The URL can be used to link to this page

Home My WebLink About0003 HALYARD WAY - Health 3 Halyard Way Centerville P A = 194 082 I i ,I ,i eawfie 1521/3 ORA 10% P2 �_ _-. � _=- - �._ � -tee..«_ _ _ I� d '7'� i a i� �� G .� �' �� ,L, r� :, ,1 ,� ,� %, �,� OF fHE rpm Town of Barnstable Barnstable Board of Health AFAMMICaft * BAMSTABLE, y MAss. g 200 Main Street,Hyannis MA 02601 1 16 I V .9. �0 iOjFp�,�A 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi March 29, 2021 Danilo and Vera DeLima 3 Halyard Way Centerville, MA 02632 Re: 3 Halyard Way, Centerville and Assessors' Map 194, Parcel 082 NOTICE TO ABATE VIOLATION OF THE TOWN OF BARNSTABLE CODE, $360-16 AND 20A AND E. The property owned by you located at 3 Halyard Way, Centerville, MA was inspected on March 25, 2021 by Donald Desmarais RS, Health Inspector for the Town of Barnstable because of a complaint. The following violation of the Town of Barnstable On-Site Sewage Disposal Systems Ordinance, §360, was observed: 060-16; Town of Barnstable Code: The septic system is in hydraulic failure. Raw sewage was observed at ground level at the back corner of the property. You are ordered to correct the above listed violation through the following directives: 1. You are directed to hire a licensed septage hauler to pump the overflowing septic system within twenty-four(24) hours of receipt of this letter. 2. You are also directed to keep the on-site sewage disposal system pumped as many times as necessary (daily if need be)to keep it overflowing onto the ground. 3. You are further directed to contact and hire a professional engineer to determine the cause of failure in respect to the aforementioned system within 21 days. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in the issuance of non-criminal ticket citations of$100.00 each. Each day's failure to comply with an order of the Board of Health shall constitute a separate violation. Q: order letters/sewage violations/3 Halyard Way,Centerville.doc i e PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health CERTIFIED MAIL: 7012 1010 0000 2847 9176 Q: order letters/sewage violations/3 Halyard Way,Centerville.doc r �� $97 Bk 27159 F's 167 i 02-25-2013 & 03 40g:3. NOTICE: The Town of Barnstable recommends hat_ the anpfimAnt seek legal advice to prepare a properly warded deed, restriction document _.jam, O DEED RESTRICTION q WHEREAS, v o n ;�� l!M f . (owner's na e) 5 u� EU1ZlE D 0 263.2 °MA ' (address) is the owner of o alyro P-0 Uip V located /(address) - at C� �� Ut1�c a a?6 3 z MA (hereinafter referred to as zo and being shawr� o}? a plan entitled "Subdivision of Land in 91 99 W CU/ MA, Property of et at, duly recorded in Barnstable County Registry of Deeds in Plan Book 0(U-5-3 o?' Page ®0 ; Or on Land Court Plan Number WHEREAS, VOM Per . L t Ail P as the owner of said lot has (owner's name) agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included. in any home built on said lot as a ' pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition-to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code- Title V; Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; and authorizing the issuance of a building permit for the cor structio.n of a.single family home on this property, is requiring that the agreement for the restriction.on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, -� &tdr ', r NOW, THEREFORE, V�R� _0 l�'M� does hereby place the t (owner's name) following restriction on his above-referenced land in accordance with his aa•reem -n with the Town of Rarnc+ahla R•nard of t &al:t Flhish•r stri, LBJ1. run with the-land and be bindrng upon all.successors in title: 3 _A4 2Y9 W A Y may have constructed = (address) upon the lot house containing no more than _0 3 ( ) bedrooms. , & )-1'0 agrees that this shall be permanent deed (owners name) restriction affecting located on Celyt6)2 Ville MA, and . being shown on the plan recorded in Plan Book aoS3'a , Paged ,-/V 9 Or on Land Court Plan For title of see the following deed: Book 105 3,2,, Page . Or Land Court Certificate of Title Number Executed as a sealed instrument day of `'� l Owner's signature Owner's signature Owners signature COMMONWEALTH OF MASSACHUSETTS NIGSSGil sk�k 5 ss r. aJ 20 j3 Then personally appeared the above-named known to me to be the person who executed the foregoing instrument and acknowledged the same to be -L free act and deed, before me, i,lilliid,„fly' r l DR / ALESS NA TUNATi Note de .� to IB , Expires .0 M Com si Notary n:� '� 5t" � Flublic0 r 2018 commission ee, p1ires: n, ) (date) BARNSTABLE REGISTRY .OF DEEDS Arnr1r i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMOW 4AIWS�' 09 d DEPARTMENT OF ENVIRONMENTAL PROTECTION FV-Is O V 350 MAIN STREET 6 WEST YARMOUTH,MA = 508-775-2800 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP 194—PARC 082 Property Address: 3 HAI,YARD WAY .� CENTE.cVILLE,MA 02632 T 'L Owner's Name: VASYS,JONAS _ Owner's Address: 132 ROSEMARY ROAD DEDHAM,MA 02026 Date of Inspection APRIL 28,2005 Name of Inspector:(please print) JAMES D.SEARS Company Name: A&B Canco _ Mailing Address: 350 Main Street West Yarmouth,MA 02673 Telephone Number: 508-775-2800 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 the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority . Fails Inspector's Signature: Date: The system inspector shall suPmitapy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completaig this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the >ystem owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to th system owner and copies sent tot he buyer,if arplicable,and the approving authority. Notes and Comments *k k*This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2-000 l ' x Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 3 HALYARD WAY CENTERVILLE,MA 02632 Owner: VASYS,JONAS Date of Inspection: APRIL 28,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: .( I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined" please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced _ obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 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 ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 3 HALYARD WAY CENTERVILLE,MA 02632 Owner: VASYS,JONAS Date of Inspection: APRIL 28,2005 C. Further Evaluation is Required by the Board of Health:N/A Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety,or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or 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,safety and 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 SAS and the SAS is within a Zone 1 of public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance ** This system passes if the well water analysis,performed at a DEP certified laboratory,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,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 3 4 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 3 HALYARD WAY CENTERVILLE,MA 02632 Owner: VASYS,JONAS Date of Inspection: APRIL 28,2005 D. System Failure Criteria applicable to all systems: N/A You must indicate"yes" or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to 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 pit is less than 6"below invert or available volume is less than%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 SAS,cesspool or privy is below high ground water elevation N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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. (This system passes if the well water analysis performed at a DEP certified laboratory,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 or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: N/A To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No 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 H of a public water supply well. If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system is failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 3 HALYARD WAY CENTERVE LE,MA 02632 Owner: VASYS,JONAS Date of Inspection: APR1L 28, 2005 Check if the following have been done. You must indicate`yes"or"no"as to each of the following Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ Were all system components,including the SAS,located on site? ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3Xb)] Title 5 Inspection Form 6/15/2000 5 j i Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 3 HALYARD WAY CENTERVILLE,MA 02632 Owner: VASYS,JONAS Date of Inspection: APRIL 28,2005 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CNIR 15.203(for example: 110 gpd x#1 of bedrooms: 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): 2003—72,000 GAL/2004—61,000 GAL Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sgft,etc.): 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/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: 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) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1985 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 �f OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 3 HALYARD WAY CENT7ERVILLE,MA 02632 Owner: VASYS,JONAS Date of Inspection: APRIL 28,2005 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 14" Materials of construction: Cast iron ✓ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): ✓ Depth below grade: _20" Material of construction: concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000-GALLON PRECAST Sludge depth: 6" Distance from top of sludge to the bottom of outlet tee or baffle: 24" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 16" How were dimensions determined: TAPE&ASBUILT Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): MAIN TANK AT WORKING LEVEL,INLET BAFFLE—OUTLET BAFFLE. NO SIGN OF OVER LAODING OR LEAKAGE. GREASE TRAP(located on site plan) N/A Depth below grade: Material of construction: _ concrete metal _ fiberglass _ polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 ' a Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 3 HALYARD WAY CENTERVILLE,MA 02632 Owner: VASYS,JONAS Date of Inspection: APRIL 28,2005 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no) Alarm level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.,): D-BOX IS 16"X 2 1"—26"BELOW GRADE,ONE LINE IN—ONE LINE OUT.BOX IS CLEAN&SOLID. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 , A Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 3 HALYARD WAY VASYS,JONAS Owner: VASYS,JAMES Date of Inspection: APRIL 28,2005 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type J leaching pits,number: 1 leaching chambers,number: leaching galleries,number leaching trenches,number,length leaching fields,number,'dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) LEACHING IS ONE 1000-GAI,LON PRE CAST PIT WITH COVER AT 30".2'WATER IN PIT,STAIN LINE AT 28.NO SIGN OF OVER LOADING OR SOLID CARRY OVER. CESSPOOLS: N/A (cesspool must be pumped as part of inspectionXlocate 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: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (locate on site plan) Materials of Construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Title 5 Inspection Form 6/15/2000 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 3 HALYARD WAY VASYS,JONAS Owner: VASYS, JAMES Date of Inspection: APRIL 28,2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. T JI d c AI Page I 1 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 3 HALYARD WAY CENTERVILLE,MA 02632 . Owner: VASYS,JONAS Date of Inspection: APRIL 28. 2005 SITE EXAM Slope Surface water. Check cellar Shallow wells Estimated depth to no groundwater 12 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 7 Observation site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation Accessed tJSGS database-explain: You must describe how you established the high ground water elevation: TEST HOLE 12'NO WATER. TEST HOLE 3' BELOW BOTTOM OF PIT. BOTTOM OF PIT AT 9' JL ! _� Iva TOWN OF BARNSTABLE LOCATION-3 SEWAGE # VILLAGE C EX,7 ASSESSOR'S MAP & LOT r �� a48%tht1-:R'S NAME&PHONE NO. L" C d SEPTIC TANK CAPACITY �- LEACHING FACELITY: (type) (size) NO.OF BEDROOMS 'a BUILDER OR OWNER PERMITDATE: DATE: ' Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist 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 q.r7 ao - o I3 N No.�......... Fizz.... .......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® QF HEALTH ..... .....OF,.. 4::!% 2 .. ... .. .......................................' Application is,hereby made for a Permit to Construct 4-'l 'or Repair an Individual Sewage Disposal System at: a; ess- ------------ ............ ...... ........................... ..Xocation- ess t . ........... ---- - --------------------------------- ...............ve'-� ......=.-�.. ............................ er dres, ............................................... ................ .. . ....... ........ -------*---------- --------- Installer Address Type of Building Size Sq. feet U Dwelling—No. of Bedrooms........j............................Expansion Attic (1/44) Garbage Grinder (4ja N4 P4 Other—Type of Building ........................1.... No. of persons............................ Showers Cafeteria Otherfixtures ...................................................................................................... ... Design Flow_._..... .............................gallons per person per day. Total daily flow.....I ..Sff _gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width.._____._....... Diameter________-__---.- Depth_._............. 41 x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area..............0-----sq. ft. Seepage Pit No..................... Diameter.._.__...___.__..... Depth below inlet_...._.............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing to ( ) 4 3. P(/ Percolation Test Results Performed by oC2 ------ Date-A ............. b..4 Test Pit No. I................minutes per inch Depth of Test Pit-__-__-_-.----......-- Depth to ground water_.__.._..............._. OLI Test Pit No. 2................minutes per inch Depth of Test Pit.__...........__.... Depth to ground water.......____._-_......... ... ... ....... ................................................................................. -A--------------- 0 Description of ---------------------------------------- ----------------------------------- ................................................... -------------------------- ---- ................................................................................................. ...................... . ......................................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................. ................... ...........................0........................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the.rprj'sions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in ope 4,11un until 4 Certificate of Compliance has bQ 'issued by the board of 4palth., Signed---.. ................. 7 ................ Date eipplication Approved By.<.:. .�. ....... ....... ............ .J: —/7 _I�z ................0.............................. ......... .......................... Date Application Disapproved for the following reasons:.........................................................................................................0...... ....................................................................................................................................................................................................... Date PermitNo..................0...................0............ Issued....................................................... Date ---------- ............. FEE..............0........... THE COMMONWEALTH OF MASSACHUSETTS BOARD X/1 OF HEALTH ......OF--/ ........................... Appliration for Disposal Works Tomitrurtion 11trutit Application is hereby made for a'Permit to Construct (-1 -ror Repair an Individual Sewage Disposal System at, ................. ,,,�Lo'cation�A&ress Address ......................1��,-,? Installer ................................... Address Type of Building Size Lot/ ......Sq. feet Dwelling—No. of Bedrooms.......LZ...........m....................Expansion Attic 10d Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers Cafeteria PA PA Other fixtures Design Flow.......�//0 .....................................gallons per person per day. Total daily flow.... .......................gallons. Septic Tank—Liquid'capacity............gallons Length................ Width.. Diameter................ Depth.......--....... Disposal Trench—No..................... Width_._.........._......lot- Lengt'h`.-*._ .......... ..... Total,leaching area.._. ..........sq. ft. Seepage Pit No..................... Diameter........:.....__.... Depth below inlet......._ ......... Total leaching area.. .........sq. f t. Z Other Distribution box ( ) Dosing tank ( ), —1, Percolation Test Results Performed by..._ ....... DateXt............. ...... 4 Test Pit No. I................minutes per inch Depth of Test Pit.._..........._..... Depth to ground water..__.........._......... 44 Test Pit No. 2................minutes per inch Depth of Test Pit................--.. Depth to ground water........................ .................................................................................. 44. .............. --------- ....... 0 Description of S ..... cvl_ ,4 , oil.0 - 0.1 'Aga ................................................................................. —.e.q........ -�. .. ............................................................. ........................... ----------------- .................................................................................. Z ..................................................................................**.........*--------------- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ..................................................................7............**.........*------------------------*---------------------- .......-------------- ...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with ovsons 0 1 the pr ii f'ITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in opery(ton until g Certificate of Compliance has been issued by the board of health. 4 ................ ....... ............... .......................... r --------- <Application Approved By..... - -------- ........ ....... —.......................... Date Application Disapproved for the following reasons:................................................................................................................ .......................................................................................................................................................................................................... Permit No...... Date ......................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH IJf Tntifiratr of Tomplitturr. THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by.......... ......................................................................................................................................... Installer atoe........... _ . / .............has been installed in accordance wit H the provisions off iTLE 5 of The State Sanitary Code as qescribed in the application for Disposal Works Construction Permit No.......... ... . .... dated_____________q/" ......... _?t� .......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST UED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................10 — I_V —�? ...................................................... Inspector..........---... . ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 95 2-C No�..- ..............7 ..... ..... .......... FEE........................ Disposal Worko Towitrudion "prrutit Permission is hereby granted................ A(—Ve \J E.T E>1 A0. ...................................................... to Construct�(L4'or\Repair an Ind"'JIV i'd"ua`1Sew`a'ge'Disposal System .. at No... zl�ro ......................................... Street — ft as shown on the application for Disposal Works Construction Permit N0'5K-_�_ Dated.....? .................. p V .......... ........ ....... Board of Health DATE........................ tl ............. FORM 1255 A. M. SULKIN, INC., BOSTON �;T ►' IOX'16101HE I NCM i� !. }/�T.EoS/t.ia T1ERoi v5NO/`��.4,'Si i�.L 0 E�N�-So�.x�c'.oOQ��-f_SG�4E=G-E��'.'.?Q-�y�.E-T,T"L��fgTs�=,,'r,Q�r-rZe E,N�.q�--//IE24Q-S oEt�,GfO-Ti//.T c,�.Nja!OE,vS///C?Q2+--EAQ.l�f.�i9F4 C�L_-1.-G�i-p1�,7_TI(�i'I lEILLL?/I;�A,.-..c�.E�y3X�'0.$►-.ONr1,I'3—L-tOomG4-t oi��EEit,'..,k�4O r`eiI2-._'�,4t%�.E!tl'i'j/`LTr=e 1Ws G!.Cf,s�•L/P/T�%,��h/i.�.-1�_�',L.G�-.•E�h�_/T�U-:'t!GE�T'2`/3 36"1q;hGvYIkyT�-,.y_-E.i.—�^i•ijr'rt�'tt1 't�.Q?`'7x1:��^,�/✓'.O.3_o��U,�_.__,TT�l!E,-!'ry r./r,J Q la/�.•d��j /OAZ. {I{!INS/',-r!o/t vG//33zii,,i.,�_EGEN YEs'�t'r:�*�r:_Ja%E�VI!3✓P=O-:r/ai E�x r A:B�':/i G�/IT�O0�`i�Ts2�E r-l/-�'�-t�T EVXY0.'ixX_�*4-_lN2,/'.',.�0.afy 0�.,r/,_8v,r/-�.-�3S'.S�A.�ac�4Qs2.aar"�'oZ}rjho�,g o!{�So,�!P..✓'��o�Co'_'0 oti3,-s_��'�''�_G/{Gt GS�s�,`i?'t J.3F Elr�.%E�94 q N T�/'0S.P9�O S,hz��V-9�_1.!,�I:.' a—sOG,fi,jI�,t!2 , T,oLOT21S. o"4 a �Q15. elf- 4 ,o %C 07> . . T ! dt+,SG *.�of`TSti ro i-•.. Nf., PADM Tl Ja?A .� {SULLIV o . I t LO �f k!t� � d7�#b 71 }L_ /-. T . IW06r0 AYIA L ;Tj T T/F/ Li/ 41- fir S. p rtT To CPG6 'Y TN.4TYs B-d-e7ae€ y /v Amz7 /s ,vo7 in oFi 4L-- wwo, . .` 11 .i yE,e�o/V.S.�4UG��aT l�E U.SEp - •bfiGCS� -� -aA�xTr--C t4,4 G— I C 93' + y Tol PETEP SULLIVAN v parr rao. 23 1 .�j. LCTT a. �{_43 \Atk , , , EL54,0. ELtb3� Lo0610A 6601 L r cos,a EL( 2, j , µti ,. E►oo.o 1�or�TE� � 9 �' t '� . -z 3 � 4 C I Iow ; FW G A FAIT NO. Z— C9 L� INSTA " LER'S NAME ADDI: ESS LIF tic? ea 6 Z( I U I L D E R 0 R/ OWN ER g �04 DATIE PER ;PIT I S 5 U E D �� -✓� -'�� D D -ATE C0MPLIANr. E IS5UEG 1 ® —ze? -gs l c D� I r �k C 7�' CC) m S-r,4 C�osc7" • O I \� OFrf C 3 �aG -3 , V" II 1 0 � CZ05& T � F 10 o �� 67�) ov. � r r �y1 i i _ xz x • f I Y Y