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Home My WebLink About0244 NORTH STREET UNIT BLDG 1 UNIT A - HYANNIS CONDOS __.-- _ E 244 NORTH STREET—Northport ` Hyannis f f i. r 5 '�.` ...3 .s p SS"' ."`o•'S. gXFSw t�:+a .�?.:''. -b7Ss 05`i 4- ,is`Y ° ! <3' aC Nx} r r n .+a �3•P . s 5 x i'Y'. q _ X '3a ti SUBSURFACE SEWAGE D.1SP.OSAL SYSTEM.INSPECTION FORM PART A CERTIFICATION(continued) Broken pipe(s)replaced . Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four 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 C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by The Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1).SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE-.)DETERMINES.THAT THE-SYSTEM IS FUNCTION- :" '' 1tNG`IN A MANNERITHAT PROTECT-THE"PUBLIC HEALTH,AND'SAFETY AND THE ENVIRONMENT"!, The system has'a septic'tank`and soil absorption system and'is within 100 Feet to a surface water supply or tributary to a^surface water supply. . The system has a septic tank and soil absorption system and is with a Zone I of a.public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free;from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm• D)SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. .The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS } or cesspool. Discharge or ponding of efluent 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 clog- _ Liquid SAS or cesspool. ; " Liquid�tdepth in cesspool is less than 6"below invert or available volume is less than 1/2 S X;;, a•r b.e j ' is day.flow. Required pumping more than 4 times inthe last year NOT due to clogged or obstructed ; '. pipe(s). Number of times pumped -2- F 'P' Md bd BORTOLOTTI CONSTRUCTION, INC. ,eI `� �999 k 765 WAKEBY.ROAD,MARSTONS MILLS, MA 02648 508471-9399 508428-8926 FAX: 508428-9399 ti SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Z � t PART A CERTIFICATION Property Address: 7 12LZM / 3 Date of Inspection: 3 Inspector's me: Owner's Name and Address: OL CERTIFICATION STAT . ENT• I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection. The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site sewage disposal/6ystems. The System: ✓ Passes Conditionally PasseV Needs Further ' ati y i Local Aproving`Authortt�,,.' Fails Inspector's Signature: Date: The System Inspector shall submit a copy of this inspection report to the Approving authority within thir- ty(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 Department of Environmental,Protection. The original should be sent to.the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: A)SYS M PASSES: I have not found an information which indicates dicates that the system violates an of the f '1 y at ure - criteria as defined in 310 CMk 15.303. Any failure criteria not evaluated are indicated below. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system, upon comple- tion of the replacement or repair, passes inspection. Indicate yes,nor,or not determined(Y,N,OR ND). Describe basis of determination in all instances. If not determined",explain why not. The septic tank is metal,cracked,structurally unsound, shows substantial infiltration or j exfiltration,or tank failure is imminent. The system will pass inspection.if the existing sep- tic tank.is Xeplaced with a conforming septic tank as approved by The Board of Health. Sewage backkup or breakout or high static water,level observed in Lthe distribution box is due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval,of The Board of Health): _ 1 _ "'Sn „ -`l f• '� ,h'3p SUBSURFACE SEWAGE DISPOSA' CSYSTEM INSPECTION FORM ,PART B CHECKLIST(continued) e facility owner(and occupants,if different from owner).were provided with information on the proper maintenance of Subsurface Disposal System' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C v- SYSTEM INFORMATION } FLOW CONDITIONS Design Flow: /6 fo s�alions Number of Bedrooms: Number of Current Residents: /Ly7tc�b D/yi Garbage Grinder: /��n Laundry Connected To System: Seasonal Use:A�7x Water Meter ReadingTs, if�av—ailable: Last Date Hof Occupancy: 5V . c�:, L2000�d c?�✓ - ' COM_MERCLAI✓iNDUSTRI_Ai (� : , Type of Establishment:- Design 1716vi:LLLLgallonstday Grease Trap Present: (yes or no). Industrial)Waste Holding Tank Present.' "Non*Sanitary Waste'Discharged To The Title V System: w - Water Meter Readings;If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: r7 r S stem Pam as-part of inspection: If s volutne um Y 1 p per _ Y , P 1 ilallons Reason for pumping: TYPES SYSTEM: ' _V Septic Tank/Distribution Box/Soil Absorption System Single Cesspool ; Overflow Cesspool Privy Shared System(If yes,attach previous inspection records, if any) Other OXIMATE AGE of all components,date installed(if known)and source of information: `Sews a odors detect when arriving at the site: 4 -4- s f SUBSURFACE SEWAGE'DISPOSAL.SYSTEM INSPECTION NORM PART A CERTIFICATION (conlirmcd) Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 Feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any 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. .If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant 'threat to public health and safety and the environment because one or more of the following ;conditions exist: r The system is within 400.:Feet of a:surface,drinking water supply The.system is within 200 Feet of a tributary to a surface drinking water.supply The system is located in a nitrogen sensitive area Interim Wellhead Protection Area ..(IWPA)or a mapped Zone II of a public water supply well } The owner or operator of any,such system shall bring the system and,facili .,into fulL ompliance with the groundwater treatment program.requirements of 314 CMR 5.00 and 6.00. _Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the following have been done: _,Pumping information was requested of the owner,occupant,and Board of Health. . _None of the system components have been pumped for atleast two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ✓As-built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. /The system does not receive non-sanitary or industrial waste flow. /The site was inspected for signs of breakout. 1/ All system components,excluding the Soil Absorption System,have.been located on site. ---- he septic tank manholes were uncovered,opened,and the-inteiiorvof the septic tank was in- : :. ;:,• ` spected for condition of baffles or tees,material of constructton,dimensions,depth of liquid, ,..t depth of sludge,depth of scum. ,� " ✓The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. -3- rr't�*�`' :"f". -.k:. .. a ''"ii`a y� 'vy"` x a";dt y, a x. 9u' ,. a ktn�,' ' p Nr �.! i i. 'i"^F.' ^l.'3� »ux ✓�J.FY 9i' 1i`�' f � �+ z4' 'rt�gp ,'m �. SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM - PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS): (Locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods)' If not determined to be present,explain: Type. Leaching pits,number: Leaching chambers,number: Leaching galleries,number: Leaching trenches,number,length; r Leaching fields,number,dimensions: Overflow cesspool,number: Comm- en� (note condition of soil,signs of hydr ulic failure level of ponding,condition of vegetation, etc.) 1—MA Rtl /Q" CESSPOOLS: .t)U t 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: r Inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soilk,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) i PRIVY: Materials of construction: Dimensions: Depth of,.,Solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) t -6- ,SUBSURFACE SEWAGE DISPOSAL SVSTEM.INSPECTION FORM PART C' aR 7< GENERAL INFORMATION (continued) SEPTIC TANK: Depth below grade: Material of Constniction: l/concrete metal FRP Other (explain) Dimisions: Sludge Depth: J`" Scum Thickness: 5� Distance from top o sludge to bottom of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments,- (recommendation for pumping,condition of inlet and outlet tees or baffles;depth of liquid level in relation t utlet invert, structural integrity,evidence of leakage.etc. 410,06 opL GREASE TRAP: /JU Depth Below Grade: Material of Constriction: concrete metal FRP Other (explain) — — — — Dimensions: Scum Thickness:' Distance from top of scum to top of outlet tee or baffle: Comments,:.(recommendation for pumping,condition of.inlet and`outiet tees'or tiaflles,depth of liquid -level in relation to outlet invert, structural integrity,evidence of leakage etc) .. _ TIGHT OR HOLDING TANK: /JU Depth Below Grade: Material of Construction: concrete—metal FRP Other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm Level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: Depth of liquid level above outlet invert: Comments: (note if e_l and distrib tion is equal, evi ence of solids carryover,evidenc of 1 age into 0 out of box,etc. PUMP CHAMBER: Pomp'is in workirigorder: .. .' F.,... - - Comments: (note condition of pump-chamber,condition of'pumps`ind applrienances,etc) i a '.,SUBSURFACE SEWAGE DISPOSAL..SYSTEM INSPECTION FORM' PART C SYSTEM INFORMATION (continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include des to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. 90 �y DEPTH TO GROUNDWATER: Depth to groundwater: l' Feet �O , � Method of Determination or Appro 'mation: A4 .5. dC T n 44 .a i / BORTOLOTTI CONSTRUCTION, INC. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address Prop Date of Inspec Map arce Own kJo�-96 30`� 3�'. ZL PART A — CHECKLIST CHECK IF THE FOLLOWING HAVE BEEN DONE: t/F'UMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF HEALTH. NONE OF THE SYSTEM COMPONENTS HAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND THE SYSTEM HAS BEEN RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE COLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO THE SYSTEM RECENTLY OR AS PART OF THIS INSPECTION. S-BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED. NOTE IF THEY ARE NOT AVAILABLE WITH N/A. L/THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK-UP. /HE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. t ALL SYSTEM COMPONENTS,EXCLUDING THE SAS,HAVE BEEN LOCATED ON THE SITE. E SEPTIC TANK MANHOLES WERE UNCOVERED,OPENED,AND THE INTERIOR OF THE SEPTIC TANK WAS INSPECTED FOR CONDITION OF BAFFLES OR TEES,MATERIAL OF CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID,DEPTH OF SLUDGE, DEPTH OF SCUM. E SIZE AND LOCATION OF THE SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR APPROXIMATED BY NON-INTRUSIVE METHODS. L,` HE FACILITY OWNER(AND OCCUPANTS,IFDIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER �--MAINTENANCE OF SSDS. PART B — SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL No of Bedrooms No of Current Residents Garbage Grinder YKLaundry Connected to System (J Seasonal Use NON RESIDENTIAL: Calculated flow WATER METER READINGS,IF AVAILABLE: GALLONS Pumping Records and Source of Information: O level' h e-xf Ay g/-ler J, m# SYSTEM PUMPED AS PART OF INSPECTION? IF YES,VOLUME PUMPED = . GALS Reason for Pumping: 1101 TYPE OF S M: c Septic tank/distribution box/soil absorption system V� Single Cesspool Overflow Cesspool P�xl�i/"�� j Shared system (if yes,attach previous inspection records, if any) Other(explain) Approximate age of all components. Date installed,if known. Source of Information. NA Nle r rirSEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE? Q .1 ~Y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B- SYSTEM INFORMATION (Continued) SEPTIC A K: Depth below grade s1 Dimensions: 7 6 Material of construction: 4.--"Concrete Metal FRP Other} Sludge Depth 71111 /611 Distance from top of.1ludge to bottom of outlet tee or baffle 91 el Scum Thickness Distance from Top of Scum to top of outlet tee or we Distance from bottom of Scum to bottom of outlet tee or baffle e-41M Ael®.&v e`u7 cam mments: CL O O G F d DIST BUTI N BOX:X: G DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT Comments: 1' Q PUMP HAMBER: Pumps in working order? Comments: SOIL ABSORPTION SYSTEM (SAS): IF NOT PRESENT,EXPLAIN: TYPE: C mments K CQ.ta•e I Pam`" nd i- e,2 26 do• ,Y�o� ed- CESSPOOLS: O Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimension of cesspool Materials of construction Indication of groundwater inflow(cesspool must be pumped) Comments: PRIVY: d Materials of construction Dimensions Depth of solids Comments: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued] SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES,LANDMARKS OR BENCHMARKS. LOCATE ALL mus WITHIN 100' VIA S-01 ' 61 DEPTH TO;GROUNDWATER: DEPTH TO GROUNDWATER METHOD OF DETERMINATION OR APPROXIMATION: ,¢ /BX/�rIQ'r ram► -l��t (�. S �/e /�'��" SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA i (Indlcale Y—yes N-no ND—not determined.Describe basis of determination.If"not determined explain why not) i Backup of Sewage into Facility? Discharge or ponding of effluent to the surface of the ground or surface waters?, Static liquid level in the districution box above outlet invert? A-114. Liquid depth in cesspool, 6"below invert or available volume, 1/2 day flow? Required pumping 4 times or more in the last year? Number of times pumped Septic tank is metal?cracked?:structurally unsound?substantial infiltration?substantial exfiltration? tank failure imminent? "v Is any portion of the SAS,cesspool or privy, below the high groundwater elevation? / Within 50 feet of a surface water? Within 100 feet of a surface water supply or tributary to surface water supply? N Within a Zone I of a public well? Within 50 feet of a private water supply well? I �v Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools&privies only, not the SAS)? Less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,amonia nitrogen and nitrate nitrogen. PART D — CERTIFICATION INSPECTOR: ROBERT J.BORTOLOTTI ADDRESS: 765 WAKEBY ROAD, MARSTONS MILLS COMPANY: BORTOLOTTI CONSTRUCTION INC. MA 02648 (508) 771-9399 CERTIFICATION STATEMENT I CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION REPORTED IS TRUE,ACCURATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED AND ANY RECOMMENDATION REGARDING UPGRADE,MAINTENANCE AND REPAIR ARE CONSISTENT WITH MY TRAINING AND EXPERIENCE IN THE PROPER FUNCTION AND MAINTENANCE OF ON—SITE SEWAGE DISPOSAL SYSTEMS. CH7:11AVE NOT.FOUND ANY INFORMATION WHICH INDICATES THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC HEALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15.303. ANY FAILURE CRITERIA NOT EVALUATED AREAS STATED.IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. I HAVE DETERMINED THAT THE SYSTEM FAILS TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN 310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. INSPECTOR'S SIGNATURE: //0 DATE: ORIGINAL TO SYSTEM OWNER,COPIES:BUYER(d appllcable);APPROVING AUTHORITY 1 No THE COMMONWEALTH OF MASSACHUSETTS ` BOAR® OF HEALTH ...................... ..................oF... UGC.---------------............_....---- / Applirat" n for Uippvo al nrki Tomitrnrtiun amit r'tl6'r' i P dYZ-f C_".D am h i.W s Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at• p ' ........ ..... 1 :....... .. ... ' .. --� l-c "_.�.�.------....................................... Loc tipn-Address Lot N . Owner Address W Installer Address cc�� U Type of Building �u�•pt (�, Size Lot_2..,P_5 ..Sq. feet, Dwelling—No. of Bedroom ___------ ---••--•.... G.....................Expansion Attic ( ) rbage Grinder ( ) per4 Other—Type of Building �..NO. of persons-------- ----------- Showers Cafeteria (/ Q' Other fixtures ._,_�._ • W Design Flow................. 7._.__.___._gallons per person pt?r dap Total d�il 4QW.........10(Y0. ................__�llo�. WSeptic Tank—Liqui capacity gallons Length__J1_._/(J___ Width.�r__'______ Diameter................ Depthz�n.._.. x Disposal Trench—No..................... Width.................... Total Length...... _ll_.._t.--- Total leaching area..13.6�s q. ft. 3 Seepage Pit No__________________ Diameter....... �..... Depth below inlet_...?........... Total leaching area..................sq. ft. Z Other Distribution box Dosing ank Percolation Test Resul Performed by---• ��`'o..r' 1 1 � Date ,.a Test Pit No. I...&Z._minutes per inch Depth of Test Pl .._._/. ... Depth to ground water-_-0 �t�'-1.Z Test Pit No. 2................minutes per inch Depth of Test Pit------J v....... Depth to ground water___C--' .!''J& e--------,----- -----------------------------------------------------t..........r-------------ft -•---•------•-- -------•---------•-- 0' Description of Soil.....0..— .-�lb-s'7C 1. : c� 1_: s. __G 1 .._--------- ------------- x W V Nature of Repairs or Alterations—Anf we when applicable................................................................................................ --------•-- 'eu. - �f � '------.Ql tn� ------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ITLl 5 of the State Sanitary Code— The undersigned further a ees not to pla he system in operation until a Certificate of Compliance has been issued by the board Of health. K�l►��-f C ,(J Date Application Approved By • = - = ....^ Application Disapproved for the following reasons:..................................... --••--------•-•--------•---------------•--......••... Date ........_... ..................................•---------•---------------•-------------------......-----••••..........._ Date PermitNo......................................................... Issued..........................-............................ Date No................_..... . THE COMMONWEALTH OF MASSACIiUSETTS _- BOARD OF HEALTH ..........� .:�-..�................OF...� �rPA-351 _............................................................ App irFation for Dispmial Workii Tonstrur#ion ramit Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal System at: Q, `l ; fj t .....Cj ........................................................ - -----------____ -_- •- ----s' -_-_- Location Address • - -i••� �. �._ s . " ..` ` ..... PX/ Lot N .._ ....--- ` ............... Owner Address W .... .... Installer Address __ Type of Building Utl�(;4J (� Size Lot___ ___________ __Sq. feet Dwelling—No. of Bedroom ..__......_.•.......:::..:...................Expansion Attic'( ) 'arbage Grinder Other—T e p 1 Other—Type of Buildin g l___. __ No. of persons......___............. Showers }— Cafeteria 17 `.�.............gallons per erson er da . Total dail Other fixtures .___..._ W Design Flow_._r`�_..._:� Oo �.��j g P P y flow._._.._.____�.._t=- -a..................gallons."-; WSeptic Tank—Liquid:capacity �D.gallons Length__l. ..__� .. Width........... Diameter................ Depth^ x Disposal Trench o .....Width.................... Total Length....... ___......._. Total leaching arealz dsq. ft. -I Seepage Pit. No t Diameter......1.,._..... Depth below inlet.... Total leaching area..................sq. ft. Z Other'Distribution'b'ox �'�`L Dosingank Performed bY•----(,.�fi � L)tQ � � 7� . /... f f Percolation Test Resul s - ------------•-_.... -• Date. Y ••••. •...••-•- a Test Pit No. L....�_.�-___minutes per inch Depth of Test Pif..__�.,_'_......_ Depth to ground water__-'!� �- f3;4 Test Pit No. 2................minutes per inch Depth of Test Pit......L2........ Depth to ground water,_'_-- :,*,;`'111 0 ? i a :.--------.--•••--•-----••----••---•................•-•-•...•••--•--......._A----•--•••-•••-------••- ------ D Description of Soil..... -3' �J f��i.�t -t-Qf: �[a 1 s:-:-.._.. -�.:=I�- Y14ec-.�..��►�?._. � _ .....__ V ............................. •---------•-••••......:...............•-------•••-••-••--•-----•-•----•••••.....•----•-•-••---••--•----•......_..--•-•-••-••--•---•-----•-•-•---•--••---...----..._..------ W U Nature of Repairs or Alterations—Answer when applicable...................................................................................._........__. �t Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT_ 5 of the State Sanitary Code—The undersigned further aarees not to plaqesthle system in operation until a Certificate of Compliance ha�.been issued by the board of health. � .I�tx,11\I�Ti-1 cz.-, r.}f Signed...........................v---------------........-------•-------•-------- ----••-- ................................ ,/� �t Date Application Approved BYr�i y/ ............................. Date Application Disapproved for the following reasons-----------------------------------------•-----------•-------•---------------•-------...•--......--•-•-----.._.._ ........................................•---------------......------------....------------------...---._..._..----•---------------------------------------------------.................................. Date Permit No. .............. ,. Issued..-•--------------- -_----•-. - ---------•-•._.......•••-•------_....Date THE COMMONWEALTH OF MAS$ACH,USETTS BOARD OF HEALTH .......... r,,,,. 3. .............O F. �� z,.- .: .:' : . ........................................ Trrtifiratr of ToutpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed bl-.(or Repaired ( ), by---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Installer 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 ---. ............. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.�Tt:.. ...:.:................. FEE . .,-'_... ... ..... �i��u�aal urk� �on,�iratr�iun rraatii Permissionis hereby granted................................................................... ••----•••-•----•--••-•-•---•--•-•••-•--••-•....-----:................_.._. to Construct (&,I or Repair ( ) an Individual Sewage Disposal System at No. ' --••-5' Street as shown on the application for Disposal Works Construction Permit No................1--- Dated.......................................... Z— ......Z------- oar of health DATE------ ..................................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS TOWN OF BARNSTABLE--�:' /_Acm, , LOCATION �/' D�'L=N SE # � �� S . VILLAGE C> O�' J` / �ApS�SES R'S MAP& LOT6�3e �/Y 5� ) '''NAME&PHONE NO r k/G A0` (Pc4 7/ SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �S ��l (size) Q� L e�7• NO.OF BEDROOMS L BUILDER R OWNER /»mac /(LGr/-/�ei PERMTTDATE: 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 et of eachin fac' ) / � Feet Furnished b U;/,,O ncSr�ic;�� e �'� 3�. 71VI fd �. ��a�T � �'� � w �� y, �19' � . 0 3` , � C�. �y goy �, o� � � Q, C� �0V No ..�.1—.. � ' `� Fps.............................. f� rTHE COMMONWE'ALTH` F MASSACHUSETTS BOAR® OF HEALTH 101-00--..----....0F.: 1 .e.. "------------------------------------------- Appiiration for Dhiposa1 Workri Tnnitxnrtion ranfit Application is hereby made for a"Permit to Construct (Y) or Repair ( ) an Individual Sewage Disposal System at /04!..... .)L-A Location-Address r o tCN t t ..... Owner Address W Installer Address Type of Building ` f abw°r"'• is LL-,D t U 6 Size Lot.................... .....Sq. feet �., Dwelling—No. of Bedrooms�:j..........................................Expansion Attic ( ) Garbage Grinder ( ) aOther 1�ype of Building l�.&UW_L..... No. of persons............................ Showers (�<— Cafeteria dOther fixtgres ---------------------------------------•---......-----"------------------------------------------------------------------- '-._...... W Design Flow..15-GAL. anllnr;�:.�r•r Total 1 w fl ..............._; —7 -....... Ions. W Septic Tank—Liquid capacity.-/CD..Ugallons Length._d..= ---- Wi Diameter________________ Depth. ......... .. x Disposal Trench—No..................... Width.. . ....._._._.. Total Length...... .... Total leaching area....................sq. ft. Seepage Pit No---------I......... Diameter....... ----------- Depth below inlet.................... Total leaching area....".�.O...sq. ft. Z Other Distribution box Y 5 Dosin tank Percolation Test Resul s Performed by - `�" �� ---------- Date--- .......... ... . a� Test Pit No. 1_.�.. _minutes per inch Depth of Test Pit - Depth to ground water.....0 p p b t---•- p g ts-�✓ tO (.� Test Pit No. 2................minutes per inch Depth of Test Pit...... Depth to round water--- e i........... . ----------------------------------------- Description of Soil J. -._.._ _ � lt- - ��.........or UW .......................•••-••-----•-••------••-----••--•--••------------•--------•-•---------------------•------•-•••-•------••....-------•-•-•-----•••---•--�----------------•--•--------------a+ Nature of Repairs or Alterations—Answer when applicable_-_., cam_ ^- .�a� r_••--_--_-- '�"°" ------------•...................•---•--------------.....------------•-•- ---•-------••- -----.....---• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the"provisions of iITIE 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 by the board of health. Signed......K.E.E�PAiT.". 14h4 EMaY v Date Application Approved BY �i e.._...... .. 1.L Date �.. --••-•-------- Application Disapproved for the following reasons---------------------------------------------------------------•----------------•------------•--•-----........--- -•--------------------------•••-•---•----....---....••--------------------....-•--------•••--•----------•---•---•---•---••-•-•---•••--------•--------••--•---•----------•------•--•----•-----•••-••-•--- Date PermitNo......................................................... Issued...:................................................... Date No......................... �` _ 1. FEB............................. r� THE COMMONWEALTH—DF MASSACHUSETTS BOARD OF HEALTH :.:2WX ....---.....OF.!s1..,6A"-f.. >W75(— ......... ................................................. App irFation for Dispau at-Works Towitratrtiun anti# Application is hereby made for a Permit to Construct (y) or Repair ( ) an Individual Sewage Disposal System at: V ................ »• ..... L•ocation--Address ' or.-Lot N ......................r..... . ��= ....._1 �..........: ..r }.� ....... SCf � __..1: 71:' _...�Fi• ..� . �.................................... W Owner Address �I ............... ........ ....... Installer Address UType of Building g Z607— 1Z l..>I L.:')) U 6 Size Lot............................Sq. feet Dwelling—No. of Bedrooms.............................................Expansion Attic ( ) Gar age Grinder ( ) Other A Type of Building' ..... No. of persons............................ Showers (1 ") — Cafeteria d Other fixt ..................................... Design F1ow.jS.0 r .r.:;r>._.' . =_._gaffe ..p y. Total d it flow.................. .:..............gallons; W Septic Tank—Liquid'capacity'—/(?=(-)gallons Length-----`-- Width_ .."�f?.. Diameter._ ;/ " �•••Depth:..•.......... x Disposal Trench—No. .................... Width ....... Total Length....... ... Total leaching area....................sq. ft. Seepage Pit NO.........I---------- Diameter.................... Depth below inlet.................... Total leaching area. ,j...sq. ft. Z Other Distribution box ) Dosin tank f `\],_ t � Percolation Test R esu is Performed by--- �---�r��-•---------- Date---- .-------- Test Pit No. ...7_.--minutes per inch Depth of Test Pit..... .._.._ Depth to ground Gt, Test Pit No. 2................minutes per inch Depth of Test Pit.....�°��...__.. Depth to ground water.................... 6 �• ......... .. ---•--•Description of Soil.. �= = •. x ........... U -••-••••-•••-••-••••••••••••-•••-•-•••-----•••--•••-••-•••--•••.........••--•-••-••-•••--•-•---•-••••-••--••................•-......•.------......•-••-•-••••--•••••-•••••- W ••••••••••••----------------------•-•••••--••--•••------••-•---...-••••••-•-•---•--•..................--••- ' VZE% c� may-- r -�r� � (<. Nature of R air AlAlte >o k 1n over when applicable......-----•-•---•....... ----------------------••••-•-••-••-•... •-------•---------------------------------------•-------•--•------•-------------------.....-•.-•---•••----•....-••••----•--•••-•••-•••--•••-••---•-•-•••••--•••-•••••••••......-••-••-----••..._...._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITiE 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 by the board of health. 1NSigned... .=.... . ` F- 4.f too� _y ___. t . � ....................... Date Application Approved By ......•••...............................•• Date Application Disapproved for the following reasons--------------------•-------••-----------------------------------------------------.................---........_ ---------------------------------•-••---....-•-----------•-•------------•---------....--•--•-•---------•.•-••••-•---•---------•--•-•-------••----•-------•••----••••-••--••-----•••••-•-•••••-------•--- Date PermitNo...............••••----......._....._......•-•---------. Issued....................................................... _ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. OF.... .... ..................................................... THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired �) bY...............................................................................................•. ------.....----.....•••---•--------------•------...•--•--••••-•-•----....--•-•-----•---._._.... Installer at.........---s -------�`�-�- �J`` has been`ih tad in aLl -a c� 3vith tl~ rovisions -� 1-8 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.. ... .... !!-------------- dated.............:..........___.__........_........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT CLONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................•-------•----..............----•--•--•---•---... Inspector................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF No.. ,,.. 2./. / D �.rY, , . > FEE...... c Raposal Works Toro rnrtivit rru it Permissionis hereby granted.............................................................................................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo.............. ----•-• - -` T{.......... >`........ Street as shown on the applicatio for Disposal Works Construction Permit No..................... Dated.......................................... } 7 ---•-••--••-_..... �-•3/-- i�ToHealth DATE.............. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 1 _7-77-- r r7 4, ?j V ("J AVVI 3, > r "J61 114 �011 )z op kz 6t, I I e- �Tvz,.vl LIZ 44, OF j ALAN BAXT W. 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