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HomeMy WebLinkAbout0018 LIMERICK COURT - Health 18 LIMERICK COURT CENTERVILLE— r A = 169 081 TOWN -OF r(% LOCATION: Z/ ^7 A /c R_ 7' VILLAGE: ���✓/T!E',Q rt �i� M LOT # : ,C�PERMIT�i INSTALLER' S NAME: ✓�A / E'SZr7 e e t.,"s.- INSTALLER' S PHONE # : -2 LEACHING FACILITY: (type)?. � .,� s (size)1aX3 NO. OF BEDROOMS: BUILDER OR OWNER: �21 9/✓ �o Zy !t / G2 PERMIT DATE: COMPLIANCE DATE: D/ DRAW DIAGRAM ON BACK � C ;L 3 �� 13 �r�o AD 13D P �. = ;Z, 7 -w No. d Fee �9— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PURL C HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes Zipphratton for ]0igpo9;a1 *petem Conztructton Permtt Application for a Permit to Construct(,Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. J - Owner's Name,Address and Tel.No. � f/C"( C Timid Assessor's Map/Parcel Installer's Name,Address,and Tel.No. 7.7 7 Designer's Name,Address and Tel.No. ,Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building el Lc /1a.�A, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow %C gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued)aT this Board of Health. Signed Date �> Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued 7'� �� ..... .. TOWN OF LOCATION: VILLAGE: P E RM.I T A LOT INSTALLER' S NAME: 5- INSTALLER'S PHONE 2 FACILITY (type)� -7 , LEACHING :T-A/151' /2' No. OF BEDROOMS : BUILDER 2-4 Ltol PERMIT DATE: . 3z�L 2 1 COMPLIANCE DATE: 7 0 a . DRAW DIAGRAM ON BACK 13, 5 Q -7 nn C. No. ^" , Fee c THE COMMONWEALTH OF MASSACHUSETTS Entered in computer.-, Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS _ application for Mizpaaf*"tem Construction Permit Application for a Permit to Construct( epair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual,Components Location Address or Lot No. J.6:::_ - lz� Owner's Name,Address and Tel.No. jf X O Assessor's Map/Parcel I d 9�Q�/ G�'�✓7�`. '�� Gam! �/g'!C G�' G �lrT �. ti Installer's Name,Address,and Tel.No. 7' J'�p 7 O, Designer's Name,Address and Tel.No. Type of Building: c 'Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building or �.1'/l7�vvldyo. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �� gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) l t/ y✓C-".�,,./ JJ/J' . .13o.X , �' ' J'10 ry 6' ,3 rrc ']C/�.� aCa'f' Date last inspected: a Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued this Board of-Health. Signed �_.,� _ Date Application Approved by _ - - t%� k- r Date Application Disapproved for the following reasons r Permit No. 0.,f Date Issued t 0/ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS ry ' ,C-ertif irate of Compliance -' THIS IS TO CERTIFY,that the On-site Sewage Dis osal System Constructed'( Repaired( )Upgraded( ) Abandoned( )by lTlni �c�"�p�'e✓� _ C7 at �� L /lz, iF'/G�' T G w>"� lZi A • has been constructed in accordance vyith the provisions of Title 5 and the for Disposal System Construction Permit No7P0'/r/f'"A dated 7- installer Designer The issuance of this peYmi shall not be construed as a guarantee that the sy ill frrcti� s de'41signe . Date /J�6 Inspector No. �� tf Fee ev, W THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpool 6potem Construction Permit Permission is hereby granted to Construct( )*epair( )Upgrade( )Abandon System located at /h Gt /� �L� C 7- and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. t Provided:Construction must be completed within three years of the date of this,,)effnit. Date: e-� z '� Approvedby 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, ( �j'7 ��3� �UI� , hereby certify that the application for disposal works construction permit signed by me dated "` �7— , concerning the property located at �'t �G�C G�` �"� � meets all of the following criteria: !/ • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. �• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. v" There are no wetlands within 100 feet of the proposed septic system r/• There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed ZI• There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S.will be located with 2 t 50 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation +the MAX.High G.W. Adjustment. _ ✓ DIFFERENCE BETWEEN A and B SIGNED : cry DATE: ✓� 0 J [Please Ske proposed plan of system on back]. NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFA \O L —1 121 DEPARTMENT OF ENVIRONMENTAL PRO-, TIS1' ONE WINTER STREET_ . BOSTON, MA 02108 617-292.5500M FC �1' •` rod J ��,� 1— ��re9 WILLIAM F.WELD yoFgls9� `9�TRLPY Governor Lin cretan SP ARGEO PAUL CELLUCCI D STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 9 5 Commissioner PART A CERTIFICATION Property Address: 1 t', L m I Address of Owner: Date of Inspection: 12 I U ``) (If different) 2- lv p S+a � W Name of Inspector: Rotp ix� W�� �� �M ft 02,(,6-7 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: L- Mailing Address: 2� Telephone Number: '7 -7 K — D G 814 CERTIFICATION STATEMENT I certify that I have pgrsonally 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-sitg sewage disposal systems. The system: ZPasses Conditionally Passes T Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signatur Date: _ The System Inspector shall su mit a copy ofrhisinspection 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 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: AJM PASSES: 71 have not found any information which indicates that the system violates any of the failure criteria a5 defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: BJ 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 yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty(20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:(/www.magnet.state.ma.us/dep {'j Printed on Recyded Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM PART A CERTIFICATION (continued) Property Address: C 0�"Y -�C�h��W f Owner: t1_1>a n Date of Inspection: Z - )p -ci`7 B) SYSTEM CONDITIONALLY PASSES (continued) Ll 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). Describe observations: 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 Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 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 water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply.or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR.11 PART A CERTIFICATION (continued) Property A dress: S L` h..ex-`'Lk Owner: �Jh (tzlv—k-Uh Date of Inspection: DI SYSTEM FAILS: You must indicate ei;r,er "Yes" or "No" as to each of the following: kI have determined that the system violates one or more 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 correct the failure. Yes N.iK ',/ Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. V Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. _✓ Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_ Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 1/ Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El 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: 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 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 II of 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 CNiR 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 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: �. �Y\ -E,�c-�•�h Date of Inspection: 1 Z— 0 c+-7 Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following: Ye No Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)] (revised 04/25/97) Page 4 of 10 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: l,oi h 1i Date of Inspection: I 'Z — I c r17 FLOW CONDITIONS RESIDENTIAL: Design flow:yuo g.p.d./bedroorn for S.A.S. Number of bedrooms: y Number of current residents: Garbage grinder (yes or no):� Laundry connected to syste (yes or no): Seasonal use (yes or nol: / 5 r 21 S O-typ , ig '2,3 owh Water meter readings, if av ilable (last two (2) year usage (gpd): Sump Pump(yes or n4 S�— S "Cj Last date of occupancy: COMMERCIAL/INDUSTRIAL: 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 PUMPING RECORDS and source of information: Now-- System pumped as part of inspection: (yes or no)_ If yes, volume pumped: rtallons Reason for pumping: TYPE K'SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: 1$�4 J S Sewage odors detected when arriving at the site: (yes or no) (rev;aad 04/25/97) Page 5 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property ddress: �e- Owner: T-31f) ;COY Date of Inspection: Z— ( b �l 7 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _cast iron Y40 PVC—other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:_ (locate on site plan) tl .Depth below grade:..La. Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: '7 Sludge depth:yt Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: LGSS Irt c\ Distance from top of scum to top of outlet tee or baffle: tt Distance from bottom of scum to bottom of outleHee or baffle:_ How dimensions were determined: ntfJ�Oi�" —1 Comments: (recommendation for pumping, condition of inlet and o tlet tees or baffles, depth of liquid level in relation to outlet inv rt, structural integrity, evidence of leakage, etc.) GREASE TRAP: (locate on site plan) 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: (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) Pigs 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: L hen k`(- C Owner: Date of Inspection: TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or 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 level: Alarm in working order_Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER:_ (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.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: l Owner: ' )'n r}"� Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (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:L leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of v edition, etc.) CESSPOOLS: (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: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (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.) (revised 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: )g L , vr\kv-,v V--C(,v.x—r Ce.*, urV%kkL Owner: 1V11,on 4,V-kaN Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (locate where public water supply comes into house) ^ ex-,— 0 (zeviwd 04/25/97) Page 9 of 10 v SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property A less: $ L \,, ,-v- C,, Owner: uo-s Date of Inspection: I Z, l 6— CC? Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data t Describe in your own words how you established the High Groundwater Elevation. (Must be completed) (revised 04/25/97) Page 10 of 10 No......................... .................... TH��MONWEALTH OF MASSACHUSETTS kCA-J BOARD OF. � H L 14 4 E. ...... . . ..... . . . .. ......................... Appliration for Uisposal Morko Tonarurtion Vvernfit Application is hereby ma, e for a Permit to Construct ( ),Qr Repair an individual Sewage Disposal S .. ...............Y... . .... ... ......... r. Ai. .......a;......ef. ......... /-ocation • dressor.Lot No. ... ......... .............. .................................................................................................. Owner Address Installer Address U Type of Building Size Lot ZZ...1.1.4.11.....Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder a Other—Type of Building ............................ No. of persons.......5. ........ ...... Showers Cafeteria Other fixtu ................................................................................................­0. ....................................... Design Flow....................T_2� gallons per person per day. Total daily flow........... . .....d....................gallons. ........... 6 -gallons Length................ Width................ Diameter................ Depth................04 Septic Tank—Liquid capacity/ ..A Disposal Trench—N Total Len--th ... Total leaching area ........sq. ft. --------------------- Wi4th b ......i�:....Seepage Pit No--------/------------ Diamete W"'al Depth below inlet.... ........... Total leaching area".'..JA;.: q. ft. Other Distribution box Dosing tank Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit_.........__.__._... Depth to ground water-_-_-__._-____-___---_-. Test Pit No. 2................minutes per inch Depth of Test Pit...____............. Depth to ground water------------------------ 0 Description of Soil_-a-n............. U ......................................................................................................................................................................................................... W xI ---------------------------------------------------------------------------------------------------------------------...................................... ........................................... U Nature of Repairs or Alterations—Answer when applicable................................................................................................ .........k-................................... ......................................................................................................................................................... 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 the board of health. I/ Signed. ... ........................................................................... ................................ 0,Application Approved By....... ...% . 11,4- ----- - ­- ------ -- ............ ... ........ Application Disapproved for the following reasons:. -------- . ........ ..... ............................................... ..........................................................................................6­......................................................................................................... Date PermitNo......................................................... Issued........................................................ Date No.._,: ..�-=�-•----. Flex., ........:............. THE COMMONWEALTH OF MASSACHUSETTS BOARD F H EA, I z............................. AVVIiratgngt for Biapoottt lVarkii Tonotrurtion Vamit Application is hereby made for a Permit to Construct ( )._or Repair ( ) an Individual Sewage Disposal r -1_ .................. _. c .. s f, . ocation Address f or Lot No. :�r 7 - vrr W tu'i Al, Owner Address a .,... ._....fit. �{ic ,�i �� ............... .................................................................................................. Installer Address Type of Building -- Size Lot _ �,..1. '_.._..Sq. feet Dwelling—No. of Bedrooms....................�.....................Expansion_,Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of ersons__._._. Showers a YP -g----------------------------------•--------•P --=-----------....- ( ) — Cafeteria ( ) Other fixtur ___------- ----___.. ------------------- W Design Flow...................' % ......_., allons per person per day. Total daily flow_......__ ._'" _..__._..gallons. WSeptic Tank—Liquid capacity ygallons Length................ Width................ Diameter......._........ Depth................ x Disposal Trench—N . ................... Width... _ . Total Length_._....__,.____.___ Total leaching area....................sq. ft. Seepage Pit No________ ___........ Diameter-I1'a�.; 16e th below inlet____ Total leaching area � P ....-•-•-- a .� (�•�sq. ft. Z Other Distribution box ( ) Ddsing tank ( ) aPercolation Test Results Performed by.......................................................................... Date....................................... H Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--------------........ .. (T_I Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................... _................................f..:..........•-•-•••-•••--••••-------•-•_....._......-•-----•--._...-••-•---•••--•----•--....-•--•-----.......---•- ODescription of Soil = .-4... r-•----------•--------••••----------------------------------------------------------------•----------------------- 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 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 the board of health. Signedr.. _..... ............................•--•__._____ ................................ Application Approved B Date Application Disapproved for the following reasons:. :__ C�_M:._......._.�___. �!����.............................................. .........---••--•----------•----•......... .......................••-••.____........ Date PermitNo........._............................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL r �._ ,•-7 ,'Zra! `J..............OF....... ......... ....�� ................. Tertifirate of Tontphattre T IS TO RTI , Thatl e Individual Sewage Disposal System constructed ( ) or Repaired ( ) by. ..:;t;,. .. �....._.... ...._..----•.................•--------....._..__..._......_._.............._._....--- [nstal has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.............................�_ ,S:_. dated._._.... __y��_2--_•-._••------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR�bED AS A GUARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector..........-......................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH f NO... ..,J.... ._.. FEE...n�................. Diopoottl Works Tonotrudioat rautit Permissioni hereby granted.......................................................................................... .................................................... to Constru ) or R pair ) an Individual Sewa�l�posal Syst atNo.. ...: ... ._...f ..f= s ....... . ...� �................... Street as shown on the application for Disposal Works Construction Per" it N ._.. . .___.. ... Yaed___._ -�.-•°'�"'"` f • DATE................................................................................ Board of flealtht//'' FORM 1255 HOBBS & WARREN. INC., PUBLISHERS v 7s /t l S'TWG` tt. DLt1ELY1ofG xh: 0 41 • LO.T _7/ _CLA.S 5iF/CAT/0N....- SIDE tH:OF- .� try RICHARD ` JAMES 4.. O'HEARN "°`278" o N CERTIFIED PLOT PLAN /N. � o sTO I3�,eN� Z E_, MASS. -sup-. �``� �07- g�5 4 L/M R/C/< ou.2 T .I CERTIFY Tf%AT THE gm-D11vo •RICHARD 'J O'HEARN, .S., R. 'S, SHOWN ON THIS PLAN /S LOCATED /91 MAIN ST (RTE. 28) ON THE GROUND AS'IND/CATED.AND . . .WEST DENN/S , 'MAS S. CONFORMS TO' THE PONING' LAWS ,OF 1a2�isr,913� MASS. DA7 E: 4 CALE.Lj 1 = 40 O Z8 LAND SURVEYOR DR."$Y DA E � REG. ,� . -.�,.-•�� -.v f. JLTI PLE LISTING r SERVICE 1 � , F O CAPE COD BOARD OF REALTORS Listing Furn. ❑ ` No. Price 7 ® ....63.7.9..... . 3:.� .,.`�00 - R Part.Furn. ❑ Village ..Centez`°ille.......... ...... ... .. ................ ranch.:.: Type.House .... ......... ....:........ ..... Age ...new... No. Rms. ... .... .Bed Rms. ......2 1 .........Bats. . _ . Lot .... x....:...:...........Area. .. 25,104 anndeck .........Fireplaces ....YOB...... no Landscaped......3!es.................Garage.::... n°..... ........ Breezeway .._.......... Basement: Full ® Partial Caps Cod . Foundation ........poured...................................................... Heating System ... F.W.Aa. P.: ..:...Q ............ ..Fuel Used .gas .....Hot.Water By has... Roof aBPhalt................ Siding ...cedar........... Conditions (Ext.) .....neW....... .:.(Int.) ......new ............... Insulation: Cap ® Walls JR. ........................Screens'.: Doors Windows ❑ Storm: Doors & Windows in room with fire l.ce kitchen with cabinets and stoves dining area with 1st Floor Y ..............................�- .......I......................... ................. ........................:... raid ng,g�,a88,doolcs to sundeck, two bedrooms. There is wall-to-wall carpeting throughout . .......... .... .... ......... ... c •...hou88;, ..r�Blkout ba ement••whic...can be utilized for recreation or living area. • ...........BtMding..Dimensions.........................z, .............. Title Reference: Book........ Town ❑ Tank ❑ Town ® Street P P das:. Piped -® Water:-Well ❑ Jec.IPP.-�P:P]Faved yes......Zoning R P age.. .....S�w.r: Septic �] s Grade bu - Distance from: Beaches.:.:.`.:!?!?n� Stores ...�.min6 Churches...g..min .... ......:..........:.Schools: High......... s Assessed Value .. II. Taxes Land Buildings Total General H Fire Water Other Total School $ $ $ $ $ $ $ APPEO TELY .. ......... $3G0.00NOT AS ' Orig. Mortgage $................................... Unpaid Mortgage Bal. $ ....... . ................................: .... Rate ....... Monthly Payments $................................................ Term ...................:............ Approx. Cash Req'd $...::................:... Mortgagee ........ .............................................:........................ Comments. This is a nice corner lot in a finished development. .......................................................................................... Information herein is believed to be accurate but is not warranted. CUT ALONG THIS LINE Furn.. Listing Exp. Unfurn. Ej Date �9��,��72 Date .1h817.3......... Price $ .28�:59PPazt Furn. [ Listing No. 379......... Street Lot 64 corne Taramac Rd. Village . ......CenterQille ........... ...... n o ..Possessio n passing weer .... James K -Smith. ................. ..............Tel.. Home ......362ta .-6860 . .........Bus. .. ...................... r jvx � Home Road Barnstable C Old Airport ..... ity, Zone, State s. 02630 `-.— ess• Street .... .......t............... Maa Jr. (W.H.W.) ListingBroker ...William E•:.Dace t......................:................................................. Tel........ 75.3.94.8,...... Address: (Street) .57.O..Wt;st..P?tin..sr1et....................................... Village ..:... Hyannis.. .........................._.. ......