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HomeMy WebLinkAbout0054 UNCLE WILLYS WAY - Health 54 UNCLE WILLY'S WAY, HYANNIS A = i r k —# TOWN OF BARNSTABBLE I:,OCATION l/A****eZ4r 46"Zlle'r4"SEWAGE VILLAGE A-SSSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO.y,10*'-Z SEPTIC TANK CAPACITY 00® LEACHING FACILITY: (type) (size) NO. OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: I Separation Distance Between the: �� �✓/dT�� III 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(-lm � �® y l ® � r � Cho a ` fic,6 No. � / / ► Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes 1U PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2ppYtcatton for Disposal *pstPm Coustruttton Permit Apph tion fo ermit to Construct( ) Repair( pgrade(Abandon( ) EI.Complete System ❑Individual Components Location Address or Lot No.f fi !s,- G Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 7 9 —T.2 Installer's Name,Address,and Tel.No. V V Designer's Name,Address,and Tel.No. Type of Building: 'y Dwelling No.of Bedrooms v Lot Size sq.ft. Garbage Grinder( ) Other Type of Building ez No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date /���� Number of sheets / Revision Date Title Size of Septic Tank ���/�TJ�' I0�dType of S.A.S. CC9 Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 ironmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar f Healt ne 9 Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued �6 No. Fee _.m THE COMMONWEALTH OF MASSACHUSETTS Entered in compu er: ts 'PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yf tZipplicatlon for MIsposal 6psten Construction permit Appl a i n fo ernit to Construct( ) Repair(Upgrade(Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. L Owner's Name,Address,and Tel.No. �t Assessor's Map/Parcel .2 9. — —?.. Installer's Name,Address,and Tel.No. esigner's Name,Address,and Tel.No. Type of Building: - Dwelling No.of Bedrooms t Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) 'Other Fixtures A "Design Flow(min.required) gpd Design flow provided gpd ` Plan Date /--� S� Number of sheets / Revision Date Title Size of Septic Tank �`X/��"/�47 /00 01y-ppe o S.A.S. c,//�J/yJor��/ Description of Soil Nature of Repairs or Alterations(Answer when applicable) c�G� �j�f✓ t`$ 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 E vironmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar f Healt ne a Date Application Approved by Date Application Disapproved by s. Date for the following reasons Permit No. � Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance _ ` THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by ,C<�eu ( A— —f"e®,;0 'G J3 l/ G at ;�S/ !�/✓C,C l,�/��y✓' /,&,t/�has been constLuoted in accorA c with the provisions of Title 5 and the for Disposal System Construction Permit No Installer_ Z�47O � /`r Designer / #bedrooms Approved desi gpd The issuance of thi pe it shall not be construed as a guarantee that the system will nction e igned. Date Inspector �J ---------------------%. ---------------- - - ---- --------------- --------------------------------- No. Fee - - - ��` THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal �&pstrm Construction permit Permission is hereby granted to Construct( ) Repair(Gf` Upgrade( Abandon( ) System located at ,� s.' f/ CG �' /G LV .14 d 'x )v �y and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction mu Abe co pleted within three years of the date of this permit. Date Approved by I . . i Town of Barnstable Regulatory Services E Richard V.Scali,Interim Director = snursrnBttE. � Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 I Office: 508-862-4644 Fax: 5N-790-6304 Installer&Designer Certification Form Date: "t jvI Sewage Permit 00 9� Assessor's 1blapTarcel Designer: ytit� j- }{�{ `� Installer: Address: _q,46i1 Z") fit Address: On Lk Q%f�'c+'d L was issued a permit to install a (date) (installer) septic system at 5 01-jW& LOW r' based on a design drawn by (address) CJ koo 61 M dated (designer) J/' I certify that the septicsystem referenced ced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the PA approval letters (if applicable) ��LZ�OF A•�q�s a= DAVID yt' y sta 's Si ) MASON m I M.1066 (Designer s Signature) (Affix 15 Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\SepticlDesigner Certification Fom Rev 8-1¢13.doc Cam• ' rn°S F I>� a Town of Barnstable �1tte P tk,_ ' Department of Regulatory Services M� Public health Division Date e's39 200 Main Street,Hyannis MA 02601 ""' Date Scheduled ,r �� r J' Time---. 'Fee Pd. - Soil lSudabili B ty Ass s�ment for S e zs sa ,� Performed• �/`�, Witnessed By: LOCATION&GENERAT, INFORMATION Location Address , `� ✓/�/�'� Owner's Name p Addms. OJ✓Ct ST- Assessor's Map/Parcel: ��a�, J `�sO— G✓� Jys�[ Engineer's Namce,.,,. NEW CONSTRUCTION REPAIR _ Telephone# Land Use- 7- Slopes(%) Surface Stones Dlstanceb ftom: Open Water Body ft _Possible Wet Area 4 ft DrinkingVyaierWell . ft Dralha Property Line . go Way ft —ft Other ft SIMUCH:(Street name,dimensions of lot,exact locations of teat holes&perc lists,locate wetlands in proximity to holes) Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping fi•oln Pit Face Estimated Seasonal High Groundwater Method Used: DETERMINATION FOR SEASONAL''HIGH WATER TABLE Depth Observed standing In obs.hole: Dallth to weeping from side of obs.hole: Depot to loll mottled: Index Well Y Reading Date: Index Well level Groundwater Adjustment fit. Adj.Groundwater Leval PERCOLATION-TEST bate„_„,,Observatloti Hole ff Time at 9" Depth of Pero Time at G" Start Pro-soak Time Time(9"-6") End Pre-soak Rate Min./htch Site Suitability Assessment: Site Passed site Failed: +{ _ 1 Additional Testing Needed(Y/N) Original_ Public-Health Division ; t 1 j4 Observdion Hole Data To Be-Completed on Back ***Y£percolation test is to be conducted within 100' Of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEP-PIC.\PERCFORM.DOC �� DEEP-OBSERVATION HOLE LOG Hole# Depth from Sall Horizon Soil Texture Sdil Color Soll• Other Surface(in.) (USDA) (Munsell) Mottling (Stricture,Stonod;Boulders. r eii etency.%'4revall z DEEP OBSERVATION HOLL LOG Hole# Depth from Sall Horizon Soil Texture Soil Color Soil Other. Surface(in.) (USDA) (Mupsell) Mottling (Structure,Stonca,Boulders. consistchov,%Orayoll t DEEP OBSERVATION HOLE LOG Hole# Depth from Sall Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. o Ito c O DEEP OBSERVATION HOLE LOG Hole# Depth from Sall Horizon Soil Texture Sall Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stapes;Boulders. Consistency, , Flood Insurance Rate May: Above 500 year f lood boundary No_ Yes -Z Within 500 year boundary No 1!r 'Ye.._..� Within 100 year flood boundary No. Ydi . Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervl u m torial exist in all areas observed thrpughout the area proposed for the soil absorptibn system? F If not,what is the depth of haturally occurring pery ous material? Certification I certify that on lb (date)I have passed the soil evaluator examination approved by the Department of Enviro ental Protection and that the above analysis was perf, med by me consistent with the required training, ,,Ind ex erience described in'10 CUR 15.017. Signature Datb [/- QA5EI"riCWERCPORM.DOC TROY WILLIAMS SEPTIC INSPECTIONS � 7 g Certified by MA Department of Environmental Protection 08) 385-1300 19 Hummel Drive South Den-nis, MA 02660 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS - - DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM L PART A / � l CERTIFICATION ) Property Address: 5 y H G c IN r �r y S wG+, Name of Owner uH k �•• F�l�-✓r ty- o .,r`: Address of Owner: L l y ��v / �.-uJ2h . . Date of Inspection: 8 A 7 1 q (�c•rN S D/� / /vlw. o�63a . Name of Inspector:(Please Print) Troy Williams 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: Troy Williams Se tin c Inspections Mailing Address: 19 Hummel Drive, so. Dennis, MA 02660 Telephone Number: (508) 385-1300 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 Evaluation By the Local Approving Authority _ Fails ks a Inspector's Signhire.F�, Date: 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 of Environmental Protection. The original should be sent to Ire system owner and copies sent to the buyer,if applicable, and the approving authority. NOTES AND COMMENTS Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification is not to be construed as a guarantee of future working condition of system,piping or components. This inspection represents the conditions of the system on the Date of Inspection noted above. 17ev i sed :, E SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Prop"Address: Owner: 54 Uncle Willys Way,Hyannis,MA Date of Inspection: Susan King Fulcher August 17, 1999 INSPECTION SUMMARY: Check A, B, C, or D:' A. /SYSTEM PASSES: V � , 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: /V/A 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 determine tion 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 of 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 r revised 9/2/98 e�e2of11 V SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address; 54 Uncle Willys Way,Hyannis,MA Owner: Susan King Fulcher Date of Inspection: August 17, 1999 C. FURTHER EVALUATION IS REQUIRED BY,THE BOARD OF HEALTH: N�n 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. 11 SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM tS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of 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 of 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 I 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 rP\ Ct /219Q SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 54.Uncle Willys Way,Hyannis,MA Property Address: Susan King Fulcher OWf1ef: August 17, 1999 Date of Inspection: 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 1 5.303. .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 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 Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a"surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less-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: /Vh 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 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 11 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 P. c4of II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 54 Uncle Willys Way,Hyannis,MA Ownef: Susan King Fulcher Date of Inspection: August 17, 1999 Check if the following have been done: You must indicate either "Yes" or "No- as to each of the following: Yes �C No — Pumping information was provided by the owner, occupant, or Board of Health. )k�5�e- — None of the system components have been pumped-forest least two weeks and-the system has been,receiving•norrnal 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 condition 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)1 The facility owner (and occupants,if different from owner) were.provided with information on tha.propermaintenanceof Subsurface Disposal Systems. {f revised 9/2 '9^ Page sorii t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: 54 Uncle Willys Way,Hyannis,MA' Date of Inspection: Susan King Fulcher August 17, 1999 FLOW CONDITIONSRESIDENTIAL: Design flow: CIO g_p,d./bedroom. Number of bedrooms design): Number of bedrooms (actual): Total DESIGN flow Number of current residents: a Garbage grinder(yes or no):_I(6 Laundry(separate system) (yes or no):.A/Q If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use(yes or no):_&. ( VE-S pr- w `b Water meter readings,if available(last two year's usage(gpd): `�8��CldJ�rJ c�(/� s G� 7 GV! 600 k 0,- y Sump Pump(yes or no): Aia Last date of occupancy: —r. pd>G COMMERCIAL/INDUSTRIAL: A/l/9 , Type of establishment: Design flow:_ qpd (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: /� �iS 7J 5- - z . % N �h t o w so,.� . System pumped as part of inspectio : (yes or no) No If yes, volume pumped: gallons Reason for pumping: TYPE 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 of known) and source of information:s A, /1,--k_. 3/36 /? y Sewage odors detected when arriving at the site: (yes or no) NO s revised 9/2/98 regr6or I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(corrtim ed) Property Address: Owner: 54 Uncle Willys Way,Hyannis,MA Date of k-p-tion: Susan King Fulcher A BUILDING SEWER: August 17, 1999 (Locate on site plan) n Depth below grade: /8 Material of construction: cast iron_�,/40 PVC ✓other(explain) ;!VTf JL'.-.. Pu Distance from private Jate auNNry we'll Of SUCLIOn line Nl,9 Diameter ' Comments:(condition of joints, van' g, evidence of leakage,etc.) SEPTIC TANK. (locate on site plan) 01 Depth below grade: I Material of construction:-k/-Concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age— ls.age confirmed by Certificate of Compliance_(Yes/No) Dimensions:_ S rX ry �X6 /O170 Ga /la i1 . Sludge depth:! Distance from top of sludge to bottom of outlet tee or baffle: a '/o 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: /� n How dimensions were determined: .Comments: (recommendation for pumping, condition of inlet a d outlet tees or baffles,depth of liquid level in relation to outlet invert, structur&Hntegrity, evidence of leakage,etc.) UC_ GG� >�e,- i,. / . Ar4K o j ,c cc,e ,�� 6 V—,L o S i h s a a. o✓ Lev r`. v w r.,+�rt GREASE TRAP: (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, etc.) revised 9/2/98 Page 7ofIt SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 54 Uncle Willys Way,Hyannis,MA Date of Inspection: Susan King Fulcher August 17, 1999 TIGHT OR HOLDING TANK: N(`a(Tank must be Pum ped ped 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: &J ( i Comments: (no e.if level and distribution is equal,evidence of solids`carryover, evidence of leakage into or out of box; etc.) 4k L.J:ok S J 1�.� � y� p ��� l/�S' 6 rf�✓ PUMP CHAMBER:�q (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 P.2e8ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 54 Uncle Willys Way,Hyannis,MA Date of Inspection: Susan King Fulcher August 17, 1999/ SOIL ABSORPTION SYSTEM(SAS):�/ ` (locate on site plan, if possible; excavation not required, location may be approximated by non-intrusive methods) If not located,explain: , Type: r leaching pits, number: 0.! `1- (o X6 c:► } H,', S Ham_ leaching chambers,number:_ leaching galleries,number:_ leaching trenches, number, length: 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.) L a 3. r., a c- t S G cEssPo oLs: d (locate on site plan)n Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:�1i9 (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 9of II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(corrtinued) Property Address: owner: 54 Uncle Willys Way,Hyannis,MA Date of Inspection: Susan King Fulcher August 17, 1999 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) )600 • � f PJ revised 9/21/98 Page 10ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 54 Uncle Willys Way,Hyannis,MA Date of Inspection: `Susan King Fulcher August 17, 1999 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 /5 Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record r Observed Site JAbutting property, observation 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) 'a/�J G---� r '�r✓l �,�"• 0. C[ '�.�,o '/ 4 U/__ /.� 1J us S`�C q✓�✓rt of �,.�c� r r.�o /S—t i h C,-r mac. . L v t4v L1% d /� 1 c G, c �,/ P ; f' C L�rr ) t„Jw, " S wI o revised 9/2/98 Pugs II of II � _ YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$10.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you.must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: i . lir��f {l��r�.' �• -� �,. � Fill in please: APPLICANT'S YOUR NAME/S: tZ BUSINESS YOUR HOME ADDRESS: C S LA 'a � I f ? TELEPHONE #" Home Telephone Number NAME OF CORPORATION: C,Z-S S Col—,lt*'-2 Uc j/ 0 h- NAME OF NEW BUSINESS TYPE OF BUSINESS Lr-i�SC �C IS THIS A HOME OCCUPATION? YES, NO ADDRESS OF BUSINESS `�' G''/v CL(- �i L-(�l C S-�ri, �/ MAP/PARCEL NUMBER (Assessing) Wheri starting a new business here are several things y LOUstWon oar o ly in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you need.,.You MUST GO TO 200 Main St. corner of a( Yarmouth Rd. &Main Street) to malce sure you have the appropriate permits and.licenses required to legally operate your business in this town. 1. -BUILDING COMlWS61b1NER'S OFFICE This individual has.b'en-in r ,ed o an permit requirements that pertain to this�type:of busines U.ST COMPLY WITH HOME OCCUPATION RULES AND REGULATIONS. FAILURE TO- ��, Alwhor' ed,Signature** n COMPLY MAY RESULT INFINES. 2. BOARD OF HEALTH This individual individual has een n f the permit requirements that pertain to this type of business. Authorized Signature** MUST„OMPLY WITH ALL COMMENTS: HAZARDOUS MATERIALS REGULATIONS 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has-been informed of the licensing requirements that pertain to this type of business. Authorized Signature** . COMMENTS: . v� `r , / � /�( TOWN OF BARNSTABLE Date 1Z TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: /C.'5 S BUSINESS LOCATION: 1�,c� V b-CC(- lz INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: S©K A / �/l0 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) � Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison"labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) I1/6 PAA-Tef, //� S Spot removers &cleaning fluids (dry cleaners) 5106 Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials LOCATION SEWAGE PERMIT NO. VILLAGE 61 lfirtJ�/G.S - I, INS A LLER'S NA-,ME i ADDRESS BUILDER OR OWNER 11,17 DATE PERMIT ISSUED DAT E COMPLIANCE I S S U E 0 ®�� a �1 No................ ~ Fms.12 5 . THE COMMONWEALTH OF MASSACHUSETTS BOAR® HEALTH Y� OF........ ................ ........................... ApV tratiou for Dtip.oii al 10orkg Towitrurtion thrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .........4. ...4a A1�►�e ..: -------------------- -'..............I.�,e------..............-s -----•-'-'---""-"'-".......'--'"'-•- Location address or Lot No. Ow .Address Installer Address d Type of Building A7( Size Lot............................Sq. ff�ft Dwelling—No. of Bedrooms.__....3_r` ............................Expansion Attic ( ) Garbage Grinder ('v p`4 Other—Type of Building dwelt, No. of persons____________________________ Showers ( ) — Cafeteria ( ) Other fixtures ...................... W Design Flow...........5.45........................gallons per person per day. Total daily flow.___.__......_..33a................gallons. WSeptic Tank(—Liquid capacity).000•gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.............._----- Total Length.................... Total leaching area....................sq. ft. Seepage Pit Other Distribution box Dosing.... No.__...J..__._( _.---) Diameter....... D g....... D th below i et__..�w......_.... Totaeaphing area4l�......sq. ft.' tank a Percolation Test Results 'Performed by ____________ _____ ......... ___......__...... ,__........_..._ Date j%� Test Pit No. 1 ,, ------minutes per inch N- Depth of Test Pi 7--- Depth to ground water------------------------ (i Test Pit No. 2................minutes per in h Depth of Test Pit.................... Depth Pa' •-------- Description of Soil © -1 -- ------------------ - = - �. 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 L ITIL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ed by the board of healthl Sigd -----------------------••- ..................... ................................ Date Application Approved BY...._.... ,' ---- ---- d��f..�..................... ........................................ Date Application Disapproved for the following reasons:---•••-••--•••-•-•---•-•-•-•--••-••••--•--••••••---•--•••--••-••-•-••-•---------------------••--............•... '-----.•...--••--=--•'--------------•-------••------------------------------------------'•----------•---'---•-•----------------- ----------------------------------------------------------------------- Date I PermitNo......................................................... Issued_:t '3_� ................... Y--•- .--�._ _ - -- Date No................'.. .... rv� Fun.......:%?.� . THE COMMONWEALTH OF MASSACHUSETTS LBOA RD HEALTH .... ...........OF........ .' -40+411__---•----------------------------------------- % , pp ftrafilan Or DJapo t Narks Tnwunr#inn rrti i# Application is hereby made for a".Permit to Construct ( )`br Repair ( ) an Individual Sewage Disposal System at: , d • . . �►.+. ::.. . ... : ..........................' 1................................................ -• Location'"sl e�r�ess ���,,,• or Lot No. ..... -- .. . ......--•--•-•••--•.._ -•-------------------------------------------- s Address 4,10 _______________4..........._...___.........__._..._____________._.............__. Installer Address Type of Building Size Lot............................Sq. t, --Expansion Attic Garbage Grinder Dwelling—No. of Bedrooms_..__ �_" p ( ) g aOther—Type of Building No. of persons____________________________ Showers ( ) — Cafeteria ( ) a .. Other fixtures ----------------------------- --------------------------=`----------------- -- W Design Flow._____ ►_ ___._______ gallons per person per day Total daily flow________ gallons. Wx PtTank(—Liquid Jl uld ca ac>t - -�gal�hns Length................. _____ ___.__4_ x• Width________________ Diameter................ Depth................ Disposal Trench No d ._ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No______ _____________ Diameter....... $........ Depth below i et _ __._..._. Totahirag area :+ __..sq. ft. Z Other Distribution box ( ): Dosing tank/ 6r '~ Percolation Test Results Performed b ............: ..... ._..._..___ _..___.. . Date.__ �__:._� " !�"_ Test Pit No. L_ "'_minutes per,inch. Depth of Test Pit____________________ Depth to ground water_______________________- L,:, Test Pit No. 2................minutes per i h Depth of Test Pit____________________ Depth to ground water........................ _ p� O Descriptio of S rl- A r f V , ------------------------------------------------------------------------------------ W UNature of Repairs or Alterations—Answer when applicable............................................................................................... ------------••------•••----•----•-•--•• •----•---------- •--- ----•• ............................................... Agreement: t The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ued by the board of health Sra ------ . = C ---------•-•-----•"---- .......................... Date Application Approved By... - .•---.... ' Date Application Disapproved for the following reasons-.......................................------------................�................................:........... .................•--"-......-•----•-------•-•----------------.....-"---:....-•---•---------•-----...---•----•-••......--•--•--••••-••-------------------.--•--......-------r--------------------. ate Permit No............... = ._.. Issued s •^..... Date THE COMMONWEALTH OF MASSACHUSETTS f f BOARD OF HEALTH .............. �� ...............OF........... .......`............._......._....-......--•----- Trrtifiratr f�lamph anrr .. T IS IS T CE IFY, That tare u vi ,e` ge+Disposal System constructed ( ) or Repaired ( ) by---- . .. ... ....... . . --"............ ----- ------ ......... ...... Inst 1 has been installed in accordance with the provisions of T r of The State Sanita'ry C de e ihhed in the application fqr Disposal Works Construction Permit No. �°" dated................................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST E S A UARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.----...3 �Z� Inspector..... _._...•-•••-......••-•--•--••---••-• ................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD RF ..HEALTH LL ..... ;'t. ....-......OF.. :. '--... N ............�?.. FEE.__. .+........`..... i �a nri�a Permission is,hereby granted. • ..... . t to Construct ) r Repair ( ) a In vld al =age j i�osal stemgo - at No. `" fit?' '•• _....... . Stre _ { as shown on the application for Disposal Works Construction Per t o.:.__ �______ ated---- 3 ....................... -•••--- .....�f a ......................... Board of Health DATE.---._. --•-- --------- -----•�•----.....---._._....-•---... _._._:.. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS . r ;..r 301L LOG �>n� U�:A\V.nk�n�ex/ia.u.Jycavni�s�liAiil/1ix � -_------ // —, 2 PEAS TONE LOAM 9 FILL 12 MAX. r-.- 4"C. 1. DIST L B O X °ia'MIN 0 _ i +! 24'MIN. f7 I.ZC :({ �{ '15 . .1000 I •ee> 1000— GAL. d o01 s GAL. o' PRECAST OR t, L a! M `� a�I 3K i 15 0 SEPTIC 6 , n�•�, BLOCK, ° TANK °o SEEPAGE PIT °' , ° Area✓c*% 5 r t, ka N• 20' MINIMUM ; � '. °o Ttal= 267 � I, a ,• — — — — — � I FOUNDATION Jo I %: WASHED STONE 1 1 ELEVATION SKETCH --- to - --- ►tRC. RATt � _L � TEST BY SCALE I = 4' - — - TOWN INSPECTOR ?*p L M'A4&A� BACKHOE OPERATOR . S TEST MADE ON : !' 10— Lo off,? CA 7R _ �Exp. T.r :5epticTeak. h w� L Ct j I_ 2°'� a-•------=---.,.,..,. 5' ..�'� - ''�,% ' -!�" cam..'` �'CY C� f�3�' "$, f ylot �NE C. �LLr lob 5lclleW.,116 1$ ,s,c x 2,5-0 B6)"kAa 7� 4 x 9•0 - ° 79 64 9 ELEVATION SCHEDULE _.._.. PROPOSED SITE PLAN INV AT FOUNDATION ��'✓ ,' ' SEWAGE SYSTEM DESIGN ^I � INTO SEPTIC TANK = f�f�• � IN 3 NV. OCT OF SEPTIC TANK = 100.4:' // J { R 'r` NV ',TO DISTRIBUTION BOX = ��- '`? SCALE I '=��? f't�:�n C'1.1l 1911�r NV OUT OF DISTRIBUTION BOX = t,k9 c' C 0-9 `yr rr'' •gP� P S G ENV INTO SEEPAGE PIT = 9caa.ru v CAPE COD SURVEY CONSULTANTS f3A'4A T - r ROUTE 132 !� 7 BOTTOM OF PIT = ��' HYANNIS, MASS �, fAtt4ECti" °• A 01-113iON BCSTON SURVEY CONSULTAmrs, INC. '"%'1 �47 04 8 BOTTOM OF STONE LAYER = °5 f - ASSESSORS MAP : 4ZqZ PARCEL �Zz TEST HOLE LOGS slt'111 cojni-'� %vitlt 'l'itle V lard "foml o loard of FLOOD ZONE: � �/� SO L EVALUATOR' *49 61 • .. I lealth Itegula(ions. - - WITNESS -^1 � In I 2) 'I he installer shall verily lire location of utilities, sewer inverts and septic REFERENCE: _-_1,: J6� "' Z� DATE: cantponents prior to installation and selling base elevations. (� �' PERCOLATION RACE: G Z t I , 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per loot. 'I I lirst — - - , two feet out of the d-box to the icaching shall be level. TH- I TH-2 ��-��r•�3�5 _- U'S3 - -- 4) 'I'his plan is not to be utilized for property line determination nor any other ------ ,_ purpose other than the proposed system ins(allation. r- 5) All septic components trust meet'fitle V specifications. 10 1 6) (larking shall not be constructed over 1110 septic comp onew.s. l t 4710 V 7) 'lie property is bounded by property corners and property lines. Lb I �b p �� j 8) "l'he property owner shall review design considerations to approve of total LOCATION MAP ` design flow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed l`��• ( � approval of the design flow by the owner. i C L 9) 'I'Ite existing leaching or cesspools shall be pumped and filled with material L� per Title V abandomnent procedures. 1'hose within the proposed SAS shall \� (e �� r 104�' be removed along with contaminated soil and replaced with clean sand per . lq Title V specs. `'' �`[� \� 10)System components to be 10 feet from water line. Sewer lines crossiu l the 5" ` water line shall be sleeved with 4 inch SCI 140 PVC with ends grouted if \ ) l� _ applicable. 'l'l►e proposed SAS is being installed below the water service — 1rj° b� line. The line is to be sleeved as aforementioned and maintained in place. Q -- S E P T I C SYSTEM DES I GN 11) If a garbage grinder exists it is to be removed and is (Ire responsibility of the owner to ensure such. _ \ FLOW ESTIMATE 12)'I he installer is to take caution in excavation around the gas line ilsuch � 2 exists. �y F �J BEDROOMS AT I D GAL/DAY/BEDROOM -` GAL/DAY l3)"I'ite installer shrill verify the location, quantity and elevation of the sewer -i 0 lines exiting the dwelling"rior to the installation. ply ��( 14)'I'his plan is representative only that a system can fit on a property meeting � - ---� � SEPTIC TANK 'title V requirements. I� ��OGAL/DAY x 2 DAYS - �C�GAL USE IDZGALLON SEPTIC TANK ( 4- 0-*Ic ABSORPTION SYSTEM 1 1 WTI i5lt> \ Q SIDE AREA: Zk LCj �- �Z,`t'jv XZ„k ,� - I � I ,9� a � UJ�VIU y c a BOTTOM AREA: Z57 N, 1Z e> X 00 Z3-]►3J� MASON y v F� S1 �Z--- Q SEPTIC SYSTEM SECT I ON IT 14 --y �i �5 B •AND 1�����__- _ �` w � tk L acBOX- 0 W v 11 -�_ 110 3ti'Myx, Alq_ t I 1 o COb GAL ��,Zj� �3i I-PPA� tfiJ . SEPT IC TANK t (5U5nWLf) p� l OTIDM�I YL SITE AND SEWAGE PLAN LOCATION : 4 U waf, l�lU�,t l PREPARED FOR : M O ! w SCALE: j DAV I D. B . MASON RS DATE: I 0 DBC ENV I RONMEN�TAL DESIGNS b EAST SANDWICH . MA DATE HEALTH AGENT ( 508 ) 833- 2177