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HomeMy WebLinkAbout0306 SCUDDER AVENUE - Health 306 SCUDDER AVE., HYANNIS A= I CUMIONZWE LTH OF MASSACHI;SETTS _ F EXECUTAT OFFICE OF E\BIRO\mE\TAL AFF.AMS •DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE t1Z\TER STREET.BOS T ON ILA 0210t 161.1 242-550%, TRUDY COX-7 Secre:a--v ARGEO PALL CELLUCCI DAVID B STR--uc Governor Co=miss:oner SUBSURFACE SEWAGE DISPOSAL SYSTEM OMPECTION FORM PART'A CERTIFICATION PrOpe'riAddress= 306 Scudder Ave. , 0w,5 uzanna rwin Alterson d. , Lexington Date of Inspection:�3/. 0.0 Hyannis Add►assofownar: Name of inspector:11ilaase Print)Wm. E. Robinson Sr. 1 am a DEP approved s eel inspector to Section 15—W of ride 5 9310 CMR 15.000) CompartyName: Wm. E . Robinson Sep is Service MaRingAddress: PO Box I0 9. Centerville NLA Telephone Number: 77 K—R. 7(� CERTIFICATION STATEMENT 1 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 inspection. The inspection was performed based on my training and-experience in the proper function and maintenance of on-site se age disposal systems. The system: d Passes Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Q ? Inspector's Signature: " " I►IDS Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty 130)days of completing this inspection. If the system is a shared system or has a design flow of 10.000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS f � m�� a. OCT 2 0 2000 ?(WM of f3aeNS ABA E HMTH DER zev-LseO PaFrIof11 n �: -1rz o^Rec%-6rd Psnr• r. SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART A CERTIFICATION Icondnued) Noperty Address: 306 -Scudder Ave. , Hyannis a': Alterson Date of Inspection: T—,?/—p-,® WSPECTION SUMMARY: Check 40 B, C, o/ D: A. S T N PASSES: Z !have not found any information which indicates that'any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. S TEM CONDITIONALLY PASSES: ne or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system.upon mpletion of the replacement or repair,as approved by the Board of Health,will pass. Indicate ye ,no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined'.explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance!attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal,is cracked,structurally unsound. shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection If the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipets) or due to a broken, settled or uneven distribution box. The system will pass inspection if Iwith approval of the Board of Health). broken pipets)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipets). The system will pass inspection if(with approval of the Board of Health): broken pipets)are replaced obstruction is removed revJ Sew 9/2/98 Page 2of11 I� ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 306 Scudder Ave. , Hyannis Ow"ef of Ins o ALA-erson Date n: 11^3 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES W ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone 1 of a public water supply welt. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER _"A`.'ise P2Qc3or1) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 306 Scudder Ave. , Hyannis Owner: Date of InsA Won g-3l—o—v D. SYSTEM FAILS: You must'ndicate either "Yes" or "No" to each of the following: 1 ave determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this d ermination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an 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 112 day flow. 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LAR E SYSTEM FAILS: You must indicate either "Yes' or "No' to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 It of a public water supply well) The ow r or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. rev-se6 5%2/5t Pagr4of11 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Prop"Address: 306 Scudder Ave. , Hyannis Owner: Alterson Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No _ Pumping information was provided by the owner,occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and•the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ✓ _ As built plans have been obtained and examined. Note if they are not available with NIA. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non sanitary or industrial waste flow. _ The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. ' / The size and location of the Soil Absorption System on the site has been determined based on: V _ Existing information. For example, Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) )15.302(3)(b)) , The facility owner land occupants,if different from owner) were provided with information on the propermaintenaacm of SubSurface Disposal Systems. re i'i se 1j2 Page 5 of 11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION 'ropertyAddress: ! Y Owner: 306- Scudder Ave. Hyannis Date of In Br>r s on FLOW CONDITIONS RESIDENTIAL: Design flow: S0 g.p.d./bedroom. Number of bedrooms (design): Number of bedrooms (actual):, Total DESIGN flow L),5 O Number of current residents: 0 Garbage grinder(yes or no):96=0 Laundry(separate system) (yes or no)-AU ; If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no):A0 Water meter readings, if available (last two year's usage(gpd): Sump Pump(yes or no): A,,c7 r 1 998-1 999 100, 500 gal. Last date of occupancy: CO MERCIAUINDUSTRIAL: Type of establishment: Desig flow: gpd ( Based on 15.203) .Basis f design flow Greas trap present: (yes or no)_ .Indus ial Waste Holding Tank present: (yes or no)— Non- nitary waste discharged to the Title 5 system: (yes or no)_ Wat meter readings, if available: !Last ate of occupancy: 'OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)-.,ye-=r If yes, volume pumped: ��✓� gallons � Reason or pumping: .",t_ r 'TYPE OF TEM 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other Q APPROXIMATE AGE of all components, date installed fif known) and source Of information: f Sewage odors detected when arriving at the site: (yes or no)A d revised 9/2/9 E Page 6of11 + SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION few"imted) 4op"Address: 306 Scudder Ave. , Hyannis Owner: p 1 �p Date of Ins dE�CbtT'rson BUIL ING SEINER: lLocat on site plan) Depth low grade:_ Materia of construction:_cast iron_40 PVC_other (explain) Distant from private water supply well or suction line Diamet r Cornnts: (condition of joints, venting, evidence of leakage,-etc.) SEPTIC TANK:_ (locate on site plan) !1 Depth below grade Material of construction: ✓concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age Is.age confirmed by Certificate of Compliance_(Yes/No) Dimensions: Sludge depth: I Distance from top of slugge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom ot outlet tee or baffle:f How dimensions were determined: /� )d>. 14 'omments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liyu i�Igvel in relation to outlet nvert, structural integrity, evidence of leakage, etc.) bU�� �A� /d •- 1� curt Y C" 3 rk rm 1h La .,-b 4.1 GR E TRAP: (locate on site plan) Depth low grade:_ Materia of construction:_concrete_metal_Fiberglass _Polyethylene_otherlexplain) Dimensi ns: Scum t ickness: Distanc from top of scum to top of outlet tee or baffle: Dist'an a from bottom of scum to bottom of outlet tee or baffle: Date last pumping: Com ents: Irec mendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evid ce of leakage, etc.) 15i 2/5d Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(con6mied) Arop"Address: 306 -Scudder Ave. , Hyannis Owrw: Alterson Date of Inspection: 'n OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) Ilocat on site plan) Depth elow grade:_ Materia of construction:_concrete_metal_Fiberglass_Polyethylene_otherlexplain) Dimens' ns: Capaci gallons Design flow: gallons!day Alarm resent Alar level: Alarm in working order: Yes_ No Date of previous pumping: Co ments: Icon ition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: L" (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note if level and di st 'bution is equal, evi nceofsolids carryover, evidence of leakpge into or out of box, etc.) J V �. PUMP CHAMBER:v (locate on site plan) G . Pumps in working order: (Yes or No)� Alarms in working order(Yes or No)-xa `s Comments: (note condition of purryp cham r, condition of pumps and Appurtenances, etc.) L w UO IS 1 D if X •� &L •� revise.' 9/2/SC Page 8or11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'roperty Address: 306 Scudder Ave. , Hyannis Owner: Alterson Date of Inspection: SOIL ABSORPTION SYSTEM(SAS):_✓ (locate on site plan, if possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits'. number:_ leaching chambers,number: leaching galleries, number:_ leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number:_ Alternative system: Name of Technology: Comments: (note condition of soil, ns of hydra}lic failure, level of ponding. damp�,oil, c�dition of vegetation, etc.) o A a- � G C OOLS:_ (locat on site plan) Number nd configuration: Depth-to of liquid to inlet invert: Depth of olids layer: )epth of cum layer: Dimension of cesspool: Materials f construction. Indication f groundwater: i flow (cesspool must be pumped as part of inspection; Comme ts: (note c ndition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate o site plan) Material of construction: Depth of solids: Dimensions: Comme ts: Inote c dition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Pag( 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Noperty Address: 306 _.Scudder Ave. , Hyannis )wrier* Alterson Jate of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) L — � 1 �T z y c revised 5;'2/9E Pap,10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) roperty Address: 306 Scu-dder Ave. , Hyannis Owner. Alterson Date of wapection. T NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Deep Groundwater depth: Shallow Moderate SITE EXAM Slope Surface water Check Cellir Shallow wells Estimated Depth to Groundwater/6 Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting property,observation hole. basement sump etc.) /D/ytermined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators. installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) ,3 0 � ) ra,� l�'b 3 19 97 � revised 9/2/9E Page 11ofII TOWN OF BARNSTABLE LOCATION,3 0 (0 .Sc.,I d d e SEWAGE #�-✓ " ��� VII.L/.�uE a�o/),q-1-7a1 5 t'J0 - ASSESSOR'S MAP&LOTZ9;L19Z1 INSTALLER'S NAME&PHONE NO. nbpm b P d' SOM ZhC SEPTIC TANK CAPACITY i=r--)C) RIM n Dt (— LEACHING FACILITY: (type) /-/ In ri 1171223010 iZ (size) NO.OF BEDROOMS Y r 1B1?R OR OWNER eg!✓ �� � PERMTTDATE:,/,/0- !!- COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching faciliy) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 1 i i y 1 AsmasW-pin: ,- 94 Y PARCENO:- ..;; ;: 3 0. 0 0 No..--•-------•--------- FEB.............................. THE COMMONWEALTH OF MASSACHUSETTS '�• BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration. for Diinpmial lV ark,i Tonitrnrtion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair )(X)DXan Individual Sewage Disposal System at: 306 Scudder Ave Hyannisport,Mass . ................................................................................................. ------------------------------------------------•-------------------------••-•----•-•..........--- Location-Address or Lot No. o----------------------------------------------------------------------------- --------------------------------------•-------------------------------------------•--•------------ o,rne Address W Joseph P. Macomber fir. a . ---c.o--------------------------------------------------------- ----------------------------------------------------------------------------------------•--------- � Installer Address VType of Building Size Lot............................Sq. feet Dwelling$ No. of Bedrooms........3---------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons------------------------- Showers ( ) — Cafeteria ( ) A4 Other fixtures ............................................................. Design Flow.........5-rj----------------------__-__gallons per person per day. Total daily flow----_-.33a.....................,------gallons. WSeptic TanN iDoQquid capacity j_4p.©_gallons Lengtlg-►-6ii------- Width-_ t-.1.p 3- Diameter................ Depth-5-1__71'.... x Disposal Trench—No. ____________________ Width-------------------- Total Length-------------------- Total leaching area--___________--_--sq. ft. 3 Seepage Pit No------1............. Diameter-----6'._--._---. Depth below inlet-3_1............... Total leaching area..................sq. ft. Z Other Distribution box (1 ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date--------------------------------........ a Test Pit No. 1................minutes per inch Depth of Test Pit-----.-------------- Depth to ground water----__._-__-_-_--.----.. rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 ------------------------------------------------------ ---------------------------------------------....------------------------......------------------..... 0 Description of Soil........................................................................................................................................................................ x Loamy-__sand- -to medium to fine sand v ---.---- -------- . . . ---- -----------------------------------------------............................................. W .............. --------.------------------------------------------------...----------------------------------....-------------------------_..... x '10 ---- . r U Nature of Repairs or Alterations—Answer when applicable______________________________....._____._-.___._ �........ `°__ z1^-.: `�'`'� n n t r.�sfi ll__ .. �-�^�►. vim" Agreement: Lib Y ar-ov.,c[ Z4 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with i Y the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the oS system in operation until a Certificate of Complia ce has be n i,%, ue4 by the o d of health. bow Signed ` --- Application.Approved BY :_... _...... ------ - G/ ....._............................ Dace..._.... .._ Application.Disapproved for the following reasons: ...............................................................------.............----------------------------------------------- 1 Permit No. �.. .. Issued ..---- �l ' ... ---------- Dare THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH � ,•TOWN OF BARNSTABLE Alipfiration for Di,ra{. aiial urkai C omitrurtion Vautit Application is hereby made for a Permit to Construct ( ) or Repair (XNXan Individual Sewage Disposal System at s w fl 306 Scudder, Abe ;,Hyann spo�t;,-Iq.s�� . ....................== =--••;- .......-..................................................... _--••-----_---••••----------- Location-Address or Lot No. Owner Address W Joseph P. Macomber Jr. PQ Installer Address UType of Building Size Lot............................Sq. feet Dwelling-No. of Bedrooms________ _____________________________-__Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ----------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 04 Other fixtures W' Design Flow-___-____SC_____________________________gallons per person per day. Total daily flow-_____-�?n______________._.._P._. _gallons. WSeptic Tanl4, 9-C[Ciquid capacitv'�_vffggallons LengtIB A 6Jl__-___ Width__/.J_.1-)it_ Diameter________________ De th_5.s 7��.-_ x Disposal Trench—No..____________________ Width-------------------- Total Length.................... Total leaching area....................sq. ft. � + +Seepage Pit No.-____1......__._-_ Diameter________6____________ Depth below inlet-�______._______.-. Total leaching area.................. ft. __.z Other Distribution box (1 ) Dosing tank ( ) ~' Percolation Test Results Performed b ..............................:................ Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water......................... 44 Test Pit No. 2................minutes per,inch Depth of Test Pit-------------------- Depth to ground water........................ 0 04 ---------------------------------------------------------•---•--.....-_-•---•----_-•--------•------•--------•---•------•--•........................................................... Description of Soil........................................................................................................................................................................ � Loamy_•.sand._to_-.medium_--sand to fine sand ----------------•-----------------------------------------•--__•---....-••----••---•---- W U Nature of Repairs or Alterations—Answer when applicable._._ ._rr " '""" a '............. -.:•_-�°• Agreement: +n , r�+�l� ..0 i"irn Y/ A.V_ Zr"4.d The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with t the provisions of TITLE 5 of the State Environmental Code The undersigned further agrees not to place the o ' system in operation-until a Certificate of Complia ce has be n i ued by the o d of health. .- Signed - - - ----- 10/31/9 5 ' - - ---....... -3..y- ......-------. .................................... ....-----...................... Application.Approved By ..........: Fri .".... ---------- - ------- .� -------------------- ------ ._f - ---a J ---...-.gre.......-ate- '' Application Disapproved for the following reafons- --------------------------------------------------------------- -------------.._..----------------------....---- .................-------------------.........-----... ----... ----------- Permlt No. ..... /��'' ----- -------- Issued ------ Ua�e -------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE` Certifi ate of Torap iMriCP THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired.)Zxxx) by -Joseph...-Y-----Macomb.er --Jr- ------------------------ Insriuer at 3-.06----S--udder_.Ave_..Hyan.n s.port_<.Ma. ;3 ------------------------------------------------------------------------ ----- has been installed in accordance with the provisions of TITI , 5 .the St to Environmental Cod as described in.. the application for Disposal Works Construction Permit N . . � ...------�- -- dated .. .. �' THE ISSUANCE OF THIS CERTIFICATE SHALL NOt BE CONSTRUE[ AS�,A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ± w DATE---------- f. / '-- --..... - ---------------------:.. Ins ecto ... / THE COMMONWEALTH OF'WASSACHUSETTS BOARD OF HEALTH / ►� TOWN OF BARNSTABLE $ 0.00 No..................1.... � FEE........................ Disposal Worse Tomitr ion "rrmit Joseph---P.Macomber Jr.___________________________ . Permission is hereby granted------------ - - ----•-•----...------------- -----------------------........-----..........-•--- to Construct ( ) or Repair�.Xx) an Individual Sewage Disposal System at No.3o6...S•cudder Ave Hyann_isport•,Mass. ................ _ ------------ •--------•--------•---------------•----------•---............ / � J as shown on the application for Disposal Works Construction Perrr�i ` j°�f '° ; Dated..<__.�-L-3 ����' • .. //�� ®�' '�i-^� �.�-- Board of Health �^ DATE ,t -----------•------------•-•--- .................... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, Joseph P. Macomber Jr, hereby certify that the application for disposal works construction permit signed by me dated 1 0/31 /9 5 , concerning the property located at 306 Scudder Ave Hyannisport Tot 6 meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is A feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED : DATE: 1 0/31 /9 5 LICEN SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 5 2 [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted].- r ,"' �4 --. x t\ g vJ A f C 41 o J 006 ? I - L4X Ip0 l 14 „ ��T D/sT G � 26� N / i 8oX a�� l„ loon(oAL. O/ i - J sC,oTic J_ ' 74 1 - • q�. ��- o � %ten ir ol o NIF F� usr to �' ) -0? ��� M4 at as shy �ppRSE FORM lit 7 NIF . � : s�ssv,✓ '' P If- -0i�1AvV,4Aero��,d PLOT LA CERTIFIED �EGEND , ��r�nE2 ✓E •_ ISTINa SPOT ELEVATION _Ox0 q `l: , � !.. �0 r 6 �1 /t//V 1-ST'v K T-� EX CONTOUR 0 R(?Rf_'iT EXISTING SPOT ELEVATION _ 9RUCE IN FINISHED — E�oRE FINISHED CONTOUR $ OF HEALTH '� .� � ��•����� p BOARD TE yo APPROVE Ho sys��' SCALE' / "= 40 DATE DATE ET AGENT /✓�cKv� 5 I CERTIFY THAT THE PROP ���ERING CO. IN CLIENT--- THIS P OB N0. b-0 2-3 BUI FORMS To THE NZONING EGISTERE REGISTERED J M MASS. CIVIL LAND DR.BY= - -- OFNBARNSTABLE � ENGINEER SURVEYOR CH. By ---�� — g 2 By ?12 MAIN STREET :' .`>:,.;;n;� SHEET �.OF ? DATE 7W 61t .6LAND SU HYANNIS. 016l 7 LO-C A ION A C E PERMIT NO. VILLA ` INS � L �E ':S NA _X i ADDRESS R UILDE.R>, . OR NER DATE PERMIT ISSUED �� ° C? F DAT E C,OMPLIANC!E ISSUED .. K � p .r �Sv T _ 4 . Existing 41x12 ' Leaching pit EXi New 41xl2l Leaching it Existing 1000 gallo Septic tank. Rear 306 Scudder Ave H annis ort�Mass Y P i c No.... - %'..� .:� F;3s....... L............... THE TS BOARD OF , HEALTH i.. X ------.OF...................S ........... .......................... ---- Apptiration for Mipoiial Works Toniarurttun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at .................Za/........it! .......... .................................................................. -•Location-Address /. ........................................... -•-• - -. - -•---•••-•-----or... Lot No. / Owner �— Address i •-••••........................ .....• ..... ......••^•'^--' - .. ..... ............................ Installer Addre r ss i PQ U Type of Building Size Lot.. .J_71...Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Building ps yp g ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ----------------------------------------•---- W Design Flow............................................gallons per person per day. Total daily flow................ ............gallons. WSeptic Tank—Liquid capacity,/ allons Length................ Width................ Diameter__-________`__,Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total,leaching area---;U-6----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---....................CcAfc.........._................... Date.....- �1 x- ._...0 4 / Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_-___________•__-______- f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 -••-------••--•---------------------•---••-•----••-----•-------..............-------•--•-•--•--•----......................................................... 0 Description of Soil.-. ---. . --••- ----•-------- 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 TITLE 5 of the State Sanitary Code—The ersigned furthen.agrees not to place the system in Aeration it a C t- sate Complianke has been ' the o ealth. y. Sig --- •-••-------•. ----- ---------/CJ ../.7 e APplicio pro ed y----.-----.•----------- ----`-------. -• -- -- . .................... .......... _ f Date Application Disapproved for th f ollowtg reasons:-----•--------------•----------•-----------------------•-------------------------------.._..-----..........._.- _....•-•.........•--••----------------•-----------------•----.....:--------------•--....-•---------•------•---••-----------•-•--•---•-•-•-•---•--•------------------•--------•---------................ Date PermitNo................................................... .... Issued_....................................................... Date No.... J.. Fps...... ................_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ota r-)...............OF..............._�/_..................................................... . ppfirution for Ropmal Works Tomilrurtinn thrmit - Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at -----...-- f`:�"- ----•------------------------------------- Location-Address / or Lot No. •Owner � /'�,/� J ! ,f Address� ••.................. W .................•...........___------••--- .....,/-•-•-.Y_..•R�.... C....._._..---•-� • �i--.f./ `' --l�f_ ............................... Installer // Address Type of Building Size Lot_y ...1. �....Sq. feet aDwelling—No. of Bedrooms.........................................._:'".Expansion Attic ( �) rr Garbage'Grinder. ( ) Other—T e of Buildin ._ _ ' No. of;persons--__ _- - Showers Cafeteria Otherfixtures ...............•..... -------------------•----------•---------•-------•. :... .._...... W Design Flow............................................gallons per person per day. Total daily flow............... _.�.r,�_._-------•--gallons. WSeptic Tank—Liquid capacity/6W.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.........._......... Total Length.................... Total leaching area.Z&C-----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......................���C.-_............................ Date......./V/ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ......-----•-----••. -••-•••--•-------------••--••-----------------•--............•••-----_............................................................. O Description _- - --tion of Soil______________ G...........................rrf - •---•• ✓'ems-L.✓ ..............................................................._...........------.... _ W --•-------•••---------------------•---•--------------- ---•---•-------------•-•----------------•-----•-•------........••--•---------••--•--•--•---••-••--........................................ UNature 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 TITLij 5 of the State Sanitary Code— Th dersigned further agrees not to place the system in t. eration,uAtil a C rtificate '1 Compliadce has bees the o ealth. Si ---- ....._ ----•- ----_..... �-- . / A li tiA f 4 rQ ed!I3 e -•---••..................................Date Application Disapproved for th following reasons__________________________________________________ ._.._..._.._. ....••--•-------------------••---•----------------=---------••--•-----........-----------...............------------•--...•----------•------••--•-•-•--•-•-••----•---•-••--•-----•--•••---•••--•••--•--- Date PermitNo.................................. Issued.---------------••--------•------------ •---•-----------•................... Date THE COMMONWEALTH OF MASSACHUSETTS y BOARD OF HEALTH ..........................................OF..................................................................................... Trr#ifirair of Toutphatirr THIS IS TO CERTIFY That -he In ividual Sewage Dis,osal System con ted ( i) or Repaired ( ) r.. • .,,,-.. Inst er � �` �' :. o° at...................... -� has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__. ..__.___ 1' �`'----•----- dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE•• :............. ---•----....--------------------...._•--_.. Inspector......................................................l.__ _._.._........_....._.. • i i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF..................................................................................... FEE........................ i uu�t1 murk Ton's#rudian pautit Permission is hereby granted.......................... . • •- • -----------•----------------..__...----•-------------------------..............___..... _ to Construct ( ) or Repair a�ndividuaSewage D sposa�.System at No. r:, t_ ff�t-------------- Street 1< / as shown on the application for Disposal Works Construction Permit No. /I..__..__ Dated...... ................. rr ... ------------------ -----------------------------`-------------------------_-- Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON ' I L' T C t. top iv 10 o o N�� wiz v s T 6 2-0 357 o Of M,d ' d 0RSE v No.09�1�4 sw . "_Sl SSV.✓ 'W S/ONA\ - / 'LEGEND EXISTING SPOT- ELEVATION Ox0 -�' ,:��. CERTIFIED PLOT PLAN EXISTING CONTOUR -- p - - - , �;: ::.,,;br FINISHED SPOT ELEVATION LoT6 sc.�l�vc ✓E; FtNiSHED CONTOUR , 0 6R /`�/ 1 /y/v /sP, R uct; RED, v, r=APPROVED = BOARD OF .HEALTH R� ` .SATE AGENT s > SCALE, DATEl et Z! F* LDREDGE ENGINEERING Co. IN d✓icKvGA's z CLIENT I CERTIFY THAT THE PROPOSED ' EGISTERE REGISTERED JOB NO. -FqQ 23 -BUILDING SHOWN ON THIS PLAN CIVIL LAND �� CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR OR BY: OF BARNSTABLE MASS. <, 712 MA1 N STREETS+' t CHyBYj r3. r = /y _ H Y A N N I S, , M A S$ .> M rt 2 --- : SHEET : OF � -DATE EG. LAND SURVEYOR :t Pq W oc J o . Q 0 � o w YdW v ? ` ILI Ile lz w CA M v !r !p V lk 15, IC 14 14 IA r4 It 14 .I W � 3 a • . . . . . � �{ 4i V o �V8 • q Ir-�-s�-. , Wo WONv p , v � � a4 `l 11 N a itW� � o a a � e•a ems• � � lb • • l ! 4 14 CO z J rt � k y +� V1 Q Qb. lk SETTS• H lk b u o lk V► Vhy W ' ; ;t W °� a W lK s ale ` 0 W � � QZQ �TS f y . N U-4oW � uZ � ? 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