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HomeMy WebLinkAbout0233 WILLIMANTIC DRIVE - Health 233 WILLIAMANTIG D V MARSWNS MILLS { i Cammox":EA ,TH OF MASSACHLSETTS _ EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS = F IT DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE RI\TER STREET. BOSTON ALI 0210r (617) 292.550v TRUDY COXIE Secre:ar. ARGEO PAUL CELLUCCI DAVID B STR"HS -Governor Cotnndssioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 233 Willimantic Dr . Name of Owner Beth Rogers Marstons Mills Address of Owner: Date of Inspection: //— —.q Name of Inspector:(Please Print)Wm. E . Robinson Sr . 1 am a DEP approved systerq inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000) Company Name: Wm. E . Robinson eptic Service Mailing Address: PO Box 1089, Centerville , MA Telephone Number: 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: v_ Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails / Inspector's Signature: L , Date: fl�- 07 9 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 the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS Ak ✓,'� RECEI EO f p EC 3 1999 TOWN OF BARNSTABLE HEALTH DEPT. revised 9/2/95 Pagclorn t*j �.:rted on Recge;ed Pane, ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMali t . PART A CERTIFICATION (continued) ` "roperty Adores::233 Willimantic Dr . , Marstons Mills )Weer: Beth Rogers Date of Inspection: INSPECTION SUMMARY: Check A, A C, or D: A. SYSTEM PASSES: 1 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. CO MENTS: B. SYSTEM CONDITIONALLY PASSES: ne or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon mpletion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20)years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if iwith approval of the Board of Health): broken pipe(s) are replaced obstruction is removed revised 9/2/98 Page 2ofII a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Icontimwd) PropertyAddress: 233 Willimantic Dr. , Marstons Mills Owrw: Beth Rci ers Date of Inspection:,//_ q , 9 C. RTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the ublic health, safety and the environment. 1) YSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool cr privy is within 50 feet of surface water Cesspool cr 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 revised 9/2/98 Page 3of11 s.: G SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 1 Property Address:233 Willimantic Dr. , Marstons Mills ' Owner: Beth R Og ey S Date of Inspection:A - D. S TEM FAILS: You must'ndicate either "Yes or "No" to each of the following: I ave dermined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this de erminatiteon 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 112 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: You must in icate either "Yes" or "No" to each of the following: Th following criteria apply to large systems in addition to the criteria above: T e 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 h alth and safety and the environment because one or more of the following conditions exist: Yes o 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 If of a public water supply well) The owner or perator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the apartment for further information. revised 9/2/98 Page 4or11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART B CHECKLIST P.opertyAddress: 233 Willimantic Dr, Marstons Mills owneBeth Rogers Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this / inspection. L _ As built plans have been obtained and examined. Note if they are not available with NIA. _ 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. 1V _ 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: V _ Existing information. For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)] _ The facility owner (and occupants,if different from owner) were provided with information on the proper lnaintananr.6.of Subsurface Disposal Systems. revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION -,,party Address: 233 Willimantic Dr . , Marstons Mills owner: Beth R gers Date of Inspection:/� FLOW CONDITIONS RESIDENTIAL: Design flow:41so g.p.d./bedroom. Number of bedrooms Ides�gn): Number of bedrooms (actual): Total DESIGN flow_ Number of current residents:" Garbage grinder lyes or no):� 6 Laundry(separate system) (yes or no);L; If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no):A-10 Water meter readings, if available (last two year's usage(gpd): J'7/fi 7n(0_�� Sump Pump(yes or no):R,0 n 7 Last date of occupancy://�-9 �1 d �fp dU� qa-l. COMMERC LANDUSTRIAL: Type of esta lishment: Design fFHolding d ( Based on 15.203) Basis of w Grease tnt: (yes or no)_ Industriaolding Tank present: (yes or no)_ Non•sanie discharged to the Title 5 system: (yes or no)Water mings, if available: Last datpancy:OTHER: )Last dateancy: GENERAL INFORMATION PUMPING RECORDS an source of info a System pumped as part of inspection: (yes or no)_ If yes, volume pumped: gallons Reason for pumping: TYPE3W SYSTEM Septic tank?distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records,if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known) and source of information: /�+. ✓ —I ,� -- c1. Sewage odors detected when arriving at the site: (yes or no) revised 9/2/9E Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'rop"Address: 233 Willimantic Dr . , Marstons Mills- Ownw` pAp th Ro ers Date of Iris zxt: BUILD SEWER: (Locate o site plan) Depth be[ w grade:_ Material f construction:_cast iron_40 PVC_other(explain) Distanc from private water supply well or suction line Diame r Com nts: (condition of joints, venting, evidence of leakage,etc.) SEPTIC TANK:_ (locate on site plan) Depth below grade:_ Material of construction: concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal, list age_ Is.age confirmed by Certificate of Compliance_(Yes/Noll Dimensions: C `c Sludge depth: 3—G/ Distance from top of sludge to bottom of outlet tee or baffle: 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: How dimensions were determined: ;omments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in rf lation to outlet invert, stt ctural integrity, evidence of leakage, etc.) , 66 d ��4,d � 7 � 1� T�S �� �6+ C r` �c r� GREA TRAP: (locate o site plan) Depth belo grade:_ Material of onstruction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensions: Scum thickn ss: Distance fro top of scum to top of outlet tee or baffle: Distance fro bottom of scum to bottom of outlet tee or baffle: Date of last mping: Comments: (recommend tion for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of eakage,etc.) revise: 9/2/98 Page 7of11 t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) bropertyAddress:233 Willimantic Dr. , Marstons Mills Owner: Beth Rogers ' Date of Inspection: TIG TOR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (looat on site plan) Depth elow grade:_ Materia of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimensi ns: Capacit gallons Design ow: gallons/day Alarm resent Alarm evel: Alarm in working order: Yes_ No_ Date f previous pumping: Com ents: (con tion of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOXY/ (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, etc.) - PUMP CHA ER:_ (locate on sit plan) Pumps in wor ing order: (Yes or No) Alarms in wor ing order(Yes or No) Comments: (note conditi of pump chamber, condition of pumps and appurtenances, etc.) revised 9/2/98 Page 8of11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _ PART C ' SYSTEM INFORMATION(continued) 'rop"Address:233 Willimantic Sr . , Marstons Mills . Owner: Beth Ro ers Date of Inspection://--4 —9 5 / SOIL ABSORPTION SYSTEM(SAS):G/ (locate on site plan, if possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:_ 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, s�i ns of hydraulics failure, level f ponding, damp soil, condition of vegetation etc 2 6 1 � CESSPOOLS:_ (locate site plan) Number a d configuration: Depth-top f liquid to inlet invert: Depth of s lids layer: )epth of sc m layer: Dimensions of cesspool: Materials of construction: Indication o groundwater: inf ow (cesspool must be pumped as part of inspection) Comments: (note condi on of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY-_ (locate on site plan) ` Material of construction: Dimensions: Depth of olids: Comment : (note con ition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revise^ 9/2 Page 9ofII ' - r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) bop"Address:233 Willimantic Dr. , Marstons Mills , )caner: Beth Rogers Date of Inspection: 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) W V3b G Illy r � w 7 t •3 N� o C a Ire- s revised 9;2/9R Page 10ofII L , E t : SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Icontinuedl top"Address: 233 Willimantic Dr . , Marstons Mills Owner; Beth Rogers Date of Inspection: 7 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property, observation hole, basement sump etc.) Determined from local conditions --,/—Checked with local Board of health Checked FEMA Maps —Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) AdJ�,� �� � T A/du's � /96� -Fb revised 9/2/96 Page llofll TOWN OF BARNSTABLE LOC; 110N 9S W a I Oun AM—(C. r SEWAGE # T 7— ►99 VILLAGE ,m_ I I� ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. A06 c 05on 15,C O f'i C_ SEPTIC TANK CAPACITY 1 OOC 2 LEACHING FACILITY: (type) f)—)A X e_r ize) � NO.OF BEDROOMS BUILDER OR OWNER .a,JC1 PERMITDATE: COMPLIANCE DATE: S l i ! G 7 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 � � per. ' ,� a - `9 f� N Fee' L_1�. �50 . 0o. THE COMMONWEALTH O MASSACHUSETTS Entered in computer: � Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for Xigpool *potem Construction Permit Application for a Permit to Construct( )Repair(x )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 233 Willimantic Dr Owner's Name,Address and Tel.No. Beth Rogers Assessor's Map/ParcelMa r s t on s Mills, MA 4 2 8—1 5 61 Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. Wm E Robinson Sr Septic Serv. PO Box 1089 , Centerville, MA Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(nq 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 Type of S.A.S. Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) Installation Title 5 Leaching Gi system consisting of three stonepacked infiltrators. 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 Board of Health. Signed Date Application Approved by22� Date r' f7 Application Disapproved for the following reasons Permit No. Date Issued ®" . .,1r-- , r �..,yx.. t 5• -tr s $.. - .;,,a�. ..Rti::•►'1i-rr..,Y`a'.;.4e+wif -a�Ll,fr'",T.'tY.,.n`,,.;j n� ,w+;, .-:.el. .Nr'l`.-.Y`J.:�,•6.I°'.t�.",...,�'..-w-, No. 6 / % Fee$50.00, THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: L/ Yes PUBLIC, HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zipplication for Digogal *pgtem Cougtruction Permit Application for a Permit to Construct( )Repair(x )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components i Location Address or Lot No. 233 Willimantic Dr Owner's Name,Address and Tel.No. Beth Rogers Marstons Mills MA 428-1561 Assessor's Map/Parcel Installer's Name,Address,and Tel.No. 7 7 5-8 7 7 6 Designer's Name,Address and Tel.No. ._ Wm E Robinson Sr Septic Serv. PO Box 1089, Centerville, MA Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(noj 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 Type of S.A.S. Description of Soil sand Installation Titla 5 Leaching ,F Nature of Repairs or Alterations(Answer when applicable) g system consisting of three stonepacked infiltrators. 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 b this Board of Health. Signed . �� Date Application Approved by e 2 1 Date L/r Application Disapproved for the following'reasons Permit No. qt t �' Date Issued p''�G '"" THE COMMONWEALTH OF MASSACHUSETTS Rogers BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( x)Upgraded( ) Abandoned( )bye at 233 i - ji�a antie Dr, Marstons Mills Q-02 '/' J has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No dated Installer Wm E Robinson Sr Sept Sery Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date ✓" .. Inspector - r - _— --- --------- ---------------------- No. Fee$5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Rogers 1=igPoga1 *pgtem Construction Permit Permission is hereby granted to Construct( )Repair(x )Upgrade( )Abandon( ) System located at 233 Williamantie Dr, Mars tons Mills, MA Installed by Wm E Robinson Sr Septic Srv. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of thi rmit. Date: '`� l Approved b `! � NOTICE: This form is to be used for the repair of failed septic systems only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS I,William E. Robinson, Sr.,hereby certify that the application for disposal works construction permit signed by me dated `y'off�+"L'a , concerning the property located at 233 Willimantic Dr,Marstons Mills,NU meets all of the following criteria: * There are no wetlands within 300 feet of the proposed septic system. * There are no private wells within 150 feet of the proposed septic system. * The obseved groundwater table is 14 feet or greater below the bottom of the leaching facility. * There is no increase in flow and/or change in use proposed. * There are no variances requested or needed. SIGNED: ��,,,,.,.� DATE LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60 (Attach a sketch plan of the proposed system. Also if the licensed installer proposes a certification plot plan,this plan should be submitted). Joy �p N� l ,I kt �{ .ly Ib ��� LOCATION SEWAGE PERMIT NO. V I,LLA G E 1n n INSTALLER'S NAME i ADDRESS Ow Q )E��Fr-,K 1 . l BUILDER OR O NEREAA I A I fFk MAE "� `� ` � oh DATE PERMIT ISSUED v , S7_ 9 DATE COMPLIANCE ISSUED J,ouv li�iil2_ ' � 'J �q w � �S �..^�1 0 �•s ri No...............tr�l... ............ .............. THE COMMONWEALTH OF MASSACHUSETTS o� BOARD OF HEALTH ............OF..... ..,,.. .+V =. Allp iration for Ili4posa1 Works Tontitrn.rtion ramit . Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: .►..�,>,� ...................f.A:R��s--.. ................................................. �L�cation-Address / n� q �--....-------------• Fa.. 1.!.1./Q)_;j_......`i :'��)/J..5.....•- W Owner ��� ®� 6 F���� 1... �=R • Address ess !.... --.....-----------..•- M . Installe Address -ft 11 Type of Building Size Lot__.__..._ ._ M.....Sq. feet Dwelling—No. of Bedrooms..............?...___...._.__.__._____Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Building No. of persons............................ Showers — Cafeteria f4 yP g P ( ) ( ) a Other fixtures .................................. W Design Flow..................10.._.._..........gallons per person per day. Total daily flow......5 .....................gallons. WSeptic Tank—Liquid capacity.I. .gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.........1...------- Diameter......10........ Depth below inlet....6........... Total leaching area...:2�&4...sq. ft. Z Other Distribution box X Dosing tank ( ) '-' Percolation Test Results Performed by--. ... .............. Date......S._._`z _." __. aTest Pit No. I......_..minutes per inch Depth of Test Depth to ground water... Gz, Test Pit No. 2................minutes pef inch Pepth of Test Pit.................... Depth to ground water........................ ODescription of Soil---_-------2 ..... � .................................. ....... ---------------•------------•---------•------------- x ----•-•---------------------------------------°3..-5.._..�iN..F_SA .---------------------- - x ----------------------------------------------- - . ..... -a--�.------......----------------? ----- U Nature 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 iI;'L 5 of the State Sanitary Code— The undersigned urther agrees not to place the system in operation until a Certificate of Compliance has bee i s by the -o rd o health. Sig -'/ ----•-------------- -- Q__'" "..1._ • Date Application Approved By........ --- --.. Y .. .. G ��% Date Application Disapproved for the following reasons:----••----------------------•-----------------------------------------------•-------------------------------... ..............•--•---•-----...-------•----------....------......-•----------------......--••------------------------------------•--------------•-------------------------------------------•---...._..._ / Date Permit No. Issued.._. /._............................................ Date 7 No.._....... 'G FEs....�n...�............ .i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ` Appliratilan for Disposal Murks Tonstrnrtiaan ramit Application'is hereby made for a Permit to Construct >< or Repair ( ) an Individual Sewage Disposal System at .f..........R.S ran?.s....ftil'-�s....................................... Location-Addr.- o Lot Nol _. OwY. ne Address i^t� t C. d G t+ . Install- Address Type of Building Size Lot.i tACO.....Sq. feet Dwelling—No. of Bedrooms.............. .......................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ........................... . W Design Flow.................11a................gallons per person per day. Total daily flow------ .....................gallons. WSeptic Tank—Liquid capacity` 00.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No._------_-I.......... Diameter......\0....... Depth below inlet....6........... Total leaching area...;2&(kb..sq. ft. Z Other�Distribution box 0< Dosing tank ( ) F~ Percolation Test Re,�ults ' Performed by.....F_t.h!K1 - .E.... ta� ............ Date...__�Q_...'_z. Test Pit No. 1...2.......minutes'per inch Depth of, Test Pit...t. .."._Q_ Depth to ground water---N .-..Ys. Test Pit No. 2................minutes per inch Pepth of Test Pit.................... IL)epth to ground water........................ P D Description of Soil................2------ a! ?�Q -------------•------------•-•--------- :. x ---------------------------- --------------- - -RPS.yrj.--------------------------- . --- -- . ---,..... .............=.....------------�`.. . V Nature 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 TITS 5 of the State Sanitary Code— The undersigned'urther agrees not to place the system in operation until a Certificate of Compliance has beep st by the d o iealth. V ....., ° :_ ................... -•--- / 10 Date Application Approved By.....-- f-- ....... .. Date Application Disapproved f or the following reasons:................................................................................................................ .........................•------....--------------•---------......_...._......--._...-•----•--------------------------•-------------------------------------------------------------- ................. Date PermitNo.......................... ............................. Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH ..............zat�:� !..........OF........ C ?�`�` ;. .._....-........ (Infifirafts of Taautpliatta THIS,,.L,S TO CERTIFY That the In ividu Sewage Disposal System constructed �or Repaired ( ) b ..........Z---- 'xi`-`i�l..... .k�, '�. 11'!_ _( 1 !_C _..C�:Ca.l "h�.... -`Z l_! .............. t Insta r .� at....... . . .......... has been installed in accordance with the provisions of T /5 of The State Sanitary Code as de 'bed in the application for Disposal Works Construction Permit No.. .......lv_�__-�_�................. 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 C7f- 'G \ N ..J......oF............ L: ............ No........ FEE........................ �ia��aa� nrk� n�truan rr�tt# Permission is ereby granted...... f .4. to Cons'tr .(Kor R pair ( ) an Individual Se e Dispos y t --- �. Street as shown on the application for Disposal Works ConstructionePit) :._- --- - Dated--------- ..... ` ..q DATE.......� ........................................... Board of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ' v b. � .. r - .. I ^•v =;w"" �x �..,y tart�^;+' •�, �r.. xX17 !..{: O `/v� •~ r �'j ¢.r t.:. _ ©��P , �. �r.., 1 -1ra,, ,f 'Nisi, r''1 ',��x� y �. '�.� �''a:� < � j.', t ✓l' ti. JJp/ t • "1 r �s+n ��' 9 , •'� ty �, ,N.��r y. tk,. �:. t{ ;' r E;.Y,: -.{. r r i L •'0t a-L�•fS�r* , 2- Y 'O / Na e _.3s o ;j . jo t F / o�� ROBER Ts, ' lV E W ��� ��/✓`}'f'Q!��/ --pNo 22162 jar ji t �. LEbtNb . yEXISTING � SPOT ELEVATION :; OxO- �;• CERTIFIED 'OT jPL:AN : EXISTING ':CONTOUR - _<Q LoT 9 6 GY/I� rMA�>✓TiL DR1r/� #s1. FINISHED . SPOT ELEVATION 0.0 FINI-SHEQ CONTOUR'-- R N APPROVED � BOARD � rk OF HEALTH, -" ` ' .0 All DATE AGENT _ — SCALE '.DATE �t L 014EDGE ENGINEER/NG CO. ING� f a CLIENT JAICrr/G2 a 1711: I CERTIFY THAT THE PROPOS>.D � r EGISTERE REGISTERED JO'B NO � v ? BUILDING" SHOWN ON THIS ,PL'A140'r;s t ^• CIVIL LAND; ;CONFORMS . TO THE ZONING :LAWS '- f; ENGINEER SURVEYOR OR. BY fir • — t Of+ " BARNSTA L E M S 5 F 33 NG' / MAIN ST 712 MAIN "S'T " CH. BY R fP �, SO" YARMOUTN, MASS. NYANNIS MASS. Z SHEET L OF _,,. DA E REG. LAND SURVEYOR ' i^i /1l07F3G�PT/C .-rA.V�. OR r 20 PT.' Mav GEf+CNllerG 'Pi T :4IPE /SORE ;TIol A/ -% .,BE40 pv: "JD ! /►1lN, ,, aRAP&jA 404"p/AM ET.ER 'CO/R/C'JP.�T°,� COPE Y41 SMA4L .BE:'BR2?L/6NT' Ta 4,TAXOR.(5Ald z*-n 'A 4 PV CONCRCTE M h►E.4 Y y .CAST /RO/Y C O yEI�? SH�4 L-L. BE U S EO C P/P�' N. .o/TCN /F/JV L *4r/VEy1/A Y E/e /0.�. o COI�'F/6'S. 1 p �.. r y .a C�7�.4GLT co✓Ei� • - A ,_ _ - � • CLEAN SANS :p BAC/C�/GL - L/QU/O LEVEL -• 2"LAYER d 4"CAST� p a o a oo QF I�8' IRON P/PE IGGG GAL. • a 1 • • • •' •'s• 1 o e„� `yASHED S70AIC 0 NlIN.P/rclr D/ST, %¢ Pe�it Prr SEPT/C' TANfC ° `' 1 1 s :e e • • 1 �.°°44 b o 1 1 e .. ¢ f �Z• r c EFFE17-7VC ° S : - ;. o a 1 � o OL=PT1•/ • • 1 • 0 1d��4�HED STDiYE �; • e a. c 1 • . • e ;.• • • 1 p p!y PI?ECAS 7-SE.EPAG E `., 1M6/�'RT �'LE!/ATIONS. .. a ► o r • ■ • • e_-• old e a G/7 DR EQU/v.� INVERT AT BUILD/NG �7� O F7. IN4E7' SEPT/C TANK _FT. FT D/�11�'1 C SEE OUTLET SEPTIC TA/VK FT. ` 1,vz,rT DISTR/B!/7YON BOX S'S FT SECT/ON OF' GROUND WA7--,ER TAEL - N[.ET LEACH/N!v PIT FT. SEN/AGE DISPOSAL SYSTEM LEACH//V6 P/� 7"ABUL.4TlDM ! . SeALE .�,�.. _ /`- o•• DIMEN.S'ION A -� FT. D.E316►IeI CR/TERJpt _ D/M.Fws/ow 8 %V llA9 /Q.;DF®EDRoO/�S 3 D/NfENS/O��/ C —F T. A4, .. G4AWIAS&OkSPOSA4 t/N/r SD/L_ LOG TOTAL.E.�T%M�47�E0 FLOrV 3 3 y 6AL.�DAy. SO/L TEST 14E/ SOIL 72FS7-**2 SO/L EST i UM&ER OF 40ACNtN6 RI-'.S_ l f-ECE✓, 9190 . 1 -E4EV, oATE OF SOIL.TEST. S/pg,0,4CHING T PER P/ : ��SQ PT. 0 - 2 RESULTS PVIT/VESSED BY BOTTOM 4ro4 'N/NC-POR P/T 7 SO. A'T S4 t, :_: AWRC0 AWO" RATE S!�ess r 2 i^ /y//1r�INCH 7*,, r AEItCOL4T/OIV RATE Art MIN,f IAICNA sip. FTR9RrEGEACIlN6AREA 1t. . _ t ti K gv-cN�F Mq c M, -z� t - /VI.4TZST0/✓S /V)/L[s N ROBER�i BUNT Is o / 01-ARE r&DSE EAiH�1AfG CgJIVC Na Zl182' a: CcuPse Sd„f/ � ��� F'. 7I2'MAIN ST.. w. . 33 NO. �, a } t KD G/�Ol�lllf�? YY�4TL=R E*NCOCJ�!/-pow— r HY�QIWN/3;'M.QSS.ry: .9p.1ARMO�YTIiI,A4As. Y JOB IVO. :i ..�-}g r�,:,w.- t:'�R .-.,� <r •c �,•aAF aA�:.�;,f1 '`�, --... ,.�. .-. .j ro. >.. . ..ter .. -.rr P+v•.�.�_..-�;.. . t„. ':';� r .s,,,,�r�°�' t. .. r:1.. :? . t a3� W + :September- 22 ^ 1978 `' Mr. Gary`L.- Werner_ �v Banner Home Corporation' 76 Vest Main Street -• ,Suite"104-' Hyannis, Massaehusetts,.02601 - Dear Mr. .Werner... You are. .granted a variance to in-StAl a`-sewage Leaching system • 140 'feet from-a welt in Lieu of the required 150 feet on Lot No. 96' Willimantic "Drive, Marstons. Mill . All other Town of -Barnstable Health regulations and Title ` s of the �$tate :Environmental Code must-be complied with. 'This variance expires •September l•,"' 1979`. D Very truly yours, Ann Jane E61ibaugh, Chairman „ . . Ro ert, L. 'Childs r A. W. Mandelstam'- -M. D; f BOARD OF HEALTH } TOWN OF BARNSTABLE= ' September 15, 1978 Barnstable Board of Health Town Hall Main Street Hyannis, Ma. 02601 Re : Banner Hmme Corporation Gentlemen: I am submitting a plan to provide for a sewerage disposal system for a proposed dwelling on Lot #96 Willimantic Drive, Marstons Mills , Ma. . I am reguesting varience of the local regulations of 150 ' from a well to a septic system, as shown on the attached plan. -T(D \y o/ Very Truly Yours, Gar), L. �erner Banner Home Corporation 76 West Main St . Suite 104 Hyannis, Ma. 02601 SO 40 a 3 Pktt z ; S Q J ............. '4' f p/' 0 . / (o '# q 3� y6 6 S. s at Yt Ji SOa =Sr Y' _ t7 } c 3' ` 61 t 4_ 4/ :56 OF jj 1F SER P. G o BUNIKIS +� n• r p No.2216 p '+ , GaSTcPG\�F 'ON.4t LEGEND EXISTING SPOT ELEVATION OxO CERTIFIED PLOT PLAN EXISTING CONTOUR - - - 0 - - Luz 96 lij//4-4 rw/�gNTi G DR c/E .FINISHED SPOT ELEVATION I,O.O FINISHED CONTOUR 0 = T��Ys • •. I N � n APPROVED BOARD ` OF HEALTH ` ' . , DATE AGENT _ SCALE / 40 ,. DATE r /* _�L DREDGE ENGINEERING CO INc-1-1 CLIENT UM1�L1�'n/C2 I CERTIFY THAT THE PROPOSED t' EGISTERE REGISTERED JOB N0. - iv ,U.Ii.DING 'SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING LAWS EfdGINEER \SURVEYOR DR. BY , A- 4,��1 a _ _. _ OF BARNSTA LE M S �r 33 NC' MAIN ST 712 MAIN ST. CH. BY R • 1? I3 �' ' sJ-' SO.-YARMOUTH, MASS. HYANNIS, MASS, SHEET—t 2 .O.F. --- DAT _ 4 E REG. , LAND SURVEYOR r: r7- am.22162I�P SNALL ��OAPO�[407i': TO 6Ri4® Cs.�A/✓ .E]1'TiC'A Yy CAST /h'O/s/ CCO/FR .S'/%4LL SE USED4PAC O/PE ,,C06/E9RSmw. P/7CN /N ORlVEAV. L�Y.E CO VEf? CLFAN .SANS 4"CsdST 2LAYER /ROA/ P/PF �Q G(/ 0 v o a oG�MIN. PYTCN GAL. ' a • . . •` • •• • ' a o /SASHED .57V.'/E%4'PAW rTT SEPT/C TANK D/ST, o s • ..•. • • • • ov • • o • 1 °° o o WA5N OSTDNE ao u 1 • . op pRT ELE6/AT/ONSP/T OR EQU/V. €'/NY rAT BBJ/LD/NG C17. O FT FT D/A!NL /C TAN/C �FT �_ FTC CSEE 7xIBULA_TION�TANK.5TR/8UT/ON BOXGRDuNo NITER TABLE0 07"LLQT D/STR/B/lT/ON BOX Y F7/NL=1 t.-AC,41.VG PiT AFT, .SEI�t/�LGE OISOOSA L .SYST�J►'JTj�eULi4TlD/VLEACHIIVG P/T0l/riENs/oN ADES/6/Y CR7WR/ASCALE :3 O/1OG TOTAL ESTCI�►'.+KTEO FLO`t/ 3 3 y GAL.1DAY. SO/L TESTO/ SO/L �S-r*2kuMBER QF - FACN/NG P/TS f`E[e`✓. 9 80 r^-EL�Y, OATS of SOlL'.TES$V PT RES[ILTS I4//TNE$SEb BY �607TOM A.CACHING PER P/T $Q, PT. S b PERCOLAT/OAI IeIt1TlF /lesTOTAL LE-tC,41/N6 A/QEA b so FT. : PERC:OLAT/O/V RATE�2 2— MIN.1/NCH RAESE^M E L 5 4C/ MC7 AREA SQ FT. u//Lt-/�4-• VTl C- 2./✓E OF,y4s, ra v'; �0 v C c c.Ple,Sal 9.I2 /►IAI/1t 3T 59 /dO,M.+1/ I 4�73 i 3` .' gs., �q`6\��i`` - :: �', ( NO GI?Ol1KG J i47ER-EsI+VGtw�NT,EJ�' P i. �1L'.�X/i1�/.!� !!l t�S�+.�� D: PRJ►9QLTIi►,A*.4V" �� (� GRO[/NO Lwtl T�.Q AT'_&z zv... n 4: .