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Home My WebLink About0597 PITCHER'S WAY - Health `.597:Pitcher',s,Way_- , - _. �iHyanfiis - .P A = 270 236 i I i THE COMMONWEALTH OF MASSACHUSETTS BOARD V� D o Application is hereby'made for a Permit to Construct 4,)-�orRepair an Individual Sewage isposal Address Type of Building Size Lot_-__2---�K'_Y_1$7.Sq. feet --------------- Other Distribution box Dosing teank ( _- -'--'''--_-_.--_--''-'''--' ---_'''-''------.''''---''---''-'_--_- egroeoeoc: The undersigned agrees to install the uforcdcacrJbe6 Individual Sewage Disposal Syste rniu accordance with the provisions of Article %lof the State Sanitary Code-The undersigned further agrees not mplace the system in operation until u Certificate of Compliance has been issued by 0?the board of health. 01 Sggoo --aa ',�.�� ate Application Approved Dy'--.---------��.----_--------_....�--------'% -_-_-------.---D� Application Disapproved for the following reasons:................................................................................................................ -'---------'---'----'--'--------'----'-'-------------'--------------'-- -�� -�J ��- �~�� Date' L/ � ' � PermitNo......................................................... Issued........................................................ ' Date | L------------------------------------------------------------- -'''''''''' '-'-''__--''--'_'''---'--'--'� -7 - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Applira#iun "fear Uiripwial Worka C otus#rur#imn Vrriti# Application is hereby'made for a Permit to Construct / or R pair ( ) an Individual Sewage Disposal System,ats,� ------ 1 ---rn4 --------------------- ----------`i_-----iwlr' /. ' .�___C_!-�____,_._r_.._c..t.../,��.---••-----------------------------••----- Location-Address � f or Lot No. a Wner, ddrress .•.-•--------------•-............................ -•----•----•--------•---'•-••-•-•..._...-••-•-------.........-•--•---•---•--...--••----•-••-•---- Installer Address Type of Building Size Lot _�__`r_.:;_5-.Sq. feet U Dwelling No. of Bedrooms-------- Expansion Attic Garbage Grinder aOther—Type of Building ____________________________ No. of persons...__--_.--_------..-.----_- Showers ( ) — Cafeteria ( ) dOther fixtures _off ------------ -------------- --------- --------- ---------------------•---•----•---------------••--•-••--•------------- W Design Flow.......&TM•e_--------------------------gallons per person per day. Total daily flow......... --------------------..gallons. 1:4 Septic Tc;nk—Liquid capacity/~` ions Length---------------- Width__- _ --____-- Diameter_....___-----_ Depth..-------------- xDisposal Trench—No.......... ..........,NVidth-------------------- Total Length-_-____--.--_---__ otal 1 hing area--------------------sq. ft. Seepage Pit No... t ff�i� ^'"!--_..._.. I 15el fv inlet ' s Ching area._%.tea_-_.S-____sq. ft. yh� z Other Distribution box ( f)� Dosing tank ( ) d d— �� .6 - �-' Percolation Test Results Performed bY----------- -------------------------------------------------------------- Date---------------------------------- Test Pit No. 1----------------minutes per inch Depth of 'Pest Pit...--_-__-_______-- Depth to ground water-------------_.--.-.... LT, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water.-.-_---_-_-__._-._. ------------- '----------------- -----.- D Description of Soil---------- ro `'L - f - - 1 �i +-� � t, --•----------........fa. - ------- 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 Article \I 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. . {7 > i/ Date Application Approved BY IV ................ Date Application Disapproved for the following reasons:-------•-------•--••-----•------••-------------•-- ----•---•---._-------•-------.._.......---•--------------... ---------------•--••------------------------------------------.-----•------------------------------------.-•-----------------------------------------------•--------------------------------------.---•- Permit No................................................ - - Issued------• -_."2 l ` 7/ate ----------................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f�- 'fit.✓.....OF..�. ' '•<'• t rr:./'►f.-!....� ........................... V.rr#if iratr of ("'T=11fiallrr THIS IS TO CERTIFY„fThaat/the Individual Sewage Disposal System constructed ( or Repaired ( ) ------------ �r // / +� f r r +✓__}Install- f _ has been installed in accordance with the provisions of L�lc e NI�of,iThe State Sanitary Code as described in the application for Disposal Works Construction Permit No..................5---_.,57_ ------- dated__- __ . .. ------------_-•-- THE ISSUANCE OF THIS CERTIFICATE SHALL, NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 2� DATE ..'_ --- ------... Inspector X 0*-/ ------------------------------------------------- THE-tOMMONWEALTH OF MASSACHUSETTS r-. BOARD HEALTH No........ 3- FEET. Permission is hereby granted...... S___��__•—t< +.............JJ1-s�.-�_ to Construct (�or Repair ( ) an Individual Sewage Disposal System r at No. = f :r= i`- .f/ A1�+ .�=-.�rrcc% �_........ 67 - Street as shown on the application for Disposal Works Construction Permit No_____________________ Dated-----�.._..?r1__�_ --_..--- ....................................................... ------------------------------------------------ Board of Health DATE------------------------------------------------------ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS i 10, 5 `oc, / LOTS q9 s� v sc?T C. -011lrpoo CsAL �� xanc PIT u� i Ix iJ 6 L ' 0 7- W W� X y �4tCNARii G -z A SA Eh N �o CE1ZTtF1ED P'L.bT RL..A VV j tbTloo.! to H Y s, MA,5s, CAI y 1 r-"TIFY T"AT TIdI~ �00.. thTlp 4 4tAOo4, J �!_AQ >`ERcil-4ca 1-IEQEz�w.3 CO APLYS /ITN TWS: 51 VS.L+WC-- LO T 1 Z. A, AIJn SET CK VC4UIIZE:Al46 -ITS DF TNC }} 70 W G1 ESA R N S T A t:� l..V-, FCC. # PC. PA4Es E REG l S�T''E=.IZ�D 1_A tJ�p Sty t�.V c Yo cZS TWS Vt—AW IS uoT E5ASeX:) OW AW osTEc�vILI..E o A,CasS. t64-9M 1MEkJT 5UZVEti( 4 TtNt= gFG75r-- 'S e,"O LX> APPLt C .1JT' GP.a'r- Wive Df-v rL. , Co C' 6e U'SEQ To ve:TMZMI?J& L.AT' LIweS i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION MAP PARCS. LOT i �-P1 TITLE S OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 597 Pitchers Way Hyannis Owner's Name: Arlene Martin Owner's Address: Date of Inspection: 8/8/2003 Name of Inspector: (please print) Kevin J. Sullivan Company Name: Ready Rooter Mailing Address: P.O.Box 371 �U �3 Sandwich,MA 02563 Telephone Number: (508)888-6055 Gov:}a;:`;;T} s; fn13tE CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System: --ZPasses Conditionally Passes Needs Further Evaluation by the Local Authority Fails Inspector's Signature: Date: 7/ The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 597 Pitchers Way Hyannis Owner: Arlene Martin Date of Inspection: 8/8/2003 Inspection Summary:Check A,B,C,D or E/ALWAYS complete all of Section D C. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 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"Conditio Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair approved by the Board of Health,will pass. Answer yes,no or not determined (Y,N,ND)in the for a following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or a septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or k failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank approved by the Board of Health. *A metal septic tank will pass inspection if it is stru ally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is a 'able. ND explain: Observation of sewage backup or break ut or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled r uneven distribution box.System will pass inspection if(with approval of Board of Health): en pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pump' g more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approva of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 597 Pitchers Way Hyannis Owner: Arlene Martin Date of Inspection: 8/8/2003 C. Further Evaluation is Required by the Board of Health: Conditions exist which require farther evaluation by the oard 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 dete nes in accordance with 310 CMR 15.303(lxb)that the system is not functioning in a manner which ll protect public health,safety and the environment: _Cesspool or privy is within 50 feet of a ce water _Cesspool or privy is within 50 feet of dering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public ater Supplier,if any)determines that the system is functioning in a manner that protects the public h Ith,safety and environment: _The system has a septic tank and soil absorption em(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water s ply. _The system has a septic tank and SAS and th AS is within a Zone 1 of a public water supply. _The system has a septic tank and SAS and a SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS d the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used determine distance "This system passes if the well water alysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds i icates that the well is free from pollution from that facility and the presence of ammonia nitrogen and ni nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of a analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 597 Pitchers Way Hyannis Owner: Arlene Martin Date of Inspection: 8/8/2003 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No IZ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool __%e'Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ Static liquid level in the distribution box above outlet invert due to and overloaded or clogged SAS or cesspool _ _LZ Liquid depth in cesspool is less than 6"below invert or available volume is less than %Z day flow _ -,Z Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _ _V1 Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. - ,,Z Any portion of a cesspool or privy is within a Zone 1 of a public well. _ Any portion of a cesspool or privy is 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. [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.] I/l.. (Yes/No)The system f it . I have determined that one or more of the above 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 must indicate either"yes"or"no"to each of the f owing: (The following criteria apply to large systems in add' on to the criteria above) yes no _ !the system is within 400 feet of a su drinking water supply _ the system is within 200 feet of a ' utary to a surface drinking water supply the system is located in a nitrog sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone H of a public water suppl well If you have answered"yes"to any qu 'on in Section E the system is considered a significant threat,or answered "yes"in Section D above the large s has failed.The owner or operator of any large system considered a significant threat under Section E failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner shout ntact the appropriate regional office of the Department. Page 5 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 597 Pitchers Way Hyannis Owner: Arlene Martin Date of Inspection: 8/8/2003 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? -%Z_ Has the system received normal flows in the previous two week period? _ZHave large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) _Z" Was the facility or dwelling inspected for signs of sewage back up? _jZ Was the site inspected for signs of break out? _Ne'_ Were all system components,excluding the SAS,located on site? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different than owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ,Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 597 Pitchers Way Hyannis Owner: Arlene Martin Date of Inspection: 8/8/2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):33K�D Number of current residents: Does residence have a garbage grinder(yes or no):'&? Is laundry on a separate sewage system(yes or no):cif yes separate inspection required] Laundry system inspected(yes or no):- Seasonal use:(yes or no):gam:D Water meter readings,if available(last 2 years usage(gpd)): iiLir., � �Acs_ c�t3 f G• 4G, Sump Pump(yes or no): n Last date of occupancy: COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seatslpersondsgB,et Grease trap present(yes or no):— Industrial waste holding tank present es or no):— Non-sanitary waste discharged to Title 5 system(yes or no):_ Water meter readings,if availabl . Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: ,,,,, Was system pumped as part of the inspection(yes or no): � If yes,volume pumped:�allons—How was quantity pumped determined? Reason for pumping: TYP"F SYSTEM /Septic tank,dis#iWtion soil absorption system _Single cesspool Overflow cesspool .___Privy _—Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval ____Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):fj,?fj— Page 7 of 11 OFFICIAL.,INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 597 Pitchers Way Hyannis Owner: Arlene Martin Date of Inspection: 8/8/2003 BUILDING SEWER(locate on site plan) Depth below grade:Q Materials of construction:`cast iron 40 PVC_other(explain): Distance from private water supply well or suction line: 14:r , Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: (locate on site plan) Depth below grade: ,� r Material of construction:�crete metal fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: ;C ar' x Sludge depth: " Distance from the top of sludge to bottom of outlet tee or baffle: �O Scum thickness: > 3' %T' '.d.,i, T" 'ar Distance from top of scum to top of outlet tee or baffle: " Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: %wA,v.�. jM,'�e�;�. -� ` �'•=�- Comments(on pumping recommendations,inlet and outlet tee or baffle conditioir,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): �'�.lam �,tl�-�ca'CC�`.a..,..� ��^- � •:vim. �.Af•.Y_ -k -�'4� �:y y��J�=, GREASE TRAP:_(locate on site plan) Depth below grade:— Material of construction:_concrete m fiberglass polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of o Het tee or bade: Distance from bottom of scum to om of outlet tee or baffle: Date of last pumping: Comments(on pumping recom ndations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evide ce of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 597 Pitchers Way Hyannis Owner: Arlene Martin Date of Inspection: 8/8/2003 TIGHT or HOLDING TANK: (tank m e pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction:_concrete m I_fiberglass polyethylene_other(explain): Dimensions: Capacity: _ yAlarmi ll s Design Flow: ons/day Alarm present(yes or Alarm level: rking order(yes or no): Date of last pumping: Comments(condition float switches,etc.): DISTRIBUTION BOX: (if present ust be opened)(locate on site plan) Depth of liquid level above outlet in Comments(not if box is level and d' 'bution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump c)6mber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 597 Pitchers Way Hyannis Owner: Arlene Martin Date of Inspection: 8/8/2003 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): R �e`.nr�w. •.ti. �,`� ".n �. T� � .� l� dj,:,�i ,.��_r��..,:ram'� C�',�(�, CESSPOOLS: (cess;' ert: mu be pumped as part of inspectionxlocate on site plan) Number and configuration: Depth—top of liquid to inle Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of constructi0 . Indication of groundw inflow(yes or no): Comments(note con tion of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,stims of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 597 Pitchers Way Hyannis Owner: Arlene Martin Date of Inspection: 8/8/2003 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. VVV 6 e 3 a z L 4 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 597 Pitchers Way Hyannis Owner: Arlene Martin Date of Inspection: 8/8/2003 SITE EXAM Slope Surface water Check cellar:-� Shallow wells Estimated depth to ground water.;-L. 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 154 feet of SAS) Checked with the local Board of Health-explain- Checked with local excavators,installers-(attach documentation) _ ceessed USGS database-explain: t�/. r,rA;� r; You most describe how you established the high ground water elevation: .r-- ASSESSOR'S MW NO. PARCEL 0001, S E A G L PZ PKIT Pia. W` �lat�`T-t vJ DATE PERPA T IS.SUED lzrl '16 DATA. C0MPLIANCE I S S V E D � � q� 1 � �i o �I yr, �� .�+� � ��I W �� wt. 4 i 1 y ASSESSORS MAP NO: No.._.�,1�.- .�� _PARCEL N0: ... _ �...Fss. THE COMMONWEALTH'OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Applirntiun for Disposal Works Tonstrnrtiun 1 rrmit Application is hereby made for a Permit to Construct ( ) or Repair ((X) an Individual Sewage Disposal System at: �t --- _'�.--_............e tf Ems -`'a `-`�................ ......................-... .-------------------........----------.............._..------------ Loc ton-Address � � �,S or Lot No. .... — .............. — — .. _._...___.. ---- ------------------------------------ ----------------—---.--------- W EQC)TZ4 wner�� C— Q Address ,a ........................................................UU •-----=�-----.'�... ...--- :.._._.:_tea ...0 3� C i N.. 1` -=w--------- Installer Address Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms................................._ .Expansion Attic ( ) Garbage Grinder ( ) p-, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) G4 Other fixtures -------------------------------=-------------- d W Design Flow____________________________________________gallons per person per day. Total daily flow-------------_..............................gallons. WSeptic Tank—Liquid capacity___._.______gallons Length................ Width---------------- Diameter................ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length____:______________ Total leaching area____________________sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) �-' Percolation Test Results Performed by................................-•-----------•-----••--••••-•--•-••-•-•-• Date........................................ Test Pit No. 1................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........................ a' -••-------•--•-----------------------•-••------•------• - - ------------------------------------------------------------------------- O Description of Soil.........0"-`-Z........t�L.Z.............._LT ---.....--------:i -----� ``4..vvtfi.. S... ...... U ---••-.....•-••.... .!........^--------------------•-------------------•--------............-•-------...._--•- W x ---•----•-•-•---------------••••-•••••----------•-----•------••---••--------------------••-----•----------•--•-•-------------------•--•-----•----•-----------••-••--------...-----------------------•-•- U Nature of Repairs or Alterations—Answer when applicable-----`�fl------o�CW_______J4Q.�________.�! `�co*?.............. Ui �t..w_C,._...... -•--•----._< --------------� _lSl�!� ..------5 �ST� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ......... ;-- ..... �Z -�' ...... Da e Application Approved BY ]�1 ---- E.41e..---- Application Disapproved for the fol owing reasons- ------------- ------------------------------------- ---------------------------------------------- ------- ----------------- ................................................- ------------------------------------------------ ------------------------------------------........................................................... ------------ ---------- Date PermitNo. .......?--Cl.-�.f- -- --------------------------- Issued .........-------------------------..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -N,,,,, TOWN OF BARNSTABLE R Applirntion for Uinvusal Works Towitrudiun 11antit Application is hereby made fora Permit to Construct ( ) or Repair (c) an Individual Sewage Disposal System at: •. - `-S9 ...... l T.0 f f E RS--------W....`-...----------------- .......---•---------•-------------------._................------. Location-Address or Lot No. Y—E�....`��5', wne .......... a .----�......A.14...... Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms................................ -Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Other fixtures ---------------------------•---• - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth.............. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by----------•---•-------•--•--••-•---•-•------•----------------•-•---•----. Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-__________________- --. fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -•----•----•--------•--•-••-•-•-•----•-•...........•----•---•••.....--•--------------•-•....-----•--...._..-•-•--•-------••----------------•--•---•---------- O Description of Soil �``�=` '� �. ----------. ------------------- Cx.0 ............V..... .-----•------------------------------•..-----------------------........--------------------- W U Nature of Repairs or Alterations—Answer when applicable______ 9-------c,_w a--_--__�c�.a ------- =��c>............. ------•-•-•----•------..••-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed � � - �4Nle )�� Application Approved By ------ -------------- ----- ------------------------------------------------------------------------------------------- Application Disapproved for- A v vie fol wing reason >---------------------------------------- ---------------------------------------------------------------------------- --------------------------------=-------------------------------------------------------------------------------------------------------------------------------........................................... ........................................ Date PermitNo. ........��..0.— 3.............................. Issued ----------------------........---...------ .------- --- ...... Date I THE COMMONWEALTH OF-MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE fix1e>r#tfira e of C�IImpliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by--..... ......<: aO_....-1".� c. --------------------- Installer " at -................1...............(�.I.T.C.�--� !Z...--.....W.t►.�.........f 4'E.iC�a-(�.�1\�......... .......-...... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ........... ,�..._-/J.�. ............... dated -.......... ......-..------.........-....-.-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTIFI�E AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...... 1 � Inspector .:. ' - � - ��.... -------------------------------------------- }f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �. TOWN OF BARNSTABLE No..`?� FEE... � 11inprr, lat Works Tonn#rudion rrnti# Permission is hereby granted tit l4 !r........ s'T.......................................................................................... to Construct ( ) or Repair ((,?- an Individual Sewage Disposal System. atNo........ ......... T r �{ --.....I..j-P y......--•--.........-•----------------------------------------•--------.....------. -------------..-----....... Street as shown on the application for Disposal Works Construction Permit No�r�... .zz.... Dated....... .._ ._. ....... 1' '7 ......-•................• . ........................................................ S�d of Health 61, _. DATE................................................................................ FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS