HomeMy WebLinkAbout0007 SAINT CATHERINE AVE - Health 7 ST.CATHERINE AVE., HYANNIS �..
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTI,
ONE WINTER STREET, BOSTON MA 02108 (617)292-5Vie
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ARGEO PAUL CELLUCCI °a. DAVID B.STRUHS
Governor CommissionerSUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 7 St. Catherine Avenue, Hyannis,MA Name of Owner: Linda Whitcomb
Address of Owner: 707Main Street
Date of Inspection: June 22, 2000 Hyannis, MA 02601
Name of Inspector: (Please Print) James M.Ford
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
Company Name: James M. Ford
Mailing Address: P.O. Box 49, Oster ille, MA 02655-0049 Map: 291
Telephone Number: (508)862-9400 Parcel: 059
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-site sewage disposal systems. The system:
✓ Passes
Conditionally Passes
Needs Further Eval U By the Local Approving Authority
_ Fails
Inspector's Signature: Date: June 27, 2000
The System Inspector shall submi 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 of Environmental Protection. The original should be sent to the
system owner and copies sent to the buyer,if applicable,and the approving authority.
NOTES AND COMMENTS
revised 9/2/98 .. Page Iof11
Printed on Recycled Paper ,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 7 St. Catherine Avenue, Hyannis, MA
Owner: Linda Whitcomb
Date of Inspection: June 22, 2000 „
INSPECTION SUMMARY: Check A, B, C, or D:
A. SYSTEM PASSES:
✓ 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:
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.
Indicate yes, no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not.
The septic tank is metal,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 exfiltration,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 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
revised 9/2/98 Page2ofll
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 7 St. Catherine Avenue, Hyannis, MA
Owner: Linda Whitcomb
Date of Inspection: June 22, 2000
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 the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 (1)(b)
THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND
THE ENVIRONMENT:
The system has a septic tank and.soil absorption system(SAS)and the SAS is.within 100.feet to a surface water supply or
tributary to a surface water supply.
_ The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil.absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the
well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm. Method used to determine distance (approximation not valid).
3) OTHER
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revised 9/2/98 Page 3of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 7 St. Catherine Avenue, Hyannis, MA
Owner: Linda Whitcomb
Date of Inspection: June 22, 2000
D. SYSTEM FAILS:
You must indicate either "Yes" or "No" as 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 No
Backup of sewage into facility or system component due to an 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'/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
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 alone I bf 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. 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"as 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
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
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 information.
revised 9/2/98 Page 4of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 7 St. Catherine Avenue, Hyannis, MA
Owner: Linda Whitcomb
Date of Inspection: June 22, 2000
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.
✓ _ 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.
✓ _ 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.
✓ _ All system components,excluding the Soil Absorption System,have been located on the site.
✓ _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for conditions of baffles
or tees,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. 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 occupants, if different from owner)were provided with information on the proper maintenance of
SubSurface Disposal Systems.
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revised 9/2/98 Page 5of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 7 St. Catherine Avenue, Hyannis, MA _
Owner: Linda Whitcomb
Date of Inspection: June 22, 2000
FLOW CONDITIONS
RESIDENTIAL:
Design flow: I10 g.p.d./bedroom.
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
Total DESIGN flow n/a
Number of current residents: 5
Garbage grinder(yes or no): No
Laundry(separate system)(yes or no):No; If yes, separate inspection required
Laundry system inspected(yes or no): Yes
Seasonal use(yes or no): No
Water meter readings, if available(last two year's usage(gpd): 1999-105,750 gals.:1998-101,250 gals.
Sump Pump(yes or no): No
Last date of occupancy: Currently occupied
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow: gpd(Based on 15.203)
Basis of design flow
Grease trap present: (yes or 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:
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
Not pumped since installed-per treatment plant.
System pumped as part of inspection(yes or no): No
If yes,volume pumped: gallons
Reason for pumping:
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)
I/A Technology etc. Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components,date installed(if known)and source of information: Infiltrators installed Dec. 18197-per as built
card.
Sewage odors detected when arriving at the site: (yes or no) No
revised 9/2/98 Page 6of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 7 St. Catherine Avenue, Hyannis, MA '
Owner: Linda Whitcomb
Date of Inspection: June 22, 2000
BUILDING SEWER: _
(Locate on site plan) - -
Depth below grade:
Material of construction: _cast iron _40 PVC _other(explain)
Distance from private water supply well or suction line
Diameter
Comments: (condition of joints,venting,evidence of leakage,etc.)
SEPTIC TANK: ✓
(locate on site plan)
Depth below grade: 16"
Material of construction: ✓concrete _metal _Fiberglass _Polyethylene _other(explain)
If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(Yes/No)
Dimensions: 1000 gal.
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 30".
Scum thickness: 2
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: 14"
How dimensions were determined: Measuring stick
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.) The tees were present. The liquid level was even with the outlet invert. There were no signs of leakage.
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:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage;
revised 9/2/98 Page 7of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 7 St. Catherine Avenue, Hyannis, MA
Owner: Linda Whitcomb
Date of Inspection: June 22, 2000
TIGHT OR HOLDING TANK: None (Tank must be pumped prior to, or 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:
Alarm level: Alarm in working order: Yes_ No_
Date of previous pumping:
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX: ✓
(locate on site plan)
Depth of liquid level above outlet invert: Even
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) The box was level. There
were no signs of solids or leakage.
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.)
revised 9/2/98 Page 8of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 7St. Catherine Avenue, Hyannis, MA ,
Owner: Linda Whitcomb r. t
Date of Inspection: June 22, 2000
SOIL ABSORPTION SYSTEM (SAS): ✓
(locate on site plan, if possible;excavation not required, location may be approximated by non-intrusive methods) r;t I
If not located,explain:
Type:
leaching pits, number: I-4'x 6'
leaching chambers,number:
leaching galleries, number:
leaching trenches,number, length: Infiltrators-30'x 11'x 2' (per as built card)
leaching fields, number,dimensions:
overflow cesspool, number:
Alternative system:
Name of Technology:
Comments:
(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.)
The pit was dry because the outlet invert in the box was slightly higher than the one to the infiltrators. The bottom of the pit to grade was
approx. 76" The infiltrators were not dug up There were no signs of failure or backup in the D-box. The bottom to grade was approx. 4'.
CESSPOOLS: None
(locate on site plan)
Number and configuration: F n.
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater:
inflow(cesspool must be pumped as part of inspection).
Comments: (note condition of 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.)
revised 9/2/98 Page 9of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 7 St. Catherine Avenue, Hyannis, MA
Owner: Linda Whitcomb a
Date of Inspection: June 22, 2000
Map: 291
Parcel. 059
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
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revised 9/2/98 Page 10of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 7 St. Catherine Avenue, Hyannis, MA
Owner: Linda Whitcomb
Date of Inspection: June 22, 2000
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,observation hole, basement sump etc.)
Determined from local conditions
✓ Checked with local Board of Health
Checked FEMA Maps
Checked pumping records
Check local excavators, installers
✓ Used USGS Data
Describe how you established the High Groundwater Elevation. Must be completed)
The bottom of the pit to grade was 7'6". Using the Barnstable topographic map and water contours map, the maps were
showing approx. 20' +/- to groundwater at this site. Using the Cape Cod Commission Technical Bulletin, the high
groundwater adjustment for this site(Al W 230, Zone D, 5/00)was 4.4'.
This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty
or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,
written or implied, relating to the system, the inspection and/or this report.
revised 9/2/98 page 11Of11
-�
TOWN OF BARNSTABLE
LOCATION C SEWAGE # y 7/S
VILLAGE ASSESSOR'S MAP & LOT f��
INSTALLER'S NAME&PHONE NO. � -
SEPTIC TANK CAPACITY !L,cr 151 1 �.L,�
LEACHING FACILITY: (type)-L"+il,17_bt ,4-(size) `3r�uffy�
NO.OF BEDROOMS
BUILDER OR;OWNER �` nrc r�'w l A ti •w c)
PERMITDATE: 7 7 COMPLIANCE DATE /';t
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 of leaching facility) Feet
Furnished by
61.
TOWN OF BARNSTABLE
LOCATION S`T' CA-11,\'Cri/u- AVf- SEWAGE # �� -V
'IIM! E. I-�tij4/1/IiS ASSESSOR'S MAP & LOT aciI10.5-C,
LAG
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY MD
LEACHING FACU rrY: (type) ZJAP 'TAWS (size)yX(9- 3a Xll x a,
NO.OF BEDROOMS 3
BUILDER OR OWNER
PERMTTDATE: �a' t1• �1 COI�LIANCE DATE: �a1" /�- 9-7
Sep-rc. �'�spcc c� �•a�- aow
Separation Distance Between e:
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
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No.
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01pplication for M.5pogal *pgtem Cungtruction Permit
Application for a Permit to Construct( )Repair(grade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 4— ��� . Owner's Name,Address and Tel.No.
Assessor's Map/Parcel ����`"� OS G� " �' •'`�0 ���
Installer's Name,Add and Tel.No n g(xp Designer's Name,Address and Tel.No.
S XLO
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow -;-3 O gallons per day. Calculated daily flow -3)�1c( gallons.
Plan Date l 2-��7-i 7 Number of sheets Revision Date
Title @ �-x-�I�_
Size of Septic Tank 'Z<a Sri VXM Type of S.A.S. Ca? T12Tdf�'
Description of Sofl -P
Nature of Repairs or Alterations(Answer when app icable) o -6&)c w-
v�.
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and of to place the system in operation until a Certifi-
cate of Compliance has b_e this lth.
Signed Date
Application Approved by 2, Date I
Application Disapproved for the following reasons
Permit No. 7 Date Issued f Z ,l 7-
q 7_7 1 S—
THE COMMONWEALTH OF MASSACHUSETTS i Entered in computer:
1�/ /Yes
PUBLIC'HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
Application for. Migpooar 6petem Con!5truction permit
Application for a Permit to Construct( )Repair( grade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. `", 5 i C � S
A7 T Owner's Name,Address and Tel.No. j
Assessor's Map/Parcel `
i
Installer's Name,Add a d T I N L S l f-If T-«p g Designer's Name,Address and Tel.No. r
Type of Building-.
Dwelling No.of Bedrooms ° Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3 O ° gallons per day. Calculated daily flow _1yS gallons.
Plan Date /-2 -J_:-1-7 Number of sheets Revision Date
Title 1)- CL,c Q.-
Size of Septic Tank `z�cd S`c r�L_ V-ILM Type of S.A.S. Cu �LTa�.rcW1�
Description of Soil 4)
Nature of Repairs or Alterations(Answer when applicable) �'o-a ta(( v 0- 7 sk
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r?S Si-ow__ Sv✓✓d 4 Vh �� G�•.
Date last inspected
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Agreement: -
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and of to place the system in operation--until a Certifi-
cate of Compliance has beensssat d. is B f th.
Signed ti Date Z. 7'�7
Application Approved by Date
Application Disapproved for the following reasons
Lie
Permit No. 9 7 -7/3— Date Issued 17 q"/7- / 7
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS r
BARNSTABLE, MASSACHUSETTS —
Certificate of Compliance '
THIS IS TO CERTIFY,that the On-site Sewage Disposal Sy tem Constructed )Repaired ( )Upgraded O
Abandoned( )by 16 C -E
at ST r C "'S G'2-i'tiE ST { has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. J 7- WS—dated /Z-,/7.7 7
Installer Designer
The issuance of this pe t shall,not be construed as a guarantee that the systen�wall:f ti tion as designed.
Date 1 �Z ' Inspector
i'
———————————————————————————————
———-
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No. T / 7,J7 Fee J V.
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Mig;pozal *p5tem Construction Vermit
Permission is hereby granted to Construct( •)Repair(' )Upgrade( )Abandon( )
System located at '� S i. G P-1 NE-2 1 NC 5-T• 0 iU YJ
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of thi
Date: Z 17 9 7 Approved by
L
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N j r 10/9/97
NOTICE: This Form Is To Be Used For the Repair Of Failed
Systems Onlye ,
CERTIFICATION OF SKETCH AND APPLICATION FOR
DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT
ENGINEERED PLANS)
,hereby certify that the application for disposal works
construction permit signed by me dated N ``-7 ,concerning the
property located at_
meets all of the
following criteria:
There are no wetlands located within 1o0 feet of the proposed leaching facility
There are no private wells within 150 feet of the proposed septic system
There is no increase in now and/or change in use proposed
There are no variances requested or needed.
elfthe leaching facility will be located within 250 feet of any wetlands,the bottom of the
proposed
proposed leaching facility will ugt be located less than fourteen(14)feet above the maximum adjusted
groundwater table elevation.
Please complete the following:
A)Top of Ground Elevation(according to the Engineering Division G.I.S.map)
B)Observed Groundwater Table Elevation(according to Health Division well map)
l
SIGNED: DATE: �'"0`9 _
' LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER
[Attach a sketch plan of the proposed system.Also If the licensed installer posesses a certified plot plan,
this plan should be submitted].
q:health folder:cert
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i TOWN OF BARNSTABLE
/1D SEWAGE #
VILLAGE ASSESSOR'S MAP&LOT
INS744ER'S NAME&PHONE NO. �
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SEPT 'rTANK CAPACITY L�
LEAcCHII�IG FACILITY: (type) ' " —,&,L'(size) '71y/Av
I
NO.OF BEDROOMS
BUILDER.
PERMTTDATE; 1-� 9 7 COMPLIANCE DATE: Ia —/2 " 7
SepaFation;Distance Between the:
Max6i i Adjusted Groundwater Table and Bottom of Leaching Facility Feet
PrivateWater Supply Well and Leaching Facility (If any wells exist
ofvske'or within 200 feet of leaching facility) Feet
Edge:of:Wgtland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furn"ted:ayy
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S 't fhpt� t � Zap - ®s �
. 0C=ATION 4VE., SEVVAGp: PERMIT NO,
V I.1_ L A G E # S'►. cae�herth� �� y�Q
HEN N ► s _. ._____
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D A, TE PERMIT�ISSUEQ
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..................:........................OF.....-.................................----------.-----------------..................--•-
Appliratiun for Diupuuttl Works Tunutrurtiun ramit
Application is hereby made for a Permit to Construct (l/�or Repair ( ) an Individual Sewage Disposal
System at:
Loc -Addre/ss/'- 1 'nor Lot No.
..................... GAL... ..�.-U. .C..__... . ._.. ?...[ /✓...�J..�l_.� ...._ .Y .:.....................
Address
�Wl ................. ................ . ..................................................................................................
Installer Address
as /.S J��J
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms.._..._._ ,1�........:....................Expansion Attic ( ) Gar age Grinder (
Other—T e of Building No. of persons............................ Showers — Cafeteria
W Othe fixtures ------------------•----------
W Design Flow........................:...................gallons per person per day. Total daily flow..........E.!�2>..................._gallons.
WSeptic Tank—Liquid capacity_1�aa_gallons Length__-fa......... Width................ Diameter................ Depth....4/........
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......... --
-----__-.
1.4
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 ...........................................................................................................................................................
0 Description of Soil........ -1-------- a ..........................
x 5a---.-•--------------•.........---------------------------•--...............-•----
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 TIME 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been 'ssued bytt b,, n oar��off health. y /
Signe( _1 L.�---- R/ ......... ....
PateApplication Approved By----------- .:..�7Zc _..•--•--....• ..........
Date
Application Disapproved for the following reasons----------------•------------ -------------•------------------••------------------------------------•-••------ t
...........-•-•...................•----------------------------•--......-•-------......---......----•-...I........... .............••--••••-•------------•-----•---------------.-•--- --------•--••---
Date
Permit -----------_No......... _ °�`��---- Issued.---•----------•-----------------•-•- ^
-------------- -------------- -
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........ ..-..............................OF.........................
Appliration for Disposal Works Tonstrurtion rrrutit
Application is hereby made for a Permit to Construct ( tollooeor Repair ( ) an Individual Sewage Disposal
System at
Locat nlddress
......................................................
If r or Lot No.
Address
a .............. t:... ......... .................................................................................................Installer Address
U Type of Building Size Lot..f:��..`��.�......Sq. feet
Dwelling No. of Bedrooms ........................ .Expansion.Attic� g— •--• ( ) Garbage Grinder
aOther—Type of Building ____________________________ No. of persons......-..................... Showers ( — Cafeteria ( )
Otherres -- ---------•-•-•-•••-•••-------------•••-._._.._...._..•--------•.._..._..•----------•------
d _..
W Design Flow________ ____________________ _gallons per person per day. Total daily flow........� ............g .Length.... Width................ Diameter................ Depth....
Disposal Trench—No..................... Width........-........... Total Length.................... Total leaching area..............._...sq. ft.
3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by......... ._64.kci.................................... Date..........-�'�•_,e.Y s_..____..
Test Pit No. 1........... per inch Depth of Test Pit____________________ Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Ri
D Description of Soil ,±f?.
.....................••-- e t- ....................................-•..................................._........................
U ...................................................................................................................................................................................................
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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been ssued by tl boarkof health.
Signed-:_... ................. .... 1... � ' ..
Application Approved By..................... ... .::tea.�--.-•' ../Le�~ `--....................... �?:r?if
------•-•------ Date
Application Disapproved for the following reasons____________________________________________________________________________________'_______•____------........_
------------•---------•-••---•...............•------.._.._......_..---------------------.._..---•--.......__.._.._...--------.......---------------------------...---•------------•••--...........---•--
Date
PermitNo.......... .'................. Issued_..............................____-•---..._-----:......
Date
THE. COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH •
..............CV.............OF... . 'l��! k 1�` ,`c
` : ............. ............. ...........
(Irrtif irat a of Toutplinurr 0
THIS IS TO 1; That the diva ual Sew Disposal System constructed ( ) or Repaired ( )
by----------•-------•------•-- •_• r c .........: `<..... --....-•---------------------------------------------------------•--•-•.......... _.._....
In taller
at...--------."=-`.. i C)r _n r... f .� - l 2�ctL
----•-•-- •-_... ..•-•---•. ....... ......•. --- .,„.------ -------.......----.... .........
has been installed in accordance with the provisions of TITLE of The State Sanitary Code as described in the
T "- ' l Kam- dated- - 3 3 4:- .......
application for Disposal Works Construction Permit No...........................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNGI SAT SFACTORY.
DATE...... •- lx �P...-••---•........._.. Inspector. -1- ...................................-...................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No.. ' '" t/ ... :>)!!� ....OF.......- ...................
Fn........ fad...
Disposal trks Ts�nstrur#iun PPruti#
t�2 .•--•._:..- .
Permission Is hereby granted...... �:'.�=-------------�_..---...----............... r..-----..........................................................._..
to Construct (� ) or Repair (_ ) an Individual Sewage Disposal System
at No...........................�'------...C:-6 Ac-r............ I !�K v±•�.`�� ;r.\�...��t........................
Street
as shown on the application for Disposal Works Construction Permit No.� '" Dated...... .----..-----
: .:.: :.. .. : :................. .................._
,, Board of Health
DATE...........--„ �'
FORM 1255 A. M. SULKIN, INC., BOSTON
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THE COMMONWEALTH OF.MASSACHUSETTS Fmc
BARD Z HEALT...-....- OF........ - �A ��� ..._....
Apphration -for Uiii niial Workii Towitrurtion Vrruift
Application is hereby made for a Permit to Construct (x ) or Repair ( ) an Individual Sewage Disposal
System at: Corner of Saint Catherine Avenue and
Skating Rink Road (Lot 3, Block 7)
-----------•----------------•------••------•--•----------.....----------------------.._.....------ ---•-----------•-•••-••-----••-•-•-•••-•--•-•---....-•--•••••---------••--••-----•---•-----------
David S. and Bernita L. Gro an Hyannis, MA 0260°1 Lot ° Mai Zing address
-- - - ;;§--Luke--E zal�eth--➢rive
W Delta Crane Servieew.M Robsham) .. ....__..�----------------..CraigvUU,..Mt�...M3.6--
------------------
Installer Address
Q Type of Building Size Lot.../J�---4P.R..Sq. feet
Dwelling—No. of Bedrooms..--_-Three----------------- ------Expansion Attic ( ) Garbage Grinder ( )
aaq Other—Type of Building ____________________________ No. of persons----------------------_----- Showers ( ) — Cafeteria ( )
a' Other fixtures ------------------------------
Q ---------------------------------
Design Flow.............. ..6._._..._...._..._.__._gallons per person per day. Total daily flow--------------------------------------------J-�O.--_----___-------.-_gallons.
W •,
WSeptic Tank—Liquid capacity Length................ Width................ Diameter-------......... Depth...-----___-_---
x Disposal Trench—No-------------------- Width-------------- ajL�l��.________.:Total leaching area.--._.-.----_-__-_sq. ft.
Seepage Pit No---------- Diameter�'_� ___.... Apt be w n e .................... Total Ieaciii�i area_.______._._____sq. ft.
ZOther Distribution box ( ) Dosing tank ( ) g� s � iy -- ll7 y� ;Z, - ® 13AA..,
aPercolation Test Results Performed by-------------------------------------------------------------------------- Date------------ --------------------------
a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water...-----------.-__.-._..
f� Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- IApth to ground water--__._.
------ ----------- A
.._.... .......................
Description of Soil-�-✓_..�___ c_� g [ —
------
_. . . °- .----------------------
w
UNature-of`Repd rs or Alterations—Answer when applicable................................._-__----..__.--------__---_-.------ .._...-__-_-_-._.__..
- -------------------•---------------•----------------------------....
Agreement: ,
The undersigned agrees to install the aforedesc ' ed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary C — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be sur-d t b of health.
Sig .r—
4 -y
-- - ---------- --- -------- ---------
-------------------------
- / .. . Dat
Application Approved By d- -....
Date
Application Disapproved for the following reasons:----••------------•------•------------------------------------------------•-----•---------------•-•-----------
--.......
..................-...........-........ ..................................................---------•---....................................
`r� Date
......
--------------------- Issued /... /..{ ....................
9....xrc::..................... ..:... .....................1.....+b...............�..,...
ate
��������___�__��_�-____-_-__�------------------------------ to�
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THE COMNION;WEALTH OF MASSACHUSETTS
BO�d�'( D O H EALTH' t
y ... .. to i 'u
�
OvOratiun fur nciitt1 Works C��n nr t ii rrn�i
Applicatiori ise'hereby made for a Permit to�Construct:..( ?.), or,Repair ( , ,) ¢n"Individual Sewage Dispos•iCorner Of Saint I
rt.,+mr,rs.rcm�......«.s�rw t ,Ir.ws d+nw
•_-_---___-.. --Yk &ad (Zot
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,jejL Qn�tlddre LI l�Ae/y�Lox No.� ��
............... .---_ ..i • (itwj� ' ., + + v lari Y�I vv a. «s L
Z�E»g E► 'o
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a ec .n g nit��
�vtta G9 servtog ' �� "�, A t
rp
.. __________ --------------------------------
Installer-___----___.�.. .,.a .,.-.__..,,.... -----_-_. ___...__.
vV
at
p. Eti 't .. °} ,.�+ Address
Type of Building ; . w fs
Dwelling 't No>of Bedrooms _ t y :'_EScpansion fltrie a(',b ,J z Garbage Grinder (Yg
-t �fu , t -:a `x
t a Other Type of Building No. of persons __ ; >a Showers ( ) Cafeteria wf i
o.
rOther fixtures _.. ------- x_„ r _._..._.•----- -- ----------------- !` 15' , t ------------- _� ,.
Design Flow 6 gallons per.person per day. Total daily�fldw ;' ' +�!'..__,... g illonti E
1 tnityigitld capacitv� . 'ngalLonsb ;� ength________________ Width. "Diameter------_--------
Septic Depth * A.......`AlU
4 a Disposal Trench No ...................._ , t ot L�q h 'rT taP leaching area sq Ft;
r
F Seepage Pit No --- Diamete �dth j, ofowihi �Dotal leaching area__ sq fe
Z Other Distribution box ( ) DoSinottank
ar± ,.: ','�:. �a}ll ^a ate---------•-••-
a Percolarion Test Results Performed by x+ ____________________________________ 4 p
Test Pit 170 1 i_____________minutes+" r inch,�� epth of Test Pit_.__....__. Dept i to around water
Test Pit No 2 ______________minutesperzinch'�jDepth of Test Pit.________._ �n ,Dept}i to'ground water
1 ,i/ l�f ty ¢fit y` 4� 4r}tk �t � �. 4f4 ..
4 Description fOf SO11 a �J t r �� M
°. -_-__-__'__---•-•-----___ .----- r 4 .---------------- --
x
# 34 f F
Y�-1 __________ _______ .__.__.__ _______.___ __••_
58�-y5,:,. _ _
U Nature of :epairs or Alterations—Answg when applicable............... .. ..
------------ ------ ------- ------------------------------------ _
+
Agreement t 1*+ a w: s
The undersigned agrees to. install k the,atbredesc ed Individual ` age,plispo 1'Syste i accor'dance wrtl
the provisions.-of Article X1 `of the State Sanitary C —The, r t. ed ttltotlei• re .place the system in;
operation.until.*.Certificate of Compliance Mast be Is, t ` A of ealtl i
Signe
� I.
K A
i Application Approved By--- 'i1 t , R .........
�` °r
d �T (Date
Application Disappro d for` a�zg re ons z._.. __ ____ ''
a
a. >' 's t
-r............. -- -- ----- ----- --- -----
r ,
g - ___
z� Date-
Permit ----. Issued= �
___---
x
r .Date z
THE C8:v4MONWEALTH OF MASSACHUSETTS 't
BOARD OF HEALTH a c}
(ftld atr of Tvmv1ianrr'1 ;z A
t THIS 1 Ad San
That t ref. Individual Sewage Disposal System,constructed ( ) or Repaired ( ,)
byd -•-- `; 3�, 1u -:: w
r FroB 8, � k 71 fr F� � a
has been installed in accordance with the ptovisions of Article XI of The Stafr Sanitlry Code as described in the
application for--Disposal Works Construction Permit No-----------e�__f�-_�e _
THE ISSUANCE"OF THIS ICEItT901:6 TE SHALL. NOT BE CONS RUSE®5A5=A.G ARAPITEE TH 4T xT IE
SYSTEM WIL FU CTION SATISFACT®,Rrlf
f
DATE___ _ �I `-_ _ r,'``+ �' .... Inspector•- ............. 'kS t'r k-
4 .. ____________________
v i
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' THE CQM ONWEALTH OF MASSACHUSETTS
;f I BOARD OF HEALTH
t c r µ � .....
O+r.
I)��. ....... ........ ...
l
'No. .. FEE
Ii.1hii utuitrnrtilaPermissiontti�•hereby granted- °;
to Constr t (07), or Repair ( a ndividual Sew e D• pos .1 ystem
at x_— s - . : �_ _ ice.�a . -°
Street a f•
as shown on the application for Disposdl'Works,.Construction it No Dated---
...........
.................a --------.
*, rd of. Health
DATE---- ---.. ----------------------------- ------ •-'<. ,
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
x ,
David S. and 'Bernita L: Grogan , v
Lot 3, Block 7, Corner of Saint Catherine`Avenue and Skating Rink Road
Hyannis, MA' 02601
ScaZe 1/411. to 10'
Showing Zocation of 1250 gaZZon. sanitary -system with expansion room—. 4
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