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HomeMy WebLinkAbout0044 UNCLE WILLIES WAY - Health 44 Uncle Willies Way Hyannis P A = 292 323 4 I III DATE:61210 3 _---- . 44 llnc`2e Q.i2.� ,3 Oa PROPERTY ADDRESS. y y /7yanni'3, 02601 JUN 2 0 2003 ----------------- TOWN OF BARNSTABLE HEALTH DEPT. On the above date, I inspected the septic system at the above address. This system consists of the following: 1. 1- 1000 ga.2.Pon ze/1t.ic tank. MAPZ9,2.,�_ .... 2. 1-Diat2.i2uti.on Sox. PARCEL 3. 1- 1000 ga2ion /?Zecazi- .Peaching /2.it. LOT Based on my inspection, I certify the following conditions: 4. 7hiz .iz a t.it.2e Live hept.ic zyztem. (78 Code) 5. The -6ept.ic 6yetem .iz .in plLope2 woak.ing oadea at the paezent time. 6. lda.6te wate2 .iz 67" geiow the .invent pi/2e o/ the Peaehing pit. SIGNATURE: Name:_J. P _ Macomber Jr . — Company: JoseTh_P . Macomber_& Son , Inc . Address: Box 66 Centerville , Ma . 02632-0066 Phone: 508-775-3338 THIS CERTIFICATION DOES NOT CONSTITUTES A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. _r Tan ks-Cesspools-Leachflelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 COMMONWEALTH OF MAMACHUSETTS = EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 44 Uncie U-i-e2y.s Clay yann4-3, n a•s-. Owner's Name: 7ohn 0e ete2 Owner's Address: 3 Samos C.i/zc2e Ppr/Pndy, NrziA. 0.1960 - Date of Inspection: 612103 Nameof Inspector: (please print) o.6pf2h %. maro4zge.2 a2. Company Name: �_ P_ Mrzrnm0.pl? R So .i.nc. Mailing Address: ;?, , 6i6 Centeayiiie. Nazz. 02632 Telephone Number: 5 0 R—7 7 5— 3 3 3 8 CERTIFICATION STATEMENT I certify that 1 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 Needs Further Evaluation by the Local Approving Authority Fail Inspector's Signature: - Date: U The system inspector shall su it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. if the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner.shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments r****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different ',,conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 44 /Lncie (Jay y4nn.t�s, u�s�. Owner:John Qe ,6 e z Date of Inspection: 672103 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D S sue s: s I have not found any information which indicates that any of the failure.crit�er))'a described in 310 CMR 1 .303 or in 310 CMR 15.304 exist.Any failure criteria not'evaluated are indicateeLbelow. Comments: / �l • v 7h�1Lg�fcc A/iA�iim in ,?aoo,z2e,,t woltk B. System Conditionally Passes: _,y2Z>One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board.of Health, will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. 420 The septic tank is metal and over 20 years old* or the septic tar*(whether metal or not) is structwally' . unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. 'A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND 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: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 44 Unc.ge 0-ii.2y.6 (Jay ynnn.iz, Mazz. Owner: John 6)e9,6 e2 Date of Inspection:6/210 3 C. Further Evaluation is Required by the Board of Health: ,-06 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 envirorunent. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(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. lio The system has a septic tank and SAS and the SAS is less than 100,f�et b�t or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and 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. 3 Page 4 of 1 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Add ress:44 Uncle 61-..P2t a Way Ky¢nni.e, l'lrc.6�. Owner: ghn GJe��st`ea Date of Inspection: 612103 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No / J ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool r/ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or IX SAS or cesspool !/ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool f-0_)Md C 62" —) _ V1 Liquid depth in cesspeel is less than 6"below invert or available volume is less than ''/z day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped � An y portion of the SAS,cesspool or privy is below high ground water elevation. t/ y portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface T water supply. y 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria U are triggered. A copy of the analysis must be attached to this form.] (YesfNo)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303. therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no/ _ �'/ the system is within 400 feet of a surface drinking water supply e system is within 200 feet of a tributary,to a surface drinking water supply l� the system is located in,a nitrogen sensitive area(Interim Wellhead Protection Area—I WPA)or a mapped Zone.I1 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. 4 Page 5 of 1 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:44 Unc.Pe .Jay K anniz Na.s.s. Owner: John 0e .3 e Z Date of Inspection:6/2 03 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 in 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,ej€tluding the SAS, located on site ? 4 _ 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 ? 2 Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no Existing information. For example, a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)) 5 Page 6 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:44 Unc.t?e Clay Kya2rz ieLNa.,3. Owner: John Ne&,3te2 _T Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): c/ Number of bedrooms(actual): ,p�.� DESIGN flow based on 310 CMR J 5.203 (for example: 110 gpd x# of bedrooms):3XJP�= /v Number of current residents: Does residence have a garbage grinder(yes or no):I5 Is laundry on a separate sewage systemes or no):,UO [if yes separate inspection required] Laundry system inspected(yes or no): 8 S Seasonal use: (yes or no):_ Water meter readings, if available(last 2 years usage(gpd)): 2001=37, 500 qai Pon,3=102. 74 GPD Sump pump(yes or no): 41V _ ga i P o n.6=2 6 7. 13 9P D Last date of occupancy: COMMERCIAIANDUSTR.IAL Type of establishment: Design flow(based on 310 CMR 15.203): , /�gpd Basis of design flow(seats/person's'/^sgft,etc.):_�JA Grease trap present(yes or no):�G�' Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):,12,1f Water meter readings, if available: Last date of occupancy/use: . OTHER(describe): lea GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): If yes, volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: T_YP� OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool 15 Overflow cesspool Privy /J4 Shared system(yes or no)(if yes,attach previous inspection records, if any) /t4 Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from'system owner) 4),6 Tight tank NA Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: !'� �ilyy Were sewage odors detected when arriving at the site(yes or no): 4� 6 Page 7ofII OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Add ress:4 4 Un c'.Pe ld i Q Q .s`° Qa y yanr .i.z Ma.6.6 Owner: John Negz.te2 Date of Inspection: 612103 . BUILDING SEWER(locate on site plan) Depth below grade: IoV Materials of construction:,Beast iron Z0 PVC�Z ,,Cher(explain): �¢ Distance from private water supply well or suction line,p v/� Comments(on condition of joints, venting, evidence of leakage,etc.): No evidence o =Peaky e. The .s ztem t, ven.ted .th2ouy .the houze ven.t.s. SEPTIC TANK: Zlocate on siteplan)lcW Depth below grade: "y � ` Material of construction: l�concrete_ametalA4�';_fiberglass t�) olyethylene d_bother(explain) If tank is metal list age:_ is age confirmed by a Certificate of Compliance(yes or no):,z2—/(attach a copy of certificate) Dimensions: Sludge depth: 6 Distance from top of sludge to bottom of outlet tee or baffle-Ztl«. Scum thickness: ;r.4 4-e, Distance from top of scum to top of outlet tee or baffler Distance from bonom of scum to'bonom f outlet tee orbaffle: -,.: . How.were dimensions determined: Llingp Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): ga/19age dih/2oaaP i,3 /22ezent. ne s .st- ee ae to /2 a e ` an -i�3 1tuc uaaii .sound and .6 ow., .no evidence o erg age.`L.iqu.id .Peve.P r-.t the ou'ijet ' .invent .i.s 51" GREASE TRAA ;(locate on site plan) e: Depth below grade:el—.0 Material of construction:,L&concrete,�metaLt6 fibergl'assolyethylene..�,&other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bonom of scum to bottom of outlet tee or baffler Date of last pumping:_dam Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels_ as related to outlet invert,evidence of leakage,etc.): 'J 0rjA0 fariIn LA 0.t�A1Lg612R . 7 Page 8 of I I OFFICIAL INSPECT ' FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACES .GE DISPOSAL. SYSTEM INSPECTION FORM PART C rEM INFORMATION(continued) Property Address:44/Un c 2(e m/.d.i.94.s !Ja y /IulL i J Owner: John G/egzte,z Date of Inspection: TIGHT or HOLDING TANK-1At/::nk must be pumped at time of inspection)(locate on site plan) Depth below grade: JJO Material of construction:Wconc metal�&berglass�yolyethylene,&A�other(explain): Dimensions: Capacity: NA Design Flow: E 'day Alarm present(yes or no): Alarm level: �W,)A Alarm�in wc. order(yes or no):� Date of last pumping: � _ Comments (condition of alarm and witches,etc.): 7��ht o4 hnPrl:nq Znnkz , a/tg np.t p2eaent. DISTRIBUTION BOX:'Z(if l must be opened)(locate on site plan) Depth of liquid level above outlet ii. .+ )d Comments (note if box is level and : )ution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box etc.): ) Di.61_2.igut.ion &ox ha.s one Pate/ta-g. No evidence o/ zo.P.ida ca22y oyea, No ebidence---o—T 2e¢ age '.cn o oa out ol tfte tox. PUMP CHAMBEB41/�(locate . plan) Pumps in working order(yes or no): Alarms in working order(yes or no' Comments(note condition of pump _)er, condition of pumps and appurtenances, etc.): Dump rhoulpa 1.A no.t_/12eben.t, 1 8 Page 9 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Urza-ee Q.iPPue Vay Owner: ohn egzte/t Date of Inspection:6/ SOIL ABSORPTION SYSTEM (SAS):Zlocate on site plan,excavation not required) 1- 1000 aa.P.Pon R2eca6t .Peach.in4 /z.it. If SAS not located explain why: f nrri prl . .coo 4age 10 TYPe ✓ leaching pits, number: leaching chambers, number: 0 leaching galleries,number: O _Ay) leaching trenches,number, length: A)o leaching fields, number,dimensions:© 22-1 overflow cesspool, number: r— 0 innovative/altemative system Type/name of technology:%/�.(/ TJUG M✓`1�6Vt ' Comments (note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition ofvegetation, etc.): Loam .6and to medium /°ine sand. No z.iynh oZ hydaau.P.ic ,"a.iivag o2 2ond.iny. Soi.Pb ate d2u. Vegeta ion i,3 noitma . CESSPOOLS (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n Depth-top of liquid to inlet invert: �J/9 Depth of solids layer: �) Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no):�IQ Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): CQd.AIpooOn rino .nni 417,eAgn4 . PRIVY -,(locate on site plan) Materials of construction: 1114 Dimensions: Depth of solids: _ Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): 9 Page 10 of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM • PART C SYSTEM INFORMATION (continued) ProperryAddress: 44 /1ne.ee ldii.Py, day y¢nn c73, ETT Owoer;aohn lVe ,6 en Date o(lospectioo; SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including tics to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 Net. Locate where publie.�water supply enters the building. 1 s , l01 Page 1 I of 1 l OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 LLncPe Gl� PPy�s Clay yann.i.6, Plash. Owneraohn 0e e2 Date of lospectioa: 6/2/03 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 7—y feet Please indicate (check)all methods used to determine the high ground water elevation: N_L_Obtained from system design plans on record - if checked,date of design plan reviewed: N,4 yfS—Observed site(abutting property/observation hole within 150 feet of SAS) NIL Checked with local Board of Health-explain: NA NO Checked with local excavators, installers-(attach documentation) yLLAccessed USGS database-explain:htt,:/Ito wn. &a/tnetaUe, PIA. CLS, You must describe how you established the high ground water elevation: U,6ed: Gahaetu 9 Nigee2 Nodee. 72116194 gaound watea P.P_eyailnnA nP.nuo '6ea 2eue2. U.6ed: 11SGS: OkAgaarjlion i eZZ r/rifn �iino 1992 U.3ed; USGS g1z.ound wate2 en evat.ionz. aanua2y 1992 Leaching L� i Pit �/ .cct ' I Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the bosom Of the leaching pit and the adjusted groundwater table is feet. 1l `` T.ATE-nFT1T-'T'-{rnra.n'nn+rrrrrrt nerrnlfr.7A�nHTn/TwwlT\TRTR'il lfaTTlrtAT .�I .TT-Tr-t•-rr-- -. r-. . TOWN OF L3aan.3tag-ee BOARD OF HEALTH j SU(1SURFACF SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION •••T!•1T••.••.:1�T.IIR�TTTt.T{Tnl-.ft1*IT+IIPJRTf iT1Trt'I T'1 VTR"\irR1R�`T►lA���\ tTH ..+tI--T � �. A —TYPO OR. PRINT CLEARLY— PROPERTY INSPECTED STREET ADDRES$ 44 Uncie GIiiiyz Qay Kyann.iz, Na.6.6. ASSESSORS MAP, BLOCK AND PARCEL # � " 3 OWNER' s NAME _John Uegz'tea PART D. - CERTIFICATION r NAME OF INSPECTOR Joseph P. Macomber Jr.. COMPANY NAME Joseph P. Macomber & Stfi ' Inc COMPANY ADDRESS Box 66 Centerville Mass 02632 Strvvt To wrt o r city Staty LIP COMPANY TELEPHONE ( 508 ) 775 3338 FAX ( 508 ) 790 _ 1578 m CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported omplete as of the time of * inspection . The l ction ed is true , accurate , and ins e wa s P 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 ; ' System 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 con acted 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 . F 1 Inspector Signature Date 31nd copy of this certification must be provided to the OWNER, the BUYER ( Where aPplicable ) and the BOARD OF ){EAL1'1l. IF If the inspection FAILED , the owner or "o"perator shall upgrade ' the eyetem within one year of the date of the inspection , unless allowed or required otherwise as provided in 3.10 CMR 16 . 3061 partd . doc a3 (1SS1 33NVIldW03 31VQ ✓� ` � �� a3nSSI 11WH3d 3 1 V a 3NMO 80 H 3011 R 8 SS3N0 (IV I 3WVN SA311 V1SN1 39V111A 'ON 1118V3d 39VM3S 010 NOIIV301 94 1 �,� aSnQtf J � 1 � ti r � /r No.........:Z.?-1'.--... Fizz.....�::5�.............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH To.-Wo7..................of.Barn.s.h.,b.�B.-...� y. n_n..t.� � Appliration for Dispas al Works Tonitrurtion famit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at y. ..... - .... 0 .............................................................. Location-Address or Lot No. J. Albert Bassett .......Box �3...S.Q>Atka.... 4kttk�.a---M ;. a........... - ----- -------------................----. ner Addre s Installer Address - Type of Building Size Lot-----1.0 420.._..Sq. feet Dwelling—No. of Bedrooms... ...........................Expansion Attic ( ) Garbage Grinder (No) Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ................................... Q .................. ....................•--•------••-•--•-----------------•-------------•--•--.•----- �t W Design Flow----•-....1.1.0------------------------•gallons per eru ay. Total dl ily flow gallons. WSeptic Tank—Liquid capacity.1000 .gallons Length_137.6...... Width.4'.IU.. Diameter................ Depth..4..0..... Disposal Trench—No..................... Width.9_........._._.... Total Length.........t....... Total leaching area....................sq. ft. Seepage Pit No--------I........... Diameter....ta'..0...._ Depth below inlet_...(....... Total leaching area... . .___sq. ft. Z Other Distribution box Dosin tank Percolation Test Results Performed by._ g7�_ d. -- Netj__(In.52 A+41l15 Date........ �.1 ........... Test Pit No. 4.lie�.? . __minutes per inch Depth of Test Pit.12.�Q"...... Depth to ground water_Orle.._d!Q.C. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to r er........................ �Pk,CK.. ss -------------------- ODescription of Soil.....�SR ._pisn.---•-•-•-------------------------------•------------------------------------------- .---•--- -------. q�y- -----............ x o DANA � V - ----W------------ W •-•.................................................•-•••........_..._............... �ECHWE.•. ................ {VIE.( U Nature of Repairs or Alterations—Answer when applicable----------------------------------------- ___ _p_[Vo_07%.p ................ ....................•---•--------•---•--------•--------•----••-••---•••••-••-......-•-------•-----••......--•-----•-•---•---••. F EF` �L .................. Agreement: S ?�t s/ NAL The undersigned agrees to install the aforedescribed Individual Sewage Disposal ccordance with. the provisions of iITL E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be s ue by e and of he It_,__ Si ed.. ........ Date Application Approved BY----- - - ._. .--• ---.:ct��------ --•--------------------------------- -•---�-�.1�---��Date Application Disapproved for the following reasons---------------••----•---------------•-----•------------•----....--------------------------------••.............. .....................•-----...----...--------•-----•----•--.....-•--------•------•---------•-•------••---•---•-•-•------------•-•-----•-•-•---•-------•--•••----••-•-•---•--•--••-----•------•-•-------- Date PermitNo....................................................... ' Issued.........=............................................. Date t. No.. ......3G..... FEs...... ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' 1.o?.tR!n.................OF. ,".'n.'t Apphration for Biipog al Works Tonitrurtion ramit 1, Application"is'hereby made for a Permit to Construct (�) or Repair ( ) an Individual Sewage Disposal r Syst t -- a4................................ .........•-- ....cad Q.----------•---••-- - Location Address or-Lot No. " Albert BASSett -- -- ...................... Owner Address r Installer 1J f ��JOt•4 .Aea .. � Il �- 1 U Type of;Building �• Size Lot...... �Q.�.... ...._ q. feet Dwelling—No. of Bedrooms..._._ ............Expansion Attic ( ) Garbage Grinder (W a a Other—Type of Building .............................. No. of persons.........:............_----- Showers ( ) — Cafeteria ( ) Other fixtures ........................... .------ --- -----------------------------•---•-------------------------..... W Design Flow___ . K__________________gallons per ` Ver day. Total daily flow..............._...3. .............gallons. WSeptic Tank—Liquid capacity 0 gallons Length.8"k,...__. Width.. 16. Diameter................ Depth..$ 0.-.. x Disposal Trench No .................... Width................... Total Length.................... Total leaching area....................sq. ft. Seepage`Pit No. ... ........... Diameter....TO... `.`... Depth below inlet..... :.1 ...... Total leaching area.... .61.._sq. ft. Z Other Distribution box (' Dosin tank ( ) Percolation Test Results Performed by._ 7=f7t' _ lrtl" tn.L4.t+.IS Date.........���1�� _�_ Test Pit No. 1...... "....minutes per inch Depth of Test Pit._1 2_-10.".... Depth to ground water-NDAC'._ .0c. rZ4 Test Pit No; 2................minutes per inch Depth of Test Pit.................... Depth to gro ....................... a' .. --------------•---...---••---------•-----.........._...............------....... F MASS. 0 O Description of Soil------ 2�'--P1 1,_'�-(2----------•---•----•--•-•---------------------------------------------•---- ". -• . x o UAW A­ - N ----•--•-••---...-•----••-•....................................•------------------.....-•-•-...---------......_. .. ..... Ltd_-----_... ___4. . sAcxELxNIE Z. -E12 U Nature of Repairs or Alterations—Answer when applrable---------------------------------^________ _____ __No_- 470 14Nv �0 Agreement: ZONAL The tndersigned agrees to install the aforedescribed Individual Sewage Disposal Sys cordance with the provisions of TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n ' s ed by the b p4rd of healt Sa.. -. --•--- --•---- ------------ ---- ' -- ------ Da Application Approved By.... •-- --•- ...... .......�...l .'._ �.... Date Application Disapproved for the following reasons-................................--------------------------------------------------------•-•••...------ ._...._ . ---------------------•-----------------------------------.........__.................................................................................................................................. Date I PPermit No........................................ ............... Issued_....................................................... o Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF: HEALTH Town..................oF.... .'..tons .............................. Trrtif irFa#r of Toutph anrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (Vl'or Repaired ( ) a taller at e ...... _Ti.t? . i!' 9-.V10"�fj .21 � ,, - ------------•----------------------•----- •------- -- ----.. t has been installed in accordance with the provisions of T 5 of The State Sanitary Code as described in the r application for Disposal Works Construction Permit No.. ....__.� f_______________ dated_-..__�_'_�v-�__--.7€ .�...___.::_,� THE ISSUANCE_OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 4- P PY DATE...... .- Inspector V j THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOM ........ ......... --- ...: , No.... _.��� OF FEE ..... . �io�ooatl orko ��no�ttrtion rrmit �-°,, ` -^ Permission is ereby granted...............�_ ._.__. . .A.....<. ew ---- ?;; to Construct 0or Repair anIn � at No.--- VQ . � t _ ._. Y -I ; :_ r •---;-•-•-•--......... Street as shown on the application for Disposal Works Construction Pe No ____ ______ ____ Dated.._" �`' ` ....... � .. �.. - Board of Hei r DATE---------------/D..................................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ` '� ' " 1 i I i L" SOIL LOS 4 �i(k�i�U<f�\Vi aF 4titri.is/c / wv�,.rA/i!/C I,i c /.o3- 3 3 PE AS TONE LOAM 8 FILL 12"MAX. ° e p r I 4%.I. 546-5 ,'z 1$7 BOX I, ° 4 ° o -)2n ?.P-7 /0'MIN. 1000 1 24 MIN. ° D I ° u • 1000— GAL. o G I misb a/f • GAL. ° - RECAST OR SEPTIC llro o° P c D I `� s>. 93.7 F 6 I D o e ° f- TANK BLOCK SEEPAGE PIT PIIT o' Area ofsf I t ° 791 s t o # ` 20' MINIMUM (o °'• °° Ta �'�75F- ° p °� 91.7 t ck 1 { FOUNDATION %z WASHED STONE I ' ELEVATION SKETCH �--- 10' -{ PQRC. PAT17 {' Q000ge 2-9� /nick r 4 t - SCALE: 1"= 4' TEST BY : _N C_F. TOWN INSPECTOR: 24+,L AV-tt*&A >, BACKHOE OPERATOR : 1•R ' S/ f? Or/ /`l° TEST MADE ON I 3o-7,P 1,)Es fi ire, c/c/a o ly 2)Maas,all*wj,61,0 dailk Iaw Ior thA; .s m: � r� s We 2.so ypo%`sp 470 gpV cos Ar/ S_ �- `2 cz; .-.c 7 E- p.q Tp 4 a ' ;=>A-o P- °1. Z", TC,- p q loc,60 Lot L of z a 14,470 T. r. 3D+ 8cnC6 Marlc.,'Top C.,S. f ELEVATION SCHEDULE _ PROPOSED SITE PLAN I. INV. AT FOUNDATION SEVASE SYOTEM DESIGN 2. I'NV. INTO SEPTIC TANK IN 3. I NV. OUT OF SEPTIC TANK = 1Q . 1 4. INV. INTO DISTRIBUTION BOX = 101190 �Zoe Wllul'c� WRY I SC E: I 20 , 19?P 5 INV. OUT OF DISTRIBUTION BOX = C_ 6 35ill _ � �,ZflFMsc A 6. INV INTO SEEPAGE PIT = CAPE COD SURVEY CONSULTANTS ( DANA y^ G- I - - ROUTE 132 i o vi i 7BOTTOM OF PIT = '95.5(a ., M<KE I HYANNIS, MASS. i NO 147 247t3} IA DIVISION BOSTON SURVEY CONSULTANTS, INC. B. BOTTOM OF STONE LAYER k