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HomeMy WebLinkAbout0058 WASHINGTON AVENUE - Health 58 WASHINGTON AVE HYANNIS A = 287 093 t l Y TOWN OF BARNSTABLE LOCATION �c7 U w ��f� A-)(2- SEWAGE VILLAGE d ASSESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO.� A'�OS 3C;-366f-- SEPTIC TANK CAPACITY LEACHING FACILITY:(type) �� (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER ? BUILDER OR OWNER 00M(S (NC, lU - ORJ DATE PERMIT ISSUED: Z DATE COMPLIANCE ISSUED: h 7/— ,?a VARIANCE GRANTED: Yes r1 No 4�A 0 xo9 d oz� II tl �r r f" 093 BORTOLOTTI CONSTRUCTION, INC., .765 WAKEBY ROAD,MARSTONS MILLS, MA pp 0 508-771-9399 508428-8926 FAX: 508428-9399 1,19 Z9 SUBSURFACE SEWAGE DISPOSAL SYSTEM 1NSPECTI R RA PART A t 2 \� CERTIFICATION Property Address: Date of Inspection: ! / 9 Inspector's Name: O%yner's Name and Address: % D. (o� CERTIFICATION STATE ENTs I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection. The inspection was per- formed 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 B the Local Aproving Authority. Fails Inspector's Signature: Date: l2`�p The System Inspector shall submit a copy of this inspection report to the Approving authority within thir- ty(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 td the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY! A)SYST M PASSES: I 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; One or more system components need to be replaced or repaired. The system,upon comple- tion of the replacement or repair, passes inspection. Indicate yes, nor;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 sep- tic tank is replaced with a conforming septic tank as approved by The+Board of Health. Sewage backkup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): - 1 - i Y, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r PART A ,,� , ��.` CERTIFICATION(continued) Broken pe i (s)replaced p r Obstruction is removed Distribution Box is levelled or replaced 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 THEBOARD 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 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. 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT.THE PUBLIC HEALTH AND SAFETY AND THE _., . .ENVIRONMENT• ;r .; The system has,a septic tank and soil absorption system aid 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 with a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system and 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. the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. - D)SYSTEM FAILS: 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 etluent 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 clog- r ged SAS or cesspool.: Liquid depth in cesspool:is ess than.6"below invert:or available,yolume is less than 1/2 day flow. - Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped -2- j , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 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 i",pan 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)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design flow of a system is 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: 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 ma Zone 11 of a ublic water su l well. ( ) PPS P PP Y The owner or operator of any such system shall biing'the system'and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 alid 6:00. Please gonsult the local regional office of the Department for further information.. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check" the following have been done: Pumping information was requested of the owner,occupant,and Board of Health. _None of the system components have been pumped for atleast 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 N/A. J "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 site. tr __L4he septic tank manholes were uncovered,opened,and the interior of the septic tank was in- -'p •" ks ed for condition of baffles ortees,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 existing information or approximated by non-intrusive methods. -3- i SUBSURFACE S_EWAGE'DISPOSAL SYSTEM'iNSPECTION FORM PART B CHECKLIST(continued) �e facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM_INFOORMATION". FLOW CONDITIONS Design Flow: 33o gallons Number of Bedrooms.. v? Number of Current Residents: Garbage Grinder: �) Laundry Connected To System: Seasonal Use: Water Meter Readings, if available: Last Date of Occupancy:_, ae2i�4 LGQ Pn od,i�a�cO COM_MERCIAI JINDIIST IAi -AJ U - Type of Establishment: 4 Design Flow:. "- gallonstday Grease Trap Present:(yes or no)"` -Industrial Waste Holding Tank Present:-- Non-Sanitary Waste Discharged To The Title V System: " - Water Meter Readings,If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: /JU System Pumped as-pan inspection: ,J U 1f yes,volume pum gallons Reason for pumping: TYEE'OF SYSTEM: Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous inspection records, if any) Other(explain): PROXIMATE AGE of all components date installed(if known)and source of information: oh Se age odors detected 'when arriving`at the site: A -4- _ _. Jlb I { {,, t..Y SUBSURFACESEWAGE.D,ISPOSAL.SVSTEM:I.NSPECTION FORM n. PART C GENERAL INFORMATION (continued) SEPTIC TANK: Depth below grade: Material of Constnuction: 1--concrete metal FRP Other (explain) Dimisions: Sludge Depth: Scum Thickness: Distance from top of sludge to bottom 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 aBles,depth of liquid level in relation to outlet invert, structural-integrfty, evidence of leakage, etc.) Q® GREASE TRAP: ,o Depth Below Grade: Material of Construction:—concrete - metal_FRP Other (explain) Dimensions: Scum Thickness: Distance from top of scum to top of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and`outlet tees or baffles;deptli'(if liquid level in relation to outlet invert,-structural integrity,,evidence of leakage,,etc.) TIGHT OR HOLDING TANK:/06 Depth Below Grade: Material of Construction:__concrete_metal_FRP_Otlter(explain) Dimensions: Capacity: gallons Design Flo«: gallons/day Alarm Level: Comments: (condition of inlet tee, condition of alarm and float swi(ches, etc.) DISTRIBUTION BOX: 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: _Pump-i`s'in working order. w.-Comments:. note condition.of ump CIr ii11be ,- , . 1; co ii dreota o_f5� rti fs aAard' �r ppiirt.,enances etc.) t :_� rr 0 i F . .. .r. SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM a ' ' PART.0 . SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS): t/ ' (Locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: Leaching pits, number: Leaching chambers, number: Leaching galleries,number: Leaching trenches,'number;length: Leaching fields,number,dimensions: Overflow cesspool, number: Co ts: (note condition of soil, signs of hydraulic failure level'of pouting,condition of vegeta on, etc.) GL /DOO CESSPOOLS: X)d Number and configuration: Depth-top of liquid to inlet invert Depth-of solids layer: Depth,of scum layer: Dimensions'of Cesspool: Materials of construction: Indication of groundwater: Inflow(cesspool must be pumped as part of inspection) Comments: note condition of soilk signs of hydraulic failure level f ndin( g y o .po g,condition of vegetation, etc.) PRIVY: Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) v ' e....+..r�...»—•r....__........ .:..tea+:.`..y.« r+a--+...w+•.w-«.rw...+...»....:_»...._. -:c...... .. .+ .......:....... ........._.,....v.�.. ..» „...... ... ...... -6 - SUBSURFACE'SEWAGE DISPOSAL'SYSTEM INSPECTION FORM ,PART C SYSTEM INFORMATION (continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. O I - - I I Lp DEPTH TO GROUNDWATER: Depth to groundwater: Z Feet / Method of Determination or Appro imation: /� /�911 ��nl �•J. l T -7- ipsq 1 � Fps......./.0_0....._ THE COMMONWEALTH OF MASSACHUSETTS A S 4o,,L7- BOAR® OF HEALTH Z, AlLf TOWN OF BARNSTABLE APOVE9 Barnstable CQftCGfM1a Appliration for Uhipoii al Workfi Tomitr� i =� Application is hereby made for a Permit to Construct ( ) or Repair ( ) a InV'S' Sewage Disposal S stem at* •...Ale4-----O/L) -------------- ........ .....W------ Loc tip- ..v..e.......... .......ff w A dr ssn r � Installer Ad ress Q Type of Building .. Size Lot............................Sq. feet U Dwelling—No. of Bedrooms......... ...............Expansion Attic ( ) Garbage Grinder ( ) a Other—Type e of Building a, yp g ____________________________ No. of persons.......IS............. Showers ( ) — Cafeteria ( ) p' Other fixtures --_---------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... 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........................ 04 ---•-------------------------------•----•-------....---••--•--------......----------•--•-•-••----......-•---------•-------•------••-•---------•-•••----..-•-- 0 Description of Soil........................................................................................................................................................................ x V -----•--••-••-•-•-••---•••------••••-•--------------•••---------------------•-•••-••-----------•--•-••-----------------••••-•--•-----•-•-------•--•---•------••--•-•......---------••-..........-------- W ----••••••-•................•----••--•-•--------••------------------••--•••-•----•---._...••-••-•---------•--•-------•---•--•------•---- V Nature of Repairs or Alterations—Answer when applicable...C.) __-----1�` & _f......... ------------ ��..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ......................................-------------------------------------------------------------------- ------------------ ---------------- Daze Application Approved By ------------ .9...-../..---1 — .. ...... ............................................................................... Dace Application Disapproved for the following reasons: ------------------- ------------- ---- ----------------------------------------------------------------- ------------ ------------------------------------------------------------------------------------------ ............--......--....---------------- ................................... .....................------ Date - .... .... Issued Permit No. ...Y�--'--- Date Nu..-!P2.................. { FPS...... �. ..._ THE COMMONWEALTH OF MASSACHUSETTS , BOARD OF HEALTH s �C I',- .� -- _� r r c,C TOWN OF BARNSTABLE App iratiun for 14.4p gal Workii Tunutrnrtiou'rprmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) a Individual Sewage D isal j�III'ta�- �/0e's©xv . -... V-e`Ce�r UGUCucl�........................ ........ ......... �r . --- a ...... .... ---------•• -------- ------------ ------------------- � Installer Address UType of Building f� Size Lot............................Sq. feet t-, Dwelling—No. of Bedrooms---•---•.-_1.....� .................Expansion Attic ( ) Garbage Grinder ( ) a e of Building a Other—T yp g ............................ No. of persons................... Showers ( ) — Cafeteria ( ) Other fixtures .........................................--•-•-••-•-- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ l a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-----••••---------------------•--•••--•••••••-•---•----••-•-•-...••••••...........•.......--_--•---....................................................... 0 Description of Soil..................................................-•---•-•-------•------------------------------------------------------....--•--------------------•......------•..... x c.� -•--------- ----------------------------------- ---------------------- •------------- •---------------------------------------------------------------•----------------------------------•------------ W V Nature of Repairs or Alterations—Answer when applicable.___________ ___________ ---- __ L /,�� A rem ne " 1 � g ; The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed.------ ---------------- ------------------±------------------------ -------------------------------------- Dare Application Approved BY ..--..-..-�- --- ---- -�.`�`""-""� ��..--.-/. ...%.�-. ............................... Date Application Disapproved for the following reasons- ---------- ----------- ---- --- ------------------------------------- ..................................... ------------ ................................................. -------------------------......----------------------------------------------------------------------------------------------------------------------- -------------..- : - ---------......---- Date Permit No. o� ' `-� �'`�. .............. ...... Issued .. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE &r#tf ratr of Contylian>re THIS IS V TO-�.� , That the Individual Sewage Disposal System constructed ( ) or Repaired (�") by ......... .. .�a'''.'V........--- .--------------- ........---.......--------- . ----------......................- 3 1 /{� � Installer atV ....... . ...... ---- -- `---. ._�en_ ---------------------------------------- ---been installed in accordance with the provisions of TITLE 5 c°-f The State Envir nmental Code as described in the application for Disposal Works Construction Permit No. ....... a.-....17�..2-- dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE - ... -y�F�, t f---------�-------------------------------------------- Inspector ....................... J........................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1� TOWN OF BARNSTABLE/J FEE..d..................... No.. "�. .. �� iu�ruu�t . urku �unutr ion Fermi# Permissionis hereby granted.............................................----•••--•-•-•••---••----•----•-•---•-----•-•••••-•-•-•-•.....•••--•••..-•-•-.............--•••- to Construct ( )Car��2e air ) n Individual Sewage Disposal System atNo-------------•--•--.......-U---...--------...----............... .-•---•-.....! -' V Street y Q 2 as shown on the application for Disposal Works Construction Permit N '! :.. ✓o�.. Dated.......................................... -------•----.......-•--------.. ................................................ DATE_ —� Board of Health ---------------------------------•-------------...._...--•-••-••-•--••........ FORM 36508 HOBBS&WARREN.INC..PUBLISHERS f rrr Q. i 40 cqi TOWN OF BARNSTABLE , LOCATION W f f� (El.SEWAGE j VILLAGE ; ASSESSOR'S MAP Cz LOT INSTALLER'S NAME'',PHONE NO. �/�QS SEPTIC TANK CAPACITY = i I LEACHING FACILITY:(type) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER '_ e of BUILDER OR OWNER /l:Y� f/U (S JA/C, (.t So& DATE PERMIT ISSUED: ! b - - e2 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes , No �� I i No.....7/......... ................... THE COMMONWEALTH OF MASSACHUSETTS _---.,BOARD ®F 1-1 E,�LT 1'°'1 G ......OF.......... ............... �' v � 4 Application is hereby made for a Permit to Construct ( ) or Repair (✓) an Individual Sewage Disposal r System at: < , ;i�....1/ - - -----• • : .............. ...-•- ------- ------ .......-•-•----•---••• •---•---•---------•-------...-....... cation- ddress •••••-----•or•Lot No. - - ------ ........--................. ---......---- •- -....--•--•-•---........••••••••-----•----••--- Ow� Address W � Installer Address Type of Building Size Lot--------_...................Sq. feet U Dwelling—No. of Bedrooms________________________________ _Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ---------------------------- ......................... Design Flow..........................................._gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No.____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY..............................................................-........... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.........-.......... Depth to ground water........................ 4, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................... R+ ---•--------------------------------------•-•---.._..--•--••-------------------••--•------....-•----............................0..........................-- 0 Description of Soil........................................................................................................................................................................ ------•---•----..-..•-•••••----•-••----------•---••••-•-------------------••••-._.._.__....-------•••---••••-••-----•--••-••-••••-••---•---•-------•-------------•------------•---•.........-----•...__. W ---------------------•-•-•---•--------------------------•-----•--•-••••------•-----------•-••••••••--•-------- UNature of Repairs or Alterations—An r �ap�l.ica..ble.....__ - ................. .........................................................••-- �• - ---- -•---•---••-• - -- ------ --••-••••• Agreement: i The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in ccordance 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 en 'ssued by the board of health. Signe `�y ...................................... ................................ rc-. Date Application Approved By- Application Disapproved for the following reasons:------•-----------------------------------------------------------------•--•----•..................-•---••-•-- ..................................•••----•----••-•-•••-----••-----•------------------•--•----....•-----..._..••-•-----•-•----------------...--••••-----••-•-••-•••._.......•.--•_._.__.................... Date PermitNo......................................................... Issued........................................................ Date No... .•............. - F$$............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH --.....OF.............. .........: K Appliration for Miipoiial Works Tonotrudion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (We) an Individual Sewage Disposal System at t • ., ...................... ............................................ . cation-Address /J or Lot No. •.. .... a'--- .. . ---- ---••••••.....--•----••---. ----•----•-- a� - +.r 5. ............................................... W Ow Address a ............................ .......:........................................................... .....................•................----•••••--------•-........-•----........................... Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms.............................................,-� g— Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ....:....................... No. of persons............................ Showers ( ) — Cafeteria ( ) Q Other fixtures ----••-•----. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter................ Depth................ x Disposal Trench'=No......:.............. Width.................... Total Length.................... Total leaching area._._................sq. ft. Seepage Pit No---------------------- Diameter:-.__---__•---__---- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (, ) Dosing tank ( ) aPercolation Test Results Performed by---- -------------------------------------------•------•--------•------.. Date........................................ 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.:___................... -----------------•------------......-----•------._......--------------•--------------•----.............-•--•-----------:..::_.....::------.................. 0 Description of Soil....................................................................................................................--•----------------------......-----------.......... W U Nature of Repairs or Alterations—An w n applicable.____._ - ..... .__. _�__._. . ""............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in ccordance with the pro%-isions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha en ssued b the board of health. Signed = -----------------•-••••------•-•--- ................................ Date ApplicationApproved By........................................................-----------------------------=-------••- Date Application Disapproved for the following reasons:................................................................................................................. ............................................................. ................................. .................--•---------------•--•-•---------•--•...._.------- ......----•----- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH .......OF................. . ✓ .....,.................... Tpdif irate of Tort"fiam THIS T CERTI That the Individual Sewage Disposal System constructed ( . ') or Repaired ( by................ °. . .....-••- ---------------------------------------------------------------------•----------.._..•-•••••---_..... fj at...................... I........ --- ----• --------------In-----er-------------------•---------------------•--------•-----------------------••-•-- has been installed in accordance with le provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No----------------------------------------- dated.......................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY, , DATE --------------- Inspector.. .............•---•-................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF/)HEALTH /o . `�/ . ......... 1�` ......OF.. ....- ....................................•.... ....... No.---- FEE. utaposat r Tod ion amit Permission is hereby granted:.= - ..................... to Construct (, ) or Rep r ( a Indi ' ua . e age Dispo 1.System / at No../— .... l/ v eet ' / as shown on the application for isposal Works Construction Wermia) d ' ,l '/ .;--- Board of Health DATE..... .._ , _.. .................................... FORM 125 HOBBS & WARREN, !NC., PUBLISHERS - o N/F N A JEAN Z. MARSHALL _ a 0 - \\ ASSESSORS MAP 287 CRAIGVILLE _ ^ - PARCEL 103 IROADDEED BOOK 1032. PAGE 043z3 MILDRED ONEIL '16.25 N/F' - LOCUSASSESSORS MAP 287 s3' JOAN M C'WATERS TP.. WASHA�PARCEL 30 `Sg, ASSESSORS MAP 287 CERT. 19313 y 2 .2' PARCEL 102 N/E D TT FIVE DEED BOOK 9272. PAGE 129 FRANCIS&MARIE E. ONEIL WASHUSE ASSESSORS MAP 287 sA OLEO BOOK R2964.PAGE 78 NANTLIcKE FOR REGISTRY-USE ONLY h _° ST OF MY LOT B SCALE 1" M 1000 PROFESGIOt AL KNOWLCDG AP CETI TO THE EEIf FORMATION AND BEUEF THAT THIS PLAN CONFORMS N/F .70 +J 13,287±S.F, 4,o ro a �� TO THE RULES ANDDEEDS. REGULATIONS OF CASSES HER I PAGE ?R. •j Z N/F - n �— TkE REGISTRY OF DEEDS. ASSESSORS MAP 287 CRAIG&SUSAN CHAPMAN? - PARCEL 89 q ASSESSORS,MAP 287 0 DEED BOOK 7394, PAGE 164 - _ PARCEL 99 LOT A / 117. DEED BOOK 9003,PACE 088 L=24.62' . SHAPE FACTOR IS LOT B&LOr 12 / R=17.O8 WASP INVESTMENTS INC. - ' REGORD LOCU SN ( ) I S�EQHMBIlQN �+ jC��+tP! iW �>6-42. N"-R®�''I.GKf�oSS FARMER�074�;E`-s U��G1$�RED I N76 i74' ASSESSORS MAP 287 �/I PARCEL tOC NE $ 1 LAND rn yn�- z0,0'W L=16.35'OEEG B'OK 10D02.PAGE 092 CURRENT OWNER: CRAIG EDWARD CHAPMAN \ a3° LOT 12 ED LAND 7 3j0"E K �` TITLE REFERENCE: DEED BOOK 9003,PAGE 088 4,906± S.F. Ow zR-4q•SO I / \` L=16.71' I - PROFESSIONAL LAND SURVEYOR DATE � SS R=11.58' PLAN REFERENCE- LC 20173L.t yes�`p1 \ SC95j•/JfLOT 1s600'`"�� 72 s :I lL- � ASSESSORS MAP:. 297 LOT 6 / caoH ��0`` PARCEL. 99 , - 3 1�_ EXSIA Ip CURRENT OWNER: WRRY L.ALVERSON PLAN OF LAND (NOT TO BE CONSIDERED - _ TITLE REFERENCE: CERTIFICATE 94763 A SEPER TE BUILDING LOT) o o v _- rjY`�i93(. EXISTING z m PLAN REFERENCE CERT LC 20173 aSN a °_ Hh 5E r \ O MARTEN OWEI! I r� 20 S�tqSq's 0.9'n L—- 14/F _�'� z t a ASSESSORS MAP: 287 #3S Pr \ J 3`4 E%ISTING •� - JOHN W. JR &ELIZABETH G. LAMFG (� `V PARCEL 93 MOUNT VERNON ROAD ASSESSORS MAP 287 9 - ASSESSORS MAP 287 1 PARCEL 90 0 \ sys BARN S7 33.0g• PARCEL 98 - DEED ROOK 7976,PAGE 055 - 4 v\ / 4 53''so- ��I 5, CERT 148305 \f RESIDENTIAL-ZONE: RF-1 _ IN `<•53• z SETBACKS: FRONT 30' S7 50 f SIDE 15' REAR 15' HYANNIS o MASSACHUSETTS on �583"38�5 p` MINIMUM L07 SIZE: 43,5605.F. G LOT 11 103.32' _ - - - D-F-fA 39. ) ;� 32 4''_ >��MfN`� s� MINIMUM LOT FRONTAGE 20' (BARNSTABLE COUNTY) N/F 'I�/( c SOT p{TRRY L. ALVERSON III I/n' r1 _ vas p+rr MINIMUM LOT VADTH: 125' ASSESSORS MAP 287 I PARCEL 93 C r CERT 94763 ,3 GROUNUWATFR OVLkL4Y OIS fRIC I: A(NOT A ZONE II) ( j W ;�J'�yC (NOA SEPERATENBU BUILDING G LOT)' DUNE 9, 2000 z ' LOT 5 34,959± S.F ' - LOT 9 BARNSTABLE PLANNING BOARD REVISIONS N/F NO DATE DESC Q m / MARCELLA D. HEAD JOSLPHNG. HGRNE . APPROVAL UNDER THE SUBDIVISION "L* I�{,•�7D Htoyx_ &Ambe At�pmoO a av S83:i8'1 0'E l ASSESSORS MAP 287 CONTROL LAW NOT REQUIRED PARCEL 92 ASSESSORS MAP 287 O iv ���' I CERT 144784 o PARCEL 97 s _ CEk f. 94880 19 —�.__��.____ 5.28 0 j 249 49' �____._ _ w o/ 85.Sp•N8.3'3g•15-:- �1 ' _ n - 94.93 a _ J - I mrv1 / ceo,i'_' - -- J+ PC3i&RNL a NCE PK N83'36't5'W G I73� - I - N61'32'39.7/f ��� 1 'S `g°" N8.T38.1 g..W REG157ERED_LAND 6.10' ��+� E%IS T/NG 1 1 PREPARED FOR. UfdREgSTEREO LA­ND— 6o ov Mrs SUSAN CHAPMAN HOUSE -"d.3' - P.O. BOX 1134 J_ F. HYANNISPORT, MA 02647 N IT HATHERINE GROVES PARCEL A ALVERTON ASSESSOR 7 8,608± S.F. S MA?28 PARCEL 94 DEED 0001•179 6 a 2 PARCEL"A"&LOT n UNDER ONE OtMVCRSHLn ,' PAGE 280 BSC I . _ z SHAPE FACTOR 27.4 i DATE. The BSC Group, Inc PARCEL A AND LOT 11 HAVE ALREADY BEEN COMBINED - (PARCEL- A &LOT 11) h AS SHOW^!ON LAND COURT PLAN 20173-D.FOR THE PURPOSE - ( NO DETFMENATION AS TO COMPLIANCE WITH THE ZONING ORDINANCE OF SHOWING THE LAND COURT REGISTRATION LINE THEY HAVE REOUIREMNETS HAS BEEN MADE OR INTENDED BY THE ABOVE ENDORSEMENT. BEEN LABELED AS SEPARATE ENTITIES �' 1 LOTS CREATED FOR CONVEYANCING PURPOSES ONLY. 657 MOLD Street, Unit 6 PARCEL A 8.60Bx S.F West Yarmouth, Massachusetts LOT L 3A5r92 S.F 63 71 /'{ I HEREBY CERTIFY THAT THE ACTUAL SURVEY WAS MADE ON THE GROUND 02673 TOTAL AREA a3,557± S.F. _ ��_ IN ACCORDANCE WITH LAND COURT INSTRUCTIONS OF 1989 ON OR BETWEEN N83"}g'I q•M, t FEBRUARY 10. 20DO AND FEBRUARY 11. 2000. 508 778 8919 .. LOT 6 AND LOT 12 ARE TO BE COMBINED BY THIS PLAN - �-.INGTON r BUT ARE SHOWN AS SEPARATE ENTITIES FOR THE PURPOSE ��� iV V AVENUE - L © 1Y'JY iTc 85.'.4,eup.Ins li OF SHOWING THE LAND COURT REGISTRATION LINE (45'ttaOF PUB _ LE: LOT 1 AREA 18,906 SF —�.��-�— __._3.2871 SF. DATE ____ FORT THE B CL GROUP. ___ oCA�.i5— ____ i0 is a m ' �T 12 4.906_ S F. n TOTAL LOT R A - , ' - NOTE: - PROJ. MGR.: C. FIELD ALL DISTANCES EDM UNLESS OTHERWISE NOTED. FIELD: P. H. /A. D. CALC./DESIGN: K. HEALY .• M EDM PRECISION± 5— + 5ppm DRAWN: K. HEALY LINEAR ERROR OF CLOSURE -.v^O8' - CHECK: C. FIELD ' - DIRECTIONAL ERROR OF CLOSURE N 57"22'54"E O RELADVE PRECISION =1-132.198 FILE: 8701-LC.DWG i DWG. NO: 5217-01 SHEET 1 OF 1 JOB. NO: 4-8101.00 l