HomeMy WebLinkAbout0490 OAKLAND ROAD - Health 490 OaklandRoa
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TOWN OF BARNSTABLE �
LOCATION 0 CA k LA Nil SEWAGE # 2001 _y 3 Z
VI ,LAGE ASSESSOR'S MAP & LOT,�7 a-01-7
INSTALLER'S NAME&PHONE NO. A C
SEPTIC TANK CAPACFTY eSS 0 0 t
' LEACHING FACILITY: (type) -3-16Z0 W C11,1 l,0o&11' (size) 3 34= 1.5
NO. OF BEDROOMS 3
BUELDER OR OWNER
PERMITDATE: . 02 7hUv I COMPLIANCE DATE:.
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 'Feet
Private Water Supply Well and Leaching Facility (If any wells exist kL
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
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1%49
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
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DEPARTMENT OF ENVIRONMENTAL PROTECTION
IAAP
PARCEi. d .,.
LOT
TITLE 5
1'14FFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 490 Oakland Road
Hyannis MA 02601
Owner's Name: Gary&Linda Chase 7FEB
IVED
Owner's Address: Same
Date of lmspection: February 16,2004 5 2004
Name cif Inspector: PATRICK M.O'CONNELL TOWN
WHEOF B NSTABLE
Company Name: SEPTIC INSPECTION SERVICES CO.
Mailing; Address: 189 CAMMETT ROAD
MARSTONS MILLS MA 02648
Teleph Sae Number: 508-428-1779
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information re c� lttJJJ/,'
below i 3 true,accurate and complete as of the time of the inspection.The inspection was performed based OF MA
training and experience in the proper function and maintenance of on site sewage disposal systems.I am`•1�� • .••••�••., S ��i�
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: G
ATRIC ;
X Passes m
Conditionally Passes () L :cd c
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: ; ex---'� `e,� Date: _2/16/04_
The systc m inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)wit hin 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.Thy;original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authoriiy.
Notes and Comments: System not designed for garbage grinder,recommend removing.
""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 Im,pection Form 6/15/2000 page 1
Page 2 if I 1
12tFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 490 Oakland Road,Hyannis
Owner: Gary&Linda Chase
Date of]Inspection: February 1.6,2004
Inspecl ion Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
_XX_ I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 3 10 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass" section need to be replaced or
repaired.The system,upon completion of the replacement or repair, as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If'"not determined"please
explain
the septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing,tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance
indicating;that the tank is less than 20 years old is available.
ND exF lain:
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 exf lain:
the system required pumping more than 4 times a year due to broken or obstnncted pipe(s).The system will
pass in:p,-ction if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND exI lain:
Page 3 ifll
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Propert;r Address: 490 Oakland Road,Hyannis
Owner: Gary&Linda Chase
Date of lInspection: February 16,2004
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
systein is functioning in a manner that protects the public health,safety and environment:
The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_^ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance _
*"This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nib-ate 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:
Page 4 :)f 11
i2iFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 440 Oakland Road,Hyannis
Owner: Gary&Linda Chase
Date of']nspection: February 16,2004
D. System Failure Criteria applicable to all systems:
You mint indicate"yes"or"no"to each of the following for all inspections:
Yes lJ,)
X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
_X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
X Liquid depth in cesspool is less than 6"below invert or available volume is less than''/Z 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 form.]
_No_.(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd•
You muse indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
_ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed.The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304.Tie system owner should contact the appropriate regional office of the Department.
A
Page 5 of 11
,"►FFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEW-AGE-DISPOSAL-SVST'EM-INSP '.
PART B
CHECKLIST
Property Address: 490 Oakland Road,Hyannis
Owner: Gary&Linda Chase
Date of Inspection: February 16,2004
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
X_ _ _ Pumping information was provided by the owner,occupant, or Board of Health
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?
Have large volumes of water been introduced to the system recently or as part of this inspection`!
_X_ __ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
_X_ __ Was the facility or dwelling inspected for signs of sewage back up?
_X_ _ Was the site inspected for signs of break out ?
_X_ __ Were all system components,excluding the SAS,located on site?
_X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the
condition of the baffles or tees,material of construction,dimensions, depth of liquid,depth of sludge and depth of
scum?
_X ___ 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.
_X_ _ Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of
distance;is unacceptable)[310 CMR 15.302(3)(b)]
Page 6 J 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 490 Oakland Road,Hyannis
Owner: Gary&Linda Chase
Date of*Inspection: February 16,2004
FLOW CONDITIONS
RESIDENTIAL
Numbe-of bedrooms(design): 4 Number of bedrooms(actual): 4
DESIG�[flow based on 310 CMR 15.203 (for example: l 10 gpd x#of bedrooms):440
Numbe-of current residents:3
Does residence have a garbage grinder(yes or no): Yes
Is laundi y on a separate sewage system(yes or no):No [if yes separate inspection required]
Laundr, system inspected(yes or no):
Season,il use: (yes or no):No
Water rn wter readings, if available(last 2 years usage(gpd)): 2002—17,100 cu.ft. 2003—8,100 cu.ft._
Sump pump(yes or no): No 189,000 gal.=258 gpd.
Last da:c of occupancy: Currently Occupied
COMM ERCIALANDUSTRIAL
Type of establishment:
Design.f.ow(based on 310 CMR 15.203): gpd
Basis o f Design flow(seats/persons/sgft,ete.):
Grease h ap 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 nr;ter readings,if available:
Last da:e of occupancy/use:
OTHE R(describe):
GENERAL INFORMATION
Pumpial;Records: None
Source o f information: -
Was sy:,t-,m pumped as part of the inspection(yes or no): No
If yes,vc lume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
_X_Septic tank,distribution box, soil absorption system
_Sing.e cesspool
_Ov-j flow cesspool
_Pri v;
ShariA system(yes or no)(if yes,attach previous inspection records, if any)
Inn o--✓ative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtain I from system owner)
_Ti€h.:tank _Attach a copy of the DEP approval
Otlie.-(describe):
Approximate age of all components,date installed(if known)and source of information:
Compliance date: 1/18/01
Were seH age odors detected when arriving at the site(yes or no): No
Page 7 -J 11
i;)FFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 490 Oakland Road,Hyannis
Owner: Gary& Linda Chase
Date of Inspection: February 16,2004
BUILDING SEWER: X (locate on site plan)
Depth hclow grade: l'
Material i of construction:_X_cast iron _40 PVC_other(explain):
Distance from private water supply well or suction line: 30'
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC'TANK: X (locate on site plan)
Depth below grade: 18"
Material of construction:—X—concrete_metal_fiberglass_polyethylene
_other(explain)
If tank s metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimem ions: 10.5'long x 5.8'wide—1500 gal.
Sludge depth: 3"
Distance from top of sludge to bottom of outlet tee or baffle:29"
Scum thickness: 2"
Distance from top of scum to top of outlet tee or baffle: 7"
Distance from bottom of scum to bottom of outlet tee or baffle: 12"
How mere dimensions determined: STICK WITH HINGE FLAP.
Comments(on pumping recommendations, inlet and outlet-tee or baffle condition,structural integrity,liquid levels
as relatod to outlet invert,evidence of leakage, etc.):
Tees intact and clear,tank not in need of pumping.
GREASE TRAP: No (locate on site plan)
Depth Below grade:_
Material if construction:_concrete_metal_fiberglass_polyethylene_other
(explain)
Dimen:ions:
Scum tl►41ness:
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 lest pumping:
Commc nl:s(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels
as relatod to outlet invert,evidence of leakage,etc.):
Page 8 of 1 i
t'►FFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 490 Oakland Road,Hyannis
Owner: Gary&Linda Chase
Date of]Inspection: February 16,2004
TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan)
i
Depth he low grade:
Material of construction: concrete metal fiberglass_polyethylene___other(explain):
Dimens ions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm.le vel: Alarm in working order(yes or no):
Date of Last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: X (if present must be opened) (locate on site plan)
Depth cif 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 set level,no high stains or solids carryover. Liquid level at bottom of single outlet pine
PUMP CHAMBER: No (locate on site plan)
Pumps in working order(yes or no):
Alarms it working order(yes or no):
Commems(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Page 9 --f 11
i:1FFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 490 Oakland Road,Hyannis
Owner: Gary&Linda Chase
Date of Inspection: February lb,2004
SOIL/k.BSORPTION SYSTEM(SAS):X (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:
_X_leaching chambers,number: Three 500 gal,drywells�
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
inrn)vative/alternative system Type/name of technology:
Comme-nts(note condition of soil,signs of hydraulic failure,level of ponding,damp soil.,condition of vegetation,
etc.): Area over SAS shows no evidence of ponding,breakout or excessive vegetation.
CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan)
Numbe°<<nd configuration:
Depth-"top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimens ie ns of cesspool:
Materials of construction:
Indicatioti of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRW : No (locate on site plan)
Materials of construction:
Dimem io is:
Depth of solids:
Comment;(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
r n
Page 1O of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 490 Oakland Road,Hyannis
Owner: Gary& Linda Chase
Date of Inspection: February 16,2004
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a.sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchrr arks. Locate all wells within 100 feet. Locate where public water supply enters the building.
Oakland Road
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Page 11 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 490 Oakland Road,Hyannis
Owner: Gary&Linda Chase
Date of Inspection: February 16,2004
SITE EXAM
Slope None
Surface water None
Check ce liar Dry
Shallow wells None
Estimated depth to ground water: More than 30 feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record- If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Cie c-ked with local Board of Health-explain:
C Ze-.ked with local excavators,installers-(attach documentation)
_X`Accessed USGS database-explain: USGS topo map and town GIS
You must describe how you established the high ground water elevation:
Topo map shows property above el.60 and town groundwater contour map shows water at el.30.
r.-
No. y ��' :;,j Fee$ 5 0.0 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: f�
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Zippfication for Oiopogal Opotem Conotruction Permit
Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) complete System ❑Individual Components
Location Address or Lot No.4 9 0 Oakland Road Owner's Name,Address and Tel.No. 5 0 8—61 7—7 2 8—1 1 01
yang s �Maiss.. 02601 Linda Chase
essors ap/P'M A 7;Z Q l r 490 Oakland Road Hyannis,Mass.02601
Installer's Name,Address,and TO.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—7 7 5—3 3 3 8
J.P.Macomber & Son Inc. J.P.Macomber & Son Inc.
Box 66 Centerville,Mass.02632 Box 66 Centerville,Mass.02632
Type of Building:
DwellingXXXNo.of Bedrooms - Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 462 gallons per day. Calculated daily flow 4 X 1 1 0=4 4 0 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Vo Type of S.A.S. 3 3 Y2 3
Description of Soil: Loamy sand to medium f ine sand.
Nature of Repairs or Alterations(Answer when applicable)Omitting c e s s p o l s. Installing
1 -1500 gallon septic tank; 1 -Distribution box an -500 gallon
leaching chambers packed in 4 ' of 1 '-z" stone. 34 'X1 'X2 '
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issu by thi Boyd of ealth.
Signed Date6/2 5/01
Application Approved by Date K77 7/0
Application Disapproved for the following reasons
Of
Permit No. 'j�tt73 14 2— Date Issued 7
No. Levi` y ?Z"' _ may- d-. Fee $ 5 0 0 0
r •
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓�
i Yes"
�. PUBLIC HEALTH DIVISION.--TOWN OFBARNSTABLE, MASSACHUSETTS
0[pplication.for Migooal OpOem_Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon W`Complete System ❑Individual Components
Location Address or Lot No.4 9 0 Oakland Road Owner's Name,Address and Tel.No. 5 0 8—61 7-7 2 8-1 101
Rana s atss. 02601 Linda Chase
essors apgUe 7 490 Oakland Road Hyannis,Mass.02601
Installer's Name,Address,and Tel.No. 50 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—7 7 5—3 3 3 8
J.P.Macomber & Son Inc. I J.P.Macomber & Son Inc.
Box 66 Centerville,Mass.02632 Box 66 Centerville,Mass.02632
t Type of Building: f u /j (
DwellingXXXNo.of Bedrooms� Lot Size t sq.°ft. ,, Garbage Grinder( )
Other Type of Building - No.of Pe sons,•y Showers( ) Cafeteria( )
Other Fixtures 7
Design Flow 462 gallons per dayr,Calculated daily flow 4 X 110=4 4 0 gallons.
Plan Date " '' Number-of sheets Revision Date
Title .. a -
Size of Septic Tank V0 tag,l Type of S.A.S.
Description of Soil Loamy sand to m ium f4ihe sand. ,
x •.A
Nature of Repairs orAlteratoas(Answer when apphcable)Onaitting ce s:pools: Installing—.
1-1500 gallon s44tii tank l§Distribution box an t--500 gallon
leaching chambers packed in 4 of 12' stone. 34 X1 X2
Date last inspected: tj
Agreement: { a
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issu d by thi Bo d of Health.
Signed Date 6/2 5/01
Application Approved by 0 _ Date z U
Application Disapproved for the following reasons
Pe No.,-ZArV I U 12-11 Date Issued 6 Z 7
^.
THE COMMONWEALTH OF MASSACHUSETTS
p-
BARNSTABLE, MASSACHUSETTS
`Certificate of Compliance( 0 ,"
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed,( ),Repaired( )!Upgradedx(XX)
Abandoned( )by ' J.P.Macomber & Son Inc.
490 Oakt1 and Road Hyannis,Mass. has been constru/cted in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. �/'1/1 Z-dated lD —Z 7`�
Installer J.P.Macomber & Son Inc. Designer J.P.Macomber & Son Inc.
The issuance of this permit shall not be construed as a guarantee that the syst`m wil function a destg ed.
Dat 0f ido Inspector w.
— —------------- —————— -------- -----�
No. /- 2 Z-7 7- -0 l 7 Fee. . `5 0.00
l
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
liqu of *pgtem Con0truction Permit
y
Permission is hereby granted to Construct( )Repair( )Upgrade rlX4 Abandon( )
Systemlocatedat 490 Oakland RoadSHyannis,Mass.
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Constructi n must a completed within three years of the date of this e it.
Date: Z 7 �7J Approved by
l
1/6199
NOTICE: This Form Is To Be Used For the Repair.Of Failed
Septic Systems Only.
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
Joseph P.Macomber Jr. hereby certify that the application for disposal works
construction permit signed by me dated 6/2 5/01 concerning the
property located at 490 Oakland Road Hyannis,Mass. meets all of the
Mowing criteria:
Ae failed system is connected to a residential dwelling only. There are no commercial or business
cues associated with the dwelling.
tAc soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
There are no wetlands within 100 fat of the proposed septic system
There are no private wells within 150 fat of the proposed septic system
V, There is no Lr6ease in Dow and/or change in use proposed
/There are no variances requested or needed.
The bottom of the proposed leaching facility will not located less than five feet above the
maximum adjusted groundwater table clevadon. (Adjust the groundwater table using the Frimptor
method when applicable)
//lf the S.A.S. will be located with 250 fat of any vegetated wetlands, the bottom of the proposed
leaching facility will not be located less than founcen(14) fat above the maximum adjusted
groundwater table elevation,
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information)
B) G.W. Elevadon ' ® +the MAX. High G.W. Adjustment. � a
DEFERENCE BETWEEN A and B
SIGNED : DATE: 6/25/01'
(Sketc posed plan of system on back).
q:health folds.em
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vB:LAGE' _I-IVg,+VA//S ASS
ESSO:R S MAP
INSTALLER'S NAME 8c PHONE NO. _ T_ .0 A C.d ,41
SEPTIC TANK CAPACITY S C)0
s:
'LEACENG FACIi.ITY: �LO liJ CA!/t/t'l/Sta/r�s(sue) 3 3%
cryi�) 3
:NO. OF BEDROOMS
y
BUELDER OR OWNER
PERMITDATE: 2 2#v COMPLIANCE DATE
I= Separauoti'Drstante Between tire:
M4kimum:Adj6sted.Groundwater Table to the Bottom of Leaching Facility Feet
.. Pn:vate Water Supply Welland Leaclung;FaciLty:.:,(If any. wells east '!
ti
on site or wtttun 200 feet of leactung faciLty)
Feet
Edge of Wetland and Leaching FaciLty(If:any we.tlandsexist... ,.
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within 3.Q0 fget_of leaching faciLty) Feet
Furnished b ------------
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