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HomeMy WebLinkAbout0025 SECOND AVENUE (HYANNIS) - Health 25 SECOND AVENUE,HYANNIS A= 246 212 I III i I i E 0 -' TOWN OF ARNSTABLE LOCATION x :� mil' -', RAGE # - VI LLAGE #YA/VN4SSESSOR'S MAP & LOT 2' 6— Z INSTALLER'S NAME&PHONE NO. it�5 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) /c jz) 3 �� "'��'S (size) f,NO. OF BEDROOMS BUILDER OR OWNER Pn.r ° F PERMiT DATE: i I' LOCI"C,�4 -COMPLIANCE DATE: , .". C 3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist 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 bi ' - 6 ---- `. . 0 1 6 { v `v\e w V, is f No. Lev Z' (p ! Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipprication for Migpogal 6pgtem C.Qngtruction Vermita YAppficationfor a Permifto Construct )Repair(f 1 Upgrade(k Abandon( ) kcomplete System ❑Individual Components Location Address or Lot No. 25 S'9CesA41) 19V&;/Vd,�5 Owner's Name,Address and Tel.No. Assessor's Map/ParcelRA,o 2� ?.4,1 , Z/Z i_ , ` MAIA1 JAMe6 �4 7 9J 0 - Z¢t,3 Installer's N drgs. a d Teyy No, (l d Y j �Deesiggnner's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other ape of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow © gallons per day. Calculated daily flow �® gallons. Plan Date /d- 02- Number of sheets / Revision Date Title S Size of Septic Tank 4000 G47 t . Type of S.A.S. Description of Soil Q /.� BCD/ j /_II—IL�Ld�'�jyJ Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the End tal Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by Board Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. 2-00 2-� Date Issued i/ / 02- No. _ Fee boa %+ Entered in computer: N r/ THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZipoYication for Mizpogar *potem (Construction ermit Application for a Permit to Construct')Repair Upgrade()()Abandon( ) Complete System El Individual Components Location Address or Lot No. 2 5 SFCON� /�V"t)Z5 Owner's Name,Address and Tel.No. Ty.: .,�o ,"'IS8 Assessor's Map/Parcel IV AP 24-G i���t . 2 l Z 4),IMy All_OMT M-4 �7 90 - Z 1-6 3 ,Installer's Nacq dress,and Tell,No _ F es, „Designer's Name,Address and Tel.No. f�ss6e W, 14:4: 4 M4VW Sags S 41 • /9 91L Type of Building: Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( ) Other r-- Type of Building - -- - No Hof Persons, `—r r Showers( ) Cafeteria-(_ ,) Other Fixtures Design Flow gallons per day. Calculated daily flow 3 30 gallons. a: Plan Date / �OZ Number of sheets Revision Date Title 511C/�E�JA6� �d Q/+ LG/ 29Wlc/ Size of Septic Tank /ADO t7.9'L , Type of S.k..S:' 2/WW &6;e SS/Srt/!Z_ w Description of Soil d ZI.O.1 /r �� ���� ��}7y1 's��•��/23�� .5*Al-b Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions.of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue/d_by,/thi' Board o -alth. Signed ;mil Date �6 • A— Applic4tion Approved by I Date v h following.reasons Application Disapproved for-the a follo ing _e so s-- t f P ZUG Z ' 4 Permit No. 5� Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance _ THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired pgraded( ) Aband ned( )by atS deco°' Ya-n�1 Sff� has been constru ted in cordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2U0 2-- 57( dated `� 1 Installer Designer The issuance of this permit shall not be construed as a guarantee that the system }will functions as1 designed. Date 1 Inspector J 4"j. Fee THE COMMONWEALTHAF MASSACHUSETTS f PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS •° wigooal *p!5teln Congtrruction Permit Permission is hereby grjed ISConstruc �-✓�( ' Repair( r) p ade(X)Abandatn( ) System located at 2 Ca - A-o4PLI s�Oy i and as described in-,the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5'and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this p 2 Date:_ —� Approved by y TOWN OF. ARNSTA.BLE FF,,�� 1 LOCATION Q ril -� SEWAGE #�° � °t r16 V VILLAGE C� q . ASSESSOR'S & LOT 2` Z INSTALLER'S NAME&PHONE NO. f SEPTIC TANK CAPACITY �aS LEACHING FACILITY: �r� C '� r,� (h'Pe) /��+ � .(size) NO.OF BEDROOMS A BUILDER OR OWNER ✓�VJ PERMITDATE: ) -l-G COMPLIANCE DATE: I r C 3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist 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 I 4-Cok /J 00 Xvt Vol.( Co..� f; r IeX W ---------- -- LOCATION : . SEWa(:,E PERMIT UO. — 1� 1N! TilLLER5 IJWE ADDRESS BUILDER 5 Q L MF- ADDRESS D fITE PER"VT ISSUED DATE COMPLI WACE ISSUED r 1 i Q C A THE COMMONWEALTH OF MASSACHUSETTS BOAR® HEA l.. .. ................OF........ ...... _ r.. .. r. �' .------. Appliratinaa -for BiiipoiiFal Worbi Totmtrurtioaa Vrrnfil Application i hereby made for a Permit to Construct ( (4or Repair (I—) an Individual Sewage Disposal System at Act , d -- ----------------------- •------------------------------•--------------•-------•----------- ---------•----- Location-Address / /� Lot Q net Address 48e Installer Address d YP g .. ,-Aq. feet = cc� Type of Building vv�� Size Lot.��� �l��'� Dwelling—No. of Bedrooms-_.-_-ate......................._-__-Expansion Attic ( ) Garbage Grinder ( �_ Other—Type of Building ----------------------------- No. of persons...... Showers — Cafeteria a' Other fixtures __...._� ���% 2e -.____._, d ----------- ---------- ------------------------------ - W Design Flow........._� Q-------------------------gallons per person per day. Total daily flow------------- -•.-----d-_-__--_--___.gallons. Septic Tank—Liquid capacity-/440J_gallons Length................ Width................ Diameter------.--------- Depth................ xDisposal Trench—No.__.. _... .__ nth---- ...- Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No../�P6�__ ___. %iameter........._j epth below inlet.................... Total leaching area-------.----------sq. ft. z Other Distribution box ( ) Dosing tank ( ) .-, . Percolation Test Results Performed by 'A--e---------/I-- s°� d�� Date.... Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water..--_---------.--.-.._.. LT, Test Pit No. 2................minutes per inch Depth of Test,Pit.................... Depth to ground water--.--.---_---_--__---__. a , ---------- ------. ......................................................... 0 Description of Soil-------------------------------------------- -------------- c'w_ __,�_ �._... -T = C--- 1T h�« = ` ......................... ------ ------ ----- ---- ----------- ----- ------------------------------------------------------ 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee su, by t board of health. - 2 Signed-- �- ---------------- ------------Dace------------ Application Approved B '�C Date Application Disapproved for the Mowing reasons: ....................................................... ..........................................................-••-•------••-•---••-----• ...................................................... Date Permit No......... �j -•--...---••--•-•--....... Issued--- ` _ C Date- No.......7.LP......... F>cs... Q... .. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH _._. .. - .._. -.. _...............OF.............................................................. .� S lirtt$in -for Di-qjiuitt1 Worku Totui#rurtion Prnuff, Application i •hereby made for a Permit to Construct ( �or Repair ( ) an Individual Sewage Disposal .System at• i� ............... • - ••.. .••. • Location•Address - r Lot o. �a her r" Address Installer ~Cx�% / � Address Type of Building Size feet �dO U Dwelling—No. of Bedrooms..._.._ --.._-__.Expansion Attic ( ) Garbage Grinder ( )� Other—Type T e of Building ............................ No. of persons .p., yp g p � Showers ( f) — Cafeteria ( ) d Other fixtures -•------'-t t r = :ti-----•-•--•`?=,1'` 'E Other W Design Flow----------- .........................gallons per person per day. Total daily flow... ____-.-.--.__gallons. Septic Tank—Liquid capacity-10_d_ -gallons Length-_-___•_________ Width._............. Diameter__-_------....._ Depth..-_-.--_--.--- W p Total Length-------------------- Total leaching area..-_...._-._-..___-_sq. ft. x Dis osal"Trench—No. .._ _ _ VVi}�Ith____._ .___ Seepage Pit No._ (6Q. iamet r.._.._.__._.b—Aepth below inlet.................... Total leaching area------- ----------sq. ft. z Other Distribution box ( ) Dosing tank ( ) c:. 41 a Percolation Test Results Performed b *.---.____-/�_�.._ ��--`_______________________ Date____................_______.___.____..-. ,.-a Test Pit No. 1----------------minutes per inch Depth of Test Pit--._--__.___._____-- Depth to ground water...------_-_----.-._---- �14 Test Pit Nor 2----------------minutes per inch Depth of Test Pit____________________ Depth to ground water_.._:._______•__.__.-.. . : O Description of Soil ----- ------- ------------------- x f= msT _f ----- -- 7_. 1_____ k_______ ______b__ �__........... �y,/�_/ �..// -__ ---_-__-- ,_.- , ♦ ____ ________ _______L__ t_/ _ _.___ Y _.�_.....e .- -_-_--__-____-________---- 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 Article XI of the State Sanitary Code—The undersigned furtheK agrees not,.to place the system in operation-until a Certificate of m b u by th rfhealth- Signed... ........ ........... ...........�..�........_�_�_.. _w. -----•--• .. [ Date ApplicationApproved BY---_------- ---` --4................................................. ................ Date Application Disapproved for the fPlowing reasons:.-•------•-------------------------------------------------•----•--------------.....-•--------•--------------•-- t i .� / Permit No. � Xl '-='-�--------------------------- Issued..--- -° L---�--t.......------ Date .... 'i I Date THE ,COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 3h .,� ....... lJ �':...........OF............:.........h....:5....f .......................................... (ITrr#ifira#r of G ampiianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( :), bY.................. t�h !-----------•-" -'----------•- 1 It Installer has been installed in accordance with the p.r.ovisions of Article XI of The State Sanitary Code as described in the application for Disposal WorksCori truction _ ____________W-W . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU AS A G ARANTEE THAT THE SYSTEM WIJLL FUNCTION SATISFACTORY. DATE------- . Z , ' -- --•--•--•-- -=•=`= -----=------•--------------------- Inspector........ _-•- - = THE COMMONWEALTH OF MASSACHUSETTS l' BOARD OF HEALTH L/to ............./ �...........OF.......0r bV,tP..hdl. . .. ---- No.••--......•••. FEE........................ Permission is hereby granted--------- k 1---•------- 1f/--......--•---•--••----•-------------------•......--•••---•---..__. ...... to Construct or Repair ( ) an Individual Sewage Dispo a] gem treet .� as shown'on the application for;Disposal Works Construction 'Prmit No..... Dated____/i-- - 7- _ ---------------------------------------------------------------------------------- ---t.. Board of Health DATE - FORM 1255 HOBBS & WARREN.-INC.. PUBLISHERS - '� I I 3 a r DATE:_ 2/:8/96 - PROPERTY ADDRESS: .25 Second Ave West Hyannisport O 61" -Mass . ' On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 1 -1000 ,gallon .septic tank. 2. 1 -1000 gallon Leaching pit. Based on my Insoactlon, I certify the following conditions: 1 . This is a.,title five septic system..... 78 C.Qsde ) 2. No. ,Bistribution' box present. 3 . The septic system is in proper working order ) at the present time. } , • ; SIGNATURE: L/, 1- ' 1- 4 Name J P M_ac'omber Jr... Company: J• P_Macomber- & Son-_Inc Fe B co Address _-8e�c-bb-----= ------- k �9y Cente1rvi11e Mass : 02.632 ' Phone:__-508�JJ3338------- 1 -- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY M—M L . ,MACOMBER & SON, INC.nks-Cesspools-Leachflelds Pumped & Installed own Sewer Connections 6' Centerville, MA 02632-0066 77.5-3338 775-6412 Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection William F.Weld xe Trudy Co Gowrnor Say x@ Argeo Paul Ceiluccl David B.Struhs LL GoMamor • Commlaalorrr • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 25 Second Ave Hyannisport West Address of Owner.John Bigotto Date of Inspection: 2/8/9 6 (If different) 96 Clinton Street Nameoflnspector. JJoosseph P. Macomber Jr. Glastonbury, CONN 06033 J.P.Macomber & .Sori e>� >cone 1�ox� i6 Centerville,Mans . 02632 508-775-3338 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ,,,Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority.' _ Fails Inspector's Signat Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A,B,C,or D: A] SYSTEM PASSES: have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: , 10 One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,�Po,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved by the Board:of Health. , (revised 11/03/95) 1 One Winter Street o Boston,Massachusetts 02108 a FAX(611)556-1049 • Telephone(617)292-SM 3'Printed.Recycled Paper V. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) PropertyAddress:25 Second Ave Wst Hyannisport,Mass . Owner. John Bigotto Date of Inspection: 2/8/9 6 B)SYSTEM CONDITIONALLY PASSES(continued) jf[Q Sewage backup or breakout or static water level observed in the distribution boat is due to broken or obstructed pipe(s) or due to a broke settled or uneven distribution boat. The will iris n if with approval of the Board of n. �m Pam+ P� ( PP Health): broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced Ae The system required Pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: , ID Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. Z) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. A& The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. JD The system has a septic tank and soil absorption system and is leas 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. S) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropertyAddreas: 25 Second Ave West Hyanni sport,Mass . Owner. John Bigotto Date of Inspection:2/S 9 6 D) SYSTEM FAILS: • e ti O I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the. failure. - Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface watem due to an overloaded or clogged SAS or cesspool. A4&& Static liquid level in the distribution bout above outlet invert due to an overloaded or clogged SAS or cesspool. %20 Liquid depth in tesspeel is less than 6"below invert or available volume is leas than U2 day flow. At 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.ceaspool or privy is within a Zone I of a public well. i 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 cobf.orm bacteria,volatile organic compounds,ammonia nitrogea.and nitrate nitrogen. El LARGE SYSTEM FAILS: 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 signifuant threat to public health and safety and the environment because one or more of the following conditions exist: �11} 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 suPPIY the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IRiPA)or a mapped Zone If of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for Anther Information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 25 Second Ave West Hyanni sport,Mass. Owner. John Bigotto ° Date of Inspection: 2/$/9 6 ° Check K the following have been done: Pumping information was requested of the owner,occupant,and Board of health. Zone of the system components have been pumped for at least two weeks and the system has been receiv ing normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ZAs built plans have been obtained and examined. Note if they are not available with N/A ZThe facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow YThe site was inspected for signs of breakout. All system components,including 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. 2The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. ZThe facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub. Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION , Property Address: 25 Second Ave West Hyannisport,Mass . Owner. John Bigotto Date of Inspection: 2/g/9 6 . FLOW CONDITIONS RESIDENTIAL: e Design flow:1,(�Lgallons e Number of bedrooms: Number of current residents:__ Garbage grinder(Yes or no):�Q Laundry connected to system(yes or no).441 Seasonal use(yes or }' i.�5"lyyZ�i Water meter readings,if available: " � a l�d Last date of occupancy:Agavoo COMMERCIAL/INDUSTRIAL- Type of establishment- Design flow: VR gallons/day Grease trap present:(yes or no)--O Industrial Waste Holding Tank present: (yes or no)A)6 Non4anitary waste discharged to the Title 5 system: (yes or no)" Water meter readings,if available: MA Last date of occupancy: OTHER(Describe) /11� Last date of occupancy: GENERAL INFORMATION PUMPING$FCORDS and sgurce of info �: �� ���� lV f- t T� System pumped as part of inspection:(yes or no)le,5 ' If yes,volume pumped: f ns Reason for pumping- TYPE OF SYSTEM Septic ton' —L ion ban/soil absorption system , No singie cesspool A/d Overnow cesspool AV Privy Shared system(Yes or no) (if yes,attach previous inspection records,if any) Other(explain) XIMATE AGE of all components;date installed(if known)and source of information: � yiPP.i9 l� Sewage odors detected when arriving at the site:(yes or no)dzl/ (revised 11/03/95) 6 b SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddresr 25 Second Ave West Hyanni sport,Mass. Owner. John Bigotto Date Of Inspection: 2/g/9 6 SEPTIC,TANK/—IDOdlg.4 aoa/r*t' {i • ' • (locate on site plan) Depth below grade: Material of construction:_L,4ncrete metal_FRP_other(e:plain) Dimensions: `/ $Distance firm top of sludge to bottom of outlet tee or baffle: Scum tblcl .me:�_ Distance from top of scum to top of outlet tee or baffle:�_ Distance from bottom of scum to bottom of outlet tee or baffle.. Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidenceofleakage,etc.)-Pump septic tank every 2_3years . Inlet & outlet teen Arp ptructurally sourid,Tank is Gtrn(-turally Gnund anri nn done of 1PakaoP WP�711�=T1 gl�`P;)+l n tanlr at time nf i cnti nn Heavy -S 6'1 i8 & 80--ds leay4rzs rtQ ej2a�arP needed at the nrPGPnt tAmP _ GREASE TRAP:, (locate on site plan) Depth below grade: Material of construction:Lawnerete_metal_FRP_other(explain) E Dimensions: A Scum thickness: Distance from top of scum to top of outlet tee or baffle:12ft— Distance from bottom of scum to bottom of outlet tee or baffle:& Comments: (recommendation for pumping,condition of inlet and outlet tees or balnes,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) Xb �wt�tl�al�7"cs (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address: 25 Second Ave West Hyannisport,Mass . Owner. John Bigotto Date of Iaspeotion: 2/g/9 6 TIGHT OR HOLDING TANIi{:,&bVa'.- e , (locate an site plan) • Depth below grader Material of construction: jooncrete metal FRP_other(explain) - AM Dimensions: --/d P Capacity: 0a gallons Design flow: allous/day Alarm level: Comments: (condition of inlet tee,condition of alarm and That switches,etc.) DISTRIBUTION BO&•L)CNt- (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP CHAMBER:Ah61t?- (locate on site plan) Pumps in working order:(yes or no)-& Comments: (note conditjeu of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) PropertyAddrem 25 Secand Ave West Hyannisport,Mass . Owner. John Bigotto Date of Inspection: 2/g/9 6 SOIL ABSORPTION SYSTEM(SAS):1�OOd�� .0�t � A (locate on site plan,if poss:u ;excavation not requiirld,but may be approximated by non-intrusive method) 0 If not determined to be present,explain: Pi , a number. leaching chambers,oumberl2 leaching galleries,number.(Z_ leaching trenches,number,length D leaching fields,number,dimensions: Q overflow cesspool,number. Comments:(note condition of soil,signs of lvdraulic failure,level of ponfng, pf ve etcJ Loamy sand ;no to medium san •no signs of Wr is "al , No relpairs are nee e a e presencetime. ea Tng 1 t ts'�- CESSPOOLS: (locate on site plan) Number and configuration:_ 1A Depth-top of liquid to inlet invert• Depth of solids layer. Depth of scum layer. Dimensions of cesspool Materials of construction• Indication of groundwater: t)AL) inflow(cesspool must be pumped as part of inspection)_ Comments:(note condition of soil,signs of hydraulic,failure,level of ponding,condition of vegetation,etc.) PRIVY:/j&V,l (locate on site plan) Materials of oonstruc i=- /1�r9 Dimeaaioas_ Depth of solids: Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) (revised 11/03/95)• g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address Owner. Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: s iaclads ties to at last two permanent references landmarks or benchmarks locate all wells within 100' /AWN r: III DEPTH TO GROUNDWATER O VS Depth to groundwater-at*—feet _ shod of or a proximation; , G (revised 11/03/95) 9 •rnnrn�n.rsr•rr-srnr+m:nmera-nnaerrrsrsrr.s.•�-mrt�srremr*+ns�-aa rra-o�r.,r.+ .rtrnaa-.trr+rr.—!•.n;•.i—• 'TOWN OF Barnstable BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION h-•rrt-T•••::T—rna-.rrnrtrm•R:+r.a-nemzrm-m�'r—zv+-s,rsr-asnr�r IN ss smnrmr�rrssatsrrrr.r.::r,�rr•r.-ter -. -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 25 Second Ave West Hyannisport` ,Mass. ASSESSORS MAP, BLOCK AND PARCEL ��- 0 OWNER' s NAME John Bigott4o PART' D - CERTIFICATION NAME OF INSPECTOR Joseph P. Macomber Jr. COMPANY NAME J.P.Macomber & Son Inc COMPANY ADDRESS Box 66 Centerville Mass . 02632 Street Town or City State LIP COMPANY TELEPHONE (508 ) 775 3338 FAX ( 198 1578 !. R CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate, and complete as of the time of >inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one: XXXXXXSystem PASSED ` The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection• which I have conducted has found that .the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature yi - Date _2/13/96 ,_/ One copy of this certification must be provided to the OWNER, the BUYER (where applicable) and the DOARD OF HEALTH. * If the inspection FAILED, the owner or operator shall upgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 310 CMR 16 . 305 . s TI�CE COAMONVVEALTH OF MASSA.CHCTS TTS DEPARTII/.[ENT OF ENVIRONMENTAL P"OTECTION ' . BE IT KNOIWN THAT Joseph P. 112acomber, Jr. :.;Has satisfied;the;.Departments qualifications;as= regiwed and-is' hereby - authorized_ to:use the:title. . .CERTIMD TITLE 5 SYSTEM INSPECTOR as provided-M` 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Deparbment of Environmental Protection. June to 1995 _ Acting Director of theW-ion of Water Pollution Control " TOWN OF BARNSTABLE LOCATIONq:?� 56xQX2/ SEWAGE # LY[LLAQE �' / /����' ��ASSESSOR'S MAP&LOT NAME&PHONE NO. _;7, SEPTIC TANK CAPACITY lope LEACHING FACILITY: (type) A019 (size) 64�A! NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: r Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) 40L Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 f�hin ,ty Feet Furnished b �/'% 1 5`4 e CA 6- ivN t tt _ a 4 i a� r � R 1 I 1 I • I I i ``aA\ `t 1 r 00 ILL :--� 1 �� 71 O f 1 • I ; ;.i ,i a ------ I --- -- - - - -- --- - -- . - - - -- I I- � -- �-------- -- ---, :I,- - --- , -------,.- ------------------ - --�---,--------------- ---�---- ---- --- -- ------------- ----- -- - - ---------- �-------- I I- . F I . I I � � I I I I I � I � I I I � I � . I � . I I I � I . I I . � - � - : - I I . I I : 1 4 1 1 . I . �I I I I � I � I I , I . . "I �f I � � . I i I � I I 11, I . . . � I I . I ; . � I I � I I I � I I I . . I I I 11 . I � I 1��/Z- 15' 725--s-7- /??5�4/477-5 1 1 � I I I . 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