HomeMy WebLinkAbout0151 MAIN ST./RTE 6A(W.BARN.) - Health 151 MAIN STREET, W. BARNSTABLE
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE HINTER STREET. BOSTON• NIA 02108 617•29'-5500
'ILLI.-%yI F WELD ,1�l,�, , TRH D) CO\i
Jr:rclan
Go�emor
ARGEO PAUL CELLUCCI a" DA ID 8 STRI ilk
Li Govemor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTI N-xFOfjl�flpCO" "s Jnc:
PART A C;� R F�7
CERTIFICATION Tom,, 2 T
West
1 98
Property Address: 1 51 Route 6A Barnstable,Mass. Address of Owner: 9 Date of Inspection: 4/17/98 (If different) C
Name of Inspector: .Tncc=h P_Mar amber it.
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR'15..000)
Company Name: J.P.Macomber & Son Inc.
Mailing Address: BOX 66 Centerville,Mass . 02632
Telephone Number: `;QA_77c, "RV1R
CERTIFICATION STATEMENT
I cen,fy that I have personally inspected the sewage disposal system at this address and that the information reported below is true. accura!e
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function anc
maintenance of on-site sewage disposal systems. The system:
asses
_ Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature: ,� Date:
The System Inspecto hall 4submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this
inspection If the system is a shared system or has a design flow of 10,000 god 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.
INSPECTION SUMMARY: Check A, B, C, or D:
A) SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 C,&AR 1 5 303
Any failure criteria not evaluated are indicated below.
COMMENTS.
B) SYSTEM CONDITIONALLY PASSES:
One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system upon
completion of the replacement or repair, as approved by the Board of Health, will pass.
Indicate ye�s�,�,)no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not
2' The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Cenif,cate 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 exfrltration. or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic ;an.
as approved by the Board of Health.
(raviaad 04/25/97) Page 1 of 10
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t j Prinleo on Recycled Paper
SUBSURFACE SEWACE DISPOSAL SYSTEM INSPECTION FOR-
PART A
CERTIFICATION (continued)
151 Route 6A West Barnstable,Mass .
O"^°' Mary Hamilton
Dili 0 lnsp<<:,an 4/17/98
3I SYSTE." CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed it) the d15(ribul'On DOx is c-e
pipe(s) or due to a broken, senled or uneven distribution box. The system will pass ns 2
Board of Health) Describe observations:
broken pipe(s) are replaced
Obslruclion is removed
distribution box is levelled or replaced
The system required pumping more than four limes a year due to broken or obst,,,lvc -e s s "
nspeci,on I (with approval of the Board of Health)
broken pipe(s) are replaced
obstrucl,on is removed
C1 FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
,VU Cor.o.tjonl exist wh,cn require lusher evaluation by the Board of Health in order to
D�Dl,c nealth, wiery and the environment
u SYSTEM WILL PASS UNLESS BOARD OF HEALTH DEZERI.AINES THAT THE SYSTEM IS NOT FU�C"O�"•
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
&f1 Cesspool or phvy is wi(hin 50 feet of a surface wale(
&0 Cesspool or privy is within SO feet of a bordering vegetated wetland or a sal! rrarsn
'i SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF AP?2-- =
THE SYSTEM IS FUN'C-TIONINC IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAF�'_t A,=
ENVIRONMENT.
The system has a wpoc tank and sort absorption system (SAS) and the SAS is ,,,r-,n r:
tr,butary to a surface water supply.
The system has a septic tank and soil absorption System and the SAS is within a Zone c _ -
The system nas a septic tank and soil absorption system and the SAS is within)") 50
wit
The system has a septic tank and soil absorption system and the SAS s less man IpC ee'. =
private water supply well, unless a well water analysis for coliform OJcleria and 'o:j -!e 0"55
the well is free from pollution from that facility and the presence of ammonia nwc� en anc
less than 5 ppm method used to determine distance 'e/."Y (approximation no:
J; OTHER
i
I I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:1 51 Route 6A West Barnstable,Mass.
Owner: Mary Hamilton
Date of Inspection: 4/1 7/98
D) SYSTEM FAILS:
You must indicate ewer "Yes" or "No" as to each of the following:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CmR 15.303. The bass
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to cortec-,
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 distr utron box above outlet invert due to an overloaded or clogged SAS or cesspool
n ca&&p 1Z' l l`
Liquid depth in Gbi3�4io�is less than 6" below invert or available volume is less than 1/2 day floe.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped 0--.
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 supp;�
4 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 \ rh no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis or
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E) LARGE SYSTEM FAILS:
You must indicate either "Yes" or "No" as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
/,/fL . The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
Yes No
,t),¢ the system is within 400 feet of a surface drinking water supply
4�4 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 a o: a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information
(revised 04/25/97) Page 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 151 Route 6A West Barnstable,Mass .
Owner: Mary Hamilton
Date of Inspection: 4/1 7/98
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. 1/•/" y f
None of the system components have been pumped for at least two weeks and the system has been receiving norrr,a!
flow rates during that period. Large volumes of water have not been introduced into the system recently or
as part of this inspection.
As built plans have been obtained and examined. Note if they are not available with N/A
The facility o: dwelling was inspected for signs of sewage back-up.
The s,,,ste,m d.)es not receive non-sanitary or industrial waste flow.
4 _ The site %•,as :nspected for signs of breakout.
_ All system: components, eluding 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 :ee , material of construction, dimensions, depth of liquid, depth of sludge, depth of scum
— The size and locau)n of the Soil Absorption System on the site has been determined based on
The facility owner (and occupants, if cjfferent from owner) were provided with information on the proper maintenance of
Sub-Suriace Disposal System.
Existing information. Ex. Plan at B.O.H.
Determined l i the field (if, any of the failure criteria related to Part C is at issue, approximation of distance is
unaccept.;:):e (13.302(3)(b)J
(revised 04/25/97) Page 4 of 10
JOSEPH B.MACOMUR&SON,]fie.
gO.BOX 66
XWzZX
frame: Mary Hamilton McCready 362-4513 cumomw cone:
flames:: 151 Route 6A mham
Town: W Barnstable star: Ma zo: 02668
Mailing address:
151 Rte 6A W Barnstable MA 02668
Maint every 2 yr April
76 79 80 81 87 Everett Paananen
4121189 pump T 105.00 4125/89
4/17191 pump T 105.00 4126/91
3/31/93 pump T 135.00 4/2/93
417/95 pump T 145.00 4/21/95
3/13/97 pump T 175.00 3/25/97
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 151 Route 6A West Barnstable,Mass.
Owner: Mary Hamilton
Date of Inspection:4/1 7/98
FLOW CONDITIONS
RESIDENTIAL:
Design flow~: "9�M R. /bedroom for S.A.S.
Number of bedrooms: P
Number of current residents:
Garbage grinder (yes or no) A�6
Laundry connected to system (yes or no).-L'16
Seasonal use (yes or no):_
Water meter readings, if available (last two (2) year usage (gpd):
Sump Pump (yes or no): X)
er l�. lfi�
cs
Las( date of occupancy � _ E ' EC
COMMERCIAUINDUSTRIAL:
Type of establishment: �(//
Design flow: A, •gallons/day
Grease trap present: (yes or no)-&A
Industrial waste Holding Tank present: (yes or no) i
Non-sanitary waste discharged to the Title S system: (yes or no)A24
Water meter readings, if available: L�
A 14
Last date of occupancy:—lJ _
OTHER: ;Describe)
Las( date of occupancy: N
GENERAL INFORMATION
PUMPING Rt�:,ORDS and ource of into matron:
System pumped as 6an of inspection: (yes or no) b
If yes, volume pumped: / allons < >>
Reason for pumping: j� /N? - STlrirlr y��
TYPE OF SYSTEM
Septic tank/distribution box/soil absorption system
/'r? Single cesspool
IV E Overflow cesspool
a'y Privy
41 Shared system (yes or no) (if yes, attach previous inspection records, if any)
y I/A Technology etc. Copy of up to date contrail
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information: Z/1—)
Sewage odors detected when arriving at the site: (yes or no) 61��
(revised 04/25/97) page 5 of 10
BARNSTABLE COUNTY DEPARTMENT OF HEALTH & THE ENVIRONMENT
Of B,jR,y
P.O. BOX 427
ti s, SUPERIOR COURT HOUSE
BARNSTABLE, MASSACHUSETTS 02630
A
• �TA57 • PHONE: 362-2:51
EXT. 3 3 7
SAMPLING INSTRUCTIONS FOR PRIVATE WELLS
An improperly taken sample wastes your money and has neither scientific accuracy nor legal
acceptance.
1. Obtain sterile sampling bottle from the County Lab or Town Health Department.
Bottles sterilized at home are not acceptable.
2. It is recommended to use a straight faucet, preferably NOT swing-type.
3. Turn on the cold water and let it run for five (S) minutes.
4. Fill the bottle leaving one inch air space. Do not fill bottle to the top. Be careful not to touch
the inside of the bottle or cap with the faucet, your hands, or anything else.
5. Fill out the reverse side of this form. The laboratory requires accurate and complete
information. The person filling the bottle must sign the form
6. The charge for a routine well analysis (coliform bacteria, pH, conductivity, iron, nitrate,
sodium and copper) is S25.00. Checks should be made payable to Barnstable County.
Exact change is required if paying in cash. Additional tests require additional fees.
Consult lab or a price list for exact information.
7. Samples are accepted Monday - Thursday from 8:00 AM to 4:00 PM and Friday 8:00 A-M to
I:00 PM. They must be delivered to the lab within 6 hours of collection or 24 hours if
refrigerated.
8. Completion of tests and results takes 7-10 business days. Results will be sent in the mail.
9. Special requests such as results in 2 -3 days and sample acceptance on Friday from 1:00 PIM to
4:00 PM are available for an additional charge. Contact the laboratory for availability.
NOTICE: WATER FROM THE SAME SOURCE CAN PRODUCE CONTRARY RESULTS
IF TESTED AT DIFFERENT TIIytES AND/OR DIFFERENT LOCATIONS_. THE
COUNTY OF BARNSTABLE SHALL NOT BE LIABLE FOR DAMAGES
RESULTING FROM THE RELIANCE ON RESULTS OF WATER TESTS
ACCURATELY PERFORMED
PLEASE COMPLETE REVERSE SIDE OF FORM
PLEASE READ INSTRUCTIONS ON REVERSE SIDE BEFORE COMPLETING THIS FORIM
B,\RNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT
362-251 1 X 337
DRINKING WATER ANALYSIS LABORATORY SHEET
Name Sampling Date: T rn?
stalling Address: Sample Location:
(Street or Box)
(Town or City) (State) (Zip) -
Telephone: Year House was Built:
Bottle Identification Number: Well Depth Feet
(Taken from Bottle)
Reason for testing (Check one):
❑ susp_ct a problem ❑ required by DEgE
❑ for information only ❑ new well
real estate transaction• other:
Note': Some banks and mortgage companies may require additional testLng %vhich
n.ore and requires more water. Check with Lab before bringing in th? samn.t
Distance of supply frcm possible contamination sources (check all that apply):
septi,: tank / cesspool — feet ❑ farm
❑ saltc�c! highway feet ❑ buried fuel tank
❑ lane. :?:l feet ❑ other
17eatTnent used:
❑ non?
❑ wat,: softener
❑ filte-
SIGNATURE OF S,4,.Mi,LE COLLECTOR
❑ Well Driller ❑ Owner ❑ Realtor ❑ Tenant .J
-------------------------------------------------------------------------------------------. . . . .
- FOR LAB USE ONLY -
i
—Total (�cllform / 100 ni!
pH
Conductivity (microml.os / cm)
Iron (ppm) -_--
:Nitrate- Nitrogen (pp:::!
Sodium (ppm)
Copper (ppm) � -----
L
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 151 Route 6A West Barnstable,Mass .
Owner: Mary Hamilton
Date of Inspection:4/1 7/9 8
BUILDING SEWER: .
iloca(e on site plan)
Depth below grader
Material of construction: cast iron Z, /40 PVC — other (explain)
Distance from private water supply well or suction line JeT'7`
Diameter
yrr
Comments: (condition of joints, venting, evidence of leakage, etc.)
Aiii 2i!L N 6 . /deVk�-- 020.(rr�.ld
SEPTIC TANK:L60,1Y44A)0
(locate on site plan)
r/
Depth below grade: � �
Material of construction: Yconcrete _metal _Fiberglass _Polyethylene _other(explain)
If tank is metal, list age V1,*1 Is age confirmed by Cenificate of Compliance &,LX(Yes/No)
S " J
Dimensions /C'G '/& Ei '� "lLii� ✓ �� Il/ll
Sludge depth:
Distance from top of sludge to bonom of outlet tee or baffler
Scum thickness ) n)
Distance from top of scum to top of outlet tee or baffle: li
Distance from bottom of scum to bon of outlet ee or baffle:_
How dimensions were determined: 1
Comments:
(recommendation for pumping, conditi of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.) [ "d-
�1"A&,k 25 2714
f
GREASE TRAP: r{��
(locate on site plan)
Depth below grade 'V4
Material of construction:4--,4concrete�VA metal s`AFiberglassA-19Polyethylene f;4other(explain)
Dimensions: 4)A
Scum thickness: A,'11-
Distance from top of scum to top of outlet tee or baffle: .t',l
Distance from bottom of scum to bottom of outlet tee or baffler
Date of last pumping:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.)
(revised 04/25/97) Page 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Properly Address:1 51 Route 6A West Barnstable,Mass.
Owner` Mary Hamilton
Date of Inspection: 4/1 7/98
SOIL ABSORPTION SYSTEM
;locate on site plan, if possible, excavation not required, but may be approximated by non-intrusive me(nocs)
If not determined to be present, explain:
Type leaching pits, number.
leaching chambers, numbe
leaching galleries, number: Q
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Alternative system. 1014
Name of Technology:
Comments:
(note condition of soil, signs of h draulic failure, level of ponding, condition of vegetation, etc.) ,
or
CESSPOOLS:
(locate on s,te plan)
~'umber and configuration: 0 r
Depth-top of liquid to inlet invert: le-/R
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool: /Ujff
Materials of construction: I'/A
Indication of groundwater: it/X
inflow (cesspool must be pumped as panof inspection) p �r
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY:11 D 'C?.
(locale on site plan)
Materials of construction: ,C14 Dimensions
Depth of solids If,14
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
tr.vl..d 04/25/97) D.g. a of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM%
PART C
SYSTEM INFORh1ATION (continued)
PrO;)er(. Address: 151 Route 6A West Barnstable,Mass.
O-ne,. Mary Hamilton
Dare et Inspect'on: 4/17/98
TICHT OR HOIDINC TANK 16(Tank mull be pumped pr,u' Io, or at time, of inspection)
llo(j:e on s,(e plan)
Deptn allow grade AO
ma.er�a1 o construaron:40/f concreleN,+metal tii}.FrberglassALPolyethylenes�f other(expla,n)
Uf1
D' eos'ons _ 4'A
Capac.ry gallons
Design 1-0., gallonVday
Alarrr. .e•el �� Alarm in working Order Yes.'(,A NU
Dale o' 0re"ous pump,ng
COmme e
(cone.t.on 01 -nlet tee, condition of alarm and float swathes, etc I
Or or
DISTR13UTtO.N BOX:
'.-Oca:e :1 we plan)
De:: c _.-d level above outlet inven
Commi-:s
(note .1 level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, c.,
%. ---
L U - ---
PU.ti1P CHA.%iBER:&V
17
tlocxc c-) s,:e plan)
P mpr .r ,.Orking order: (Yes or NO)
�
Atari".) ..Or4ing order (Yes or No) /
Comr..er:s
,nO:e ;o-c•:•on of pump chamber, condition of pumps and appuneninces• etc.)
P.g. 7 of 10
L_
SUBSURFACE SEwACE DISPOSAL SYSTEM INSPECTION FORti�
PART C
SYSTEM INFORMATION (continued)
Proper.y ACc,eW 151 Route 6A West Barnstable,Mass .
O»per Mary Hamilton
Date of inspection: 4/1 7/98
SKETCH OF SEWAGE DISPOSAL SYSTEM:
ce ties to at least rwo permanent references landmarks or benchmarks
xa.e all wells within 100• (locate where public water supply comes into house)
_�
t..
�J� I
:T1
Ir•v:•.c :�/:5/97) ➢•y• 9 of 10
SUBSURFACE SEWAGE DISP SYSTE•." INSPECTION FOR'o
SYSTEM INFOI ON (continued)
Propene ;' Cress: 151 Route 6A West Barnstable
O-ner: Mary Hamilton
Date of Ins?ectlOn: 4/17/98
i
De�,h o C.'ouncwater 11 Feet
Please nciczte all the methods used to determine High Groundwai(Y El .a on:
Cc.a,ned from Design Plans on record
oser.a:ion of Site (Abuning prope �observallon hole, basernGr-T s jmp etc )
V- ✓e:e•m,ne it from local conditions
`nec, nrtn local Board of health
e:, :�'✓� maps
p;rnp,ng records
��":cC• local excavators. installers
'-SCS Data -
Desc,. - ,o.r own words now you established the High Grounds xcr: eva:ion Must be comple:ec';
Used water contours map.
Gahrety & MIller Model
12/16/94
.-.-♦^r•-rt•'T'rT -.T�.T•�T.•S'•�r T.TT'.'.T'TTT:TT...1'iT1t T'lST.TLT.�':� _.
TOWN OF Barnstable WARD OF HEALTH �
SUUSURFACF SFWAGE DISPOSAL SYSTEM INSPECTION FORM - PART U CERTIFICATION
••�. F..._..._r......_-.ue--r�.r.r-n•na:.:a.•--.r.rrrr+•..—•.':--z.-+*m—rer*.ec-+rnr*rarrrm-sra mnr.rsm-�.—•�rr+...r.:—..-r. A
—TYPE OR PRINT CLEARLY—
PROPERTY INSPECTED
STREET ADDRESS 151 Route 6A West Barnstable
Mass
ASSESSORS MAP , DLOCK AND PARCEL # G�
OWNER' s NAME Mary uami I'tr)n
PART D - CERTIFICATION
NAME OF INSPECTOR Joseph P.Macomber Jr.
COMPANY NAME J.P.Macomber & Soa 'Inc.
COMPANY ADDRESS Box 66 Centerville,Mass . 02632
Street Town or City S t a t 9 LIP
COMPANY TELEPHONE (508 ) 775 - 3338 FAX (508 � 790 -1578
CERTIFICATION STATEMENT c
I certify that I have personally inspected the sewage disposal system at
this address and that the information reported is true , accurate , and
complete as of the time of .-inspection . The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of or)-
site sewage disposal systems ,
Check one ;
System PASSED
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
health oI' the environment as defined in 310 CMR 16 - 303 , Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form .
System FAILED*
The inspection which I have conducted has found that the system fails to
protect the public health and the environment in accordance with 'title
5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form .
Inspector Signature Da —/�t e
One copy of this certification must be provided to the OWNER , the BUYER
( where applicable ) and the 130ARD OF 11BAL'1'Il .
* It the inspection FAILED , the owner or operator shall upgrade the ayutem
it,hin one year of the date of the inspection , unless allowed or required
otherwise as provided in 310 CMR 15 . 305 .
partd . doc
-
ASSESSOR'S MAP NO. ` PARCEL�2 71 �� 9 1
i0 CAT ION c5 � S E w A C PE RMdT NO.
-VILLAGE �1
Z--
IN 'STA LLER'S NAME i ADDRESS
a-^3 J--t--OL�-e-s pA�-rd
U I L D E R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED1
WELL
N
/ S O®
torn F - - Jv3°
TOWN OF BARNSTABLE
LOCATION A eVA4 SEWAGE #
VILLAGEeAk-4r 3'� i(C� ASSESSOR'S MAP & LOT DZ
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
r
LEACHING FACILITY: (type) AOXf (size) 620
NO.OF BEDROOMS
BUILDER OR OWNER zgW
PERMTTDATE: 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 le ' a 'lity) Feet
Furnished b / ����d
i
w
U, T
ti
THE COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF ENVIRONMENTAL PROTECTION .
BE IT KNOWN THAT
Joseph P. Macomber, Jr.
Has satisfied the Department's qualifications as required and is hereby
authorized to use the title
CERTIFIED TITLE 5 SYSTEM INSPECTOR
as provided in 310 CMR 15 .340 and Section 13 of Chapter 21 A of the
General Laws. Issued by The Department of Environmental Protection.
June 8. 1995
Acting Direcugofffic L ion of Water Pollution Control
i
a
No. ..... Fss ....._
THE COMMONWEALTH.� OF MASSACHUSETTS
BOARD OF HEALTH
T y'...'v........_..oF..... �Lrzivs7 3 3G .................. ........ -
Allp iration for Diopoint Works Tonotrurtion Frrutit
l Application is . er made for a Permit ,to Construct or Repair an Individual Sewage Disposal
PP ��YI �.:�. (� P ( ) g P
Y
S stem at
--.:STAl........ ,�1�/ .. f!T A.....w.�......e t/sTABL� LoT
/ Location-Address or Lot No.
............................................ ...................................../_ .........................._
caner Address
- : .... .._.... 5 ♦ ...........................................
Installer Address
d Type of Building Size Lot_ 7 ov .......Sq. feet ..f
Dwelling—No. of Bedrooms................3...................._...Expansion Attic ( ) Garbage Grinder ( )
Other—Type T e of Building No. of persons............................ Showers
tz, YP g ---------------•------------ P ( ) — Cafeteria ( )
Q, Other fixtures -----•-----------------------------------------••-----------------------------------------------•-------•-----------------------••----•-------------
d
W Design Flow.................:s'........._........._gallons per person per day. Total daily flow............336......................gallons.
WSeptic Tank—Liquid capacity_�q.gallons Length Width.'?�'4�'. Diameter________________ Depth.f'8."_-
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No......... ......... Diameter.......? Depth below inlet.....6........... Total leaching area.?X7......sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
a Percolation Test Results Performed by..PP!e p..........--• ._ Date.,,- /---.
,,y ... . . T-------------------
Test Pit No. 1.... '.._.minutes per inch Depth of Test Pit----!�............. Depth to ground water........................
f=, Test Pit No. 2.......Z...minutes per inch Depth of Test Pit----Z ........ Depth to ground water........................
a ---------------------------------- ---------------
0 Description of Soil.....-� 3�..-----woo. �... �.-&-Sai C' 6-.i=/.5 .�_Mom:__S !l�.
x
w
---------------------------------------------------------------------------------------•----------------------•--------------------------------------------•---------------------------------......----
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 TI1i U 5 of the State Samtar Code—.The undersigned further agrees not to place the system in
oper '1 a Certifi een is ed y thg.ho rd%of h lth.
Sed------ -- -- -- - - ....... ..-
�Application Ap ved BY---- ....... ..-- ....=. .... ...............................:.....•-•- •-•-•- �, �
'Date
Application Disapproved for the following reasons:..............................................................................................................
.....-----•----•---•.....................................---•-•------------•---------...------------....------••-•---.... •---•--•----.
Date
PermitNo......................................................... Issued..------------....... ...............................
Datee
-- - - - - _ -----------------------------------
No.. .. Fim
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
T
Appliratiun for Diupuuttl Works Tomitrurtion "ami#
Application is hereby made for a Permit to Construct (uy or Repair ( ) an Individual Sewage Disposal
System at: y
.5T�?�- �i5111AI V ��i7 Z,4 k1 !3f rz�/ST�}��f:� �T
...............--.................. .... .. -•-•-••---------•---................... .......--•-------------•--•••-••---•••...... ...------...._._......._..................
Location-Address
- or Lot No.
.. .. -•..............•----..........._........._-..---
Owner Address
............................................. --�a'.-`-..... ..'----•------•----------•-.....-•--••-•-•--•....................................................
Installer Address
d Type of Building Size Lot.. .Vic'`'...._._Sq. feet "
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
a'4 Other—Type of Building No. of ersons____________________________ Showers
YP g -------------•-------------- P ( ) — Cafeteria ( )
� Other fixtures -___--•-•---•-------------------------------•-------__---••---------•-------••-•--•--------•---__•_-_•-•----------------•-•---•-••••------_--------•-
W Design Flow...............___-'__.____.____......_.__gallons per person per dray. Total daily flow______..____.' ��'_._..______....._._ allon�s.
WSeptic Tank—Liquid capacity_�,b'gallons Length____ ____._ Width.. G_____ Diameter________________ Depth............
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
_ Seepage Pit No---------- Diameter........ ` ___.__. Depth below inlet.................... Total leaching area..Z...�
......sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'-' Percolation Test Results Performed by...............................Z-=. L-Z���
a ...•-----...-•----•-----•-•-.............. Date_...--------•-•--•:=---•-••-------•---�
a Test Pit No. 1___.4_`.._.minutes per inch Depth of Test Pit____- ____ Depth to ground water..........................
�--,
f% Test Pit No. 2..............minutes per inch Depth of Test Pit..... Depth to ground water______ ____________
a ---•-------------•••-••-----•--------•--••------...._....---••.....•---•....._......•---•---•---_.... -•-..._........
O ca L l'f/OUr�Ga. f�' S�c3-Sr�� G. G 1_5Z' 1-•-iG7•_a.
Description of Soil__....•_•--- ----•-•........_. _.._..•-••--• •-••-••-•----•--•--•--------••--•••�..._...----------------------•••-•-----•-•-•....._._..•---
x
w
--------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------•---•-•-•-•---•--•--•-•-••••-
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 iITLF: 5 of the State Sanitar Code The undersigned further agrees not to place the system in
oper a Certifi omp een is >fed `y thg►bOr
rd f h lth.
ned_
- _....
Application App ved B .�
. bate
Application Disapproved for the following reasons:.......................................................................................................... --_
_.......••-------------------------•-----•---•-••••--•-----.....-----------•-----•---•---._._.......•---•--•---•--............--•----••-••-••--•...-••---------••-••-----•---•-•----••-•-•••---•----•---
Date
PermitNo...................................................... Issued........................................................
Date
THE"COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
(Irr#if iratr of Toutphattrie
THIS IS TO CERTIFY, That tIW_4ndiyiduaI Sewage Disposal System constructed (�-,)�`br Repaired ( )
by r?rtr..
Ins all
at._..-•-•.. := 'A�..... -•• -•--- c� ..........................
has been installed in accordance with the provisions of ^'IF The State Sanitary Code as de ibf in the
application for Disposal Works Construction Permit No ___._' :.1............. dated__ _..?___.____.....
THE ISSUANCE OF THIS CERTIFICATE SHALL'NOT BE CONSTRUED AS A GU RANTEE THAT THE
SYSTEM WILL FUNCTION,S . ISRACTORY.
DATE................... .......:ter....... .............. Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
r'x BOARD OF HEALTH
v h�/1� �,9�zr�is T.�&G6_
,�/L ............. ........................OF...-...._..._......._..........,_...:..---.-...._.._.__._..-__-.._...._._........._.. ,..
NO .-""1.7 FEE ........
aiupuu d ■.(�yJ.�yp7[ rku Tonu#.rur#ion �rnlil
Permission <s hereby granted.. Ca. .••-•.............................
to Construct ofRe air, J an Individual Sewage Disposal System
-•--•-•. •-• --- •......................as shown on lication for street
°f ,!,!
pp r Disposal Works Construction Permit N46 1q� D ed_ . ............... .............
._ ,
of Health `
DATE........'�
FORM 125 - M.SULKIN• INC.• BOSTON t
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it I
1
7� G,9
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47
40
4 �Z' \ / "15T/NG
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ptr
J
73, o 00 sQ,FT
/VaTE-- EZ",o9 BsiseD oN WEST B BG
.4sSuM�v D�Tu.y, LOCATION . ......... . ......
SCALE ,��� �o .. .... DATE
PLAN REFERENCE
on/
. .. . . . . . . . ... . . . . .. ... .. . .. ... ...... . . . . .
4.61
EDWARD
Vp
`e'...�5 . . . .. .. . . . . r . . . . . . .
N ci0 ci� Vz I CERTIFY THAT THE E.C{STin/C .�uiL7j/n/CG
SHOWN ON THIS PLAN IS LOCATED ON THE GROUND
". AS SHOWN HEREON,
DATE . .. .Y...�. . .. f, �
fit//LG/AM F_ �W/FT R&777-/oAvE� REGISTERED LAND SURVEYOR
i
f
Z SN �s
L. _Go. 90
TOP OF FOUNDATION
CONCRETE COVER
CONCRETE COVERS
7.54 •'e a 4"CAST IRON 12�"MAX.
OR SCHEDULE 40 SCHEDULE 40 PV 12"MAX. •
�
P.V.C. PIPE . 4C.(ONLY) -T� PITCH 1/4'�PER. PIPE - MIN. LEACH
PITCH 1/4"PER.FT. PIT
E�St/sT+NGn,sgg7 PRECAST
o' INVERT J LEACHING
` o EL.s3.3` .. INVERT PIT OR
SEPTIC TANK DIST. INVERT oe w e:�
o INVERT BOF( EL Sa,4o _ EQUIV.
. ../000.... GAL. INVERT 6` ►_a- o'o; EL. /.•Z' .. Soy INVERT WW 0: . 3/4 T011/2'
EL...:..7.
EL •�� a.' u �: WASHED
° w STONE
4Z /p ez,42.00 ..:
.• 3G'�.—W DIA. --•� Al—�N oC
• • /o' DIA. c�o..rr�xEv
PROFI LE OF GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM
�7 NO SCALE
/�--SZ7o
SOIL LOG WITNESSED BY :
DATE T<►!'f L/9Bl TIME.?;!S BOARD OF HEALTH
TEST HOLE I TEST HOLE 2 GsDW ) Ls /CI�ZC� ENGINEER
ELEV. . .So. Co
. . . ELEV. .. .. . . . .
v✓oop[egry WcoDGoAry
3d" S a-sac. 3�-' Spa so,t, DESIGN DATA
ez.47 6o ex.49,00 3
NUMBER OF BEDROOMS
84. TOTAL ESTIMATED FLOW . . 33o GALLONS/DAY
7B..So
BOTTOM LEACHING AREA SQ.FT. /PIT/G.P.D.
SAr/D Pam. SA-;ID
SIDE LEACHING AREA . . . �88.5 SQ.FT./ PIT/47/ GP.D.
GARBAGE DISPOSAL .tYPA16. .(50% AREA INCREASE)
TOTAL LEACHING AREA zG7.-oo• SQ.FT
KF¢ E2.38.Lo /Sb' �z.3J o 0
PERCOLATION RATE LG55 v Tl✓o MIN/INCH
.!✓.9. .WATER ENCOUNTERED LEACHING AREA PER PERCOLATION RATE .ATO.. SQ.FT./c•PD•
NUMBER OF LEACHING PITS . 0^��• P/T INi�/
APPROVED . . . . BOARD OF HEALTH ���' -.0` STDNE� ON
DATE . . . . . . . . .
AGENT OR INSPECTOR
A OF eNgsss
OF "Y"
LoT .At/ �o� EDVfk�t0 �yGJ � ALL
�vT� . . LA . . . . - o �ELLEY
. 0 No. 264.00
pp �
Isng, VNRAP\P�
PETITIONER ; . . . . . . ``�'�,=L.',�ru,