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HomeMy WebLinkAbout0051 BAY VIEW STREET - Health 51 Bay View Street Hyannis.. P A = 342 040 0 0 e ° e ° ° e a pp 9 ° v ° n ' o ° 11 Commonwealth of Massachusetts mk� 'ri$Ir� �: n ¢ew�iall IIi7�*i�A�"*'I''r%n �Aliri�'1 1 I61G (/ ! t6.s�, �•alv�vv■%01 ■ ■ wr■ ■■■ - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r• 51 BAYVIEW ST —`� Property Address SCOTT SLATER Owner owner's Name information is HYANNIS MA 02601 JULY 27, 2011 required for every _— ... ..... -- page City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any Please gee cornPleteness checklist at the and of the form. Important:When A. General Information filling out forms on the computer, _ I use only the tab 1. Inspector'. key to move your cursor-do not MARK L WHITE use the return Name of Inspector _ y key. A.b. I:ANUU Company Name 350 MAIN ST-ROUTE_2.8 Company Address W YARMOUTH _ MA 02673 Cityfrown State Zip Code 508-775-2820 S113381 Telephone Number License Number R If'_arti�it�atir�n V• MVr• •MM�.v•• 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 propel`'unction and nlai�itef idl If,=01 011 Si« sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000).The system: LI Passes ED Conditionally Passes ❑ Faiis ❑ Needs Further Evaluation by the Local Approving Authority JULY 27 2011 Inspector's Signature _ Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 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 arr^.rnprimtA roninnal office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use a a�_a a:..r� T6:.. a•ww .I.a.a• w�•�.i.i�o C ,%--tiro wCtem will norfrwrtw in the.flittlre Iandiar i!L thhat l-'i—Ie. I III, Ir,5 PC-\,NVII VV60 I/v�a 4dr 0-v v•• )v•+.••• r the same or different conditions of use. gnu l �� Subauft V S.•`. ,.�:.•.,....,,c,.�>e.,,.ce,.�1 of 1? Commonwealth of Massachusetts .,s v® a -.vs as a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ; 51 BAYVIEW ST Property Address SCOTT SLATER _. ..:... .. --- Owner Owner's Name information is HYANNIS MA 02601 JULY 27, 2011 required for every :.:._ ..... _..._.... ._ page. CdylTown state Zip Code Date of Inspection ®. `.�rdrfseVca`ev�e (cunt./ Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: Exi 1 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. i Comments: test I B) System Conditionally Passes: I tJ, be ❑ One or more system components as described in the"Con iitiorial Pass" se;Uoill need to replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. r`hcnL►hp hry fnr°vcc" 11nn"r%r"nnt dintprrningrl" (Y N, ND)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 exflltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a 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. ❑ Y 9 N ❑ ND (Explain below): in',c.�i v Cw; ,upee,:-i rw'�i:e�,Uw Ur-.^.C.S4 a r':,^.0 1 s,..:�..n.Page 2_f 17 ts;1�•osroe i Commonwealth of Massachusetts R" �tb � 1s�li� V VR �®�A�/ �OC��p►aaOdi®AAA ■ %oA ■AA Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 BAYVIEW ST _..._.,._ Property Address SCOTT SLATER - -. ......_ - .. . .. ..__._,_... .. .. ...... _.,_. . ... Owner Owner's Name information is MYANNIS MA 02601 JULY 27, 2011 required1GrC'-- _..... --.._... _ - — —._...... page. Cttyfiown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cunt.): ❑ 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 ❑ Y ❑ N ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (Explain below): i❑ dictrihl itinn box is IP\/Plod nr rAnIne ?rf ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will rpa_gg incnertinn if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO(Explain below): Cl Fsrr►har Fy-ileinfinn is Rs±nieirpd 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 public health, safety or the environment. .moo 5 rxCµ!i��r�M cam,. nf:JC::+•_urs saygSu cp sal Cvatefr.pn_on_.3 rA 57 t5iru•09/08 Commonwealth of Massachusetts Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 BAYVI EW ST Property Address SCOTT SLATER Owner Owner's Name information is HYANNIS MA 02601 JULY 27, 2011 requileu lul tvVVIFY page. City/Town State Zip Code Date of inspection 1. System will pass unless Board of Health determines in accordance with 310 CIVIR 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 wetiand or a sait marsh B. Certification (cont.) 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: ❑ S in The system has a septic tank and soil absorption system (SAS artud the SA0 1 Is wit I 14 wit 100 feet of a surface water supply or tributary to a surface water supply. El The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. Li The system has a septic tank and SAS and the SAS is within 60 feet of a private water supply well. El 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 inalvsis. performed at a DEP certified laboratory, for coliform bacteria indicates absent 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 E)) S,y Stem Faillstra 11ri aria Aninfirah1p to All Svstems: You must indicate"Yes" or"No"to each of the following for all inspections: T;,,-5 0ffiC;.j!nS—i n FC-rM:S,�,�S.,rfaCe -ge Di.5nn."ISY."IPM Pao&4 of 17 t5irts•09/08 Commonwealth of Massachusetts "I"it-1® 5 P1 eCial 1r�diw®e%+rna $ Forte ® i810� ri @/0 !®Vm ® ■9 ■o�L/wft►`c�✓s ® ® eaa Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - - 51 BAYVIEW_ ST V-" Property Address ....._.___ __. _...._... _..,_. �. SCOTT_SLATER_ __ _..- . ... _ _...... ...- -... .. Owner Owner's Name information is._ HYANNIS MA 02601 JULY 27,.2011� requiied i0r eery - - -- page. Citylrown _ State Zip Code Date of Inspection Yes No Rarrkiin of cauianP into facility or system component due to overloaded or LJ U clogged SAS or cesspool ❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool IStatic fit quld i_v_l the Aietr:bult;^ hnv vhn to r%t itiGt invart tit rg to an nXtArIonriari ❑ or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than YZ day flow B. Certification (cont.) Yes No ❑ FX1 Required pumping more than 4 times in the last year W i due to ciogged or obstructed pipe(s). Number of times pumped: ❑ ❑x Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ Q Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Q Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ O 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- r u,uuvyN�. ❑ 0 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 correci the rauure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. ♦i_- ies NO ❑ ❑ the system is within 400 feet of a surface drinking water supply Tilde.5� &:.^,��r.FOf:�i'$L'b^.U��^M�Set Vay^-f"f:e-c—!System.Pa—V S of 17 t5ms•09/OS commonwealth of Massachusetts ® I&VU W® ®%/Q"I am ® �s■ a to a - - a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 BAYVIEW ST _ - - '" ' Property Address SCOTT SLATER - --.. . _.._ . .. ..----._. - ...... Owner Owner's Name information is HYANNIS MA 02601 JULY 27, 2011 required for every .—__..__ _ ....... page. Crtyriown - _— —� State Zip Code Cate of Inspection ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply _ tho system is loratPd in a nitrooen sensitive area (interim Wellhead Protection Li U Area—IWPA)or a mapped Zone II 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 has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shaii upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No Cl x❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ Q Were any of the system components pumped out in the previous two weeks? ❑ x❑ Has the system received normal flows in the previous two week period? ❑ Q 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 El available note as N/A) Q ❑ Was the facility or dwelling inspected for signs of sewage back up? Q ❑ Was the site inspected for signs of break out? ❑x ❑ Were all system components, including the SAS, located on site? Q ❑ 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? Q ❑ Was the facility owner(and occupants if different from owner)provided with _.dace se t..y5t% 111-D: information on the proper fnair1teitan�c of JUUJUI14:2 acwayc disposal aya�c���o: The size and location of the Soil Absorption System (SAS)on the site has been determined based on: n n Fvic+inn informatinn For example a nlan at the Board of Health. Q ❑ 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(5)) t D. System Information TJ�5^^iC k1O•eL'i_^KCT:.C,hm vfECe Sewage nicn -i Sv Item•Pao 6 of 17 t5ins•09/08 v" Commonwealth of Massachusetts - `r;4.1® r Pe%Ism Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 BAYVIEW ST_ _ _.. _...._.. _. _._... y1J Property Address SCOTT SLATER ... .... —...... . .....--_--_ Owner owner's Name information is HYANNIS MA 02601 JULY 27, 2011 page. cttylTown — state Zip Code Date of Inspection Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(ac ivai). - DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): D. System information Description: Number of current residents: Does residence have a garbage grinder? DYes Z No Is laundry on a separate sewage system? [if yes separate inspection required] Dyes O No Laundry system inspected? DYes 0 No Seasonal use? DYes 0 No 2009-2100 Water meter readings, if available(last 2 years usage (gpd)): CU.FT Detail: m n n- Surnup? DYes Z No •r r • UNKNOWN Last date of occupancy: Date Cc r ial Flour Pnn/�itinnC� _. Type of Establishment: DOCTORS OFFICE rwr�5 !•gp=t 0n cnrm C n,A-v_n Ccru gm Nw+ca!S m vda •Pagw 7 of 17 t5ins•Q9l08 _ - - _ - Commonwealth of Massachusetts �ma s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 51 BAYVIEW ST ____... _....... -. Property Address Y SCOTT SLATER....._._ ---..... ,.... - -.... . . _....._. . . .... - Owner Owner's Name information is - NYANNIS MA 02601 _ JULY 27, 2011 requiredwI evciy .. -_._._.,......... _. page. Ciry/Town State Zip Code Date of Inspection Design flow(based on 310 CMR 15"203): Gallons per day(gpd) Basis of design flow (seats/personslsq.ft., etc.): -- - Grease trap present? E]Yes 0 No �. Industrial waste holding tank present? uYes u No Non-sanitary waste discharged to the Title 5 system? Dyes 0 No Water meter readings, if available: -�---D. System Information (cont.) .I ulvK Last date of occupancy/use: -_._........._� —_.... .. . ..--_--.-- Date Other(describe below): -2__.�-L•-- t�Cn�Peli imunnaLivn Pumping Records: Source of information: —- "" Was system pumped as part of the inspection? ❑Yes n No If yes, volume pumped: gallons Now was quantity pumped determined? yM Reason for pumping: Type of System: © Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool -- rgie G official Inspec ion Form; $--saga Disoosal system-Pace 8 of 17 r Commonwealth of Massachusetts T m r�� lt6V� V �mefcois3A1. ' spat%fi^n ��rm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments H = 51 BAYVIEW ST Property Address SCOTT SLATER Owner Owner's Name information is HYANNIS MA _ 02601 JULY 27, 2011 cyuicdwrc'vciy - page. City/Town State Zip Code Date of Inspection ❑ Privy !=1 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)and a copy of latest inspection of the i/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): D. System information (cont.) Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? CJYes 0 No Building Sewer(locate on site plan): Depth below grade: 25 INCHES feet Material of construction: XU 40 PVC ❑other(explain ____...._.... D cast iron )� Distance from private water supply well or suction line: - - — feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 18 INCHES feet Material of construction: Onpow!.cy i�in5•u9iue r 5 nw�:. i�e..e.atnn C�.m•c„tip„�oro c�..,o dn.n.pgo O ryf 17 Commonwealth of Massachusetts I'r Prtrm a IUW ®® a a vo ■am s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments = 51 BAYVIEW ST __..._. _..-. ``''• Property Address SCOTT_SLATER ..... Owner Owner's Name — information is HYANNIS MA .-.., 02601_ JULY 27, 2011 required for every _ _ page. Gitylrown State Zip Code Date of inspection CO concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: yGaro is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑Yes x No 1500 GALLONS PRECAST T Dimr?nsinns: 31NCHES Sludge depth: --` D_ Svstarn Information (cont_) Septic Tank(cont.) �-- a_ bo ft rri 01,Outlet tee or baffle 55 INCHES Ul�ulQIIC:C IIVIII tV�.!VI bIUV}�c tv uvuunr yr vuarca wa. vi vun.v 0 -- Scum thickness 12 INCHES. Distance from top of scum to top of outlet tee or uaule -- - _ Distance from bottom of scum to bottom of outlet tee or baffle 14 INCHES - PLAN-TAPE-SLUDGE JUDGE How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integ(ity, liquid levels as related to outlet invert, evidence of leakage, etc.): r�.r.. Ar%A10f3vrnr/1 I MICI Inu CT TCC_rll ITl CT TCr-_AI 1 frr1N/F�7S T(-)r.PAr)F_ NO SIGN OF UOU14M/-%I A "r\IIVV L-"V L-L-rr'ra-f rOVER LOADING OR LEAKAGE t5ins•09M Trtln 5 rorW-f tns ev_tf From: Disposal System•Page 10 of 17 Commonwealth of Massachusetts r,- m Tiff® A tIffitiml Ir°,anat-firm F'nrM Subsurface Sewage Disposal System Form-Not for Voluntary Assessments = 51 BAYVIEW ST _.__..._._ Property Address SCOTT SLATER Owner Owner's tdame information Is HYANNIS MA 02601 JULY 27, 2011 req::ired for eve:; _...._. _.. .- Zip Code Date of Inspection page. City/Town state Grease Trap(locate on site plan): Depth below grade: .--feet.. ...............__. Material of construction: U concrete D metal D fiberglass D polyethyiene D 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: ..Date- D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(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 --~ i5'u v9fri"o -fat 5 Ajf+r_iol lnSPer i0r1 Fnryn;Sut*urf.2 59Wne,nicnncal C rem-Pa-0 11 Of 17 i Commonwealth of Massachusetts - Tm c fliFficLal Inal�®�ficn m (� I I L 1� mi �■ !��O ie►ddr�,o�A o av m o n e s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments J 51 BAYVIEW ST Property Address S --�..TT SLATER ....... __.. Owner Owner's Name information is - HYANNIS MA 02601_ — JULY 27, 2011 required forevery -'— --`.' page. Cityrrown State Zip Code Date of Inspection Design Flow: .._ _....... ........---------._._..............._.._ gallons per day Alarm present: ❑ Yes ❑ No Alarm level: --- Alarm in working order: C7 Yes ❑ No Date of last pumping: - Date ..... --- Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No D. System Information (cont.) Distribution Box(if present must be opened)(locate on Site pram): Depth of liquid level above outlet invert -- - _ Comments(.^.ate if hnv ig iAyel nnri dictrihiiti n to OL!tle.ts equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): NO DISTRIBUTION BOX __..... ... P'UMIP fChaM.wi(l0--o,.ty on site 11lany Pumps in working order: ❑Yes ❑ No rni.,t nw,.,el[nr..ero;nn❑nrm C•hcLrLce.Cnwanta Diernca)Rvctam•AAnn 19 of 17 I�ioS•UYillRf •»»••••• � . . . Commonwealth of Massachusetts C '�9� rm Q NLN�� VJ %*�1 81%W1G11 05 m������������m w @-%-rw two Subsurface Sewage Disposal SystemmFmrm -NotforVo|unbaryAosesmnlants VV8T ^~ Property Address S! !�-SLA.E ___________ ........ _______ _. Owner C�no �w�me information is HYANN|G A 02601 ... JULY.2T`�01.i-_'' _---- mqu�=uoxcv�� pay*. -_ _ ----_---_-_-____. ----- State �pCode Da�o,|nspa�mn � ohynu�n �h� Alarms in working ordar --.~n [] No Comments(note condition of pump chamber, condition of pumps and appurienances, etc.).' -SmB�AhmmrnNmo System /$AEA (locate on site plan, excavation not naquired): |fGA | not located, explain why: D. System Information (cont.) Typo: 6 FOOT PITS Faohingoba nunnbec2 - � � [l leaching nun�Uec -------------- ^_ � 0 leaching galleries number: -- M |emchingtnenchaa number, length: -------------- [] leaching fields number, dimensions: -- overflow oemspocJ number: --�--'-------' ^ n innovabve/a|temobvesymtem | r�pe/nenneofboot:c!c�y. --------- - --------- Comments(note condition of soil, signs of hydraulic failure, level cfpondin0. damp soil, condition of vegetation, etc.): �A,:muwm�:*m:m=.o�,�,mor:��ow��/»m��'r�e^��`, ��'osv Commonwealth of Massachusetts 0 1408 MEN Subsurface Sewage Disposal System Form Not for Voluntary Assessments 51 BAYVIEW ST .... _ _..Property Address SCOTTSLATER ___-.._ _._ _..._.. _......... ......-- Owner Owner's Name information is HYANNIS MA 02601 JULY 27, 2011 required iur every _.....--- page CitylTown state Zip Code Date of Inspection LEACHING IS 2 PITS _....._.__ - . Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration `- Depth--top of liquid to inlet invert Depth of solids layer �J Depth of scum layer Dimensions of cesspool -....". Materials of construction Indication of groundwater inflow ❑Yes ❑ No D. System information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: i Dimensions -- - Tale$AHirial inspevion From:,5 Axwrbynr Sa..vn�B Divosal system•Pam 14 of 17 tmns•vyiu:s _..._.�. _�__..... Commonwealth of Massachusetts m rn 'Tifl® J; flffie-®al Inncit-4inn �nr m ® ■%4%0 � '%WGV1V5%^a r Me ■Us Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 51,BAYVIEW ST Property Address SCOTT SLATER Owner Owner's Name information is HYANNIS MA 02601 JULY 27,2011 page. City own State Zip Code Date of.Inspection Depth of solids --- _... ------...._........ ..... .� — Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): D. System Information (cons.) CLcf.-h f"If Cc—onc Dien I Cve}cnZ• prn�dr o?viimw Qf thA sewar7P f�1.Cf_�n.Sal SVStPIYI; 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. Check one of the boxes below: M him i_ckott-h in tha grace holnmi F drawing attached separately rs ��� Tb 5 t Qf it i xt t Inyninn Form Subsurface:SewaOe Disposal System•Pape 15 of V Commonwealth of Massachusetts —ROM, Ir,014.1,ft r, f%ff*sg-;g21 Inanar-finn Fnrm 0 JL1qU %0 %05Vt1%05%A11 lie W - I Subsurface sewage Disposal System Form-Not for Voluntary Assessments 51 BAYVIEW ST Property Address SCOTT SLATER .......... Owner Owner's Name is MA 02601 JULY 27, 2011 ... HYANNIS '"i required Tor evefy State Zip Code Date o lnsp,�Wn- page. Cityrrown D. System Information (cont.) Site Exam: nx Check Slope NONE UO Surface water NONE R (-hor.k e,,Pllar DRY rXI Shallow wells NONE 14+feet p+,,- isinh ground water: teet Please indicate all methods used to determine the high ground water elevation: Trite 5 Offral Inspection Form:Subsurface Sewage ojwsai System•Page JS of 17 t5ird-09= Commonwealth of Massachusetts °7 ifla J; [1ffir inl Inemnar-fi �n Fnrm w ■b0V w � � a m aa ■ rae■ aa ■aPw w e sar.ma m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 SAYVIEW ST Property Address SCOTT SLATER Owner Owner's Name — information is MYANNIS MA 02601 page- for JULY 27, 2011 ramo„o.., _ _ ._..— --- . ... ...........-- pa9e. � v' Citylrown state Zip Code Date of Inspection ❑ Obtained from system design plans on record if checked, taste of design Ntatt re-viewed: Date ❑ Observed 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 USGS database-explain: You must describe how you established the high ground water elevation: WENT THROUGH THE BOTTOM OF THE DRY PIT 6 FEET DEEP. THE PIT IS 6 FEET DEEP,THE PIT Is 2'A FEET BELOW GRADE AND WE WENT 6 FEET THROUGH THE BOTTOM. Before filing this Inspection Report, please see Report Completeness Checklist on next page. E. Report Completeness Checklist Q Inspection Summary: A, B, C, D, or E checked • Inspection Summary D (System Failure Criteria Applicable to All Systems) completed • System Information—Estimated depth to high groundwater O Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file Title 5 official Inspection Form:subsurface Sewage Disposal System•Page 17 of 17 "1 DATE; 5/21/02 PROPERTY ADDRESS; 51 Bayview Street ----------------------- Hyannis ,Mass . 02601 ------------------------ On the above date, I Inspected the septic system at the abov a �SFIVE® This system consists of the following; 1 . 1-1500 gallon septic tank. JUN 0 4 2002 2 . 2-1000 gallon precast leaching pits . ( 6 ' X10 ' ) TOWN OFBARNSTABLE HEALTH DEPT. Based on my Inspection, I certify the following conditions; 3 . This is a title five septic system T Sow.. ( 78 Code ) m 4 . The septic system is in proper working order z q at the present time . MAP - 5 . Pumped the septic tank at time of inspection . pRCEL : ® � 61 6 . Waste water in #2 pit is 60" below the invert pipe . #1 �i't' -�`A�••:••�•• is presently dry . LOT SIG NATURE:-,• _ Name: j_�_ Macomber �Jr.____-- Company; Joseph_P _ Macomber-& Son , Inc , Address ; Box 66 __Centerville , Ma_-02632-0066 v� Phone: 508_775_3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tans• spools Leachflelds Pumped & Installed Town Sewer Connection: P.O. Box 66 Centerville, MA 02632.0 666 775.3338 775.6412 ,,pp�er �.\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 51 Bayview Street Hyannis ,Mass . Owner's Name: William Skinner Owner's Address: 8 Sachem Drive Qenterville .Mass . 02632 Date of Inspection: 72TTU Name of Inspector: (please print) Joseph P .Macomber Jr . Company Name-J.P.Macomber & Son Inc . Mailing Address:Box 66 02632 Telephone Number: 508-175-3338 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 trainine and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to ection 15.340 of Title 5(310 CMR 15.000). The system: / 11 Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority' g Fails 11 Inspector's Signature: Date: P The system inspector shall s mit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 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 DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****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 6/15/2000 page I i Page 2 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:51 Bayview Street Hyannis , ass . Owner: William Skinner Date of Inspection:5 21 02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passer ( have not found any informs io which indicates that any of the failure criteria described in 310 CMR 15.303 br to 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time . B. System Conditionally Passes: /0 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. 106 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 a 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: Nome-Observation of sewage backup or break out or high static water level in the is.rributi — box ue 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: 2 Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 51 Bayview Street Hyannis ,Mass . Owner: William Skinner Date of Inspection: 5 21 02 C. Further Evaluation is Required by the Board of Health: A0 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: Ab 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 any)determines that the system is functioning in a manner that protects the public health,safety and environment: ,VO 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. 10 The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supple. �a 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 I, 0 feet bu 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: 3 Page 4 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Properry Address:51 Bayview Street Hyannis ,Mass . Owoer: William Skinner Date of Inspection: 5/21/02 D. System Failure Criteria applicable to all systems: You must indicate "yes"or"no" to each of the following for all inspections: Yes No _ ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ischarge 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 th disrribution box bove outlet inven due to an overloaded or clogged SAS or cesspool X44:5a _ �iquid depth in.coKpoo}is less than 6" below invert or available volume is less than ''A day flow _ // Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number — /6f times pumped 0 . L/ y ponion of the SAS, cesspool or privy is below high ground water elevation. �y portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. y ponion of a cesspool or privy is within a Zone I of a public well. ✓ Any ponion of a cesspool or privy is within 50 feet of a private water supply well. An,v ponion 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. jTbis system passes if'the well water analysis, performed at a DEP certinied 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.) i A)d (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 C. Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design now 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) `es no _ Zhe system is within 400 feet of a surface drinking water supply �t}ye 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 If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "\es" in Section D above the large system has 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 !5 304 The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 51 Bayview Street Hyannis , Mass . Owner: William Skinner Date of Inspection: 5/21/0 2 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 rt/ 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? j/Have large volumes of water been introduced to the system recently or as part of this inspection ? r/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,-'e�cluding 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 ? ZWas 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)on the site 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(3)(b)) 5 i Page 6 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 51 Bayview Street Hyannis ,Mass . Owner: William Skinner Date of Inspection: 5 21 0 2 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): AO Number of bedrooms(actual): A44 DESIGN flow based on 310 CMR 15.203 (for example: 1 10 gpd x# of bedrooms): .e" Number of current residents: 1,44 Does residence have a garbage grinder(yes or no): .G'/� Is laundry on a separate sewage system (yes or no):o,0 [if yes separate inspection required] Laundry system inspected(yes or no):&A Seasonal use: (yes or no):,iO Water meter readings, if available(last 2 years usage(gpd)):7/00-7/1/01=. 15 , 750,=gallons=43: 15 GP© Sump pump(yes orno):A)d — luz= 32 , 250 gallons= 8 . 36 GPI Last date of occupancy:��t COMM ERCIAL/INDU R19J., F Type of establishment: 6rS% �t8 Design flow(based on 310 CMR 15.203 : gpd / Basis of design flow(seats/person s ft,etc)): Grease trap present(yes or no): wj,V Industrial waste holding tank present(yes or no):,D Non-sanitary waste discharged to the Title 5 system (yes or no): .6)0 Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records; Source of information: 1� Was system pumped as part of the inspection(yes or no): ' If yes, volume pumped:/S�AO gal � -- How was u try pumpeo determined? Reason for pumping: y -&W4 f46 TYPR OF SYSTEM //Septic tank, , soil absorption system Single cesspool 42 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 Z ined from systeZ owner) Tight tank -1W Attach a copy of the DEP approval t6)0 Other(describe): f/# pp �e ase o 1lcomponents,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):146110 6 Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 51 Bayview Street Hyannis . Mass . Owner: William Skinner Date of Inspection: 5/21 /0 2 BUILDING SEWER(locate on site plan) i Depth below grade: 53,11" J Materials of construction: _cast iron ✓ 40 PVCXAother(explain): ,trip Distance from private water supply well or suction line: tT`,*' Comments(on condition of joints, venting,evidence of leakage,etc.): Joints appear tight . No evidence of leakage The system is vented through thO roof vent . SEPTIC TANK: Zlocate on site plan) Depth below grade: 1r Material of construction: ; concreteA)OmetalV01_fiberg]ass�_�polyethylene /Qother(explain) At If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no);, (attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness:_r- Distance from top of scum to top of outlet tee or baffle: a Distance from bottom of scum to bolt m of outlet tee or baffle: How were dimensions determined: �,4!0 Q i,L(gp�c,G/i�yf Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Pump the septic the septic tank. annually Inlet & outlet tees are in place .The tank is structurally sound -and shoals no evidence of// leakage . GREASE TRAI�/44V(locate on site plan) Depth below grade: Material of construction:,i�Y-concrete metal eeftberglass,Akpolyethylene,i�tother (explain): AIW Dimensions: A1, Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scuNo bottom of outlet tee or ba � 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.): �1 4/,4 Graese trap ; s not nresPnt 7 Page 8 of 1 I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 51 Bayview Street yannis , ass . Owner: William Skinner Date of Inspection: 5/21/0 2 TIGHT or HOLDING TAN a (tank must be pumped at time of inspect ion)(locate on site plan) Depth below grade: Material of construction: A,!Lconcretety_metal fiberglass jo polyethylene other(explain): Dimensions: 19/ Capacity: 210 gallons Design Flow: .60 gallons/day Alarm present(yes or no): Alarm level: ,L/!4 Alarm in working order(yes or no): t,14 Date of last pumping: A_ Comments(condition of alarm and float switches, etc.): Tight or holding tanks are not present . DISTRIBUTION BO? &A&(if present must be opened)(locate on site plan) Depth of liquid level above"outlet invert:—� 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.): Distribution box is not present _ PUMP CHAMBER9>WX(locate on site plan) Pumps in working order(yes or no): 44f Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): �10 Pump chamber is not present . 8 Page 9 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 51 Bayview Street Hyannis ,Mass . Owner: William Skinner Date of Inspection: 5/21 /0 2 SOIL ABSORPTION SYSTEM (SAS): locate on site plan, excavation not required) 2-1000 gallon precast leaching pits . If SAS not located explain why: #1 pit is dry . #2 pit has 12" of waste water . ( 60' below the invert pipe I nrated see pagp 10 Tvp leaching pits. number: 10, ,00 leaching chambers, number: N8 leaching galleries, number: Ze leaching trenches, number, length: Ve? leaching fields, number, dimensions: overflow,cesspool, number: innovative/alternative system Type/name of technology: j�15V C?F Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Loamy sand to medium fine sand No signs of hydraulic failure ar nnnding Soils are dry . Pits are under asphalt with cast iron rings & covers to grade . CESSPOOLS44,e (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n Depth -top of liquid to inlet invert: Depth of solids layer: Depth of scum laver: Dimensions of cesspool: lie Materials of construction: Indication of groundwater inflow(yes or no): A& Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): CPsspob.ls. arP not present _ PRIVY,{��(locate on site plan) Materials of construction: 1040 Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy is not present / 9 Page 10 of I i OFFICLA-L rNSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properry nddress5l Bayview Street yannis , ass . Owocr: William Skinner Dille of Insp<ctioo: 5 21 02 SKETCH OF SEWAGE DISPOSAL SYSTEM PTOvidc s sketch of the sewiee disposrl system including tics to at Ieast two permanent rererenee land ocnclvnuks. Locstc ell wells within too feet. Locite where public water supply enters the building. -marks or • s /O 0 � ' sll" 3 ( cc 10 Page 11 of I 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS j SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water Q r 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: Observed 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 USGS database-explain: You must describe how you established the high ground water elevation: Tup of Ground Leaching Pit :eet l Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the bottom�r, of the leaching pit and the adjusted groundwater table is� feet. 11 y •nrn rr—ni•rs---.rr•ern.—arr.•norrrner.asrrrrr.:-.•n�:+vn:•nsrerrrrrrrtiva*+a'rtsr.a•en .ter-�—..-. r...F 1 TOWN OF Barnstable BOARD OF HEALTH SUIISURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION .-•T•..-•.:•--.iia��-n.rr.+•rt•rrm rs��rrrrr�Trr.�—��+mer��+mr-r+nr*+eavr nrmn*rs:sn-sTs nmt n''nrrnReo�rrr.,rrrr.•rrrr•r•„ �..� -TYPE OR PRINT CI.EARLY•- PIIOPERTY INSPECTED STREET ADDRESS 51 Bayview Street Hyannis ,Mass . ' ASSESSORS MAP , BLOCK AND PARCEL # 342/040 OWNER' s NAME William Skinner PART D - CERTIFICATION Y NAME OF INSPECTOR Joseph P.Macomber Jr . COMPANY NAME J. P.Macomber & Son Inch COMPANY ADDRESS Box 66 Centerville , Mass . 02632 Street Town or City State LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX (508 ) 790 _ 1578 R , CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposaj system at this address and that t1Ye information reported is true , accurate , and omplete as of the time of :inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , Check one : //System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or tile. environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA seetio►Y of this form . System FAILED* \ The inspection which I have con acted has found that the system fails to Protect t1►e j)ublic health and the environment in accordance with Title 5 , 3.10 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signatur Date `� i�l d;�Z_ ne copy of this certification must be provided to the OWNER, the BUYER twhere applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or"" perator shall upgrade he syste within o'ne year of the date of the inspection , unless allowed ortr6quiredm otherwise as provided in 310 CMR 15 . 305 , partd .doc TOWN OF BARNSTABLE ' OCATION lawoi� 405w� SEWAGE # � ]VILLAGE ASSESSOR'S MAP & LOT ��STALLER'S NAME&PHONE NO. (_ SEPTIC TANK CAPACITY LEACHING FACILITY: (type) *e (size) G NO. OF BEDROOMS ��Q Il. r ^ BUDER OR OWNER Gy/.�it/�9 PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (1f any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Lea rig Facility (If any well ds exist within 300 fee 7111 ty) Feet Furnished b �' ,\ � � ��� �� �� i �\ � � .. ��o� �� ��\ \ � /�'�'' ` � i o ��\ © - _ �\ , � o i .. � � � ;_ . �.. ---,; - ,� J G' TOWN OF BARNSTABLE r� AT10NSDK SEWAGE # VILLAGE ASSESSOR'S MAP 6& LOTV 4/,Z-040 INSTALLER'S NAME fa PHONE NO. laurn VS S b iSEPTIC TANK CAPACITY 1500 49 I LEACHING FACILITY:(type) a e� . (size) 6 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER L/C BUILDER OR OWNER DATE PERMIT ISSUED: / — 9y` DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No c - c , c 9�r M J c➢ 0110 No.. �%a Fps...... .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diinpwi tl Wor1w C owitrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair Y ) an Individual Sewage Disposal System a .................. nn �+ •--- Location- Address or Lot No. k------ -----------------------------------•---•------ -•---••-•--••............................. •---........-..----......--------------------------- ... Owner ddress w �d o lv 13.E us------------------------------------------- a 6.. ,a% l k---.t/Ure.•......o �.a-i1� Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.............................. .. .Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) A4 Other fixtures ............................... . . - Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ ,-a Test 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........................ a .....-•--••------------•--•-•--•------------•••••-•••••••••••-••••------•---•---•-------------------......................................................... • 0 Description of Soil........................................................................................................................................................................ W U •-•-----•••••••--•••-•-•--••••-••-••••••-•••-•-..._...---•••••-•-•-•---------•-----••-----•••-•------------••••••••••-•----•--------------------•----------------•-----•••••••••--.....-•--------•------ W ---------------------------•--------------------------......---•-----------------.....----------........-----------.._..-•----••--------...-•-••-•- ------------ U Nature of Repairs or Alterations=Answer when applicable_... QGt.._.____.., �,.CP1 . . ........................ ..----------•-----------------•---•---------•-•----------------- -------------------------------•••--•••-----•-•--•----........------••---•••-•-•-•••--.....-----.....••-•••......---••---------..--•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by e board of health. Signed . CQ.[/`O / ................ Application Approved By e ......... ........................................................................................................ ................Dace.................. Application Disapproved for the following reasons: ....................................................................................................................................... ................................................................................................................................................................................................................ ........................................ q� PermitNo.-................�.....�✓�.....�..................... Issued ........... ................s✓........................... Dare o1q 0 No......,................. s - �f! Fss..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Divi-pnuttl Work.6 Tunitrurtiun 11amit ' Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System a . ' 5� � +vUis�j s�R�� _ .... --- -------------------------------------------------------------------- ------------------------ ----�a--�-------------------.------------------ 7�7\ Ck' � ocation-Address or Lot No. f� .. tS N ...--------•---....-•----------------------------••-----...-•-•----•-•----••-.................--- R�0 y�` Owner ddress w © �m0US a /Y��Ac� l _.�N- ost�r.l� ._........_. -•••--- Y Installer Address Q Type of Builing ( ) Size Lot___.......... feet V DwellingNo. of Bedrooms--------------------------------------------Expansion Attic Garbage Grinder PL, Other—Type of Building ............................ No. of persons............................ Showers ( ) — 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. 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... j GT, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ••••••-••-••-----------•----••-••••••--•••••...-•-••-----••-•••-••••----••-••--••----•......•-----•-.......................................................... Descriptionof Soil-•--••••••••-••-•=..................................................................._;_.... x w •=--••••...•----------------------:::..........------..._...- .....---------•-------....•-- -•--- U Nature of Repairs or Alterations ' Answer when applicable---. 01�1__-_-.._-�kid�._L•........7 vk______________•,_____.. � Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental 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. /u�t�t/1-�vy�,l�0 �" c� Signed ........... ....... .. .......:....................................................................... ..�..........q ..... Application Approved By-' ........................................ Dace Application Disapproved for the following reasons: ..................................:............................:........................................................................ ......................................................... .................................................................................................................................. ........................................ .................. PermitNo ..�J..../............................ Issued ......... ................ ............ ...... Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE jertifi ate of CITempliance T IS S TO CEFF, , That the Individual Sewage Disposal System constructed ( ) or Repaired ) by �3 U•w�✓s ................ ................................... ............................................................................................................................................................................. " In nllu at ...............�f....�........./�'�'.U/ 'G..........................>�1�.....................................:................ has been installed in accordance with the provisions of TITI. ,00ff The State Environmental C de as�desoribed-in the application for Disposal Works Construction Permit No.O..�T...�°... �'�....r�------------ dated .............................................0 THE ISSUANCE OVTHIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SAT ISFA T RY. DATE............................... ............ .L....... ................................... ' Inspector ................... ..................cl 'Z/ ............................ ------------------------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No �. FEE.........--•--•--....... Diu u J 1 orkii (to—}�trurtiun "lermit Permission is hereby granted.......ny...-----•.......•--•••......-�J.0 ;J S---•-••••---------••••.....................•••••......••............... to Constru or Repair. ()( n Individu 1 Sew e.Disposal System / yU!z w .� at No.•---•••�---•••.......r... •----••----••-•...---•------........f �°�_/�/5---------------------------------------------------------------------------------••-- --.-.--- Street S� �s� ,.� �� as shown on the application for Disposal Works Construction r No..........:... /.�_'Date___.. ._......................... -------------•-••---••--.---••---•--•••. . ..................... - ,� Board of Health DATE................................................................................. FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS 'a; AsBuilt Page 1 of 1 TOWN OF BARNSTABLE '.00ATION J"" 1lGi� � Jv SEWAGE # A'v VILLAGE X l r�: �,�i ASSESSOR'S MAP& LOT 3 r7 INSTALLER'S NAME&PHONE NO. 10, SEPTIC TANK CAPACITY LEACHING FACILITY: (type (size) NO.OF BEDROOMS BUILDER OR OWNER_�(l�,l�>»/.9•�J IVG� PERMIT DATE: COMPLIANCE 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 Wjb d Lea ng Facility(If any wetl ds exist within f I ty) Feet Furnished V1t 00 / C J ( i 4a http://issgl2/intranet/propdata/prebuilt.aspx?mappar=342040&seq=1 1/11/2011 Parcel Detail Page 1 of 3 o� 4 b i B,lHAS't,1RLE, `• -r 2,f _-«:...rr,'.t+!!�� +' 44 �.. tom.. Logged In As: Parcel D e la 11 Wednesday, Ap Parcel Lookup Parcel Info i Parcel ID 342=040 I Developedr LOT 1213 Location.51 BAY VIEW STREET I Pri Frontage 160 Sec Road I- Sec Frontage Village HYANNIS I Fire District HYANNIS Sewer Acct I Road Index 0094 Asbuilt Septic Scan: Interactive � r 342040 1 Map Owner Info- owner I HUNG, CHARLES & CHEN, LI-WEN, I Co-owner Streetl 904 SILVER SPUR ROAD, #225 I Street2 city I RLLING HLS EST I State CA zip 190274. 1 country Land Info Acres 0.27 Use MED OFC BLDG I zoning MS Nghbd C104 Topography. I Road Utilities I Location j� Construction Info Building 1 of 1 Year 1935 I Roof�` I WOOD FRAME I Built Struct I Wall all Effect Area 3016 Roof AC -I Cover F !I Type NONE^-�I Style lOffice Bldg I In I Bed Wall Rooms Model Commercial I Int Bath Floor Carpet I R oms 0 Full*2/2 Grade Average Plus I Heat Total Type Rooms http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=28429 4/14/2010 Parcel Detail Page 2 of 3 29 GAS 34 BMT 3 Stories Heat Oil Found- Poured Conc. ,2& Fuel ation - I I I A S BMT BAS. i I- Permit History. Issue Date Purpose Permit# Amount Insp Date Commen 02/01/1994 B36478 $75,000 HY REN( 11/01/1981 B23649 $0 01/15/1982 00:00:00 HY ADD'I 03/01/1978 620023 $0 01/15/1979 00:00:00 HY ADD'I Visit History Date Who Purpose 12/11/2009 00:00:00 Michele Arigo Change of Address 08/1 5/1 995 00:00:00 ML Sales History Line Sale Date Owner Book/Page Sale P 1 07/02/2002 'HUNG, CHARLES & CHEN, LI-WEN 15331/343 2 06/13/1978 SKINNER, EDITH R 2727/339 Assessment History. Save# Year Building Value XF Value OB Value Land Value Total Parc( 1 2010 $224,900 $0 $4,600 $95,100 2 2009 $195,700 $0 $4,800 $102,800 3 2008 $191,000 $0 $9,500 $102,800 5 2007 $191,000 $0 $9,500 $102,800 6 2006 $220,800 $0 $2,000 $102,800 7 2005 $222,400 $0 $2,000 $79,000 ; 8 2004 $171,300 $0 $2,000 $79,000 9 2003 $115,900 $0 $2,000 $54,600 ; 10 '2002 $167,100 $0 $2,000 $54,600 11 2001 $167,100 $0 $2,000 $54,600 12 2000 $107,900 $0 $2,000 $46,100 13 1999 $107,900 $0 $2,000 $46,100 ; 14 1998 $107,900 $0 $2,000 $46,100 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=28429 4/14/2010 ` Parcel Detail Page 3 of 3 15 1997 $90,500 $0 $0 $46,100 16 1996 $90,500 $0 $0 $46,100 17 1995 $36,700 $0 $0 $40,100 18 1994 $100,500 $0 $0 $80,600 19 1993 $100,500 $0 $0 $80,600 20 1992 $114,700 $0 $0 $89,600 21 1991 $87,100 $0 $0 $128,000 22 1990 $87,100 $0 $0 $128,000 23 1989 $87,100 $0 $0 $128,000 24 1988 $135,700 $0 $0 $79,400 25 1987 $135,700 $0 $0 $79,400 26 1986 $135,700 $0 $0 $79,400 Photos ILI • i http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=28429 4/14/2010 /100� TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: �ifl�AM �� Sk)NIyEJQ m � Mail To: BUSINESS LOCATION: J- r Board of Health MAILING ADDRESS: 30 v vih-1 a 7— Town of Barnstable P.O. Box 534 TELEPHONE NUMBER: Hyannis, MA 02601 CONTACT PERSON: 4v IC,# hneg EMERGENCY CONTACT TELEPHONE NUMBER: O `77 vl) 3 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NOS_ This form must,be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store: Quantity/Case Quantity/Case Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners -I Hydraulic fluid (including brake fluid) Disinfectants Qav JOh(s.o011tn0: Oylt��u Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may j Spot removers & cleaning fluids be toxic or hazardous (please list): e (dry cleaners) • Q fM�( . Other cleaning solvents 6 C#..4its � Bug and tar removers ��(,� Household cleansers, oven cleaners �r► tG Vf 9 -•�LG�q j1n9 White Copy- Health Department/ Canary Copy-Business � 111 �. L O.0 AT y N �. �.3 U Cum EWA T- G P E R M�� � VILLAGE IN.STA LLER'S NAME & ADDRESS BUILDER OR OWNER 510A-NEf2 DATE PERMIT ISSUED 3; 15-� � DATE COMPLIANCE : ISSUED O is ROO- No................_....... Fps. !S.._............ 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL r ............OF...... 67�72_7. ........ .��... Appliration for Disposal lforkg Tnnitrnrtiun Prrani# Application is hereby made for a Per to Construct K or Repair ( ) an Individual Sewage Disposal System at ......... Q .... .................................. �h»a ...... �..._......__ / -- ....... Location-Addres or I,�t ....... ........ ........ ........... '/ yI Q .1--Owner Address ,Wa -------�'_1.11 ...... lt()4R....................................... ................................................................................................. Installer Address �[ dType of Building Size Lot�?'.�_�^...L......Sq. feet Dwelling—No. of Bedrooms...... ................Expansion Attic) Garbage Grinder /A> `4 Other—Type of Building �J ..d No. of persons............................ Showers p,, yp g �_,..'_..... p (/ ) — Cafeteria (/�� dOther fixtures ---------� �- 9:07--- e...-M a-------- Q sh.----A!LkA1-»-`-�--------•-•-••-----•------------ W Design Flow.................................... .----_gallons per person per �y. Total daily WSeptic Tank—Liquid'capacit/ ....... allons Length...O...__.... Width...16........__ Diameter................ Depth....6......... x Disposal Trench—No. .................... Width.............._..... Total Length.................... Total leaching area....,,._ff.......__._.sq. ft. 3 Seepage Pit No....... _........ Diameter....t� .__..... Depth below t�`G� Total leaching area..7.-�. ....sq. ft. Z Other Distribution box Dosing tank (/�Q aPercolation Test Results Performed by........ ............... Date..... �� Test Pit No. l... nv4.......minutes per inch Depth of Test Pit....h�........ Depth to ground water._//­�­...6t.V. 44 Test Pit No. 2............:...minutes per inch- Depth of Test Pit....Z ........ Depth to ground water........................ei rr ../:................ .................••-------------------- ....._..............__.... Description of Soil.. - C a........ L..-----•-'S• a'-z!---�......------••----------------------------------------- U --•------------------------•--------------...........------•-----------------------...-------•------•---------------------•--------•--------------•----------------------------••-•-....------------••• W UNature 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 TITLE 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 of health. ged-----------------------------------------------------------•-----•-••......---•--. D Application Approved By.... b .. .. �. >3.--f�� ..................... Date Application Disapproved for the following reasons:........... - 1 ...... ... ........•--•-----••-----••-•-•--••-••••--••---•-•---------•--...•---...-•-_... ..........................................................................................................•--------•---•---••••----•- -----------------•----------•--••---•••-------•-••-•--•--••------- Date PermitNo........................................................ Issued....................................................... 07e-� No................--....... ............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. -- ---------------------------------------------------- ApplirFa#ion for Uiiposaal Works Totiatruriion Errant Application is hereby made for a Permit to Construct X or Repair ( ) an Individual Sewage Disposal System at• J� ,�f S t.....Y..i-/-• �L.�...� � ... We- .. r . c ion- Q� e7) Vi .....----._._.. ....----•--•....... ............. .......• --•--..__.. o Address............................................ ....... .... .........- .... Ow W Installer Address / Type of Building - . ., Size Lot...::............... .:...Sq. t Dwelling—No. of Bedroom -��_k-�__________________Expansion Attic Garbage Grinder Other—T e of Building No. of ersons____________ Sh wers QI YP g --- yC�___•_----- - P •---------- - ( �) Cafeteria ( )p. a' Other fixtures .._.__.__� :6Rh 6 -" 3 �/4 Sj �41� ....................................... ........ ----------- Design Flow............................... per person pef dam. Total dai�y fiow �°'� __ ��ar:. gallons. WSeptic Tank—Liquid'capac>ty.___::_.__..gallons Length!_.__.:.0_._ Width__._ _::....... Diameter________________ Depth................ Disposal Trench—N _.___ Width _:: ' Total Length__________________ Total leaching area.... _ sq. ft. Seepage Pit No....... .._.____ Diameter..... ..:....... Depth below inlet__-:.��?: Total leachin area_. Qp.s : ft. � ` --`-� -'--�--------------- Date-g-•--- ----- / q Z Other Distribution box (h, Dosing"tank (/ O J ! '-' Percolation Test Result Performed by......../ _.!_ �v)7 C�'_ 1%= ' 1 W - 1 t -- Test Pit No. 1....F......minutes per inch Depth of Test Pit..__ Depth to ground water...�F:��` • fs, Test Pit No. 2................minutes per inch Depth of Test Pit..... _.___........ Depth to ground water........................ LY D Description of Soil.......... � ............... ............... -------- ..................................----•-•--•----------------•....•-•--••--•-------•----••-•-----•-••...._.. W U Nature of Repairs or Alterations—Answer when applicable............................................................................................... •------------------------------------------------- -................................................................................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITU' 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 of health. i cn - -•-•......................••-----------.....---••---••----••-•---••-- ................................ Application Approved B i/_1 j l/ Gvv! 3 Date Application Disapproved for the following reasons:....................................... --••--••---._ --•---------------------------------------------------------•----------...---------._....--------.---••--.-•••-•--•----•------------•-----------------------------••------------------------•-----....... Date PermitNo.......................................•••--------------- Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD' 9,F HEALH- ...........f .................OF........../....................................................................... Qlatif irtt#r of (tontpliFatt6 THI IDS TO CERTIFY, That the Individual Sewage Disposal System constructed ( Af or Repaired ( ) by ..... . . L. E. /-------- ----------------------------- --- ------•--...............•--••---- -•-•-•---•--•-••-- at.... ��taller - �?`> has been installed in accordance with the provisions Of TI 5 of The State�Sanitary Code as described in the __ 7&-. application for Disposal Works Construction Permit No............../_.L!.................... dated__-.3..-_ _.._..._____................... THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........... uN ------- �......--•---._ Zr_._.... Inspector.... -----•--••------------------------•--••-----•-•-•--•---- THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD OF HEALTH 7� ..........,/,.. .. ..........OF................ /-G! �'�e,° l/..�L"'�................ No ... _�yv ............1.. ...... / FEE...... .. .... . Disposal orki omitra ion .rranit Permission is hereby granted ''" `` = --------------------•-------------......................... ........ _ to Construct ) or Repair ( ) an•Individual Sewage.Disposal`System Street as shown on the application for Disposal Works Construction Permit NO./__.___ _..,Ji_ Dated.___ -_ /_S•- .................... ------------------------------ DATE................................................................................ Board of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ' ,� o f• / t�"' ---_. .-----. .__ ,_,._...... \-.+ .—__ — t5 G l i l di ri e- ' /0 ,/� / / / •So i cr P,e o y P /�'l a c�y / �J Z v d�s r 1C `0 4' ,rr � l .sc ro � / �✓4vG/i/eb .li S of «�o . p -n� - Q/ - - s C ---- - 7.r, z 3 0 4e cr N 40 d w Ile b Q / e. 100 10 - r G v /�/4'' S S. 17 t/� o•ri )'77 e' 1-t Ave occ. fze � o�i5 � -1 16A. � !or v�w a. /¢ 7, 7ct3 ' - �_ T s f /o Le / Te s � X o lc z 07� .SCvccTi u .:a i-r rd o�-, #.2oc) SCr -e Q �a3'sc d ( �o o /�r•�c:'C.LPL. !'-�©1: ... `�.3.S L �Gi 1'f ,e 7r-7�7-7 �e'v ��(:._../"j .. V(• tt 00. ND you � _ _ ` J_. MASS. T1 OF Al, d,/ ��H OF A�- OWNED BY h FRANK �`�� 023• �y� �r fN / i./A M �. �✓.�/N Al� Ae FRANK 4 CONERY f7 o CONERY y FRANK CQNERY 5 TRENTQN ST. < ,Q No. 6232 No. 6573 • i i ,. � , 9 I(.;, �Q' HYANNIS, MAW. 02601 /STE�p� o9FGISTEP6\�Q. KENTMTSR6D cwoq+fIM,a,twwa suwveYOR' h0-sul � FSS70NAL�� SCA►LE t 'tta -26 FT. J//� . .j