The URL can be used to link to this page

Home My WebLink About0092 BUCKWOOD DRIVE - Health 92 BUCKWOOD'DRIVE HYANNIS A 272 084 g t i i a � ) WN OF BA STABLE cG LOCATION V c O SEWAGE # VILLAGE_ 1 � � ) �A ASSESSOR'S MAP & LOT —� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I ® CC) LEACHING FACILITY: (type) ' l c 1c9 `+f►oj ize) Y"3- NO. OF BEDROOMS BUILDER OR OWNER Ln.a ( t PERMITDATE: !12/L. 00 COMPLIANCE DATE: 2/aa/(5�n Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �_ �"�' � , _ �� i �� (� � � � � � ��a� . ; . �f No. % �� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplicatiou for Migpooal &pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 41 J Z t,�f e,,,9 0 Owner's Name,Address and Tel.No. Assessor's Map/Parcel q" 14y F j'W J f Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.1 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 gallons per day. Calculated daily flow gallons. Plan Date-. Number of sheets Revision Date Title r Size of Septic Tank 1600 Type of S.A.S. � c:"�L� � ��/ i 5?��/ Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by t,'s Bo f Health. Signed _ Date Application Approved _- Date Application Disapproved for the following reasons Permit No. Date Issued v 7 WN OF BAFZNSTABLE i LOCATION 0 C � SEWA GE # �VII.LAGE_ � � ASSESSOR'S MAP & LOT —� INSTALLER'S NAME&PHONE NO. I SEPTIC TANK CAPACITY 11000 LEACHING FACILITY:. (h'Pe) iae) NO. OF BEDROOMS /' BUILDER OR OWNER l 1 PERMITDATE: �y~ 'L�O -j f� � 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 Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by I . LJ CT- - 1 � a No Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: e PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLEs MASSACHUSETTS 01ppYication for Mi!5paaf 6pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name, ddress"and Tel No. i. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Pei s Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. r Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: ` The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system, in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifir-",�,,w,,, cate of Compliance has been issued by this Board of Health. Signed i ,Date Application Approved by Date A:21 IV Application Disapprove`d�for th o low n easons Permit No. /•A, Date Issued � ` THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS t Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by at mac` " , has been constructed in accordance with the llrAsions of Ii e an1?t9e for DispMSyste i str KJ n f rnut No.� �� ated Installer .Designer �� The issuance of this pe" 't shall i//iot be construed as a guarantee that the sy'taft will function as designed is ` Date NI Inspector 44XW, 1-0 / 1 ✓' 11 i ' d4', I / f --------------------------------------- No. � Fee �,� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS Mizpogal *pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at Ir i>91 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:Construction must be completed within three years of the date of this peraut. 1` Date: Approved by k r , 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRECTION PERMIT (WITHOUT DESIGNED PLANS) t/K hereby certify that the application for disposal works construction permit signed by me dated 0 , concerning the property located at 'i- Cv-00 r9 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. ZThe soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. t✓ There are no wetlands within 100 feet of the proposed septic system l✓ 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 W There are no variances requested or needed. The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Z- 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) (o B) G.W.Elevation +the MAX. High G.W.Adjustment. = V DIFFERENCE BETWEEN A and B SIGNED : , �� DATE: aG [Please Sketch proposed plan of sys on back]. NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert ti fj Y _� _� �\ "7�\ c �, 1 1 ;ERTIFIED SEPTIC SYSTEM REPORT 6 44R LOCATION yo 92 BUCKWOOD DR. HYANNIS, MA 02632 MAP 272 PARCEL 084 Z j PREPARED FOR SELLER MR. THOMAS HANSEN 92 BUCKWOOD DR. HYANNIS, MA 02632 BUYER MS . DORIS M . MAILHO 1815 FALMOUTH RD. CENTERVILLE, MA 02632 PREPARED BY HILLIARD HILLER P .O . BOX 250 CENTERVILLE, MA 02632 508-778-1472 R Commonwealth of Mossochusers Executive Office of Environmentcl Affcirs Department of ► Environmental Protection WlWste F.Weld Trudy Cate so---y Ga ww SVuhs AM"Paul Caik=i QavidcH mmwn•r LL GUM= SLBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address %Z , !`�� s Address of Owner. Date of bm"adon: 3/3/y 6 Sf%7 (If different) Name of Iaspeator hI hr/CL,E/1 Company Name.Address and Telephone Number. 1Ulr �750 CERTIFICATION STAT&MF-NT I certify that I have personally inspected the sewage dispoaai system at this address and that the information reported below is true, ac=xr to and complete as of the time of inspection. The inspe�.0 was perior-nerd based on my teal ing and experience in the proper=. C:�on and rt,nirltnnoney of=-site sewage disposal systems. The sysern.L—Passes _ Conditionally Passes Needs ur-her Evaluation By the Local Approving Authors Fails Inspector's 81patuve: - �� Date:-. The System Inspector shall submit a copy,of this inspecion report to the Approving Authorty with::.thirty(30) days of compisLing this iasp c=n_ If the system is a shared system or has a design flow of 10.000 gpd or greater, the inspector and the sysrxm owner:ha11 eabmit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authorty. INSPECTION SUMMARY: Cbw-' 'C,or D: Al ,SY/STEM PASSES: Y I bare not fauad any,information Which indicates that the system vioiates any of the failure ctera as defined in 310 CIM 15 702. Any fai}urs Biters net evaivated are indicated beiow. B1 SYSTEM CONDITIONALLY PASSES: One or more eystem components used to be replaced or repaired. The system.upon completion of the replacement or repair,passes Iadieau rs,m.or cot dassf sinod(Y, N, or ND 1. Descibe bases of deter=i*+Ation in all rsanc— If'not deterained ezpiain why mt) _ The septic tank is metal. tacked. strac-umay .insound. shows substant:ai or ezutratron. or tank failure is ent. The system will .ass :spec:on :ne ex=L.g septic tars:s evinces w,,. a�:for== septic anlc as An bw the Board of Health. (revised 11/03/95) 1 One WMrfM Street • Boston, Massachusetts 02108 • FAX(617) 556-1G49 • Tel•phorm(617) 292.5_vW w ' � Pnmvd on seCytN•P7arr 4 � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner. Date of Inspection: BI SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or him static water 1 1 observed in the distribution oution b is due to broken or obst:-aced pipe(s) or due to a broken. settled or uneven distributio box. The irate=will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced 0OWL—action is distribution box, levelled or replaced The system required pumping more than f times a year due to broicen or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(a are replaced obstruction' removed C] FURTHER EVALUATION IS REQUIRED BY TH BOARD OF HEALTH: Conditions exist which require ftuther evaluat n by the Board of Health in order to deter.-rune if the syste=is faiiiag to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD F HEALTH DETERMINE✓ THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT TH PUBLIC HEALTH AND SAFETY AND THE ENVIRONMEN' . Cesspool or privy is within 50 f t of a surface water Cesspool or privy is within 50 f t of a bordering vegetated wetland or a salt marsh. 4) SYSTEM WILL FAIL UNLESS THE OARD OF HEALTH (AND PUBLIC WATER 9UPPLIER. IF APPROPRIATE) DETERXINE9 THAT THE SYS IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONME The system has a septic and soil absorption system and is within 100 feet to a surface water suppiy or L—:butary to a surface water suppiy. The system has a septic and sail absorption system and is within a Zone l of a public water supply well. The system has a septic and sou absorption system and is within 50 feet of a private water supply well. The system has a septi tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unleaa a ll water analysis for colifor=bacteria and volatile organic compounds indicates that the well is free from poilutsaa from t facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 3) OTHER i N (revised 11/03/915) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontiaued) Property Address ya �`�iC�,O ev h'%9vvs Owner. /j/`Z Date of Inspection: DI SYSTEM FAILS: I have d@te^^:^ed that the system viola in violates one or more of �e followg faiiu.-e cnTer.a as denned in 310 CAL? 15.303. The basis for this data=m=tion is idenr fed below. The Baas:of Heal should be contacxd to deter^—ine what wi11 be aecassary to oor.^ect the failure. cmp"q1neat due to as overloaded or clogged SAS or cesspool. Ba-1rup of sewage into facility or system Po Dvc-�r8e or nding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or _ cewpool- Static liquid level is the diet-:bution box a' ve outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" ow laver or available voiu_te is less than: L2 day flow. Required pumping more thar. 4 times the last year NOT due to clogged or obstructed pipe(si. Number of times pumped Any portion of the Soil Absorption Sy tem. cesspool or pricy is below t e high groundwater eievation. Any portion of a eesr.pool or privy s withi:. 100 feet of a svrface water suppiv or tributary to a surface water supply. Any portion of a cesspool or privy within a Zone I of a public well Any potion of a cesspool or p is within 50 feet of a private ware-aupoiv well. Any potion of a oeaspooi or psi s less than 100 feet but greater tla:.50 feet from a private water supply well with no acceptable water qualiry analysis. If the well has been analyzed to be acceptable, attac copy of well wear analysis for coaorm bacteria. volatile organic compounds. ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The fokwmg criterm apply to large cos in addition to the cetera aoove: rat syatam serves a amity with a design flow of 10.000 gpd or greater(Large System) and the system is a sig:incant thzrat to publi beslth and safety and the env= 1ameat because one or more of the following conditions ezist: the system is within 400 feet of a surface dra]aag water supply the system is within 200 feet of a tributary to a surace draicng water suppiv the system is loeatedlm a nitrogen sensitive area(Inter.^WeUhead?rztecion Ama (IWPA) or a mapped Zone II of a pubL wazar snppiy Weil) 1 T'ha owner or oparater of any such system shall brag the system and facility into full' compiiance with them groundwater treatment pro ngniramsnts of 314 CUR 5.00 and&0(). Please consult the local regionai otT:ce of the 7epartment for `usher:aformauon. r { (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST ProQerty Addr,ssc ya - ��r��x/� �,� 1�Y9,�,vis Owner. Date of Insp.otion: Chock if the following have been done: Pumping information was requested of the owner. o=_,pant. and Board of Health. !�None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates dur=g that period. Large volumes of water have not been introduced into the system recently or as par: of this inspec^.:on. As built plans have been obtained and examined. Note if they are not available with NIA. ,ZThe facility or dwelling was inspected for aigna of sewage back-up. the system does not receive non-sanitary or industral waste flow V�Phe site was inspected for signs of breakout. !/All system components, cccluding the Soil Absorption. System. have been located on the site. L-The septic tank manholes were uncovered opened. and the interior of the septic tank was inspected for condition of baf$es or tow, material of construction, dimensions, depth of liquid. depth of sludge, depth of scan. _L,-The rise and location of the Sail Absorption System on the site ran been determined based on existing information or approximated by non-intrusive methods. The facility owner(and occupants. if different Lrom owner! were provided with information on the proper maintenat ce of Sub- BurPam Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEFI INSPECTION FORM PART C SYSTEIi INFORMATION Property Address Owner. hi.�'. j/HU�iAs /�f,LSZ•v Date of Inspection: FLOW CONDITIONS RBBIDENTLAL• Dad*flow�llons Number of bedrooms:_.3 Number of tartans raddents: Garbage Mader(yee or no): PC> Lsmxtry oaaaeasid to system(yes or no): AQ5 Seasonal use(yea or no): Water mew readings, if available: J/i�G Let date of occupancy: PrQt:St LTG y COMMERCIALM—MUSTRIAL- TMW of . Desip flow: *11onsiday Grease trap present: (pea or no)_ Indusaial Waste Holding Tank present: (,yes or no)— Nonsanita7 waste disc—bArged to the Title 5 system: (.yes or-no)_ Water meter.readings, if available: Last date of oecapanc?. OTHER:(Describe) Lost date of oaupaael: GENERAL INFORMATION PUMPING RECORDS and source of information: 87a m pumped as part of inspee on: (yes or nog If 7ae,whims pumped sallons Bsaeoa for pumping TYPE OF SYSTEM SeQtie soil absorption 97mm sic*assap,ol Overflow osespool Shared sYstasn(yes or not (if pea, attach previous inspec-t rd iaa z�cos, if any') Other(aplain) APPROXnUTE AGE of all components.date iast$lled(if mown) and source of information: map Odom d,,Vw•ed cen ai-ving at the site: eyes ar not s' (revised.11103/95) 6 f - r I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTF—M INFO PUMATION' (continued) Property Adalrees: i21Z fs Owcer. Date of Inspection: SEPTIC TANK (locsts on site plan) Depth below grads: y' Yssorial of Win:Ltsai^ete_metal_FBP _athertexplain) Dimsatiams: a X d� �• �O/) y�1" L7�� 8hrdge depth�_ Dietaacs from tap of sludge to bottom of outlet tee or baffle: Satin thicloaess: ja,, Distsuce from top of scam to top of outlet tee or baffle: Distance from bottom of scam to bar.,om of outlet tee or bat le: /7 ram.nts: (rommmendation for pumping, condition of inlet and outlet tees or baiMes. depth of'.iauid level in,relation to cutlet invert, str aczurai integrtq, evidence of 14akage, etc.) I/9!//t 11,6_0 TE ES 11p�.C> �D ,Uy 5��•[ o� LC/'` E GREASE TRAP:_ (locate on site plan) Depth below gr*A& Material of oanatnue'son:_eo —te_metal_F"IP _others espl=, Dimensions: Satin thirkTaas: Distance from top of satin top of outlet tee or baffle: Distance tom bottom of se to bosom of cutlet tee or baffle: Cam--: (remmmmdation for ping, Condition of inlet and outlet tees or bafCes. depth of liquid ievei in relation to outlet invert. ctrtc^aral iateg*ity, eeid hage mcs of l a , etc. (revised 11/03/95) s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTFM INFORIMATION (continued) Property Addren: 99 !3 +�/_4iv�/] l'i`c'• A/yf�.r�dls Owner. Aid' Date of Inspeadon: TIGHT OR HOLDING TANK 1 (]ores&on site Plea) Depth below _other(explain) Material of tonswse'ion:_ Dlmansionc C+PaCtT _P114as Design A0. Sallonsiday Alarm level ' : (condition of inirt tee, condition of alara and float switches. et ) 1 1 DISTRIBUTION BOX_ (locate on site pion) Depth of liquid level above outlet invert: Comma ts: (note if level and distrfoution is equal evidence of scans carryover, evidence of leakage into or out of box. etc.) pUMP CSAYBSR: Qoor.on site plan) Pampa is Mmimw V"or no) cow: (not+ooadidon of pr chamber, condition of PuaPs and appurtenances. etc.) 1 J (revised 11/03/95) T SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOILM PART C SYSTEM INFORMATION-(continued) PropenyMdteaw y;Z Owner- Date of Impou m SOIL AMRPTION SYSTEM (SAS): 4--' (boat+on tie plan,if ponibk;emclavation not required.but may be approximated by non-intrusive methods) If not dacermined to be present,arplain: Type: Ong per, number. Ime-hin chaanbem number:_ Laehiag galleries, number: Lr�iag trenches,number,length: law1hiag Selds, number, dimensions: overflow otespool, number: Cammeatx(note condition of soil. signs of hydraulic failure, level of ponding,condition of vegetation.etc.) Fi5'/GU/l� piT /fi�v c�vGy L/o CB88POOL9: (locate on site plan) Number tad eaa5gur Lion Depth-top of liquid to inlet invert: Depth of xilids layer Depth ofscum layer- Dimensions of cesspooL- Materials of oMU=%=ion: Iadicatim of gtvaadwater: inflow(oeeapool must be pum as par.of inspection) Comments (aria cmuH ion of soil ' of hydraulic failure, level of ponding, condition of vegeration, etc.) (locate on sits plan) MatMials of lion: Dimensions: Depth ad solids: cammsats (acts o®dit on of eoiL signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 1 (revised 11/03/95) 8 -s q SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Prop""drees: owner. /y/I. Date of Inspection: SEZTCH OF SEWAGE DISPOSAL SYSTEM: iriehw6 ties to at Last two permanent references landzarsa or benc'l—.a*ks locate an walls within 100' III .__ o DEPTH TO MOUNDWAT'ER Depth to pxmd—u r /.5 tfiet mxtbod of&u m==cn or apPr=maticn: T/ffi' XiT 1��,t�R ffi iJ�i9Gr/i:K- �/111cG�� ZZI L T !, ,ffE 5 w/L/1/,°GT�urJ i5 6•y (revised 11/03/95) 9