HomeMy WebLinkAbout0042 MELBOURNE ROAD - Health 42 MELBOURNE ROAD, HYANNIS
A= 268. 234
u
i
TOWN OF BARNSTABLE
..,ALOCATIOI �oZ Med bwrn.e, Dr\i e SEWAGE #
6�l'
�aLL GE V\�k S ASSESSOR'S MAP & LOT
&PHONE NO. ��►c � ee�l 'SD JR5=76 D2!3
SEPTIC TANK CAPACITY 1 oCx>!a--i
LEACHING FACILITY: (type) (size) 10 00 a-k
NO. OF BEDROOMS �.
BUILDER OR OWNER
PERMITDATE: E DATE: S
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 ,
CONNONWEALTH C F MA.SSA'CHUSETTS
ExElcurvE OFFICE OF ENVIR6XIMEN-rAL AFFAIR,
+ DEPARTMENT OF .ENVIRONMENTAL PROTECTS N
TM E 5
OFFICIAL WSPECTION FORM--NOT FOR VOLUNTARY ASSESSMEN 'S
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CIERTWICATION
Property Address:,
a i3
Owner's Name:
Owner's Address:
Date of inspection: 6 y_ 1 /
Name of Inspector: (I a Ise��T_in�t)• G/Qe
Company Name:--,3 . 1P�1J�ot r'Y� 'ttols
Mailing Address:—11 - 4-�4�--�
��53 1r -r6'� j
Telephone Number: _ f3S" 7608
CERTIFICATION STATEMENT
I certify that.I have personally inspected the sewage disposal system at this address and that the inforaaat:ici report-xi
below is true,accatmte and complete as of the time of the inspection. The inspection was performed based+ R my
training and experience. it:.the proper function and maintenance of on site sewage disposal systems.I vat a )Ell'
approved system insp ecr.or pursuaat to Section 15.340 oi'Title 5(310 CMR 15.000). The system:
Passes
Conditionally Paj;ses
Needs Further Evaluation by the Local Approving Authorir,,
Fails
Inspecfcir's Signavar-c Date: p
f - f
The systern, inspector s.,,a I somit a,::opy of this inspection report to the Approving Authority(Board+:+f I+ :dth+n
DEP)within 30 days o'campleting this inspection. If the system is a shared system or has a design flow of .0,000
gpd or gre=a,ter, the inspector and the system owner shall submit the report to the appropriate regiorsal offilc: ;If the
DEP. The original should be sent to;:;he system owner and copies sent to the buyer, if applicable, and the al :Proving;
authority.
Notes and comments
""This report only i escribes con ditions at the time of inspection and under the conditions of us;e at c hat
time. This.inspection do is riot address how the system will perform in the future under the same or dii>ferez.
conditions of use.
Title 5 inspection Forte 6/15/2000 page i
1
Pa e2of11
OFFICI AL INSPECTION FORM —NOT FOR Y�iMNTARY ASS-E�.'�.��;��I;E,r"T' ,
SUDISURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ht; ii.1vi
PART A
j CERTIFICATION(contimw)
Property Addr+tia: r �.
Owner: �C �^
Date of Inspecti,-n: � � O
Inspection Snrsrwry: Clbetit A,B,C,D or E/ALtAn comptew sm etBaeaYn D
A. System Pais is:
AI have not found any information which iudilca:es that any of the failure criteria described bi 0 C.1141,
15.303 or in 3 19 s'NIR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conclit.ionally passese
One or rncre system components as describe/ndona
onditional Pass"section need to b�:r:p ac:ecl oq
repaired. The s3st nri, upon completion of the replacpair,as appr ed by the Board of F' :a. h, will pass.
Answer yes,no or not determined(Y,N,ND)in the foll ing statements. If"not deters it.uC'pleas.:
explain. -__ The septic,:ark is metai and over 20 years oldptic tank(whether metal or not) is sit�u,:turally
urnsouatd,exhibi s,substantial infiltration or exSltratifailure is imminent.System will p;�r it ipeaLst if the
existing tank is mplaced with a complying septic tghaed by the Board of Health.
'A metal septic taitk will pass irnspection if it is strutnd,not leaking and if a Certifac;iv:c'+:uiittnc
�
indicating that the tank is less a-an 20 years old is tri able.
ND explain: r ; ��
Observation of sewage:backup or teak out arlsighs�tic water level�the distribution a!u, to.i9stduen.or .obstructed pipe(:�)+�r due to a l�rokeN led or t nmm,diistrrbmcioa,box.System will past inspectimr ,i• (wiji,
approval of Board oi'Health): ,
_ broken OWS)MR nphmd
obstruction is runoved
distribtdion box is lev&W or replaced
ND explain:
_ The systeiT. Zmping more thamA times a.yea'doe to broken or obstraeted:pipel's).':[!:,:systs:rn will pass inspection if;PGAh approval of the Board ofHealdt):
broken pipe(s)are replaced
obstruction is remo ved
ND explain:
2
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Pap 3 of it I
OFFICIAL:,.'NSPECTION FORM-NO1 FOR VOLUNTARY ASSESSME1ti' '. S
SUBSUILF'ACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM.
PART A
CERTIFICATION(continued)
Property Address: mej DO tl r n l DC, JQr.
Owner:_ D
Date of Inspection: /
C. Further Evaivatigoo is Required by the$oard of Health:
renditions exis r which require further evaluation by the Board of Health in orde to determine.if tit! systeas
is failing to protect publi health,sa:f:ty or the enviroaatem.
1. System will pars unless Board of Health determines in accordance with 10 CMR 15.303(1)(ti.i clasp die
system is not functioning ion a manner which will;.3rotect public healt ,safety and the euvii-mr:1enit.
Cesspool".r ;1tivy is within 5Q,feet of a surface water
Cesspool c r pri"y is within 50 feet of a bordering vegetated w and or a salt marsh
2. System will fa..l unless the Board of Health(and i:'ubli &ter Supplier, if any)determines uhi:i the
system is functions sj;in a manner that protects the pabl' health,safety and environment.-
The syster:h as a septic W*and soil absorptio:- system(SAS)and the SAS is within 100:-eei a
surface water.si,pply or tribut/dA
surface
water .apply.
_ The systen i has a septic SAS nd a SAS is within a Zone 1 of a public water supply
The systen t has a septic SAS d the IAS is within 50 feet of a private water suppl,p cu.
_ The systen,has a septic S S and the SAS is less than 100 feet but 50 feet or nor':fr:., n a
private water su pply well•*.; a to determine distance
"This system passes if the vvor analysis,Iferf srmet!at a DEP certified laboratory,for colifbr: i
bacteria and volatile organic Ids indicates that the well is iTee from pollution from that fats. y a,yd
the presence of 3rr.monia nitr nitrate nitroge n is equal to or less than 5 ppm,provided!hat a of'ter
failure criteria are triggered. f the an must be attached to this form.
3. Other:
3
F*je:4 of I i
OFFICIAL INSPECTION FORM.-NOT FOR
SUBSURFACE SEWAGE DISPOSAL SYSTEM IICS K4CT10Nj'C►i;l.y
FART A
CERTIF]iCATION(continued)
Property Addnass• AP 1 O r Le-'. (�A, r
<<6x��latL�s
Date of Inspeeaiein: j=f
D. Sysw=Fa lister eritarbi applicable to ail systeosse
You,1W indicate"yes"or"no"to each of the following for gLioapections:
Yeas No
_ Backup of sewage into facility or system.component due to overloaded or clogged.SA,S tit cesslxmi
'r Disc:han;e or ponding of effluent to the surface of the ground or surface waters due tc•ar :eerk>ar..i:d or
clolM4W SAS or cesspool
Stak liquid level in the distribution box above outlet invert due to an overloaded or
cesupuol ,, ,t . .
Liquid depth in cesspool is less than 6"be:ow invert or available volume is less than ',i i ia:,flove
�. Required pumping;:chore than 4 times in it.-last year ND3 due to clogged or obstructed ;;i!re(3).2'UMber
of antes pumped-__.
Any portion of dw-:SAS,cesspool or privy is below high ground water elevation.
Any portion of cesspool or privy is withi9 100 feet of a surface water supply or tributar, ; a surfisc:e
wahet supply.
Any portion of a c:asspool or privy is witlua a Zone 1 of a public well.
_._ Any petr:ion of a cesspool or privy is witlui:a 50 feet of a private water supply well.
Any pcvion of a cesspool or privy is less titan 100 feet but greater than SO feet from z,pri vote water
suplsly well with no acceptable water gwtl;ty analysis. (This system passes if the well+r,a:er s,ns1dysiis,
performed at a DEP certified leboratore, for coliform bacteria and volatile organic c )mipcund:j
indicates that the-well is free from pollution from dent facility and the presence,ofauimonia
nitr:qfen and nitra to nitrogen is equal ila or fees than S ppm,provided that no ether I:,ilare esfiaesria
-are triggered.A copy of the analysis must be attached to this form.]
(Yes/N0) Tile system jWg. I have determine,jj hat"gne or more of the above failure criteria,e;cist wi
descrited in 310 CNIR 15.303,ther+efos+e`dasyseem f Wa.Tbe system owe shauddccnt,,:tsluel3nc9tof
Heal to determiner what will be necessari to cornea tine fisilrue. _.
E. 'Large Systee m:
To be-considered s large system the system must sssye eitity with a design 4oey of 101M.lrjr I to 15,.C-Ut
gpd-
You must indicate either"yes"or`no"to each of olLw�ing:
(The following criteria apply to/fftta
tHut w the criteaiaabove)
yes no
the system is within 4itddng water supply
the sysi:a. is within ier a sarfae:e drinking water supply
Y the systitm:is locat in a nitrogen sensitive area(Interim Wellhead Protection Area—IWIF 9,; or a cca!:ped
Zone 11 )f a pub ' .I ter supply well
If you have answerc4/ove
s"to any question in Section :i the system is considered a significant threar, :r answc-ir;d
"yes" in Section C the la':ge system has failed. 1'he owner or operator of any large system :ohs, :ere:i a
significant threat Zer Section E or failed under Section D shall upgrade the system in accordance w i .a 3 10 CAMR.
15.304. The sys I r nwner shou..d contact the approprir.te regional office of the Department.
4
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Page 5 of I i
OFFIC$41, 121SPECTION FORM-Nor FOR VOLUNTARY ASSESSIMIE14 CSi
SL'BS'J1FACE S1'sWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHE(.XLIST
Properiy Address: _, ��� '"" ��r•t 11Q.
�'� �n
Owner: 7 Q 'j;1=
Date of Inspection:
Check iff the followitg.f ave been none.You mast indicate'yes"or"no"as to each of the following;
Yes No
Pumping ir.i'ortnation vial provided by the ow wr, occupant,or Boar&'of Health
Were any c l'the systetr, components pumped cret in the previous t'vo weeks ?
_ Has the system received normal flows in the previous two week period
Have large%-clumes of Hater been introduced ce the system recently or as part of this inspectic
Were as built plans of t11+:systetn obtained and examined?(If they were not available note as ; 4)
Was the facility or dwelling inspected for signs )f sewage hack up
Was the sit-inspected for signs of break out
Were all system compon:nts,excluding the SA.!;, located on site?
_ Were the septic tank marholes uncovered,opemd, and the interior of the tank inspected for d,: w.clition
�.
,of he ba,`tles or tees, maierial cf coristruction, dimensions,depth of liquid,depth of sludge and depth oif;,. .m ?
Was the faciiiry owner(and occupants if differaftt from owner)provided with information'XI,:: prop,:-
maintenance of subsu;-.-act sewage Disposal systems
The size and 'ocition of t b.e Soil Absorption Sy.jtern(SAS)on the site has been determine+9 tias:.i 01x:
Yes no ry
w Existing intoi-ration. For exatnple,aa plan at the!Board of Health.
Determined itt the field(if any of the failure crili-ma related to Part Cis at issue approximation 'di:ttanc:e;
is unacceptable) (3 i0{::A(]t 15,302(:0(b)j
5
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Page6of11
OFFIC;GI.L INSF IXTION FORM..NOTFOR VOLUNTARY ASM1 S.8P IENIIIS
SLAS)URFAC:E SEWAGE DISE'OSAL SYSIRM INSPECTION iF'iD M
:PART C
SYSTENI INFORMATION .
Pmlpsrty Address: a1i`t1R� f`'GtJe+,
Owner:.
Date of Inspetdbset:
W CONI]PriONS
RESIDENTIAL.
Number of bed wins(design):,� Ntnmber of bedrooms(aoneal):o� i
DESIGN flow beaA on 310 C.1vAR 15.203 (for example: 110 gpd x#of bedrooms): d
Number of currant amidennts: _
Does.residence I"in:a gmbsp grinder(yes or no): A)b
Is laundry on a separate sewaBp;system( s or ao):j (if yes separate inspection required
Laundry system i a rsected(yss or no)
as Seonal use:(yr•s ar no):
Water meter rem I'm ;s, it'ayails451e(last 2 years usage gpd))eO 0�5
Sump pump(yes or no):
Last date of occn.maac : w S
•` 1 Y �Lt�CS�Vvr
COMMERCIAiALIMUSTRIl:AL
Type of establisbiment:
Design flow(baso,d on 310 C>v!R 15.203) w
pd
Basis of design f,)vv(seats/persons/ .):
Grease trap present.yes or no):
Industrial waste t:olding tank pr ent(yes or no):
Non-sanitary was:e dischar to the Title S system(:ms or no): _
Water meter readinlls,if ilable: ,
Last date of occupar:c se:
OTHER(descry
GENbUL INFORMATION _
Pumlpiag Records IVQ3(I--
Source of utforms to' , .n: . �� � �c..c���
Was system pum;ed as pan of ibe inspections-(Yes roe ro o):L00
If yes, volume puinFed: gallons--How was quantity pumped determined?
Reason for pumpi ig: •.
TYPE OF SYSTEM
Q(!Septic tank,distibution boat,soil absorptmsys ea
Single cesspo)I
Overflow ces:pool
.,PRvy
_S;iaared systen (;,,es or no)(af yes,attach previotes,m pection ��if any
_Irnovarive,° v'17'1 ow a tech,aology. Attack.a copy ra£the aoatestt operation and maintenance conic i :t(to t>,:
obtained from sysa;cr•i owner) •
_Tiight tank .._..Attach a copy ofthe DEP appro•.al
O:her(descrit!):1�
Approximate age of.ell Corppon,trits,date installed(if k:zown)and source of information:
Were sewage odors cb;tected when arriving at the site(),es or.no):
6
Page 7 elf'11
OFFICIAL X[NSPEC'CION FORM—NOT FOR.VOLUNTARY ASSESSIVIEN'r,;
SUBS1'.1RFACE SEEWAGE DISPO AL SYSTEM INSPECTION FORJV,i
' PART C
SYSTEM INFOP:4ATION(continued)
r-l
Property Address: � 2 ��Oj r h e ,Pr'ter✓
Owner• I e-k :.;_
Date;of Inspection:_- ;/Qj
BUILDING SEWER locate on site plan)
Depth below grade:•-,,lo�
L.r2_,
Materials of construction:_cast u.on K 40 PVC ortlter(explain):
Distance:from private water supply well or suction line:
Comments (on condition of joints,venting.evidence of leakage,etc.):
SEPTIC TANK:1_(h)cate on slice plan)
Depth below grade.: f
Material of constrnction:�concrete metal____fiberl;lass_,polyethylene
_other{explain)___
If tank is :metal list ap!:• Is ago confirmed ay a Certil-ate of Compliance(yes or no): (attach.a c )y of
certificate)
Dimensions;
Sludge depth: I !!
Distance from top of;fudge to bottom Of outlet tee or baffic: �:
Scum thickness: bottom-
f
Distance from top of scum to top of outlet tee or baffle::_ ��
Distwice ltom bottom.of scum to bottom qf outlet tee or b e: �
How were dimensions determined: 6 Ur-eA
C-o=z ents (or,pumping;recommendations, inlet and outle-t tee or r baffle condition, struc=al integrir(, iiq id lavels
as related'.to o tlet `W!rt, evidence of.leakage,etc.)-
AP _, n
GREASE. TRAP: _..(locate on sita plan) J
Depth below grade:
Material of constructi+:n:`concrt:::e I—fibergi,ms__polyethylene mother
(explain):
Dimensions: _
Scum thickness: _2sctot
Distance tom top ofs":uof outlet tee or baffle:Distance from bottom Dfo bottom of outlet tee or btiffle:
Date of last pumping: _
Comments(on purnpitt:ecommendations,inlet and outlet tee or baffle condition, structural into levels
as related to outlet ' rrt evidence of leakage, etc.): Britt' lira': j
7
pages of 11
OFFI(.D L INSPECTION FORM-•NOTIO R VOLUNTARY ASS 1Sa AFNI"S
SI)II-SLRFACE SEWAGE IDI511,"AL SYSTEM INSPECTION F C INI
PART C
SYSTEM INFORMATION(cowed)
Property Addr!aa:
Owner.�.CG:I[�
"a 4t-
Date of I>aspee t iaa• j
t
TIGHT or IG OIJOdNG TANK: (tank must bae pumped sa time asf i opeet9oaxltreals on slat. ,►i i.a)
Depth below grade:
Material of construction:—_concreue meth___,fiberglass—`polyethylene otheifexp ;iin):
Dimensions:
Capacity:
Design Flow: __SWlons/day
Ala,tnn present(yes or ___
Alarm level: Alat= in working order(yea c r no):
Date of last punipfXon
Comments(conci' ofalarnrt and float switches,eici.):
DISTIUBUTION BOX:L(if present must be opened)(locate on site plan)
Depth of liquid above outlet invert:
Connments(note if'box is leve.1 and distribution to outiets equal, any evidence of solids canyov_:r, au;-evidcna-of
leakage into or c;yt of box, c. �
.__�{• Ci.S C'V2 Q cat eQ �' CAT W r
PUMP CHAMUE:R: (lccate on plan) _.
Pumps in working order(yes no);
Alarms in worku;g order s )r no): `
Comments(note coed' n of lnutsp cbambpr,c mxW xr of pump and appt+asensom ess,etc.):
8
• Page 9 of 1 I
OFFICIAL DiSPECTION FORM—NUT FOR VOLUNTARY ASSESSIOV,":'S
SUBSUFUFACE SEWAGE DISPOS�a SYSTEM INSPECTION FOWN1
PART C .
SYSTEM INFORKATION (contittued)
Property Address: _ OV
Date of Inspection:
SOIL ABSORPTiOi+ SYSTEM ,SAS):-�Y_(locate oc,Wte plan,excavation not required)
If SAS not located explain why: -
ALeT
leaching-pits,nv.1berr: '
lm:hing chambws,number:
leaching gallerics,cumber:_
leaching tenches,number, lengeli:
leaching fields,;i vrabe., dimensions:
over„how cesspocl, somber: ___
innovative/alteriuidi ie system Type/name of technolcgy:
Con-,menrs (note condi ion of soil, signs of hydraulic failure,level of ponding, damp soil,condition of ve;;�:!atio,-4
etc.):
CESSPOOLS: i cesspool must be pumpe as part of Lispectioa locate on site plan)
Number and configuration:
Depth—tilp of liquid t: in let invem -
Depth of solids layer:.__
Depth of-scum layer: _... .... .....,:
Dimensioju ofcesspoo.: _
Materials ofconmcti�x
Indication of ground ater inflow(yes or ao): � •,--- --
Comment.(note c diticn of soil,sibs of hydraulic raildic, level of ponding,condition of vegetation, ea:.;
PRIVY: (locate on t.it an)
Materials of constry an:
Dimensionzot ��Ioj!
Depth of s
Corm-nents of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc:.' r
9
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Page i o of I 1
OFFICIAL INSPECTION FORM-NOT FC MULUNTARY�ASSIE,,SSi IEN'Tl,s
SUBSURFACE SEWAGE DISP0SAL SYSTJ M V4SPEt n0A PT IM
PART'C
SYSTEM INF OR MIATION(entinued)
Pnaperty Addr,ms: ec �/�,J�1`�a&
Ooraer: @J.
Date of Inspect-,on:
SKETCH OF SEWAGE D1l3FOSAL SYSTEM
Provide a sketch o the sewap;e:disposal system including ties to at least two permanent reference la li=L,' $ Of
benchmarks.Lco:ate all wells within 100 feet.Locate;where public water supply enters the build.4q,,
ae _
�a
a� .
1®
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Page 11 of 11
OFFICIAL, INSPECTION FORM-TV OT FOR VOLUNTARY ASSES.1011�:17S
SUR81.rFtFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOl-VI
PART C
SYSTEM INFORMATION(continued)
Property Address:„ fl aP' r.t V4
4L 3
Owner: MILL;,r
Ad-
Date of Inspectioa:
t STTE EXAM
Slope
Surface water
Check cellar
Shallow wells xjv
t
Estimated depth to g-otind water s feet
Please indicate(chuck)all methods used to detestaine tl:x high ground water elevation:
Obtained front system desilRc plans on reeerd-If atecked,date of design plan reviewed:
Observed site(abatting propinty/observation hole within 150 feet of SAS) - -
Checked with lsc.al Board of Health-explain:
Checked with lac.a!excavators,installers.(attach clrcumentation)
Accessed 1JS0 S database-explain:
You must describe hc,vi you estab.ished tfR high around water elevation: [
i
I
r
t
111 e
TOWN OF BARNSTABLE
bDCATION y;, A-4 e;Z A'O LJANif 2d SEWAGE # 11
,,M� LAGE U/fJ-f 11VA&A6/ 9212XT ASSESSOR'S MAP &LOT L ��• 13
IRSTALLER'S NAME&PHONE NO. T"I'O. ./yl,f C OA49 eX t SOW
SEPTIC TANK CAPACITY. Z S Q D
LEACHING FACILITY: (type) (size) 1--OD
NO.OF BEDROOMS
BUILDER OR OWNER
U p
PERIvSITDATE:__I= COMPLIANCE DATE: J -:10
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
.i
7
41
i
95 p
7'
1 '
Fe
No. e
$ 50 .00
THE COMMONWEAL H OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
3pprication for Migogal 6petem Con6truction permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ®Komplete System El Individual Components
Location Address or Lot No. 4 2 Melbourne Road Owner's Name,Address and Tel.No. 7 9 0—4 31 5
Hyannis,Mass. 02601 Pat Doherty
Assessor's NY
c 42 Melbourne Road Hy. 02601
Installer's Name,Address,and Tel.No. 7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 7 7 5—3 3 3 8
J,P.Macomber & SON Inc. J.P.Macomber & Son Inc,.
Bic 66 03tDesville,MaEs. 02632 Bic 66 OmtEv11le,M3ss. 02632
Type of Building:
Dwelling M No.of Bedrooms 2 Lot Size sq.ft. Garbage Grinder ND )
Other Type of Building FES No.of Persons 2 Showers( ) Cafeteria( )
Other Fixtures
Design Flow 330 gallons per day. Calculated daily flow 2010=220 gallons.
Plan Date 1/29/98 Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil MBaun sand to aaarse sand.
Nature of Repairs or Alterations(Answer when applicable) RelacjM caved in sEPtic systsn. hlst�
1-1500 c dlm STtic tank and 1-1000 cpl gecast lead� pit used in sbale.
Date last inspected: 1/28/98
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 a not to place the system in operation until a Certifi-
cate of Compliance has been issue by this B ar f Hea h.
Signed Date 1/29/98
Application Approved by Date I -3_5 _ 9 5
Application Disapproved for the olio ng reasons
Permit No. 9p Date Issued
• TOWN OF BARNS/TABLE
LOCATION �/� M e L A O LIANe Rd SEWAGE # 9S•'
VILLAGE(tM s7&VANS{//S,dORt ASSESSOR'S MAP & LOT
II+1S.TALLER'S NAME&PHONE NO.
:SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size) DO D
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: --I 3 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 feet of leaching facility) Feet
`Furbished by -
Q
•
h� �Y-
i
No. Fee $ 50.00
THE COMMONWEAL H OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Zipprication for Oigpoga[ 6pgtem Congtruction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) EX&mplete System ❑Individual Components
Location Address or Lot No. 2 Melbourne Road Owner's Name,Address and Tel.No. 7 9 0—4 31 5
Hyannis,Mass. 02601 Pat Doherty
Assessor'slp/P ., 42 Melbourne Road Hy. 02601
�jZe
M
Installer's Name,Address,and Tel.No. 7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 7 7 5—3 3 3 8
J.P.Macomber & SON Inc. J.P.Macomber & Son Inc,.
HOc 66 03 ter i l e,Maw. 02632 133C 66 OmbWAlle,Maw. 02632
Type of Building:
Dwelling MNo.of Bedrooms 2 Lot Size sq. ft. Garbage Grinder tab )
Other Type of Building TES No.of Persons 2 Showers( ) Cafeteria( )
Other Fixtures
Design Flow 330 gallons per day. Calculated daily flow 2k110--M gallons.
Plan Date 1 29 98 Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil Mb l sand bc) owe Smld-
Nature of Repairs or Alterations(Answer when applicable) TWacdM Lived in sqptic 4 RMtW- M
1 1500 garm sq3tic tank and 1 1000 cpllcn gecast l,mddng pit p ckEd in stone.
Date last inspected: 1/2B/98 ,
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 an not to place the system in operation until a Certifi-
cate of Compliance has been issue by this B ard�f Hea h.
Signed Date i I29/98
Application Approved by ` Date I -19 - 9
Application Disapproved for the ollow ng reasons
Permit No. / 9 4�; Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired)Upgraded( )
Abandoned( )by J•P.M3mibc-x & Slm Inc.
at 42 Wbdm-e l V.-St Hwnispct�M'• has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer J.P.MxxrIbw & Sm ll'Ic. Designer J.P. & SM IM-
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date Inspector
1
---------------------------------------
No. - Fee S 50.00
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS
Migpogar *pgtem Congtruction Permit
Permission is hereby granted to Construct( )Repair�K )Upgrade( )Abandon( )
System located at 42 ftffin=n Rmd Wak W"i_QpmtrMk%•
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.
Date: - / y Approved by Q
=L ' CATIO SEWAGE PERMIT NO.
V'Il�y AG E
/f 1)9-IYIY`,S
I N S T A LLER'S NAME s ADDRESS
a
a U I L D E R OR OWNER
I�
DATE PERMIT ISSUED I co _ _
® DATE COMPLIANCE ISSUED ku mz6r �
No...... Fmi,rj.....................
THE COMMONWEALTH OF MASSACHUS45ETTS
BOARD OF HEALTH
..........................................OF.......................................
Appliration for M-4patial Works Tomitrurtion Prrutit
Application.is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
L4--r-4- 36, 1)1&Lh6R_.Xje. Az�
..................................................................................... ..................................................................................................
Location-Address or Lot No.
7— L A..)ILLQA................................. ---------------------------------------------
Owner �'_e's's
... . J,6%6_A:V----- ------------------------- --------------------------------------------------------------------------------------------------
...........J6 ......1"j.........
Installer Address
Type of Building Size Lot_.A2./_j�.........Sq. feet
Dwelling—No. of Bedrooms.!_._____.....................Expansion Attic Garbage Grinder W(O
Other—Type of Building ............................ No. of persons............................ Showers Cafeteria
Otherfixtures .....................................................................................................................................................
Design Flow___.____:.5-.57.....................gallons per person per day. Total daily flow........i�......................gallons.
Septic Tank—Liquid capacity/0d6.gallons Length________________ Width---._.-_._...-_- Diameter.---.-.__-.._.-_ Depth................
Disposal, Trench—No_.................... Width_...._.__.-_.-_-_-_. Total Length-.__-_._____________ Total leaching area....................sq. f t.
Seepage Pit No....... ----------- Diameter-------Y........ Depth below inlet......(a......... Total leaching area..4�,�. O...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_.-._..---..__-__-_..--.
0-4
Test Pit No. 2................minutes per inch Depth of Test Pit-_.---.._._-.---_-.. Depth to ground water----_-------_--___.----.
....----•--------------•--••------....-..._..._....._._....----•----------------•--••--••-•-!................................................................
0 Description of Soil........................................................................................................................................................................
W
U .........................................................................................................................................................................................................
W
......................................................................................................................................................................................................
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 TL H aj 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been.issued py the board of health.
Signed---- ::...
t "/ Date
. .................................. ......
...............7� '
Application Approved By...................
�0 Date
Application Disapproved for the following reasons:...............................................................................................................
.........................................................................................................................................................................................................
Date
PermitNo......................................................... Issued.......................................................
Date
------------
No. ............-. P ,>, Fxs.)..)....................
d THE COMMONWEALTH OF MASSACHUSETTS 1
BOARD OF HEALTH
4, .........................................OF.........................................................................................
AppiirFation for DhipmFai Workg Tonstrnrtuitt ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
................_Y.................g... ------. - --oca n-Address - -
-- tio Add or Lot No.
.: .� .. ----------------------------•---- --• --•--- .....------••-•••-••••-----•----------------•--•••-
Owner ................................Address
Installer Address
dType of Building Size Lot.,/O.rl ®v..........Sq. feet
aDwelling—No. of Bedrooms------- __•..•......................Expansion Attic ( ) Garbage Grinder J/a
Q, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
A4 Other fixtures ...............................................
W Design Flow........4 57.......................gallons per person per day. Total daily flow-------jam.......................gallons.
WSeptic Tank—Liquid capacity/0A.0_.gallons Length................ Width................ Diameter---------------- Depth-...............
Disposal Trench—No. .................... Width.................... Total Length.................... Total,leaching area....................sq. ft.
Seepage Pit No-------/----------- Diameter......Y......... Depth below inlet......&.......... Total leaching area.,-74.�....sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest 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........................
9 ----------•------------------..............•................................................................................................................
0 Description of Soil...................................................................................................................................................................
x
U
----------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------------------------
V Nature of Repairs or Alterations—Answer when applicable...............................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersignedlurther agrees not to place the system in
operation until a Certificate of Compliance has been-issued by the board of health.
Signed---- !!'� ../Lff--.... ---------------------- '�Y
Date
Application Approved B ................r---- ......... /. .. 4 .
..................•------------•----..............................--•___..Date
Application Disapproved for the following reasons:................ .__.._.._...._
-------------------------------•-•--------------------------------------.--------•--•-•---•---•---------...............................................................................................
Date
Permit'No...............................................=......... Issued-......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF......................................................................................
Trrtifiratr of TIantpiiFanrr
TH4S IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by
�' !!!!/�+ !.5.�. ..._... Installer
at ... ,�.1.t_.-� --••-------•-••----•----•----•-..•...--•......................................................
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.._9.-1-:n._�`__ -__--._ dated-.......................................... ....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARAN NEHAT T E
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.-•-•--•-•----�..�..�:.-�••`-•-�•---h-••-----•-------------------- Inspector--•-------------------- °.: :---• --� .-----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
f " J' ...........................................OF..................................................................................... rb
No ........E�._....... FEE_. ...............
Difivollati. orkii Tonot.rnrtion rrntit
Permission is hereby granted...........:....'.............:...'....._..........
to ConstruLct J._) or-Repair an, Individual Sewage Disposal S tem
atNot! . _. ............ ..............................................
r street. .
as shown on the application for Disposal Works Construction Permit no..................... Dated....................................
............ _,'-�----
Board of Health
DATE..........................................................................
FORM 1255 A. M. SULKIN, INC., BOSTON �)
a a
i
Lot._ 7 :. .. _ .
1-6'x4' Pit �
w/1' Stone
150 S.F.=301 G.P.1.
iv +� 1. Q®
,
i 2 Catch ;
. Basins --� ,
I Exp.
.(fS Lot 36 li,s r ;
10030 3F i
PROFILE
Propose ° i�.� NO SCx.T,L
W r 2 B., a
.. t 3 1 �� 24.0
`f a Of N - ----ry
—
'` ►Z.z
f
f JJJ ,
°Lot 35
FLAN SCALE 1''- 30'
DATE 8/24/84
SKETCH FI,"N OF LAND IN HYA,NIS,P ' 3.
FOR
► C {,"RLE S MARK.ARIAN
Bei,h(r lot. 36 as shown on a ,elan titled
" Strai7htwav" and recorded in plan book
;
250 page 143 Barnstable Le, ;istry of Deeds.
,
Elevations shown are in feet above water
in test pit .
i
Date : ^- m
Barnstable Board of Health
All Cape Engineering
E
Box 1533
Hyannis, 14ass. 02601
Tel. . 778-0058
i
E 3 T f I
_ .1 AC,0 `j
I
' San(1
__ fa Z" a r1 Kati �.
f t ,4/wrE"R ,_.ry
•� eta ,; w�� � as.
E 1 Z, ' �
s..-
F • . .a
SECTION - SEWAGE A ��
-SEPTIC TANK - - "D"BOX - - LEACH
TOP OF FON
. v- (MSL)# "2"OF VaTO
WASHED STONE .l,1ycp
ok
cv$ 4-1\ Cv
IN• OUT• 1 /�� C��
-G IN• OUT• IN - 1 '1
�••{ �J _'I 4-.10 TANIK -I 3.d`� -I��.Z.Co f 1..•,f # / \ !W \\� '-
4' r
ELEV. ELEV. ELEV. ELEV.
ELEV. ELEV. ___, J I pll
,--..�z.0'Imo_ ' gyp? �� `� � \ � Q�� '• %,�-a,��;41� � �`` o`y \ c� .✓
�'o'OF V."-lth"t
WASHED STONE
TEST HOLE LOG
d.J. ,Pcoc�( a. � . 1 . -
TEST BY Tb�a�il/inaL:"S.
TEST DATE "Y3.> WITNESS DESIGN 3 BEDROOM HOUSE \ �j{ ���5� ✓ ' �yi \ _J�.
T.H. 1 T.H. # 2 / ! f -- �� i
00" ELEV. ELEV.
\ LZ 0 DISPOSER DISPOSER �� �
PERC RATE MIN/IN. \ � `�y
o,� FLOW RATE 3301GAL./DAV) �'34 �-!rlb
LRAM SU S 49 S 11
SEPTIC TANK '330 (I.6)= � l
4-l+ �'�•9 REO'D SEPTIC TANK SIZE �~ f
LEACH FACILITY r th 4
!oCn� = 125')
- SIDE WALL Iz•S ) G/D. e I 67
cLEA�t co �: sr � BOTTOM !o z er/4-' '7 e.S ( I.o ) �� ' G/D.
TOTAL Z-0'4 .7-m 3 ci 7' -o �l�° . .�Q IV
Tl
USE: G'e.>G LEACH�I„NG pF\�n ._� �+ , � J•
O WATER ENCOUNTERED h0 <17
NOTES: (UNLESS OTHERWISE NOTED)
-nz. 1110Of �1lAa
1. DATUM(MSL)+TAKEN FROM....- ......•..... OF
2.MUNICIPAL WATER--_.-Np ..._.._...............AVAILABLE �tH
3.PIPE PITCH: 1/41'PER FOOT } - !U ARNE H,
4. DESIGN LOADING FOR ALL PRE-CAST UNITS: AASHO• 44 G\ ^� �+ DISTANCE AS CERTIFIED f "
Mir
6. PIPE JOINTS SHALL BE MADE WATERTIGHT
( ` v �I�I(*
7.CONSTROUCT ON DETAIUND COVER OLS TO BELACCORDANCE WIT SEWAGE H COMM. MASS. O O-ALA
_a ARC � t _
{ � s !! S�adl�
z6348 No. 30792 SITE Pi.A1'� _\
STATE ENVIRONMENTAL CODE TITLE 5 ",� 0 IUl.UO MA.I .�sTL�m'�
.�• Q Y� afSl• - �.-- _
REC►STFR� y04 lrfr H#!V �3 A.Z,h.l —orr'c"RS t`C,
qND SUR�� REG.,PROFE NGINEER REF: ��� �(• �k" 1 o 1-0 ►pt
�D�✓n ce�� @ngin�ering PREPARED FOR: ((" � SuTPN
CIVIL ENGINEERS
LAND SURVEYORS
7 BOARD OF HEALTH 926 Main St, .� �------------
REG.LAND SURVEYOR
1.1�aT!'cEzsl E 1 SCALE
CONTOURS (EXISTING) MA . w
.p-O- APPROVED QATE
(PROPOSED)-O-O' DATA
t