped determined? n/a Reason for pumping: n/a 11 0 VP TYPE OF SYSTEM +, X Septic tank,distribution box,soil absoi pion system „ . _Single cesspool Overflow cesspool _Privy _Sharcd system(yes or no).(if yes,attach previous inspection records, if ally) _Innovative/Alternative technology. Atta It a copy of tiie current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DE?approval Other(describe): n/a + Approximate age of all components,date installed(if known)and source of information: 1980 BY OWNER Were sewage odors detected when arriving 4the site(yes or no): NO A Page 7 of OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS CI'J SUBSURFA SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 98 BETH LANE HYANNIS, MA 02601 Owner: MRS. KEEFE Date of Inspection: 7/3/02 BUILDING SEWER(locate on site plan) Depth below grade: 14" Materials of construction: cast iron X40;P.VC other(explain): n/a Distance from private water supply well o'r suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER "i34 a, SEPTIC TANK: X(locate on site plan) l• s Depth below grade: 8" Material of construction:;Xconcrete sJn,etal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' 6'''1II 1011" Sludge depth: 3 = 71 ' Distance from top of sludge to bottom of outlet tee or baffle:31" Scum thickness: 4" 1 , 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: 14" How were dimensions determined: MEASURED Comments(on pumping.recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage ,etc.): .,. SEPTIC,TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING'EVERY.TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on.site plan) ' .j 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 scurn to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping rcciim n6nt l ins,Jnlet and outlet (cc or haftle Condition, structural integrity, liquid levels as related to outlet invert,evidence of le ,, �5akage,'etc) � a J ) 4 - n/a r,f .i 7 Page 8 of I I , OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r' , PART C ;SYSTEM INFORMATION(continued) Property Address: 98 BET,H LANE MANNIS,MA 02601 Owner: MRS. KEEFE Date of Inspection: 7/3/02 ._ TIGHT or HOLDING TANK "'(tank musf'be primped at time of inspection)(locate on site plan) >t Depth below grade: n/a Material of construction:_concrete •metal '_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Plow: n/a gallons/day `M Alarm present(yes or no): N/A fir+ Alarm'level: N/A Alarm in working order(yes or no): NO. Date of last pumping: n/a r , Comments(condition of alarm and float switches,etc.): n/a •;, DISTRIBUTION BOX: X.(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/ Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box,etc.): D-BOX IS STRUCTURAL"LY'UNSOUND.' d.,.*r PUMP CHAMBER:_(locate on site plan);, F . 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 1�1 f - .itq -Vf 4 R Page 9 of I 1 t OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C t SYSTEM INFORMATION(continued) Property Address: 98 BETH LANE HYANNIS, MA`02601 Owner: MRS. KEEFE Date of Inspection: 7/3/02 I r SOIL ABSORPTION SYSTEM (SAS):'.X (locate,on site plan,excavation not required) If SAS not located explain why: n/a Type .f! 1000 GAL 6' X 6' leaching pits, number: 1 500 GALLON CHAMBERS leaching chambers, number: 2 n/a leaching galleries, number: n/a n/a ' leaching trenches, number, length: n/a 9 I , n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a (a innovative/alternative system } Type/name of technology: n/a n Comments(note condition of so►l,'+s'gns`of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): PIT AND CHAMBERS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE. PIT WAS EMPTY AT TIME OF INSPECTION. CHAMBERS ARE NEW. BOTTOM IS AT. a16}, CESSPOOLS: (cesspool must be'punped'as part of inspection)(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: n/a Dimensions of cesspool: n/a Materials of construction: n%a'. Indication of groundwater inflow(yes or no): 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.): r.. n/a `q n • Page 10 of OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SE WAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 98 BETH LANE HYANNIS, MA 02601 Owner: MRS. KEEFE Date of Inspection: 7/3/02E SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage,d,isposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate,where public water supply enters the building. i .' E n AA 3 (� AC 3q _ 001 UL `J° ;. C Page 1 I of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS " SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ... " PART C . ",SYSTEM INFORMATION(continued) Property Address: 98 BETH L°ANG HYANNIS,MA 02601 Owner: MRS. KEEFE Date of Inspection: 7/3/02 � SITE EXAM _Slope 'Surface watera,;, Check cellar ` _Shallow wells , Estimated depth to ground water`12;feet Please.indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- if checked,date of design plan reviewed:n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board_of Health-explain: n/a NO Checked with local excavators,-installers-,(attach documentation) NO. Accessed USGS dptabase,-,explain; n/a F You must describe how you established the high ground water elevation: HAND AUGER- 12 FT., r " 4.k - 40 TA - �biL�.t rt No.OV-0 Fee —A&Cc, THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for Migozar *potent Cott!tructiort Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete SystemX X7 Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 98 Beth Lane Hyannis ,Mass . Charlene Keefe 28 Beth Lane Assessor's Map/Parcel H Y a n n i s ,Mass .0 2 6 01 Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No5 0 8—7 7 5—3 3 3 8 J.P.Macomber & Son Inc . J.P.Macomber & Son Inc. Box 66 Centerville ,Mass .02632 Box 66 66nterville ,Mass .02632 Type of Building: Dwelling XXNo.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. 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) Replaced rotted a n d inoperable distribution box. 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 Certifi- cate of Compliance has been issyed by thi Bo?d of Ilealth. Signe �� Date 7/1 /0 2 Application Approved b9,17� Date Application Disapproved for the following reaso Permit No. Date Issued No.�00 i w Fee f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: --,yes .4 PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 4 g rication for Migooar ibp.5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete SystemX XD Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 98 Beth Lane'Hyannis;Mass. Charlene Keefe 28 Beth Lane Assessor's Map/Parcel , ,, - H Y a n n i s,Mass.02601 Installer's Name,Address,and Tel.No. 5 0 8—7 7 5--3 3 3 8 Designer's Name,Address and Tel.Nos 0 8—7 7 5—3 3 3 8 J.P.Macomber & S on. I/nc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass.-0h32 Box,66 CBnterville,Mas`s.02632 Type of Building: fY Dwelling X XNo.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures _ -• "'Design Flow gallons per day. Calculated daily flow gallons. Plan Date ` a Number of sheets Revision Date ' Title �- .- f Size of Septic Tank Type„,of SA.S. Description of Soil j Nature of Repairs or Alterations(Answer when applicable) Replaced rotted a n d inoperable +distributio-n box. �- 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 Certifi- Cate of Compliance has been iss ed by thi BXW�4�� � ealth. Sgne Date 7/1 /"02_•� Application Approved 1A Date Application Disapproved for the following reaso / ;1W6, t �,._ ..-•:-Permtt�io.-.__ _ _ ,--^. ._:> >_s�,;.,_ -.�� - --DateIssued- THE COMMONWEALTH OF MASSACHUSETTS ' BARNSTABLE, MASSACHUSETTS , Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired{XX Upgraded( ) Abandoned( )by J.-P.Macomber & Son Inc. at 98 Beth Lane Hyannis,Mass. a has; 6en constructed inaccordance with the provisions of Title 5 and the for Disposal System Construction Permit No dated Installer J:P.Ma comber & Son Inc. DesignerJ.P, acomber I& Son Inc. The issuance o this e t 1 not be construed as a guarantee that the syst i as des d Date Inspector gt/7 --"— ------ ------- -- -- No. —— — --Fee AZIC THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS w Mitpoear *p6tem Cortgtruction Permit Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( ) Systemlocatedat 98, Beth Lane Hyannis,Mass. and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions: Provided:Construction mu t be co �ple��)d within three years of the date of this Date: � �L�`�'� Approved by r r TOWN OF BARNSTABLE LOCATION �/7 L A SEWAGE # c VILLAGE / /A "IS ASSESSOR'S MAP & LOT��� If INSTALLER'S NAME&PHONE NO. ��; A4 A C a A 6-eA- SO,I/ SEPTIC TANK CAPACITY / 6 06 - . D oo ,.f-/T 61W LEACHING FACILITY: (type)s2-A4 OW Cf/A,V1Y,-,e S (size) S-©O 6AL NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: - \3L�aaV' Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 s r - I' V r / �ol N. IS— Fee$ 5 0. 0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(pplication for X gpoal 6pgtem Congtruction Permit Application for a Permit to Construct( )Repair(X X Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 98 Beth Lane Owner's Name,Address and Tel.No. Hyannis ,Mass . 02601 539 Higgins Crowell Road Assessor's Map/Parcel 72 /S�1 West Yarmouth ,Mass . 02673 Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8 J. P.Macomber & Son Inc . J.P.Macomber & Son Inc , Box 66 Centerville ,Mass. 02632 Box 66 Centerville,Mass . 02632 Type of Building: DwellingX X X No.of Bedrooms 2 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons 4 Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 2 x 110=2 2 0 gallons. Plan Date Number of sheets Revision Date Title iF_XT"Ivy ea— Size of Septic Tank 1000 Type of S.A.S.1-10 0 0 pit plus 2 500 Description of Soil gallon chambers packed in Loamy sand to boner sand to fine sand. Nature of Repairs or Alterations(Answer when applicable)Add in g two 500 gallon chambers to an existing septic system. 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 Certifi- cate of Compliance has been issue by this B d e th. Signed d Date 3/2 7/9 9 Application Approved by Date 9 Application Disapproved or the following reasons Permit No. Date Issued No. Fee$ 55 0. 00�0- 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in `•mpute' r: I/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETT V RpOlication for Migpozar *pztem Construction Vermit' Apphcati on fora Permit to Construct( )Repair(X)o Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Addressor Lot No. 9 8 Beth Lane Owner's Name,Address and Tel.No. . Hyannis,Mass. 02601 539 Higgins Crowell Road Assessor's Map/Parcel �- ;� `?,�- West Yarmouth,?4ass. 02673 Installer's Name,Address,and Tel.No.5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc , Box 66 Centerville ,Mass. 02632 Box 66 Centerville,Mass. 02632 Type of Building: DwellingXXX No.of Bedrooms 2 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons 4 Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 2 x 1 10=2 2 0 gallons. Plan Date Number of sheets Revision Date TitleX Size of Septic Tank 1 QO' Type of S.A.S.1-10 00 pit plus 2 500 Description of Soil ` , gallon chambers packed in Loamy sand to boney sand" .to fine sand. Nature of Repairs or Alterations(Answe whe"'en applicable)A.d d in g two 500 gallon chambers to an existing septic system. 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 Certifi- cate of Compliance has been issued by this BlArd f1f e lth. Signed ! Date 3/2 7/9 9 Application Approved by Date 3h, Application Disapproved or the following reasons Permit No. Date Issued # --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On�ts'te Sewage Disposal System Constructed(r' )Repaired,( X)Upgraded( ) Abandoned( )by J.P.Macomber & Son Inc . at 98 Beth Lane Hyannis ,Mass. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer J.P.Macomber & Son Inc . Designer J.P.Macomber & iSon_/Inc . l The issuance of this permit sh I of be construed as a guarantee that the s 0_tem*llfunct*o as jdesignedill I Date A/ Inspector1 ( r o ---------------------------- — No. Fee 50. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Digozaf *pgtem Conotruction permit Permission is hereby granted to Construct( )Repair�X )Upgrade( )Abandon( ) Systemlocatedat 98 Beth Lane Hyannis,Mass . `i and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to '1 comply with Title 5 and the following local provisions or special conditions. 1 Provided:Construction must be completed within three years of the date of thi t. Date: 3/oV Approved by F _ - . TOWN OF BARNSTABLE LOCATION Q eff G A f SEWAGE VILLAG ASSESSOR'S MAP & LOTT��, INSTALLER'S NAME&PHONE NO._ /' /V� C ('� M IRPR- Solil SEPTIC TANK CAPACITY _�.b e0 - / o 00 ,ni% 6/ 6/ LEACHING FACILITY: (type)-1 FL c7C�J C/yr4 M��P S (size) S-©o GAL NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: TI COMPLIANCE DATE: Separation Distance Between the: . Maximum Adjusted Groundwater Table to the Bottom of Leaching Facili ty Feet I Private Water Supply Well and Leaching Facility.(If any wells exist I on site or within 200 feet of leaching facility) Feet j Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by I i i 'h n - 1/6199 NOTICE: This Porm Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, Joseph P.M a c o m b,e r J r .., hereby certify that the application for disposal works construction permit signed by me dated 3/2 7/9 9 concerning the property located at 9 8 Beth Lane Hyannis ,Mass . meets all of the following criteria: /The failed stem is connected to a residential dwelling onl r system g y. There are no commercial or business uses associated with the dwelling. _ /The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. y There are no wetlands within 100 feet of the proposed septic system t There are no private wells Within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed There are no variances requested or needed. /Thebottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor Ifeth d when applicable] he S.A.S.will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 3 B) G.W. Elevation 30 +the MAX.High G.W. Adjustment, = S DIFFERENCE BETWEEN A and B Y- 7 SIGNED : VDATE: ''�� [Sketc roposed plan of system on back]. q:health folder.cert Existing 1000 gallon leaching pit 1-500 g llo- Vl-Distribution 1-500 gallon ChamberChamber box. Existing 100 gallon septi Tank t .4 LO CAT ION SEW PERIIIIT NO. VILLAGE IMSTA LLER'S NAME 1 ADDRESS JOH,N A. AALTO BACKHOE SERVICE 150 Walnuf street West Barnstable, Mass. 02668 e U It D E R OR OWNER (' 7-- Ice�s DATE PERMIT ISSUED DATE COFAPLIANCE ISSUED �� / / � � , �. i' � w � � � � � � �� �� � �� \' � � �} • fiy�S ♦; C7)? THE COMMONWEALTH OF MASSACHUSETTS s' BOAR® OF HEALT 7 (/L'./U'...............O F.......... �/�� , ........................ Appliration for Bhip Baal Workii Tomitrurtion ranfit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System a ------------- --- -----.� � �tip. ......... Z01.J(?C..Q'.-------- ---------------- Location-Addre o Lo �/--�1. 1�.Y./........�r�1..J. =---•--------------------- -- � � rCt . res !4 __. �........................... ....., A .. .... .................... / ._ Installer Address dType of Building Size Lot. a��.............Sq. feet U Dwelling—No. of Bedrooms........3-•__________________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtu s -----------------------••--------------------- W Design Flow...........���.................._.___gallons per person Wr/day. Total dail�t�flow.._.._.....��..................... V ns. WSeptic Tank—Liquid capacit41" gallons Length.....__--___-_.:_.`Width__:.-��ff_....... Diameter________________ Depth................ x Disposal Trench—Ng. .................... Width.__`j -------- Total Length------- ...... Total leaching area___ —sq. ft. Seepage Pit No.-__--../---.__- . Diameter-___AV_._. Depth below inlet.................... Total leaching area. .._...._.._sq. ft. z Other Distribution box ) - Dosing tank ( -) Percolation Test Results Performed by------------------------------------------- ------------ Date...----------------•-..________.__-•__-. as Test Pit No. 1.../-� minutes per inch Depth of Test Pit..... .......... Depth to ground water___"_j0W" Test Pit No. 2_..� ____minutes per inch Depth of Test Pit..... �...._ Depth to ground water--------- ® - -/-�--••--------- Description of Soil___. "___ _.._ ___� � !�..... J_.. _ U ----------------••- ---------------------------------- W .-••--•--- ------------------------------------------------------------------------------------------------------------ •-- ----- ---------------------------------------------------------------•---- UNature 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'T T I_.: p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ued by the ®board of health. "7 igne "'_ T •-----•--- •1-- Dates Application Approved By.... (:;•.. .. ..�6's _ ,� Date Application Disapproved for the following redsons:...................-••-•--•-•--•---•-•--------------------••-•---------•=•-•-•-••---•......---•-•---•---_..... ..........•-•--•••--•--•-••--•-•---•-.....••-•••---•••--••-••-•-•-•-•-•---••---•-••------•-•-•••--••--...-----•----•-•----••...e-------------------------.............................................. ,.� Date - PermitNo......................................................... Issued......_/•------` -`--- ----•---------- Date 07? 3v N ......... -Fmi........................... THE COMMONWEALTH OF MASSACHUSETTS • OARD .................OF........ ................................................................................ Appliration for Dhipatial IV s Tomitrurtion Vantit Application is hereby made for a Permit to Construct'12 or Repair an Individual Sewage Disposal System ..4i; ......... ------------ .... .................... ........ .... .. ...... ........................................................... ......... .................... ......................... ftessA Installer Address PQ 4t�� Type Of Building Size Lot_...........................Sq. feet U oms.........93...........................Expansion Attic ( )Dwelling—No. of Bedrooms._______:.!!__._. Garbage Grinder ( Other—Type of Building ............................ No. of persons_________________.__________ Showers Cafeteria ( PL4Other f_4t_vrws .......................................................................................................I_ !I1 0'"J1 _10.� -:3':ar0--------------------------- Design Flow____._ lt!=......... - 0--gallons per person pifAay. Total da' Ow............................................0 9 Septic Tank—Liquid capacit/ .....gallons Length------------_-- Width____------------ Diameter________________ Depth............... Disposal Trench—No_.................... Width �et ...... Total Length______.__ e..... Total leaching area_._ ft. Seepage Pit No______________ Diameter.....W...--Depth below inlet.................... Total leaching area..t!!............sq. ft. Z Other Distribution box O Dosing tank Percolation Test Resul s Performed by------ .................... Date_.___.____.___... ---- Depth to ground water ;-Depth of Test Pit...../0..)- Ame-------------------- .....*.... V 1_4 Test Pit No. L. 2 1 ...minutes per inch .... R_ 44 Test PitNo. 2................minutes per inch Depth of Test Pit_..____.__.--------- Depth to ground water........................ P4 io­ a 0 Description of Soil-.--. logo i ........... ............... ................................................... U ........................... .......... ........I.......................................................................... "211, ............... ----------------------------------------------------------------------------------- -----------------------------------------------------.............................................. U Nature of Repairs or Alterations—Answer when, applicable----------I............................................................ .......................... ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T'!.,7:, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iuued by the byaro V9_ 17 _,,,Signe ........... . . ................ .................... .......................... Application Approved BY__ _________. --- ...... .. ..................... ... I Date ;_ Oa �.--•______________•---•-- ----- Application Disapproved for the following reasons:..................................... ........................................................................ ...................................................--------------------------------------........................................................................................................... Date PermitNo------------------...................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... ...........W IV.......OF........ 7 ... . ....................... 01rdifiratr of Toutpliattrr THIS IS TO. CERTIFY That tjebdivi..uaI...Sewage Disposal System constructed ( rr Repaired by.... ............. ............ 1 . ...... ...............I-------------------------------------------------- -------- Lat..................... ------.. .... a......*e45' .....&E..... ------------------------- --------------- - '-'has been installed in accordance with the provisions of TI P, 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No --- -------71.4........... dated--------- -----------$-------__. .......... 5"' .. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST D AS GU NTEE THAT THE SYSTEM WILILFUNCTIO SATISFACTORY. DATE............. .................................... In. r..... ...................................... ........... ... .... ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 11)WN S A f,:" )U ST A k:�Ll��_ ..........................................OF.............................6....................................................... NFEE........................ Disposal Vorko TM, trait P rmi io il!s hereby granted___________.J[PAA.A�____________..xlv�...........................................................I............... to Construct:- or R i Dispo U." QaIr idual S at No.........)1_1 _1AVEL--------- ---- ................................................. . b. ................................................................ -------------- Street /02 , r— 'r 'r- as shown on the application for Disposal Works Construction Permi, o/...4bated........................................... ...4W 4 .......... .. .... ... ........................ DATE................. 77 Board of Health ............................................................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS TYPICAL STEM SY ' PROFILE AREA PLAN FINISH GRADE= _ I FDN TOP NOT TO SCALE SCALE : I J' (' 11_ 1 , ,C�d ` / S I $':,� FINISH _GRADE OVER TANK H G FINISH OVER PIT=,I">, O , - q 0T 8 BETH S LANE .. . . :., OR vc o o , ,. P ., C. I. PEES ... ..., o • 1 B MT ,� , • 1 e 1 Aw . t GAL. 4 r • f FLR DIST'� BO REINFORCEDX .. o o • e o 0 0-1 CONC E R T E 8 TO 'BE INSTALLED ON • 0 1 1 e • ' o . . / 1 e A LEVEL STABLE • • o _, e - r :: ,- a 1 '0 • • o o e o : SEPTIC TANK .n _., • • • e o e_e ,gi TO. BE INSTALLED ON:A LEVEL BASE� StABLE o • : • • • ' e o . • _1 e e 12it2 18 WA,.`. HED PEASTONE ALL .. ,• BRICK a:;MORTAR COURSES AS o e o • • • '0 1 o e AROUND OF IRONS`FINES �..� REQUIRED TO BRING COVER TO GRAD E : N US PLACE I_ " . . . LEACHING IT 11 - 11 /..'Z0. 00 24 :C' MANHOLE COVER 81 3/4 0 .I 1 2 WASHED CRUSHED t BASE T B V -, . •., FRAME . STONE ALL OF E 0 E LEVEL R ME , SEE DETAIL 1 -IRONS FINES AND DUST_IN PLACE � 1 QFOR FIN. GRA ., E SYSTEM PROFILE SEE S E SOIL AND PERCOLATION :...,Y HIll "11 4 ; � DATA _ PER C. RAT T n _ 1 _ � FOR IN .E V ., 4 � . �a . ,V LE SEE I o C. D. SPOHR 2� 7 • _ , , , • M F ,, . TAKEN BY . 7:!? • .�.,.,- lt� If�LET , o , SYSTE PRO ILE , , _ { _, .. ! a r o q $ D> LINE a _ - ra WIT B 8 �ra,, �' ��`��. f-1 OPENINGS W 4 I ; a /a �. / o OUTCR DIA.B, 13 4 0 o _DATE. L_ - OC7 f INSIDE DIA. , , � .,. . n 3,.25 7 TEST PIT GND ELEV. 4c, r D :� A _ o. _ ;; ,TOTAL , v�e c cRsr o 3 -, . ; AREA ,I _ �.. T oD x > T- _ _ M ,.. ..I G 0 cif ,+" f ::. s., f :. . • :.-.1.I ... 5, �SIDe�1 >x ; 0 0 D I t _ 0 _ I _ `.. >� % _3.4 C�.� ,� s 6 D 1 A. I EFFECT'IV DIA. � .t BOT. pERC. HOLE f l� .n .'� ,. OWN �- G 407 LE /�Ci1IN'G PIT SECTION ,. •,.� NO SCALE _ *. . E S I G N AT T - NO E. DO ,NOT RUN HEAVY ;EQUIPMENT OVERSYSTEM ,} N0. OF BEDROOMS .,.,,.., _.G�. ' D I S P 0 S A { F -1 LEACHING PIT NOTES. 3c3 EST. TOTAL DAILY EFFLUENT GALS. . P G+c'� : CONC. TO BE 4000 P.SI a 28 DAYS . ' SEPTIC TANKL. GAL. , 1 2. RCINF.-W 6 x 6 6 GA. W. W. M. I ,��f` IE� T� 7°� SNUTA/A/ O�! Tl-�Y',S PL 3. -2 :AND 4 SECTIONS ARE AVAILABLE .FOR F 1A: 5'r QI GENERAL , NOTES T2�W�I p. GREATER DEPTH REQUIREMENTS REGU�:F�7"Bc V I . ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN • ^ �' -,�„ • � / �'" . � NOT , ACCORDANCE T T•�' E �f?C�c'� 'f WITH ! LE 5 0f THE STATE SANITARY CODE . EXCAVATE.TO ELEV.— OR LOWER AS DATED JULY 11977 a'ANY LOCAL RULES APPLICABLE. REQUIRED TO REMOVE A AM AND : A TA ALL LOAM CLAY CON I N ING A ; `2. ANY CHANGE TO THIS PLAN -MUST BE APPRD. IN , MATERIAL` BENEATH PIT REPLACE T E I R E L CE EXCAVATED MATERIAL I OWNERS � �4 `. WRITING BY .MR. :CHARLES D. SPOHR. WITH CLEAN CLAY FREE GRAVEL MECHANICALLY 3. WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACKFILLING COMPACTED IN PLACE. _ , , r ; NOTIFY THE ENGINEER AND BOARD OF HEALTH FOR INSPECTION. SIDE AREA S.f.� S:F/GALGALS 4 F A.. FOUND ANON ELEV. MUST BE CHECKED WHEN COMPLETED. c0 F/' e ,+ BOTTOM AREA- S-F.�_S. F. GAL-GALS ., 5. THE M SE ELEVS UST NOT BE CHANGED WITHOUT WRITTEN _2 APPROVAL B A .TOTAL AREA S. F. TOTAL .. .GALS Y CH RLES D SPOHR. LEGEND FOUNDATION INSPECTION REQD. WHEN EXCAVATED. I -1- 50.0 EXIT. GROUND ELEV. B. M. NOTE . FINISH INISH' GROUND ELEV- UNDERLINED R,E V. DATE R I P T_I - DESC ON � '�„ 47 50 PIPE INVERT. ELEV. 14 4 L ; 7. .� ) Oil/ PAY U . ., LOT e 9S50"E0 L , -�-;� @ TEST PIT LOCATION SEWAGE DI SPOSAL SYSTEM - FOR 0 . o SEPTIC TANK � AREA LAN* : DISTRIBUTION BOX CLARK 1� rLy " IN , BU L � � - - t F, F s NO T E zo �,� �aT rev B E T H S LANE �^r 4 C. 1 . PIPEr'"� `.. w. _ ,„ ' ' �,� s ` tl P CHER� WAYS YA tfitttttt-I— 4 BIT. FIBER PIPE TIGHT JOINTS I.l . .�/•� v, y��^b • P C,D HR . DESIGNED... S O DATE "fi°:` DRAWI , F_"A _ �. c" c, ,.. 'S�JVS.�,r, ?� N G NO .PROPERTY LINE ` ,��szc�: �� ,: f £ t rf..J ..T ,.�..�. .,:,� � _S i F i DRAWN: , �„� SCALE:AS SHOWN MIN. CODE DISTANCE sew + . , A EC P CL` LOT HOUSE ,, � ,� 09 ,cl . MAP S w.. . , NECKED., C. D. $ •