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HomeMy WebLinkAbout0007 GINGER LANE - Health 1 GINGER LN, OSTERVILLE �A= 165-012 .. 1 0 a u L 1 E i � TOWN OF BARNSTABLE r 1 LOCATION ��hq�r/h7 SEWAGE # �4eo Ge VILLAGE S�e `�1�`L ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 69rM4 IVIl G®rCV` SEPTIC TANK CAPACITY LEACHING FACILITY: (type).�46t�-440 (s) (size) 5s'x7 NO.OF BEDROOMS 1 r1 BUILDER OR OWNER ��^^ Nt PERMITDATE: X'�� COMPLIANCE.DATE: '"7 7 -- 1,Sf 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 a —Pt-7 Peat �y 3Q � No..`.........._....... Fxs.... .v............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ApplirFativat for Mit u.!3Fai Wor1w Tomitrurtiura Vertuff Application is hereby made for a Permit to Construct ( ) or Repair (K) an Individual Sewage Disposal System at: ............................••---........_...-•-•--------...------------ -----•-•---•••--•-_...-• -•-•--------------i-- -----•----------------°---,-•-G-- ....... .............. ----- ��J� 40 l Location- ' dd ; I�/j i- 1 Q C✓I � sr�2(�l LAZE ✓v✓T ......�_._..._....--•---------••---•. •-•---6 -------------- •-•-••------------------ t ................. Owner ress W U ." /L vc4—z fo,l `ZCe#� GJ�t ✓1/I tis.f Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms_______________y__--_-__--_.---___..__-Expansion Attie ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons.................._--------- Showers ( ) — Cafeteria ( ) 44 Other fixtures _____ w Design Flow...................... .....................gallons per person per day. Total daily flow---------- __-__.___-.......................gallons. WSeptic Tank—Liquid capacity--gallons Length___,./947 Width..Ste__ Diameter---------------- Depth................ x Disposal Trench—No. ......../........ Width...... .....___ Total Length---4!��Kof Total leaching area....................sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.___r `T___ Total leaching area..................sq. ft. Z Other Distribution box (0-0 Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ ------------------ ------------------------------•-•-•--•---•-••-•-•---------------------•••-----••......................................................... 0 Description of Soil......................................................................................................................... .............................................. x w U Nature of Repairs or Alterat�p ns—Answer_ wen japplicable.._� ..'_ __''Q tip ( / Agreement-- 1 K a4a e-.," 5 ys�Le,-,j7 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 be sue by he board of health. Signed ........... . . ..... ...... . ._.. .,•... - - " -, . `Application..Approved BY ................... ^ T�J� . - ...........- - � ------------------------- Application Disapproved for the following reasons- ---------------------------------------------------------------------------..........----......------------------------------- - ----------------=--------------------- -----------.................................................. Permit No. - ................... Issued ------ `------ u- - Date • y No.. ....----�/� FEs.....�.0............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Allp iratinn f,ar Di-tipw3al Works Tomitriir#inn 11amit Application is hereby made for a Permit to Construct ( ) or Repair X) an Individual Sewage Disposal System at: .....................•---•---•-----•---•-•-......•----------•=-----•......_..•-------- -•-•••-----•-•----;= .......................................................... Location- 4ddr•ss or Lot No. W 1/111r1i G l CGS. ; `'-7-C 4J/��.....c.r Owner �Ad^ess W 9�►~/JLU a / ..1.5 i i ZV t., !(�_1 `7X_ G F1� cs-J .l/-�1d Installer Address VType of Building Size Lot............................Sq. feet ., Dwelling— No. of Bedrooms----------------- ------_-_-___---__-..Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ----.-__------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 04 Other fixtures -------------------------------•-----------•-•--•-••------------.--.------------------ .............................................................. W Design Flow---------------------- ----------gallons per person per day. Total daily flow........... .......................gallons. WSeptic Tank—Liquid capacity/P _gallons Length-_.- Width-_ `%`jam__ Diameter................ Depth................ x Disposal Trench—No. ......../ ........ Width------.�'i........... Total Length.._��a+�t _ Total leaching area....................sq. ft. Seepage Pit No------------ ------- Diameter.................... Depth below inlet----- Total leaching area..................sq. ft. Z Other Distribution box (t�<) Dosing tank ( ) aPercolation Test Results Performed bY----------................................................................ Date........................................ ,.-I Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water......................... GZ4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ a ----•------------------------------------------------------------------------------••------...............•----•----•--•-------•---•-•----.....•••......•.... 0 Description of Soil........................................................................................................................................................................ x W x --- --------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ U Nature of Repairs or Alterattipns—Answer when applicable._ "..... �_Ito-�.._�i_`/-!U)...............�-- T�nJI� Q rs T% LSQac� _._ .................................../ c.............................. (Nr Zr Agreement: yri UhGl'e l^ 5 ySl4ehj 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 be sued by he board of health. Signed ............ ....... ........ ..--�---------------:------ y�` Daces---'' Application,Approved BY 457----------------------- -------------- .......`.,.." .------------- ------------------------------.---... ... .. ✓........ i7 Dare Application Disapproved for the following reasons: ...........................................`✓..............................- --------------------------------------------------�9N------------ --.......................................... ------------------------------------------ --------- _------------------------- Permit No- ---------------- -- --------- ---- ------------------- Issued ,� - 3�-----...... Dare ti THE COMMONWEALTH OF MASSACHUSETTS 1 �j/ Z - BOARD OF HEALTH / (/ G_ TOWN OF BARNSTABLE C11Ez#if rate of Compliance THIS IS TO CERTIFY, Th t the Individual Sewage Disposal stem constructed ( ) or Repaired /�21e rI C -G�..................................J rc�' 7� . - - _.....by - - ---G............................................... at ............................................................. -----............C �� AGE -----L.4!- n--------------------`-s.---- / ---------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The 5tate Environmental Code as described in— the application for Disposal Works Construction Permit No.4 .. D h dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.....---------- .---. ..-rl - - - Inspector .... -k ----------------- ----------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No�`✓--.......� FEE..............•-•-•---.. Dininttl Workii Tnnntrudinii rrmit Permission is hereby granted . ---------------------------••-•-••••------............. to Construct ( ) or Repair (5, 4) an Individual Sewage Disposal System _ atNo................................................:-------C 1 _s%. -:.......C AI------ ; ........................................ Street as shown on the application for Disposal Works Construction Perm' I 7__ / � Date �� �.. ��" ------.:_...._,:......._ .��- =...... ��J---- -- - ..... ....`�.. ��� Board of Health DATE '------------------ FORM 36508 HOBBS h WARREN.INC..PUBLISHERS ( ^ m SENDER: I also wish to receive the y Complete items 1 and/or 2 for additional services. m • Complete items 3,and 4a&b. following Services (for an extra ra U) • Print your name and address on the reverse of this form so that we can feel: > 4) return this card to you. m • Attach this form to the front of the mailpiece,or on the back if space 1. El Addressee's Address N does not permit. 4, ``I t • Write"Return Receipt Requested"on the mail piece below the article number. 2 ❑ Restricted Delivery a • The Return Receipt will show to whom the article was delivered and the date U o delivered. Consult postmaster for fee. 3. Article Addressed to: 4a. Article Number 7 L 4b. Service Type ( E ❑ Registered ❑ Insured Certified ❑ COD y W El Express Mail ❑ Return Receipt for 2 I p� I I Merchandise 81 7. Dat of Delivery 4-1 a 01 5. Signature (Addressee) 8. Addre s Address(Only if requested Y and fe is paid) �o 6. ignature (Agent) F' 0 PS Form 3811, December 1991 *U.S.GPO:1993-352.714 DOMESTIC RETURN RECEIPT 1 i UNITED STATES POSTAL SERVICE Official Business PENALTY FOR PRIVATE USE TO AVOID PAYMENT US MAIL OF POSTAGE,$300 �rI M Print your name, address and ZIP Code here r 11 I • � ;i Boar!OT Heft Town of BWMIN61� P0. Box 534 . tF, ifs, Massachusetts 02801, Z• 348 641 1.53 .. Receipt for r Certified Mail No Insurance Coverage Provided UTA,E© Do not use for International Mail MVALWW CE (See Reverse) OMi Sent to t Street and No. Rf � P.O.,State and ZIP Code O � Postage M E Certified Fee O LL Special Delivery Fee �. LL FRestricted LQel iveryf F-.ee =R etu rncR ece i ptcS how ing to Whom&Date Delivered Return Receipt Showing to Whom, Date,and Addressee's Address TOTAL Postage �L &Fees $ Postmark or Date STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). m 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(no extra charge). CC 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address of the article,date,detach and retain the receipt,and mail the article. 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed co ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. C Go 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, M endorse RESTRICTED DELIVERY on the front of the article. 0 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If L- return raceipt is requested,check the applicable blocks in item 1 of Form 3811. a 6. Save this receipt and present it if you make inquiry. 105603-93-13.0219 Town of Barnstable s � Department,of Health, Safety,and Environmental Services • snxt+s ABM t MAS& } Health Division 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A McKean FAX: 509-775-3344 Director of Public Health May 30, 1995 TO: M. Madden 7 Ginger Lane Osterville, MA 02655 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 7 Ginger Lane, Osterville was inspected on May 17, 1995 by Peter Sulllivan/Joseph Macomber a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Liquid level observed over the top of the cesspool cover(hydraulic failure). You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within(14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF TEVBOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health ASSESSORS NIAP NO: PARCEL NO: (�� l , [Installer letter] T0: U �� ' '�"� ate ffi:n' _ �jrn Ccra.e. ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by ou located` at r7 C>sE ,(.boas inspected on G�1711V5 by4 - _ '� a Massachusetts licensed septic inspector. Nx=cat T The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the followin You are directed to hire a licensed Town of Barnstable septic system installer to asubmit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to l any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable {; • e t Y PROPERTY ADDRESS:_7 Ginger_LaaQ-_________ Osterville Mass 02655 ---------------- On the above date, 1 Inspected the septic system. at the above address. This system consists of the following: A. 2-6x8'-block cesspools. !1 1 Based on my Inspection, I certify the following conditions: A: This is not a title. five septic system B. The sewage sytem was filled to capacity. C. The system is in failure. SIGNATURE, __ i Name:_J_P_Macomber ,'______ i Company: J_P_Macomb�r - uu_Iz�c Address: _------ ----- _Centerville`Ma_ssj_0Zr2-32 Phone: 508-775- ... THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachflelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775.3338 775.6412 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , Address of property 7 �,,\Dc t-aN G 05rZe�i i_L_e Owner ' s name M#dden Date of Inspection !}� \�� 19 15 PART A CHECKLIST Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of. water have not been introduced into the system recently or as part of this inspection. 1V 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 site was inspected for signs of breakout. A11 system components; excluding the SAS, have been located on the site. o C csr,Pco L, v nl L� 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 SAS on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. \. L ES 6 U _F LC C ►.� r4 uc-T 7 1 K)£F-X_P.L C_ A. C-xIe3 AA--=L E C__t 0 t tV O Z'C_ FD 'Z tT V t -n+c Li Pc p(= C 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential number of bedrooms number of current residents No garbage grinder, yes or no ` ES laundry connected to system, yes or no Qo seasonal use, yes or no If nonresidential, calculated flow: Water meter readings, if available: Last date of occupancy P Y GENERAL INFORMATION Pumping records and source of inf rmation: I System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: Type of system Septic tank/distribution box/soil absorption system —X,-_ Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) Approximate age of all components. Date installed, if known. Source of informat ' on: (S, C oV }-4©c � OYES %5 Sewage odors detected when arriving at the site, yes or no 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B 1111 SYSTEM INFORMATION continued ,SEPTIC TANK: V-- (locate on site plan) depth below grade: material of construction: concrete metal FRP other(explain) dimensions: sludge depth distance from top of sludge to bottom of outlet tee or baffle 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. 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, recommendations for repairs, etc. ) DISTRIBUTION BOX: ►ko&4 c , (locate on site plan) . depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc. ) PUMP CHAMBER: (locate on site plan) pumps in working order, yes or no Comments: (note condition of pump chamber, condition of _pumps and appurtenances, recommendations for maintenance or repairs,etc. ) 1 a: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B l SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : _ (locate on site plan, if- possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: , Type leaching pits and number leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level of ponding, . condition of vegetation, recommendations for maintenance or repairs,etc. ) CESSPOOLS (locate on site plan) : number and configuration LDS depth-top of liquid to inlet invert _=_ 6 « 0y ee 7c) depth of solids layer44 Cot9E2 ©�q depth of scum layer dimensions of .cesspool materials of .construction indication of groundwater inflow (cesspool must be pumped as so part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level 'of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) _ eC-SSS�� 1til htY��Zf V L��, (=A t L) e-G PRIVY: �U1..1 t� '. (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, recommendations for maintenance or repairs,etc. ) ',•-- '• 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' ► 0U i n6 7 y I'C7 DEPTH TO GROUNDWATER G 4` depth to p groundwater method of determination or approximation: U5GS 7 )eO b►U qZ rcCt2k,?- -Y.e, e.GAS ,,a i\75 c LZ r- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined", explain why not) '.� Backup of sewage into facility? Discharge or pond'ing of effluent to the surface of the ground or surface waters? Static liquid level in the distribution box above outlet invert? Y-E�L Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow. c" �nrt,• ou���OF Gv.aC�. -- SY5T�M, t�,l t�`la��vLlL ����2 MWIL Required pumping 4 times or more in the last year? ~" number of times pumped Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? •iVv Is any portion of the SAS, cesspool or privy: below the high groundwater elevation? y within 50 feet of a surface water? �U within . 100 feet of a surface water supply or tributary to a surface water supply? 0 within a Zone I of a public well? ►`0 within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? within 50 feet of a private water supply well? " PP Y 0 less than 100 feet but greater than 50 feet from a private water ater 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 Qrganic compounds, ammonia nitrogen j and nitrate nitrogen. 05/18/1995 11:24 508-428-3508 C.-.O.MM. WATER DEPT ?AaE 03 KEY NUMBER <3260 > NAME 4MADDEN, LAWRENCE > B—C 1 B—C 2 B—C 3 B—C 4 STREET 85 WIANNO CIR CITY OSTERVILLE ST MA ZIP 02655-2114 REF 1 REF 2 PHONE (508) 428-9794 REF 3 REF 4 METER NO. < 3018> DATE READING CONS STREET <CINCER LN NO. 7N 12/31/94 3 100 CITY OST 0 L30 ST LOC 11/18/94 0 0 PHONE ( ) — 11/18/94 1287 97 06/30/94 1190 32 ROUTE' RUi•IBER 14 14/3i/7J it✓v ai`r SERVICE DATE 12/12/66 06/30/93 1043 54 METER DATE 11/18/94 12/31/92 989 104 CAPACITY 7 06/30/92 885 30 STYLE T10 SIZE 1 RATE SCHEDULE KEY PIT PLASTIC NOTE RR LEFT SIDE RENTAL & SY SYS! ADDITIONAL CONS 0 ALTERNATE MIN 0 SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART D CERTIFICATION Inspector : Peter Sullivan PE Location :7 Ginger Lane Osterville Date : May17,1995 Certification Statement I 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. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303 . The basis for this determination is provided in the FAILURE CRITERIA section of this form. y your d al'Z Peter Sullivan PE Distribution: t ne Original to system owner Buyer PATER Board of Heath SULLIVAN NO. 29733 o AL No..9, _�X5 Fss... ...3 0..0 0... THE COMMONWEALTH OF.MASSACHUSETTS BOARD OF HEALTH �. TOWN OF BARNSTABLE Applirtttioit for Dirpooal Worlio Tonfitrurtion Permit Application is hereby made for a Permit to Construct ( ) or RepairX(gX an Individual Sewage Disposal . System at ................7...Ginger...pane.-GstervIL e---•--•------- --•--••-----......................-•---•-•-•--............................................... Location-Address or Lot No. ................Ma iden........--••-------........--------•---.........----•-........... .............-----............ .............................................................. Owner Address W ................J.A P..-MaC0J03beir...Jr....................................... Installer Address Type of Building Size Lot...................:. ...Sq. feet U Dwellin }feNo. of Bedrooms............. Expansion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons.....................--..... Showers ( ) — Cafeteria ( ) 0" Other fixtures ....................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W. Septic Tank—Liquid capacity............gallons Length................ Width....-........... Diameter................ Depth................ x Disposal Trench—No. .................... Width..:................. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..............,..sq. ft. Z Other Distribution box ( ) Dosing tank ( ) _ Percolation Test Results Performed by..-•-•-•••••-•................ ... ....•.................................... Date...........-............................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ L% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ p♦ .....................••---•-••------........•-•----•---•-•-••--••-•-----•----.....................----•---••-••----•....._......................-- ..... Descriptionof Soil..........................Sand...&...Gravel.......................................................................................................... x W :..... -----•---•......................•--•----•.........-•--••--••••--....................--•-•-•--•--••-••........................ UNature of Repairs or Alterations—Answer when applicable..--Qmi.t...Cesspoals....-Install...1. 1.5Q0--.--- ...............qaj-ion...tank....l.ndiS.tribut.i.on...hax..and...two....1.Il0-0..-gallon...Leach...pits._........ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia ce has b en 'ssue by the and opf health. Signed ... .. . ... ..... ... ....3.f.-.2.81.9.5............ I3rc Application Approved By ..............................:........ ...% .......ate.. Application Disapproved for the following reasons: ......................................................................................................................................... ............................................. ........... Permit No. ..........................7. ................... Issued ...... .............. .... Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ( /vertifirate of C11omplinure THIS IS TO 'CERTIFY, That the Individual Sewage Disposal System_ constructed ( ) or Repaired f XX ) by ............J.,-P..Ma.comber....Jr................................................. ................................................................................. in er at .... ....................nger...La.ne...Os.ter.v.il.1.e......................................................................::..............................:............................................ has been installed in accordance with the provisions of TITI. hO to e Environmental Code as described in the application for Disposal Works Construction Permit No. tom. :.-- ... dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION.SATISFACTORY. DATE........................................................................................................ Inspector................................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH "-. TOWN OF BARNSTABLE ' 3G.OU Ropoind orko Tonotrurtiun Permit t Permission is hereby granted........7...P..19,aComLien..J7r....................................................................................._.... to Construct ( ) or Repair(X n an Individual Sewage Disposal System IN 7 r-incier• Lane, n. �n atNo. .................................................Y., .1. ..............•------...------.. .-----•----•---.........................--•-----.....---------..................... as shown on the application for Disposal Works Construction Pere-- -1.. atS.:..--�1- ` i ............1/.�-'�.0 .. . -�`--.... ..............._ �� Board of Health DATE........ --....-----•...... ..........� ............---•--••--- M - FORM 36308 H0889 tl WARREN.INC..PUBLISHERS