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Home My WebLink About0009 BLUE JAY DRIVE - Health 9 BLUE JAY DRIVE l Hyannis A = 268 — 008 `I � e If f Commonwealth of Massachusetts 1P a,6 �_dd� W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 Blue Jay Dr.M ` Property Address Edward Stevens Owner 'Owner's Name information is required for Hyannis Ma. 02601 9/23/2010 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 way. Please see completeness checklist at the end of the form. Important:n 'lli A. General Information When filling out I ^ forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name t� P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification ., k o o # g I certify that I have personally inspected the sewage disposal system at this address and DO the information reported below is true, accurate and complete as of the time of the inspection.Y6e irftection was performed based on my training and experience in the proper function and maintenanewof oasite sewage disposal systems. I am a DEP approved system inspector pursuant to Section�.34Tmof t Title 5 (310 CMR 15.000).The system: 3 U) ® Passes ❑ Conditionally Passes ❑ Fails w ❑ Needs Further Evaluation by the Local Approving Authority m 9/23/2010 Insr6UOK1Sr1CjQdLU1U 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 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. ****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. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 1 ' Commonwealth of Massachusetts W Title 5 Official Inspection Form _ a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 9 Blue Jay Dr. Property Address Edward Stevens Owner Owner's Name information is required for Hyannis Ma. 02601 9/23/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (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 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. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 9 Blue Jay Dr. Property Address Edward Stevens Owner Owner's Name information is required for Hyannis Ma. 02601 9/23/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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 ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ 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 pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) 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 public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: - ❑ Cesspool or privy is within 50 feet of a surface water, ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 9 Blue Jay Dr. Property Address Edward Stevens Owner Owner's Name information is required for Hyannis Ma. 02601 9/23/2010 every page. City/Town State Zip Code Date of Inspection 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: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a'private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria 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: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters El ® 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 Y2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 9 Blue Jay Dr. Property Address Edward Stevens Owner Owner's Name information is required for Hyannis Ma. 02601 9/23/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 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. [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- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: 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. 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 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 shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form.- Not for Voluntary Assessments ,M 9 Blue Jay Dr. Property Address Edward Stevens Owner Owner's Name information is required for Hyannis Ma. 02601 9/23/2010 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® 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(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 9 Blue Jay Dr. Property Address Edward Stevens Owner Owner's Name information is required for Hyannis Ma. 02601 9/23/2010 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d NA 9 ( Y 9 (9p ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 9/2010 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 9 Blue Jay Dr. Property Address Edward Stevens Owner Owner's Name information is required for Hyannis Ma. 02601 9/23/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ® Single cesspool ® Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)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): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 9 Blue Jay Dr. Property Address Edward Stevens Owner Owner's Name information is required for Hyannis Ma. 02601 9/23/2010 every page. City/Town State Zip Code Date of Inspection 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? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 16"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line. 10+ feet Comments (on condition of joints,venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 N, Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Blue Jay Dr. Property Address Edward Stevens Owner Owner's Name information is required for Hyannis Ma. 02601 9/23/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet 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: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Blue Jay Dr, Property Address Edward Stevens Owner Owner's Name information is Hyannis Ma. 02601 9/23/2010 required for y every page. City/Town State Zip Code Date of Inspection 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 Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No ti 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 j Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 9 Blue Jay Dr. 1y Property Address Edward Stevens Owner" Owner's Name information is required for Hyannis Ma. 02601 9/23/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 9 Blue Jay Dr. Property Address Edward Stevens Owner Owner's Name information is required for Hyannis Ma. 02601 9/23/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.No signs of hydraulic failure.Leaching pit was dry at time of inspection.Stain line observed 4' below invert. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 2 1-main and 1-overflow Depth—top of liquid to inlet invert dry Depth of solids layer 3" 3" Depth of scum layer Dimensions of cesspool both 6'x8' Materials of construction Concrete block Indication of groundwater inflow ❑ Yes ® No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Blue Jay Dr. M Property Address Edward Stevens Owner Owner's Name information is required for Hyannis Ma. 02601 9/23/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Sandy dry soil.No signs of hydraulic failure.Both cesspools were dry at time of inspection.Stain lines were up to invet going to leaching pit which was dry also .Stain line 4' below invert. 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.): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size ® ® Zoom Out jIn `1 1i h[ R r S�11t F) rR INL \ f 10 Dx s .,�� y z r � 65Y' • *RN�4�'�`A�; � MAY �{iS YI iyx•'h k 1N C S 3�.�" Le`'�'��s R..+$'�' �,{"'fi'I. IN, s^ f' �E � .#-' A -'W"l, Set Scale 1" = 20 I Aerial Photos I MAP DISCLAIMER ('nn++rinhf')nt)r-7(11f1 Tn...n of Rornetohlu AAA All rinhte rnecn== nF/1^l F/1nIn Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 Blue Jay Dr. Property Address Edward Stevens Owner Owner's Name information is required for Hyannis annis Ma. 02601 9/23/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallowwells Estimated depth to high ground water: Bottom of LP 20' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: As-Built ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges od groundwater elevations. i Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 9 Blue Jay Dr. Property Address Edward Stevens Owner Owner's Name information is required for Hyannis Ma. 02601 9/23/2010 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist _ E Inspection Summary:A, B, C, D, or E checked E Inspection Summary D (System Failure Criteria Applicable to All Systems) completed E System Information—Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 No. us�� 3� Y Fee ho THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIppliLAtion for Zisposal Opstem Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. —1 131.1E 5YAy ` Owner's Name,Address,and Tel.No. [;D Assessor's Map/Parcel 'Z b�r jpv 41k4v%v%`5 Installer's Name,Address,and Tel.No. �r,Q@ qP„x Designer's Name,Address,and Tel.No. f Type of Building: , ) Dwelling No.of Bedrooms !V Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd 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 ns fle-Z ill.1X_ fT~ �,�" To ��4 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 Certificate of Compliance has been issued by this Board of Healtb Si Date 1 0'� Application Approved by Date f u - a %y L7 Application Disapproved by Date for the following reasons Permit No. 2,t)C, Date Issued 10 -U 4 � ^�-r.,.+:.,- a�..�.+a.r-t•.-�+_..-R.,»,:`._..«n,,......m•r�-. . .t,�r'n..atr: .. --. ,.._---`^'e.+�-«.,:....;..�:.,^,-��..�..,..wi`+.�w{a.....r�- •...�.a..., .. n ,.r p� yNo. z�UL "( � l Fee / UU THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN-OF BARNSTABLE, MASSACHUSETTS Yes ftpIication for Disposal 6pstem (Construction 3permit Application for a Permit to Construct( ) Repair W Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. q 3J V r SAy �� Owner's Name,Address,and Tel.No. U�) S jEv S Assessor's Map/Parcel 0,3 / 1�1 V1`> Installer's Name,Address,and Tel.No. G dQ, �-YL(tr�„yC Designer's Name,Address,and Tel.No. Type of Building: ! t n Dwelling No.of Bedrooms �J �!' Lot Size sq.ft. Garbage Grinder( ) Other Type of Building �_No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil It Nature of Repairs or Alterations(Answer when applicable) L �Q.,O yn,�L yy-v, Q -ro 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 Certificate of Compliance has been issued by this Board of Hea . Signed + 1 C._,.. Date_ U Application Approved b /� � i Y _ � n Date u Application Disapproved by Cr Date for the following reasons Permit No. U 2 - 32 Lf Date Issued J1, _ 2 U ------------------------------------------------------------------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS `1 BARNSTABLE;MASSACHUSETTS f f (Certificate of Compliance THIS IS TO C/E�RTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired� ) Upgraded( ) Abandoned( )by ( _rAr,/1 Q,�j tQ-c E-�v�a a I S<.S L at 3 Jl-ti 17 f ttir,,� ( A-t,vt,, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. O� - 3.2"I dated Installer C�%LLC_ ��'11�-V{vviS e� Designer #bedrooms w I A Approved design fl w gpd The issuance of tliis permit shall not be construed as a guarantee that the system will function as designed. Date Inspector �� 1' No. .-? 3� l Fee /Uy THE COMMONWEALTH OF MASSACHUSETTS 1 r PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS` "T- r _ 7 Misposal *pstem Construction permit Permission is hereby granted to Construct( ) Repair(,X) Upgrade( ) Abandon( ) System located at 9 -b A I 4�1 I and as described in the above Application for Disposal System Construction Permit..The applicant recognized his/her duty to comply with t; Title 5 and the following local provisions or special conditions. Provided:Construction jmust be completed within three years of the date of this permit.�v ^ F Date b I �f�l Approved by r { - D �0 No.------------ ------- Fee---- --=------------- BOARD OF HEALTH , � TOWN OF BARNSTABLE U' Application-*rWell Con0rurtionPermit Application is hereby made for a permit o C str Alter ( ), or Repair ( )an`iffMiv1dua�We11 "� Locations— Addre — Assessors Map and Parcel — Owner Ad ress - - 4./ — ——— ------ — — — &=�- ---- '-----------— -------- ller — Driller Address Type of Building Dwelling--------f/ � j-r----------------------------------- Other - Type of Building----------------------------- No. of Persons--------------------------_ --- T -------------- 4 YPe of Well------ - - - - - Capacity----------------------------------------- Purpose of Well----- 1`s�A ----------------- —--_---- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signe 7 = --- — v - f q— (� _ date Application Approved By- - --- 'u --- - ------ date Application Disapproved for the following rea s:------------------------—-------------------------------------_____—__--_________ — -- — — -- -- — — ------ - - —- — — - ------- --- _to date _ - Permit No. - --{ -- ------- Issued ----�1 1�- - --- dat BOARD OF HEALTH TOWN OF BARNSTABLE Certifirate ®f Compliance THIS IS TO CERTIFY, That the In ividual Well Constructed ( ), Altered ( �Repa re by- --- ----- i — — - - - -- �+,� Insta er j at------�`� 6 —�f ILA - — =------ - L` L ------------------------------ has been installed in accordance with the provisions of the Town of Barnstable Board of al P,utate Well Protection, Regulation as described in the application for Well Construction Permit Noltd &ated------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------— - — — — -- Inspector---------------------------------------------------------------------- No.-------------------- Fee---- ---------------- BOARD OF HEALTH TOWN OF BARNSTABLE AppivationArlVe[C Con0r,uctionPermit Application is hereby made for a permit o C str c ), Alter ( ), or Repair ( )afindiv'idruak Weak T yl Location — Add Assessors Map and Parcel -�- --------- -- Owner taller — Driller Address Type of Building Dwelling------)I IZ----------------------------------- Other - Type of Building---------------------------------- No. of Persons------------------------------— --- t Type of Well— -----`-"- ------------- -— YP ------------- Capacity-------------------------------------- Purpose of Well------Q f z-A-v------------------------ Agreement: 1 The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The ,< Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees notto• 1 place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signe -date Application Approved By ' / -----------——-------------- date I� Application Disapproved for the following rea s:-------------__—_—___________—___________________ r ----------------------- ----------— --- • ------ - ---- ----—--------- ---- --- -—-- date-- ---- - -Permit No. -- - ---- --- -- -- --------- Issued---- ----------- ------------------------------------ date ------------------------------L---------------------------------------------------, ------------.---------- BOARD OF HEALTH TOWN OF BARNSTABLE ��ertif irate ®f �ompriance � THIS IS,�TO CERTIFY, That the Individual Well Constructed ( ), Altered ( r-,# R 'rea'�)� by- �+ - --- '- - --�1-------------------------------------- - ------ I sta ell r has been installed in accordance with the provisions of the Town of Barnstable Board of alth P; ate Well Protection` Regulation as described in the application for Well Construction Permit Nowp ---!_-Dated------------;------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL , SYSTEM WILL FUNCTION SATISFACTORY. \. f DATE- --- --------— —== - -- Inspector--------------------------------------------- ! " -------------------------------------------------------------------------------------------------=----- BOARD OF HEALTH TOWN OF BARNSTABLE .ell Cootruct ion Permit - - ��No. �j- - - Fee-Ll -- ---------- Permission is hereby granted-- i: No g )Construct ( ), �lte 1?/u(— dividy�l� e] at.1 - - - -- Y d 1 s r skeet as sh 'w�yn';on the application fora l�l_ell Construction Permit No. --'- v- vD/- D�1 6 —- -- - - Dated - ---------------------- 91 ------------------ - --- - kS----------- ,a of Health DATE--1D _� LOCAT1001 `7 ,9/&e JOy `" SEWAGE PERMIT NO• CW K- 00 VILLAGE �y 3 INSTA LLER'S NAME i ADDRESS �a 0 U I L D E 0 OR OWNER DATE PERMIT ISSUED lo, 4 DATE C 0 M P L I A N C E ISSUED�� _gU i J 1-4 O Cl 5 r' 1� 1r f Fxs..$.... ..00........._ THE COMMONWEALTH OF MASSACHUSETTS EOAR® . OF HEALTH Town OF Barnstable ........... ..... ...............'-'-""'.----'-.......................... Appliration for Elhipmi al Work5 Towitrairtinn anift Application is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal System at: L�7.:... a' d �..MA....02601 Location-Address or Lot No. John-Kilam...............•--•--•--•--....---•------------......--•---•------••----- 4.7...Greexitxee.. .......D6o.7.1.........--- Owner Address a A_•&..B._Cesspool._Seryice............................................... 128 Bishops Terrace,..Hyannis= MA 02601- Installer Address dType of Building Size Lot..... ..................Sq. feet U Dwelling—No. of Bedrooms.................3......._----------------Expansion Attic ( ) Garbage Grinder ( ) pa,, 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. 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........................... and x W ------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------•--•••......-•------•-•- UNature of Repairs or Alterations—Answer when applicable.___insttallat:ion---of__s...l,_000--- alloxl..pre.-Ca.st, sterne..packed...leach--pit...(averfl.cw.)-.......................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of IT: y g g p y 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 h h. " A . Signed.Z.- -_. .-- ��-....-a.0/.22/a0........ / ate Application Approved BY ' .. .. ............................................ 10 22/__80 Date Application Disapproved for the following reasons---------------------------------------------------------------•-------....-------------- ................... -•--•---•---------------------•-•••--------••----------•--•-•-•••---•-•--••------•---------------•••••-----------••-•--•---•-------•-'-•-------------•-••-"-----•----"----"---'----••--------------. Date Permit No.80------------------•-----------------------•----... Issued................rul22.80.. Date ✓t :A Fps ....5.00............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. ..... '� -.....oF........Ba,rnstable Allpliration for Biopooal Worko Tonotrnrtion "amit Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at: `�. fg. 0260_1 ........ Location-Address or Lot No. J Jokes.Wilso •••---------••-•--•--••--••-•••-•••------•---•-•...----••---••------_.. 06A7.1............ Owner Address W A & BCesspool Service 128••Eishops Terrace,.. MA 02601_ -- - --------•-----...----•---•-----•-•---•--•_-•-•- s �l Installer� Address UType of Building Size Lot..... ......... ........Sq. feet .-� Dwelling—No. of Bedrooms.................3_........................Expansion Attic ( . ) Garbage Grinder ( ) aOther —Type of Building ............................ No. of persons.........3................. Showers ( ) Cafeteria ( ) d 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. 1................minutes per inch Depth of Test Pit..............--- Depth to ground water.--__-----_-_.-_---_---. tz., Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •---•-•••----••-----...----•-------••--...•--••••••----•---•--••-•--•-•-............................................-....................................... DDescription of Soil Sand...-•--•••-•--•-•-•--•..............•-•---•------------------•-•-------------------••------------------•------•---•--•-•-••-----•--- x W U Nature of Repairs or Alterations—Answer when applicable_.Lnstatio ___0 __2__1_�000__ allon__pre-east, stone--. ...t-Qmernw.)........................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TTL, y g g p . y of the State Sanitary Code—The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the board of 1 h. Signed G lc��;L �` _1- -� sl:.s_�`2.L�11,•.1 f ..... 9122/80._....._ Date, Application Approved By... r'�1�•._. _ _--_-_____10-2180........ Date Application Disapproved for the following reasons:................................................................................................................ ---•----•-•-....•-•-•................••---••••--•••••-----•------•••-•-•-•••-•---•--•----•----••--•••--•-...••••--•-----------------•--------.--•-----•--•-•-----•--------------......................... Date Permit No . 10 22 80 Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................Town.....-....OF........B,ainstable.................................... Trrtif irtt#.r of T antpliatta ATIIS�S TO CERTIFY, That t e Individual Sewage Disposal System constructed ( ) or Repaired ( X) by________________ esspool Service, 12� Bishops Terrace, Hyannis,- N,A- 02601---_275-6264. Instal er at...9 Bluejay Ln, Hyannis, �,A 02601 John utilson has been installed in accordance with the provisions of TITLE ` fThe State Sanitary Code as esc ibed in the application for Disposal Works Construction Permit No......'0_"- co................... da.ted------.---.--10�22�8.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE:..............1.0 22�80 ..�2 -._...........-•--••---••••--•-•••--•-•------------- Inspector--•---THE COMMONWEALTH OF MASSACHUSET BOARD OF HEALT °0-�, _2. To..... .......OF.. -ra n...t ..ale.......................................... No.......`............... FEE.... ..5.00 ...... Disposal Workii T11notr ion amit Permission is hereby granted.........A-.& Cesspool•_.....vice----............................................................................ to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at No...9-- 'lue ax LA.,-Hxannise NA 02601 - John Wilson ------------------------------------------------------- Street as'shown on the application for Disposal Works Construction mIt No. �o"... 10 22 �0 Dated-----------------• •••--1-•--...•-_.. 1" - jja 9•.'. DATE 10/22/80 r. oard of Health ----------•--- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS