HomeMy WebLinkAbout0884 MAIN STREET (COTUIT) - Health - I ---
884 li�IAIN STREET, COTUT
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DATE: 7/12/96
:_"_...884 R C VE®
Cotuit Mass . AU 1 1996
02 63 5 HEALTH DEPT.
] ,
70M OF BARNSTA13LE
On the Above date, I Inspected the septic system at the above address.
This ui trig; toll vrirlg:
1 . 1 -grea6e trap. • 1 -4 'x4l distribution cesspool, 1 -6 'x8l block
cesspool and 1-1000 gallon precast leaching pit.
Based bn my Inf;�c-ction, I c i rally tl-ie following conditions:
1 . This is not a title five septic system.
2. This is a sewage system.
3 . The sewage system is in proper working
order at the present time
ISIGNATURF:
Name : J . P . Macomber
Company: J . P . tlacun�ber �- nc .
Addr t
y L v
(' 3l G)I;
T?d!S i f_ t ,.. ;C;,.. _ r :-UTi_ A CIUARANTY Oil
b.
--SEPHI P, }, M;OMS-ER & SON, INC.
Tanks-Ca s;pool&-Lu ochflelds
rUi7ipa•d Z In,Y:Alied
Town Sower Connections
Cer�;er :i!le, MA C232-0066
7 5-3333 775-6412
A�.a..
%)i a 4 b,� �/Ie 15 VND,9 P`• V�0 Y V i
Wuhan F.Wald Trudy Cox*
ow.r,.« "V*WY
kgao Paul Cslluccl Davw D. Struhs
LL Cc vrn:,r CarmJaalor>.r
i
Si;i SUltl'AC1; SE'•t':1C 1: UISPOSA-L SYSTF-ht INSPECTION FORM
P:JtT A
i'!'I P I CA'I'l O N
'olupany Na uc, Address &A TclePhu-1 :' .`,.
'. P.Macomber « Son Inc . Box 66 Genterville ,Mass . 02632 508-775-3338
EIITrF'Ic�;�•rfor� sr;,', ,!;-;',
�1. thi, a{dmr; and that the u:formation reported Ialow is true, accura.ta
colnp!ete as Of tE.0 t..L'3 Of I,..', u'"' �:�'..,...::<�� ba_c--:I on Illy training and expQriczca In the prvl:2r function and
kt44
vpoctol'a 8lrwttrl-w� d
ho 3ystel:: . .:factor r ^U s tii:it o com of thi.a ?u re;:,?n to the ApprovuiZ Authority within thirty (30) days of completing this
spo'tioa. L'the ry 2w:_'I i, .. ;t: o b; '..'e:: yr i_,a a clec! n Dow of i0,000 gpd or greater, the inspector and the system owner shall submit the
,r.rt to the epprrprirta rug; ,. 1 sf. L:c a.rtl:,en: of ct.:"rvcuttontal Protection.
'be original rho d t.o c<:;: t.; t:.; :.ad c.?pi(, to the buyer, if appGceble and the approving authority.
- I have to ;n iolvtes any cf the fa, m crte is as deGnod in 310 CIt 15.303.
Any failure criteria not evu t:at,;J we i.cucaw lti!•:':.
J SYSTEM CO\DITIOIN''AUY PASSLS:
Cne or ::-re r: ,,,. , _ l L ot.or. of the caawat o
..,. ,. ,.. ., ,,.. ;.. . ..; ,.,., a;.' "n upJ' :�:,:ap! rvpla r repair, parses
t.
by C::2 ...arid of i:k:�:....
evisc-d 11/03/95) i
�?. . VAnter • Rn.tnn )Ad—i_et_h!_._ a._ FAX (F 6 1049 0 Te!aohone (6171 292.SVv1
URFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOluii
PART A
CERTIFICATION (oontinuod)
n Street Cotuit Mass .
Owner. I'" . ;n S a w y er
D:,t.r of (, ;I0
Bl SYSTEM CONDIT10NAi.LY PASSES (continue-d)
Sewage backup or breakout or hVh 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):
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
jam` 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
Cl FURTHER EVALUATION IS REQUIRED 13Y ,mE BOARD OF HEALTH:
Ll r 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; :: _:: .".':d th; enviontnent.
1) SYS'I`LA `FILL 7P,St3 i2NLE.SS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT.
i.kl` Cosspool or privy is within 50 feet of a surface water
Ceaspool 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 TILkT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETY AND T11E ENVIRONMENT:
'l'he syste:a has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a
surface water supply.
t' The systera has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
The system has a septic ta.ik and soli 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
sunp.v weD, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free
from l:cl:ution fnvnn that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm
3) OTHER
7e S�+
c'C,Tc:C
(revised 11/03/95) 2
L:WFI FI CATION (ountinued)
tit yi:fdNa .
0awyer
Date Of 1;1
Dj S Y S
A,,e I hive dtwwruliiL-i Co-,t One '.Yatelti violates one or more of the following failure criteria as defined i.:,. 2 ^ M 15.303 '110 f"."r
this determination is identified below. The B,>ard of Health should be contacted to determine what vi;jj loo ra ecaary to corrv�:t Ll-.j
fa-Dui'e.
due to an overloaded or cloj%vJ Sr
"'agv into facuit), or W).-:1" con1pollellt
/V17 Discharge or poudbig of effluent to Ll,., surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
A 'VVVt due i overload or clogged SAS or cesspool.
.�IYVICI Static liquid level in Lhk� L-� i�',jve Outlet U1 to tut overloaded
Af6` Liquid depth in cesspwl is ie" tium 6" below invert or available volume is le"than 112"y flow.
a/p) Required pumping more than 4 tires in the last year NOT due to clogged or obstructod pip-e(s).
Number of times pumped
Al Any portion of the Soil Syl;Lcin, cesspool or privy is below the high groundwater elevation.
iL Any portion Of a c-sV),)l or Pri 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a ce"Fxx)l or privy is within a Zone I of a public well.
2LO Any portion of a cesspool or privy is within 50 feet of a private water supply well.
ZL'D Any portion of a cesspool or Priv-Y is less than 100 feet but greater than 60 feet from a privaW water supply well with no
acce Pi :_I'e r quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
i: volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
L4) u.
El LAJIGE SYSTEM
,,j,jy to 1,1 above:
iilLhLion to the crit-eria, a ve:
IV The system"rv-)4' a faci4Lty with a dwi&n of 1U,000 gpd or grater (Large System) and the a a ij;n!f lun t throat to public
health and safety a.rtd the environment because one or more of the following conditions exist:
the system is within 400 feet of a surface drinking water supply
the Eye!1-1r) is W;thvi 200 f&,?L of a tributary to a surface drinking water supply
N the SN'13, -1 i'q k't'auxi in a se111;itive area (InWrim Wellhead Protection Area (BVP,'L) or a nap pod Zoiielfofa public
41 d briny the and facility into full wilipliaLce -,;,iLh LLiv
T lva�e ,'Ongult the local regional office of the Department for further iilforivation..
3
(revi;cd 1 J
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Add,.- 884 main Street Cotuit,Mass .
Ownem: Marion Sawyer
Date of InapootIow7/12/96
Check if the following have boon done:
4/Pumping information was requested of the owner, occupant, and Board of Health.
,None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
Z.A. built plans have boen obtained and examined. Note if they are not available with N/A.
2Th.e facility or dwelling was inspected for signs of sewage back-up.
.c
The system doe; not receive non-aw-dU ry or industrial waste now
sijla of breakout.
41-/ syaten; =.;:c: :: nts, Ucludi.ng the Soil Absorption System, have been located on the site.
rv-d,;(„-The septic tw',k 1—r-iholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baIIles or
Leos, 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
�appm;di tod by non•ultrusive methods.
-1 "t hc• is ility u,v:.ea (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-
Surface l;ia x;.i.l System,
(revised 11/03/95) 4
E
)
AINF ACE SEWAGE DISPOSAIL SYSTEM INSPECTION }'Ul:iei
PART C
SYSTEM INFUIWAT10N
Marion n },ryer
884 Main Street' Cotuit,Mass .
n1, ral
FLOW CONDITIONS
RF-:9IDEWT]A1.:
Nuu:l:or of bodrw:::a: ;;
,, i 1'+ ,
Nu=Wr of current ro+ide U;-a
Carta,-o grinder(yes or
Laundry connoctod to rysteL�k (yc,a;or uo):
Water meter ro:... if ova!:Gle: jig` � �C .r'�>ij / i'� `� � ' J' ; )/i\
Last duw of occupancy:
CONMERCIAI./iA DUSTRIAI:
Type of uta'uliol•:u....t: 4} _ !!11 — .i -' --
Duign Ilow: } ballot j
Creaoc true pr:i c:.. '�'La ;Pri I
Waver
Last daw of ------
2
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GENERAL INFORAATION
i a f
uc
PU\11'I;iU It::L:J: r t
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' o
e
r;� rifgrn itro.t
e
,)..1.
privy
S1_,:c1 ..... ( c: ::r .. ! „(Y bttach previ,.a uspection rocords, if any)
__�.. Opt,:r ;... , •
i
1' r :d eo.•: f info :alica
J :��z C� i E i ? ' /,L r( d- >Yc �Jiii/ /j' !�''�'��' hk '%'7��s 1�L3 �7�f `.l. ./!�i?cGsN r 94,
0. :,r no) '
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I JOSEPH P.MACO .&SON,INC.
f' / y�
P.O.BOX
66= MA
span
-0066
Name: Marion Saylor McClo Ilan 425-2064 ' •'' Customer Code: ;
Address: 884 Main Street msa�r
Town: Cotuit state:Ma zip:02635
Nailing address:
882 Plain St Cotuit MA 02635
Notes: . 848587
4127189 purnp 185.00 5111189
.8127191 pgt 2 pools 185.00 9110191
11112191 pump 2 pools 105.00 111212191
119192 system LP 1575.00 1114192
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(,F
SUBSURFACE SEWAGE'DISPOSAL SYSTEM INSPECTION FORM
I PART C-
SYSTEM INFORMATION (continued)
Property Address: 884 Main Street Cotuit,Mass .
Owner: Marion Sawyer
Date of Inspection: 7/12/96 ;
SEPTIC TANK: ',t,✓t, ( 4 I
(locate on site plan)
Depth below grade:_,
Material of constructionalconcrete _metal _FRP —other(explain)
Ai fl.
Dimensions: A A
Sludge depth: .
Distance from top of sludge to bottom of outlet tee or baffle:• i .,_
Scum thickness:— E
Distance from top of scum to top of outlet tee or baffle: kii _
Distance from bottom of scum to bottom of outlet tee or baffle.. /QLL
Comments: '
(recommendation for pumping, condition of inlet and outlet tees or baffle, depth of liquid IP.vel in relation to outlet invert, structural
vity, evidence of leakage, etc.) f _
a
GREASE TRAP. yEJ E {
(locate on site pian)
Depth below grade:,,"w�/( � `
Material of constrnlrti6n;y loncrete _metal _FRP other(explain)
Dimensions;
Scum thickness:�f_.7k:'
Distance from top ui scum to top of out ,:( tee or baffle:j�- L,
Distance from bosom of troy) 1,1 t;ata,r o; ouue; tee or bafiie--�
I y2`C1-F-C1
Comments:
(recommendation for pumping, condi—ri of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage,
k
s •
6
(revised 0115195) 6
Dice of.Inspection: 7/12/9 6
TIGHT OR
(locate On aiL. ; 6
Dapih below ;,Tac :
Material of conatn•.ctiuo:1U/ cQi;crvte _metal_FRP _other(explain)
Dimensions: jl'/i
Capacity:_Q,"�} grlluc;:a
Design flow: 4'4 Xabouu/day
Alarm level:_ AM
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
l
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box,etc.)
No 6—Y-1 A�jt, T�
PUMP CHAMBER:'
(locate on site plan)
Pumps in working order:(yes or no) /J '
Comments:
(note condition of pump chamber;condition of pump+ and appurtenances, etc.)
ila Cr��<<ldt✓�r_'fi d
w
(revised 11/03/95) 7
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1
SUBSUlW"%Ct DISPOSAL SYSTEM INSPECTION FORM
PART C
INFORMATION (ooutinuod)
PropertyAddro" 884 Main Street Cotuit,Mass .
Owner. 7/12/96
Data of Inspootion: Marion Sawyer
SOIL ABSORPTION SYSTEM (SAS):,
(locate on site plan, if possible; eicavation not mquirw, uuL uu,y 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, dimerions:— --- -_— --
overflow cesspool, number:
Comments: (note condition of soil, sins of hydraulic failure, level of ponding, condition of vegetation,etc.)
Sand;Uo signs ^�-drau1 z fai11i=e lr�nrlinb-;-A•1l tr�a+atinn iQ
f
CESSPOOLS:
(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: "214 q —6
Materials of constntction: �� ,.r,.=e. , �
�)T
Indication of groundwater:
inflow (cesspool must be pumped as part of inspection) 0,161 Ab a!,t? 1 �f cele 2C-wly
Comments: (note condition of soil, sigrw of hydra:,.lic failure, level of ponding, condition of vegetation, etc.)
Sand;Xr) signs ofhydraill i r fai birP or =ondi ng. Al l yegPt ion i
--
PRIVY•
(locate on site pLin)
Materials of oonstructioa: Dimensions:__
-Depth of solids:
Comjment ; (note c
ondit
ion coil,of sifpig of hydruulic failure, level of pouding, condition of vegetation,*etc.)
(revised 11/03/95) g
1 '
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(oontinued)
PropertyAd"x 884 Main Street Cotuit,Mass .
Owner. Marion Sawyer
Date of Inspection: 7/12/9 6
SKETCH OF SEWAGE DISPOSAL SYSTEM: •
include ties to at least two permanent reforenou landmarks or benchmarks
locate all wells within 100'
Cotuit Water Company
428-2687
"/.s s
Q� 0
Y �
i
DEPTH TO GROUNDWATER
Depth to Groundwater. 20 1 X fat
method of determination or approximation: Installed 1000 gallon leaching pit in 1 /7/9 2 No water
-----_aYlCniintpred of 121 . Perms91 -538
(revised 11/03/95) 9
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enrXsrA.eL E: eoAno OF ASEFSscns
AVIS r f?rY, P INC o
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THE COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BE IT KNOWN THAT
Joseph P. Macomber, Jr.
Has satisfied the Department's qualifications as required and is hereby
authorized to use the title
CERTIFIED TITLE 5 SYSTEM INSPECTOR
as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the
General Laws. Issued by The Department of Environmental Protection.
June 8, 1995
Acting Director of the ' ' •ion of Water Pollution Control
c
i 1,O, : Uh' Barnstable isunitu L,
;:r}r,ti,('h; ;iI;HAGh; [)1S1'US1G SYSTEM Itr ,,, ECI'IUN I"ORht - r
-TYPE OR PRINT CI.EAR1.1•-
_. L,_Ma1I1-a�tir9P.t_C0tj]i t, MaSS
A S S E S S 0 S MIAP , BLOC,": ;1NU PARCEL #i
OWNER' s NAME Marion Sa-4y-er
PAI?T V - CERTIFICATION
NAHE OF INSPECTOR Joseph P.MAcomber Jr.
COMPANY NAME J.P.Macomber & Son Inc.
COMPANY ADDRESS Box 66 Centerville ,Mass . 02632
Street Town or City State ilP
COMPANY 'TELEPHONE ( ) - FAX
C1'RTIFICATION STA`I'EMEN7
I certify that I have personally inspected the sewage disposa"'. system at
this address and that the information reported is true , accurate , and
complete as of L)le Lime of ;pection . The inspection was performed and any
recommendations regardillg ; Trade , maintenance , and repair are consistent
with my training and experience in the proper fui.;; tion and maintenance of on-
site sewage disposal systems :
Check one :
XXXXXXX=kysteai PASSED
ThE, insE)ecLion wi : ,. l; I have conducted has not found any information
which indicuLes Lit,.t; the systeln fails to ar'1equately protect public
hetalLh or Lhe environmenL as defined in 310 CMR 15 , 303 , Any failure
criLer _ nit evaluated are as stated in the FAILURE CR:!.'i'ERIA section of
Lhis form .
System FAILED
c,-hich I liave conducted has found that the system fails to
J: rotect lie pkiblic heal Lh and the environment in accordaric.e faith 'Title
31C) is ii . 303 , and a, s1)eciflcally noted on PART C - FAILURE
C It'ITE!tIA of this i1-1SpeCtian form .
Ilispector Slg,Ilatu4e4o" Date 7 13/96.
One copy of this cert.i fication must be provided to ti-Ye OWNEit , the( where aPPl icable ) aj'ikJ tho 130A[U) OF HEALTH.
* If the lr:spectl �)n FAILED , the owner or opa1,C itt: : oha11 upgrhan ' t11e ;in
wit-,1)in one year t-lie date of the inspection , ui).Less allowed or re,, . 1
otherwise cis provided in 310 CMR 16 , 305 .
TOWN OF BARNSTABLE
&A&f 1 Z -,
VILLAGE ASSESSOR'S MAP &nLOT
INSTALLER'S NAME&PHONE NO.\I•/ /f�/ll ly �r��►� �i
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size) GGCJ
NO.OF BEDROOMS
BUILDER OR OWNER 11V~
PCHMPMATE: 6�1 � 0 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) ; Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet f 1- c ' .acility) Feet
Furnished by
t
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��
� ��
� Q � � .�,_ - ---
-C -- -----� -------------V�"�°'9''-- -----
� 1 d �
i� .
�,
,� .
aq- TOWN OF BARNSTABLE
LOCATION "''" `"�'� m r SEWAGE # 3 S�
VILLAGE (-,,t aL ASSESSOR'S MAP & LOT 6�
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) ,p i r (size) or) 6,
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER J��-
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED �-
VARIANCE GRANTED: Yes No
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APPROVED
N f earnatablo Concomdon Depenment
Fimicl....
i t�_MONWEALTH OF MASSACHUSETTS
Signed ..B0AR®Dt7F HEALTH
TOWN OF BARNSTABLE
Appliration for Biogoout Workii Tonitrnrtion Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal
System at:'
882 Main Street Cotuit
................_................................................................................ ----.....-----........._..............----•-------.........------..........._..........-----------
Location-Address or Lot No.
Sawyer...................•-----...-----•--•--•----.......-----------•---•---------•---
W
J.P.Macomber Jr. Owner Address
Installer Address
Type of Building Size Lot............................Sq. feet
U DwellingX No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building No. of persons............................ Showers — Cafeteria
A4Other 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........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of.Test Pit--- ................ Depth to ground water..---------.----__.----.
a' •--------------------••--•--••-•-•••--••••--•---....------..........--•-•---•---•---•---••--..--••••.........................................................
0 Description of Soil........................................................................................................................................................................
W Sand
U •......-----•-•------•-•----•----•-------------------------------•--------------•-•-•----------
W ---•------•-------------------------------•---•-•-•----------- --•--••---••------•----•-------•••-----•-••--••-•---••-------•-----•-•---------•---------------•---•---•-••---••--••-•--•-..._.......--
U Nature of Repairs or Ajter.�8F6 gA��swer w$en afAinbgle P ------------------------------------------------------------------------------•-------
1 1 U a11on 11ea.....ln ft,
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 Complia ce has ee ss d by the oar of health.
Signed --- ....% 11Z2.7 9 1..
--... ..-...- - - -----------------------------
Date
Application Approved By ............... ------- ---........----......--
--------- ---- ----------- -----------------------
Date
Application Disapproved for the following reasons- ------------------------ --- - ----------------------------- -- - --------- - ----- ................................
------------------------------------------------------ ....----------------------........----------.........--.-......------------------------------ .............-------------------------
Dare
PermitNo. ...----- f..-. �---------------------- Issued ------------------------------..--...--- -- ------------------
Date
9r- 6733
N.E—COM T_ MONWEALTH OF MASSACHUSETTS
t
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Disposal Works Tonstrnrtinn rgrmit
Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual'Sewage Disposal
System at: � J, - e y
882 Main Street Cotuit
-•- - ... .--•-----•----•--••---•----•--•---•--------•-•----•---•--•.........•---- •-•--•--••••••........•-•-•••••--•••......---•-•..................................................
Sawyer
Location-Address or Lot No.
---••-------•-------•-------------------------------------•-------•----------------........_......
W J.P.Macomber Jr. Owner Address
a •••.....-•••----•-•••-•••••....••-•-•..._.-•••-••--•-•••••-•-•••-•-•••--......-••••............... ..•-•••••..............................-_... ...-•••-•••-•-•••...............................
nstaller I y Address
,r .
Type of B Sq. feet
Q uildin r ? 1 Size Lot............................
Dwellingff No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of.Building,_rf........................ No. of persons............................ Showers ( , ) — Cafeteria ( )
dOther fixtures ------------------------------------------------•--•---•----•••---•-----•--
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Len r.............. 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.i..--•---------------------.......----
� Test Pit No. I................minutes per inch Depth of Test Pit.---.---............ Depth to grouts"d water.----...................
Lz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground•.water........--..........---.
Q+' --•-•----•-•----------------••-••••-••••-•••--•-••...--•-••--••••••......._r-•-••--._....•-•.......--- :..... ---------------------•-•--
xDescription of Soil rid ---------•••. ---------•--••---•---•..........................................................
U ••--•••••••---•••------•••••--•••••••••....•------•••-•-•-•-••-•••-••-•••-•--••--••-•-••---••-•----•---•••--••--•----•-•--•••---•••••------------••. `, ..........................
UW •••••-----------------------------------••------------•-------•-•--••---•-----------•-••••......---------- ...........---------•-----•------••......•-----......-••--•. •-----------
Nature of Repairs or Alter t' ga wer when ap8licablle.`ty ...........................................
J_ ��lon leap: In Alt.
-----------------------------------------------------------------••--- -----•-•••-•••-•....•••--------•-••••-•----------------•---•-•----••--•---• -------•--•-•••---................................
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 Complia rce has eeni'ssued by the boar of health.
Signed ...... r........ t' l.1/2-� 1........
_ Date
Application Approved By ............... .. J---
Date
Application Disapproved for the following reasons- --------------------------------- --------------------------------------------------------------------------------------------------
---------------------------------------------- -- ----------------------------------------------------------- --- --- ---------------- ------------ --------------- ----- ----- ------------ ----------------------------------------
q Date
Permit No. . r..-..S.:� �. .................. "Issued ..-------------------------- .............. `.
Date
r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
l
V��Prtifirate of (NILIontylianve
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX)
by J.P.Macomber Jr.
..............................................----- ------- ------------------------------ ----- - - --- - --------------------..............................................-------------------------------------
Insmller
882 Main Street Cotuit
at -----
. . -- -- .......... .................................... ............................................................................................................... ........
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ...... ?/... `�...�?. .------ dated ................................---------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..................... `.-. .^ { ............................................ Inspector . a------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
ql � TOWN OF BARNSTABLE $ 30.00
No.... 5� FEE........................
Disposal Works Tnn#rudion Vrrmit
Macomber Jr.
Permission is hereby granted-------------J.P-'..-------•---------•-------••-- -------XX
n e re e_t ) an Individual Sewage Disposal System
it
atNo...............................................................................................................................................................................................
Street
as shown on the application for Disposal Works Construction Permit No.7:539 Dated..........................................
/ j Board of Health
DATE............................. •%--^---<--•••--•••-•••••......•-•••_._...
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS
s� v
SOIL EVALUATOR & PERCOLATION TES'IFORMge I of a
� F
PLOIHETp Town of Barnstable
'� Qn
BARNSTABLE. Dehartinent of hlcalth, Safety, and F,nviron►►►ental Services
MASS.
,6,9. Ilk.0� Public Health Division
PIED MPS
367 Main SU•eet, I lyannis MA 02601
OI'licc: 508-790-6265
PAX: 509-775-3344
7 T 11 Assesslr1 en t for Se wag
e Dls oral
Soil ,ultabl T
Az),EnbunS MAP NO,. 3.=
PARCEL NO' 82
Date: `—��
,It C: G 40
Performed By:
7 AG 0
Witnessed [3y:
(hvncr's Name
Location AJJress �-n—�¢,�fl Of
FF Ai�i.� Sr �FE��- ��� ,����eey �s q.
Lo rvir' a/o
C-46c.2o5s• )Zrzz, t
Address.and
Lot N: 5
'telephone H
Asscsux's Map/parcel:
NEW CONSTRUCTION ✓ REPAIR
Office R vi w Yes ✓
Published Soil Survey Available: No Soil ma unit
Year Published i_ 99l �c/ G
Publication Scale /"N4002 p
._. -.—
Drainage Class 45xC_��✓L Soil Limitations Yeses✓L
Sur(icial Geological Report Available: No
Year Published II q-7 -- Publication Scale
Geologic Material (Map Unit) _
Landform n"A' t�P
Flood Insurance Rate Map: yes
Above 500 year flood boundary No ✓ Yes
Within 500 year boundary
Within 100 year flood boundary No
Yes
Wetland Area:
National Wetland Inventory Map(map unit)
Wetlands Conservancy Program Map(map unit)
Current Water Resource Conditions(
tions Month
USGS): MBelow Normal
Range: Above Normal
Other References Reviewed:
[AT APPROVED FOIZM- 12/07/95
P_ eels-' FORM I l - SUIL ►?VALUATOR FORM
1'al;c 2 of 4
L.ocalion Address or Lot No. �
On-site Review
Deep Hole Number L Date: IZ ' /P'9& Time: /o /`' Weather
Location (identify on site plan)
Land Use e�6;L>6W71 •L— Slope M 0 --3 Surface Stones b
Vegetation Cw1A� /r�EcJ
Landform 14Asr 49,2a- �TrG'� A'4'0' l
Position on landscape (sketch on the back)
Distances from:
Open Water Body /70 feet Drainage way feet
Possible Wet Area feet Property Line �-a feet
Drinking Water Well feet Other
DEEP OBSERVATION HOLE LOG*
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency. %
//��
Gravel)
O- Ar s L /oya y/3 n ,4 Ssi C
L. S' ,o y2 V3 U
Z'S
174� IZO
MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Parent Material(geologic) oU�iG/ (/"t.J�/rJ DepthtoBedrock:
Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: _
EAtimated Seasonal High Ground Water: 36 GU•�7e7Z
DEP APPROVED FORM• 12/07/9S
101ZM 11 - SU11, EVALUATOR F0101
Page 3 of
Location Address or I,ot No.
Determination or Seasonal Hi li Water Table
Method Used:
inches
El Depth observed standing in observation hole inches
❑ Depth weeping from side of observation hole
❑ Depth to soil mottles inches
❑, Ground water adjustment ....-
feet
Reading Date
Index well level
Index Well Number, ...
Adjusted ground water level .
Adjustment factor II //
Ell �l cl � / /), Al' 10 . -- Nei
De th of Natural) ,occurring Pervious Material
al exist
Does at least fou
r feet of naturally occurring pervious
risy tem7 in all
observed throughout the area proposed for the soil absorptionaterial?
If not, what is the depth of naturally occurring pervious
Certification
certif .that on MAC/ - 1�YS (date) I havepassed ect on and thatithe above analysiE
uator examinatior
I y the Department of Environmental
approved by
was performed by me consistent with the required training, expertise an exper�enc
described in 310 CMR 15.017.
C � Date
V Igle
Signature,
12/07/95
DFP APPRO�•F.D FORM•
1 �
FORM 12 . PERCOLATION TEST
Page 4 of 4
Location Address or Lot No.
COMMONWEALTH OF MASSACHUSETTS
Massachusetts
Percolation Test'
��v�9G Time:. /n —
.Date: /Z
Observation Hole # l
Depth of Perc
Start Pre-soak
End Pre-soak
Time at 12"
Time at 9"
Time at 6"
Time (9"-610
)
Rate Min./Inch l/� 2�,,w".1
IVnnim um of 1 percolation test must be performed in both the primary area AND
reserve area.
Site Failed ❑ .........
Site Passed ..:......................................_...
.......... ............
.................................................................:.
Performed By.
Witnessed By: �
.__ ............ .
............. ... ..............
comments:
DEF AFFROVFD FORM-12/07/95