The URL can be used to link to this page

Home My WebLink About0089 HATHAWAY ROAD - Health 89 HATHAWAY 126AID, ®STERVILLE A= o i I n TOWN OF BARNSTABLE LOCATION a q 4AIk A-w Atl (it SEWAGE # Y) 0 e C l V1 V� VT,LAGE CAS ASSESSOR'S MAP&LOT / INSTALLER'S NAME&PHONE NOt�rcc �(c�ee�l I�M� SEPTIC TANK CAPACITY �" A 114, 0 3 2 -�-- LEACHING FACILITY: (type) w®o ( (size) SOT '7 A�NO.OF BEDROOMS 3 t BUILDER OR OWNER C�,�l�`► PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply.Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachi facili, ) Feet Furnished by I&C- x �us� 1 s, �� TOWN OF BARNSTABLE LOYATION 5 �'�r'"'o w�Y SEWAGE# S 7 7 VILLAGE y //e ASSESSOR'S MAP&LOT/ f INSTALLER'S NAME&PHONE NO. 14 -ems r- SEPTIC TANK CAPACITY /S—o cP 6:1`�' f LEACHING FACILITY: (type)3 Ste " �/ � •s(size) llcl X/2 g X Z NO.OF BEDROOMS BUILDER OR OWNER ti (r;�`w Ova J,//)/ \_ PERMTTDATE: " 2?0' "9- COMPLIANCE DATE: Separation Distance Between the: a Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist C 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 byl/ C Ado /_ 6 F QS S° 6b 1 1 � 1AA a � t 9 No. _ / 7 Fee--�� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for. &g ool *pgtem Cow6truction Permit �. Application is hereby made for a Permit to Construct(x)or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. �9 1441-4AW.4y ?o d, OS4Crville ESQ N,ot A y 24,vo/�y Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. All G'A P c tt r/h, y9 2o. .9 Type of Building: Dwelling No.of Bedrooms Garbage Grinder(— ) Other Type of Building /Ze5 No.of Persons Showers(,3) Cafeteria(_ ) Other Fixtures 'J '/ Design Flow �/7 gallons per day. Calculated daily flow 7 yd gallons. Plan Date f D—a- �- Number of sheets / Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) Se OQ tic S�f�� a L nu a ti^N4G o 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 not to place the system in operation until a Certifi- cate of Compliance has been issued by4s Board of Health. Signed Date Application Approved by ze2— O Application Disapproved for th ollowin reasons Permit No. �� 17 7 7 Date Issued A(a clO ^/ ,� • •`.fl.:t•`' Ksy. ry ! .—. � 4-Y... ',•.a r/ .r �j c�... a .. .. t -� � � ' 1 � � t./ � •'* sl ., I�r No. / `1 +� ! _.A..w:�' -Fee x _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppft ation for Migaal *pgtem Congtruction permit iApplication is hereby made for a Permit,to Construct(>0 or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. `.of 78 N/' 11� errs. /?C. g9 N41-4Aw.,y R0., J OS-F«V,Ile- E19 N�f Away 2� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ,411 CA P C E7"17,/ri e C f-/n 7 ". tY 9 N;AR 619 fee,AQJ ` :.� Type of Building: Dwelling No.of Bedrooms Garbage Grinder( � ) Other Type of Building /Qe5 No.of Persons ;2 Showers(3) Cafeteria( _) Other Fixtures / , Design Flow ' - �la '7 gallons per day. Calculated daily flow 7' y0 gallons. Plan Date 10— a Number of sheets / Revision Date Title y _ ... ,, ..• Description'of'Soil • Nature of Repairs or Alterations(Answer when applicable) Sf o tic 5V S-61 14i�a oi.,dP • A Date last inspected: R — a 1/— /99S_ h 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 not to place the system in operation until a Certifi- cate of Compliance has been issue 's Board of Health. Signed / Date f Application Approved by A2 4La t Application Disapproved for theVollowi'n-j reasons ` Permit No. q��— 1777 Date Issued d��— ra Q '/ THE COMMONWEALTH OF MASSACHUSETTS— PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced( )on by ` for slyw .. as t has been con ructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated�d ' ' Use of this system is conditioned on compliance with the provisions s5,fe below: Or No. 772� Fee /THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH,DIVISION - BARNSTABLE, MASSACHUSETTS v ligpogal 60tem Congtruction Permit Permission is hereby granted to � y%P G I"3� to construct(X)repair( )an On-site Sewage System located at 29 41&fAA A4 lekel, r' 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. All construction must be completed Mithin two years of the date below. Date: Approve F .40 ' wide C.i3: d.M. 30.6. Sir — IS4.St ( 104 E 34" La r 78 I. i 4 d0 S6 344 \ { �� L } 77 tot( . _ _ ci 1.0 76� _ Shaded atea N ed°add p�iopoa - I I I I 31.3 !,' �,'j it ion. on. -�1- 21 30' aep tr c ,goo p O L _ 303 ioCe to ue Use'3-500 o a tone.al , ,P, ite No Sca& E NA NG d - ._........ -- _ 11 3 o j'. yi_ �4, So _ ,, ,'�,': '1 w �- --2-G�J.t.O ��r�� — :tone 6 11 a"`-"d g o t tell eL pep-tic�,�ate,rc Upc�.aile ; i ST.te [)tOn b� .('a i 414 UJ•i rvino, O1AehflV tp, I;q �3P.uu Cod 78 c-. ilw winon 4C.f266LI-72 Reuc tiona.. ace on an aaAawd da tw t:. ��✓c �e�can, w1o. ued�orli. �! &a/bPa,tec! -Cow 4140 dad Date: cent: l a� e o o ,ak j t i e -' �iecy d,S00 cat .50-tt. atea 442 �_ . ._._ At Cape �1 q;ne 4112 .74 - 327 'qpd 49 Ratbo-t ate-a -186 44 l4yanni,., I'W 0601 1EG � . .74 - .137.6 gpd .,�• ptou 464 qpd i h�ro. 3?4'a0 , , J f --1--1--i 1 j .. j. 1 .i I 4--1: ,•1. Existing Conditions 5-17-19 Re-labeled storage 1-10-19 i i I r c�z ! Bulkhead Boiler/ Utility/Storage ,F i Electrical/ 5 Shop Lv bell 1 r i Water Meter I 1 Az f i n OGII).. Rya-m,11 (� 2 'X20' I Closet I I N71 Ga.! - 1 4'x s Room is JX-131 Store oorn •5 i Media Room, 21N911 Den. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property 89 �'�� R��-��V� 'd� e'v•`1 e Owner' s name 06�1V_ Date. of Inspection ASS, atj, kc�qg PART A CHECKLIST Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. _V"- 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. J' 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. J,� All system components, excluding the SAS, 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. _v,"_ The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. _k/' The facility .owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. �0 3L11� AUG 3 ,1 1995 �N P 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential _ number of bedrooms O number of current residents _Q garbage grinder, yes or no laundry connected to system, yes or no �t seasonal use, yes or no If nonresidential , calculated flow: Water meter readings, if available: o 2 Last date of occupancy GENERAL: INFORMAT.ION Pumping records and source of information- /Vy System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: Type of system SjA'VNW= Septic tank/distribution box/soil absorption system Syslm -r 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 information: Sewage odors detected when arriving at the site, yes or no i 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: (locate on site plan) depth below grade material of construction: concrete metal FRP other(explain) dimensions: /00069/ ��. X �✓ ��/r sludge depth W distance from top of sludge to bottom of outlet tee or baffle 0 scum thickness ,R 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. ) v DISTRIBUTION BOX:_ (locate on site plan) depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out .of box, recommendation for repairs, etc. ) PUMP CHAMBER _ (locate on site plan) pumps in working order, yes or no Comments: urtenances (note condition of pump chamber, condition of pumps and' app , recommendations for maintenance or repairs, etc. ) 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : 3 (w.= (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 l - I py0 !�� ecAsT 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 mai, tenance or repairs, etc. ) CESSPOOLS (locate on site plan) : number and configuration ,�Plle '�OC depth-top of liquid to inlet invert depth of solids layer depth of scum layer dimensions of cesspool X materials of construction indication of groundwater inflow (cesspool must be pumped as part of inspection) /1/0 Comments: (note condition of soil, signs of hydraulic failure, level of ponding, ations for maintenance or repairs,etc. ) condition of vegetation, recommend P ) g , PRIVY : (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. ) 1?. 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 ' 'BACK Aar IT Th C.-Spool- Svrsle. 7 Boy 1.0oo L S Us le- a .T /6 ' � DEPTH TO GROUNDWATER ox7 0 depth to groundwater T .� method of determination or approximation: b7 vi / 12 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 ponding of effluent to the surface of the ground or surface waters? Static liquid level in the distribution box above outlet invert? ��`-- Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? 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? Is any portion of the SAS, cesspool or privy: Abelow the high groundwater elevation? within 50 feet of a surface water? within 100 feet of a surface water supply or tributary to a surface water supply? l within a Zone I of a public well? within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? L?� within 50 feet of a private water supply well . _4/ 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 analysi for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. 13 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector Company Name BRACE MACALLISTER SHORELINE -CONSTRUCTION Company Address L3 POND STREET OSTERVILLE, MA 02655 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 manitenance of on-site sewage disposal systems. Chec one: I. have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15. 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. 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. Inspector' s Signature &ax,- Date Original to system owner .Copies to: Buyer (if applicable) Approving authority FEz THE C,'OMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH I � " Appliration for U44pos al' Mork, Con ra r ion= a ut Application is hereby made for a Permit to Construct ( ) or Repair ndiv ual Sre�age DisposaI x System at: V /C j .... .1,�1�.....�X ..... --------------------- Loc tion-Address N Owner Address W a "K's;-_._.....`.................................. ............................ . ............ Installer Address d Type of Buildin Size Lot.................... ......Sq. �et Dwelling No. of Bedrooms....................:................:......Expansion Attic ( ) Garbage Grinder O Other--Type of Building No. of persons............................ Showers — Cafeteria Pa Other fixtures •-----------------•---'-'----•'-'- -'- d -•---...--------'--•---'-------•----------------------................................................ WDesign Flow.......................................... allons per person per day. Total daily flow...........:................................gallons. WSeptic Tank Liquid capacityallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No..................... Width.. ........_ .... Total Length.........___ ----- Total leaching area....................sq. ft. Seepage Pit No..../............. Diameter........ Depth below inlet.......t�....._. Total leaching area.-._�.Lsq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by........................................................................... Date.._....--•------------------------------ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ PS 0 Description of Soil........................................................................................................................................................................ V --------------- ------------------------------ UW ______________________ Nature of Re airs or Alterations—Answer when h 1 -_____-__..__ .,,,.,......... ... . ....... 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 issued by the board of health. SignV.7 "Al.............. ...._.... D to Application Approved B am✓ --- ---4� ......................... f _...-•"-...Date Application Disapproved for the following reasons:............................................................................ . .__........__. ' ..........................................-.............................................................................................................................................................. u Date PermitNo......................................................... Issued_ ...t --••'----..._-•------•----•---'-• ` Date MW N ............._....... Fps..... ......_............._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................ ..................OF...................................... Appliration for Disposal Works Permit,, Application is hereby made for a Permit to Construct or Repair jndi�ival S age/Disposal System at �1�110w-- ,&................. ............... .......................................... ............................. N20 S......................... ...71a.......... ......... .... Owner ddress .................................................................. ............................. ....................................................a.............................................. Installer Address- Type..of Building Size Lot............................Sq. f t Dwelling' No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showets Cafeteria Otherfixtures ............................................................................................. ........................................................ Design Flow allpns per person per day. Total daily.flow...........................................gallons. 9 Septic TanX.L`iqui'd----c`ap*`ac'i_t----------- gallons Length________________ Width..._..._.._::_.. Diameter..................Depth................ W YI/P-----I �4 Disposal Trench—No ------ Width ............... Total Length.........._,e....... Total leaching area....___.._ sq. ft. --------- Diameter..._.__...... Depth below inlet......A�!........ Total leaching -------sq. ft. Seepage Pit No..../---------------- Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by.......................................................................... Date....----------...........---...-------- T6st Pit No. I................minutes per inch Depth of Test Pit._..._.._........_._ Depth to ground water.._._.._........_...___. fZq Test Pit No. 2......:.........minutes per inch Depth of Test PiL...................-Depth to ground water:._:..._._.........._... ............................................................................................................................................................. 0 Description of Soil-----.................................................................................................................................................................. -s..................... ............................................................................................................................................................................... ......................................................................................................................................................................................................... U Nature of Repairs vo I.41terations Answer whenI' ..... ------ ---------- . ......... ... ... ........................... 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 C&#ficate of Compliance has been issued by the board of health. S. IgIrle_'. _410.14 ate Application Approved By. 742 ...... .............. .................... ....—....../.. Date Application Disapproved for the folloteing reasons:................................ ................................. ...................................... ...............................................................................................................................................................................................-------- Date PermitNo.......................................................... Issued......................................................... Date THE -COMMONWEALTH OF MASSACHUSETTS;,_,,,+r,, BOARD OF EALTH .... OF. . ..... -- ------------------ ............ .................................. (.11.1rdifiratr of Tompliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by------_....................... ...... . ............................ ..... _ -- -- ------ Xns 2 -------------------------- at........ '4.... .... s.�. . ..-'el **------------------------ 7State Sanitary Code a has bee inkalle in accordance with the provisions of TIT 55 0) s desc the ... dated'_:...__." ........... application for Disposal Works Construction Permit No...7 ...........7............. dated'-:..... ..... .......... plic.ati .... .. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ............... ........... .... DATE....,--'L_ 7,9........................................... Inspector...../Z.1L. ......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OW HEALTH F.. ............... ............ . ............................ NO-1947. FEE........................ Permissionis hereby granted..................................................................................�.......... ................................. to,Construct or P>epair ��ndividual SewaR! System Isp at No....,..... ...iv . . ....... .......... .......................... Street 77 as shown on the application for Disposal Works Construction Perm Da. ........................................ . .. . ..... . .... .. ............. .. .... ...................... .............. Board of Health DATE.._... ..................... % FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS