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Home My WebLink About0080 SECOND AVENUE (HYANNIS) - Health 80 SECOND AVE, HYANNIS -44 A = �I i DATE:__5J 181_9.9--- PROPERTY ADDRESS:—80 Second Avenue ---------------------- -- West—H annis ort Ma . 02672 ------------------------ On the above date, I inspected the septic system at the above address. This system consists of the following: 1 . 1z=6X8 cesspool / 2 . 1-1000 gallon leaching pit C 07 Based on my inspection, I certify the 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 present time . 4. Both the cesspool and the leaching pit are dry at the present time . SIGNATURE:, Name:—J.P. Macomber Jr_______ Company: Joseph_P. Macomber_& Son, Inc . Address:— Box—66 --- --------------- Centerville , Ma. 02632-0066 -------------------- Phone: 508-775-3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY lotsawn 0 Ptena JOSEPH P. MACOMBER & SON, INC. �! J U N 4 1999 Tanks-Cesspools-LeachfieIds Pumped & Installed ToµrNop MT AqLE Town Sewer Connections �� ►�E m)67 �a P.O. Box 66 Centerville, MA 02632-0066 , 775-3338 775-6412 `� COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292.5500 TRUDY CO? Secreta ARGEO PAUL CELLUCCI DAVID B. STRU1 Governor Commission SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property address: 80 Second Avenue Name of o�v�er Robert Anderson d W. Hyannisport Address of Owner: Date of impaction: Auburn , Ma . 01501 Nam.of ksspector:(Please Print)J o s e p o P. Macomber Jr . 1 am a DEP approved system Inspector pursuarrt to Section 15.340 of'rite 5 (310 CMR I S.000) Company Name: _Inc . M&MNAddre": Box 66 , Centerville . Ma . 02632-0066 Teiaphone Number: �5R^77 S--23 3 Q CERTIFICATION STATEMENT I certify that I have personally Inspected the sewage disposal system at this address and that the Information reported below is true, accurate and complete as of the time of Inspection. The Inspection was performed based on my training and experience in the proper function and maintenance of on- it ewage disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Irupector's Signature: The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (30) days of completing this Inspection. If the system Is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department otr£nvironmental Protection. The original should be sent to VTv system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS \'b J AI to RECEIVED .� JUN 41999 j TOWN OF BARNgASLE y HEALTNDEPT. ,r� revised 9/2/98 Page IofII %.T Printed on Recycled Pipe( SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PrW-tyAddress: 80 Second Avenue , W. Hyannisport Owrw: Robert Anderson Dais of Inspection: 5/1 8/9 9 INSPECTION SUMMARY: Check A, B, C, of A A. SYSTEM PASSES: J[, I have not found any information which Indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: — BOth the and 1 Par hi no nit aye dr.. at the present time . B. SYSTEM CONDITIONALLY PASSES: 41�) 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. Indicate yes,no,or not determined(Y,N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. j The septic tank is metal, unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance (attached)Indicating that the tank was installed within twenty (20) years prior to the date of the Inspection; or the septic tank, whether or not metal,Is cracked, structurally unsound, shows substantial infiltration or exfiluation, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup 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). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced " The system required pumphig-more than'fourtimes a yeardue to broken or obstructed pipe(s). The system wHhn3r^ Inspection if(with approval of the Board of Health): broken plpe(s) are replaced obstruction is removed revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (cw*xred) Prop"WAddrau: 80 Second Avenue , W. Hyannisport Owrow- Robert Anderson DZU of lr-pocd— 5/18/99 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 falling to protect the public health, safety and the environment. 1) SYSTDd WIU PASS UNLESS BOARD OF HEALTH DETERMINES INACCORDANCE W1TH 310 CAdR 16.303 (1)(b) THAT THE SYS IS NOT FUNCTIONING IN A MAMMER WHICH.]A".pAQIPCT THE PUBLIC HEALTKAND SAFETY OMD THE EX ONJd - Cesspool or privy Is wlthIn 60 feet of surface water Cesspool or privy Is within 60 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH WID PUBLIC WATER SUPPUER, IF ANY)DEnDwLNE.S THAT THE SYSTEI FUNCTIONING W A MANNER THAT PROTECTS THE PUBUC HEAL*Pi AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS Is within 100 feet of a surface water supply tributary to a surface water supply. The system has a septic tank and soli absorption system and the SAS Is withln a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS Is within 60 fast of a private water supply w*J. The system has a septic tank and soil absorption system and the SAS Is less than 100 feet but 60 test or more from a private water supply well,unless a wall water analysis for coliform bacteria and volatile organic compounds Indicates the well Is free from pollution from that facility and the presence of-ammonia nitrogen and Nuats nitrogen Is equal to or less than 6 ppm. Method used to determins distance •4114 (approximation not valid).• 3) OTHER revised 9/2/98 Page 3orii SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PropenyAddreu: 80 Second Avenue , W. Hyannisport , Owrw: Robert Anderson Date of 4upection: 5/18/9 9 D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described 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. Yes N� - � Backup of-sewage iMoiaciiity-or•sYatem component duo¢o an overloaded orclegged-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 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 Q. 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. Y Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic-compounds, ammonia nitrogen and nitrate nitrogen. - E. LARGE SYSTEM FAILS: 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: / The system serves a facility with a design flow of 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: Yes No ,/21 /4Z/ the system is within 400 feet of a surface drinking water supply the system•Is•witl4n 200 fee tof•a-tributary-toe IOU Ffao"finkirag-we te(-GU pply - --- 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further Inforpadon. revised 9/2/98 Page 4orii SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PropertyAd&"s: 80 Second Avenue , W. Hyannisport O1Nf1ef Robert Anderson Data of Inspection: 5/18/9 9 Check if the following have been done:You must Indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. VNone of the system mcompoaants.haiw:b"n puatpad4or at,Jeast twoweaks and•the•system hasbveawaceiuiwg wwsaaal flo 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. _ 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. — ��,,i//�� All system components,:aY�cluding the Soil Absorption System, have been located on the site. _Jl/Qi The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baff or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System orrthe site has been determined based on: Existing information. For example, Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable / (15.302(3)(b)) The facility owner.(and.occupaau,if d1Har9W 1r0m.0lvne1)-WaraArouidad,w)th iniounasioaon th��ana+�ain =M ^f SubSurface Disposal Systems. I irevised 9/2/98 Page 5ofII 1 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 80 Second Avenue , W. Hyantisport O1M1ef Robert Anderson Date of Inspection: 5/18/9 9 FLOW CONDITIONS RESIDENTIAL: Design flow: I2a g.p.d./bedro . Number of bedrooms(d sig Number of bedrooms(actual):_ Total DESIGN flow Number of current residents: - Garbage grinder(yes or no): Laundry(separate system) (yes or ): . If yes, separatelmpection.required Laundry system inspected 1yes or o) Seasonal use(yes or no): -XL5 nn /� /+ Water meter readings,if available(last two year's usage(gpd): r/ 1 q7 Sump Pump(yes or no):A0 / � Last date of occupancy:, COMMERCIALIINDUSTRIAL: Type of establishment: Design flow: d ( Based on 15.203) Basis of design flow J Grease trap present:(yes or nouLg Industrial Waste Holding Tank present:(yes or no)J20 Non-sanitary waste discharged to the Titl 5 system: (yes or no)AW Water meter readings,if available: A�/A - Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING REqORDS and ource of information: zz� ^/ ,yl 3�' System pumped as part of ins action: (yes or no)IV If yes, volume pumped: a gallons Reason for pumping:vA —t37-m,-r It6 V TYPE OF SYSTEM Z Septic tank/distribution box/soil absorption system —L Single cesspool Overflow aesspeel ev ts�clilr�' py Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) b I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank �f Copy of DEP Approval Other —1L1/9 APPROXIMATE A E of al components, date installe6iif known)•end source.of•information: Sewage odors detected when arriving at the site:(yes or novL--I/j revised 9/2/9$ Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATiON (continued) PropeMAddra": 80 Second Avenue , W. Hyanniport Owner: Robert Anderson Diu of Inspection: 5/18/9 9 BUILDING SEWER: (Locate on site plan) Depth below grade:, Material of construction:Zst IronZ4O PVC_other(explain) Distance from povate water supply well or suction line Diameter Comments:(condition of joints, venting, evidence of 1eakage,-etC.) — Joints appear tight NO P.ri dance 9f lealeage . SEPTIC TANK: 9 (locate on site plan) Depth below grade:,, Material of construction oncrateAg.ataL(.Fiberglass,VZP01yethylene4/4othar(explain) If tank Is Enetal, list age is.age.conrumed by Certificate of Compliance_ (Yes/No) Dimensions: W14 Sludge depth:_ Distance from top of sludge to bottom of outlet tee orbaffte:—,�& —' Scum thickness:_ Distance from top of scum to top of outlet tee or baffle: J , Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: Comments: (recommendation for pumping, condition of Inlet and outlet teas or-baffles. depth of liquid level in relation to outlet invert, structural-�ntegrit evidence of leakage, etc.) Septic tank is not nrosonts GREASETRAP: r I, (locate on site plan) Depth below grade:.4A Material of construction: oncrota metal Fiberglass,/Polyethylene�ther(explain) Dimensions: ZI Scum thickness: // Distance from top of scum to top of outlet tee or battle: l Distance from bottom of scpm to bottom of outlet tee or baffle: L Date of last pumping: l` Comments: (recommendation for pumping, condition of Inlet and outlet toes or'baffles. depth of liquid level in relation to outlet invert. itructuraj intagrit evidence of leakage, etc.) rease trap is not present revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 80 Second Avenue . W. Hyannisport Owner: Robert Anderson Data of Inspection: 5/18/9 9 TIGHT OR HOLDING TANKNUONJTank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:NA Material of cons truction;1,n,6oncrete Ajnetal VAibergiassA/4olyethyleneeL4other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order:Yes/VANo/)R- Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) Tight nr hnl rli nn tonks aFe 3iet pre __ DISTRIBUTION BOX: e (locate on site plan) Depth of liquid level above outlet invert: N/7 Comments: (note-if level and distribution is equal, evidenoe of solids carryover, evidence of leakage into or out of box, etc.) Distribution box is not nrPePnt PUMP CHAMBER:_J/&Ve (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.) Pump chamber is not nrP1RPn't _ revised 9/2/98 P age 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PropertyAddrass: 80 Second Avenue , W. Hyannisport OM/fef: Robert Anderson Data of Inspection: S/18/9 9 SOIL ABSORPTION SYSTEM(SAS): 1K (locate on site plan,If possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number: leaching chambers,number: leaching galleries,number: leaching trenches, number,length: leaching fields, number, dlmenslons: overflow cesspool,number: Alternative system: r Name of Technology: Comments: (note condition of soil, signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.) Loamy sand to bonPy mpdij,m canri Nn Sians Gf hydrauliE are (' S4�one fi�� hat nw �rarlo Tho 2&6 3 33�p^ i }�—�g oei6zo--graa e . CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to Inlet Invert: V Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: 4 Indication of groundwater: inflow (cesspool must b pump d s part of inspecti 1 . o _ �,r��1 erred' ��y Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of.vegetation, etc.) Same as above , PRIVY:Z f ie_ (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.) Privy is not present . revised 9/2/98 . Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART C SYSTEM LUFORMAT10N(contirxied) NW-1yAd&—:80 Seacond Avenue , W. Hyannisport own«: Robert Anderson Dou or h POC'6 no 5/18/9.9 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locale where public water supply comes Into house) I �I i revised 9/2/98 P2&C10of11 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 80 Second Avenue , W. Hyannisport , Owner: Robert Anderson Date of Inspection: 5/1 8/9 9 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater( Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed.Site(Abutting property, bservation hole,basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Used water contours map. Gahrety & MIller Model 12 revised 9/2798 Page 11of11 ` •r•.nTw T-n,•r�r•+-'+r' �rwn•nsrw.re..*rnT+T*mn�.•+nnrmrnmntntaai�'�+�n wn T�-�-�'nT+T—.�..r... I TOWN OF BARNSTABLE LVJARD OF HEALTH 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D .- CERTIFICATION 1I11 i `� F.�•4T'.�T•'.•.:•—T..IRS.STT1.l1RT1'n.'1TIT{TA'RfT/11T'T�.S•IT�1TR��RnIr1��iTiRiT�R�T6T1 ITTnnTTT.Ti9'tRP'nTr.•.-5I'f'T"r•1_.•^ -TYPE-OR PAINT CIXARLY- PROPERTY INSPECTED STREET ADDRESS 8Q . Second Avenue , West Hyannisport ASSESSORS MAP , BLOCK AND PARCEL # OWNER' s NAME Robert °Anderson PART D - CERTIFICATION r NAME OF INSPECTOR Joseph P. Macomber Jr . COMPANY NAME Joseph P . Macomber & Son, Inc . COMPANY ADDRESS Box 66 Centerville , Ma . 02632-0066 Street Town or City Stag LIP COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 )790 -1578 CERTIFICATION STATEMENT II certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time of•inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one.:.. - Sylsteai-PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have condlcted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . .t�.�l�4 Inspector Signature � Date •-'�� One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the DOARD OF HEAL1'll: • If the inspection FAILED, the owner or operator shall upgrade ' the eyetem within one year o(' the date of the inspection , unless allowed or required otherwise as provided in 3.10 CMR 16 . 305 . partd .doc TOWN OF BARNSTABLE LOCATION -fO S e C O�cL SEWAGE # VILLAGE 1144 AIXII Lf o R ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITYAtype) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER ldw BUILDER OR OWNER DATE PERMIT ISSUED:* DATE COMPLIANCE ISSUED: j � VARIANCE GRANTED: Yes No (�- . 1 � �� a I � ' '� ��,r5 - M I 5C i 1 Fss..- ....30.00 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE ApplirFa#ion for UiipnoFal Warks Tongtrnrtinn ramit Application is hereby made for'a Permit to Construct ( ) or Repair �XX an Individual Sewage Disposal System at: 80 Second AVE West Hyannisport ................__ __._.......-.._.. ............ --------------------------- ..............................................• ---- .......................................... Location-Address or Lot No. __C&r.I...Andersna........................................................... ..........--.........................................................................:....._..... Owner Address w J.P.Macomber Jr. ---•------ -------- Installer Address p d Type of Building Size Lot----------------------------Sq. feet U Dwelling 2-No. of Bedrooms_____________2_____________._.____---..-__Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------_-____ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures -------------------------------------------------- •-- d -----••-•••----------- W Design Flow..............................................gallons per person per day. Total daily flow..................................__________gallons. WSeptic Tank—Liquid"capacity............gallons - Length................ Width................ Diameter................ Depth................ 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_---_-----------_--_---. f= Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... a -----------•----------------•---------------------•-------------------•••---•--•--------------------------------------------•-------------•-----••-•--------- O . Sand & Gravel Description of Soil = ---------------•--------•----------------------------------------------------•--------•--------------------------••---------•-. x W UNature'of Repairs or Alterations—Answer when applicable................................................................................................ ------------------------------------1-1�0�---. Tlt-'--------------------------•-•--•-----•--••-----•----....•-••--------•---•••-•-....------ 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 b n sued by the board of health. fit/ 4/3/91 Signed . °-------------`-----. --------- ` ...... ------------- ........................................ Application Approved By. Date Application Disapproved for the following reasons: .................................................------ ------- ---------------- -------------------- -- ------------------------------------------------------------------------------------------------------.....................................................----------------------------------- ...... ........................................ Permit No. . .....................rJ`r-- ............................ Issued .........:- ''". � �- ... -..--..- --Date-.-.-- ..--..- 4 No.-- �--f- Fic$ .30.00 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE , ppftratiott for Disposal Works Tnnhmdiun firrmi# Application is hereby made for a Permit to Construct ( ) or Repair `(i.X;j an Individual Sewage Disposal System at: 80 Second AVE West H,yannisp�ort ................_......__.........--- ..._.....-------•--------- - ..._.....--•-------------..._.....------------ .• -.._._._...._........ Location-Address or Lot No. .. fl:"1 A!�� rG^n......-•................................•-------=---------- ••---.....-•-•...••-•-----...-----...-•------...............•------------------------------•------ Owner Address W J.P.Macomber Jr. ...........................................................••-•-----------••._........--------•--- ..............................................•................................................... ,-I $4 Installer Address Q Type of Building Size Lot............................Sq. feet Dwelling x No. of Bedrooms_____________P._._..__.________________.__Expansion Attic ( ) Garbage Grinder:( ) 'PL4_l Other—Type of Building No. of persons____________________________ Showers — Cafeteria PLOther 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. L_______________minutes per inch Depth of Test Pit.................... Depth to ground water----------------_----- rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ---•---------••---------------••-•--••-•----•••--•--•••----•---.._...•••-••---------•-----•---------......................................................... 0 ,Description of Soil............................................Sand....&...Gra_ve 1 W U -•--••-••-•••••••••----•••---•••-••-••----...-•-----•...-------•----------•--------•------•-•------._....•--•••--------•-••----.....---••-•-•--------------------------•-•-•-•------------.._..._------ W UNature of Repairs or Alterations—Answer when applicable............................................................................................ 1-1000 gallon leaching pit. 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. �► /�� all /3/91 Signed Date Application Approved BY W. fir. / 1 rT c ---:��'�'"� ----------- � Dace Application Disapproved for the following reasons- .................................... ------------------------------------- ............................ ------------------- ------ ---------------- -------------- .......... .........................----------------...----...----....---------------------------------...-----------------------------........ -------................................ Date Permit No. . . /` �''r .. Issued ------------------- <" Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certifirate of Cromyliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed'( ) or Repaired ( xx) j .P.Placomber Jr. by.............................................------------------------..................------------------------------- Installer at ---I—Second---Ave West Hyann �:p.Art--------------------------------------------------------------------------------- --------------------------------- --- 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. ...qz� ....-4--4-.--..-...0.. dated ..,�� .�---:��.�-.-.�!.-, THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..............45 '� ��- � ------- ......................... Inspector-'--._� -t.�r .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH- r'. J No•••1�1',"' -�1 TOWN OF BARNSTABLE FEE.... .•-�n-•-n!..- Disposal Works Tuono#rwtion "prrntii Permission is hereby grantede(:_P:l Via. (amk r••.Tr-=•.-.................................................................................................. to Construct ( ) or Repair (K ) an Individual Sewage Disposal System at No...�:g_._Secend Ave West THYn nn snort .Mass . ---------------•---•-------•-----•-=-._:.:------......--................................................................................................................ Street as shown on the application for Disposal Works Construction Permit NO' Ze/6 Dated....... 1t� Board of Health • DATE........... -•---•---------------- FORM 36508 HOBBS 6 WARREN.INC.,PUBLISHERS