The URL can be used to link to this page

Home My WebLink About0038 CROOKED POND ROAD - Health 38 CROOKED POND ROAD, HYANNIS A= o TOWN OF B ST4ABLE LOCATION G r00/Le� Oh roe' SEWAGE # �"70$ VILLAGE A4 1f/7I?/S ASSESSOR'S MAP & LOT�9��S INSTALLER'S NAME&PHONE NO. �� GD P )r V =93 SEPTIC.TANK CAPACITY -Smd9Q� LEACHING FACILITY: (type) A*#& Mom/ CY9 (size) hPX k Z NO.:OF BEDROOMS `3 BUILDER OR OWNER PERMIT DATE: Z'Z 2 -f7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) /� Feet Edge of Wetland and Leaching Facility(If any wetlands exist W. ithin 300 feet of leaching facility) Feet Furnished by A'Z:y:y3 0 TOWN OF B STABLE G/'490��GL� ® -7Z LOCATION �D/9 r SEWAGE # VILLAGE 7!I/Ij9 ASSESSOR'S MAP & LOT;p9/—/-5 INSTALLER'S NAME&PHONE NO. �D�� CD J` 7r y 93�:Y SEPTIC TANK CAPACITY LEACHING FACILITY: (type) /� ��/oI`D/"5 C � (size) P,e3r Z NO.OF BEDROOMS 3 BUILDER OR OWNER ��°� PERMITDATE: I Z—Z2 -f7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) /�'� Feet Edge of Wetland and Leaching Facility(If any wetlands exist �+/� Feet within 300 feet of leaching facility) Furnished by v w N � �, � t � � l �' � o� `� � c� ti N �� 'V \tl ^a, i 3 . � TOWN OF B®ARNSTABLE LOCATION 2!2� SEWAGE # VILLAGE /l/�-5 ASSESSOR'S MAP & LOT Z _/3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITYL/` LEACHING FACILITY: (type)��u/ldv1o,,J <<1J (size) Id X le �<.2 NO. OF BEDROOMS 3 BUILDER 0 OWNE & PERMIT DATE: IZ-Zz—3 ` COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Pnyate Water Supply Well and Leaching Facility (If any wells exist / Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching-facility) Feet Furnished by I i. S Its �11 No. Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pphration for Mizpaaf *pztem Construction Vermit Application for a Permit to Construct( )Repair( )Upgrade(r )Abandon( ) C►'J Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's ame,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder Other Type of Building &P_!27� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ko gallons per day. Calculated daily flow 3A57 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /",0 Type of S.A.S. Description of Soil Nature of-Repairs or Alterations(Answer when applicable) T)ZAe,_.X 1L�9/P Date last inspected: Agreement: ` The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system f in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss y t 's and f Heal .ued Signed Date Application Approved by Date 7Z ZZ Application Disapproved for the following reasons Permit No. 7--7 7i Date Issued 1 Z 2 2- LZ No- / �—7� � �f ..�. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: yf Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for �Dtgaar bpgtem Con!5tructton Permit Application for a Permit to Construct( )Repair( )Upgrade(!' )Abandon( ) M Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 6 iln Il ieo4w- 7/ 9j,,V Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 1114 gallons per day. Calculated daily flow 1331V gallons. Plan Date Number of sheets Revision Date Title f Size of Septic Tank /5`�d 9l! Type of S.A.S. /off 34.t'Z /VU19�/s?� s 1 , Description of Soil " Nature of Repairs or Alterations(Answer when applicable) �`i�/� �/a9/'✓ Date last inspected: Agreement: • The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system t in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until_a Certifi- cate of Compliance has been issued , this Board of Health. Signed Date Application Approved by I Date Application Disapproved for the following reasons Permit No. 7— 7 Z Date Issued 77 --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE TI that the On ite Sewage Disposal System Constructed( )Repaired( x')Upgraded Abandoned( )by FY, n �Ji9 at S G e l �S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ?7— 7 Z 7 dated i 2 - 7 2' 9 7 Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector ---------------------------------------- NO. Fee THE COMMONWEALTH OF MASSACHUSETTS v v PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Itopozal *pztem Con! trurtton Permit Permission is hereby granted to Construct( )Repair( )Up ade( /JjAbandon( ) System located at and as described in the'above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: �2 2 Z 77 Approved by r i 10/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) hereby certify that the application for disposal works construction permit signed by me dated l Z/Z Z-!�T , concerning the P g property located at C�®��2�f� ®/�� meets all of the following criteria: 1✓ There are no wetlands located within 100 feet of the proposed leaching facility Y There are no private wells within 150 feet of the proposed septic system /There is no increase in flow and/or change in use proposed V�If ere are no variances requested or needed. the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will=be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) `7 • ` B)Observed Groundwater Table Elevation(according to Health Division well map) Z SIGNED : DATE: LICENSEJPTICSYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:cert i, O �F ll rIAes CD Paste �G O OHO uJ Q � 1 DATE:____4L3 L95 PROPERTY ADDRESS:_3o Crook d _pnn�2,oad___ Hyannis ------------------------ Mass._02601_ On the above date, I inspected the septic system at the above address. This system consists of the following: A. Two 6 'x8 ' Block cesspools. Based on my inspection, 1 certify the following conditions: A. This not a title five septic system. B. This is a sewage system. C. The sewage system is in proper working order at the present time. SIGNATURE: , ovt a Name: J.P.Macomber Jr Company: JL P,-Ua.CQmb-e-r---&--%om-2nc. Address: RECEIVED _ s� ��_____________ —_CEnterville,Mass_ APR 1 0 1995_02632 HEAL7HDEpT V''►�il 0FRO NSTAIR E Phone:—__SQt�ZZ�.3�3H_____-- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachflelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 i draft 1113195 a SUBSURFACE SE«'AGE DISPOSAL SYSTEM INSPECTION FORM Address of property 36 L toGk&_,A Po/u c) l AMA" Owner's name (and/or resident) Date of Inspection - 3 ,cj cj PART A CHECKLIST Check if the following have been done: Pumping information was requested of d Board of p g q the owner, occupant, an Health 0/4:- None of the system components have been pumped for at least 30 days and the uN 0 system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained. r-orn v_ The facility or dwelling was inspected for signs of sewage back-up. The site was inspected for signs of breakout. V All system components, excluding the SAS, have been located on the site. 1� 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 SAS 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 SSDS. r draft 1113195 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORNIATION FLOW CONDITIONS If residential 2 number of bedrooms 12._ number of current residents u!v �G garbage grinder. yes or no laundry connected to system, yes or no Z seasonal use, yes or no If nonresidential, calculated flow: Water meter readings, if available: ? Last date of occupancy GENERAL INFORMATION I ...,ri in records and source of information; P g 7�718 B System pumped as part of inspection, yes or no if yes, volume pumped 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) Approximate age of all components. Date installed, if known. Source of information: OLD - z S y„ �v y,f o/o( ��,��,/,�:( ' I i Sewage odors detected when arriving at the site, yes or no draft 1/13195 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INI:OPMATION continued SEPTIC TANK:_ 1' 61U (locate on site plan) depth below grade: material of construction: concrete _metal _FRP _other(explain) dimensions: sludge depth distance from top f sludge to bottom of outlet tee or baffle scum thickness distance from top ef scum to top of outlet tee or baffle distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pum ing, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural int grity, evidence of leakage, recommendations for repairs, etc.) DISTRIBUTION BOX:_ (locate on site plan) depth of liquid level abov outlet invert Comments: (note if level and distribution is a ual, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc.) draft 1113195 11 PUMP CHAMBER:_ ate on site plan) pumps in working o er, yes or no . Comments: (note condition of pump cha ber, conditior `of`"pumps and appurtenances, recommendations for maintenance or repairs,etc.) f 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 and number leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, numberJ� -- Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc.) � Z draft 1113195 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued CESSPOOLS: (locate on site plan) number and configuration 2 Ce SS pouf c I S r RcO 45 Tow K depth-top of liquid to inlet invert G n,nT( 6at,,) depth of solids layer depth of scum layer / dimensions of cesspool X 8 materials of construction N"e, btoe !� indication of groundwater Drc, 4 inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc.) PRIVY: Lam, (locate on site plan) materials of const ction dimensions depth of solids Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations maintenance or repairs,etc.) i draft 1113195 13 i SUBSURFACE SEWAGE DISPOSAL SYSTENI INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 5-Vti7- OJ 38 i l '?5 l 1 y�.�� DEPTH TO GROUNDWATER OP—depth to groundwater /7C9 method of determination or approximation: i draft 1113195 SUBSURFACE SE«'AGE DISPOSAL SYSTEM NSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not) 00 Backup of sewage into facility? tib Discharge.or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the distribution box above outlet invert? /vD Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? /)v Pumped 4 times or more in the last year? number of times pumped Y-(-� Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy: No below the high groundwater elevation? N O within 50 feet of a surface water? /Vo within 100 feet of a surface water supply or tributary to a surface water supply? No within a Zone I of a public well? IV& within 50 feet of a bordering vegetated wetland or salt marsh? A16 within 50 feet of a private water supply well? 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 colifotm bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. .F draft 1113195 15 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector R taco 0,4dt //4� 4-T , Inspector Number j2S 4f- / -;6 Company Name 20 Company Address 3c.x 2.5 d z(-- ' 3 Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. Check one: I have not found any information which indicates that the system fails to 1, C(i,ii 1 e,v - 11ouse, adequately protect public health or the environment as defined in 310 CMR n 15.303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303. The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector's Signature Date Original to system owner Copies to: Buyer (if applicable) proving authority THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -- of....... ... . -��. . . ... . .. .... .... �� ttt ,arks Cnlatt� tort tt � ttttt Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at• ................ 64... AL ® 19 & L catio Addres or Lo o. !J. ' ... `... r + '+�f �• 6�------------------------- W Owner Address nstaller Address UType of Building Size Lot----------------------------Sq. feet ., Dwelling—No. of Bedrooms----------- ---------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------ -- W Design Flow______________�4Q....._______.._._..gallons per person per day. Total daily flow.......... gallons. .-.-. WSeptic Tank—Liquid capacity-/gallons Length---------------- Width................ Diameter..........------ Depth................ x Disposal Trench—No_____________________ Width--------------------- Tot I Length.................... Total leaching area--------------------sq. ft. Pit No.______._/.._..._.. Diameter--- Seepage !_ De t17 bc� t t 1 ! P • - - ',,��''' ��/ ��-------------------sc. ft. z Other Distribution box ( ) Dosing tank ( ) /61 16 — l— 77 aPercolation Test Results Performed bY----------- .............................................................. Date-.--------------------------•-- a Test 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----------------------- ------ :. ODescription of Soil ....... ;J Y � .... ---- ... ------------------------------------------ ---------------- ----------------------------- x x ............. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- V 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 Article XI of the State Sanitary Code—The.undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i ued by the board of health. 4,2 (� Signed..' •----- - _ Date Application Approved BY -G ' -----7._/ _77--------- - Application Disapproved for the following reasons:-------•---------------•---------------•---------------•--------•-•--------•--•-------------Da-e-------------- -------------------------------------------------------------------------------------•--------------•--•.-------•--•----------•-----••-••---•...---------•--••-••------------•--•-----------•---------•. Date Permit No. 3-17 7 Issued _. �_� ------ ----------- &k- Date No�-----•---------•------• t..- Flzs. ....... .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ---- Appliration -fur Uhipoiial Workii Tomitrurthin Vrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at F Locah Addres > t or Lo ---------------- O ner , j Address P' nstaller Address UType of Building 'Size LQt...........................Sq. feet Dwelling—No. of Bedrooms----------z---------------------------Expansion Attic ( ) Gzrbage Grinder ( ) a4 Other—Type of Building ................... p ---Showers ( ) — Cafeteria ( ) No. of ersons...- Q' Other fixtures ...................................................... d -----------------••----------------•----......... W Design Flow.............. 10....................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... I Dept;i, l - t g t------------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) ' jj �C r 77 Percolation Test Results Performed by-------------------------------------------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit..------------------ Depth to ground water......._-- f� Test Pit No. 2................minutes per inch Depth of Test Pit_................. Depth to ground water_-._..----_----.___----- ------•.... -A- - -----• ••------------ O Description of Soil______________________ __ ___ _----�__� ._-__ W ------------------------------•--------------- UNature of Repairs or Alterations—Answer when applicable....•------------------------------------------------------------------------------------------ ------------------------ ----•----.-------_-.------------------------------------.-----.--•.----------.-.-----------.-------------------.----.------------------.-•-----.----------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' sued by the board of healthy^ Signed.-- -- . . / d Date Application Approved By---------------------------------------- �•--------- L 7:' _7 7--------•- Date Application Disapproved for the following reasons:-----•-•------•---...--•-------------------•-......----------•-•-•-••-----................_...--•.............••- ...............•-•-..............--•----------------------------•---------------•-----.....--•-----•-----•-----......---••------•-•-•-------------•-----------•-----------------------••--------------- Date PermitNo.......................................................... issued........................................................ Date _ -7. f THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALT, , . ...... ...........O F........ ........................... Trrtifiratr of fU"Umpliattrr THhS IS 0 CE#TYFY, That t1ye-Individival Sewage Disposal System constructed' (Z-") or Repaired ( ) by- . = 1 Installer has been installed in accordance with the provisions o Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.................._---------------------- dated...7=14-__-_7.7.____-____.___.._. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. S _ -�L f DATE............... ------------------------------------------------------------- Inspector Inspector-----4 . i THE COMMONWEALTH OF MASSACHUSETTS r BOARD O HEALTH 6,77 t G ......OF.......... ....... z...,............................................ No......................... FEE---/3. ...... - %spoli rkii mitr inn Vrrutit Permission hereby granted - ----- -----•-•--_-•----•--•-•--•----............. to Constr (� ) or it ( )�j n In tvt t 1 Se�ya D/�spo System eet ` as shown on the application for Disposal Works Construction/PeI �_,. ____________. D�d_.7.-Lt 7�__........ 3� z r re� Board of Health Jew Ef DATE. t -----------------------------------------------------------------------=----•-• FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS "•'`' LU:as 5T Hour ffi t 8 Vic, �1>�s•.�-*,-� .1. �u'•er;'f� 5�1..1 fl —�--� - —-- �Al ———- - 144u • --: 4 , . _ � - - -- - = -- - - - - r IF t� LZ• ItQU-D LEVEL ..L_ T7;1 I T Y P l GA L S EPT I G T I►.1.14L T y P t' CAL- 5 T-R-I D V•T'I O N �K- ►.+OT TO ALE NOT- TO 5C-A.LE 3v4' F t► �sN G�aoL F1►.�+5 6taso� TqP oc ;:-OQwj O .1 L L C.9! Q �K 1000 QA L Di�T 8Ox `� ' , ,♦ „J c.ru�NEU STgNQ T Fri QicsuRCtC`O Ccv•C I III t� �n B£TlAst-FL < o NOT TO _-'�►l.is • 0\,\ 22 i D 60 _ N ^V N z p At- 1�GElOD t , x a- � N a .?r« h 1` ;-t' �� i�W►Jrc e Dpi A1.Z'S 'EA-4---Ty Is QNAwa •M' CNKQ �r AINY iy P&Jw �_ _s i