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Home My WebLink About0294 SCUDDER AVENUE - Health 294 Scudder Avenue Hyannis A-= 288-225 o f { 1 .�e e i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments2 294 Scudder Ave { J Property Address Joan Knowlton Owner Owner's Name information is Hyannis MA 02601 April 23, 2008 required for y p every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name 189 Cammett Road Company Address Marstons Mills MA 02648 raun Cityrrown State Zip Code 508-428-1779 S1 12855 Telephone Number License Number B. Certification 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: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority April 23 2008 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a 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. ****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. 08-103 Knowlton.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA ■• a nwealth of Massachusetts • L Title Official Insp ec .c ubsurtace Sewage Disposal System F �1On Form Scudderq,.,p Form Not for Voluntary Assessments ProPellY Address Omar Joan Knowiton �ORf1 an Is owner's Name required, annis eves Page. DrIY/rorm M— 026� A ZIP Code nl 23, 2008 Date of inspection B. Certification (cont.) Inspection Summary: Check A,B,C,p or E a/wa A) System Passes: ys complete all of Section D ® I have not found an info in 310 CAM 15.303y information which indicates that an indicated below. or m t310 CMR 15. y of the failure criteria described 304 exist.Any failure criteria not evaluated are Comments: Tank is not in need of um in at this time, leachin s stem has no signs of surchar a or saturation. 9) System Conditionally Passes; ❑ One or more system replaced or re ai components as described in the'Conditional the Board Patred. The system, capon completion of the replacement of Health, will pass. ass"section need to be Answer yes, no or not determined or repair, as approved by determined," M N. ND)in the❑for the following please explain. ❑ The septic tank is metal and over 20 oldR or statements. If"ne. structurally unsound, exhi4�its substantial nfiltrationtoee�ltr tank System will pass inspections the existing tank is replaced (whether metal or;1ot� n approved b anon or tank failure is im1 y the Board of Health. with a complying Inent. A metal se 9 septic ta► k as Of Compliance n�•c:att will pass inspection if it is sttvctura!ly sound, p g that the tank is less than 20 ND Explain: not leaking and it a Certificate years old is available. T ❑ Observation of sewag�backup to broken or obstructed or break out or high static water level in the distribution box du pass inspection if wither pe(s)or due to a broken, settled or uneven distribution box. System approval of Board of Health): e ❑ � broken i � Y em will P PQ(s)are replaced ❑ obstruction is removed -103 Know t mdot.�8108 Tft 5 Ofroal Inspection Fora':subsutfaoe sawege Disposal System•Page 2 0115 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 294 Scudder Ave Property Address Joan Knowlton Owner Owner's Name information is p required for y H annis MA 02601 April 23 2008 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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 system 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. 08-103 Knowlton.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 I Commonwealth of Massachusetts t Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "t 294 Scudder Ave Property Address Joan Knowlton Owner Owner's Name information is Hyannis MA 02601 Aril 23 2008 required for y P every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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: i **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow El ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® 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. 08-103 Knowhon.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 294 Scudder Ave Property Address Joan Knowlton Owner Owner's Name information is Hyannis MA 02601 April 23, 2008 required for y P every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No . ❑ ® Any portion of a cesspool or privy is within a Zone 1 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 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. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. 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. The system owner should contact the appropriate regional office of the Department. 08-103 Knowlton.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 294 Scudder Ave Property Address Joan Knowlton Owner Owner's Name information is Hyannis MA 02601 April 23 2008 required for y p , every page. CitylTown State Zip Code Date of Inspection C. Checklist 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? ® ❑ 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? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ 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? N ❑ 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: ❑ ® 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(5)] 08-103 Knowlton.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 294 Scudder Ave Property Address Joan Knowlton Owner Owner's Name information is Hyannis MA 02601 April 23, 2008 required for Y P every page. Citylrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 23,250 gal. _ 9 ( Y 9 (gpd)): 31 gpd. Sump pump? ❑ Yes ® No Last date of occupancy: CurrentlyOccupied Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 08-103 Knowllon.doe-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 294 Scudder Ave Property Address Joan Knowlton Owner Owner's Name information is required for Hyannis MA 02601 April 23, 2008 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Tank pumped every 2-3 years Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1985 Were sewage odors detected when arriving at the site? ❑ Yes ® No 08-103 Knowlton.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 294 Scudder Ave Property Address Joan Knowlton Owner Owner's Name information is Hyannis MA 02601 A ri123 2008 required for y P every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 1' Depth below grade: feet Material of construction: cast iron❑ 40 PVC M other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2'feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 8.5' long x 5.2'wide- 1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness Trace Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Measured 08-103 Knowlton.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 294 Scudder Ave Property Address Joan Knowlton Owner Owner's Name information is Hyannis MA 02601 Aril 23 2008 required for Y P every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was found at bottom of outlet invert, tees are intact and clear. Tank is not in need of pumping at this time. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): 9 08-103 Knowlton.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 294 Scudder Ave Property Address Joan Knowlton Owner Owner's Name information is Hyannis MA 02601 April 23, 2008 required for y P every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover; any evidence of leakage into or out of box, etc.): No solids or high stains observed. Liquid level at bottom of single outlet pipe. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 08-103 Knowtton.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .�' 294 Scudder Ave Property Address Joan Knowlton Owner Owner's Name information is Hyannis MA 02601 Aril 23, 2008 required for y P every page. Cityrrown State Zip Code Date of inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: Three Flowdifussors. ❑ 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.): Probed stone surrounding Flowdifussors, no evidence of saturation or surcharge was found. 08-103 Knowllon.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ..�' 294 Scudder Ave Property Address Joan Knowlton Owner Owner's Name . information is required for Hyannis MA 02601 April 23, 2008 every page. City1rown State Zip Code Date of Inspection D. System Information (cont.) Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition 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, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 08-103 Knowlton.doc-08M Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °t 294 Scudder Ave Property Address Joan Knowlton Owner Owner's Name information is Hyannis MA 02601 April 23, 2008 required for y P every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 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. iF,,29, , ,4J\/\r\ \/\/\J\/\/\r\r\J♦/\/\/ \/\/\/\J\/\/\J\/\/\J\/\r\J\J 29 7 3 25 Water Service Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 294 Scudder Ave Property Address Joan Knowlton Owner Owner's Name information is April H annis MA 02601 23, 2008 required for y every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to ground water: 12 feet Please indicate all methods used to determine the high ground water elevation:. ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Pond at rear of property is 6-8 feet lower than bottom of leaching system. 08-103 Knowllon.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Town of Barnstable �F1HE Regulatory Services BARNSTABLE, ; Thomas F. Geiler,Director 9� i63. `�� prE1��a Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the Disposal Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. QASEPTIC\Disclaimer Private Septic Inspections-DOC -,, - S,q's - &�� aae-a- MC-,P (' IC988 a C3) t-� 0 C.A T ION .S E W A C PF AM IT NO. `VILLAGE T W A � 5 I. LER°S HA. E4 - ADOPESS � II I L D E R DR OWNER -- . DATE PERMIT ISSUEQ DATE C 0 M P I A N C E ISSUED � --.., � � � . 1 � N w -� �' I � � G C � ��. e3 �. -� 1 41 .............. THE COMMONWEALTH OF MASSACHUSETTS I yw,�I_wr BOAR® OF HEALTH ✓ � .... /v......OF...................... ............... L ..........._. C� / Appliration for Bwvooal Workii Tonitrur#ion Prrutit Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal System at: .....1......_--_----_..................•...... .. .............................9........ - - .....- 0) L cation- ress Lo Owner ress •-- •--- Installer �,� Address p Type of Building /J `"d Size Lot__�L1�__8 ..Sq. feet V Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) �+ Other—T e of Building # No. of persons............................ Showers.. — Cafeteria Q' Other fixtures .-----••---••-•-••----•---•-••-• - W Design Flow..............................................gallons per person per day. Total daily flow__._.............��..%5V........gallons. WSeptic Tank—Liquid capacity/.gallons Length................ Width................ Diameter................ Depth................ 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 ( / f '" Percolation Test Results Performed by------------------- ......... 1--- � Test Pit No. 1...._._. ___. minutes per inch Depth of Test Pit.................... Depth to ground water........................ f3, Test Pit No. �0- - minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil-----•--•.................••--••......•-••-•--s� ..`� L�--L-- -------•------------.-----.....------------ x W -------------------- ....................................................................... ---•••------------••---•--------••------•---•••••••••••---•--•-•••--••-•............••--•-•.............. U Nature of Repairs or Alterations—Answer when applicable____________•_-___---.......................................................................... Agreement: The undersigned agrees to install the aforedescribe Individual Sewage.Disposal System in accordance with the provisions of TITA U 5 of the State Sanitary Code .The undersign further agrees not to place the system in o at'op ntil C cat f/ Zmpliance has been i ed by the b o healt ( J' (� Signe .-- ...... ....... --------- - - ------------•----------------•- at --i/.. App1E ion pproved Y u Jb Da e Application Disapproved for the f oll z g reasons:........ Q Date Permit No.---•--..5? ..•.&. .. Issued------------� j 6 Date -•---------------- No................_....... FEst......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r ......OF................... s� 46 Applirntion for UiipooFal Works Tonstrnrtion Prrmit Application is hereby made for a Permit to Construct m or Repair ( ) an Individual Sewage Disposal System at: ...... .�T__...�......:' U .-...... "/�?, ............./-`- ----------------------- Location-Address Lo W Own r —*— Add ress Installer Address j U Type of Building Size Lot_. 1.-� _..Sq. feet r., Dwelling—No. of Bedrooms---- ........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -----------------------------------•------------•-----.-•---•--------------••••......--•-••--•--••------- t0----...... W Design Flow............................................gallons per person per day. Total daily flow..................}--..:-_----_.------gallons. WSeptic Tank—Liquid capacity..,,&,pogallons 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 ( r-) l°v�Gs Percolation Test Results Performed by................`�..........__.................!...................... Date........... ___.-,.._ rl Test Pit No. 2 6... nutessper inch Depth of Test Pit........`........ Depth to ground water....................... l �... f ... ODescription of Soil------------------------- ......--••-- - •-------•--•--•----••----••--...•••----•-•-•-•--•----••--•••••--------------•• x U ----------------------- --------- -------------------- .--.------------ ------------------- ......----------- ------------------------------------------------- ----------------------- ------------ •------------ W UNature of Repairs or Alterations—Answer when applicable................................................................................................ ••••---•--•-•-••--•_...••••-•-••------•-------•---•---•----•................••-•-•--...............-•-•-------------•-----•---•--•-•----••--•--•••••--•-•-•-------•-•--•-•-••--•--------•.......---••--• Agreement: The undersigned agrees to install the aforedescrib Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code The undersign further agrees not to place the system in op grati*n until C cat gY ompliance has been ' ued by the by heatt . Sign -•---------------- --------- ---- - •-- - -------------•--------••---- Ailc/a AptVX76D-.e—r ove y----•------------ >1 �/•>. ......... � at g Dat Application Disapproved for the f oll; ang reasons-----------------------------------------------------------------•-••-••----------•-•......................... ---•...............................•------•------------------...--------------------------.....----•----••---•-•••-•---•-•-•-•---•=_------••---••--••l-•-.............................................. )6 �� Date Permit No.......... ---•-6-7 ----------------- Issued...---•------ --------- ... ................. Date THE COMMONWEALTH OF MASSACHUSETTS Y BOARD OF HEALTH .......................................OF..................................................................................... Trr#ifirtttr of ToutpliFatta THIS IS TO CERTIFY, That the Individual Sewage Disposal,System c nstructed,(�) or Repaired("" ,)by Installer --•-•-. at has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as escribed in"tlW— application for Disposal Works Construction Permit No......................................... dated_....�JS_ _5...__.............THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C NSTRUED AS UARA TEE THAT THE SYSTEM WILL FUN TI N SATISFACTORY. y DATE--•--•----..----.'� ...l 9 �S ... Inspector---•--•. r• THE COMMONWEALTH OF MASSAC USETTS BOARD OF HEALTH OF......................•••-•..1.._ FEE........................ io o �tl or � � ttr$i n r • i Permission is hereby granted. =-------------•••••-••--......... to Construcorair ( n In i 1 Se;gjeispos tem �$ at NO.......... ..�__ tree t _t Q'S_6 _. as shown on the application for Disposal Works Construction Permit No________________ ___ I��te .-_______---_- - ._......•.........•.. ----------------•••----••-•-•----- ........ ----- ----------••-------•----.-- ----•-•---.._ DATE. �. s a d of Health _•..... -8-- ................................................ FORM 1255 A. M. SULKIN, INC., BOSTON r five .._._.�_� . .e...�-.....�.....�..•.. �...�._.-�..e.r.-,-....-... - � .. 4 y T UCH^> ' Owl(l �� •/� J - -'�� f, ei AAA gel I V1 •� l a . / 0 � �"� . � -✓ `\- o . r,� ��p'�'�\fir r��i�, • .91 Fy ry —D J� OF ORSE �Qp No.10951 O VI :;/p �� o LEGEND ,. CERTIFIED ERTI =IED{. 1 PLOT LOT o r PLAN nEXISTING SPOT ELEVATION ®x0 6 � C . oBeRTEY S_I. /t Sii ONISHED SPOT ELEVATION 00 d=I I S FI E D CONTOUR ® � BRu Cr LLL h EDGjz/ i ` �AP.PROVED,l BOARD OF HEALTH Mr r° n IN ` .. ,f � r a DATE AGENT � � ~ SALE: GD: DATE I?/ IZV DRED6E ENGINEERING CO. lI!l /V CLIENT I CERTIFY THAT THE PROPOSED , EClSTERE *,, REGISTEREDJOB 140. �_ 23 BUILDINGSHOWN ON THIS PLAN . C V.FL LAND CONFORMS TO THE ZONING LAWS � INEER SURVEYOR BY= A EN DR. AA OF BARNSTABLE , MAS " 71 ° M A I N' STREET' CFI. BY: tiYAW.NI:S;: MA$$ ` SHEET OF �" TE REG, LAND SURVEYOR t TAN 20 FT. M/II/ IVO- e //r E/TNCAr 7,Ve.SEPT/G /�G OR r S LxrAcNIma P/T A.R& NOR& TITAN M/N. GRAO��A 24•VIAAl E;rZV CO VCA-,AE7'E CO i EN SHALL B.F SAP00 .VT- TO lSJ A PZ.64N EXTRA t' —. . 4�PYC' P1PF �. CONCA 7W ' t1E.4VY CAST/.?ON CO✓L�'R S/,+ALL 8E US6'� O MIN. P/TGN . !F/N OR/VZ=PVAY 1 e '• �B .0, O;A®E Cd✓EIS CL EAA1 SANG r Llgillo LEVEL - . _ 2�LAY.ER �. i 0 •�.o n F .K�C.P/PE p s • •• • e • e I•rfl/N.P/TCN G GAL. ♦t • • WASHED S7YJME lST. o . ' • • • • • . W. a / e / PerR SEPTYC T�/VEC , p ( 4. • BOX t 1 e � e • r 1 o • � ! k e 3 2• f - I ii . :e / • e�EFj�ECP7Vg • r �S1fED STONE • De • 1eD�PT®+l • et • a Ap. ,Q ° a • e • • e fast j• o , 3.77 •o p pREcAsr SEER4GE • • • ,e a • •• • � . P p DR EQl! V IN��RT �LgY�4T/®!4/S c�Pc. y ? �O G®r�/per y e ►. • e o: e • e °o P�r _ a s �L 9 a �, . . INVERT, AT, Bl/!LD/NG 9g, FTC(S,�7gEl//�4TJON�. /HEFT,.S+S'PrIC .'r.41VK 98 a FT, l z F7. D/AM 8 7 DUTLT SEPTiC.TAAa/4 q FT /IVZE 4011SM-14l?/ON BOX 97't�.FT 04174ETD157R lJT/0NAD.,y . 96.13 A ' INLET'.LEi9CN/NG Imo'/T � _ _ - FT x >ev s onioousioM A Li s/GAr c OT�RZ sus �: SIQAr AIVA AUR OA EE®R® aARIaG.=- 015, o5AL t✓Aoor.:.n�o,+� ir. 5 .SOl�. LAG �j . TOTAL EST// 3'PEO FYAAV 3 3 o 0.44 .a4V AfUNIS.EIP Ow LE•4CXlMa PITS .,0AT'E ®P' S/d,E�s4CH1MG PERP1T 1 5/ �: fp + t /v�/ctlNi�l.+/� Z. RESULTS.JV17-M `SSEIB NY 84T"To!'9 tEJIC/f//VG,PE1�t l�/T' N 3 . - T+ o I RC�7L/+T/0/i* AAr4 L-o at':�'yt �' TOT�4L L S't//N� AREA s c1r3S o L- PArMCOZ.A OAS//�s�''� �' T2� N91F1 /NCH 4p W. � v-. •So /GT�57 . sr Derr RCN 0F.'Ai�S, s H OF ,�� ,•., .,r. �>• „:;7` .. .-: K� :- '' iry �.Q-•��. rs'.>'ti x.an- ✓ '� ��- �': :.�y- ;?r-...>a. r r. 3z � a E. ;'>i., �'t' 1 ,., "'c F: ., ._•r r_ .I rr*. ...., ,.n 1- i.r. .".�' :r Y eti - mn.r Yr: .:x•.. - �. 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'".�„`, TM„yAi ; b> .F•` 9 �,*.. - ,,�`�"�M Yyr'L k 'r�A"'I ,r Y ' . Y r /f c J -QTOWN OF BARNSTABLE _ VOCATION `1 �uGC.` r 1 flQ SEWAGE# S� VILLAGE "1&L►NY\1'S ASSESSOR'S MAP&PARCEL R4&WAW,4;R'S NAME&PHONE NO. e r�tC-l� nrv, SEPTIC TANK CAPACITY QV qJ LEACHING FACILITY (type) 200UQaors (size) NO. OF BEDROOMS 3 .OWNER ^ ,,v,\ PERMIT DATE: COMRt=ff DATE:T,v P q .a3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility feet Private Water Supply Weli and-Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) feet Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY .......:... .Q � vuay 2s 3 �25 Water Service f1 t z'2 t. 4 F , 1 MS yr. 09 c zili - �r 3 sP � W� ♦ W. i o 1 ,. - / oT B \ _ 3 � q � y t a , L -D I Q Q�'7 V, C`el �.V�'V 76 S,F.�i \ �•/,IS �6 ooU � � . OF A1,4 3F: rt Z : p o ORSE z �, t1[h Pw No.10951 O 4 ivi GISTSa�� \�-/ —4 �` � � � ONf�L LEGEND EXITING .SPOT ELEVATION OxO �� d3w��,�� CERTIFIED PLOT PLAN EX'1STiN3 CONT� uR ---- - - - ��_ -- `� �� r — s 0 , '• " O 7- 9 s c a, aFl:PIISFIED1 SPOT ELEVATION 0.0 '� �i s20SERT N / I FINF$I ED ''CONTOUR 0 m --__—_-- r. r' ELDRED, F �v r IN PR®.VED= BOARS OF HEALTH > to •. n `! Jt,7 r 'DATE. AGENT `` SCALE_ � ' i 'GD� ' DATES 1z ' /r �GJKuLAS a # 1�1�° /�t�Ei�NC�INEERI#Vfa CO. IIV CLIENT I `CERTIFY THAT THE PROPOSED ` Eels '. REGISTERED JOB N0. �040�3 BUILDING SHOWN ON THIS PLAN /�� A CiV41l. " LAND BEN- IN.I*ER =,� '' DR. CONFORMS TO THE ZONING LAWS ,7 SURVEYOR , --- OF BARNSTABLE AAAS M`ai N STREET CH .By: Y '1'ty i':E`l�A I�}• f Y�MA_ � ,♦a f '`, SHEET_ OF TE REG. LAND SURVEYOR `erg 114cc � k '' v . ''� 2 ° �► z r UT 44 \ 14 ` ft 14� 2 01 ti q5 � � . . • a. . . . . ® ® ® ® wa � � Y CA NOU 1 `; 1� � • O V � . . .i-� tea,..' s "�a.-�ir � �•v vat. am y. . _ •. • _ . • . • I l� �y ¢_ ' '1Q' 41 -:V ` -I f� r `j `i �'• lip,11'C�J `& `l.'XI �2v -ooIra SO O Ct 4 41 � �,- Yam �: � � �` � g-� � a •W � € :•:: .1. ,. ,.. W:W lk Q Z :t,J W 1N@�Q� r H-----�I . o o ♦ V/ J C-7-* 2o i ora LO 7- L0T 2° Al pRnPoSFD ,ya�R 110 h /' C 3 plcK uND�i2 b--a Co ry STA&CT VA) pGn�lT .fit: Sz011005' r G �2 O T \� Z- O Z -: LEGEND CERTIFIED PLOT PLAN EXI'8.TING SPOT ELEVATION Ox0 EXISTING CONTOUR --- 0 Sc"v�E�2 vE . FINISHED SPOT ELEVATION �ROBERT ;':� y.�l "� ✓� FINISHED CONTOUR 0r B. y" ELUi' )C2E IN APPROVED � BOARD OF HEALTH �,� Rio. 193i? .' �;, SAJI-A �z�,�'Q L GATE AGENT SCALE, /"= Gvr DATE , 7� s- LDREDGE ENGINEERING CO. IN N/`-"`"'° s I CERTIFY THAT THE jCvvA/°A-r1d1V CLIENT SHOWN 'ON THIS PLAN 18 LOCATED EGISTERE REGISTERED JOB NO. . u4�Z3 ON THE GROUND AS INDICATED A &- CIVIL LAND A. ,� CONFORMS TO THE ZONING LAWS: ENGINEER SURVEYOR DR. 0� sARNBTAd E � MAS8 712 MAIN STREET CH. BY. 7 B� ..• .�,� _f'- `--- H YA N N I S, MASS. SHEET of / TE REG. LAND SURVEYOR f NEW 4'Xa'DECK t i EXISTING aw BATH n 0 EXISTING BEDROOM �X El El 177) I NEW CARPET / ifffilskmm o PROPOSED NEW BEDROOM FIB RG • LASS• � EXISTING REMOVE EXISTING in BALCONY EAVE WALLS & DOORS SPACE TILE NEW 5'—O" CASED BUILT-IN OPENING '" LINENCLOSET T-3 3/4• 9'-2 3/4" 12'-0" 12'-0" NEW OFFICE 24'-O• PROPOSED 0 I'-O' ` ATTIC, ACCESS a EXISTING ATTIC PROPOSED SECOND f= LG SCALE: 1/1„ = I,—O„ 25'-0" 7 6tC. - - y 7