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HomeMy WebLinkAbout0106 HATHAWAY ROAD - Health / f 6 HATHAWAY 'DSTERVILLE�' 'A= DATE: . 10/11 /00__ PROPERTY ADDRESS: --------_----__ 166_Hathaway Road__ Osterville, Ma._02655 ____ On the above date, I Inspected the septlo aystem at the above address. This system conslsts of the following 1 . 2-6 'X8 ' Block VCesspools. 2. 1 -Distribution box.. 3 . 1 -1000 gallon precsat leaching pit. eased on my Inspectlon, I certify the following conditions: 4. This is a split system. 16 'X8 ' block cesspool and box in and 1 -1000 gallon precast pit as an overflow. ! O 5. 1 -6 'X8' block cesspool in the front of the house. 6. The sewage system is in proper working order at the present time. Main cesspool in rear is under concrete & flagstone stone patio. SIGNATURE:. Name :_,,_ ,_jH s_Qmt q_r_,Ln---..__.. Company: Jo?.!2h_P _ Macomber„& Son , Inc , Address:_ Box_66 __Cant:vrvi11GL 'a__02632-•0066 Phone:___ -------- THIS CERTIFICATION oorS NOT CONSTITUTE A GUARANTY OR WARRANTY rag JOSEPN P. MACOMBER & SON, INC. T+nki•C1sipoolr'•LItchll�idi Pumped 4 1nItsllld _ Town sswor Connsclons P.O. Box 6775.3J38e�77, MA 02632.0066 RECEIVED O C T 1 9 2000 TOWN OF BARNSTABLE HEALTH DEPT. COMMONWEALTH OF MASSACHUSETTS t EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTm= OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292.6600 TRUDY COXE - - SeCTfJJY '. ARGEO PAUL CELLUCCI DAVM B. STRUHS Governor r Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM WSP'ECTION FORM PART A CERTIFICATION ` PrOpem Address: 106 Hathaway Road Naffw of Owner Joan Cox O s t e r v i l l a Address of Ownw: Dno of Mup.csson: 10/1 1 /0� Mum. of Mupe,ator: (pW,";14 oseph P. Macomber Jr. I sen a DEP approved sy*wn Inspector pursuant to Sact{ort 16.340 of TFde 6(310 CMR 15.000) C.o„,p,,,y M,,,w: Jose h P. Macomber & S n Inc. Ma&rVA6&e&s' j3oX bb, centerville , Ma . 02632-0066 TaJ.apl+ory Ntarr+ber' — — � ' CERTIRG►T10M STATEAtE}IT cerdty that I have personally Inspected the sewage disposal system at this address and that the Information reported below Is true. accurst• and complete as of the dme of lrupectlon. The Inspectlon was performed based on my training and experience In the proper function and ma.ntenance of on-sit e13wage dlsposal systems. The system: Passes _ Conditionally Passes _ Nseds Further Evaluation By the Local Approving Authority _ Fails The System Inspect r all submit a cop=thl, ctlon report to the Approving Authority(Board of Health or DEP)wh:Nn thirty(30) days of completing this Ins ctlon. If the system Is a shared system or has a design flow of 10,000 gpd or greater,the Inspector and the system owner stall submit the report to the appropriate regional office of the Department v nv{ronmenrall Yrotectlon. The original should,ba sent tovw system owns( and copies sent to the buyer, If applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 PagtIof11 t, /nnted on It"Wd rope( SUS.3UAYAC1 SEWAGE DISPOSAL 5YS•T111 WKCTION IFOPJA . PART A CU TViCAMN (oondnue47 r P►oo.Ry A6Craaa: 106 HathawayRoad Osterville own+..: Joan Cox Dercf or ku a-son: 1 0/1 1 /0 0 V4p*Cr4N SVur.uutYt Che k A. B, C, Of D' A. S�PAS I have not found any information wNch Indcates that any of the fjure conddons described In 310 CMR 14,303 #xtst Any W crftsr( nor,OYLI ted uo Indcatod below, Cotes: Main cesspool in the back ccess B. SYSTE?J CONDMONALLY PASSES: 1 One a more sy#tom sompononu u do#ortbod In the 'COC4404ta1►aao'soodon roved to be toplaood of repaUed. The systam. v compiedon of the roplaoement a fepalr,w approved by the Soard of Health, wW paw#. wdc6te or not determined(Y. N, of ND). Doocribe bawls of deteaminadon In all Irtatartoes. If'not det@rnQ%od', expla!A why not• The aepdc tank Is metal, unless the owner or oporstw has peov{ded the system kwpeotw whh a copy of a C04vnu19 Ccmp.Uance (anachad)Indlcadnp that the tank was WWJ*d within twenty(20)yews pr(w to tit@ date of the Vupocvo the septic tank, whether or not metal,Is stocked, owetura.Uy unwound, show# oubstanda)InWedon Of oaft►vedon• a faliure Is IrrrNlnent. The system wW peas InapooUon If the exl#Unp swede tank Is replaced whh a ownplytnp septic tan approved by the Board of Health. .� Sewage backup or breakout or Nph stado water level observed In the ds'trlbudon box Is dus to broken w oarwctad p of due to a broken, oordod or uneven dl#Vtbudon box. The system wW pass U wpocUon If(wM approval of Vw Boa+# c HealNl. broken p)pe(s) are replaced obswcdon Is removed dI#Vibudon box Is levelled of,replaced The synem requkod pvmphn177rmv dwt'fourthno#v•yosrduo to brdllmor obstP ated pipe(•). 7Ae Wr.*'Wm " InspocUon II(with approved of the So"of Hoalth)t broken plps(s) ar#foplacid obstrucdon Is removed • r . , gill Page 3or11' revised 9/2/98- SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECnON FORM PART A cEwnscATION (corrtlra+eE) P,%-.*M Ad&o&&: 106 Hathaway Road, Osterville Ownw: Joan Cox Dew 04 tns.p•acdon: 1 0/1 1 /0 0 C. FVRT'HEA EVALUATION IS REOUIRED BY THE BOARD OF HEALTH: Ce nftons exist which require further evaluation by the Board of Health In order to datermins if the system is t&MA9 to protect tho public health, safety and the onvlronment. ES IN ACCORDANCE WTTH 1) N ONING IN A MANNER WHJCKya_L pAQIECT HEALTH W '1 SYSTDJ THE pUSUC bEALT}IAND3AFE"r1MD TFit EEWZ8OkUB L IS NOT FV 0 Cesspool or privy is within 60 foot of surface water Cesspool or privy Is within 60 foot of a bordering vegetated wetland or a salt marsh. UPPLIER,IF A)M 2) SYSTEM Q W A UI.rJ1NSNEA THAT PROTECTS THE PUBLIC HEALTH ANBUC D SAFETY AND THE ENVIR�EWT:�T THE SYSTBw t3 fi1NCTIO NI The system has a septic tank and loll absorption system ISA31 and the 3A3 Is within 100 feet of a wrfsce water supply or tributary to 6 surface wster supply• The system has • •optic tank and loll oboorptlon system and the SA3 Is wlWn a Zone I of a public water supply weU. The system has • septic tank and loll absorption system and the SAS Is within 60 toot of a private water wpplY wou. The system has a septic tank and toll absorption system and the SAS Is loss than 100 foot but 60 foot to mW* trom o private water supply wall, unless o well water snalytla for collform bacteria and volatile orguJc compounds tndlcates Met V%4 well Is flat hom pollution from that facility and the presence of•mmonloVoge n not viand nitrate nitrogen Is OW&I to or loss than 6 ppm. Method used to determint distance _ (appr 3) OTHER This is a sews e s s , e r o -6 X o a r ry ) n front of house there is one V X8 ' block cesspool. The system in the rear of the house handles both gray water and sewage. The front cesspool handles one bathroom. . Pate)of It ' revised 9/2/98 i SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM � �} PART A -j CERTV:ICATION (condnued) P.opwTy Addrw: 106 Hathaway Road, Osterville owrwr; Joan Cox Derts of lr+ap+ctlon 1 0/1 1 /0 0 D. SYSTEM FAILS: 15,303, The b"A for this You must Indicate elther 'Yes' or -NO' to each of the following: AI&4 I have determined that one or moreThe tBoardhe lof Health owing lshouldure nbeticontacted to determineons exist as desciwhatt will be n cessary to �W tl" t"I doterminstion Is Identlff•d below. Y e s No �J pompons"doe 40 an oveffoe orvIe99��gSa.c�aPool. .�.•-•-- - Backup of tow e9•I^to�eCIW�•m� ed SAS or Discharge or pondlnq of o Muent to the surface o1 the ground or surface waters due to an overtoade0 or do99 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 then 6' below Invert or available volume Is loss than 1/2 day flow. Required pumping more than 4 times In the lest Year due to clopped or obstructed pipe($)• Number o1 times pumped Q_• Any portion o1 the Soil Absorption System. cesspool or privy Is below the hlph groundwater elevation- Any feet of a surface water supply or tributary to a surface water wDplY Any portion of a css>pooC or privy Is within 1 Any potion of a cesspool or privy Is•within a Zone 1 of a public well. Any portion of a cesspool or privy Is within 60 toot of a private water supply well. (/Any portion of a cesspool o►privy Is less then 100 toot but greater than 60 feet hom a Private water supply wolf witT the well acceptable wgtl qualitlye nalorgynlocofmpounds hammonla analyzed nlu pen and niuete nitrogen.if COPY of weU water envyele —colllorm bact E LARGE SYSTEM FAILS: • you must Indicate either -Yes' or IN to large Systems each of In o InaddltIon to the criteria above: The following criteria apply The system serves a facii y he wwith a e because Of one or more gpd or grob ZIA the tolloewingrcondltion exist System) and the system I+ a slgrJftca+tt ttveat t health and safety and t Yes No / .. �_ .. fl the system Is within 400 foot of a surface drinking water Supply er -40 wrieoedr♦r+kln4 w+ser w►1�Y the eystem•le-wI04A 200 (eetoh+- ►t Y Zone It of e _� the eyetem Is located In a nitrogen sensitive ergo(Interim Wellhead Protection Area IWPA).Or mapped wolor supply woil) The owner or operator of any such system shall upgrade the system In eecordance with J10 CMR 16.304(21• Pte+se consort the local r ofbcs of the Department for further Infognstion. Psge 4 of 11 revised 9/2/98 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMA PART S CHECKLIST Propwty Ad&o&&: 106 Hathaway Road, Osterville own«: Joan Cox Oau of tnapectan: 1 0/1 1 /0 0 Check If the following have been done: You must Indicate either 'Yet' or 'No' as to each of the following: Yes No �•�`// Pumping Information was provided by the owner, occupant, or Board of Health. _ Y None of the systsmcornpo++ntt►arr:ba+n h"j.%4"mse081 +q..d R rates during that period. Large volumes of waist have not been Introduced.lnto the system recently or +a pert of uvs 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-aarJtary or Industrial waste flow. _ The eke wee Inspected for signs of breakout. _ All system components, *"Iuding the Soil Absorption System, have been located on the sits. The septic tank manholes wets uncovered, opened, and the Interior of the septic tank was Inspected for condtion of bar or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The site and location of the Soil Absorption System orrthe sits has boon determined based on: (/ Existing Information. For example, Plan at B.O.H. Oetermined In the field (If any of the failure criteria related to Part C Is at Issue, approximation of distsncs Is v"cceptats I I fi.3021311b11 The facility ownw land-or c,p•^«,Jf dltiaraot from.cacau sa l.warayuldarl with 1nfn i �rn1oaon s"- ,:+s-t-^ SubSurfacs Disposal Systems. F .r revised' 9/2/98 Pstf5Of11 r I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PtopertYAdar*": 106 Hathaway Road, Osterville owner: Joan Cox D.o.of 1 0/1 1 /0 0 ROW CONDITIONS RESIOENT1Al: Deslon flow: �1 )�- g•p•d•/bedroom. Number of bedrooNumber o}bedrooms(actual):l Total DESIGN Flo Number of current residents: Garbage grinder(yes or no): i5 Laundry(separate system) or It yes, sepwielnap+cdon.required —. Laundry system Inspected es r no) Seasonal use(yes or no):adw �/ F Water meter readings,If ev able (last two year's usage Igpd): n� /X 1 Sump Pump(yes or nol: 1 Last date of occupancy: CommERCtAL/W DUSTRW L: Type of establishment: Design flow: d ( Be ed on 16.203) Basis of design flow Grease trap present: (yes or no) Industrial Waste Molding Tank present: (yes or no),& Non-sanitary waste discharged to the Title 6 system: ( s or no)" _ Water meter readings,If available: Lest date of occupency: did OTHER:(Describe) Lest date of occupancy: GENERAL INFORMATION PUMPING RECORDS and so fee pf nformetlon: System pumped as part of Inspection:(yes or no) If yes, volume pumped: gallons Reason for pumping: TYPE of SYSTEM �/ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool w 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 Installedilf known)-and souroe ofJw(am+don: Sewage odors detected when-arriving at the site:(Yes or no) revised 9/2/98 Paet4ofIt r SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (c"rdrwdl Propwty Address: 106 Hathaway Road, Osterville D.•r+«: Joan Cox Dete of Inspection: 1 0/1 1 /0 0 BUILDING SEWER: ILocats on site plan) u ' Depth below grads: Material of con! ctlo :Y ci Iron 40 PVer�zplaln) S ' ` o Distance from I ate wa •r au ply wall or auction line Diameter—.if_ Comments: (condition of)olnts, venting, evidence of It k6le,-etc.) leakage. Joints s ems ven SEYM TANK (locate on she plan) Depth below grade: 414 Material of construction:concreteA-�fmetaI Vj4FIberglas&4/APolyethylene other(explainI If Isnk Is Fetal, list age&1 is.ape.conArmed by Certificate of Compllince (Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee ort atfie: /Y-0 Scum thickness:_4[4 Distance from top of scum to top of outlet tee or baffle: �A Distance from bottom of scum to bottom of outlet tee or batfle: l� Now dimensions were determined: 4M Comments: irecommendation for pumping, condition of Inlet and outlet tees or-baffles, depth of liquid level In relation to outlet invert. structural integrity. e fnuI�fc�ea�aae. etc.) Se ti pumped annua G GREASE TFLAP::i lye (Iocete on site plan) Depth below grade:40 e//r0 otherlezplaln) Material of constructlon:+V#concrets�metel.VAFlberglass*Y Polyethylen A Dimensions: Scum thickness: Distance ftom top of scum to top of outlet tee or baMe: . Distance from bottom of scum to bottom of outlet tee or baffle: I� Data of last pumping: Comments: e9^n Irecorr+mendation for pumping, condition of.inlst and outlet tees or baffles, depth of llquld level In relation to outlat Invert, structural nt evidence of leakage. etc.) rease trap is not pzeseat. revised 9/2/98 Ps`e7orll SU&SURfACt SEWAGE D13POSAL SYSTUd W3►EC=N FO,R1A /ART C � SYSTOA WFORMAMW fooa*ti--d) 106 Hathaway Road, Osterville Joan COx o.o# o,Edon: 1 0/1 1 /0 0 .no OR NOLDWO TANK:. (Tons meal be pumped prior to, or at time of, inapoation) (locate on sit# pion) Depth below grad#: M#l#rlsJ of conswction:/,�concr#te/J�,,m#taJ.lJ�FlbarglOssd�B Fdr#thyfenyoth#r(explsln) Dlm#nsiow IP&CITY: gallons Da#ign ROW: g►lionslday Alarm prNent Alarm I#V#I: Alarm�In,WWo(king order:Y. Noy Date *I pr#vfov# pvmping, Commanu: ,condrgon 91 INeI lao, sondJtion of ►I►rm and float switchss, ate.) present. OtSTRIIiIITION pox,_ ,iota,# on slt# plan) Oapth of lipvld level above ovtlot Inwll:� Comment'. nee II level end dlatrlbvUon Is ogv41, ev(donoa of solids Oafryovo(, wld.nao of lookage Into of out of►ox, Old') Bistr ' 1 enc ra6nce of leakage Mn . pvu/C}4AtlSM�dsfJ� Ilocet# on tit# Aran) gg pumps In working order:(Yea or Not !T Al►rm#In working Olga'lye► or No' comment#: (note condition 91 pump chamber, condition of pumps and appurtmancas, atd, am e hf#lof11 revised 9/2/98 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C '. SYSTEM INFORMATION fcortdnuod) PmpwtyAd&*": 106 Hathaway Road, .Osterville M Ownw: Joan Cox Da,of Inspection: 1 0/1 �,/0 0 SOLI ABSORrMN SYSTEM(SAS): (local@ on site plan, If possible:excavation not required,location may be approximated by non-lntrusive methods) If not located, explain: Type: 1 leaching pits, number: leeching chambers, numbs leaching galleries,number: leaching trenches, number, length: leaching fields, number, dimebons• overflow cesspool,number: Alternative system: ^lLl1'sry . Name of Technology: _ S 7 Comments: >A r' (note condition of soil, signs of hydraulic failure, Ieve1 of pondIn damp soil, condition of vegetation, etc.) Loam n� edi um tin C�nd No signs of hydraulic failure or onding. of s are dr _VP etatinn iG nnrm i CESs LS: hrough the sidewall. er (locate on site plan) fr Nvmber and configuration: //I— sj Depth•top of liquid to Inle vart: Depth of solids layer: Depth of scum Isyer: Dimensions of cesspool: Matedois of construction: 3'' Indication of groundwater: A_' l ' Inflow (cesspool must be pumped as part of Inspection) Did n o evidence- ot water lntrusinn _ Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of•vegetatlon, etc.) Same as ahem fP PRIVY: Notate on site plan) Mstodals of construe on: �� Dimensions: "eyX Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation;etc.) Privy is not prPsent _ revised 9/2/98 Pege9ofII r 3U93URFA"SEWAGE D13FOSAL IYSTDA 04SP"' ION FORJA ►ART C '. SYSTVA LN OiU.IATION toorrdrwE) 106 Hathaway Road, Osterville Joan Cox o.v o1 �^j 1 0/1 1 /0 0 SKETCH OF SEWAGE DISPOSAL SYSTEM: lndud, d#r to st I#&it two psrmsnsnt reference Iandmuks or bsnchmsrks locoto NI welly wlWn 100' (LOCete where publlo wster supply oomes Into house) i . i t o(, r d Os�rv�� revised 9/2/98 h=r 10 of 11 r t S1,193URFACE SEWAOE DLSP93AL 3Y3TDd WSPkMON FORM t, FART C 3Y3TIW{NFORµ nON Icondrwdl ' hop*M Ad&*": 106 Hathaway Road, Osterville owns: Joan Cox oae of trup.ctSon: 1 0/1 1 /0 0 NRCS Report name Sou Type_ TyplcN depth to groundwater VSOS Oat# w#bsite visited Observation Wells checked OroundwsNr depth: 3hallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Ertimated Depth to OrovndwaterA4- Feet Meese Indicate all the methods used to determine High Groundwater Elovadon: _Obtained horn Design flans on record Observed Site (Abvtdng p(opert baervatlon hole, basemeot sump tic.) petermined Irom local condldons Checked with local Board of health _C ecked fEMA Mape Checked pumping records Ch#cked local excavators. installers Vied V503 Data Describe how yov established the High Oroundwater Elevadon. IHtEJ be completed) . Used; Water contours Map. Gahrety & Miller Model 12/16/94 lrorll revised 9/2/98 n�e IP TOWN OF BARNSTABLE WARE) OF HEALTH � SUII3URFACR SEHAGF, DISRJSAL .SYSTEM INSUCTION FORM - PART D .- CERTIFICATION -•�n�+••••.+.—mod i �.•.+w.r•�w.w• r.w��+raw•w��st�wo.��.w—•++w�rwvwrww.w.w�� ww v-ram..--.. _. -TYPO OA P118T C11 AAtY- P/IOPERTY INSPECTED STREET ADDRESS 106 Hathaway Road, Osterville ASSESSORS HAP , BLOCK AND PARCEL ;Y /21 d(� OWNER' s NAHE Joan COx PART D - C917rIP'ICATION NAHE OF INSPECTOR Joseph P. Macomber Jr, COHPANY NAME Joseph P. Macomber & '`Son, Inc. COMPANY ADDRESS Box 66 Centerville MA. 02632-0066 Streit Tovn or C ty $tat• tTP COMPANY TELEPHONC ( 508 ) 775 - 3338 FAX ( ) CCR'rIFICATION STATEHCNT I certify that I have personally inspected the sewage dieposei`1 system at this address and that the information reported is true , accurate , and omplete 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 . Ch one ; ; 2Systeoi PASSED The inspection which I have conducted has not found any information which Indicates that the system fails to adequately protect public healLh or the environment as defined in 310 CHR 16 . 303 . Any failure. criteria not evaluated are as stated in the FAILURE CRITERIA section of this form , Systeta FAILEUs The ilnspection which I have con Voted, has found that the system fails to protect the })tiblic I;enith and the environment in accordance with Title 5 , 110 CHR 15 , 303 , and as speciflcally noted on PART C - FAILURE CRITERIA of this Inspection form . Inspector Signature - Date ^�v a( ne COPY of this ertlfication must be provided to the OWNER , the BUYER here applloable ) and the BOARD OF H EALTII. yI... • If the inspection FAILED, thv owner or operator shall upgrade ' the system within one year of tl)e date of the inspection , unless allowed or required otherwise as provided in 3.10 CHR 16 . 306 . partd .doc TOWN OF BARNSTABLE LOCATION _j�� -t- c Je4 Rh— SEWAGE # -&V- AW VILLAGE _ CT. ASSESSOR'S MAP & LOT P f 0.70 INSTALLER'S NAME& PHONE.NO. 4rr �L � ►.1�.� ::Z 71 SEPTIC TANK CAPACITY 1.�C LEACHING FACILITY: (type) 7 c l— (size) lee- o NO. OF BEDROOMS A PER OTE: ��3—r/ COMPLIANCE DATE: Separation Distance Between the. Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility J 7" -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 f 35T M •, q6 O.O t •-A - _o o — No. Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: D ✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprtcatton for 30tgpozar *pttem Congtructton 'Vermtt Application for a Permit to Construct( . )Repair(t')Upgrade( )Abandon( ) El Complete System e1ndividual Components Location Address or Lot No. A 1-aA / Owner's Name,Address and Tel.No. wwa Assessor's Map/Parcel �// 0,5 le !- Installer's Name,Addres and Tel.No. Designer' Name,Address and Tel.No. or�o�a�1 Co�s�` a�v�Cd�e i. -77/�� � Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(✓ Other Type of Building ��� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 15-00 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) /�i�,t��lOGe G'�✓.J�®/ !.y>�``/? /��9Q� 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 by this Bo of He th. Signed c'- to c3�© Application Approved by at Application Disapproved for the following reasons on Permit No. Date Issued -=� _. O �� No�. D D ,.. Fee � Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS - Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for �Di000al *pgtem Con6truction Permit Application for a Permit to Construct( . )Repair(�)Upgrade( )Abandon( ) D Complete System J Individual Components Location Addressor Lot No. Owner's Name,Address and Tel.No. /�,� ffa�.�lGlGr/py.y� 7"vp�I Cox Assessor's Map/Parcel � ///� Installer's Name,Addres ,and Tel.No. Designer' Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms ,3 . Lot Size sq.ft. Garbage Grinder( Other Type of Building Pr1�� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow I gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /5-00 Type of S.A.S. �I'! Description of Soil; r• Nature of Repairs or Alterations(Answer when applicable) k" 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 by this Bo d of Hea the Signed .-Date Application Approved by _ ! G ate Application Disapproved for the following reasons i Permit No. Date Issued n THE COMMONWEALTH OF MASSACHUSETTS Zd BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY that the On-site Sewage Disposal System Constructed( )Repaired(t/ )Upgraded( ) Abandoned( )//by ,,��Q I 1O_ at �G /�l" U/,v OcJ has beejconstructed in accordance with the provisions of Title 5 and the for disposal System Construction Permit No. �(J�'7dated Installer t Designer The issuance~ f this permit shall not be construed as a guarantee that the system will function a�d signed. Date ®1 �Ilbrol Inspectors No. O �_ _ / 0 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS �Digooar 6potem Construction Permit Permission is hereby granted to/Construct(/ )Repair(�/ )Up ade( )Abandon( ) System located at f�D / ��1 G7 waY r,-x 0o/-f"g I e and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construct'bn mu be coi leted within three years of the date of this a t. Date: v Approved by / / / -7 / / l / TOWN OF BARNSTABLE LOCATION S U&7n4=&jM Pb— SEWAGE # .200"- oof/ VILLAGE ASSESSOR'S MAP & LOT 11 f`- 7d INSTALLER'S NAME&PHONE NO. iJ 6 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) 1ddC3�AcL- NO. OF BEDROOMS UII.,DE R OWNER RMITDATE: �" —U COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any.wells exist i Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnishe by G� 3� yd 6 ° O. O No,��_.. ...._....... Fmic ........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OFH TH V Appliration for i-4plaiial Vorkfi Tnnitrnrtinn Vantit Application is hereby made for a Permit to Construct ( ) or Repair ( an Indiv' al S yao Disposal System at: Ir..., . ... .... . .........�.?j................. .........CQ = ................................................... . Lo• ti�on-Addre or Lot No. ... .. ...... .. -�/ / - .... ..... ....... ........ . -_..................---^---.... Owner Address a ...... ---.-- •----. -_----------•----------------------- ---------- ...................... Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building .. No. of persons-----------------_---------- Showers — Cafeteria a' Other fixtures .................................. W Design Flow............................................gallons per person per day. Total daily flow------_.....................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth_-_-__-_____-_-. W Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No.-•------------------ Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water...................... (z, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ R'+ ------------------------------•---•--•-•--••--•-•-••----••----------------------••--••-•..........--......................................................... 0 Description of Soil........................................................................................................................................................................ x U ---•••--•--•---------•---•-----•-•---•..................••-----•-------------------•-------•---------•------------•--•-•------•---•--•--•------•-•---••--••-----•----------------•--•----•---•----••--- -------------------------- ------- ---- ---- ---- - - ------.------------------------------------- _ i .......................... ................ U Nature of Repairs or Alterations—Answer when applicabl -e.__•-,!-0.C2.V_____-__ �� '._.......'2 Agreement. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of:T'1 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 y the boar of health. Signed. j.................. 1121.� .. ` Date ApplicationApproved By.......................-.......................................................................... ........................................ Date Application Disapproved for the following reasons-------------------------------------------------------------------------------•------------•---•--------•.•---- -•--------------------------------------------------------------•-----------------------•--•-----------------------------------------------------------....------------------------------------•----•--- ��"- ------------•---Date- PermitNo......................................................... Issued_.-j j-----•--- /----- ---• Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I M ^ACC DATA • �y ................... THE COMMONWEALTH OF MASSACHUSETTS BOARDO OF HEALTH Applirotion for Uiiposal Works Tonstrur�Lion thrutit Application is hereby made for a Permit to Construct ( ) or Repair (4`) an Individual Sewage Disposal System at: { A ;., JM ......:.......... .........i ....�?..+_t J-!.. .. .. {-. f Location-Address or Lot No. t....... f .................................................. _ Owner Address X 4L- Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............. No. of ersons........_._..___.._.._...... Showers a Other—Type g --------------- P ( ) — Cafeteria ( ) dOther fixtures ---------------------'--------------------------------------------------------------...------------------------------------•---••••••.............--- w Design Flow............................................gallons per person per day. Total daily flow.......................-....................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 •-••••••-•••-•-------•----••------•--•••••••-•---•----••-•-••••••••-•-•-••---••••---.......-•----•----•--•--••-••---•-••-•-•-••......•--- ----------------- 0 Description of Soil........................................................................................................................................................................ x U •••••-•••••••••••'••••••---•-••••••••-•---...--•••--•-•••••--••••••••......-•-•••......'----••••-----•-•-••••------•-•••••••-••••-••---•-•-•----------•••••'---••-••---••--•'-•••-••-•-••............. w U Nature of Repairs or Alterations—Answer when applicable------------------- ...... .........................................._j -" � •-•-`%.' -- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'I:.. p 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. Signed.....ff-........................... Date ApplicationApproved By.................................................................................................. Date Application Disapproved for the following reasons-----------------------------------------------•-----------------------------------------------------------•-•. ............................... --•--•-•---•-••-••-•-•--•---•---...----••••••-•--•------•....••••-••......---•-------••-•---•-•••-••'•-•••---------•-••...---------••---•••------•.........-'•••••....... Date PermitNo......................................................... Issued..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :...........OF...............:.....:'......................---""-............................... %-Unfifirtttr of Tompliatta THIS IS TO CERTIFY, That.the Individual Sewage Disposal System constructed ( ) or Repaired r- r . Installer ��' ,4' at•-••-•-•-•-�••••.. ..., . .•r�•.J ..:.1r f,ram. has been installed in accordance with the/provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated---------- ..................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....---•...................................................•••----...........---- Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No....'/................... �i��o��t1 or�� �o�t��rion .ernti# Permissionis hereby granted............ -----------------------"-----. ......."--_------------------------------------•--------------------•------...........---.. to Construct ( ) or Repair ( =)`an Individual Sewage Disposal System at No... ='..... •--•------------------------------------------------..................................................... Street ;, as shown on the application for Disposal Works Construction Per�mit,'No----e-1--r.a/• Dated...J_________________________ //- �- i Eel tc���f . � - Board of Health i DATE............... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS NOTES: 1. DATUM IS MSL 2. ASSESSORS MAP 115 PARCEL 20 3. SEPTIC SYSTEM SHOWN AS PER INSPECTION REPORT BY MACOMBER 22 4. THIS PLAN IS NOT BASED ON AN ACTUAL ON THE GROUND SURVEY, BUT IS TAKEN FROM BARNSTABLE 20 GIS INFORMATION 22 S. EXISTING DWELLING IS 3 BEDROOMS, NO GARBAGE DISPOSER 6. WATERLINE ENTERS FRONT OF DWELLINGLi l4 •. ._ 1, . EXIST. 1000 GAL LEACH PIT WITH 3' I .STONE EXIST. CESSPOOL TO ` BE REPLACED WITH 1500 GAL. SEPTIC _�� EXIST. D'BOX ; TANK. 21.4 x i� 21.4 N . w -e. �.:.-.. ^'»e.. y sF�•.w....c• a.''_ -._ .Ft '+w�+w0 -e+++.Li+1,'- +i +cw i.. Sad +a . 1 ?.. - sa�G.,-'3*^ .1»L'.'q,- .xws•T.+n' «V.,+ EXIST. DWELLING A ( e, } ;/ 21.4 >\ 16.3 18 t go D SITE PLAN F k SHOWING PROPOSED SEPTIC TANKt a OF #106 HATHAWAY ROAD ,.. IN THE.TOWN OF. _ OSTERVILLE) BARNS TABLE PREPARED FOR: BORTOLOTTI CONSTRUCTION H. ® LA L rr m as+ed . it®sue 30 0 30 60 90 cl a. I ,o down cape eagmeering, inc. CIVIL ENGINEERS F SCALE: f".= 30' DATE: DECEMBER 20, 2001 LAND SURVEYORS P ARNE H. OJ rf'.E., P.L.S. DATE 939 main at yarmouth, ma ON75 01-359 a