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Home My WebLink About0044 BUCKWOOD DRIVE - Health 44 BUCKWOOD Drt.,VE} HYANNIS A = 272 056 004 I i i TOWN OF BARNSTABLE BAR-W 4923 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager 13 fVLA6 Address of Offender '� ( 6(4C) i,JoOj L)rr1V e- MV/MB Reg.# Village/State/Zip .02 (o0 f Business Name, ��O Lam/gyp on V f( 2006 Business Address r� Signature of Enforcing Officer Village/State/Zip Location of Offense Ll xwo 0 D-we EnforcAAinyg�Dept/Division Offense D Facts i ' ' to t-� pLL �ea1S o- re y s 61/n ir(:)Ij11 d► �dC�� 4o �Q C V •, �fl� SA(.e 4 n r0l&+,('DO P Co1-6"VrS This willv"serve only as a warning' At this time no legal action ha"'s been taken. It is the goal of Town agencies "to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance.. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG.- PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W 4929 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager mar a e Address of Offend6r— Aq H &A )<Wooj ��jj9_ MV/MB Reg.# Village/State/Zip Business Name. on 6\1 If-202to Business Address Signatur-e—of Enforcing, Officer Village/State/Zip Locai,i:on- of Offense Ll q clew (.Q 6we- t*AaAt% %- MA Enforcing Dept/Division Offense Facts' ret%a to 0 . ( K .' Sjvre4 1^ r0,6�-)i500f (_0A_6'V-VS This will,-,serve only as a warning,/At this time no legal action hags been taken. It is the goal of Town agencies -to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W w' Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Gi mE Ze" fya/' y5 Address of Offender 9 cU )r 4e. MV/MB Reg.# Village/State/Zip ' +' +t' y + ' am/m ' It 20-�6 Business Name-- P � on Business Address 1 - Signature of Enforcing. Officer Village/State/Zip Location of Offense Enforcing Dept/Division Offense '" '"` Facts 3�} t 4 '4 +'^� r This will-serve only as a warning: At this time no legal action has been taken. It is the goal of Town agencies 'to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. r'PINK,,--,EN FORCING OFFICER GOLD-ENFORCING DEPT. Town of Barnstable Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO May 11, 2006 Mr. Gilmar Nunes 44 Buckwood Drive Hyannis, MA 02601 Dear Mr. Nunes, The Town of Barnstable Public Health Division Office received a complaint today regarding your property located at 44 Buckwood Drive Hyannis. The complaint included allegations regarding the installation of new windows in the attic area where there were vents, the recent construction of rooms within the basement and in the attic, and multiple vehicles parked in front of the dwelling. This afternoon, Police Officer Eric Driftmeyer and I knocked at the front door but nobody answered. We observed one car parked on the grass and multiple vehicles parked within the recently paved parking area at the front of the dwelling. We also observed several bags of refuse on the ground adjacent to the deck. All refuse must be stored within rodent proof containers with tight fitting lids. Enclosed is a warning notice in this regard. Please telephone me at(508) 862 4644 to schedule a date and time for an inspection of the interior of this dwelling. Sincerely, T Om A. McKean Director of Public Health TOWN OF BARNSTABLE BAR-W 4929 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager �Ti lyV► � �C,l✓1�� Address of Offender J1 &_(,�Wooj ar,V I& MV/MB Reg.# Village/State/Zip 026 0 ) Business Name /-/.-d 2_am,Q, on 20-oj, Business Address Signature of Enforcing Officer Village/State/Zip L �� Location of Offense L (. Lt?I�"'9Q. 4� 1 lL 1 6 nolxsS MA Enforcpping Dept/Division Offense ( �'— T` Get, �C du Facts S j A re)Ln —VrV0f C__QA'6;6rS f reA This will,,berve only as a warning At this time no legal action hafs been taken. It , is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. ' 1 e Y. . Ln § ` m CO et s aLn �t:s"� S E Lrl Postage C3 Certified Fee ) �� MRetum Reciept Fee f> Postmark (Endorsement Required) t S, He 2 , I L 0 Restricted Delivery Fee f, � FO (Endorsement Required) ;� `D r9 Total Postage&Fees $ uSPS m p Sent To O Mr. Gilmar Nunes N Stieef- . ---`Apt.No.: or PO Box No. 44 Buckwood Drive Hyannis, MA 02601 .___________________ Certified Mail Provides:a A mailing receipt rAaal aooa1Unr ooee-aAsd a A unique identifier for your mailpiece a A record of delivery kept by the Postal Service for two years Important Reminders: a Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. a Certified Mail is not available for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt seance,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restrictedelivery". a If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail . addressed to AM and FPOs. Y SECTIONSENDER: COMPLETE THIS /MPLETE TH�S SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) B. Date of Delivery item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse � �r so that we can return the card to you. C. Signature ■ Attach this card to the back of the mailpiece, n ❑Agent or on the front if space permits. ❑Addressee D. Is delive drmc m item 1? ❑Yes 1. Article Addressed to: If YES nt below: ❑ No Mr. Gilmar Nunes can 44 Buckwood Drive I Hyannis, NIA 02601 3. Service INk ❑Certified Mai Express Mail r _ _ ❑ Registered ❑ Return Receipt for Merchandise �- — ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number(Copy from service label) PS Form 3811,July 1999 Domestic Return Receipt 102595-99-M•1789 UNITED STATES POS.TAL SE14"VICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please"°print your name, address, and ZIP+4 in this box • t�� ' 30 i435 � Public-Heath Div S of n Tc 6 of 8amstable Hyannis,Massachusetts 026001 �F Town of Barnstable �AS regulatory Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO 7003 1680 0004 5458 3756 Mr.Gihnar Nunes May 24,2006 44 Buckwood Drive Hyannis,MA 02601 NOTICE TO ABATE VIOLATIONS OF THE STATE SANITARY CODE CHAPTER 2, 105 CMR 410.00, THE STATE ENVIRONMENTAL CODE TITLE 5 AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at 44 Buckwood Drive,Hyannis,MA. was inspected on May 23, 2006 at 2:30 p.m. by Paul Roma, Building Inspector and Thomas McKean, Health Agent for the Town of Barnstable because of a complaint regarding overcrowding. The following violations of the State Sanitary Code, 105 CMR 410.00,310 CMR 15.000 State Environmental Code,Title 5 were observed: 105 CMR 410.300 and 310 CMR 15.00: There were a total of five (5) rooms which are considered as "bedrooms" observed in this dwelling; [three were observed on the main floor, and two were observed within the basement.] The basement was finished and a new entrance-way was recently constructed without first obtaining any building permits. In addition, the attic area was finished without any building permits. However, the existing septic system is designed for three bedrooms maximum. Also, this property is limited to three bedrooms maximum per 310 CMR 15.214. You are ordered to remove the private rooms from the basement by removing the entrance doors and by opening all door-way entrances(by partially removing walls)to each room in the basement to minimum of five feet wide openings within fourteen(14)days of your receipt of this letter. You may request a hearing before the Board of Health if written petition requesting same is received within seven(7)days after the date the order is served. Non-compliance will result in the issuance of non-criminal ticket citations of$100.00 each. Each day's failure to comply with an order shall constitute a separate violation. PER ORD OF T BOARD OF HEALTH Thomas A. McKean Director of Public Health 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 x�-" SSORS MAP NO, Pro perty Add ress: '� �� NO (�S�D DGM Owner's Name: N 1� OFMASS9C Owner's Address: Ii- o� ANTHONY s� Date of Inspection: -D BOSWORTH Name of Inspector:(please print) t' �cFgT�F��pQ Company Name: / 2 �FsJtNsPE� Mailing Address: 1v Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I 'm a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system- ," Q —j Passes � Conditionally Passes r� Needs Further Evaluation by the Local Approving Audi&ty t Fails N � co a` z —, 1-0 Inspector's Signature: Date: The system inspector shall submit a copy of this inspection report to the Approving Authority Bo id of He@h or co DEP)within 30 days of completing this inspection.If the system is a shared system or has a desig flow of 10,000M 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 1 r t Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM' PART A CERTIFICATION(continued) Property Address: 4 Owner: Date of Inspection: —61 Inspection Summary: Check,�AB,C,D or E/ALWAYS complete all of Section D A. System Passes: ��,� have not found any information which indicates that any of the failure criteria described in 310 CMR 4I;40- or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. r Comments: w ' #' B. System Conditionally Passes One or morkysten ,compon nts as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completi' of the replacement or repair,as approved by thq Board of Health,will pass. Answer yes,no or not determined(Y,N, )in the for the following statements.If" of determined"please explain. The septic tank is metal and over 20 ye old*or the septic tank(whether metal or no is structurally unsound,exhibits substantial infiltration or exfil tion or tank failure is imminent. System will ass inspection if the existing tank is replaced with a complying septic as approved by the Board of Health. *A metal septic tank will pass inspection if it is struc ally sound,not leaking and if a Certificate Compliance indicating that the tank is less than 20 years old is avai ble. NDlexplain: Observation of sewage backup or break out or high s tic water level in the distribution box due to b Qken or obstruc d pipe(s)or due to a broken,settled or uneven distri tion box. System will pass inspection if(with approva of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or r laced ND explain: The syste required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if( ith approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 r F Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: -OW `Ale Owner: Date of Inspection: C. Further Evaluation is Required by the Board of Health: Conditions exist which require er evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety r the environment. 1. System will pass unless Board of ealth determines in accordance with 310 R 15.303(1)(b)that the system is not functioning in a man r which will protect public health,safety a d the environment: Cesspool or privy is within 50 feet f a surface water — Cesspool or privy is within 50 feet o a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and blic Water Supplier,if any)determines th the s stem is functioning in a manner that protects the pu is health,safety and environment: The system has a septic tank and soil absorption syst (SAS) a SAS is within 100 feet of a face water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is wit ' a Zone 1 of a public water supply. e system has a septic tank and SAS and the SAS is within 0 feet of a private water supply well. The stem has a septic tank and SAS and the SAS less than 0 feet but 50 feet or more from a private wat supply well".Method used to dete ' e d tance "This system asses if the well water analysis,p orme at a DEP certi ed laboratory,for coliform bacteria and vol ile organic compounds indicates that the well is free from ollution from that facility and the presence of onia nitrogen and nitrate nitrogen is equal to or less than ppm,provided that no other failure criteria are 'ggered.A copy of the analysis must be attached to this fo 3. Other: 3 1 Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: a Owner: S Date of Inspection: Q O 4/ D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No &-- Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool j�, Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than'/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the 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. �1ifJ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal 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.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist'as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 g d. Y must indicate either"yes"or"no"to each of the following: (Th following criteria apply to large systems in addition to the criteria bove) yes n _ _ e system is within 400 feet of a surface drinking water supply the stem is within 200 feet of a tributary to a surface drinking water upply _ _ the sys m is located in a nitrogen sensitive area(Interim Wellhead Prote ion Area—IWPA)or a mapped Zone II a public water supply well If you have answered es"to any question in Section E the system is considered a signi i ant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large sy tem considered a significant threat under Section E or failed under Section D shall uPly' Y upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 - Page 5 of 11 ti OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: �� /�jf�_ _ Ax ,) Owner: Date of Inspection: _C}q 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 th owner occupant,or Board of Health 1--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? Ott' 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 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 7 z4aat'f V Owner: (, N A S Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): ,3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):,71-?6 _ Number of current residents: d Does residence have a garbage grinder(yes or no): Ovd Is laundry on a separate sewage system(yes or no):2i[if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): /00 Water meter readings,if available(last 2 years usage(gpd)):,f//9 Sump pump(yes or no):" Last date of occupancy: ®, COMMERCIAIANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:0 fiM ADO Was system pumped as part of the inspection(yes or no):X.0 If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM L,"5eptic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool -Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval -Other(describe): Approximate age of all components,date installed(if known)and source of information: DS - Were sewage odors detected when arriving at the site(yes or no):)UO 6 Page 7 of I I y OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C //,,/� SYSTEM INFORMATION(continued) Property Address:7 9UG d/ i f' ®a MV Owner: Date of Inspection: BUILDING SEWER(locate on site plan) ii Depth below grade: Materials of construction:_cast iron L/40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): 00 SEPTIC TANK: (locate on site plan) Depth below grade:�_ Material of construction:_concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) j Dimensions: 44,YVY gi Sludge depth: et2" 6V .&gtg1l jxc✓ 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 to or baffle: ej How were dimensions determined: al Comments(on pumping recommendations, inle(and outlet tee or baffle condition,structural integrity,liquid leyels as related to outlet invert,evidence of leakage,etc.): � d Ce GREASE TRAP:_(locate on site plan) Depth below grade:_ Materiel of construction:—concrete_metal_fiberglass olyethylene_other (expla\(onpu Dimen Scum Distanp of scum to top of outlet tee or baffle: Distanttom of scum to bottom of outlet tee or baffle: Date oing: Commu ing recommendations,inlet and outlet tee or baffle co ition,structural integrity,liquid levels as relaet' ert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address• C t2;d APR/ Owner: S Date of Inspection: TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below de: Material of cons ction: concrete metal fiberglass_p lyethylene other(explain): Dimensions: Capacity: allons Design Flow:. allons/day Alarm present(yes or no): Alarm level: Alarm'%andfl g order(yes or no): Date of last pumping: Comments(condition of alarmt switches,etc.): DISTRIBUTION BOX:_Z(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.):Ok / - Z a/e PUMP CHAMBER: (locate on site plan) Pumps in orking order(yes or no): Alarms in rking order(yes or no): Comments(n condition of pump chamber, dition of pumps and appurtenances,etc.): 8 Page 9 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C LSYSTEM INFORMATION(continued) Property Address: ' !( Owner•C 0 S' Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ _ 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.): _ tv OeAdkd �D t U CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: pth—top of liquid to inlet invert: D th of solids layer: De of scum layer: Dime sions of cesspool: Materi s of construction: Indicatio of groundwater inflow(yes or no): Comment (note condition of soil,signs of hydraulic failure, evel of ponding,condition of vegetation,etc.): PRIVY: (loc a on site plan) Materials of constructi Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: GUUDd Owner: S Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. E B G o' fS �3e6' r i 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �f SYSTEM INFORMATION(continued) Property Address: 7 U dIF i Owner: Date of Inspection: SITE EXAM Slope �Q Surface water Check cellar Aey Shallow wells iG°Gi�G� f' Estimated depth to ground water?a feet Please indicate(check)all methods used to determine the high ground water elevation: ,0-'Obtained from system design plans on record-If checked,date of design plan reviewed:OS ffi D ,.� 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: ,Qcf �2230 � _ 11 TOWN OF BARNSTABLE c LOCATIONT r-.�Lil 6 c3�4 ��' - SEWAGE Z7,Q/—e�- VA.L•AGE� T �,( ASSESSOR'S MAP &LOT Z? INSTALLER'S NAME&PHONE NO.��P�/f��D ; ar if & SEPTIC TANK CAPACITY LEACHING FACILITY: (type)CJ fe) C&4JALSsize) ,2SV'x/o `2,x NO.OF BEDROOMS J I . BUILDER OR OWNER S A110',06 PERMUDATE: ��/tj/ COMPLIANCE DATE: Separation Distance Between the: e Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet d Private Water-Supply Well and Teaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge--`;Wetland and Leaching Facility(If any wetlands exist within,300 feet of)qaghing facility) Feet Furnished by �' s � � � � � � � � � � � , � i � ` �: �" �. � �. f, � No. aal/ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes / PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Migpogar *pgtem Con5tructiou i3ermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Own5;5,.Name,Address and Tel.No. I yLq Assessor's Map/parcel O� Ca 41 a Installer's Name,Address,and Tel.No. �`r® t� Designer's Name,Address and Tel.No. d k/i-C Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow JZa gallons per day. Calculated daily flow ; d' gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) c i e 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 Ti�5fe Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been.ssued byd of Hf Sign d ate O Application Approved by.. Date Application Disapproved for the following reasons _o Permit No. Date Issued r No. Fee �D THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: u Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for igpogar *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System T J Individual Components Location Address or Lot No. Owne ame,Address and Tel.No. 198-- 91 JU �/ .�vG ao .o fl. L)D/4 ite> . /11/4 CA V Assessor's Map/parcel � y p r �D� Installer's Nam®,Address,and Tel.No. 1U0 ✓ p Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms_ ? Lot Size st fti.1 Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow O gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil - t Nature of Repairs or Alterations(Answer when applicable) 4::- f LL d_4 e 6— �ti 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 f the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by is 'o d of Hea Sign d / ate. O Application Approved by / _ _ Date Application Disapproved or the following reasons�1 9 Permit No. "' Date Issued _ . . . ------- �- -- — — THE COMMONWEALTH OF MASSACHUSE BARNSTAB , MASSACHU3ETTS f Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed Repaired( )Upgraded( ) Abandon by , at J, y)Iel M ha b constructed in accordance with the provisions of Title 5 and the for Disposal System Construction ermi No dated Installer Designer The issuance of this pe 't-sh ll not be construed as a guarantee that the syste 1 fu� o s"desi ne . Date SIy O/ Inspector /-- — - ---- -- ... No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpogal *pgtem Qfongtruction Permit Permission is hereby gran Conptrpct( R p 'r p ra e( ) b on( ) System located at_`� r> > �// 1// r `V /J and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Cons tion ust b completed within three ears of the date of this e i Y Date: � Approved by 1 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) � �✓d��, tag hereby certify that the application for disposal works construction permit signed by me dated --I,/ `� concerning the property located at Afl® per C j�el_0 ,0 meets all of the following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no-variance s requested or needed. • The bottom of the proposed leaching facility will not be located less than Five feet above the maximum adjusted groundwater table elevation..[Adjust the groundwater table using the Frirnptor method when applicable] • If the S.A.S.will be located with 250 feet of any vegetated wetlands, the bottom'of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation (using GIS information) ® a B) G.W. Elevation +the MAX. High G.W. Adjustment . j J r s � DIFFERENCE BETWEEN A and B SIGNED : DATE: � J",/� � [Please Sketch roposed pan of system on back . iVOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cent C ! v � x c. X. TOWN OF BARNST'ABLE WAGE, 0 W r - c i LOCATION w j VII.LAGE� r _ a ASSESSOR'S'MAP &LOT27 ". y. INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY c� LEACHING FACILITY: (type) ��P `TU�✓ G�size) ��" ✓n ' �'4Z E, NO.OF BEDROOMS ' DUILLi�Vag v r�a�i_.a� a r m TE n !1D nXIMM, .... . PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any.wells exist _ Feet on sitC&within 200 feet of leaching facility) Edge of Wetland and Leaching.Facility(If any wetlands exist within 300 feet of hing facility) Feet Furnished by r• r. �r Sri k f l€ .:.5 77 t � i r � � 4 1) Lb CAT ION SEWAGE PERMIT NO. VILLAGE H/ I N S T A LLER'S NAME & ADDRESS d UILDEIII ON OWNER 0 DATE PERMIT ISSUED 7- TZ Af,( OAT E COMPLIANCE ISSUED �* G � � �'. � ?„ �� C P c A .� � a '' .. r , Na .......!..._....... .• Fmc.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF -HEALTH ® !` ----------OF....... .`'. % .................... Appliration for Bhipoii al Workii Tomitrurtion Vrrmit Application is hereby made for a Permit to Construct ( Repair-( ) an Individual Sewage Disposal System at: _ r.......................... .............................. --..---.....-._....------------------------ Location-_Address ll Lot dress Installer Address Q Type of Building Size Lot... Sq. feet Dwelling—No. of Bedrooms..___ ............................Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) A4 Other fixtures -------------------------------- d W Design Flow........�5__.`�___.....................gallons per person per day. Total daily flow......... ...............�lons� W Septic Tank—Liquid capacity __- r allons Length __•--- Width__..` ..._� -._.- Diameter................ Depth._Y,e.57 x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------- Diam er..../C>...... Depth below inlet.......` ...... Total leaching area. e �_.sq. ft. Z Other Distribution box ( Dosing tank ( ) /�_.•-•.•.-- W Percolation Test Results Performed by....��t�_e��_..C _�x_!�_�____ Date._._____ ._�__. _. � ,a Test Pit No. 1....155Lminutes per inch Depth of Test Pit__,f el`gym Depth to ground water---Are�-___. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' -•••---•---•-•---•--•---•---•-•---•-•-•-••••--••--•--•-•---•----••.......................•-•......--......................................................... 0 Description of Soil----- .`..... G.........7 1�01....- ......... , 'G� r ...........-.....Z ------ ... ............................................... W ............................... ----------------------------------------------------------------••-----------.............................................'............................................ UNature of Repairs or Alterations,—Answer when applicable........................................:...................................................... ---------------------------------------------------------------------------------------------------------------•-...------------------------------......--------------------------------------.....-•-- Agreement: , The undersigned agrees to install the aforedescribed Indiyidual'Sewage Disposal System in accordance with the provisions of iITIL- 5 of the'tState Sanitary'Code_The undersigned further agrees not to place the system in operation until.a Certificate of ' Compliane n ec y ealth. Signe . -------------•- ------------ •-- . .... ............ D ApplicationApproved -----------•------•..............................•-------------------------------•-_.. ....� /3-.. --------------- Date Application Disapprove for a following reasons--------------------------------•---------------------------------------------------------..........-•-•----•-•-• ---------------------------------•---------------------------------------•-------.•..........------------I---••••-••-••-••-•---••--•------•--•---....-----------•--•-•--•••----•--------•......--•------- Date PermitNo........................................................... Issued_....................................................... Date 4 , No. ..._-....-- . _ _. FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................G1 -'-)..---.....OF.......`f-? ......1:.. :71' ✓f fM. r ApplirFation for Biipnoal Vorkg Tomitrurtion runfit Application is hereby made for a Permit to Construct ( `')or Repair ( ) an Individual Sewage Disposal System at: ..... _........ ...............................................•------•------------ --..._..-••--•-•---...-•--•--•----•-•••----••---••••---•-•--•-._...--------•-------------•-------. Location-Address or Lot No., ieJi J/C' f l•^ is .��,.1 C� ......................—.......................................................................... •---•••-.._.._..•---••.....-•----...._..---...._..........-••----•-----------•-•---•-----...---_.. er Own p y*-�2�''f1�f(��T+i 1�tL `�Jr 'Addresst�. /l/:�i f ter'e,�f Installer Address f Type of Building Size Lot... ....... .G....✓:...Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P4Other fixtures .........................-....................................................................................... W Design Flow....._._._?. .......................gallons per person per day. Total daily flow........_ _ .........................gallons. W Septic Tank—Liquid capacity,Z��.4�allons Length._.Cam ____':_ Width................ .............`Diameter................ Depth.. %. W Disposal Trench—No..................... Width_...____...____._.__ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......;�-_-__.... Diameter..../r ...... Depth below inlet.._...` ..... Total leaching area..--?%_2�.sq. ft. Z Other Distribution box (moo)• '"ter Dosing tank ( ) _ a Percolation Test Results Performed by----- ...........�• ------•---•--••_-=...............-------.. D ----- Date........................................ ,.1 Test Pit No. 1.....-"-Z":minutes per inch Depth of Test Pit... Depth to ground water--_'t--.fi ------ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_--____--__.-__--------- ......................... ..............-----------=-------------------------------------------........................................................ O Description of Soil...... - y , . .. �..........................................................• .� a f't ....................................... ' x rt .-:.. �............W ---------- -"" . .t a <.*� its --------------------- ..-•-•- . •... :• ---• ••••-••-•-•-•-•-•--•--•-•--••--•--•---••--. 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 TITiE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ss ed by the board,of'health. Signed -...................... ------------------------------------- D Application Approved _ -_--•--. _... .. Date Application Disapprov for a following reasons---------------------------------------------------------------------------------------------------------------_ ---------------------------------------------------•----------------------._.............-•-••-•- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrtifiratr of. ( iintli idurr Tl� IS wo, ERTIFY, That the Individual Sewage Disposal fSystem constructed ( or Repaired ( ) by �� 1, Installer has been installed in accordance with the provisions of TIT 5 of The Stake Sanitary Cod s d cd in the application for Disposal orks Construction Permit No......_....:.`�!...... _...._- _ dated___Y. . ............................... THE ISSU CE F THIS CERTIFICATE SHALL NOT BE CONSTRUE® A UARANTEE THAT THE SYSTEM W FU ON SATISFACTORY. DATE... ........................................................ Inspector............. .....• ............................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..OF.............................................. f rd No......................... FEE........................ Permission is he - y-granted .; -------------- ------------------------------- to Construct ( or Re ) ndivl Sew e Disp al System t f •-- Street as shown on the a plicat• n for Disposal Works Construction F-Umi -_-----___-_-- Dated.......................................... ---------------------- ---------------------------------------------------------- Board of Health DATE--. -------------------------- FORM 1255 HOBBS & WARREN. INC.: PUBLISHERS — - ";,-, �_� "I I ,! ; _ - -__ .- , - ",, , � y : n I � I ��--,--i------__ t'. -�, __ _ � i I � ,�Ir��, - ____ .W07", , , , - _,___�_11 I- Ir� F-��'t-5�, '074,vMk-'�', I �!jp�, "N -Z�7' '�, c,-' -',' ", " -, _-�,', --,X" ___,_�_- _,-�"��_17_�,--� - -"-,,7",?7_7*_' ?'7 —r- ',___'`- � , � - 7 '�17,,-,,'7,,.-,,"-,'�-.,,-�-,-�7,,��,-',�,�, , -�,, �,,�7 `�_`T!�T5_1 11-11-11��l?""M�-,*,*,"71rl,-,.,I,-�%-,*r I , ,�, 'r 7�,,�, ,� '�", � ,t��+'-,' ,,T 71! -,f � �, - , . ,, 11� .1 - , -777��77--,, ,?,�77= ,, ." 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