HomeMy WebLinkAbout0011 DORAL ROAD - Health 1 Doral Road
Barnstable Y14
rr
a
Commonwealth of Massachusetts
Executive of Environmental Affairs
DEP
Department of J(/ VQ
Environmental Protection Z �
p 9
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM',,')<.,
PART A f�
CERTIFICATION
Property Address: 262 M arstons Lane. Barnstable, Ma. )'low
Address of O wner: John &Joyce R ademaker
(if different)
Date of Inspection: 06/20/96
N ame of I nspector: M ichael D eD ecko
Company Name, Address and Telephone number: Atlantic Environmental
P.o Box 2384 - M ashpee Ma 02649. Tel : (508) 4771420
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
Passes
---- Conditionally Passes
---- Needs further evaluation by the local Approving Authority
---- Fails
Inspector ' s Signature. . I } Date: 0622196
y
The system Inspector shall submit 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 gpd or greater, the inspector and the
system owner shall submit the report to the appropriate regional office or the Department "
of Environmental Protection.
The original should be sent to the system owner and copy sent to the buyer, if applicable
and the approving authority.
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 262 M arstons Lane. B arnstable,'M a.
Owners : John&Joyce R ademaker
Date of Inspection : 06/20/96
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 CM 15.303. Any failure criteria not evaluated are
indicated below
B)SYSTEM CONDITIONALLY PASSES:
---- One or more system components need to be replaced or repaired. The system, upon
completion of the replacement or repair, passes inspection.
I ndicate yes, no, or not determinate (Y,N, or N D). D escribe basis of determination in all
instances. If "not determinated", explain why not.
---- The septic tank is metal, 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 conforming 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 (with approval.of the Board of Health):
----- broken pipe(s) are replaced
----- obstruction is removed
n
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address : 262 M arstons Lane. B arnstable, M a.
O wner : J ohn&J oyce R ademaker.
Date of Inspection : 06120/96
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
---- Conditions exist which require further evaluation by the Board of Health in order to de-
termine if the system is failing to protect the public health , safety and the environ-
ment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE
SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT,THE
PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
---- Cesspool or privy is within 50 feet of a surface of water
---- Cesspool or privy is within 50 feet of a bordering vegetated wetland or a small
marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER
SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNC-
TIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY
AND THE ENVIRONMENT.
---- The system has a septic tank and soil absorption system and is within 100 feet to a
surface water supply or tributary to a surface water supply.
---- The system has a septic tank and soil absorption system and is within a Zone I
of a public water supply well
---- The system has a septic tank and soil absorption system and is within 50 feet
of a private water supply well.
---- The system has a septic tank and soil absorption system and is less than 100
feet but 50 feet or more from a private water supply well, unless a well water analy-
sis 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 notrogen is equal to or less than 5 ppm.
D) SYSTEM FAILS:
-- I have determined that the system violates one or mare of the following failure criteria
as defined in 310 CMR 15.303. The basis for this determination is identified below.
The Board of Health should be contacted to determine what will be necessary to cor-
rect the failure.
--- Backup of sewage into facility or system component due to an overloaded or
or clogged.SAS or cesspool.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 262 M arstons Lane. Barnstable, M a
O wner: J ohn&J oyce R ademaker
Date of Inspection : 06120/96
D) SYSTEM FAILS (continued)
-- 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 over-
loaded 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 NO T due to clogged
or obstructed pipe(s).
number of times pumped
--- Any portion of the S oil Absorption System, cesspool or privy is below the high
groundwater elevation.
--- Any portion of cesspool or privy is within 100 feet of a surface water supply
ortributary 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 ana-
lysis. 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.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 262 M arstons Lane. Barnstable, M a.
0 wner: John &Joyce R ademaker
Date of Inspection : 06/20/96
Ej LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above :
The design flow of system is 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
--- 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 I I of a public water supply well.
The owner or operator of any such system shall bring the system and facility into full compli-
ance 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.
J
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 262 M arstons Lane. Barnstable, M a.
0 wner: J ohn &J oyce R ademaker.
Gate of Inspection: 06/20/96
Check if the following have been done
-x Pumping information was requested of the owner ,occupant and Board of
Health.
--x None of the system components have been pumped for at least two weeks
and the system has been receiving normal flow rates during the period. Large
volumes of water have not been introduced into the system recently or as part
of this inspection.
--x As built plans have been obtained and examined. Note if they are not available
with N/A.
--x The facility or dwelling was inspected for signs of sewage back-up.
--x The system does not receive non-sanitary or industrial waste flow.
--x The site was inspected for signs of breakout.
--x All system components, excluding the Soil Absorption System,have been
located on the site.
---x The septic tank manholes were uncovered, opened and the interior of the sep-
tic tank was inspected for conditions of baffles or tees, material of construc-
tion, dimensions, depth of liquid, depth of sludge, depth of scum.
---x The size and location of the Soil Absorption System on the site has been deter-
mined based on existing information or approximated by non-intrusive methods
---x The facility owners and occupants if different from owner were provided with
information on the proper maintenance of Subsurface Disposal System.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 262 M arstons Lane. Barnstable, Ma.
Owner: John &Joyce Rademaker
Date of Inspection: 06/20/96
RESIDENTIAL:
Design flow : 330 gallons
Number of bedrooms : d3
Number of current residents: 0�
Garbage grinder (yes or no) : tic,
Laundry connected to system (yes or no):
Seasonal use (yes or no) : NU
Water meter readings, if available:
Last date of occupancy:
COMMERCIALANDUSTRIAL : .
Type of establishment:
Design flow : gallons/day
Grease trap present: (yes or no)
Industrial waste holding tank present(yes or no)
Non-sanitary waste discharged to the Title 5 system (yes or no)
Water meter readings, if available
Last date of occupancy
Other: (Describe) .......................................................................:....................................
Last date of occupancy:
GENERAL INFORMATION
P M PI N G RECORDS and source of information:
System pumped as part of inspection(yes or no)..... ..........
if yes, volume pomped: .................... gallons
Reason for pumping
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 262 M arstons Lane. B arnstable, M a.
O wner: J ohn &J oyce R ademaker.
Date of inspection: 06/20/96
GREASE TRAP : .......
(locate on site plan)
Depth below grade: ...............
Material of construction: ........concrete.........metal........FRP........other(explain)....
...................................................................................:..........................................
Dimensions:...............................
Scum thickness:........................
Distance from top of scum to top of outlet tee or baffle:.......................................
Distance from bottom scum to bottom of outlet tee or baffle:................................
Comments:
(Recommendation for pumping condition of inlet and outlet tees or baffles, depth of liquid
level in relation to outlet invert, structural integrity, evidence of leakage, etc.)........................
TIGHT OR HOLDING TANKS:....PC>...
(locate on site plan)
Depth below grade:..
Material of construction:........concrete........metal.........FR P..........other (explain)..........
................................................................................................................................................
Dimensions:............................
Capacity:....................gallons
Design flow:...............gallons/day
Alarm level:............................. s
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
................................................................................................................................................
................................................................................................................................................
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 262'M arstons Lane. Barnstable, M a.
Owner: John&Joyce R ademaker.
Date of inspection: 06120/96
TYPE OF 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)
--- Other (explain)........................................................... ..............................
APPROXIMATE AGE of all components, date installed (if known) and source of information
..,.. k`d)'6...........
................................................................................................................................................
................................
Sewage odors detected when arriving at the site: [yes or no).....t?' ..
SEPTIC TANK : ...
>` .�...
(locate on site plan)
Depth below grade: .. !�r
Material of construction:I r?..?� concrete ......... metal ........ FR P........ other (explain)
................................................................................................................................................
Dimensions: ..
Sludge depth.:.: ! ".:&...'l� z
Distance from top of sludge to bottom of outlet tee or baffle:....5.:yQ..........
Scum thickness:.
Distance from top of scum to top of outlet tee or baffle: .`:....... ..2.=:�.`.'..
Distance from bottom of scum to bottom of outlet tee or baffle: .a.-!.y'`..........�- e"
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.)......................
N,?cQ. �. vc����n . .�! r� .. t :. .�-� s ..m ? .
..V.tC�..
� .. .. G�. ,,?.o Q..:,,:r. -'— -A—.-\,-:��j..�S?)^ .:S.L..1.................................
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 262M arstons Lane. Barnstable, M a.
Owner: John&Joyce R ademaker
Date of inspection: 06/20/96
DISTRIBUTION BOX..!U�
(locate on site plan)
Depth of liquid level above outlet invert:...........
Comment:
(note if level and distribution equal evidence of solids carryover, evidence of leakage into
orout of box, etc.)..................................................................................................................
.............................................:................................................................................................... .
................................................................................................................................................
PUMP CHAMBER:.. si .Y.
(locate on the site)
Pumps in working order: (yes or no).... 5.
Comments:
(note condition of pump chamber, condition of pumps\and appurtenances, etc.)....................
.4:�:r�':�.'.u.•:.�..°.�....���`m.�..l.:a"S:�'.:'r`:�'�:p-?\...��:".'.`!�'�' �4r'F;F�?d:�:�.tc::..F'n }�f:.{'� ...
carc"D.............................................................. .....................................................
SOIL ABSORPTION SYSTEM (SAS):..k.: ..........
(locate on site plan, if possible, excavation not required, but may be approximated by non-
intrusive methods)
if not determined to be present, explain:
................................................................................................................................................
................................................................................................................................................
Type:
leaching pits, number ..................
leaching chambers, number:........
leaching galleries, number:...........
leaching trenches,number ,length:.....................
leaching fields, number, dimensions:...................
overflow cesspool,number:..........
Comments:
(note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation,
etc.).. n ..... . ? .\......tzz.!!.:...-........ ?- �.�...r ��Y
.�.1.�^..:.��Qre,+.Y':�5.�... .. .... .. ''�"�"-`-a+: "v..��..•:.:.7C�.�h.. ��.a".'':t.si'^'`�..�....,J1�.�`... 3`+�5���"`\
'� Z ... �� �rCr�`.�.--4�.w.- l f'c.�'�1`z„-�'z crr� tJddZ�n^.n,�-. .•
Jt�
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property address: 262 M arstons Lane. Barnstable, Ma.
0 caner: J ohn &J oyce R ademaker
Date of inspection: 06/20/96
CESSPOOLS:...I0....
(locate on site plan)
Number and configuration: ....... ........ .......
Depth-top of liquid to inlet invert: .................... ......
Depth of solids layer: .... -
Depth of scum layer: ...............................................
Dimensions of cesspool: ......................
Materials of construction: .....................
Indicator of ground water: .................... -
inflow (cesspool must be pumped as part of inspection)
.................................................................................................
.................................................................................................
Comments:
(note condition of sail, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.)
.......................:.......................................................................................::.................................
................................................................................................................................................
PR IVY : ...(lN.�....
(locate on the site)
Material of construction: .:...,...........
Dimensions: ......................
Depth of solids: ................
Comments:
(note condition of sail, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address : 262 Marstons Lane. Barnstable, Ma.
Owner: John &Joyce Rademaker.
Date of inspection: 06/20/96
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks locate at
3 O wells within 100'
.._.......
-
t-: , ay
S
y 5o
DEPTH TO GROUNDWATER:
Depth to groundwater: `-.3�..feek
Method of determination or approximative:
... .. .....
��-a ;� ... :� :: _a._..c."Six C� r;4:z.v `i,�:.�,{.s... :i:y .. 1... L�...............
............................. ............ `. ........................�
................................................................................................................................................
EL=-�7 0
ASSESSORS MAP NO. ;PARC , ,
S E W•A G.'E.P.E+R M I T N O. '
LOCATION - ---- -- = . -- - -
VILLAGE ' _ . LIZ
BARNSTABLE MN _.
INSTALLER'S, NAME ADDRESS
i - .
,
BfC.K. '97-TOWNiBROOK.ROAD - WEST YARMOUTH, MA
' BUILDER 'OR OWNER
B'
w- (owner) RADEMACHER (Bldr) J. MASON
DATE. PERMIT ISSUED�1
-s
DATE`COMPLIANCE;ISSUED r'
d"od - —" -
f
0
____
,Z�ASSESSOR'S MAP NO. q Ct PARCEL � A
LOCATION SEWAGEPERMIT NO.
262 MARSTON LANE - p� ( ( pp Y'a
VILLAGE
BARNSTABLE MA
INSTALLER'S NAME & ADDRESS
B.C.K. 97 TOWN BROOK ROAD - WEST YARMOUTH, MA
BUILDER OR OWNER
(Owner) RADEMACHER (Bldr) J. MASON
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
�.dwnd
1.
, y. �\of �� •tF - � ;
0
LA 0(A)
JSESSOPS fgp p10: 349 i
No.._.. {
�...1�.qq 37 Fic$.....$...
THE COMMONWEALTH OF MASSACHUSET.TS ,
a,0ARD� Off`- HEALLTH ^`ti
TOWN BARNSTABLE
..........................................OF..:..........:::....................::=------------......................................
Appf rats u for � n Iw �axk Cn r i�a� print
Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal
System at:
262 MARSTON-S'LANE; CUMMAQUID, ILIA jv 0 ra / a
-------------------.....----•------ ....... . ... l�1_o... -• -------- •...le...............................
JOHN & JOYCl `'MgVkkiR or Iot No.
......................-...<..................................................................... ................. -•--•-..-•--- -•-------•---••-•-.......-----.....................---
W
BC K Owner. p Address
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
U
a
p,, Other—Type of Building -------------*.............. No. of persons---------------------------- Showers ( ) Cafeteria ( )
P4Other fixtures .........-..............................................................................
W Design Flow............................................gallons per person per day. Total daily flow,...........................................gallons.
1:4 Septic Tank—Liquid'capacity__-.._----_.gallons Length................ Width................ Diameter---------------- Depth................
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. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water-._._-,.._---.__--___---
(T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 ' ...........................................................................................-.................................................................
ODescription of Soil--------------------------------•-•--:..---......................----••----------------------------.-•-----•--••-••-•-•-•-•----•--••-•••......•---•--•...-•--•-•-••--.
x
w ..
UNature of Repairs or Alterations—Answer when applicable....1000-GST D-BOX_--1000-GLI'________ ___________________
Agreement
The undersigned agrees to-install the aforedescr'ibed Individual Sewage Disposal System in accordance"with
the provisions of i i 1 L a 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 t e board o health.
Si ned.-•-•-- . •-- ---------C' 10/29/86
t� ate.,
Application Approved BY•• _ .................-- --- ..:.:.. .: :: -. 1 ----- ------ --
{ Date
Application Disapproved for the following reasons --------------------------------------------•---•------•-------------------------••-----•-- ...................
...............•-•--•---•--•••••-•----•---••-•-••---••-----•-••-•----••-•-----••••......----••--•-.....•..
Date
PermitNo.................... " ......................... Issued.......................................................
Date
349 �
No.... 37 Fmc....$...... s....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN ".........".........OF.................BARNSTABLE
Applira#ion for Diopoii al Works Tonstrnrtion anti#
Application is hereby made for a Permit to Construct ( ) or Repair X ) an Individual Sewage Disposal
System at:
262 MNKSTONS LANE, CUMMAQUID, MA
................_................................................................................ .........-•---•-----------...----•---....--------------------------...----•---•--.....---•--------
JOHN & JOYCHIUM WkER or Lot No.
......................-........................Ow r....•--•-•-••---------------•--••---...... ..........-•--------•-----•--..._.._..........-------•-...........................................
W
BCK Owner 1.4
Address
M Installer Address
V Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures .---....---•-•------•--••---••-• .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
R; Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
Disposal Trench—NTo. .................... 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. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water.....................
(Zq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..__•______-___--_.____-
04 ' •-------•------------------•-•-•-••••-•-•-•--•-•-•--••••....................--------......------------•....------................._..._...-------------------
0 Description of Soil.........................................................................................................................................................................
x
U
W
UNature of Repairs or Alterations—Answer when applicable..1000_GST----D-BOX.... 000 GLP S/L__.____._
--------------------------------------•---......---------------------.........----•---.....-----------------•--•-------------------------------------------------------------•--•--
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T 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 o4health.
V�S' ned.••--.'. ............ .....••.C._ �..�!? .._.. ........................../ _..._
10/29/86
PAO---
ateApplication A
pproved By.... .,....,.•._. _ ...._...! 2._._..-• --•..............................•-- !�
Application Disapproved for the following reasons:..............................................................................................................
-•-------••---------------------------------------------------------------•-•----------------•---•------•--------•-----•---------------------------------------•-------------------------------•----•---
Date
Permit No...........86- J f y 4-------------------------- Issued.....--------------------......_....----- ------.-----
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF .HEALTH
TOWN BARNSWMLE
.......................OF.....................................................................................
Cprr#ifirFatr of Tontplittnrr
THIS IS TO CERTIFY, That the Individual Sewage.Disposal System constructed ( ) or Repaired ( X)
byBCK ................................................................................................................................................
262 MARSTONS LANE, CUMMAQUID, MA
I
at. ....•. •----- ••...........-• •...-----•• •---•-...---•----•-•------• •---•- nstaller----•---
has been installed in accordance with the provisions of TT"IE oqf� The State Sanitary Code as descViLed in the
application for Disposal Works Construction Permit No.....�6 ._11�_Z.................. dated---------1._3 __��P ..........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAR�NTEE THAT YHE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........................I�21j -------••------••--- P--------------- Inspector ...`'.-----•----------•---•-•-•------......---..._....----•--•---.._....__
THE COMMONWEALTH OF MASSACHUSETTS 1.UQL
BOARD OF HEALTH
// . .
TOWN BARNSTABLB
......
�,. J,F..7 .....................................OF......................--------..................-------------------�................
NO......... ... ... { FEE-•-.... .�......
Disposal Works Tonntrnrttion rrm'.
,
Permission is hereby granted........................................BCK.......................••••-....•---- ......-••-•---..........._ �U'...
to Construct ( ) or Repair ( an Individual Sewage Disposal System
at No 262 M'ARSTONS LAN , CUMMAQUID, MA t
• •...-•.............. ----. ...... ----•-•. .:._._...
....
Street - -..' ,,
as shown on the application for Disposal Works Construction Permit No86-l�ly.Dated _..�� _...�.`-1�` aC�...
............................................................... .............. .............
Board of Health
DATE...... ! `' ..........................................................
FORM 1255 HOBB$ & WARREN. INC.. PUBLISHERS
^� Y
ASSESSOR'S MAP NO. 73 g 9 PARCEL 7 A
i
LOCATION SEWAGEPERMIT. NO.
262 MARSTON LANE - u-) (( Do r4-fR. Al q .
VILLAGE
BARNSTABLE MA
INSTALLER'S NAME ADDRESS
B.C.K. 97 TOWN BROOK ROAD - WEST YARMOUTH MA
BUILDER OR OWNER
(Owner) RADEMACHER (Bldr) J. MASON
I
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
dwnd .
S
o
o
G
LAu e+ Uv ! fa ra 'eG d d
`MCAT ION _ SEriACE P9 RVIT 00.
1,LtACE '
INSTA LLER'S NAVE !3 ADDRESS
t&Ko of �f
D U I L DE Q OR OCyq EW
DA T E P EIMIT ISSU E D -
I' DATE COMPLIANCE ISSUED
w�
:ry
r
1 \
y
i
f
n I
THE COMMONWEALTH OF MASSACHUSETTS
OAR® OF HEAIrTH
1.oww...-.oF.. '�� . ...............
Appliration for Dhip al Works Tons trurtion Vatnio
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
................_....... ��',�c.1..... ...... r�Iddrsr
�' �1 .....................................
ddres .�d- __ ---•------ ............. ........•-------Own -� /
u.
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms...................._.......................Expansion Attic ( ) Garbage Grinder ( )
�Pk Other—Type of Building No. of ersons_________________________ Showers
YP g -•--•----------•------------ P --- ( ) — Cafeteria ( )
Q Other 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.
3 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. 1________________minutes per inch ,Depth of Test Pit........_........... Depth to ground water........................
4q Test Pit No. 2................minutes per inch-' Depth of Test Pit.................... Depth to ground water........................
Rr'
Description of Soil 1 --•------------------------------------- ----------••------•-...........................
x :91x
U -•••---•-•-••-••••-•----•••-•-•••-•-•-••-•••--•-••--••••-•-•-••--•-•----•-•-•...•••-•-----•••-----•-••-••••-•-------•••-----•••----••••-
x ••-•-------------------------------••---•----------------•----------------•-----••-•••....•-••-----•----••-•-------------------
`'
U Nature of Repairs or Alterations—Answer when applicaablee. _.._C/ dam--------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITi 1E 5 of the State Sanitary Code— The undersigned further agyees not to place the system in
operation until a Certificate of Compliance /beeissued bySign - •--•• _..
Date
A lication A roved B _
Date
Application Disapproved for the following reasons:...............................................................................................................
••........................................•----------------•--•--•---------------•------•-••---------------------------..-•-----•----------------------------------------•----•-•--••••••-••-••••-------
Date
PermitNo......................................................... Issued.......................................................
Date
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
Im ^�c� C
DATA
i
XI
No........3 a33 FE$..........:. ....Z.,...._
THE COMMONWEALTH OF MASSACHUSETTS
---- - . BOARD OF HEALTH
�. `.�.....OF... .... ...................... ....
Appfiration for UWpooa1 Works Tomitrnrtiun ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
/mil„
Location-Address I I /. or Lot No.
...........:.:...... - .............................................................. ..........--------•••-----•-_•-••• ........
_.......
. --------
.._...--------
Owner, > j f- Address
a ---•-------•--•---•-••••..............•--•-•-----....._......__._...-•-•--• .----•.. .......... •-----......__............--•-•----•-••----..........---.......................--•---•••••••-•---.
Installer Address
Type of Building Size Lot............................Sq. feet
aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
p4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures -------•-----------------------
Q W Deign Flow :...............gallons per person per day. Total daily flow........................................ ..gallons.
WSePtic Tank—Liuid capacity------------gallons Length................ Width................ Diameter---------------- Depth................
i
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter..._------------_... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
--••------••---------- ----••-•--•-.._....•-•---••---•-=--•••--•-•--.....---...----•-•••••••••-•------•----•--•--•----•---_..•-----••------•--•••----•---•-.
O Description of Soil------------------:'--:f ---------•--•. ,`= /='/,
x
W .................................................................•--•--------...........--•---------............------.-••-------------•--•--••-•-••-•--•••....___•----.._.--••-•--_.___--•-_-•-•--
U Nature of Repairs or Alterations—Answer when applicable..._..._!:,___________________`!.r1�/!.!r______.._
-----------------------------
r :, f �---
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— T.he undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by theboard of health.
Signed ...��<� __--
:: ..._r�...
I/ Date
ApplicationApproved By....................--•••-......•---•--...........---•-••--•••---...-•----------•----•---__•-•--
Date
Application Disapproved f or the following reasons:..............................................................................................................
....---••.....................•-•--------•--•-•••---_...•---------••--•-------•---------•---•-•-----.........___.--•--------••-•---•--------•--.....-------------•----•-----.•-•-----------•_.._...•-•••-
Date
PermitNo...................................-------------------- Issued---------------------------------------------------••--
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......................:...................OF............................. ...................`................................
Trrtifirab of Tomplionre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( -)
r��/� J ........ '` .. ! s�
Installer
•-----•---••--•---------------------•---••---_-----------------------------•------------
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No......................................... dated-..............................................
THE ISSUJA E O THIS CERTIFICATE SHALL NOT BE COrA GUARANTEE THAT THE
SYSTEM WILLUIN ION SATISFACTORY.
DAT$.,.:; � = ---------••--------------------•..._•-•_-•--•- Inspector..... -•-----------••--------------....--------•--•...-•-
THE COMMONWEALTH OF MASSACHUSETTS
------ BOARD—OF HEALTHY
? '/. .. r/�% OF.. .'�/�f/ it l�.G �' ... ......................3
. ...................... / t
o� ,
......
No.....3_..........3 FEE.........................
..............
wiopont Warkii %'Donotr ion ramit T
Permission is hereby granted ' f�//_ J!>1'fF4.
.:.....-•-•-----�f !/ f ,', ( t
to Construct ( ) or Repair ( ;) an Individual Sewage Disposal System r
j1, r�i .....................................................t
at No.. ....-•-----•-•---------•••--•---••---.....--.---------------••-•----•----••---•-•••--
Street
as shown on th101's.' ` . posal Works Construction Permit No.... .______ Date ..........................................
---------------•••--------...._---------- ---• -�---•� ---•......- -••-
Board of ealth DATE------------ -...--••-••---....----•--•---•---••--FORM 125 HONC.. PUBLISHERS
�'
O n THE ®AM®®ALTH�OFUA�SS�ACHU�SETTS •
1 � _
OF..... ....................... ...............
Appliration for Dilipwial 9015,16amitrurtion Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair( ) an Individual Sewage Disposal
Syst
•-_s . ......
--Locati --:Address ••-----•or•Lot No.
-----•--•-••--••-••-••-•-•••-••. -•----•..................• •-• ••......__.._..........._.........••.....-----
ow Address
Installer Address
QType of Build' Size Lot............................Sq. feet
Dwelling o. of Bedrooms..........--.... ..................Expansion Attic ( ) Garbage Grinder ( )
p-4 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures
W Design Flow...............�fl________..gallons per person per day. Total daily flow..................... e '"? _-gallons.
P4 Septic Tank—Liquid capacity/l� .-gallons Length................ Width................ Diameter................ Depth................
W Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area...... - s(Ljt.
x
Seepage Pit No..................... Diameter-------------------- Depth below i et________ _________ Total leacch�'.n r ��sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) e �
Percolation Test Results Performed by----•-•------•-------•-•----•-•-•••••--•---•............................. Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
ti, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Description of Soil................................................
x
U -----••----•------------••----------------------------------•--._..............._..--------•-•--------------------•------...-•••--•---•••----•-•-••----•••-------••-----------------•-------------------
W --------------------------------------------------------------------------------------------------------•-•---------------------------------------------------------------------------------------------
VNature 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 Article XI 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;r:i�
01, rd of heal
igned---- -_•----/�-- ---•--- -. _..-•- -- -••--•-- ................................
Application Approved By......... .- � 1d .
Application Disapproved for the following reasons-..........-----------------------------'g7.............................................................
••-•--•.....................•-----.....-----•---------•--._..-------------------........----•------•-----------------•-••-•-------------------------------------------•-•-------------------•-•--.......
// Date
PermitNo......................................................... Issued../.. ... ..................
No...1UP,.... ... FED ......................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD ,OF HE LT
Appliration for 'Riyosal or"k,� omitrur#ion Vamit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Location Address or Lot No. -
t owner .. Address
W ,..._..... �'.�i-r!-C,..............•--............................... -..........-----•-••-------•--•--•---•--------•---------..........--•------.......................
S/ Installer Address
d Type of Buildi g Size Lot.................... .....Sq. feet
Dwelling ko. of Bedrooms-_----.--._.,�-r^�"..............Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
d Other fixtures ---------- ---------------------.----------•---
W Design Flow................- ............gallons per person per day. Total daily flow.._..__..__.._ .__..: `:"-""�' __T_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 ialet...._._ Total leac in ar :__...............sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) s�"'` "'° - / , `_
'-� Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
fq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 ----------------•-•---------------------- ----------------- -------------------------
----•----------------------------------------------------
ODescription of Soil.................................................. :� --- j --------------_-------------••----------------------------------------------.-
W
VNature 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 Article XI 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 th4errd of healtll.Signed....✓' ._ __ ✓ �'a rr.� --- -----F!-- --------------------------------
Application - � � Date
A roved B i' �41.-�:...-- s� f ^'!•. ---- ate
PP Y r r t -- --' ate- - --
Application Disapproved for the following reasons------------------------------------------ ------------------
••------------------•---------•------••--•--•----••-•----------------•--•-----------.....-----------------------------------------------------•--...-----•---- ----•-------•-•-------.................
/ Date
PermitNo......................................................... Issued..----F . -- ...... .........
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF KEALTH
1 . ...................................OF...........; ! +
r ,,,,................
'Wrti$iratr of (Somplitture
THINS TO CER FY,, IThat the Individual Sewage Disposal System constructed ( or Repaired ( )
by `r ----•••---✓ a ,
at ,p� F r ------ --•-
�. �t'A` .__T - '�"' '�..,=S 1`! ' �'�`�----�"t'�--'` {.�'�f ...- ,. --e �---
has been installed in accordance with the provisions of Article,XI of-The S to SanitaryC e as descr'bed in the
application for Disposal Works Construction Permit No------------------ ___ ._ dated .._ Iv. ._. ........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON UE® AS_A GU :NTEE THAT TIME
SYSTEM WILL UNCTION SATISFACTORY.
DATE----- .-_. i:J•..ti ............................. Inspector. -- .................----•-- .....•.-- • ........
-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF;MEALTH
t'. -..
No. ...........Z..... FEE--•.---x............
Raposal r : rks
v u t llt rrmit
Permission islh eb granted % . .....................:.........•-•-.•.
to Construct or Repair ( ) an Individual Sege Disposal System /� ,' '
at No.. ..r ..._....._.. ...
'`" f/ .. ',.a - ,.� �- r,:� r - �' ` '� .'r _ ./�.
as shown on the application for Disposal Works Construction Permit N�. =_._.__....tf..�ated...X��z� Z7
DATE...........................................•---..........--------------.........
oard f Health
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS ._
� .. u.
a ..
_ Legend
o s s g
a Parcels
.�..,
� _�,� ,_ ,�,-,., ...b .,rc....�.. .; � _- , .,� ,�_ .- Town Boundary
- #22-2' _ #21:3 #208 � Railroad Tracks
� �I _ Buildings
#25q 10 Approx.Building
} F 1 0 Buildings
#2 `tl i /` Painted Lines
#.233 r Parking Lots
f
I
� } � #232� F� r ❑Paved
Fl Unpaved
Y
Drivewa s
#275 Paved
Unpaved
•..�ti 1 ;� Roads
13 Paved Road
#1,1t �. 1
Unpaved Road
t#32 �' = f Bridge
#'3( `
rf ,
� G Paved Median
#86 Streams
. �• 3 #2�7 #,5�. - _a Marsh
Water Bodies
r _ _ J`
#533
#3€l 'r
fi
�. #326
y ( 1
# 1,9
' #35
#334
#42 28 #110
.+ .':. .4k
4112
#.ii7 1}'82 CFO MP�� �•..
Map printed on: 11/30/2021 This map is for illustration/purposes only.It is not Parcel lines shown on this/map are only graphic Town Of Barnstable GIS Unit
adequate for legal boundary determination or representations of Assessor's tax parcels.They are
Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 369 Main Street,Hyannis,MA 026ot
0 167 333 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the map 508-862-4624
reflect current conditions,and may contain such as building locations.
Approx. Scale: 1 inch= 167 feet cartographic errors or omissions. gis@town.barnstable.ma.us