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HomeMy WebLinkAbout0034 CONNEMARA CIRCLE - Health 34 CONNEMARA CIRCLE HYANNIS t ° r I ° ° o ° ° o ° ° u o c ' ° Vol* Commonwealth of Massachusetts John Grad Office Of Envlrohmehtgl Affalts D.E.P. Title V Septic Inspector ®ep®rtment Of P.O. Box 2119 Environmental Protection Teat' pA, AAA 02536 1-2 �3 �cionF.Weld � . iee, o� `, � David B. StruhsCff ® Commtpiona SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - MAY 2 0 _. ss r PART A 1996 CERTIFICATION, Property Address: 3 ��1 -�a�a '�' , �CADSes's4f Owner: e �•�:;'`, Date of Inspection: �j rC((p (If different) Name of Inspector: = Company Name, Address and Telephone Number: CERTIFICATION STATEMENT I certify that I have personalty 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: Z-� L/Passes _ Conditionally Passes ` Needs Further aluation By the Local Approving Authority _ fails Inspector's Signature: Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd 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 s\stem owner anu copies sell; to till bu�el, if applicable and the appro•.ing authority. INSPECTION SUMMARY: Chedk ALB, C, or D: AJ SYSTEM PASSES: 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. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired: The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) One WUfbr Strut • Boston,Massaohusetta 02108 . FAX(617)UG-1040 • Telephone(611)2p2.5800 Printed on RwVdW Paper SUBSURFACE SEWAGE DISPOSAL;SYSTEM INSPECTION FORM •._... a:. - . PART,A., .�• ,,.a ti CERTIFICATION (Contin" t _ .. + �a� h'. t S � �.• srt*ter. ..3 'ir I ` "' •.,•,;', %' ' J,..S w`.si iJ:#tarw�r�.St s a (r[ ��.�•cµdt i,� 4+ ,h;•i�,.�.��<�,�' ,�. Property Address: i' r t !t* J� ..Er. t t } � Y+.17 i Owner: + (� � :o a Axt : afttl 5.1}tr,'.a .5 J r •Ftl.a: r wf,#ti .a� aarir Date of inspection: \4`—}J 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,distribu(ion box. The system will pats inspection if(with'approva) of the Board of Health): Y ' broken pipe(s) are replaced--- obstruction is removed , distribution box is levelled%or replaced,;;".� „"'j. `;'�• ,,.N•ii•; ;t„ �i�,4 _ The system required pumping more than four times a year due to broken or obstructed pipe(s): The syst'e'm` will'Pas!i inspection if(with approval of the Board of Health): ,Y; ;,; .,, ygs:,i �+, i:Y L`u Sna�' ti} t:r•+: broken pipe(s) are replaced obstruction is removed ' . , i •fir ♦ -, l+ i i t „ j.� .''Ti„'. .. .. .. .. .. 3.Y?}'[,1,-y ciri: 'V'1�. ia.,•j iyiY .�a$''+.:s: .tint 1 fs. ::tl ril i';0�12r r� Mn 1 .r;!''i tt�i�:Af ,. .t'} !I$*Ciet y:fil}:rj ` °x 4ii'.CC Ott f i. 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 system1kfailing to protect the.- public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD Of HEALTH DETERMINES THAT THE SYSTEM IS NOT.FUNCTIONING AWA MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: .}. ;. . , r`�. i• ^r �y� ` � ��h :.?t9a test 1�1:ai7•r;�3i;F' _ 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. } ' •� .:,. a.t i ,: , 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)'DETER MINES THATY•- THE'SYSTEM IS FUNCTIONING IN A MANNER:THAT PROTECT THE PUBLIC HEALTH ANDsSAFETY'AND THE.�`yf`= ENVIRONMENT: �i.r ., i.cl 1. ?a:L:` t i•I� i r.' 7 7.,c }ii.'aj llt�r •r yil Si L':* ✓} �r �h tt, L 1%i- _ IhP >\sien, nd� a +eull( jan abut;U but; dbsorption sybient and is w`lhin,ices frEi :u a iiila:c 'I'.'a.C: $:irp�)`V•`\IIVV.a�j ti. u surface water supply. The s\sip- hay a septic tank and soil absorption system and is within a Zone I'of a public water supply well. ' The system has a septic tank and soil absorption system and is within 50 feet of a private water supply.we,11., _ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a`'private'water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates.that the well,is , and the presence of ammonia nitrogen and nitrate nitrogen,is equal�o or less than free from pollution from that facility 5 ..,:Z, r .`_; .,• PPm•.,. .�:�..:,:.a:�$:,.. ^:t'illi;t'3i{` ti'iilS t.,...;l+.., r".1�y48VE Y;: •Lit} i;JJf.+:3i:..1{S `�••"ttii Y:J(P._•'kk.li'1i7 �i�:c uiIi+O} :tilil 3Yr�'f 1 . .. Yf JIi4.l t^'Ai4.�ly jll.,:2"1•t.V+Fjt•1 T. ♦.•!.]�1 }J.T•'lii7 .17 �:.a •• D) SYSTEM FAILS: . 1.' .,.\. .' t.., ♦.f 4',•'. t� h �.... i�# • I have determined that the system violates one or more of the following failure criteria as defined in 310'CMR 15.303..The basis '. for this determrnation.is identified,below. The Board,of Heelth should be contacted to determine what will be neeessary.to correct ' .� ..8 .,�: .\� _�. .•tti .Y.. .�:,f3t i-,M+i f,;i.i,�l;:;rll(+fr.wl:i;i S tT7S.':YZ Si%:�iii Si;tSll J ,lf «.•,•••.� ` the failure..... �,.. . ,.. Backup of se getinto facility or system component,due 19 ap oyedo ded or.doggg!d $AS or cesspools t �, �ti c y �.,•,ra, •r • ,��..'. _ .� '<• ' ` = t � +'or ,i•� � O]n yOV flOaded Of Clogged'SAS ?` Discharge or Qondin of••effluent�to the surface of the round or'jurface Waters due t 'Of e ... .• BIr 1....u• .. cesspool. iti; tt i.. ;i �vlv ,c (revised 8/15/95) Z 3ti� c;knxt . . . .. .it..� !.!'� Rl a:.:.i,;i.-rW s• 4 �:,K.••./'�. .1' l.t c.v�': r il' iris-."r 04/i St..S',27$rt�%�' ,-'+`aft�<'; JS ik tl:: Ikriii.�l«•'5+,�•' - L� 71 L "' •�•JI\.7j i.J•!MYJK.•:w 'Y r4 .. .' .. + .. 1 f i i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART A CERTIFICATION (continued) Property Address: Owner. Date of Inspection: DI SYSTEM FAILS.(continued): " _ Static liquid level in 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 1/2--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. F Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary.to•a.'surface'water supply. _ Any portion of a cesspool or privy is within a Zone I.of a public well. Any portion of a cesspool or privy is within 50 feet of 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 welf water analysis for i coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate.nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in additiori to the criteria above: .. .. . .- :..� ... ,,,..•_ ;: a, ; -• U t :}.. - .,. . - Val �:�" Hq.] ,.c � _ ' The design flow of system is 1.0,000 gpd or greater.(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet.of a surface drinking water supply the system is within 200 feet of a tributary to a.surface drinking water supply' t the system is located in-a nitrogen sensitive area (Interim Wellhead Protection,Area (IWPA) or a mapped Zone 11 of.1 public water supply welly The.?caner 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 MO. (revised 8/15195) 3 00or SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM. PART B CHECKLIST Property s_: Owner: ��� U \ Date of Inspection: 51 Check if the following have been done:,... _Lftfn�ping information was requested of the owner, occupant, and hoard of,Health. _one of the system components have been pumped for at least two weeks and the system has been receiving)normal flo, .rates during that period. large volumes of water have not been introduced into the system recently or as part of this inspection.. ON(f� iuilt plans have been obtained and examined. Note if they are not available with N/A. _-facility or dwelling was inspected for signs of sewage back-up, l_We system does not,receive non-sanitary or industrial waste flow ~' _'[he site was inspected for signs of breakout.- !-�Cfl system components,,excluding the Soil Absorption System have been located on the site e 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, x' L-T"he size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. _The facil':} o..­•'(� '4 ^'r"rpnt5. if differPnt frnm o%N,nert, were provided with (nformapon;on the proper'mamteridnce of Sub - Surface Disposal System. .., (revised 8/15/95) 4 i SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FORM , PART C p'4%SYSTEM INFORMATION Pro pert ess: L1 (O � : ' .ti} ,7: -�''+ k:•�'• ::. <:M.:._ .:.,� Owner: Date of Inspection: 1�q(o i,'�a .' er x •,,:,:.., .t s �:.c. FLOW CONDITIONS RESIDENTIAL Design flow: allons Number of bedrooms: Number of current residents: 0 Garbage grinder(yes or no):� rt:. . . �' ... ..,>;v.,.. Laundry connected.to system (yes or no)�S Seasonal use (yes or no): (�� `.`.'y��;t«.�,` 3' .",�.? . :' 'a' ;:•;,., Water meter readings, if available: Last date of occupancy: C+ ,C1Qy _`1 7.__ 10 .,:, +e ,r�.,s ..., �r r, } •� . : �r.... 'i CCOMMERCIAUINDUSTRIAL• Type of establishment: ` rc, ,<•;)!;.s4 Li! t iirt t Design,flow:_gallonVday Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the_T,itle,5,system: (yes or no)_ Water meter readings, if available: - r• `� Last date of occupancy: OTHER: (Describe) } ;r,C Last date of occupancy: ,• .r�t+r•^ia c r n ?;� id3:try Y r a+l Wrt�f. ,t ,rc1vY GENERAL INFORMATION •;+,;;, in ^.cii rnl; .e v. .,�1•�; n•fk;y. w r;;;S (sioi l i4nj . ! PUMPING REDS and source of information: r .,'^f System pumped as part of inspection: (Yes or noY E _ _ _ If yes, volume pumried +' gall ns,i� • Gi. .. 3'Z!.i.,.f rs) i:it)..r!t1t ti )lTes i; n.,:}nG 7rT O r' rl' �`ilCs:fl fig J, t+, .r..,., ifirl , Reason for pumping: r �_.__ _._.. _ ! .:y . a.;r .; :c ;n,t!! .twj TYPE.OF SY TEM ... ,. _'.. ._ .. ... ,_..�_. ......4�_. e tic tank/distribution box/soil..ab or �- � p absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) (revised 8/15/95) 5 , $UBSJJRFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM • PART C. SYSTEM INFORMATION (continued) Prope ddress: y 'C�,t�e1Q�c. C��c�, "i;s '1 i '? ';� � i'i�r, Owner. Date of Inspe lot SEPTIC TANK (locate on site plan) t F �' p� ;.i Depth below grade:, I Material of construction: _ crete metal _FRP_other(explain) 7 s ! , ,.-• ,,.z,:. ;4;:�•,:1 Dimensions Sludge depth: Distance from top of slg4ge to bottom of outlet tee or baffle: . •• __ _ . �.��...• .• �..• Scum thickness: "— 11 - ( _ , Distance from top of scum to top of outlet tee or baffle: 1 Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition inlet and outlet tees or baffles depth of liquid level in relation to outlet invert, structural , ,,;: t' integrity evidence of leakage, etc.) L r GREASE TRAP;C� (locate on site plan) ". Depth below grade: Material of construction: _concrete _metal _FRP ­other(explain) „� ;,,.,;;:;,;. .,,• ; Dimensions: Scum tiiickne». z:�r'. . •.Y..f l Distance from top of scum to top of outlet tee or baffle: Distance from bottom ni cr,:n1 1� bottom of outlet tee or battle: I ;•t 4tdClf �. � ♦ _T 1 i��fe:1_F'a. ,"e•tattie, .`+f:T.,'.:i -..i.1,:`,� ...,..•wr w�...yr„~}. lr..w._...f' s. �1?........,_.... Comments i•_ . :} ,,:.+,., r.: t, F, ;, (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.i i r.:� :tSr�J? 1Vai.,,.�, .1 �4it.I.taj,fy ia�i.t r .'t( ,;t .i f:7'S;) t:r`.1 h'�;J:C�d tk:,.•�,r. ,,,..v �.. _ - 4 , r. PF,I4�5a U{;a ,:1a•i;.el� :i' f hs: n . ,..? .`t:;jn.:,�. }, 'iL i:! 'J{�.:zl .4 :,"' rc>>t. ti::il tt ':•�F"tutdiY dYi7t• ..� (revised 8/15/95) 6 SUBSURFACE.SEWAGE.QISPOSAL SYSTEM INSPECTION;FORM : r c PART.C r SYSTEM INFORMATION,(cpntfn� Property, s: � (`(,Q.,� �./ • �y^• s :..`.:;toµ.+ --.; ,.i. .5. �, yr i`•. s: •:._.� :e; ;.j Owner: t f, .. �: i •_ ... i , Date of InsXon: ,gr Cr'�r-` � • �t TIGHT OR HOLDING TANK: \` ra.: ,..t t .;:�+:,�,,;;.>, :,_ ; sf ts,;:.p;r, ;• . ;:k�rr. �+�; ;�,ttstvr t+..=ccr; s=- r-c. ...i . . (locate on site plan) +} . .. r. r7lSi��?C;i ..t`F•iii '.w:.v��:,r:.};... +i+ . rj Depth below grade: Material of construction: concrete metal FRP.•. other(explain) j Dimensions: �.. •:;::� ,_ ,�.,.).<.,;:; :,:: 1 Capacity: Rallons Design flow: ¢allons/da Alarm level: Comments: (condition of inlet tee, condition'of alarm and float switches,•etc.),,,1. •pi jiik);+, ' * L. t+ A. DISTRIBUTION BOX:\*4V (locate on site plan) ri Depth of liquid level above outlet invert: ' Comments: ` (note if levei and distribuoun lb equal, evidence of soiidt- ca:r)o,er, evidence of leakage into or out of box, ,/'�` {/,'.�,�,. i.:��:' .,7•.1 ...h.�:r4 .:.i ^•1 ti1,� r (i4?J: tll 1;}'l',7 c+t,l+.Zt til.n I,:f' }'si ;(f->1 i t ! ! .. PUMP CHAMBER; (locate on_site.plan) ___ _..�, ..__. . .. _ �___ _ . _ ,,.. •. ^-�__ ., Pumps in working order,(yes or no) Comments: )<< ;t�.' (note condition of pump chamber, condition of pumps and appurtenances, etc.) .. . . . 7.- 97 s • .. ... . ... . M... . ... .. • . .....u.a.. .., fM y v......-i. ,a .a_�..r;. f. .. ., .y-.4:..M•s!.......+>�.. .. s . .. • I -- ... .. .. ...... . .-w. ..�... r.•{q,... .r_ • .•,r .+�, w•.r y1.r,r+e .wr(r. ,t. • • - • .� . . _� .. .. . f n ...y .. M •r.,..�... ... +•,•_. • t ,...N,+�..• • •`. ww1♦ .. car......- (revised 8/15/95) 7, _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Ad Tess 3y Owner: rjrj ,rt•� Date of In .CJ ( ' t!',� SOIL ABSORPTION SYSTEM`(SAS):L_ *� r (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)'_ �•• �c.'.a,• t_: If not determined to be present, explain: J Type: i leaching pits, number:� G� OA, CA leaching chambers, number:_)) leaching galleries, number: , leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, tris of hydra lic failure, level of ding, condition of vegetation,etc•) CESSPOOLS: -+-i (locate on site plarf7 ' Number and configuration: i Depth-top of liquid to inlet invert: , Depth of solids layer: Depth of scum layer. .4 i Dimensions of cesspool: Materials of construction: Indication of groundv.atc-. 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.) g PRIVY: (locate on s Itelan) n 't Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure,level-of ponding, condition of vegetation, etc,) (revised 8/15/95) 8 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM �. PART C r b SYSTEM INFORMATION (continued) Property ress: y 'Cx`t�ema� Gtc Owner. Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: W. include ties to at least two permanent:references landmarks,or_benchmarks locate all wells within 100' 7w DEPTH TO„GROUNDWATER Depth to groundwater._)feet c- method of determination or approximation: (revised 8/15/95) 9 - .. t' LOCATION SEWAGE PERMIT NO. �'Y ra /�/�I BIZ niA �2 C Dt VILLAGE & INSTA LLER'S NAME & ADDRESS 4 B U I L D E R OR OWNER _ DATE PERMIT ISSUED y -3 DATE COMPLIANCE ISSUED � ..�7 1r \l tit w i No. ''�d^ Fps.... ................ -� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Tovm...........oF..........Barnstable Applira#iun for Disposal Works Tonstrurtiun ramit r Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: Connemara ............................................ -•-•••--••••••-••......-•••-•-•-•-••-------••----••••.......•-•-••._..........................•... Loc ion-Address or Lo N . - if. ... / .�. CAP. . e y ?.......l ;�i ''��! Owner - J�M R Address a ......................... .:... .1 .61_..........-•�•-•--.............-•-...._--••-- -••-••............••• ._.....••.......-•--.........•........._:_.._... ;r In taller Address 10.2.0.1. 3 d Type of Building RAN Size Lot... ... ............Sq. feet Dwelling—No. of Bedrooms............................................................................Expansion Attic ( ) Garbage Grinder (n�) Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria a' Other fixtures ...................••-••-•••••.... .. _ W Design Flow......................5.5.................gallons per person per day. Total daily flow..........330..........................gallons. WSeptic Tank—Liquid'capacit)LO.QQ..gallons Length8. (arr Width4 r J_0". Diameter________________ Depthl+_!_Q!T.._.. x Disposal Trench—No..................... Width..................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----------.-------- Diameter......J_Q_t...... Depth below inlet___.__ _t__._ _ To 1 leaching area._.2.6..7......sq. ft. ,.Z Other Distribution box (X) Dosing tank ( ) -0,A- �: aPercolation Test Results Performed b3Cape----G.Q-d-..a1. ry.Q. ri e.......1/-21 /7-9-•-_--•--.. ,.a Test Pit No. I......2-------minutes per inch Depth of Test Pit.......12.-...... Depth to ground water.....Mrua........ Test Pit No. 2.......2.......minutes per inch Depth of Test Pit-------12....... Depth to ground water_.___ri@riE,,.,__. O ..........................................•.........__.............................................•....................................... P�jFC OF�jys Description of Soil.TUJ,._Q_xQ_-2_.Q...I.Q-a?�___$G---subb iQil. -2...10:n9A---med......bmawn...aan �k- ......... sqo x -••••---•-•••••••-•----•--••••••9a.Q_ ,12•••Q---rued..Whit.e-•--sand-•----�- k....0 0.7.2-.0---1Qam..&..sub.s-Q ...Kf,rW+C-K y� U � N ................................2...0-.7..9...med__hr.mrn---s_and,---?..Q_-12_..0... e_cL._..khit.e... d.-- - .......... U Nature of Repairs or Alterations—Answer when applicable.___.................. . ........... .. c� CHAPMAN p No. 2.654 O ------------•----------------------------------------------------------------------------•--•••----••-•-••••••••-•••• ------------------- ---------------- A �y t` Fi f � greement: z / �,cFss�S The undersigned agrees to install the aforedescribed Individual Sewage I isposal System in accor the provisions of iITI.;. 5 of the State Sanitary Code— The undersigned further agrees not to p—la'ke the system in operation until a Certificate of Compliance has bee issued by the board of health. ` f l �7y....... gne .. . ... .. ............................................ b c Ll Application Approved By •.... ,.rLe~ IBA!/1 ............................ -•••••�71J a--7-9. Date Application Disapproved for the following reasons:................................................................................................................ ..-------•--------•-----•-------------------------------------------•------------•----......------------..---••-••••-•••••-•------•-••-•-•••••--••••..................--- •----••-•••-............•••... Permit No. Issued_.. •• `3- .. .. Date ... Date No................ Fx$....2., 7 s THE COMMONWEALTH OF MASSACHUSETTS,i-. W� BOAR® OF HEALTH Town........ .oF...... Barnstab].e Appi ration for R-4posa1 Works Tomtrurtion ramit Application'is,:hereby made for a Permit to'Construct (X ) or Repair ( ) an Individual Sewage Disposal System at Conne'ara Circle Lot 61 - .............................................. --•--••"--•--"--------•----•-•-•-•-"---"--"-"-•---••••••----••-•--•"-................_-•--•-----•- Location Address or Lot No. ! (? / I. r /.r i .. e'/ n 2 t f1 -- A*�t L7._i4F_,� ........................... rl a Owner Address, ..��r� .. r. .............................................. a�.tjf)_1.....:.. ^_-- Installer Address ZQ Ml d Type of Building ��=��$�a.�;�� Size Lot.___ _A.................Sq. feet Dwelling,—No. of Bedrooms..... . ................................Expansion Attic ( ) Garbage Grinder PO) `4 Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria W Other fixtures -----•-••-••..................••... --- - W Design Flow.................. 3 1.._ .........gallons per person per day. Total daily flow ..... 33P..........................gallons. WSeptic Tank—Liquid capacit}_0_00.gallons Lengthfl t 61i..... Widths t 1.Q"_ Diameter________________ Depth.'Q...__. xDisposal Trench—No..................... Width_................. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No ........ Diameter .., .Q .....Depth below jnlet_.__ __.___ Total leaching area...267......sq. ft. Z Other Distribution box (x) Dosing tank t a Percolation Test Results Performed sr b3C4 10a Surrey Con6ult tSDate...___V124/79 a Test Pit No. 1.....�... pe De pth of.Test Pit__-__12_....._. Depth to ground.water-___-none........ P ---------—---------- -••-•---- •:_______ -•••------P-------•g ......... fz, Test Pit No. 2_.... minutes per inch 'Depth of Test Pit 1 Depth to round water..... l O O F MAssq Description of SoilTPI Q•©" •Q O$ID &..61.4hoQ1 _. ,Q!9 Q..med.a. 2Z'C��n-..$ �y x ftElVWfCK G -••...........-•----•-=•-_. 9�o� t 4 ffied w .::s >►s _ ' Q�4� Q _10 & ,au � 9 �: , W 2tQ!!7.,.0 m d__brsew_..s.�llld.�_._�a4-�,�...4._>�ted. �hxl�l� aan€i � CHAPN.AN U Nature of Repair' 5or Alterations=Answer when applicable s __ ___________t_ __. rsalSystem !c ..._..... __�_��No- 27654 -"-•••......-•--------•--• --".............• •.............."-----.......... •.. ... ••. •-•AgreementThe undersigned agrees to install_the aferedescribed Individual Swage Di in accordan I the provisions of i IT;-;.;. 5 of the State-Sanitary.Code—The undersigned further agrees not to place the system in -� operation until a Certificate of Compliance'has been issued by the board of health. ------•---------------------------- Vgne 'i � f ff r- APPlication Approved`,`By...... -__ � ! a � "--------•------•---"------- ...... 's . " b i Or .. --•............................................ Date Application Disapproved for the following reasons______________ ........ e Date .Permit No.-"--- ............. - Issued «. Date _. ::THE COMMONWEALTH16F.MASSACHUSETTS BOARD OF -HEALTH W��+ - Tnt firatr of Tomiphaift1tv THIS IS TO CERTIB '; That the Ind vldual Sewage Disposal System constructed ) or Repaired ( ) by ..................................... ! Installer ---- �" 'm- w PP P P Y T •,-7 •..r y described in the has been installed in accordance 'with the rovisions of I I 5 of The State Sanitar Code as application for Disposal Works Construction'Perm>t iVo.__ Z 4._ da.ted....._ . _ >� .�_� ........... TIME ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUE®SAS A GUARANTEE THAT THE SYSTEM WILL FUNCTION ,SATISFACTORY: w DATE...................... ns tor. ................................. -••- - THE COMMONWEALTH OF MASSACHUSETTS 4BOARD OF HEALTH 79 .. .. ........ OF..... ...... . , ,P7 ............ . FEE ......... pruti$ Permission is hereby granted_._,_ _:�_. E .<h .....___ , to Construct O or Repair ( ) an Individual Sewage Disposal System at No.- � tr?_- . �euf �s ha. s ''v7 yr ----- ...- --•-- .... Street as shown on the application for Disposal,Works Construction Per No Z Dated............... .. B 11 - r a ,. DATE- Board o f xe It x 4' FORM 1255 HOBBS'&� WARREN. INC .'PUBLISHERS f•.� _ S 01LL LONG r, xr&1w1mu..t,1 A vj SLS� cs,caoX/- i*v�L4ii ..-o 1 /o T/Q•�' Z•' 'IV O•� r k ' , -OA f J_4' ; FEA9TONE •LOAM S FILL••• 12 NAX � � yyf�000 C.1'. toAr5 •1000 BOX I;.o•. 0 1000 GAL. 10 MIN. I° , 1- 24" 7&Sr ,GAL. 1e•��°. PRECAST OR� o ' SEPTIC is�No TANK I„::•;• BLOCK- �;: = ;� MIN I TON. ' 6, 1• SEEPAGE • ' i q8,� =off ff Ise° • sl t e• PIT ° °' A7ICR e0e1 20' MIN. FOUNDATION I ? '' •. I Y2" WASHED STONE ! I 95- .� N 0 W P%T E R, ELEVATION, SKETCH I 10' I PERC. RATE= -Ur�ti�€st�t�taii=sc SCALE I"= 4' TEST BY : L, tA-, E I r TOWN INSPECTOR BACKHO6 OPERATOR: Sttl. dtf psi?!'% Gv) t7 t1Kes TEST MADE ON : r ' .t 09 t LOT - ----J t9q I 1 j L.,O T 6 Z 1 TEST F I T 3" _ �Pi+e k _ :.. Io7 �cey4� , • 'BLENCH MARK +'�' r - • TOP �T 'I~ L ' '• I r •;^ A .3 , - a ./ �. ;u - .�'•� .:.e.••�,.-�...•i:�.� y—,,;-- .,,4�, „ice �'•I�u -. 80.00. iSs¢-_ _ — •-- �. _.. �� _ __ __-_ - — ate" 1 0 3 10 �r - s .._ .-....--...- _.,....,_.-_+ .•••__...•rrr c:�3��+~-,....._....._• ..r.... __ �••_�+•••.+. •nw..w..w, ..,.+Wrm...r,.�y ,_ _ .� .a-..-..__. iJ 6s7-�/��E 0 vAi.c.y �'c.at..► • --- - - _- 3 8�rvaoomS�.��vo �A�'BAfj6�tj,�i,vOit.e�.�e•//O GAS/oqy/.c�,�e:- =-330' UA4fo�'9'�•--- - - - �- . � _ ZJ/J?Ay A.C�-a�r�BCE .r�,gl4f Ftory Fo,C THi5 - - -/o7---EXif7', G'ocr�bv,IP.. S�.oEw,�v�G..t /88 .S.f X z•5 G,I?tz .t.F: 'e7 p,�cPr Co.v72su2 }° !3orTQ�I'J 79 s,r k .o cj,R�2�s•F. 79 4.6X. /af�y. �i� ar.,;,�� ► .ic P 3 ) Tocvw 1v) TF-rZ OVA/E.J48'G,F ?o THts coT i t,NFa:�,aN �~ \-A no z/f5a c1� �j :n R .L� •. Tu ELEVATION SCHEDULE •• - PROPOSED SITE PLAN I. INV. AT FOUNDATION = /o7, 3Z e 2. INV. INTO SEPTIC' TANK = o /z SEWAGE SYSTEM DESIGN- IN -3. INV' OUT OF SEPTIC TANK = /OG 8 LOT 6) 4. INV." , INTO DISTRIBUTION BOX = BOG 7 HY At-jijI a, der-5S• SCALE: I"= �20: ;E». 19 7`9 t 5. INV. OUT OF DISTRIBUTION BOX = /OG•!o4 C - 752 6. -INV.- INTO SEEPAGE PIT , /06.50 CAPE COD SURVEY CONSULTANTS ROUTE 132 7 BOTTOM OF PIT = �� HYANNIS ,MASS. n