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HomeMy WebLinkAbout0099 ELDRIDGE AVENUE - Health 99 Eldridge Ave. Hyannis A=292-281 o � s m e e R �e e o TOWN OF BARNSTABLE LOCATION L" rid ✓ SEWAGE # V'L,L'AGE ASSESSOR'S MAP & LOT�A'"a�� INSTALLER'S NAME&PHONE.NO. SEPTIC TANK CAPACITY LEACHING FACILITY (type) � � / (size) �� NO.OF BEDROOMS ' BU LDER OR OWNER ��J'J''� PERMITDATE: 1. 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 within 300 fee f 1 'n ac' 'ty) Feet Furnishe .-. o, A Locations —.Lot_ #33_i1 1_3oa.d. ___Sew.. _.Permit Village: Hyannis, Mass Installers Frank J. Linhares - T.-O.- Box 661 I'llattapoisett, Vass. Builder: William E. Dacey, Jr. . - - - - 112-West-Hain St. - - - ---_Hyanni-s•--Bass-• -- - -- Date Permit Issueds Date Compliance Issued : 7 G i �� 9� d3 ' {. --- I L r 0AT8 ;8/3/01 PROPERTY A O O R E S S; Thomas Barker —----- 99 Eldridge Ave New Hampshire 03833 On tho above dale, I Inapeoted the aeptlo ayste'rb at the above address. Thli iyslem conslsis of the following, REC;ENVFl) 1 . 1 -1000 gallon septic tank. 2. 1 -precast leaching pit. 1000 gallons. 6 'X10 ' AUG 5. 1 2001 eased on my Inspecllon, I cortlfy the following von ItT@\%FBARNSTABLE ALTH DEPT. 3 . This is a title five septic system. ( 78 Code ) 4 . The septic system is in proper working order at tll the present time. 5. The leaching pit is presently dry. 6 . Pumped septic tank at time of inspection /_/ Heavy scum & solids layers wert I Q NAT U R present. name ;-� .J'.. 1tssQat r--,U--___..__ Company; Joo • ph_Pw N•comb.r_b Son , Inc , Addre55 ;_ 8ox, 66- RECT)VFn _-Cencervi Ile L Ne,_02632-0066 AUG X5 Z001 I Phone;_-- 508_775->>>8------- TOWN OFBARNSTABLE HEALTH DEPT. THIS CIRTIFICATIOH 00eS NOT CONSTITVTC A OVARANTY OR WARRANTY RECEIVFO Cp,O. P, MACOMBER & $ON, INC. AUG 1 5 2001 EIV kpo + REC PumPod 4 In+t+llid TOWNOFBARNSTABLTown 3tw+r Conniotloni HEALTH DEPT.66 C+ntirYllll, MA 02632-0066 775J330 r756<12 .\ COMMONWEALTH OF MASSACHUSETTS r EXECUTNE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION i TITLE 5 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 99 Eldridge Ave Hyannis,Mass Owner's Name: Thomas Barker Owner's Address: 1 1 F Hi gh ctrppt Exeter New Hamnshire03833 Date of Inspection: 8/3/01 Name of inspector: (please print) J P Macomber jx Company Nil me:Joseph P. macomber & Son Inc Mailing Address: Box 66 Centerville—ma n 632 Telephone Number: 508 775 3-12$ CERTIFICATION STATEMENT 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: 2/Passes - Conditionally Passes _ Needs Further Evaluation by the Local Approving Authoriry Fa' 1 Inspectors Signature: .Date: ,�A 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 authoriry. 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 I f Paee 2 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 99 Eldridge Ave Hyannis,Mass. Owner: Thomas Barker Date of Inspection: 8/3/01 Inspection Summary: Check A,B,C,D or E/ALWAY complete all of Section D System Passes: I have not found y information which indicates that any of the failure criteria described in 310 CMA 1 5.30 or to 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the pr nt time—. B. System Conditionally Passes: _11L 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. _,Va 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 sepric 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: 4-&Zf=Observation of sewage backup or break out or hi evel in the istribution bo ue to broken or obstructed pipe(s)or due to a broken, settled or uneven istribution box. ystem w► I pass inspection if(with approval of Board of Health): broken pipc(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: AJD The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system wiI I pass inspection if(with approval of the Board of Health): _ broken pipe(s) are replaced _ obstruction is removed ND explain: 2 t' Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 99 Eldredge Ave yannis,Mass. Owner Thomas Barker Date of Inspection: 8 3 01 C. Further Evaluation is Required by the Board of Health: 100, 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. I. 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: okb 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. At The system has a septic tank and SAS and the SAS is within a Zone I of a public water supple. iUd The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. d?� The system has a septic tank and SAS and the SAS is less than 190 feet Ut 50 feet or more from a pri\•ate water supple well''. Method used to determine distance lSL/i9 '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 nirrogen 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 anached to this form. 3. Other: 3 f Page 4 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 99 Eldredge Ave Hyannis,Mass. Owner: Thomas Barker Date of Inspection: 8/3/01 D, System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No/ —Ae ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ischarge 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 ;.—Ate.-1� _/ iquid depth in cswpoo is less than 6"below invert or available volume is less than ''A day flow equtred pumping njore than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped 04Y Any portion.of the SAS, cesspool or privy is below high ground water elevation. , Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface � water supply. — y portion of a cesspool or privy is within a Zone I of a public well. — � — �trty portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. fTbis 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 analysts must be attached to this forma V0 (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 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 J _ the system is within 400 feet of a surface drinking water supply _ —Z�e system is within 200 feet of a tributary to a surface drinking water supply — Z- the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone 11 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. 4 f Page 5 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:99 Eldredge Ave yannis, ass. Owner: Thomas Barker Date of Inspection: 11 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _ ,(//Pumpins information was provided by the owner, occupant, or Board of Health 1/ Were any of the system components pumped out in the previous two weeks —je-11— Has the system received normal flows in the previous two week period? 2 Have large volumes of water been introduced to the system recently or as pan 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, 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 Pan C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)) 5 f Page 6 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 99 Eldredge Ave yannis, ass. Owner: Thomas Barker Date of Inspection: 8 3 01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):-,$— Number of bedrooms(actual): DESIGN flow based on 310 CMRR 5.203 (for example: 1 10 gpd x# of bedrooms): : Number of current resident Does residence have a garbage grinder(yes or no): !/O Is laundry on a separate sewage system !s or no):4_0 [if yes separate inspection required] Laundry system inspected(yes or no): Pr S Seasonal use: (yes or no): ' ' Water meter readings, if available(last 2 years usage(gpd)): —08��� ` 1 ✓�! Sump pump(yes or no): .1)0 �( —d J r Last date of occupancy:� COMMERCIAL/INDUSTRIAL Type of establishment: w>A Design flow(based on 310-CMR 15.203):_�� gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):A& Non-sanitary waste discharged to the Title 5 system(yes or no):li Water meter readings, if available: Last date of occupancy/use: a - OTHER(describe): AJA GENERAL INFORMATION Pumping Records Source of information: �Ud/'��p�p - „ , Was system pumped as part of the inspection(yes or no):2g,4 I If yes, volume pumped: /006gall ns-- How w s uanti pumped determined? Reason for OF SYSTEM Septic tank,dirzibution bax,soil absorption system Single cesspool .U�Overflow cesspool ,4&) Privy y�Shared system (yes or no)(if yes,attach previous inspection records, if any) .0 Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ,lam Tight tank 6�Attach a copy of the DEP approval .U�Other(describe): Approxim,ate age of all components, date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):,,_Z_?) 6 Page 7 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 99 Eldredge Ave HYannis,Mass. Owner: Thomas Barker Date of Inspection: 8 3 01 BUILDING SEWER (locate on site plan) b Depth below grade: /�/ Cast iron pipe to the Materials of construction: cast iron�Q40 PVC other(explain):septic tank. Lite PVC pipe Distance from private water supply well or suction line: /Q't from the tank to the leaching Comments (on condition ofjoints, venting, evidence of leakage, etc.): pit. Joints appear tight.No evidence of leakage System is vented through the house vent. '�" � SEPTIC TANK:�ocate on site plan) /OX files Depth below grade: C5-11 Material of construction: concreteA/6 meta lX/6fiberglass e/dpolyethylene 40ther(explain) 1 .1.4 If tank is metal list age-.,JZ6 Is age confirmed by a Certificate of Compliance(yes or no)--,1. (anach a copy of certificate) Dimensions: tIJ lU � �ur� Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:_ Scum thickness: 611 Distance from top of scum to top of outlet tee or baffle: Distance from bonom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump the septic tank every 2-3 vears. Inlet & outlet tees are in nlace.The tank is r r orally gnund and ShowG no evidence of leakage.Pumped the tank at time of inspection. GREASE TRAF '(locate on site plan) Depth below grade:.,) Material of construction,t/�i concrete,,(/_metal fiberglass ILOyolyethylene.Aother (explain): /Ui4 Dimensions: Scum thickness: AIX Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: _ W Date of last pumping: Ao 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: 99 Eldredge Ave Hyannis,Mass. Owner:Thomas Barker Date of Inspection: 8 3 01 TIGHT or HOLDING TANK(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: 00 Material of construction: concrete d2&metal fiberglass,lA polyethylene yA__other(explain): A9,4 Dimensions: A114 Capacity: dj,4 gallons Desien Flow: &14 gallons/day Alarm present (yes or no): 'C44 Alarm level: iVA Alarm in working order(yes or no): 41,4 Date of last pumping: AM Comments (condition of alarm and float switches, etc.): Tight or holding tanks are not present DISTRIBUTION BO?Gj&&,_(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:—,4 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 is not present PUMP CHAMBERI,�e. (locate on site plan) Pumps in working order(yes or no): A W Alarms in working order(yes or no): _,�24 Comments (note condition of pump chamber,condition of pumps and appurtenances, etc.): Pump chamber is not present. 8 Page 9 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:99 Eldgedge Ave Hyannis,Mass. Owner: Thomas Barker Date of Inspection: 8 3 01 SOIL ABSOR4P,T IONS TEM (SAS): (I cate on site plan,excavation not required) 14d© D��(ss ti p`' �'.Y Ay) If SAS not located explain why: Located lType eaching pits, number: _V leaching chambers, number: a leaching galleries,number: 14a leaching trenches,number, length: 0 —e leaching fields, number, dimensions: 0 ,(ld overflow cesspool, number: -Z-51— (�/ �>� �innovative/altemative system Type/name of technology: l/ (� y7L'�' "' le Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Loamy sand to. medium fine sand.Leaching pit is presently dry. Soils are dry.Vegetation is normal. CESSPOOL(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: p Depth—top of liquid to inlet invert: A 6 Depth of solids layer: - Depth of scum laver: Dimensions of cesspool: Materials of construction: ti 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: Dimensions: Depth of solids: h Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Pri vV ig nntD r'eS?11t 9 Page 10 of I I , OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properry Address:99 Eldredge Ave yannis, ass. Owner: Thomas Barker Date of Inspection:6/377T— SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including tics to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building, a C7 I� J' I 10 Page I 1 of 1 1 r M OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 99 Eldredge Ave .yannis, ass. Owner:Thomas ar er Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water/e'feet Please indicate (check)all methods used to determine the high ground water elevation: �bedl from system design plans on record-if checked,date of design plan reviewed: site a utttn rope bservation hole within 150 feet of SAS) Vp Checked with local Boar 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: Used water contours map. _Gahrety & Miller Model 1/16/94 I1 a o . 'rnT r•n.-rT�.•rr afl:JIR•nrrnls'wrt+•Rrrr+tr.7e+a►tr►r+►R.*•nrn n�r+tfi*►�•!!►�rAT `" 1Tr'�'►-ram 7rnr-••..-•.r- ) TOWN OF Barnstable WARD OF IIEALTII SUBSURFACE SEWAGF DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION I r1�T•'.".:•-T.,,�-..:rnlnrw.•rrlrir4R+reI n1e79'ra•f.'ivtR`ttwwwr-T�RAw�1RAwn♦1trwA r�ln •I*+rrr•T•„ -..•a -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 99 Eldredge Ave Hyannis,Mass. ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME ' PART D - CERTIFICATION NAME OF INSPECTOR Joseph P. Macomber Jr., COMPANY NAME Joseph P. Macomber V ion Inc COMPANY ADDRESS Box 66 Centerville Ma 02632 Street Town or City state E I P COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 ) 790- 1578 .T w CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at ID his address and that the information reported is true , accurate , and omplete as of the time of .inspection , The inspection was performed and any ecommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : G' S stelri PASSED i The inspection which 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 16 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA- section of this form . System FAILED* The inspection which I have con tcted has found that the system fails to Protect the ptlblic 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 , f r Inspector Signature Date ~!� copy of this certification must be provided to the OWNER, the BUYER One where applicable ) and the I30ARD OF HEALTit, i •gyp..., * If the inspection FAILED , the owner or operator shall upgrade ' the system within one year of the date of the inspection , unless allowed or required -otherwise as provided in 3.10 CHR 16 . 306 , partd . doc No..—�91. Fw$..�.................. THE COMMONWEALTH OF MASSACHUS TS BOA-RD EA ._ ......... .OF........... ....`�.................. .................. 9� Appliratinn -for M_gvoiial n7o_r!�Repai, -trnrtinn rrntit Application is he by made for a Permit to Construct ( ) an Individual Sewage Disposal System at: > J _------- - . .........._.... ----- c__nn-Address or I.ot IV -- ... ---•---•-•-•---•. ............. ..._•-••••-••----•-••--••-----•---•--•....•-••--•---•---------•----•------------------------------ w / wn Address ------------ --- ------------------------------------------------------ ------------------------------------------- Installer Address ��,,��aa Q Type of Building Size Lot_._ �® '__"`Sq. feet Dwelling—No. of Bedrooms._.______... -17� -------- --------- --------Expansion Attic ( ) G�frbage Grinder ( ) p`L-, Other—Type of Building ............................ No. of persons..._____--__-_--__-____-_.-_ Showers ( ) — Cafeteria ( ) Q14 Other. fixtu Q -----••-•---------------------------------------------------------------------------------------------------------------- w Design Flow-----------____.___..__.__.____.____..gallons per pe n per day. Total daily flow____--_--Z_ "L ---- --------`.."_-_gallon~. WSeptic Tank—Liquid capacity_ ------- n ............... Width.____..._._.._._ Diam r-_.------------- Depth................ x Disposal Trench—No------- idth_ _________ _____ Tot e ___ ___- _ t eaching area-------------- q. ft. Seepage Pit No--------------------- D D w e __--- Total aching area------- _ . sq. it. z Other Distribution box ( i sing tank ( ) . �� `� 2 -7y--- dam. a Percolation Test Results Performed by-------------------------------�......_._.......__._.....______.______.. Date--------.-.-.----_--------------.. 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__.__.__________-__-_... ------------------- -------•-•-------- ----------•--------------------•------•----------- --- --------------•----•-------•--•-----------•-------.----- 0 Description of Soil--- ----------------- ---------••- ---------••-----•----•- - --••-- -------------------------------- ..------•---•----•---------- x c, --- ------- --------- ­............................. -------------------------------------------------------- w x ------------------------------------------------------------------------------------------------------ U Nature of Repairs or Alterations—Answer when applicable.-____________-----------_-------------------_-------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- --•--------------•-•--•---------------------------------------------------- Agreement: The undersigned -agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code— The.undersigned further a es not to place the system in operation until a Certificate of Compliance has bbeen�• sued by4theoard of h lth� gned__-"V ��_ ---- ---------•- ----------- ----_------------ Da Application Approved B r1 ate PP PP y------------- �- �c = $ -- Application Disapproved for the following reasons-------------------• --------- - ----------------------------------•-•-•--------------------------•----------- -•....................•.••--•--.•---•-••----------------------•-•-•-------------------••-•-------- Date - Permit No......................................................... Issued...er ' , � ----7/-------__-- Date ................ THE COMMONWEALTH OF MASSACHUS TS BOARD f EA ..... . ... .. ......­---------OF...... .... ................ ..................................... Appliration -for Bi-spasal Works T trurtion Punift Application is he by made fora to Construct,arks Repair an Individual Sewage Disposal System at: ee� -7— ,T 4_1 ------------ .......Z . ...... or i�4t ...... .............................................................................................. Address Installer Address Type of Building Size Lot_o0'10,'&*%70Sq. feet Dwelling—No. of Bedrooms------------ G.r age Grinder --------Expansion Attic .1715ai Other—Type of Building ---------------------------- No. of persons---------------------------- Showers Cafeteria Other fixtu _. ----------_-- --------------------------------------------- ------------- ------------------------------------------------------------------- Design Flow...............j.....................gallons per peen per day. Total daily flow-____----Z.41 0?......0...............:""`gallons. Tank—Liquid capacity 1" a P4 Septic T, --------------- Width Di, ----- Depth..---------- ,g7..,V I oO I --- ............... r----- dth Vi 11 ----- - ------ T a- ------------- q- Disposal Trench No- ------00 -------- P ---- --- era hirigare. ft. c Seepage Pit No--------------------- W e .... . ....... Total eaching area_.._.__.__ --sq. ft. Z Other Distribution box ( I sing tank ( ) / - - 71x1-iY— o-;,& 0 4 Percolation Test Results Performed by------------_----- ----------------------------------------------------- Date----------------------------------- 4 Test Pit No. 1................minutes per inch Depth of Test Pit....._............__ Depth to ground water------------------------ V-4 Test Pit No. 2----------------minutes per inch Depth of Test Pit-................._. Depth to ground water---_--_--__--:--___--. - ------------------ ................ .. .................................................. ... ....................................................... 0 Description of Soil------ . ........ ......... ....... -------------- ------------------------------------------------------ ... ..... ............. .. .......... U ----------------------------------- ........... ...... ...................... ........I ........ ........ -----------­----I---------------------------------------------------------- -----­----------------------------- ------------------------------------------ ------------ --------------------------------------------------I------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable--------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual'Sewage Disposal System in accordance.with the provisions of Article XI of the State Sanitary Code— The der*signed further a pees not to place the system in 0 y h4 operation until a Certificate of Compliance has beenItsued b th oard of h ItY -- ------------ -------- 0gligned -------------------------------- ............................... h ... ../Da v ... �d 414—---------- Application Appro ed By�---------_41 --- - ------ Dat�e Application Disapproved for the following reasons:..............................7------------------------- ------- ............................................................................................................................................................................................... Date PermitNo.......................................................... . Issued.................................I........................ Date THE COMMONWEALTH OF MASSACHUSE BOARD OF ALTH .. .................................. 1 .Wrtifiratr of............OF..'.....:... ... . .............................................. If - "­...........W. QTkamplianre .'�;51C�ERTIFY,.,Iat thr7 tjn THIS L5 4Wdual Sewagw Disposal.System constructed J'Jor Repairedby-------------_----- ...................................... .... - ---------- e ----- -------------------------------------------------------------------X.................. nstalh .... ....... ------- at.................... ......... ------------- ------- ------------------- .......... ... ... ----------------- 415- ----------------- ---------- has been installed in accordance with the provisions of Artic I of The State Sanitary criW in the �L i ary Cod;24s, application for Disposal Works Construction Permit No........;47 ................... dated:�n------ ... ....... ---- ----- ......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE TH T THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................................................................................. Inspector.................................................................................... TVE-COMMONWEALTH OF MASSACHUSETTS 01 BOAR W!;OF H &T , .... ..... ............... .............6F ....... .................................................... N .... FE 4 6 o,rkii twtwrVvR Vrrnttt Permission is.. e y grante --------------------------................. ------------------------------------ ------ %OW... to Construct or Repior an Indi - *Se e DisyVNal Syste atNo-------------- ............................................................ ........ ................. trect as shown on the application for Disposal Works Construction it N, ---- --- )ated...Z......... ......... ............ ... .............. ..... ................... I is e y oard f Health 4 DATE................................................................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS Diagra s SUBJECT T&' :-'PPROVAL OF BOARD OF HEALTH 61 a� /CLr 71, /j \ C.G I hereby agree to conform to all the Rules and Regulations of the Town, of Barnstable regarding the above construction.