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0020 DUNN'S POND ROAD - Health
20 'Dunns Pond Road Hyannis P A = 270 021001 i COMMONWEALTH OF MASSACHUSETTS u W EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS m , d DEPARTMENT OF ENVIRONMENTAL PROTECTION C bW I O,,M SJev TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM _ Dal .. O OI PART A CERTIFICATION Property Address: 20 Dunns Pond Road,Hyannis,MA 02601 Owner's Name: George T.Cook Owner's Address: 6707 West 50 South,Laporte,IN 46350 Date of Inspection : 12/01/2006 Name of Inspector: Michael T.Bisienere Company Name: A&K Septic Systems Plus Mailing Address:565 Carriage Shop Road,East Falmouth,MA 02536 Telephone Number: 508-540-6706 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 the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: x Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: C!% � Date. 0-6 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 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 DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments: This address has a tight tank for one sink. The rest of the water goes to town sewer. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 20 Dunns Pond Road,Hyannis,MA 02601 Owner: George T.Cook Date of Inspection: 12/01/2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 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 by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: T41a G 1--f;— 17— 411 1;0000 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 20 Dunns Pond Road,Hyannis,MA 02601 Owner: George T.Cook Date of Inspection: 12/01/2006 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,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 any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: �T41a G Tn—,f;— 17— 411 G/1AAn 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 20 Dunns Pond Road,Hyannis,MA 02601 Owner: George T.Cook Date of Inspection: 12/01/2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than 'h day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X Any portion of the SAS,cesspool or privy is below high groundwater elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool.or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] No (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Titles G T—n f;t 17— All vMnnn 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:20 Dunns Pond Road,Hyannis,MA 02601 Owner: George T.Cook Date of Inspection: 12/01/2006 Check if the following have been done.You must indicate"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 Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS,located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] T;tlo G 1ne tine Fnrm 4/1 1;i1nn0 5 f Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:20 Dunns Pond Road,Hyannis,MA 02601 j Owner: George T.Cook Date of Inspection: 12/01/2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):Number of bedrooms(actual) : DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no): [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment:_Hair Salon Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.):_One Sink Grease trap present(yes or no) _NO Industrial waste holding tank present(yes or no):NO_ Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings,if available:_133326 Last date of occupancy/use:_Current OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): If yes,volume pumped:,How was quantity pumped determined? 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) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): Titles G Tnan i;t T»n 411 cnnnn 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 Dunns Pond Road,Hyannis,MA 02601 Owner: George T.Cook Date of Inspection: 12/01/2006 BUILDING SEWER(locate on site plan) Depth below grade: 6" Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.):All plumbing looks fine. SEPTIC TANK_ (locate on site plan) Depth below grade: Material of construction:—concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: standard Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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: How were dimensions determined: field instruments Comments(on pumping recommendations,inlet and outlet tee or.baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.):Recommend pumping every two years. GREASE TRAP: NA(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(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels ' as related to outlet invert,evidence of leakage,etc.): Titlo G Tncr tinn Fn—411 1;11nnn 7 I Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 Dunns Pond Road,Hyannis,MA 02601 Owner: George T.Cook Date of Inspection: 12/01/2006 TIGHT or HOLDING TANK: NA (tank must be pumped at time of inspection)(locate on site plan) Depth below grade:_16"_ Material of construction:—X_concrete metal fiberglass polyethylene other(explain): Dimensions:_6'X12'X6'6" Capacity:_2000 gallons Design Flow: gallons/day(last pumped 11/29/2006— 1200 gallons) Alarm present(yes or no):_Yes_ Alarm level: Alarm in working order(yes or no):—Yes Date of last pumping: (last pumped 11/29/2006—1200 gallons) Comments(condition of alarm and float switches,etc.): In working order DISTRIBUTION BOX: (if present must be opened)(locate on site plan)N/A Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: NA(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.): h T;tla S Tn .,t;nn Pn 411 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 Dunns Pond Road,Hyannis,MA 02601 Owner: George T. Cook Date of Inspection: 12/01/2006 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type N/A leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number, dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOOLS:—NA (cesspool must be pumped as part of inspection)(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(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): I PRIVY: NA (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.): f T;11. c me —t;— F—411';i)nnn 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:20 Dunns Pond Road,Hyannis,MA 02601 Owner: George T.Cook Date of Inspection: 12/01/2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. I Q° I p, 7 i � 3 i ,j 1 I Titles G Tnon—f;— 17—All S/Innn 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 Dunns Pond Road,Hyannis,MA 02601 Owner: George T.Cook Date of Inspection: 12/01/2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 10 plus feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Aguar hole to 10' no H2O This is a tight tank for one sink. The rest of the water goes to town sewer. Ground water is not a problem. Titles G Tn cnan4inn T:nrm 411 cnnnn 11 565 Carriage Shop Rd. A&K SEPTIC SYSTEMS East Falmouth, MA 02536 Division of Kerrigan&Axon, Inc. (508) 540-6706 FAX (508) 540-6934 December 11, 2006 Town of Barnstable Board of Health 367 Main Street Hyannis, MA 02601 RE: 20 Dunns Pond Road, Hyannis, MA 02601 To Whom It May Concern, I am enclosing a Title V Inspection report regarding the above mentioned property for your files along with a check in the amount of$25.00 to file. Do not hesitate to call if other information is required. Sincerely Francine Wilson Secretary Enc. s S � i r f / ANT �A41 UOo GAG a t No.--zoo 3—ID's- Fee 5$ 0.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS lgfg o al 6--Mem Con0tructfon Permit Permission is hereby granted to Construct(-- -)-Repair fCX)Upgrade( ._)Abandon( ) Systernlocatedat 20 . Dunns Pond Road HYannis,Mass e applicant recognizes his/her du to � e above Application for Disposal System Construction Permit.Th a and as described in the bo Appltca o p y pp g duty comply with Title 5 and the following local provisions or special conditions. Provided: Construcction st be completed within three years of the date of this pe Date: 3//'7 O 3 Approved by THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired)(XX)Upgraded( ) Abandoned( )by J.P.Macomber & Son Inc. at 20 Minn,; Pond Road Hyannis,Mass_ has been constructs in a cordance with the provisions of Title.5 and the for Disposal System Construction Permit No. FW 3-/0_S_ dated 3 7 0.3 Installer Designer The issuance of permit shall not be construed as a guarantee that the syst will unction esi ed. Date Inspector G --------------------------------------- TOWN OF BARNSTABLE N 'L�ATiON �0 N.% /: /' Si(,�AGE # Q —/0- VIL1,,A,;.GE #�Z A v&l s ASSESSOR'S MAP & LOTR70-0.21-OP 1 INSTALLER'S NAME&PHONE NO. p AIZA C !J 14 d 4 K SEPTIC TANK CAPACITY 2, U L7 C� % G '� NBC l �I2;r la ly^ LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: (7 COMPLIANCE DATE: `l C Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 14 Az o 4 TO OF BARNSTABLE W LOCATION /C® 4 �l.�- SEWAGE # VILLAGE /TYh.�� ��—�> ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /O�b Val LEACHING FACILITY: (type) 1--f�� /zP r (size) NO. OF BEDROOMS ® 1 BUILDER OR OWNERI �1P PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland Le hing Facility (If Any wetlands exist . . within 300 fe f c cility) Feet Furnishe y ti . N .Aj COV r r£ r S TOW NO F BARNS TABLE LOCATION Lt 4 D un m Pang R� SEWAGE # S'� 1 i � + VILLAG ASSESSOR'S MAP&LOT L-d jam' INSTALLER'S NAME&PHONE NO.J-f, Mar iom be-.0 SEPTIC TANK CAPACITY l.S'oC? lra Q LEACHING FACILITY: (type) I XC,-h-t �'It (size) 10c;,O "NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE:_ '�, -2D�;fZ_COMPLIANCE DATE:_1�. 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 a � I x 4 X. lk �� .�� No. ZQb 3 —/oS s r. + o �— Fee 50. 00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: , Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Mooml *raem Cougtructton Vermtt Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System X5d Individual Components Location Address or Lot No.2 0 Dunns Pond Road Owner's Name,Address and Tel.No. Uea o s l�fapipaze s. 02601 "L'70-02-1- oo Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. J.P.Macomber & Son Inc. Peter Sullivan,P.E. Box 66 Centerville,Mass. 02632 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) T n s t a 11 i n cj 1 —2 0 0 0 ga l l c n tight tank. ( Beauty Salon) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued y this B Hea h. Signed Date3/17/0.3 Application Approved by Date 3 r G 3 Application Disapproved for the following reasons Permit.No. 2b0 3 (6 Date Issued 3 h G3 ew aQDUl Gff �1"., No zab 3 'f C�J � y a .�'""'"�f� Fee $2 810 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes 1 PUBLIC HEALTH DIVISION —TOWN OF BARNSTABLES MASSACHUSETTS p Zip�pfication for Miopooal *p5temc Conotruction Permit . Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System X©Individual Components Location Address or Lot No.20 Dunns Pond Road Owner's Name,Address and Tel.No. Hyannis Mass.02601 Assessor's Map�Parcel'Z`7U_ 2 1- o U Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 fl Designer's Name,Address and Tel.No. J.P.Macomber & Son Inc. Peter Sullivan,P.E. Box 66 Centerville,Maps.02632 Type of Building: ', r o ms L Dwelling No..of Bed o0 of Size s .ft. Garbage Grinder 9 g r ` Other Type of Building,.. No.of Persons Showers( ) Cafeteria( ) ' Other Fixtures w. .. 'Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets '` Revision Date { Title r a Size of Septic Tank pe of S.A.S. WA Description of Soil j Nature of Repairs or Alterations(Answer when applicable) Installing 1—2 0 0 0 gallon tight tank. ( Beauty Salon) Date last inspected: i i Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued y this`Roar Zea Signed Date 3/1 7/0 3 Applicationf Approved by ' Date' 3 r7 0 3 Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS l Certificate of Compliance THIS I'S TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired)(XX)Upgraded( ) Abandoned( )by J.P.Macomber & Son Inc. at 20 T)unnS Pond Road Hyannis,Mass. has been constructs in a cordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 006 3-/0 S dated 3 : O 3 Installer . Designer The issuance of this permit shall not be construed as a guarantee that the system will function�'_desined./� Date 1 1�) n Inspector k) f No. zoo 3-(oS Fee $50.00 THE COMMONWEALTH OF MASSACHUSETTS 6 PUBLIC HEALTH DIVISION BARNSTABLE: MASSACHUSETTS ,n MisSpO al *p$tem COlt!6truction Permit Permission is hereby granted to Construct( )Repair" )Upgrade( )Abandon( ) System located at 20 Dunns Pond Road HYann i s,Mass. and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this pe t. Date: 3/ /'7/C� Approved by TOWN OF BAR NSTABLE _ LOCATION I Q jQ 1"IyAl-S , SWAGE # 0637/os I a o-o-2t—yo1 VILLAGE # ASSESSOR'S MAP & LOT i INSTALLER'S NAME&PHONE NO. /lIA C U/14 t'e9 t- 5—o.� I II SEPTIC TANK CAPACITY r Sa LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: (I COMPLIANCE DATE: `I C Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by i . � o WZON7 �Q o Typ�y- 4-lJL 1 S3 t3NK J 1 N LG -�� � -• �' ,l , I TOWN OF BARNSTABLE Oft t T� 4�'��`♦w OFFICE OF „JITLn ; BOARD OF HEALTH y6 q. 367 MAIN STREET 12093 k' HYANNIS. MASS.02601 October 7, 1996 Peter Sullivan, P.E. Baxter & Nye, Inc. 812 Main Street Osterville, MA 02655 Dear Mr, Sullivan: Your application to install a tight tank at LaSalon Beauty Salon Located at TA Dunn's Pond Road, Hyannis is approved. The plans dated September 6, 1996 were reviewed by the Board of Health members and were found to be in compliance with the State Environmental Code, Title 5. The tank will receive industrial wastes from sinks which are solely dedicated for this use. The tank will be pumped by J.P. Macomber & Sons on an as needed basis and hauled to the Yarmouth Sewer Treatment Plant. Please express our thanks to your client for his/her cooperation in this regard. Sincerely yours, �CYt�yc. vt�,L Susan G. Ras , R.S. Chairman Board of Health Town of Barnstable TM/bcs t, fission, A , rj; y- 14-02 10: 34 BARNSTABLE HEALTH DEPT 5087906304 P .05 /r �2 i S to '�.v.v- rJ C� r of , H OF .I f 1 PETER r� J SULLIVAN NO.29733 CIVIL r LJ I o m cq O Crl�6T 1�¢.oPos EO `.J T%CWT TANG SZ' � ZCoo 6��.o.ars I JI E 4j'-77 6Z 1�1c1cE'. "T�-�►S P�FarJ 1 S � ��i•�'. � � _��1p�1 �ZOM 1-(,ova ?L( IKA �� �Ar.\1L�� GJV��I.I;`t CDNSUL'C7�t i-CS C� 1 `> Iti �oee•���o►.� �SHC G► z[.9 4. 270 A W= 4 �Yr ,ate. a6 Tet1A MAL% 5087906304 P _06 f �OF PETER Tt Q4T "r^JAY. : a SA►Lwa r� Nam' CIVIL O a 'D MSI& C e ITW.A%A 'Da���� �o�� $EnvT�( SA�o►.1 \S,203 ZW (a S'oo )O 'PE2_ ��5,20002� 2000 aA.L.Lo►J t-�t ► ►-A , �o'TLWtLL E rA, AY-. r- Wa T TEQL-nGWT w 7F—C- cWsf-, CISEe- *ALL PetJE`7'QP►ZlO1,kS 564AALL '8E SEA(-ED M E �suQE WA"��-f16HT1JASS. ITtiG OUTSIDE oF,71A TAr.1�. 5 SAL c w�T f- 9�O9 w�-n-� AKN AarZO?r j o�fie, -COA NG �T o� Sao fi o� S09-n0 A.L S ucro�.� G Centel 615 L N 2 M ET AS z E6� Nd, F-: L — . . 49,d TaN� /,Y I Goo GAG '�Z 3/5 CAPAGlTY .8o t EL 44.0 EL 43• L 23 CPT A '$ A 7 C la IA4 G CL ZO PEe 5£A -,�oNE 11 �� �LAZE SKEET ?I'� CC-crtae6tF- AeCAS try-14-02 10: 34 BARNSTABLE HEALTH DEPT 5087906304 I .BA/ u"''"s9 i •tl��J � .sp ..11 -� � i_, _ ' �:T ' �'• ,0�. 7e d �1V ILuller r. p 132) Ix tT 0 -114 ittl e rf 4, t��'Se ��• t �� r• Pf ���4�t�q♦ '� I f� •�r \ .��0 -D Y r''- SO rl • Q z 10 ct . l 1, •.!�'. P,�a � /, � tr f"• , •o�ik�,l' �. tee• n".l,a . 11.,rih11+ •�---7�• 'nJ � 0 3� t•` ��((�r •�' tablebud T . aNrs O y ♦ / W n� pkt �:��. f" .u� • '•. � 3 � 9 Fire 13m Is ���..q/' .� 11 •.. ' !Y "� 11, GOIf, o Pam'' _ .1•. � � '� I,-•COUrsle-.'-. � (. In sr It i i Yf 1f, 'Y Y — ••i�iJ 1 j rr ; DCEA, Itl� q q.y•a tl •�•• �•( `i 11tJt n rY^�j YI q �� u • �• �.) 1 I ; �7 iris B� •_n�:i'¢�,u�i 1 �, �) •.:5: ..(.�'�:lfl i/'' 1f ./ i(Vb� 10 - L)�•'- �.:1:i w5 Metes. U. S. G. S. QUADRANGLE JiJ►1►� s ®� eip BAXTER & NYE, INC. 812 MAIN SIRE[ T i4whi►&At.6 M A OSTERVILLE, MASS., 02655 y - (508)-428••-91;1 SHEET 8r= Date:-//Z-f � TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAMEOFBUSINESS: � ,u � BUSINESS LOCATION: ao J",n 5 PEA i6 cetA .MAILING ADDRESS: r INVENTORY TELEPHONE NUMBER: 0 - TOTAL AMOUNT: CONTACT PERSON: Imo, ev,.- Cr,7 , )e'er EMERGENCY CONTACT TELEPHONE NUMBER: TYPE OF BUSINESS: s! FIRE U(SICT OTHER INFORMATION: — " Waste Transportation: Name of Hauler: _ WM o�34e r Destination: Waste Product: Licensed?1e No LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. . NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Observed (gallons): Antifreeze(for gasoline or coolant systems) Drain cleaners .NEW USED Cesspool cleaners Automatic transmission fluid � Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) .Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid•(electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt& roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride)- Paint &varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor&furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil &stain removers Other products not listed which you feel (including bleach). may be toxic or hazardous (please list): Spot removers & cleaning fluids Misc.: ,���,,,,/RW 4-1 (dry-cleaners) Other cleaning solvents o Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE cOM LIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2. Printers BOARD OF HEALTH 3.Auto Body Shops unsatisfactory- 4. Manufacturers COMPANYM�wt '\ (see"Orders") 5.Retail Stores n� 6.Fuel Suppliers ADDRESS �S.� r� �`�'—�C18SS' 7. Miscellaneous O.c,dt.S QUANTITIES AND STORAGE (IN_ indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline Jet Fuel (A) Diesel, Kerosene, #2(B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers 1 1 CL Ckj) es Miscellaneous: At,� C7 i Sv,C y DISPOSALIRECLAMATION REMARK hA Q_� �rb Mp3J 1. Sanitary Sewage 2.Water Supply 1 rl - G 0 O Town Sewer JOublic CrV_0\19R �ivlkl I)d On-site OPriva 3. Indoor Floor Drains S NO Ya 0 Holding tank: O Catch basin/D well �S S O On-site syste ,, ,Qa u 4. Outdoor Surface NO ORDERS: 0 Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter I Narne of Hauler Destination Waste Product 1. YES INO 2. Person( In ewed -Inspector Date DATE:5/6/02------ PROPERTY ADDRESS: 20-Dunns--Pond Road -- ----- -------------= Hyannis ,Mass . ------------------------ ------------------------ RECEIVED On the above date, I Inspected the septic system at the abov address, This system consists of the following: JUN 0 4 2002 1 . 1-1500 gallon septic tank . TOWN OFBARNSTABLE 2 . 1-Distribution box . HEALTH DEPT. 3 . 1-1000 gallon precast leaching pit . . ( 6 ' X 10 ' ) Based on my Inspection, I certify the following conditions: �� 4 . This is a title five septic system , . ( 78 .Code ) 5 . The septic system is in proper working order at the present time . MAP PARCEL LOT SIG NATURE:-J _ Name:_I_F.-lLasomber JIrj__--_- Company: Joseph_P _ Macomber_& Son , Inc . Address ; Box 66 -------------------- --Centerville , Ma_-02632-0066 Phone: 508-775-3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tanks•Cesspools•Leachflelds Pumped & Installed Town Sewer Connectlons P.O. Box 66 Centerville, MA 02632.0066 775.3338 775.6412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAJRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 20 Dunns Pond Road Hyannis ,Mass . Owner's Name: Marie Walsh Owner's Address: 692 Craigville Beach Road West H annis ort Mass . 02601 Date of Inspection. Name of Inspector: (please print) Joseph P . Macomber Jr . Company Name:J . P .Macomber & Son Inc . Mailing Address:Box 66 Centerville ,Mass . 02632 Telephone Number: 508-775-3338 CERTIFICATION STATEMENT 1 certify that 1 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 the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to ection 15.340 of Title 5(310 CMR 15.000). The system: ✓✓✓ Passes _ Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails ilInspector's Signature: Date: The system inspector shall ubmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 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 DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments This report only describes conditions at the time of inspection and under the conditions of use at that �time. This inspection does not address how the system will perform in the future under the same or different conditions of use. -- Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 20 Dunns Pond Road Hyannis ,Mass . Owner: Marie Walsh Date of Inspection: 5 6 02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A:XA System Passes v not found an�4eox �Anyy hich indicates that any of the failure criteria described in 310 CMR 15.303�ae o 310 CMR T . sfailure criteria not evaluated are indicated below. Comm_ents: The septic system is in proper working order at the present time . 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 by.the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If"'not determined" please explain. d The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. 'A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. N'D explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain 2 Page 3 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 20 Dunns Pond Road yannis , ass . Owner: Marie Walsh Date of Inspection:5/6/02 C. Further Evaluation is Required by the Board of Health: At Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: /lib Cesspool or privy is within 50 feet of a surface water Aj 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 any) determines that the system is functioning in a manner that protects the public health, safety and environment: The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. IV Q The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. Vd The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than}00 feet�ut 50 feet or more from a w private water supply ell". Method used to determine distance .Gd/ "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: r 3 Page 4 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 20 Dunns Pond Road Hyannis , Mass . Owner: Marie Walsh Date of Inspection: 5 6 02 D. System Failure Criteria applicable to all systems: You must indicate "yes"or"no" to each of the following for all inspections: Yes No/ _ ackup of sewage into facility or system component due to 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 j,.Amle �Ixo/ _ Liquid depth in eo"pee4-is less than 6" below invert or available volume is less than h day Flow VRequired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number — �of times pumped �y portion of the SAS, cesspool or privy is below high ground water elevation. J Any portion of 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 y portion of a cesspool or privy is within 50 feet of a private water supply well.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. )This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) Ivlp (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15 303. therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design now of io,000 gpd to 15,000 gpd• You must indicate either"yes" or"no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA)or a mapped f Zone 11 of a public water supply well I f you have answered "yes"to any question in Section E the system is considered a significant threat, or answered es" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR !5 304 The system owner should contact the appropriate regional office of the Department. 4 Page 5 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 20 Dunns Pond Road Hyannis , Mass . Owner:Marie Walsh Date of Inspection: 5 6 5 2 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner. occupant, or Board of Health y1were any of the system components pumped out in the previous two weeks Has the system received normal flows in the previous two week period ? Have large volumes of water been introduced to the system recently or as part of this inspection ? Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out ? Were all system components,.Q luding the SAS, located on site? Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth. of sludge and depth of scum ? Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no Existing information. For example, a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance _ is unacceptable)(310 CMR 15.302(3)(b)) 5 ' Fe - Page 6 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 20 Dunns Pond Road _Hyannis ,Mass Owner: Marie Walsh Date of Inspection: 5/6/0 2 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): t1A Number of bedrooms(actual): 41,4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): _A/� Number of current residents: 4114 Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system (yes or no):ZAJ [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no):Ay Water meter readings, if available (last 2 years usage(gpd)): Sump pump(yes or no): WJ0 Last date of occupancy: aX COMM ERCIAL(INDUS AL Type of establishment: r Design flow(based on 310 CMR 1 .203): gpd /► Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):dh_l Industrial waste holding tank present (yes or no): 4 Non-sanitary waste discharged to the Title 5 system(yes or no)): Water meter readings, if available: M0-01=48 ,-000 gallons=131 . 51 GPD Last date of occupancy/use: QQT=Q-2,�45 , 000 gallons=123 . 29GPD OTHER(describe);kk��,� GENERAL INFORMATION Pumping Records Source of information: Was system pumped as pan of the inspection (yes or no): If yes, volume pumped: Q gallons -- How was quantity pumped determined? Reason for pumping: .Ili¢ TYP OF SYSTEM Septic tank, distribution box, soil absorption system 4 Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records, if any) 1!61nnovative/Altemativ.e technology. Attach a copy of the current operation and maintenance contract(to be obtained from systqn owner) X)OTight tank 40 Attach a copy of the DEP approval /wOther(describe): Approximate ofjill components d te. lied (' known and source of Were sewage odors detected when arriving at the site(yes or no):,ZA 6 Page 7 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 20 Dunns Pond Road Hyannis , Mass . Owner: Marie Walsh Date of Inspection: 5 6/0 2 BUILDING SEWER(locate on site plan) Depth below grade:_i%nL� � 4 (explain): �/J Materials of construction: cast [ron 40 PVC ,bother Distance from private water supply well or suction line:"e f Comments(on condition of joints, venting, evidence of leakage, etc.): Joints appear tight . No evidence of leakage . The sytem is vented through the roof vents . SEPTIC TANK: (locate on site plany0�10R"06�r Depth below grade: V� Material of construction: concrete4.O metalf[berglass V0polyethylene 4U©other(explain) All If tank is metal list age:44f is age confirmed by a Certificate of Compliance (yes or no):413 (attach a copy of certificate) /> Dimensions:lb' �� s5' 4lG�4� s�r Sludge depth: 22 !z Distance from top of udge to bottom of outlet tee or baffle: Scum thickness: J Distance from top of scum to top of outlet tee or baffle: 1 Distance from bottom of scum to botto�r t of qutlet t e or baffle: How were dimensions determined:. �✓ 17�(J Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The septic tank should pumped annuall , Inlet & outlet tees are in p ace . T e tank is structurally sound and shows no evidence of leakage . Liquid level at the outlet invert is fifty one inches . GREASE TRAPA,�locate on site plan) Depth below grade: Ab" Material of construct ion:4i4 concrete,c/d metal_fiberglass,G�9 polyethylene other (explain): ,►1i9 Dimensions: Itu Scum thickness: Distance from top of scum to top of outlet tee or baffle: 4),4 Distance from bottom of scum to bottom of outlet tee or baffle: 4,?4_ Date of last pumping: _ A�4 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease trap is not present . 7 Page 8 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 Dunns Pond Road yannis , ass . Owner:Marie Walsh Date of Inspection: 5 6702 TIGHT or HOLDING TANX4&—e- (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction:�R concrete metal,&L4 fiberglass polyethylene AW other(explain): AIA Dimensions: Alf Capacity: gallons Design Flow: gallons/day Alarm present (yes or no): = Alarm level: _414 Alarm in working order(yes or no): 41,4 Date of last pumping: Ni¢ Comments (condition of alarm and float switches, etc.): Tight or holding tanks are not present DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Ale Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box has one lateral . No evidence of solids carry nvPr _ No PyirlPnrP of leakage into or out of the box PUMP CHAMBEWI tle,(locate on site plan) Pumps in working order(yes or no): 11L_ Alarms in working order(yes or no): J� Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber is not present . 8 k Page 9 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 20 Dunns Pond Road Hyannis ,Mass . Owner: Marie Walsh Date of Inspection: 5 6 FO2 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) 1-1000 gallon precast leaching pit . . 6 'X10 ' If SAS not located explain why: Located ; See page 10 Typ leaching pits, number: � �O leaching chambers, number: leaching galleries,number: leaching trenches, number, length: 12 leaching fields,number, dimensions: overflow cesspool, number: �r innovative/alternative system Type/name of technology::� Ii//� o �� Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Loamy sand to medium fine sand No signs of hydraulic failure or ponding . Soils are dry . Vegetation is norm- . CESSPOOLSt&tlt: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: l Depth of scum laver: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc:): Cesspools are not present . PRIVYA�(locate on site plan) Materials of construction: �L/} Dimensions: Depth of solids: lfl/ — Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy is not present 9 Pagc 10 0( I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properry Address: 20 Dunns Pond Road Hyannis .Mass . Owocr: Marie Walsh Dstr of Inspcctioo; SKETCH OF SEW,ICE DISPOSAL SYSTEM Provide i sketch of the 1ews4c dispostl system including tics to ttl least two permanent reference landmarks or ocnc"Liks. Locitc ill wells within 100 No. Locate where public weer supply enters the building. r 'aawr-1 L 10 Page 1 1 of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 20 Dunns POND Road yannis ,Mass . Owner:Marie Wa sh Date of Inspection: 6 0 2 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: 0 tem desi Tans on record - if checked,date of design plan reviewed: bserved site(abuttin pro a bservation hole within 150 feet of SAS) d Checked with local Boar o Health-explain: ftChecked with local excavators, install-(a ch documentation) Accessed USGS database-explain: /,5,z You must describe how you established the high ground water elevation: Used : Gahret & Miller Mode1 . 12/16/94 Grolin. t _Ater eleyeiefts above — sea level USGS ; Observation well data , done IQQ2 USED ; USGS ; Technical -4ullFtin 92-000—`J PlatP #2 lanu, r 199� , roun Annual ranges ground water elevations . Leaching ` Pit 0�4 ;eet Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the bottom of the leaching pit and the adjusted groundwater table is f� feet. 11 •r.'nrw.—n:rs*--'r- rnrmr•nmrir�.n+m.re*�r::�.+-Rrr:m-mnn rss•rs-mot�rrrn ire+ TOWN OF Barnstable BOARD OF 11EALTII SUIISURFACF SFWAGE DISPOSAL SYSTF,M 0 INSPFCTION FORM - PART D - CEIt'i'JFICATiON •••T!•t�T••.••.�f—T.11•.��TT1 T T.TI'n.TT TT Seri/1TTT'r•tl."1:1T1"\TR1I1"'T'9�rVln(Ar`p11R!{Amm7 nT I -TYPO OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 20 Dunns Pond Road Hyannis , Mass . ' ASSESSORS MAP , BLOCK AND PARCEL # 270/021 OWNER' s NAME Marie Walsh PART D - CERTIFICATION NAME OF INSPECTORJoseph P . Macomber Jr . COMPANY NAME J • P . Macomber & Son Inc .-r ' COMPANY ADDRESS Box 66 Centerville , Mass . 02632 Strvvt Town or Clty state .LIP COMPANY TELEPHONE (508 ) 775 _ 3338 FAX ( 508 ) 790 - 1578 r< CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposaj system at this address and that the information reported . is true', accurate , and omplete as of the time of The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , ' n i Ilal, Check one ; System PASSED The inspection ►ihich I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form , System FAILED* \ The inspection wilicl, I have con Vcted has found that the system fails to Protect the j)ublic health and the environment in accordance with Title 5 , 3.10 CMR 15 - 303 , and as specifically noted on PART C - FAILURE CRITERIA, of this inspection form , Inspector Signature /_ Dat,: ne copy of this rt.ification must be provided to the OWNER, the BUYER he applicable ) and the BOARD OF HEAL1`JI, * If the inspection FAILED, the owner or*" perator shall upgrade ayste within one year of the date of the inspection , unless allowed orthe requiredm otherwise as provided in 3.10 CMR 15 . 305 . purtd .doc ' i I _ 05/U,/9002 10:23 FAX 428 4838 HINLIN GROVER GRAC Q 002 JOSEPH P. MACON13ER & SON, INC. Tanta - C1S . Loochfidft PumpW A MstdW TOM 96M COMM951M . � PA. Box 96 Cenbwft. CIA 0004M � 74M rr4W2 INVOICE Lid Solon Wad Redy 02-5510 692 Ctaig %Beady Road 2128102 Cent ®MA 0 TEn s 20 Dumps Pond Road Comb 1.5%every 30 days HyWkMA 2/ff= Rrow ism paw tank. $17&00 Now Mons V thavepit Mon manfor every y m�a 110 d sktbe Yore CRMfM SUBTOTAL gn BA1,A= DUL: , aet3�re i1�OtaR+st�ipt r �oFzr+e rq,�, Regulatory Services y�P °s Thomas F. Geiler,Director * B"NSTABLE. ` 9�pr �A Public Health Division E c rya Thomas McKean,Director 200 Main Street, .Hyannis,MA 02601 p.. S, ,Y•l DATE: GQ- NUMBER OF PAGES TO FOLLOW: TO: FROM: PHONE: / f 2L-�— I'� PHONE: (508)862-4644 ' FAX PHONE: / f FAX PHONE.. (508)790-6304 NO NOTES/COMMENTS: Q:UiEALTH\Fax For n.aoc TOWN OF BARNSTABLE 6�R CF THE OFFICE OF = Baaa9TeBL i BOARD OF HEALTH f MAD& 0 a mvY 367 MAIN STREET HYANNIS, MASS.02601 November 19, 1996 To: All Owners of Hair Salons Connected To Onsite Sewage Disposal System Located In The Town Of Barnstable On November.5, 1996,the Board of Health voted to issue the following policy relating to hair salons: 1) Every owner of any new hair salon and any existing hair salon which is seeking approval to install additional seats in the hair salon which is connected to an onsite sewage disposal system, shall submit plans for a holding tank prepared by a professional engineer or registered sanitarian. The holding tank shall be designed to collect industrial wastes,not sewage wastes. The plans shall be designed in accordance with 310 CMR 15.260 and shall be submitted to the Department of Environmental Protection and the Board of Health prior to opening for business or prior to installing additional seats. 2) Every owner of a new hair salon and any existing hair salon which is seeking approval to install additional seats in the hair salon and which is connected to an onsite sewage disposal system,shall install a holding tank,in accordance with the approved plans, prior to opening for business(or in the case of increased seating,prior to installing any additional seats). The holding tank shall be installed by a disposal works installer who is licensed by the Town of Barnstable. (3) All hair salons in existence prior to November 20, 1996 will be contacted by the Board of Health regarding a holding tank policy after the completion of the University of Massachusetts Study and after receiving communication(s)from the MA Department of Environmental Protection. If you should have any questions,please contact the Public Health Division Office at 790-6265. *Definition of"new"-A proposed hair salon which will open for business after November 20, 1996. PER ORDER OF THE BOARD OF HEALTH Susan G. sk,R.S.,blidirman ' R Grad , S. (0 J�q, h` hy,M.D. Board of alth �- Town of Barnstable salons TOWN OF BARNSTABLE yQF TH f toy, OFFICE OF DAH39TABL : BOARD OF HEALTH � MAld p, '639- �� 367 MAIN STREET �0 MPY�' HYANNIS, MASS.02601 October 7, 1996 Peter Sullivan, P.E. Baxter&Nye, Inc. 812 Main Street Osterville, MA 02655 Dear Mr. Sullivan: Your application to install a tight tank at LaSalon Beauty Salon Located at :aA Dunn's Pond Road, Hyannis is approved. The plans dated September 6, 1996 were reviewed by the Board of Health members and were found to be in compliance with the State Environmental Code, Title 5. The tank will receive industrial wastes from sinks which are solely dedicated for this use. The tank will be pumped by J.P. Macomber & Sons on an as needed basis and hauled to the Yarmouth Sewer Treatment Plant. Please express our thanks to your client for his/her cooperation in this regard. Sincerely yours, Susan G. Ras , R.S. Chairman Board of Health Town of Barnstable TM/bcs lasalon BAXTER & NYE, INC. Professional Land Surveyors and Civil Engineers 812 Main Street •Osterville, Massachusetts 02655 Tel. (508) 428-9131 FAX(508)428-3750 WILLIAM C.NYE,P.L.S.-President PETER SULLIVAN,P.E.-Vice President-Engineering RICHARD A. BAXTER, P.L.S. -Vice President September 6, 1996 Town of Barnstable �1 �12! `r �' 01-ice of the Board of Health o p� •! 367 Main Street 11yannis, Ma., 02601 SEP 91q�ii R.e: LaSalon - 20 Dunn's Pond Road Ti:=ht Tank Application Dear hoard. In response to your letter of August 21, 1996 please consider this as an application to install a tight tank at LaSalon a beauty salon at Dunn's Pond Road, Hyannis. I have attached the following for your review. 1 Tight Tank/Overall Plan dated 9/6/96 Sheet 1/3 2. 1-ight Tank/Design Calculations dated 9/6/96 Sheet 2/3 3. Locus Plan/LJS(iS Quadrangle Sheet 3/3 The tank will receive flow from sinks dedicated solely for perms and dyes. The tank will be pumped by JP Macomber& Sons on an as needed basis and hauled to the Yarmouth Sever Treatment Plant. The tank will be inspected by Macomber ailer the 1 st and 2nd week to deter nine actual flow and with that data a pumping schedule developed. The tank will then be inspected every three months. 1 trust that this meets your present needs. Very truly yours; OF & Nye In PETERSULLIVAN NO.29M CIVIL eter Su Ivan, P.E ! V.P. En ineerin l D P,SER0 MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS I AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS �o (� ITI � U {. CJ p a� � � � J%- r fr o N Q - _ . o IT► 31 J Qw ♦mot ' `QA--.!t PQ ri OD (IN � Tq UA = C al-1 Goff 0 CA a r do µ OF PETE SULLIVAN ` + �141{T Tp.1.�vC. A. A►1..L11�1 N0.29 733 CIVIL �ES16�N► �4t�Gtat.AT�01as ,. ON A,L 0►J \5,2 03 \oo pa me— C�kA,\Q.. (LI C Ates 'PE�2.. ��5,2 GoCz� 2 OCX� c�At_LO►:.1 tyt� ►�► , T"E TA AY- \S� E,& WATE✓�L•T"\GNT V./f�TEF-?PoC) . -T - CwE'-, '-ISCi- !{A(2L '�Et�IE`T�-P.-ROI.StS s544A LL 8G SEA�,(-.F.D Ta E SU2E W ATr--'e'r16 wITM A-CN A,epzoPflate, coartN(o 1�6�Ei.1T, Avo%o svat- A LAV-t-O\ seT OtJ btoEol= -Tl(0 4'T kASe- t�,E Ac�E:e_ S F% 53.5 C ekej L SPaGJ�� CL (Lt6�S Z.Ne-M SET 1 ITV, L �:j Tt(ter�T 49,2 tN�• J/ 'EL , 4 7 �l 49,b TAtN`- ��//v>.' 2000 Cows. '1Z 3/5- CAPAC.cTY SL 44,0 EL L23 V T S ILvt a _ A XV'Ea It 14 YC 114 cc EL zo me_ SEA ��Nc tl W 'S'�''�zyj(•LZ 1' I�SS SKELT Z/S Z6-c.KAe.6tF. AZCAG • A Fill D , ISM I �e� Ti �•� r e� I ID i I HP OfficeJet Fax Log Report for Personal Printer/Fax/Copier BARNSTABLE HEALTH DEFT 5087906304 May-14-02 10:37 identification Iseult Pages I= Pak one lotion Diagnostic 915084284839 OK 07 Sent May-14 10:32 00:04:14 002586030022 1.2.0 2.8 TOXIC AND HAZ DOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: J A IQV1l Mail To: BUSINESS LOCATION: 1W hoh,431�5 Pomb R1>1 Board of Health MAILING ADDRESS: MJ9:� 02,60/ Town of Barnstable P.O. Box 534 TELEPHONE NUMBER: Hyannis, MA 02601 CONTACT PERSON: _ EMERGENCY CONTACT TELEPHONE NUMBER II�YII I 3qq —(2-qO Does your firm store any of the toxic or hazardous materials Fisted below, either for sale or for your own use, in quantities tot ling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store: Quantity/Case Quantity/Case Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, ki� Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business LJ $ 30.00 No.. _ Fx$.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at: ..2Q...A.unjas... s2z�d_._Rs�ac�......�yann s------------------ Location-Address or Lot No. Marie Walsh Owner Address W J.P.Macomber Jr. Installer Address Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms--------------------------------------- ----Expansion Attic ( ) Garbage Grinder PO) Other—Type of Building ..Salon------.----- No. of persons------2-------------------- Showers ( ) Cafeteria ( ) Q' Other fixtures .....2---Chairs---1-/-2---bath................................................................................................ 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........................................ ,Wa Test Pit No. I---------_-----minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ---------------------------------•.....---------------------------••------•-----------------.....•--......................................................... 0 Description of Soil........................................................................................................................................................................ x Sand & Gravel v ---------••---•--....----•-------•---------•-----••------------•---•••-------------------------------------•-•-----------.......---------------•--•-----•------•--------............................... W .................................... -----------------------------------------------------------------------------------------------------------------------------------------------------------•------- U Nature of Repairs or Alterations—Answer when applicable----_1---1-5Q0....gallon_-tank....1--distribution/' box(,'.,-, . —1000____gallon _ leadr_-_pit. Omit existing cesspool Agreement: The undersigned agrees to'install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of tie State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli nce has be n ' sued y the board oj health. Signed ----- - _ 2/2 0/9 5 -.Date........-_:...... Application.Approved By .. . . ...... .. ........... --- - ---------- .. . .. .... ...... . .— -------- --------------------- ---'-----...-- ..........—'.—.' Date Application Disapproved for the following reafo s. .... ........ .................... ... ...... ..................... .................. -- ............................................... ----...---------------------------------------------------_------------ ----. . 1 Date Permit No. �- .:....-.... Issued .... -- . ----- --------------------------- Da � ilts No.._.. FEic $ 3 0 0 0 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE � Y Applirativit for Diipntiu1 Wor1w Tontitrurtiuu ramit Application is hereby made for a Permit to Construct ( ) or Repair (xy) an Individual Sewage Disposal System at: --------------------------------------------•--------•---•--•---...._--------•--•----------•--•-- Location-Address or Lot No. Marie Walsh' owner Address W J:P.Macomber Jr. s` Installer Address Type of Building Size Lot__________________--__-- S __ q. feet ►.a Dwelling— No. of Bedrooms..................:-------------------------Expansion Attic ( ) Garbage Grinder 00) _Other—Type T e of Building. S.a-lon-.-------._- No. of persons .................. Showers a •_- __. yp g. -- p ( ) — Cafeteria ( ) Other fixtures -----2---C-ha i s----1--/2 bath-------------------------------- ---------------------------------------•---------••--•------- -_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 b Date_______________________________________ 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........................ a. ............ •---------------------••--------------•---•-•-•---•-•-.._..._-------•--•--•----._..._........................................................... Q\ Description of Soil_____________________ x Sand & Gravel v --•--------------------------------------------•-------------------•---------------------..... -------------------------------------------------------------------------•------------•--•-•-••-......•-- UW -•---------------------------------------•------•------•----------------.....-----------•-•--•••--••-------------------------------------------------------------••--•---------•--••--..._...-•--------- Nature of Repairs or Alterations—Answer when applicable..----1 -1 5-(J-O-- gallon tank---l--d stxibut op/ boxc 1 -1000 gallon kleach nit. Omit exist ng cesspool. ---•--•. ...................... Agreement: V 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 Compii nce has benn/1sued by the board o, health. Signed ----- / --� 2/2 0/a 5 .. . ...... . ...............:...... /f Dace Application,Approved By .... �/I; ..... -0--- -- - - T/'�f�C-'------------------------ I (/ .v�...,...v U ................Date...-.............. Application Disapproved for the following reafo s ......................... .. ....... . . ....... ... ... ............_..__....._......... .._..._............ ---- -..--.............. ... Late Permit No. .... ..... .................................. Issued ) Da e THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cler#ifirate of (Q.1-amplian e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired kXX ) by .........J..-P-.-M.acom.,.ber---Jr-.............----------...--- ---------- _ -------......----- - --_.... ----..------- -------------.------------------------ _Ins:dler . .......... at -----------2.0.:-Dun..ns....Po.nd---Poad----u.ya_nn -5------------------------------------------------------------ -----------------------..------------------------------------------- has been installed in accordance with the provisions of TITLE of�Th 1-6-0 ta��nvironmental Code as described in the application for Disposal Works Construction Permit I ...:_.....-----.--.... - ......... dated .................._._.__----------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......_ .. t.. ..�........�.6 --q..-%-------------------------------- Inspector ) -------...._...------ -------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ��.5p.5pTOWN OF BARNSTABLE 30.00 No._.1.... >I FEE.. Dtupnottl Vorkii Trruutrudiuu "rrutit Permission is hereby granted-------J...P- Macomber Jr. --------------------------•-•-•--•----------------------•-----------------------•------•--------------•...._..._.... to Construct ( or Re air XX ) an Individual Sewage Disposal System - z u lluz I - --- --- Road Hyannis---------------- ---- -----....�.-..y�-....._ at No. , / y rr Street �f /( J shown on the application fo Disposal Works Constructio Permit No.-._._...._,. ._�_ ated f�. ... ... .-------- as V Boa d of Heali(h r � V DATE.......... ... , FORM 36508 HOBB3 8c WAR EN,IN .,PUBLISHER3 TOWN OF BARNSTABLE LOCATION$n nODc Ponct RA SEWAGE li V LLAGE ycnn ASSESSOR'S MAP & LOT 6� •� INSTALLERS NAME&PHONE NO.J D mar—amhe,r• 7��— ��A' SEPTIC TANK CAPACITY 1 r_s�Tj2L1 SgQ3L�1a LEACHII�IG:FACII.ITY: (type) dC i^ �' P 1 t (size) 10QQ' f NO.OF BEDROOMS BUILDER:.OR:OWNER .is PERmrrDAT- E 7, -20- _COMPLIANCE DATE:,_ 1. " Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet j Private Wafer Supply Well and Leaching Facility (1f any wells exist on site;orvgithin 200 feet of leaching facility) Feet Edge of Weiland and Leaching Facility(If any wetlands exist within 300.feet of leaching facility) Feet !. Furnished by' F, 14 Q : . Q \ i I A • , I