HomeMy WebLinkAbout0036 CRAIGVILLE BEACH ROAD - Health 36 Craigville Beach Road
Hyannis -
A= 288-001
-
Commonweaith of Massachusettsull 1�
Executive Office of Environmental Affairs AVWWMMNEM� r
atl
Department of
REcEwEO
Environmental Protectio a MOW,, 1 ? 1917
William F.Weld TOWNOFBAANSTAB
tioNrnor HEALTH DEPT. ftldr
Arg" Paul C91luccl C r�
U.Goomu DaVld
5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A _
nn CERTIFICATION
Property Aaareaa: 3 4 1 I.v• f��=^�1'e.`s.�'
/ -/4-" �� Address of Owner. � 9-�.
Date of Inspection: ��t-�•
(If different) �����"'n�r�7 J 1
Nature of Inspector. ,zjJ��..t-•-.� �u-r�-�- / 7 �2 .
Company Name,Address and Telephone Number.
CERTIFICATION STATEMENT i . c�-� r �? 7 —U•3—'``�� � Yr^-,r" S
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:
/� Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
1 �
Inspector's Signature: (�,
� A•l_ac.u.�+.--� � Date:
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inwpection. If the system is a shard system or has a design flow of 10,000 gpd or greater,the inspector and the system owr.,ar 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:
_ J .- 1 have not found any information which indicates that the system violatestany of the failure criteria as defined in i;t0 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,paves
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 4sak 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 11/03/95) I
One Winter Street ' Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)M-Saco
Printed on Recycled Paper .
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:-
Owner.
Date of Inspection:
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):
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
— The system required Pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(a)are replaced
obstruction is removed
no
CI FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES 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, I•F APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
— The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a
surface water supply.
— The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well,
— The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well•
— The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well, unless a well water analysis for 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 Iwo than 6 ppm.
}
3) OTHER
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(rev ised.11/03/95) 2
M
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:
Owner.
Date of Inspection:
D) SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for
this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the
failure.
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
�o
Liquid depth in cesspool is leas 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.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface waiter 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.
El LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to pabUr
health and safety and the environment because one or more of the following conditions exist.
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone 13 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 Auther information..
(revised 11/03/95) 3
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Y°
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address`
Owner.
Date of Inspection: iLl
Check if the following have been done:
ZP,Mping information was requested of the owner, occupant, and Board of Health.
None of the system components have been pumped for at least two weeks and the system has been re6eiving normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
Lfl�As built plans have been obtained and examined. Note if they are not available with N/A. 0'
The facility or dwelling was inspected for signs of sewage back-up.
[/The system does not receive non-sanitary or industrial waste flow
v The site was inspected for signs of breakout.
V All system components, excluding the Soil Absorption System, have been located on the site.
✓The ieptic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baSles 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 existing information or
approximated by non-intrusive methods.
!%The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
}
(revised 11/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM IN ORMATION
Property Address 3 4' CJtt>-u ac-�C A�'�e-cG' !`cs�' `(% t✓"u`��t"
Owner �'12�}t XXc.e.Fuc_c
Date of Inspection:
RESIDENTIAL- FLOW CONDITIONS
Design flow:j yj2 gallons
Number of bedrooms:
Number of current residents:
Garbage Finder(yes or no):A)0
Laundry connected to system (yes or no):
Seasonal use(yes or no): �
Water meter readings, if available:
I
Last date of occupancy:
COMMERCIAL/I ND USTRIAI.
Type of establishment:
Design Dow:------gallons/day
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:
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Last date of occupancy:
OTHER: (Describe)
Last date of occupancy:
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GENERAL INFORMATION
PUMPING RECORDS and source of information:
System pumped as part of inspection: (yes or no)_
If yes,volume pumped: gallons
Reason for pumping.
TYPE OF SYSTEM
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)
Other(explain)
a
APPROXIMATE AGE of all components, date installed(if known)and source of information: r'�7' 5-, Al
Sewage odors detected when arriving at the site: (yes or no)
j.
(revised 11/03/95) 6
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued) n
Property Address
Owner.
Date of Inspection: _ 1 u _ 41
SEPTIC TANK_
(locate on site plan) -
Depth below grade: :2`(
Material of constntction: _concrete_metal_FRP_other(ezplain)
Dimensions: i5ecl C f
Shidge depth: !
Distance from to of al �p dge to bottom of outlet tee or baffle:,
Scum thickness: ,2�/
Distance from top of scum to top of outlet tee or baffle: 15
Distance from bottom of scum to bottom of outlet tee or baffle: + �n®
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.)
GREASE TRAP:_
(locate on site plan)
Depth below grade:
Material of construction: _concrete_metal_FRP—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:
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 11/03/95) 6
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address
Owner.
Date of Inspection: G._ IL, - 117
TIGHT OR BOLDING TANK
(locate on site plan) —
Depth below grade:
Material of construction:—concrete—metal—FRP—other<explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm level:
�o
Comments:
(condition of inlet tee, condition of alarm and float switches,etc.)
DISTRIBUTION BOX_L,I
(locate on site plan) ,
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leafage into or out of box,etc.)
PUMP CHAMBER_
(locate on site plan)
Pumps in working order:(yes or no) '
Comments:
(note condition of pump chamber,condition 4pumps and appurtenances, etc.) '
(revised 11/03/95) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
' c SYSTEM INFORMATION(continued)
Property Address L. �'�L`iY -cam. ev. •��
Owner. .,, tic-t-c✓a
Date of Inspection: /c Y' —7
SOIL ABSORPTION SYSTEM (SAS):_
(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:
leaching chambers, number:_
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number: ^«
Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetationetc.)
a
CESSPOOLS:_
(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(osspool must be pumped as part of inspection)
Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.)
}
PRIVY:_
(locate on site plan)
Materials of construction: Dimensions:
Depth of solids:
Comments: (note oonditiop of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.)
(revised 11/03/95) g
, 1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM i
PART C
SYSTEM INFORMATION (oontinued)
Property Address
Owner.
Date of Inspection:
i
SKEICB OF SEWAGE DISPOSAL SYSTEM: flf
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
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�n
1
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. I
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DEPTH TO GROUNDWATER
Depth to pvundwater. S. 7 feet
method of determination or approximation:
421—
T ` �
(revksed 11/03/95) g -
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH /80 0
TOWN OF BARNSTABLE FzE//�' =U
No. -------------»------- tIItt PrI1Lif
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�i� IIIS arkv,TDYi�
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Permission is hereby granted_. _- � �- O�
> a Individual Sewage Disposal Systett►
to Construct ( ) or�opai� �C _3at No__ G___. ----• street
N
•�` ! Dated. - �J
shown on the application for Disposal Works Construction Pe40; t-
as
Ci
Board of Hcalth
DATE------------ -•----•------ ---
poRM 36506 HogeS WARREN,Pic-PUBLISHERS
Tvwry yr l3AKIVD i I��L-G
f�Ertifi�crx#P Of COMPliance
he I dividual Sewage Disposal System constructed ( ) or'Repaired ( t�
T IS 70 CER IF hat t .. : ....... .............. ............... .
/��
.............. . - -
l dated .a
has been installed in accordance with the provisions of TI" .E 5 of e St to vironmental Code as escrt to
o al Works Construction.Permit No. ._ ' ..� •.
the application for Dtsp s
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT TH `
SYSTEM WILL FUNCTION SA�TI-S—FACTORY.
DATE ----- ..:... .-. -.. -- -
.......
. . . . . .
Oct- 16-97 08: 58A BARNSTABLE HEALTH DEPT 5087606304 P . 01
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jl�C Nov 5
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TOWN OF BARNSTABLE
LOCATION �r ;c.�%.f�- SEWAGE
VILLAGE , , �` C ASSESSOR'S MAP & LOT�Jf$l,0®/
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY l01>
LEACHING FACILITY:(type) /4 U o o (size) �l
NO. OF BEDROOMS-PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: ^ c 3
DATE COMPLIANCE ISSUED: "''
VARIANCE GRANTED: Yes No
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ASSESSORS MAP NO:
PARCEL NO: ®0 i '" "
No t FEZ....`QO........... l�.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE =4
Appliration fur Dirpnial Wor1w Towitrurtinn Brut
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
-, - .... -------- -------------------------------------------- ---- ------------------------------------------
_._."'hill V'Iddress or Lot No.
.... .14-4,ill..------._--.-•........................................... ............................--•
APa aer Address
Installer Address
d Type of Building Size Lot............................Sq. feet
Dwelling— No. of Bedrooms------------ .........____._________Expansion Attic ( ) Garbage Grinder ( )
0`4 Other—Type of Building ____________________________ No. of persons_____________________-___- Showers ( ) — Cafeteria ( )
a' Other fixtures _______________________________ _ _
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
W _ Septic Tank—Liquid capacitylM.o---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........................................
a
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
.:............•-------------...__-•---•---._....---._..___.__.__._...---•---•--••--•---•----......_....._.........._.........._........._.........-•---------
0 Description of Soil------'......................•-•----••-•-------------------------------•---._._......._...-----....---------•-'•--•-----•-------------------------------•••••••.......--
- -- -------------- ... ----------
------------.-...
U Nature of Re airs or Alt ations—Answer when ap livable.-----e� '�.�--�>�-�_O__ __- _:--. •-------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environme Code—The undersigned further agrees not to place the
system in operation until a Certificate of Complian e ha been iss d y t oard of health.
" t
Signed -------------- - ---- .................. ....-....-.............-..--.....:....--
Date
:.�Application Approved By ....
V Date
Application Disapproved for the following reasonf. ........................................................................................................................................
... ......................................................................................... .......... .... .......... ..........-.....-.-.........--........................-..... ........ ...........-...............-
Date
Permit No. ............... .. 1................. Issued ............ .......................
Date
I
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
CQrttftCt to of CII>l yli2inve
THIS IS TO CER IF , That the I dividual Sewage Disposal System constructed ( ) or Repaired
........................................................... . .... ..
b ..........��a*c�'c"owlth
.�•%J�Z�`0 lcrat ...... .. 1...... .... �1 / �Te
-------.11✓ ...�._.............. ......... . ......-- ....
has been installed in rdance the provisions of TI'�-�-,EE.�nvironmental Code as described in
the application for Disposal Works Construction Permit No. -f-31 _.._''� 1._.. dated .---le--
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. C/i
DATE. ...... � ... .^ Inspector .....�.... .........7V7 .- -..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
FEE./.�...._.:.....:?.'�
��#� Uan�rrmi#
Permission is hereby granted........... ---- ,.. / 'i - -----------------------------------------------------
to Construct ( ) or Repair; ti)an Individual Sewage Disposal System
atNo..- 2�..... x.- ,c� .._ �� '- .. -------------•----.........
Street
PP P - - � Ste'-.2S.......
as shown on the application for Disposal Vb'orlcs Construction Perrr�lix � Dated-
Board of Health 4
DATE........ ---......--------....__._
FORM 3880a HOBBS&WARREN.INC..PUBLISHERS
-- ..,. /. ,,� .. "°`L '.:i..i .�.J "tr'a'- r�'�.+Yi a.+'i+..��.. �.� wu „•u._`. _..0 r- .-ai- J
ram.-�...yV-:.e.r.7-re-r,' ,H�r-•`v-!+L'....+�/ �r:JJ '.wyfr' .3-+rYr+`v 4l'r .+�•+ i
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Di n!ul Works,Tvtwtrgr#iun rratit
Application is hereby made for a Permit to Construct ( ) or I epair ( :y) an Individual Sewage Disposal
System at:
,/Docation-Address r J'or Lot No. y
///� /n{ Ow per .may, - -Addressi
(/ J _ _________________________ ..........................................._--::-_#.....-........._.
/ Installer ! !^ Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms.___,.__..�____-_______-__-:_---_.-Expansion Attic ( ) Garbage Grinder ( ) j
aOther—Type of Building -------------- ---- -___-_ No. of persons......................... Showers ( ) — Cafeteria ( )
Q' Other fixtures ________________ ______________ _ _
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity/S_QQ___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........................
rX4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
�+ ----------------------------------
•-------
•---------------------
_-_.................
_...........
_.......
•............
•---..._......
_------------
•••---------
0 Description of Soil------------------•------------•-------•-------------------•--•--•-----•------------------------------•-------------------------------------------------....•••....--•--
x
U .----------------------------------------------------------------------------------------------------------------------------------------------------------.............................................
1 ____________________________ \
W _ -------------- - -.--•-------------___-_-------------_-----------_---••••••----•
x
Un applicable. 1 .-._..
;��-�tlf � 0 A f�-c'
Nature o Re airs or It ations—Answer when
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 Ceriificate of Compliance has been iss�ueeddby `t1 ee--board of health.
Signed ..:........FU—CF c 2.....c `..'f-.,� !1 .t.................
" ..............................
Dace
Application Approved By ..:.. ........ .;. .............._ ...
Application Disapproved for the following reasons: --------- ..--------------' -.V...............................................................-........ .
... .............. ' .. ' ' -- .................... ...... -'' ._............................... • . .......................-'.. ........................................
`` Dare
Permit No. ?..-Y."......�`... ................_ _��...Issued .......... ^ .'.....� �.....'T7;■*
Dare
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yS�ESOf�'S MAP NO. t�!' PARCEL
LOCA ?iA?` F PERMIT NO- 2
� U �r-J s'
VILLAGE
,,.I N S T A L L E R'S N A M'E_ A A'D`D'R E SAS
e U I L D E R OR OWN EN
•it "'' <s� .F
DATE PERMIT ISSUED
DATE COMPLIANCE• ISSUED �
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Y �
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ASSESSORS MAP NO: a
�36_ . ZBOARD OF HEALTh' Fps
....
No..............:. PARCEL NO.: t- TOWN$F BARNSTABL6_
THE COMMO WEAL ?eCHUS T S
0 BOX 534
BOARD OF HEAWTA41S, MASs. 02601
..........................................OF......................................-----------------•-•-------------._..---•---••----
Applirtt#ion for Biquiii al Morks Ton#rin (ernti#
Application is hereby made for a Permit to Construct ( ) or Repair ( Individual Sewage Disposal
Syst t
.. .. 1 �t . .... � - - ------------------------------------------------------------------•--------•-......--
�ocati Address �9 or Lot o.
�� -�b---�l� 36_ Crai.vill.. Beac�i-_Ra.._•,--_w.. Hyan...... t
ner ' ddrmS A 02660
W ig st ms Z G Great Western A . , Dennis,,
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms..........3................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria -
Q' Other 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.......................................
aTest Pit No. 1................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........................
a •••----•--•••••--•---•--••--••-••-...••--•••-•--....•••.................•-----------•--..._..._.........--••----•---•---....•-•...-•------•----•••..._.......
0 Description of Soil............... aYid._.....---•....................:..•-•-•-•-•--•---•--•-------------------------------------•-•---------._...---•--•---------•••-------•-•--•••.
^�
--------------------------------------------------------------------------------- -----•----------------------------...-----------------------------•------••---------------••......-•••-...............
In llation of a 600 gallon, re
U Nature of Repairs or Alterations—Answer when applicable............ ................................................................_...........
cast leach pit , stone packed.
---•--•••. --------------------------•---------•-----------------------------.........
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Di s yste in accordance with
the provisions of TITLE 5 of the State Sanitary Co e undersigned furth agrees n o place the system in
operation until a Certificate of Compliance has s e j — ar of healtk.
Sig .d ..........
. ..............• ......
------------ ------ Date
Application Application Approved By.................• • ............. ... .•............................................... ...............5/%- 6
Date
Application Disapproved for the following reasons-------------•-•------------...--•----•----------------------..._..----------•----------------•-•---•--...------
...---••--•----•-•--•----•--••-•----------------•-•-----•--------••-•----•---•--••--------••------------^-..---•----.....-----------•-•-•--......•-•-•---- -•-••-•-• ---.... •••---•---••-
Date
r 1LPermit No.............8.6.-.................................... Issued.... -- 5/.za/ ...........
7
No. 8 S6'
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..................... .................._OF.....................................................................................
Applirationlor Disposal Works Toustrurtion ramit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
3 t .................. ..................................................................................................
1
Location-Address
36 Craigville 1%'actV�' Rd. s W. !jEi�ni�jsport
L.I.S........i;ij�" ........*....*"_ _ '".............._.........................
w &ddress S
nhe V 7-1_(::e Great Western R Dennis, MA 02660
..7%W_AX
- -------------- . ... ..................................................................................................
I stail
staller Address
U Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms-........3...............................Expansion Attic Garbage Grinder
aOther—Type of Building ........................... No. of persons............................. Showers Cafeteria
Otherfixtures .............6........................................................................................................................................
Design Flow........................... ........:......gallons per person per day. Total daily flow............................................gallons.
1:4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
Disposal Trench—No. .................... Width.....---............ Total Length.................... Total leaching area....................sq. f t.
Seepage Pit No--------------------- Diameter.--.................
Depth below inlet......._............ Total leaching area..................sq. f t.
Z Other Distribution box ( ) Dosing tank ( )
�.-j
)_4 Percolation Test Results Performed by------------------------------------
-------------------"..............."" Date........................................
Test Pit No. I..................minutes per inch Depth of Test Pit.................... Depth to ground water..--....................
fTq Test Pit No. 2................minutes per inch Depth of Test Pit...-............__.. Depth to ground water........................
P4 .............................................................................................................................................................
0 Description of Soil..... Sand
.........................................................................................................................................................
U .........................................................................................................................................................................................................
.............................................................................................................................................................
----------------*--------------------
U Nature of Repairs or Alterations—Answer when applicable_ n nst4llat Io of a......pq...ep
1�q]RR...X?re.-
cast leach pitg stone packed.
........ --
... . ...... ---------------
............................................................................................. ---------*................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE: 5 of the State Sanitary Code The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed........................ 5/60/86
Date
Application Approved B3r7.
----------- ............ ---------------5/ OJ86......
,,Date
Application Disapproved for the following reasons:................................................................................................................
.........................................................................................................................................................................................................
Date
------------ Issued----. 251- /86Permit No.............R6- f7 .........
-22)/� se"e;c- e4lao 1-119-5- Date -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town Barnstable
......................
..*......OF...........*.......**.......... .........................
U lv-;� Trrtffirab of Toutpliatta
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired
X)
by......H AQK anI2 §6�
. A. ... ------
at... 36 Craleiyille Beach Road,... --...-
Installer 2
---4y juRrj�.t...M.....0 672 - Louise Davis
....................*-- ------------------------------------------- ....... ......................................................
has been installed in accordance with the provisions of TITT7 'f The State Sanitary C de as de5cribed in the
application for Disposal Works Construction Permit No....... ........ date( .......................
THE ISSUANCE OF THIS CERTIFICATE NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FEMICTION SATISFACTORY.
DATE...................... ......................... Inspector......... . ...............................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
6 Town Barnstable
... ...... F....................... .
8
No....... Fzz.....
..........
Disposal Works Tonstrurting Vern it
Permission is hereby ffi ........: j.
.......tG.0...................................
to Cons or ftir X I divVual ewage Disposal System
e 3� A t W. Hyannisport, MA
at N0.. r&�gv 4 Qe 02672 - Louise Davis
5 .......................................................... ................................................................................
ppli Street 6
as shown on the application for Disposal Works Construction Permit No....8............. Dated....._... 6 8.......................
........................... ....................... ........................................
Board of Peaff;
DAT........ ..".1--y- ..... i 5:.�G.....---------
FORM 1255 A. M. SULKIN, INC., BOSTON
DESIGN DATA
STRUCTURE r
1 r '. DESIGN FLOW r x
4�� v
zoo ti DNA SEPTIC TANK.
/' LEACHING RATES . SIDE AREA C>"1 GPD/SF
BOTTOM AREA _ ..," GPD/SF
ry LEACHING FACILITY
:J�V
\ 91) — \�`�--i_ Z92. I 1 m !! TR—M C� �'kr T �. • i .. 7� t,C�.�.c 17 X2—,4N
'-115�)J G • P.�.
1 f �°►0}--'� '� \ \ ,�.� k �x�� �: PLAN REFERENCE
o c%v't ELr=.ter. �9,�-1
06,-t � C�Q�E �� W 00�3-S /'`r -.J"1....�7't.J'i.-J'Y\•--•
L(07 ,4z ` • � , \� \ �./ /l f t \ �U
L9 ASSESSORS LOT NO.
--
` D-g 00 .; NOTE
W Q u a/ ,� fl; I. ALL MATERIALS AND CONSTRUCTION METHODS
\ ��
TO CONFORM WITH COMM, OF MASS . TITLE =
U u.-
�, o T Q ,!i ENVI RONMENTAL CODE
f
1 r + t
1(II �I J
� RpQ �..1�•ti--t-- � V '
\4 �
N 0'Nr
zo.ol
,-A+4
►o�. � - PLAN .
_ SCALE
TEST PIT N0. TEST PIT N0. <__- SOIL OBSERVATION PITS
EL_ EV. =: - ELEV. ----- -
-- gca DATE OF TEST n
ENGINEER
j-;�
B.0.H. AG E N T
EXCAVATOR
� I N T PFN 0 . ..'a; T I Nt N
--- — � t� - - — PERC RATE AT > F . - <2__ M / I .
IF
3' STanaE
--— -- 0-0
I u' 14WA
r �
1,Y
ELLIS & THULIN , INC.
LAND SURVEYORS AND CIVIL ENGINEERS ;
- --- -- - - I ------ - - — _ _ EAST SANDWICH, MASS.
SECTION THR U SEPTIC SYSTEMViD
t 1
SCALE H OR I Z . • ` - = V E RT, ���•�y ��.�� Iv,t�.��-1 1� ; -��` QQ , n .� �-- ,��; za•:
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