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HomeMy WebLinkAbout0091 BRISTOL AVENUE - Health 91'BRISTOL AVENUE,HYANNIS A= 291 150 l e D ° i ° i III l ° f ° COMMON EALTII OF MASSAC11USETTS I;;s EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS UFPARTMENT OF ENVIRONMENTAL PROTFCTI ()NI:. W1N1r.R S'VREET. BOSTON. NIA 02108 6i_ 292.5500 v � 1v11.1 10i r w l t.h �4R1!UY G XE Gcncrnor 350 MAIN STREET 6 Src ar. WEST YARMOUTH, MA 15Tut)n i11: ARGCO PAI It-CI.I.I.1IC(1 508-775-2800rim _ C n i inner l.t Gnvcmnr �'�p N SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR PART A S CERTIFICATION MAP 291 PAR 150 PROPERTY ADDRESS: 91 BRISTOL AVE,HYANNIS ADDRESS OF OWNER: DATE OF INSPECTION: OCTOBER 22, 1998 MICHAEL KARRAS NAME OF INSPECTOR : JAMES D.SEARS I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR 15.000) COMPANY NAME: A&B Canco MAILING ADDRESS: 350 Main Street,West Yarmouth,MA 02673 TELEPHONE NUMBER: (508)775-2800 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: X PASSES CONDITIONALLY PASSES NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS INSPECTORS SIGNATURE: DATE: OCTOBER 22, 1998 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 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. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: X I have 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. COMMENTS: SITE OVER ALL PASSES, INSPECTION OF SYSTEM IS BASED ON CONDITION OF SYSTEM AT THE TIME OF THE INSPECTION.THERE IS NO GUARANTEE ON THE LIFE OF THE SYSTEM. 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 b the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or NO). Describe basis of determination in all instances. If"not determined", explain why not) N/A 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 is failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. Page 1 of 10 • (Revised 04/25/97) DE'on the World Wide Web:http://www.magnet.state.ma.un/d SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 91 BRISTOL AVE, HYANNIS Owner: KARRAS,MICHAEL Date of Inspection: OCTOBER 22, 1998 B]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). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C]FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N/A 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) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)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 to 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 1 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 and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (Revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 91 BRISTOL AVE, HYANNIS Owner: KARRAS,MICHAEL Date of Inspection: OCTOBER 22, 1998 DJ SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: N/A 1 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 necessary to correct the failure. Yes No 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 over- loaded 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'h 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 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 coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria above: N/A 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 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 mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full 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 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 91 BRISTOL AVE,HYANNIS Owner: KARRAS, MICHAEL Date of Inspection: OCTOBER 22,1998 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,including 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 The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. X Existing information.Ex.Plan at B.O.H. X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)[15.302(3)(b)] (Revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 91 BRISTOL AVE,HYANNIS Owner: KARRAS,MICHAEL Date of Inspection: OCTOBER 22, 1998 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 g.p.d./bedroom for S.A.S. ! Number of bedrooms: 3 Number of current residents: 4 Garbage grinder(yes or no): NO Laundry connected to system(yes or no): YES Seasonal use(yes or no) NO Water meter readings, if available(last two(2)year usage(gpd): 1997 94,800/1998 113,300 Sump Pump(yes or no): NO COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gallonslday Grease trap present:(yes or no): _ Industrial Waste Holding Tank present:(yes or no) Non-sanitary waste discharged to the Title 5 system:(yes or no) Water meter readings, if available: _ I Last date of occupancy: _ i OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: N/A System pumped as part of inspection:(yes or no) NO If yes, volume pumped: Gallons Reason for pumping 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. Copy of up to date contract? Other APPROXIMATE AGE of all components,date installed(if known)and source of information: 1995 PERMIT#95-1020 Sewage odors detected when arriving at the site:(yes or no) NO I (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 91 BRISTOL AVE,HYANNIS Owner: KARRAS,MICHAEL Date of Inspection: OCTOBER 22, 1998 BUILDING SEWER: N/A (Locate on site plan) ' Depth below grade: Material of construction cast iron 40 PVC other(explain) Distance from private water supply well or suction line Diameter i Comments:(condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK:X (Locate on site plan) Depth below grade: 16 Material of construction X concrete __ metal — Fiberglass — Polyethylene — other(explain) If tank is metal,list age Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: 1,500 GALLON PRE CAST Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How dimensions were determined AS BUILT&TAPE 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.) TNAK AT WORKING LEVEL,TANK AND COVERS 16"BELOW GRADE OUTLET BAFFLE GREASE TRAP: N/A (locate on site plan) Depth below grade: Material of construction — concrete — metal — Fiberglass — Polyethylene — other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,evidence of leakage,etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 91 BRISTOL AVE,HYANNIS Owner: DARRAS,MICHAEL Date of Inspection: OCTOBER 22,1998 TIGHT OR HOLDING TANK: N/A (Tank must be pumped prior to,or at time,of inspection) (Locate on site plan) Depth below grade: Material of construction concrete metal Fiberglass Polyethylene other(explain) Dimensions: Capacity: Design flow: gallons/day Alarm level: Alarm in working order _ Yes; _ No Date of previous pumping: _ Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX:X (locate on site plan) Depth of liquid level above outlet invert: 0 Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc,) D-BOX IS 16"X 16",26"BELOW GRADE ONE LINE IN ONE LINE OUT, BOX IS CLEAN AND LEVEL. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) I (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 91 BRISTOL AVE, HYANNIS Owner: KARRAS,MICHAEL Date of Inspection: OCTOBER 22, 1998 SOIL ABSORPTION SYSTEM(SAS):X (locate on site plan,if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits,number: 1 leaching chambers,number: _ leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number, alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) ONE 600 GALLON PIT 4"WATER IN PIT, PIT IS 4'BELOW GRADE,COVER 10"BELOW GRADE. CESSPOOLS: N/A (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: _ Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments:: (note condition of soil,signs of hydraulic failure, ,level of ponding,condition of vegetation,etc.) PRIVY: N/A (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) (revised 04/25/97) Page 8 of 10 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 91 BRISTOL AVE, HYANNIS Owner: KARRAS,MICHAEL Date of Inspection: OCTOBER 22, 1998 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100(locate where public water supply comes into house) PAN 0 0 0 i (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 91 BRISTOL AVE, HYANNIS Owner: KARRAS, MICHAEL Date of Inspection: OCTOBER 22, 1998 Depth to no groundwater 12 feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record X Observation of Site(Abutting property,observation hole,basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators,installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(Must be completed) NOTE TEST HOLE NO WATER 12'TEST HOLE (revised 04/25/97) Page 10 of 10 �� ► �— TOWN OF BARNSTABLE LOCATION 92 A-' /E SEWAGE# 95 VILLAGE ASSESSOR'S MAP&LOT 79/ 13-0 INSTALLER'S NAME&PHONE NO. �J�H 196 Iry SEPTIC TANK CAPACrrY /Ssl7C> LEACHING FACELrrY: (type) cfa (size) X/!� • NO.OF BEDROOMS `3 00, BUILDER OR OWNER o vvi'd Aa PERMTTDATE: COMPLIANCE DATE: Ff 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 V h 4� f o ASSESSORS MAP N0: _ PARCEL NO li NOJ Fxi3 3.?.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Di-tipoottl Work.6 Tomitrurtion Permit Application is hereby made for a Permit to Construct ( ) or Repair ('C) an Individual Sewage Disposal System at Location-Address o o Lot N . ........... -=...'•v..�qL�, ................................/ �1'If1 s .Js...�)ius per,ncr n r ss , Installer Address UType of Building 3 Size Lot............................Sq. feet Dwelling— No. of Bedrooms.........___________________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) WOther fixtures --------------------------------------•---------•-----_.-_-----------•----------------- W Design Flow............................................gallons per person per day. Total daily flow................................._..........gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '" Percolation Test Results Performed by.......................................................................... Date........................................ 1 Test Pit No. 1................minutes per Inch Depth of Test Pit.................... Depth to ground water........................ rX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R; -------------------- ------------------------------------------------------------------------ •••••-•------------------------------- ...... .-------------- ...... 0 Description of Soil........................................................................................................................................................................ x U •••-••••-•---•-•••---••--•-•--••-••----•-•.._._..•••••---------•••-•-•-•---•-•----••-•••••••••-•-....-•••••---•••....-••----•-•••--•--••-•-•-•-••--•---•-••--•--•-••-••--•-------••-••-•-•-••......•••-- w --------------------------------------•--•---------...------.........................-•-------------•--------------------------------......------..........•-•-•------•-•-••• ----- U Nature of Repairs or Altera ions—Answer whe applicable.... � .21�-8_ ........TO_--.•-_:Ti'TL //✓ST/�LL,... /.�Q 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 ha en issued by th�,,ard health. Sined ....................... ...................... .......C .................. ............ . Application.Approved By .....e..... �........ .......... ...... -..... Due Application Disapproved for the following reasons: ................................................... ................................................................................... ................................ .............. . ..::....::............................................................ ......................... 0 .............�..._.......... ............. Permit J ..................... ......... Issued ............... ..... ................. Dace 00 1 THE COMMONWEALTH OF MASSACHUSETTS i� BOARD OF HEALTH TOWN OF BARNSTABLE 1 Appliratiun for DiuVuuul Works Tomitrurtiun 11antit Application is hereby made for a Permit to Construct ( ) or Repair (,�/) an Individual Sewage Disposal System at: �� Location-Address or Lot No. V . ..... .."'-..... .. ..................Lc�AC,c I�/7- r. 11 Yi5,_- T��c.�---�!//LC S O v. r '/ < A,d........aZE^........A-.... 1�0e- �-�C./.[/�.�-------------•-- Installer Address Type of Building Size Lot............................Sq. feet ►, Dwelling— No. of Bedrooms..........__ .............................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—Type of Building No. of persons............................ Showers g ---------------------------- P ( ) — Cafeteria ( ) ...4Other fixtures ------------------------------------------------------------------------------------------------------------------•-------•------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length________________ Width---------------- Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 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. I________________minutes per Inch Depth of Test Pit.................... Depth to ground water........................ �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ix ..........................................•-------.....------.................--•-•---------.....--'......................................................... 0 Description of Soil........................................................................................................................................................................ W V ----••--•-----•---••---••••--------•----------------••-•-•-----•-----------------•--------------•-------------•-•-------------------•---------...---------------•---•-------...----'-------•------_..... W U Nature of Repairs or Alterations—Answer when applicable....UPe<Xvl ----.--•.-7(�--- T!-T/-_�........................ in/,ST�...... �3vn �;A -= �I.±/,C-.... is�.�'i 6(i 71��.. -----4.,'y ------.4"' ... 7- 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 hq, 4en 'ssued by the board of health. Signed .................... ............... ... . .... . ... ................................. ........... .�....�....... Application Approved By ....... .:....�i .. ......... ...... 2r............................... ".. Ca�,,l`��. Application Disapproved for the following rearonr: ....................................... .......... ........................................................................... ................................................................................................................................................................................................................ ........................................ Permit No. .... f� ..fr� ........ Issued ....�.................D. �i� ......................... u�« THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (NILIPertifirate of U-ampliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (!/) by ..................................................................Jc1�±..n.....f�...... ........................................................................................................................ .. at .......................................!9/...... ......... ............................................................................................................... has been installed in accordance with the provisions'of TITLE 5 of Thy State Environmental Code as described in the application for Disposal Works Construction Permit No. �� "... Lf..�Y4 dated..`...Ocv---.-..- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................................................................................................ Inspector ..............................................•--._............................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 30 No..� � ��d FEE.• ...........:.. 11iupusttl Works Tonstrurtion Frrmit Permissionis hereby granted------------------�ULirt....R..'A &--------------------------•------.-------.------------------------••---.----------.--- to Construct ( ) or Repair n Ind;* idual Sm a Disposal System at No................ C!_ ..............� .4s-ni?./.5 //.''.. ............ as shown on the application for Disposal Works Construction Perrr�a�2GV6`'��"��6 Dated....�.�._�4..'_,�-�- -•-------•------------------------ X..ard� -H---e-a--lt-h------------------------------------------- DATE................ .. ................../ / .. Z .......... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS No..........`........ FRic.............................. THEBO COMMON®ALOTH AR OF MASSACHUSETTS ..........0F.......... A. . . . ...... ...... .. � H E .................. Allpfiration far. Dispaiial lVarkg Tonlitrurtivit ramit Applicatiow is hereby made for a Permit to ConSt-uct or Repair. an Individual Sewage Disposal Sysjt at,- xtvjek�...i ..�W�.... ..... _d, --------11-1---I--- -­­11---­­­.......................................... . . ........ .... YPI- -- LoC23,on,Address or Lot No. .................................................................. ................................... ................................ 6JL� Address -------------------------------------------------------------------------------------------------- ------------------------------------ Installer Address -4- Type of Buildings Size Lot._/,�.��........Sq. feel U Dwelling 4 No. of Bedrooms....... 7.............................Expansion Attic Garbage Grinder (Yo PL4 Other—Type of Building ............................ No. of persons......_...._._.._.._.._..... Showers Cafeteria A4Other fixtures ------------------------------------------------------------------------------------------------------- .......... .< ;0....................gallons. .W Design Flow LU.—_.........gallons per person per day. Total daily flow...3M�-- ------------------------------- 04 Septic Tank T*'L"i'q"u'i'd""'c'ap"a'ci't'y./,�Wallons Length................ Width................ Diameter---------------- Depth___.__.__....... Disposal Trench—No Width Total Length..____....... .......... Total leaching area.........;;.... ..sq. f t. .... Depth below inlet Total leaching areaZ_41.�;.....sq. ft. Seepage Pit No......... 'Diameter.._._.,'*'...", e------------ inlet_ Other Distribution box ( ) Dosing tanj�?( 07 1 X" Percolation-Te*t Results Performed by........—A? .................................. Date.. Test-Pit NO-!I... -----minutes per inch Depth of Test Pit.................... Depth to group water..__........____.___.... -- - Test Pit No. 2..................minutes per inch Depth of Test.Pit____________________ Depth to ground water........................ .......... 1 -------------------------------- ------_ �-- 0 Description of Soil------ = .................................. .... 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'TT:,— 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has e n issued Vsu e d bD the d health. SigSd . ...... .............................. Date _j p Application Approved By....... .... ............. 7 Date Application Disapproved for the following reasons:................................................................................................................ ..................................................................................................................................I..................................................................... Date PermitNo......................................................... Issued-------------------------------------------------------- Date No........................ FmO�f..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD HE ...................... ..... 0 .............OF........ Appliration for Dhipasal Workii Tomitriartion thrutit Application is hereby made for a Permit to Cons ruct or Repair an Individual Sewage Disposal Systa J2... . ....... ...... .... ...... ........................... ... ................................................. Cons uct L0C ion Add s .................................... ....................................... ................................................. 01 ;11�,.Address .. ... . . .................................... ................................................................................. .............. Installer Address zic_ U Type of Buildm�p Size Lotl_r,.�` ...... So. feet Dwelling X No. of Bedrooms------wy..............................Expansion Attic Garbage Grind"er'(/y4 A4 Other—Type of Building ............................ No. of persons...._....................... Showers Cafeteria PL4 Other fixtures .................................................................................................... . <11 Z_T"iP....................*----------- W Design Flow _.gallons per person per day. Total daily flow....7je................................gallons. 9 Septic Tank L'L"'iq"u"id'....capacity/W Ilons Length................ Width.......____..__. Diameter--------------_ Depth.........._..... Disposal Trench—N�--------- ...... Width ------- Total Length --- Total leaching area ---sq. f t. Depth below Total leaching ar;;.:?T.:*.............sq. f t. Seepage Pit No........A----------- Diameter..... ..... )w ini Other Distribution box Dosing to ,( Percolation Test Result Performed by......... ...................................... Date_o,��... Test Pit No. .-minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.__................. Depth to ground water_-__._.......__..._.___. I. ..... ................................... .......;�VIW Z i�"" >11,----- Description of Soil------0.-1......X.V.X /"-' C � 40 0 ....... ......... ....................... .................................................... ------------------ ......................................................................................................................................................................................................... U ........................................................................................................................................................................................................ 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'T'LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in I-� operation until a Certificate of Compliance has jeen issued e)o halthe Si .. .......411&6......... .......................... Daty Application Approved By...._ ......4rro ... ..... ?y - ---------------- Date Application Disapproved for the following reasons:.............................................................................................................. ....................................................................................................................................................................................................... Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF, HEALT T ... . .............OF...........Z.!!;;W .................. Tntifiratr of Tomplianre TOIS I TO*TIFY,,7hat4e Indivi)Mj Sewage Disposal System constructed or Repaired by..... ...... ....... .......... ......................... -/----------------------6 s a, t '00 a ................ ..... ..... ..... ..... .. - ----- -_ ------- .. ................................................ has been installed in accordance with the provisions of T TTN, of The State Sane* aryv Code as Z describ d the P......application for Disposal Works Construction Permit No. ...�?Jf............. dated_.'._...Y.........$`_ ......................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIO SATISFACTORY. 4 • ---------------------------------------------------------------- DATE............................ .......•... Inspector.... '.&,�:1 THE COMMONWEALTH OF MASSACHUSETTS BOARD 'OF HEALTH ..................0 F �9 .... -................................................................. 3 J No.................. ..... FEE........................ R11110vit Sur onotrurUan Pamit PeI reby ranted---C/...* ....... ................. ............... ............................................................ r t k� to on R an InOiduid Sewage D* sal S)Oterry pr)Repair eZ C 0 .....2.............. ............ ................................ Street P � , �4 2 91- do P It -3.D as shown on the application for Disposal Works Construction P it N ated........ ........................... - W44 .............................. ..... ...................... Board of Health 7 DATE ..............2/...;Oel..................... FORM ' '0 1,;"1255 HIBBS & WARREN. INC.. PUBLISHERS +` _ . „��-.,'•ram' Y t . 16 AL C. 11v r y u/ 1. 4 s:r25you U© ry LEGEND jXl#TlNQ SPOT ELEVATION Oxo �*�`-"�'4� �� CERTIFIED PLOT PLAN y IV Irk XtB `INA CONTOUR --- 0 --- _ .�°��,���, oF��, t, tJ:*ED, $POT ELEVATION � � ko � p /�Y� �� FIlIt H O CONTOUR 0 d��r ? `;* — •+�� a �C!NIF(f$ iT lip IN PFRCIVED•l BOARD` OF HEALTH q pr�.221R2 aaS. V AGENT �,A�`�'�' SCALEt / �'� 30 DAM AO ad ENGINEERING CO! 'NOCLIEN a cc • i CERTIFY THAT THE PROPOSED R6 R 618ThRED a BUILDING S� OWN ON THIS PLAN � , JOB N0. �1�y _ tL uA�1Y r DR.BYt �� CONFORMS TO THE ZONING LAWS OF BARN B JN a. 712 MAIM ST. CH. BY: ... :. , HYANNIS, MASS. ,Z . SHEET OF DATE REG. LAND SURVEYD ,'Y:. /YOTLc : /F EITHER TN,�'SEP7/G TANk OR T 2D FT N/N. LEi4CH//VG P/T AMe MORE rNAN /2"ArELOW 14 Pr. M/NC - CrR/►0E, A "",P1 tM FTER CO3VC.t'E rW COo•Oir. y K---- I .�� /r �jTi?At 9 CONGRC7Y� «PVC P/PE /4-=,4 V Y CA S T /R O/Y C 0✓ZPA' S oYA L-I- tS�.IF l/S EO MIN. P/TC/V 2•�•�.. M/N. CO/VCRE TE CCU✓ER CLEAN SAND L/QU/D LEVEL _ 4"C/IST 2 LAYER RO /GoQ 0 0 0 -'b MIN.PTLN GAL. D/ST, e 1 • • • • • • • ' p4o WA5HFD STONE `PER IT SEPTIC TA/VK BOX p • a e • • • 'Apo p , e b r: e • Qp 1 •EFFECT/✓L Ir • • 3�4 - �/2 o • • DEPTH • • • • o WASHED STONE :'`: ° • . • • • • • ;v PRECAST SEEPAGE P/T OR EQUIV. 1AIV4w 'T E4E1iA7'1oN5 `�Co oy,, r� a : op s • • • • • •aa o /NYERT'AT OU/LQ/NG T, t 94''� F • 6 D/AM. S SEPTIC TANK ;Or. FT _ FT O/Xl!►J._�^ C EE TAe!/L�1T/ON> OUTLET SEPTIC TANK, 9 �9 FT. //V,(ET D/STR/BUT/ON BOX f A 7 FT. SEC T/ON OF GROuNo W,4-rER TABLE OU7ZETD/5TR/BUT/ON BOX ��� FT /NLET LEACH/NLs /�/T yFr. SELVAGE DISPOSAL SYSTEM TAQIJLAT/DIV LEACH1 VG F'/T DIME/VS/ON A 7-5- FT. DES/G/V CRITERIA SCALE : %4 " _ / ' O� p/HENS/ON $�f FT. NUMBER OF 6EOROOMS G,4R0AGED/5PO.SAL UN/T SOIL LOG SOIL TEST TOTAL E3T/MATEO FLOsN� 3G GAL.1DAY -SOIL TEST 41/ SO/L 7- ST#2 NUMBER OF -04CHlMG P/7_S f^ELEY. T• G _,arLEY. IF 6' G ,DATE OF SO/L TEST AP�� Qf S/OE LEACH/NG PER P/T / _SQ, FT. G �- RESULTS AV/TNESSED BYA-==�� BOTTOM LEr4CN/NG PER P/T $Q. FT. �Cc��♦ S•!t S PeW COLA7.1ON DATE,*/ l�If �M/NvI/NCH TOTi4G LEACH/N E T.G AR,--A c SQ. F PEkCOLf►T/GN RATE 2 I'— M:N;, l NGH RESERI/E LE,4G"NlN6 ARLa.� �w.= •,SQ. FT. / �/� � i. ' '- •.. `mot � s� �' c ,/0 r-� S/'c v P. �S�,GN�, �''� ELOREDGE ENG/VEER/NG sp W.,INC. u _ ... / �' • a 7/Z MAIN ST. ❑ NO G/TOV1Vo J V,4TCiT ArVCOU/V7&- HYAA/n/i3 MASS. Q GROUA10 1-i/.A7-ER AT ELElI -. .IOB /VD. f SHE,ET OF i