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HomeMy WebLinkAbout0031 WAYLAND ROAD - Health (2) � w101WooFdland Ave s .,ib4x4� r�dU-y tt k� s d Hy �t3 a nnsa I { COMMONWEALTH OF MASSACHUSETTS 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: 101 IFoodland Avenue \; Hyannis,MA 0:.601 mil'1 Owner's Name: Earl Macdowell Owner's Address: Date of Inspection: Decenber 12, 2011 Name of Inspector: (Please Print) Janes M Ford Company Name: James M. Ford Mailing Address P.O.Box 49 Osterville,MA 02655-0049 R 2 - t Telephone Number: (508)862-9400 y CERTIFICATION STATEMENT ' a I certify that I have personally inspected the sewage disposal system at this address and that the inforniatiofi*port.E9 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: - � 3 Passes Conditionally Passes . Beds Further Evaluation by the Local Approving Authority I ails Inspector's Signature: Date: December 20, 2011 The system inspector shall su t a copy of tpis 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 Connnents ****This report only describes conditions ache 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. lLW Title S.Inspectron Fon 6/15/2000 n page // Page 2.of I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property.Address: 101 Woodland Avenue Hyannis MA Owner: Earl Macdowell Date of Inspection: December 12, 2011 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.3.04 exist: Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes:. 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: The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or eafiltration 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 oldJs 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: - 101 Woodland Avenge Hyannis,MA Owner: Earl Macdowell Date of Inspection: December 12. 2011 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the.environment. 1. System will.pass unless Board of Health determines in accordance with 3.10 CMR 15.303 (1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh .2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or.tributary. to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. . The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply.well". Method used to determine distance *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,, Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 101 Woodland Avenue Hyannis,MA Owner: Earl Macdowell Date of Inspection: Deceniber 1 Z 2011 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow _ ✓ Required pumping more than4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high groundwater elevation. ✓ Any portion of 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 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 are triggered. A copy-of the analysis must be attached to this form.] No (Yes/No)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 System: 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 _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in..a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or.a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section.E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section.E.or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 101 [Woodland Avenue Hyannis,MA Owner: Earl Macdowell Date of Inspection: December 12, 2011 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection?. n/a Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ Were all system components,excluding the SAS,located on site? _ Were the septic tank manholes uncovered,opened,and the interior of the tank .inspected for the condition . of the baffles or tees,material of construction,dimensions,depth,of liquid,depth of sludge and depth of scum.? ✓ 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 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 101 ffoodland.Avenue Hyannis,MA Owner: Earl Macdowell Date of Inspection: December 12, 2011 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: I Does residence have a garbage.grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No . Seasonal use(yes or no): No Water meter readings;if available(last 2 years usage(gpd)): Unknown Sump Pump (yes or no): No Last date of occupancy: Currently COMMERCIAL/INDUSTRIAL Type of establislunent: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.)-. Grease trap present(yes Qr no): Industrial waste holding tank,present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/user OTHER(describe): GENERAL INFORMATION - Pumping.Records Source of.information: Unknown Was system pumped as part of the inspection(yes or no): Yes If yes,volume pumped; gallons--How was quantity pumped determined? Reason for pumping: Maintenance TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)_ (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be . obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed on unknown date Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION.FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property.Address: 101 Woodland Avenue Hyannis,MA Owner: Earl Macdoivell Date of Inspection: December 12, 2011 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 2". Material of construction: ✓ concrete _metal _fiberglass polyethylene other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 ol. Sludge depth: 2" Distance from top of sludge to bottom of outlet-tee or baffle: 30" Scum thickness: 10 Distance from top of scum to.top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: : Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.). Tees were present. The liquid level was even with the outlet invert. There did not appear to be any sieris ofleakake The tank was pumped after the inspection . GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): , 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 101 Woodland Avenue Hyannis,MA Owner: Earl Macdowell Date of Inspection: December 12, 2011 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or.no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments.(condition of alarm and float switches,etc.): DISTRIBUTION BOX: . ✓ (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc.): The D-box was izornial. The cover was 6"below. PUMP CHAMBER: None (locate on site plan) Pumps in working order.(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of.pumps and appurtenances,etc.): 8 i Page 9 of 11 OFFICIAL INSPECTION'FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 101 Woodland Avenue Hyannis;MA Owner.: Earl Macdowell Date of Inspection`. December 12, 2011 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type: ✓ leaching pits,.number: I- 6'i 6'(1000 gal.) leaching chambers,number: leaching galleries,number: Teaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system .Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) The leach pit had 2'6"of liquid on the bottom. The scum level was 3' up from the bottom. There did not appear to be any signs of failure The cover was 12"below CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or.no): Cormnents (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level.of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM INFORMATION (continued) Property Address:, 101 Woodland Avenue Hyannis,.MA Owner: Earl Macdowed Date of Inspection: . December 12, 2011 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. = aA o � p a ❑ 3 � o � 1146 a , y a 32 71b y ao ay 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 101,Woodland Avenue Hyannis MA Owner: Earl Macdowell Date of Inspection: December 12, 2011 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 30 +/- feet Please indicate(check) all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with 1Qcal excavators, installers-(attach documentation) Accessed USGS database-explain: You nmst describe how you established.the high ground water elevation: Using Barnstable topographic and water contours neaps the snaps were showing approxini tely 30'+/-to groundwater at this site. This report has been prepared only for the'septic system and components described herein. This septic system has been. inspected and passed as of the date of inspection. This report is not a warranty oi-guarmuee that the system will f mction.pi operly in the fixture. There.have been no warr'arities or guarantees,either expressed, written or implied, relating to the septic system, the inspection, this report and/or any componews.of the septic systein which have rtot. been located and inspected. i 11 TOWN OF BARNSTABLE LOCATION 'O �J f!��.Iq/� �AV�, SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I OM LEACHING FACILITY:(type) PrT ". (size) I M NO.OF BEDROOM./SA 3 OWNER MAC✓IAC. OW PERMIT DATE: COMPLIANCE DATE: 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 r O p ��. 00 y� • C� Date To Whom It May Concern: I, 1 , voluntarily grant permission to the Town (Occupants name) of Barnstable Board of Health (Agent or Health Inspector) to inspect.my dwelling unit located at 0anb Z g D Ave. / ,y h y y S in accordance (House#, [Apt\Unit#if applicable], street,village) with the Town of Barnstable Code (Chapters 59 and 170) and the State Sanitary Code (105 CMR 410.000) on I hereby authorize and name �� (Date of inspection) FA21-e,v e A tObtie L to be my representative resentative for the P _ (Occupant representative) purpose of this inspection. ��2 L �� X4 r-'t)!'u02 Z is an adult person (Occupant representative) designated and duly authorized to act on my behalf and will be accompanying the Town of Barnstable Board of Health for the inspection, granting access to any and all locations (including bedrooms, bathrooms, closets, etc.,) allowing the use of photographs and answering questions. This authorization is only valid for the inspection date specified above, and must be renewed for any future inspection(s.) Occupants Signature \ Date Occupant Representative Signature \ Date Q:\Rental Ordinance\inspection permission 2.doc i &P".PE ytu -- vq f 1 )AMES M_ V Nara Uc.N A15798 Iwo RC) C)o IAVV C, qYC n I s U n t c Z:_ \IV�, _ -n James M. Venuti - Owner Post Office Box 797 ■ Cotuit, MA 02635 Phone/Fax 508-428-7000 Email:jmvelectric@yahoo.com r � + � . . �, �,`� y4 �D� �.l�a�G%� �� R ,, r � � o��o/ �� - �a� _�� � � �� ��y �a�� � 9 � �s TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Dat Time: In Out . C { Owner Tenant Address �I � Address16 Compliance Remarks or t Regulation# Yes NO Recommendations r. 2. Kitchen Facilities 3. Bathroom Facilities �G✓� 4. Water Supply -7- i " 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities "4 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17.Temporary Housing 18. Driveway Width �. 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms �� umber of Vehicles Allowed,(max) Number of Persons Allowed (max) Person(s) Interviewed spec V If Public Building such as Store or Hotel/Motel specify he LOW`& WELLER, INC. "Fiddler's Green Plaza" 714 Main Street, P.O. Box 119 Yarmouth Port, Massachusetts 02675 362-6868 362-8131 'Registered: George Low, Jr., R.L.S. Land Surveyors A. Paul Simard, P.E. Professional Engineers William G. Weller, Consultant April 7, 1987 BOARD OF HEALTH Town of Barnstable Barnstable, MA 02630 RE: Lots 2 & 3 - Woodland Ave Hyannis Gentlemen:. Please be advised that we have supervised and inspected the installation and construction of the new sewage systems for the above referenced locations. We find that the systems have been installed and completed in accordance with the approved plan. If you have any questions, please do not hesitate to contact US. Very tru, y y s, / A. Paul Simar .E,_. APS:kew DATE fV0V, I d ( l 3 ' TOWN OF BARNSTABLE • Hof THE TOE. FEE 2's-i`Co:. l��Q ♦� OFFICE OF RECEIVED BY DAEI7TME WASI , BOARD OF HEALTH f670' `e� 367 MAIN STREET �0 Jul HYANNIS. MASS. 02601 VARIANCE REQUEST FORM All variances must be submitted FIFTEEN (15) days prior to the scheduled Board of Health meeting. ff NAME OF ,APPLICANT /k R U - IA.AC_C_ DOLU EQL— TEL. NO. ®� ADDRESS OF APPLICANT LV O O D (a N rj• 40E , NAME OF OWNER OF PROPERTY 1 L L F. M 0O LoLTLL SUBDIVISION NAME DATE APPROVED ASSESSORS MAP AND PARCEL NUMBER cQ 67 LOCATION OF REQUEST to—t W U ca iD L Pro o Ve SIZE OF LOT i i 4-(0 SQ. FT. WETLANDS WITHIN 200 FT. OF PROPERTY: Yes-No-1- VARIANCE FROM REGULATION(Li.st Regulation) REASON FOR VARIANCE(May attach letter- if more space is needed) "JCS 01, �' f _ . o �" La IJL.�-�% lwtL �i_e _ (� Z4 4'L .'�f-W e P- �� � � �hr� ,`l� AA, � c�� U 1-0 r-. PLAN - TWO COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARI CE REQUEST. VARIANCE APPROVED _ NOT APPROVED _ REASON FOR DISAPROVAL Robert L. Childs, Chairman Ann Jane Eshbaugh Grover C.M. Farrish, M.D. BOARD OF HEALTH TOWN OF BARNSTABLE .D December 4; '1906 Mr. Earl:F M ePgweiV. 65 Woodland-Avenue, - 1 annis...Ma- 02601 . Dear Mr tic' ow.ell You"rate granted a variance from the Board of Health' Zriterifi.,Ground ' ;Water, Prgtection Reg�iiatiQii `lintitlii_g dallq sewage `flows to 33d �&ltdns per-acre; ,,ta nstall.an on=_site,..aewage. TUposai .System on �ot-2,'Wgodland l�veiiue Hyi nia�'tvith,the follov_91ng_c6hditions M1 '�iie designing. eng neer''must supe;vise'consrruction .of.,the:orY sirs ::. Sewage ,Disposal. m Syste and..certify: in uzriting that his-deign has been I complied' w tb prjot. to,.•fssuance of a Certificate 'of Complianco, or occupancy Pefmif. (2) The ;dWellfng cannpt,.have more tharr,two bedttroins or- exceec# five - t,r (5)-rooms.n eptfrety:: _ f 3) ' garbage grfnder-is'not authorized. 4}. it should be recorded or% ttie Bill of Sale that th6 On-SI'te, Sewage D q"oral System.'must� .be pumped `„every three 13) Years' and written _ .certification submitted to the"Board o -l;eeith. (5) VaTiance-expires January I, 1988._ , This- vast&nce-is gran'te'd.,because the urea- is alMost .fully developed with few remainfag_;vacant,lots. The7 dwelling is 'restricted to'.,two bedrooifis " with a projected T16e 'S Sewage Flow Bstitriate oP _20 gallons per `daj. Cape Cod tanning and-`isconomic'Devel opment-estimate average dwelling "sewage flow. Fa'tes:`as 1b5 gallons"per day based on aneverage eccupaney - of three persons The lot'size'is approximately •I13 of''ah acre. It 'is the 'opinion of the`'Board•-tbat' the installation oi'-a Sewagez`Dlsposal System ort•ithis lot- will,not sigz9ficantly' effect the problems associated with th&-ground water in-this Area "The:Board_'strongly recommends Town sewer for the.area. Very ruler ours, ` Ro rt L. Ehilds; Chairman - Y BOARD OF.HEAL'TH TOWN OF'BARNSTABLE ; JMK/bs, IN > v i I a 3 - i .. , � j .`. {, . .{ ;. � . { _ d } u1 1 r " f � i No .... as.y ` Fmc............................. e THE COMMONWEALTH OF MASSACHUSETTS AR® OF I—IEALTENGNING ENGINEER MUST SUPERVISE j INSTALLATION AND CERTIFY IN WRITING ...�3: l�As....OF.......A. !..�` <. .t.7� r.:a " E vAS INSTALLED IN STRICT AppilrFation for BhgpaaFa1 ,ark Cray` i r tianT �e �riti# Application is .hereby made for a Permit to Construct ( )_ or Repair ( ) an Individual Sewage Disposal System at: ...... ,.. ...�..-.............. -------------------- -------------•-----•-•---••--•--•---••----- ---.............-------------------•-•--. Location-Address �^ or Loto. c" �/ •--•---•--- =--+�lN -• t L�.._ ! ............... .......DN i� .......... ,::7:. /. ...!.:.:_P",'�.',.J.�.... -4Y.sir _ Owner Address a .............. .. .. ......C4 5;�CL.L................... ............................ --------•---•-------•---•----.....------ Installer Address d Type of Building Size Lot...........................Sq. feet U Dwelling—No. of Bedrooms.______ l...._r .......................Expansion Attic ( ) Garbage Grinder ( ) 'PL4-I Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures -__-_---•___________________ W Design Flow.............. ...............gallons per person per day. Total daily flow___. _:._.............gallons. �� x Disposal Trenchtic Tank—Liqudocapacity-/�a�adl�hns Lengt�.�Length e g hidth--- !--�v-�-Total leaching area.- Depth__•-�sq. f� W , Seepage Pit No------I------------ Diameter____________________ Depth below.inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) . Dosing tank ( ) `-� Percolation Test Results Performed by........................................................................... Date........................................ 0..1 Test 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........................ . x ----------------------------------------•••. :. j. O Description of Soil..... �C �------ ride.................................-�-- . Z C..Ic�c+o� V -----•----------•-•----------------------------------•----------•--•••••--•••-•--••------------•--•---...--•-•-......-------••••-----•-•------•--•-•-•--•-------•--------------------.........----•-.... W -------- -----------------------------------------------------------------------------------------------------------------------------•--------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable............................................................................................... --------•------------------------------------------------------•----------------------------------------------------------------------------------------- ......................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal--System in accordance with the provisions of T1TI.;=. p of the State Sanitary Code—The undersigned further agrees n t ce the system in operation until a Certificate of Compliance has issued by e boa healthne : ...... . ... . ... - ................................ ................................ DaJ� ApplicationApproved By............................... ....................--.... .-.................... ------..... --------- Date Application Disapproved for the following reasons-------------•---------=-----•----•--•-------------------------•--......-----------------...-•--•--•------••-•••. ----------------------------------------------------------------•--------------------...---•--------------••••••-••••-•••-•-----------•............--•---••----•---------•-----••----•-•----•--...._..-- Date PermitNo. ...........--1----................................. Issued....................................................... Date a NoFER.......... ............... THE COMMONWEALTH OF MASSACHUSETTS .BOARD OF HEALTH ......OF...... .: C..................................... Appliration for Biipuiiaal Works T. mitrur#iuu Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................_. I....,�---44.4G........................ Location-Address �C or Lot No. ------- -•�-•------...=- -•.................................... ----------------- •`ate.=1•------- l- ��� ��� Owner Address W ----•-•- - ..'..mac..�.:::.a�_ ':_5:........................ 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 ( ) Gll - r rr. i. Design Flow.•:Other fixtures.:_-•`••_•�••_:-•allons per person per day. Total dailyflow.:............. gallons. W - C4� Septic Tank—Liquid capacity�.._._�...gallons Length----.�_._._... Width../...__?_.._ Diameter.-.-'......... Depth.::`r.._...... Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------I-------------- 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........................ tz, Test Pit No. 2.......... ....minutes per inch Depth of Test Pit.................... Depth to ground water........................ a _ -- •---------- ---•.............. ..........r•._, Descriptionof Soil = .............................•--...-- •---. •----••...-••----••-•-•--•--•--••- •---••--••••......••----. -------------- •--------------------•--•------•---•--•-•------••---- ---------------------------......------••-----•------•-----------------------•---------------------------•----------------•••-•.............. —Answer when applicable.___________________________________________________________________............................ U Nature of Repairs or Alterations --------------------------------•--•------------------------------••---------••-......-----•-----•-•••--.....------••-•••••--•••-•--••••---••-•---•------•••-•---•-••-••--••--•-------•-............-•-- _ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with '= the provisions of iT"IE 5 of the State Sanitary Code—The undersigned further agrees n t ce the system in operation until a Certificate of Compliance has ben•issued by e boaYa f health. DApplication Approved B ...................................................... ............................. } =' ��--•----- Date Application Disapproved for the following reosons:................................................................................................................ -•-------------------------•-•---------------•---•----------------------------------...---...-•-------.....------------------------------. ---------------- --------- ............................... Date Permit No.-----............................' .... Issued.-----•--------------------------•--.... _ ............. Date ' THE COMMONWEALTH OF MASSACHUSETTS -- BOARD OF HEALTH ...L-� ; ......................................OF...... .:..............C1'. .... .�.4:.t........................... C ler#ifirFate laf Toutpliatta THIS IS TO CERTIFY,,,That the Individual Sewage Disposal System constructed ( )' or Repaired ( } b ................... . ... ------------•---------- ----------.................... .... _ ,yy pa Installer at.-•--••••. . r c. 1./._1 r 1.?_s `..�.:.:^t_� _._t�. V ,__ `-�4 r�if z/!_! '._::a................................•------•-.............-------------- has been installed in accordance with the provisions of T,i.i 1j of The State Sanitary Code as descri ed in the application for Disposal Works Construction.Permit No._� "_ f �' ) ' r� PP 1 -••--._.7 dated - = -.. _--..----------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �^ DATE.............."l...--cl --••-•�•-.7•-•-••......---•-•-----...---. Inspector--•--- ---- -= J-cS -�.. ,,,..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................................... ft... w_•_ �, .. I�0........: ......... FEE........ . _ #rttr�tUan �erutit Permission is hereby granted.... . ...... 1 = .t.` _4_c... .._.._._..-------.-------._............. to Construct s(� or Repair ( ) an Indiv}}idual Sewage Disposal System at N0.----- •----•..................................[,1..};� A"hlt', ....... � >nl .................................... ........ Street as shown on the application for Disposal Works Construction Permit No`............ .`..... Dated............ ................... ................... 4 as -- ..................... Board of Health`v DATE............. - - =--------------------- . .. FORM 1255 HOBBS & VY/ARREN. INC.. 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