HomeMy WebLinkAbout0056 MARSTON AVENUE - Health 56 •Marston Ave
288-208 Hyannis!,
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DATE 8121106
PROPERTY ADDRESS 56 /7a/tzton Ave , 01
Na z 02601
On the above date, the septic system at the address above was - �
Inspected.
This system consists of the following: 3 �/
1.1 1-1000 ga eion zept.ic tank. 2S
2., 1-Diet/Ligation Box.i
3.j 2-1000 ga.2.2on ieach.ing p it s.j
Based on inspection, I certify the following .conditions:
4.., 7h.i-6 .is a 71t-ee Five .3e/21-.ic by.5tem . (78Code) ' = --
5o Septic .system .is .in pao.pea woak.ing oadea at, the paesent t`ime.i
Leach pit 1 .i s haile leeU., Leach pit # 2 has V o�e wat ea .in .it o
71
SIGNATUR
Name: Robert A. Paolini '
Company. Joseph P. Macomber & Son Inc_.
Address: P. 0. Box 66
Centerville, Mass 02632
Phone: 508-775-3338 or 508-775-6412
LP—MACOMBER & SON, INC.
an ks-Cesspools-Leachfields
Pumped &.Installed
Town Sewer Connections
66 Centerville, MA 026.32-0066
775=3338 775-6412
•
COMMONWEALTH.OF MASS ACHUSE I TS
Ex FcunvE OFFICE OF ENVIRONMENTAL AFFAIRS
:DEPARTMENT OF ENMONMENTAL PROTECTION
d
TITLE 5
OFFICIAL INSPECTION FORM—.NOT:FOR.VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART-A
CERTIFICATION
Property Address: ..5 6 Na 2 z.t o n {l v e
Kyann.ib
Owner's Name: Y i i iam Day.iz
Owner's Address: .6 a m e IS D f Z
td G il►i15 OD f t" . .
Date of Inspection: 8121106
Name of Inspector:(please print) RabQrt A a0.1in
Company Name: 7_ P_A a c o m p'It .S:o.n Inc.
Mailing Address: _ n o y 66
en e2v c e, a6.s..02632
Telephone Number: 5 0 8-7 7 5=3 3 3 8
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.A340 of Title 5(310 CMR 15:000). The system:
XXXpasses =
-Conditionally Passes
N Further Evaluation by the Local Approving Authority
Inspector's Signature: Date:
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 sltared 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 11
OFFICIAL INSPECTION:.FORM—NOT FOR VOLUNTARY ASSESSMENTS'
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOB
PART f1
CERTIFICATION(continued)
Property Address: 5 6 Na4zt on Ave
flt/ann.ieRo2:�
Owner: V-i-g2.iam lDay.iz
Date of Inspection: 8121106
Inspection Summary: Check A,B,C,D or E/ALWAVS,�completeall of Section:D
A. System Passes: qES
NO I have not found any information which indicates`that-any of the failure criteria described-in 3.10 CMR
15.303.or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
Septic 6yztem .iz .in /22ope2 wo2k.ing oade2 at. the ./22ezent t.imeo
B. System Conditional) Passes:
Y Y
NO One or more system components as described in the"Conditional-Pass"section need to be.replaced.or
repaired.The system,upon co
mpletion letion ofthe 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.
NO The septic tank is metal and.over 20 years old*or the septic tank(whether metal or not)is:strncturally
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 theBoard 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:
NO 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:
NO 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 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTI.FICATION(continued)
Property Address: 56 Naae _an Avn
Kuann.i.sno2.f _
Owner: td i e-eiam DaviA
Date of Inspection: 8121106
C. Further Evaluation is Required by the Board of Health:
O 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:
no Cesspool or privy is within.50 feet of a surface water
n� 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:
no The system has aseptic tank and soil absorption system(SAS).and the SAS is within 100 feet.ofa
surface water supply or tributary to a-surface water supply.
n o The system has a septic tank and SAS and the SAS is within a Zone 1 of a public watersupply.
no The system has aseptic tank and.SA&and the SAS is within 50 feet of a private water supply well.
no .The system has a septic.tank and SAS and the SAS is less than 100 feet.but 50 feet or more fronN a
private water supply well". Method used to determine distance vizua-e
"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:
3
Page.4 of 11
OFFICIAL INSPECTION FORM—NOT FOR:VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL:SYS?'EM.INSPECTION FORM
PART A :.
CERTIFICATION(continued)
Property Address: 5 6 Razz_t o n a v e
/Iyann.i.6Ro.2 t
owner:U-i eiiam Davie
Date of Inspection: 8121106
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 ologged SAS or cesspoo
l
y
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
X Liquid depth in-cesspool is less than.6"below invert or available volume is less than'%.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 ground water 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 forip.]
NO (Yes/No)The system fails.I have determined that one or moreof 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 100000 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
X the system is within 400 feet of a surface drinking water supply
— y the system is within 200 feet of a tributary to a surface drinking water supply
X 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.
4
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACESEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
yanit.i�5/zoa.�
Owner: W.iiiiam Day.iz
Date of Inspection: 8121106
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
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,ticluding 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))
5
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:
yann.izpoit
Owner: Nii-P_ •a D y).i
Date of.Inspection: 8121106
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of.bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330
Number of current residents: 0
Does residence have a garbage grinder(yes or no): n o
Is laundry on a separate sewage system(yes or no): n o [if yes separate inspection required]
Laundry system inspected(yes or no):rL 1 -61- p �1�(� Z7
(yes or Seasonal use: n.o
, ';
Water meter readings,if available(last 2 years usage(gpd)): T(; L2_0
Sump Pump(yes or no): n o
Last date of occupancy: unknown .
COMMERCIALIEN USTRIAL
Type ofestabilsirrIent: N/A
Design flow(la,ed 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):
Non-sanitary waste discharged to the Title 5 system-(yes or no):
Water meter readings,if available:
Last date of occupancy/use:
a
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: 6116106 RurnR &y 1.i P.i Nacomtle2 _
Was system pumped as part of the inspection(yes or no):no
if yes,volume pumped:_gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
X 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:
new ieachina .in.6-taiied 8112194
Were sewage odors detected when arriving at the site(yes or no):__O_o
6
1
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENT'S
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 56 8ag.et on' ave
yann.i�s/�ogt
Owner: bl i_.P-Oi am 7n»i,c
Date of Inspection: 8120106
BUILDING SEWER(locate on site plan)
Depth below grade: 2 4
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.):
7,ointz alun_az?- #ight.i No -Peakage.i .SUit _m yeated hgouah houze vent.)
SEPTIC TANK:Ue_Xlocate on site plan) 10 0 0 ga P 2 o n h
Depth below grader
Material of construction:X 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) 1
Dimensions:8' 6"X5' 8"X4 ' 0"
Sludge depth:_t zaee
Distance from;op of sludge to bottom of outlet tee or baffle: 0
Scum thickness: t r a c e
Distance from top of scum to top of outlet tee or baffler tga c e
Distance from bottom of scum to bottom of outlet tee or baffle: tga ce
How were dimensions determined: m e a s ult ed
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.): _-
umI2 tank evegy 2 yea/tz.i Iniet 9 out$et tee. age .in-i22ace.i
Tnnk i.s AnuarL Aln Ai,gnA n pnaAagv.i
GREASE TRAP: NC(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,iniet'and outlet tee or baffle condition,structural integrity,liquid levels
as re ted to outl t invert,evidence of leakage,et .):
ygease tgap t.6 not /2ge. enZ
7
Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM �--.
PART C
SYSTEM INFORMATION(continued)
Property Address: 5 6 Na a z t o n R v e
OwnerW i eiiam Dav-iz
Date of Inspection: 8121106
TIGHT or HOLDING TANK: NO (tank must be pumped at time of inspection)(locate on site plan) .
Depth below grade: -
Material of construction: concrete metal fiberglass polyethylene othet(explain): .
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes.or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
Tight oa ho2d.ing tanks aze not /2/te6ent,
DISTRIBUTION BOX:_�Le_z(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: 0
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.):
Box .is $evei.i Has 2 eate2at6.i No .so eid ea22yove2 oa .leakage .in oa
PUMP CHAMBER: NO (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.):
Piimg rhamlLoa 1A n_o# nn_P_AP_nf
4 I
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: 56 m(7 n A f n n 4i
• Kuann.i.s�n�.�_
Owner:. (d i u Lrtm� 7n)),;A
Date of Inspection: 8121106
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Located zee 12age ' 10., -
Type
l leaching pits,number: 2
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.):
-� Loamy to medium .sand. No .6.ignb oZ Za.iiu2e oa Rond.iago So.iez aae dIty.1
Vegetation .iz noama eo
CESSPOOLS: N0 (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 br no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
Cezzpoo.0,3 ate not /zae�sent
PRIVY: Nt) (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.):
l2.ivy ib not /22e sent
9
Page l0,of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE--SEWAGE DISPOSAL SYSTEM INSPECTION FORM
l PART C .
\ SYSTEM INFORMATION(continued)
Property Address: 5 6 N .i t o n 4))v
Kyann.��/�o-a.t
Owner: bl.iMam Davi.s
Date of Inspection: 8127106
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provi4e a sketch of the sewage disposal system including ties to at Ieast two permanent referftki landmarks or
benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.. '
ti
V4 dr
"< �• r %6
,
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: .56 Naazt on Ave
/lyan.n.i�Roat .
Owner: bl.iiiiam Day.iz
Date of Inspection: 8121106
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:
NO Obtained from system design plans oh record-If checked,date of design plan reviewed-
y e z Observed site(abutting property/observation hole within 150,feet of SAS)
ce,6 Checked with local Board of Health-explain:z a u:D f nagd
no Checked`with local excavators,installers-(attach documentation)
e s Accessed USGS database=explain: ;t;6/2.t own.,g a a n z;ta 2e.,ma.�u is
/�.. You must describe how you established the high ground water elevation:
llsed • Cal2e Cod Comm4-340n ldatea 7aaie Cori.touaz And %aliie Idatea SuI212Py
Oeii head /24otect.ion aaeas mad , Sent 9995
Vate2 ae souaeez 04"11 ce cape cod commtZzon l
GroundTop of
Leaching
Pit feet
Groundwater: Feet Below Bottom of Pit High
• g 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
feet.
11
-.rOWN of 141M c:va R ('r 130ARD QF 11EA`LT11
SUBSURFACE 89KA08 nISPOSA4 SYSTEM I OPECTLON FORM - PART D.• CERTIFICATIONlow
.�
-TYPE Olt P110T 01,941 Y-
PI?OP1;RTY roPs0THJ2
STREET ADDRESS
hu3ESSORS MAP, I3LWK AND 'PARCEL /�
cam
OWNER's NAME {`l�
PART:D -• 0RRTIFI0AZK0N ,
Robert A:-Paaiiki
NAME -OF INSPECTOR ,.-.
COMPANY NAME _: Jo's' Ali" :: Maj-nmhrs.r. &:..gn
COMPANY ADDR388 f,.t C oX '6t . a 'Lrvj j6- td ro2,63-2-6066
Toxtt•or City.. 109 P
COMPANY TE49PHONS f 508. Q7.5 3338 FAX 1- 508•1.1190 4 f578 .NO
I
C1,irr 'FICATION. STATEMENT
I .certify that. I 'have personal-ly ..inspected .the Qewage 'dia .0,si1. system at
this address and that•:tbi6* information reported ,is true,. aooUra•te•, acid
omplete al of the time .a�f�inspeetion.� The inspection was performed and any
recommendattons regard.ing .upgrade•, .maintenance 1'. and rePa•ir ,are•_aongis'tent
with), my trainip,9 and experience in th8 ppoper function- acid maintenance of on—
.site sewage ateposai. systems ,
Check ones
SysteM PASSID
The inspection which J. have .•eondu¢ted has .,n-o-t• found any informAion .
which indicates' that the system' fails to 'adeduatel ., protect .publl.•o
health or the envi.ropment as defined itt• .310 CMR. 16• 30.3•* -Any f1tiiu•re
criteria odb ••evalun ed' are as staffed in the- FAII,UIM -CRI'PWA .s+eeti"on o•f
this. form.
System FAILED*
The nspectiott which. I have 00' cm ted -has found that the system fails to
protect the public 11e41th And the ens4rortinen•t ' in acgo'rd•ance with Title
61 310 CMR 15 ,303, and as • speeif ioally noted-on .PART C FAILURE
CRITERIA of this inspection °.tor
Ins.pecto>' signature' 'DaQ
ne` copy of this cet-t f iO4t•l:ott trust •be rovl:d'ad to the .QWN 1�1 t BU'tgR'•
where applicable) and trh DgARD OIV 11EA Ttt• ..
* rf the inspection FAIL'Eb•, thb ,cwne$'.ox""gverator eyetem.
within one year of the dta' •e of the inepection, unless, a7;'ldwsd Qr- regA, ,red
nthnrwine. as. Provided iT1 qJ0 CMR 160061.
TOWN OF BARNSTABLE
LOCATION 4 k- S;raN A, ✓ -
SEWAGE #
T
VILLAGE�}v.`1 AjA11 S `.2D A ASSESSOR'S MAP & LOT ?0V
INSTALLER'S NAME & PHONE NO. ,r Ag A � S o�
i
SEPTIC TANK CAPACITY / ® ® !�
LEACHING`FACIL ITY:(type) p/T (size) /- a e a
NO. OF BEDROOMS S PRIVATE WELL OR PUBLIC WATER
4j BUILDER OR OWNER V)
DATE PERMIT ISSUED: -5 Cj
DATE COMPLIANCE ISSUED: — I"� ? L l_
VARIANCE GRANTED: Yes No ��
� �
r � "�' �.�
`�
� � �
e ,
�u'
� '
� � `
k � � �3
� ��
,,�
- I
'' w o� 1
r �;
..-_ _ _ _ �-�-r�_
f
E
a� 30 00
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Nu Apphration for Di-tipootti Workii Tonotrnrtion remit
Application is hereby made for a Permit to Construct ( ) or Repair (KX) an Individual Sewage Disposal
System at:
4 Marstons Ave Hyannis
....._......----•-•--....--•--...---•-•--------••---------------------------•----•.... -----------•--•---------•----•••---•...••....-------f-
Location-Address or Lot No.
William Davis
Owner Address
W J.P.Macomber Jr.
Installer Address
PQ
UType of Building Size Lot............................Sq. feet
Dwelling-XNo. of Bedrooms----------------2-----.-.._--.--.---_...Expansion Attic ( ) Garbage Grinder ( )
PL4 Other—Type of Building _------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures ............................... . .
W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacity------------gallons Length---------------- Width.......-.-..---- Diameter................ Depth................
x Disposal Trench—No- -------------------- Width.................... Total Length-------------------- Total leaching area....................sq. ft.
Seepage Pit No--------------_---- Diameter.-.-..-.------.----- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I----------------minutes per inch Depth of Test Pit.-.---_---_----.-- Depth to ground water.......---..............
Test Pit No. 2................minutes per inch Depth of Test Pit............----.... Depth to ground water........................
a •-----------------------------------•-•----------•--------•---•-----• ......................................................................................
0 Description of Soil--------------------------------------------•-
San & Grave
U ------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------••---------
W
-------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------•-•--
V --Nature of Repairs or Alterations—Answer when applicable...........Ad cI_i n 1-10 0 0 a l l o n leaching p i t
J•Q.e i.s. - ng..tank-•&.-P i•t
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the
system in operation until a Certificate of Complia ce has be i ued b the boa o ealth.
8/5/9a
Signe .....:.
-------------------------------
Date
-`^-�
Application Approved BY v....- -.. ... .......... '..Date
Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------------
...... ............................................. .....------------------------------------------------......... .........................--...... ----------------------------------------
Permit No. L! .=L... ..................... Issued
------------------------------------------Date-----
Date L/
/` `I
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
TPrtifi ate of Grayliance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( XX)�
by J.P.Macomber Jr.
------- --------._.-...-------------------------------------...--- ------------------------------ --- -----------------_.._......----------------.._._.---------------..-------............ .. ...
Installer
54 Marstons Ave Hyannis
at .-------_-------------------------------------------------------------------------------......---- ----------------------------------------------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of TITLE 5 f The State Environmental Code as described in
the application for Disposal Works Construction Permit No. .---- y.......�y._7 dated ------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE (/ 1- 1. r Inspector _----- ------------- .----'7-- .---- ---....--.._-----------------------------
(--- / -----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
7� TOWN OF BARNSTABLE $ 30.00
No...-....,�.�..-��-.:1._./ FEE........................
i �rD �t1 orkii Tanotrurtivrt Uvermit
Permission is hereby granted....J.P.Macomber Jr.
----------------- --------------------------------------------------.....-----------------------------........---
to Constr�tct or Repair 1(X�t) an Individual Sewage Disposal System .
54 M- rstons Ave Hyannis.
atNo...............................................................................................---------------------------------- - ----------------------------------------------------------------------------------
Street /r
as shown on the application for Disposal Works Construction Permit No.--,.- -�7 Dated-----�-- ..�._.-? (-/_.
Board of Health
DATE............. .......5. .. ...................
FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS
t
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
(� TOWN OF BARNSTABLE
Appliratiun for Mupuutti` Wurk,5 Tunutrnrtiun rrrntit
Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal
System at:
4 Marstons Ave Hyannis
---. -._....• . ... --- - - • • ------------------------------------ ------•----------------------••------------•-•--------•---•-•-----•---------------•--------.-.----
William Davis Location-Address or Lot No.
W J.P.Macomber Jr. Owner Address
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling 3( No. of Bedrooms................. ..-.-•.-----..---..------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of Building ............................ No. of persons-------.--.----------------- Showers ( ) — Cafeteria ( )
QOther fixtures --------------------------------------------------------------------------------------- ---------------------------------------------------•---------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length._............. Width...--.---------- Diameter_............. Depth----..-......---
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No----_--------------- Diameter.------------------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by---- ------------------•--••---------••• ................................. Date........................................
W
a 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......................................... ----------...------------------------------................--•---•......--
l-
x 5ancI Grave -
U ••••------------------------•-•-------•...--•---------------•----------------------------•......----•-•-•---•--
W
UNature of Repairs or Alterations—Answer when applicable--------...Adding 1..1 D 0 0 gallon leaching p i t
t o.-ex i s t-ing..t o nk... .... it---------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Complia ce has bee is-ued by the boa d o Wealth.
Signe --_ 8/5/94
I
ti Date /Application Approved By .. .. 15 e'er !
Application Disapproved for the following reasons:
........................................................................................--------------------.......-----..........---------------------------------------------------....................-... .......................
PermitNo. 7-t-/ ------- ...../...................... Issued ........................................................Date-----
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD�r HEf-NL_T
zrw� _0F........ . ..... ............. ......................
Application is hereby made for a Permit to Construct (&�_Or Repair an Individual Sewage Disposal
Address
rIns a ddress
Dwellingy�Nlo. of Bedrooms.......... T=:T........................Expansion Attic PaZage Grinder
Nel'o-w eHe . ....... Total leaching area..�T.�q. ft.'
Z Other Distribution box Dosing tank ( )
P4 .........../
.... W. ...........................................................................................................................
............................................................. ......... ......................................................................... ....................................................
Agreement:
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
Application Approved By----
-------------------
2/---;�Y;te
Date
�
�
|
�
' ate'
r
THE COMMONWEALTH OF MASSACHUSETTS
14- BOARD Of HE�SLTH .
h.
Applir tion for Rapmial Worse Tomdrurtion 15amit
A lication is hereby made for a Permit to Construct ��
pp y ( , � or Repair ( ) an .Individual Sewage Disposal
Syst at
''
.ter ....../* '� ' .......... .............
............................
Local, Address
Lot N .
. ,r
.zY."f...: 4"
•� _ �/ � ney i �r Address E
.. . .... .................................................................................................
nstaller Address
Type of Building Size Lot..._I�,�"�,�'" ; "" ...Sq. feet
Dwelling-k'No. of Bedrooms........... ........................Expansion Attic ( ) image Grinder ( )
WOther—Type of Building ........................ No. of persons_-_-______.__-._•___________ Showers ( ) — Cafeteria ( )
Otherfixtures •-• --- -•••-------------...................•--....•-••---------•-----•••---•--•--•--------- --• -_----. -----•--•-•-.
. .Design Flow..................... :e). _..gallons per person per day. Total daily flow......... t ...............gallons.
USeptic Tank 4 Liquid capacity/.4'04' gailons Length................ Width_-____-_-__-,_ Diameter................Depth-__.............
xDisposal Trench—No_.................... Width..... tal n ►................. Total leaching area..__.__ sq. ft.
Seepage Pit No....I--------------- Diameter�'�tt��___ I� t i�i Tow'inlet.._..:_. ...... Total leaching area... A'_'" sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by-------••-•••----••--•••--•-•---••--••---............................... Date.......................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--.--.------___-_--._-.-
f4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 ................ .......... ................................................
'................
...............
---.......................................
O Description of Soil_____________________
U -------•-••---------------•-•--------•-:----------._...---•----••-----=---=-----------....-------------.._------------------------------------•---------------------.................................
0 Nature of Repairs or Alterations—Answer when applicable................................................................................................
-------------------------------------•••---•----•---------•-----•-••.......-•-•---••---••----.......----•------•--------.......--••-•-------••--•--•--------••-•-------------•---•--•-•--•-......_----•-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed_ _
Date
Application Approved B ----- . .____w W-7
Application Disapproved for the following reasons: '---------•-------------------------------•-----------------------------------------_--•---
Date
PermitNo.......... :......:...............:............. Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
f`Zwdd�` ......... .OF_.......42 .............
Tntifiratr of Tomptiaurr
To. IS TO CERT. ,, Th e t Individual Sewage Disposal System constructed ( ) or Repaired ( )
by - ----- ------------- ---- --- ---•------------••-------- _------
,r
}
at.. TIf
r/
= - ,=
has been installed in accordance with the provision.-'of Article XI of The State Sanitary Code as desc 'bed in the .
application for Disposal Works Construction Permit No......................
THE dated.__„ .. _y�__ _ �g�___________
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GtARAN EE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................. Inspector---••-. •------.._..._....--•------_.._...-.......----••-•--_................_..•....
"THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...... OF ..a ,w �.........................
No. . ......... FEE....ar. •. .
1
Big oiitt Workii To tr • i a Prrutit
Permission is hereby granted _ 6,4 4,�; ;�y__ _ . „.,,� - ,-...�._
to Constr t{(� or .Re air ( ),' n lndiui ual Sew " e Disposal Sys ein f , F
j. ,, .
at
reet
as shown on the application for Disposal Works Constr tion Permit'No. ---
D ----- ,.,Dated - _
..............................
b°d $oar d of Flcalth
.PATE-------------------------------------------------------------------------------- '
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS