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0088 COMPASS CIRCLE - Health
38 Compass Circle � Hyan I` � E 0 G � e N a r� II C fi n i r .l " { .,rLk 6 { s `LJ ! ` I K ? 'a 4tj.� t { t 4? 5 ' 1 Ffi :f J p CQ I v r JN 7�_ r� Nei f r ,AP426. 2010 10: 04AM N0, 417 P. 1 Town of Barnstable Health Inspector Office Hours �"E Tp�_ Regulatory Services 8:30—9:30 Thomas F.Geiler,Director 3:30—4:30 Public Health Division z659. .0� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 J Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT—SEPTIC QUESTIONNAME Date: 4010 I. General Information: Size of Propeny: .23 acre f .e. - fa Address: 88 Compass Circle Hyannis,MA 02601 Map 310 Parcel 402 Name:Barbara L.Gomes Phone#:508-957-2682 2a. How many bedrooms exist at your property now?3 2b. Are you planning to add any bedrooms?Yes If yes,how many? 1 2e. How many bedrooms total are proposed at this property(including the amnesty unit)?3 2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Show all existing rooms in the home and the amnest apartment, Provide width measurements of any open doorways. Please label each room proposed Y clearly. 3. Is the dwelling connected to public sewer? NO If the dwelling is connected to public sewer,skip questions#4 through#g below. 4. Location of dwelling is INSIDE or OUTSIDE a Saltwater Estuary Protection Zone? 5 . Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? 6. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER? 7. Is a disposal works construction permit on file? YES or NO 8. If yes,how many bedrooms were approved according to this permit? Bedrooms. 9. Were any building permits obtained for construction of additional bedrooms? YES or NO 10- Is there an engineered septic system plan on file at the Health Division? YES or NO 11. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO -----------—-----------------—--- - FOR OFFICE USE ONLY The Public Health Division has no objection to bedrooms at this property. Special Conditions: Signed: Date: QAGMD-Housing�Accessory Affordable Apa=ent ProgramWDMIMFORMS&LETI'ERS\Blank Forms amnesryapp l.DOC APR 26. 2010 10: 05AM N0, 417 P. 3 ri LAA Vi T'j L �J 1 � j P9. Is _. , .. 3 �rAPR 26, 2010 10 ; 05 AM / J� , ,� �;..' NO. 41� P. 2 ;, a � • t ��s 3; J C ` J c � ZZ • 'S�'r� � � �pro' .4 `f�_!'�'"'?s i rr,1� �` ��"l.�"✓ �LL Y� 2_v , ff �y Town of Barnstable Health Inspector F1HE Regulatory ery Services office Hours 8:30—9:30 Thomas F.Geiler,Director 3:30—4:30 ' BARNSTABLE, # Public Health Division Y MASS. 039. Thomas McKean,Director �AIFD NIA' A 200 Main Street,Hyannis,MA 02601 \ Office: 508-862-4644 Fax: 508--790-6304 AMNESTY PROGRAM APPLICANT='SEPTIC QUESTIONNAIRE Date: April 6,2010 1. General Information: Size of Property: .23 acre Address: 88 Compass Circle Hyannis,MA 02601 Map 310 Parcel 402 Name: Barbara L. Gomes Phone#: 508-957-2682 2a. How many bedrooms exist at your property now?3 2b. Are you planning to add any bedrooms?Yes If yes,how many? I 2c. How many bedrooms total are proposed at this property(including the amnesty unit)?3 2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Show all existing rooms in the home and the proposed amnesty apartment. Provide width measurements of any open doorways. Please label each room clearly. 3. Is the dwelling connected to public sewer? NO If the'dwelling is connected'to public sewer',skip que§tions#4 through#9 below. 4. Location of dwelling is INSIDE or OUTSIDE a Saltwater Estuary Protection Zone? 5 . Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? 6. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER? 7. Is a disposal works construction permit on file? YES or NO 8. If yes,how many bedrooms were approved according to this permit? Bedrooms. 9. Were any building permits obtained for construction of additional bedrooms? YES or Q7,PNO w y 10. Is there an engineered septic system plan on file at the Health Division? YES ors NO , 1 1. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO I FOR OFFICE USE ONLY Z —?Fi7 z zz The Public Health Division has no objection to bedrooms at this property. Special Conditions: 1 , Signed. Date: Q\GMD-Housin 1Acce ryAffordable Apartment Pro ram\ADMINFORMS&LETTERS\Blank Forms amnes tyaPp1 DOC W i � d McKean, Thomas From: Dabkowski, Cindy Sent: Monday,April 26, 2010 10:03 AM To: McKean, Thomas Subject: RE: 88 Compass Circle Mr. McKean The basement(once finished)will have a kitchen, bedroom, living area and bathroom. The two small rooms in the basement on the far right one is a n equipment room housing the oil tank and the hot water heater and the other is an unfinished storage room. The fourth bedroom will be located to the left of the stairs- in the basement- I will fax over the floor plan with the clarification Cindy -----Original Message----- From: McKean,Thomas Sent: Wednesday,April 21, 2010 9:08 AM To: Dabkowski,Cindy Subject: 88 Compass Circle The Health Division Office received a septic questionnaire regarding 88 Compass Circle Hyannis. Staff has the following questions: - The submitted floor plans contain unlabeled rooms. What are they used for? - Where is the fourth bedroom? We only counted three bedrooms on these plans. 1 McKean, Thomas From: McKean, Thomas Sent: Wednesday, April 21, 2010 9:08 AM To: Dabkowski, Cindy Subject: 88 Compass Circle j The Health Division Office received a septic questionnaire regarding 88 Compass Circle Hyannis. Staff has the following questions: - The submitted floor plans contain unlabeled rooms. What are they used for? - Where is the fourth bedroom? We only counted three bedrooms on these plans. 1 COct ITA1 -.-1-- C/.aScm T i� z - � f O z. c � A TOWN OF BARNSTABLE LOCATION C �''��;��SS << r� SEWAGE VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.,�9?.c,,,4 T 5--F 7 7S 3 6 SEPTIC TANK CAPACITY s f••�g /Opp CA �/,,�5 LEACHING )~ACILITY: (type �5 (size)33,s X I3� NO. OF BEDROOMS BUILDER OR OWNER �41 R h SCEn- PERMITDATE: COMPLIANCE DATE: b °1 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 J,. J3 =3� np ,� o �c L3 D z 3-3 i3L_ 3c7 �23 �= `13 o�tHE T ,o Town of Barnstable Department of Health, Safety,and Environmental Services 9$.19 Mr Public Health Division 367 Main Street,Hyannis MA 0260.1 Office: 508-862-4644 Thomas A.McKean FAX: 508-790-6304 Director of Public Health Mr. Vilson Rubio July 31, 2003 88 Compass Circle Hyannis, MA. 02601 NOTICE TO ABATE VIOLATIONS OF 310 CMR 15.000 STATE ENVIRONMENTAL CODE, TITLE 5 The property owned by you located at 88 Compass Circle, Hyannis, MA. was inspected on July 29, 2003 by Donald Desmarais, Health Inspector for the Town of Barnstable, because of a complaint regarding a noise compI i t. The following is a violation of 310 CMR 15.000 State Environmental Code, Title 5. 310 CMR 15.00. There were nine bedrooms located at the residence, along with a couch in the kitchen. However, the existing septic system capacity is designed for only four bedrooms total. You are ordered to remove the four bedrooms located in the basement and have only one bedroom in the garage (with building department approval) on or before Monday August 18, 2003. A re-inspection is scheduled to be held on Tuesday August 19, 2003 at 10:00 a.m. You may request a hearing before the Board of Health if written petition requesting it is received within seven (7) days after the date the order is served. You have also been found to be out of compliance with the Nuisance Control Regulation No. 1. You are ordered to remove the large pile of leaves and branches on the north side of the property along with the pile of mattresses and box springs on the east side by Friday August 8, 2003. Non-compliance could result in a fine of up to $100.00. Each days failure to comply with an order shall constitute a separate violation. PER ORDER OF TRE BOARD OF HEALTH Thomas A.McKean Director of Public Health Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6115/2000.Inspection forms may not be altered in any way- A. Certification COPY Important+. When MV out I. Property Info ation: forms on the c computer,use .only the tab key Property dress I to move your cursor-do not use the return key' v 7 Ci Cr.OLG/l O dress ! Cttlyffo ylTown sta / zi Code Date of inspection: `t a Date i 2. Ins dr. Nam of qmpectgr Com y Na e / 4-4 if / Ad Gityffown ��rP-Cg s�3 L/48 3 State Zlp Code Telephone Number Certification Statement: i certify that I have personally inspected the sewage disposal system at this address and that the information repotted 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 am a DEP approved system inspector pursuant to Section 15-W of Title 55(3�10 CMR 15.000).The system: v� r"'ses ❑ Conditionally Passes ❑ [`ails ❑ N ds r 11firothe Local Approving A Inspector's s+s hrre 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 thattlme.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5hnsp.doc-11l2004 Title 5 O@icial tnspecbm Form:Subsurface Sewage Disposal System- Page 1 of 16 Commonwealth of Massachusetts . Title 5 Official Inspection Form Not for Voluntary Assessments , Subsurface Sewage Disposal System Form A. Cert on (cont) c� ��5 `Pl�ss ,�. �-�/ _Zb �Gods Owners Name Date of n Inspection Summary.Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist Any failure criteria not evaluated are Indicated below. Com ts: B) Syste Conditionally Passes: ❑ One or mo system components as described in the"Conditional Pass"section need to be replaced or aired.The system, upon completion of the replacement or repair,as approved by the Board of He th,will pass. Answer yes, no or not de ined(Y,N. ND)in the❑for the following statements.If"not determined,"please explain. (] The septic tank Is metal and o 20 years old*or the septic tank(whether metal or not)Is structurally unsound,exhibits sub ntial infiltration or exfiltration or tank failure Is imminent System will pass inspection if the exi ' tank is with a complying septic tank as approved by the Board of Health. /" *A metal septic tank will pass inspection if it I structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less 20 years old is available. ND Explain: a Mrnsp.doc•11/2004 Trde 5 Official Inspection Form:Subsw1ace Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts Title 5 official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cunt.) okv A4J .l P Address state Owner's Name Da of Irapeplion B) System Conditionally Passes(cont.): ❑ Observation of se a backup or break out or high static water level in the distribution box due to broken or obstruct pipes)or due to a broken,settled or uneven distribution box.System will pass inspection If(with al of Board of Health): ❑ broken pipe(s)are rep ❑ obstruction is removed ❑ distribution box is leveled or replace Al) ND Explain: ❑ The system required pumpi ore than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(Wt approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Requ d by the Board of Health: ❑ Conditions exist which require fu r evaluation by the Board of Health in order to determine If the system is failing to protect public . ith,safety or the environment. 1. System will pass unless Board of H determines In accordance with 310 CMR 15.303(1)(b)that the system is not functio g Ina manner which will protect public health, safety and the environment: ElCesspool or privy is within 50 feet of a surface ter ❑ Cesspool or privy Is within 50 feet of a bordering vege wetland or a salt marsh L%W.doc•11/2004 Tile 5 Olficlal inspection Form:Subsurface Sewage Disposal System- Page 3 of 16 Commonwealth of Massachusetts Title 5 Official. Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cunt.) , ,�/� ft-ts%v lam °v/L o F Z1° Code Owners Name Date-U Inspection C) Further Evaluation is Requi by the Board of Health(cont.): A 2. System will unless the Board of Health(and Public Water Supplier,if any) determines that system is functioning In a manner that protects the public health, safety and environ ent: ❑ The system h a septic tank and soil absorption system(SAS)and the SAS Is within 100 feet of a ce water supply or tributary to a surface water supply. ❑ The system has a se tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic d SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and S and the SAS is less than 100 feet but 50 feet or more from a private water supply wet Method used to determine distance: **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well Is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. p 55hsp.doc•1112004 We 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts Title 5 official inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Ce 'fca " n (cunt.) Z)4 5 f ..�/ cnyrro�► ,0 ZpCode � ow,e s-Narm Date or 1 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 dogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspoo! ❑ 'OL Static liquid level in the distribution box above outlet invert due to an overloaded or dogged SAS or cesspool ❑ Uquid depth in cesspool is less than 8°below invert or available volume is less than%day flow ❑ Required pumping more than 4 times in the last year NOT due to dogged or obstructed plpe(s).Number of times pumped: ❑ Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ,!,d Any portion of cesspool or privy is within 100 feet of a surface water supply or 4� 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. ❑ j 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 collform 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. 15imp.doc.112004 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certi cyA' n (cunt.) AddrM e � � state vA I a�Code orinspegew owners Name �� E) La Systems: To be considered a large system the system must serve a facility with a design of 10,000 gpd to 15,000 gpd. For large sys ms,you must indicate either"yes"or"no"to each of the following,In addition to the questions in S tion D. YES NO ❑ ❑ th system is within 400 feet of a surface drinking water supply ❑ ❑ the s m is within 200 feet of a tributary to a surface drinking water.supply El ❑ the syste ' located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA a mapped Zone II of a public water supply well If you have answered'yes'to any qu n in Section E the system is considered a significant threat, or answered'yes"in Section D above the a system has failed.The owner or operator of any large system considered a significant threat under n E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.Th ystem owner should contact the appropriate regional office of the Department. t5insp.doc•1 MOM Tele 5 Official inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Checklist / P Address �- C' R �� ZipCode Owners Name Date of ! n 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 Hoard 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 Jam- this inspection? Were as built plans of the system obtained and examined?(if they were not available note as WA) ❑ 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(3Xb)] L9nsp.doc•1112004 Title 5 Of ial inspection Form:Subsurface Sewage Disposal System- Page 7 of 16 Commonwealth of Massachusetts v Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. Sy I formation / � N� Da 4 D/ Z1p Code Owner's Name `Date of Residential Flbw Conditions: Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15203(for example: 110 gpd x#of bedrooms): ,233 Number of current residents: Does residence have a garbage grinder? ❑ Yes WNo Is laundry on a separate sewage system?'{if yes separate inspection required] ❑ Yes [ No Laundry system inspected? j Yes ❑ No Seasonal use? Q Yes �" No Water meter readings,if available(last 2 years usage(gpd)): a (� Sump pump? ❑ Yes No Last date of occupancy: Date CommercialAndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 152 Ganom per day(0d) Basis of design flow(seats/persons/sq.fL e Grease trap pact? ❑ Yes ❑ No Industrial waste holding tank present? �'4 ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings,If available: Last date of occupancy/use: Data Other(describe): tW,sp.doc•1112004 Title 5 Official Inspection Form:Subsurface Sewage Dls o System Page a of 16 ,Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form. C. sy to 1 oirmation (cunt.) � s - � t"V �el d I-f l-�ss n�601 cityrr;5.0,00v,K state Zo code Owners Nam Date of Inpoecrion General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes' No If yes,volume pumped: gallm 8 How was quantity pumped determined? Reason for pumping: Type of m: Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shaved 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 o all corn ts,date installed(if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ( No tsinsp.doc.11/2004 Title 5 011dai Ir►spec tim Form:Subsurface sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts Title 5 Official. Inspection.. Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. Syst m formation PropejyAddress ady/T�1'4 Code Owner's tame Date of Inspecabn Building Sewer(bate on site plan): Depth below grade: feet Material of construction: ,,,f�b ❑cast iron ❑40 PVC ❑other(explain): Distance from private water supply well suction line: feet Comments(on condition of nts,ventin vidence of }oi 9� leakage,etc.): 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 ❑ Yes ❑ No certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle `� t Scum thickness ' Distance from top of scum to top of outlet tee or baffle -- 3 Distance from bottom of scum to bottom of outlet tee or baffle OM How were dimensions determined? ` S o n t t5(nsp.clot-11rnN TWe 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Trmation (co IZip Code �.�P Stag z) Owners Name Date of his Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to t invert,evid ce of leakage,etc.}: Grease Trap(locate on site plan): Depth below grade: ) 4 feet Material of construction: �/ ❑concrete ❑metal ❑fiberglass ❑polyethylene [j 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 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 ti of inspection)(locate on site plan): Depth below grade: //v,, � A Material of construction: ❑concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain): t5fisp doc-1112Q04 Title 5 Offidar Inspection Forth:Substttface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System In ormation (co?�'� l O G P AddStalress c"'T/5,o K zh'code Ownees Name Date of Tight or Holding Tank(cant.) Dimensions: Capacity: gWkm Design Flow: gabns per day Alarm pint: ❑ Yes ❑ No Alarm level: Alarm in working order ❑ Yes❑ No Date of last pumping: Data Comments(condition of alarm and float switches,etc.): Distribution Box(if present must be opened)(locate on site tan): 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. /J ❑ Yes ❑ No Alarms in working order. ❑ Yes ❑ No i5tnsp.doc•11/2t}04 7ltle 5 Olridal inspection Form: ubsurtace Sewage Disposal System Page 12 of 16 r 'Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System formation (c nt.) Prope dress Crry'T� .(J� S� Zip Code Owners Name Date of Insection Comments(note condi n of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS)(locate on site plan,excavation not required): If n t located, explain hy: .� . 76011 'OL Type: ❑ leaching pits number. ❑ leaching chambers number leaching galleries number. ❑ leaching trenches number,length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number. ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): t5insp.doc•11/20D4 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 �'. • Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Fonn C. Syste formation (con we A r'jx P dd if e5 .2( 0� C4rr;5A.0U I Staff, Zip Code Owner's Name Date of I Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inle = `vert Depth of solids layer Depth of scum layer Dimensions of cesspool --- Materials of construction Indication of groundwater inflow ElYes ElNo Comments(note condition of soil,sign\hydrraulic level of ponding,condition of vegetation, etc.): Privy(locate on site plan): N i Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic ure,level of ponding,condition of vegetation, etc.): t5insp.doc•11/2004 Tile 5 Official Inspection Form:Subsurface Sewage Disposal system Page 14 of 16 -Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System formation (cunt.) R ProT Address Ao�vff ZIP Code Owner's Name DaWof IrapeMon 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. p'\ p� I� A r �3 t4; 1? 3� �3 C_ 25 t5insp.doc•1112004 Trtle 5 official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System formation ont.)� �s Pro ,1,zAdd / /� `" °� 0 601 City n , Sta�� Zip Code �� J7 Owner's Name Date of Insp lion Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: ,3 v Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record / oZoo If checked, date of design plan reviewed: Date Observed site(abutting property/observation hole within 150 feet of SAS) Checked withloqal Board ad alth,;�xplain: Checked with local excavators,installers-(attach documentation) Accessed USGS database- explain: You must describe how you established the high ground water elevation: ICTo�f r- A-CG-X t5ihsp.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 Town of Barnstable �FZHE Tp� P`' o Regulatory Services BARNSrAHLE.1* Thomas F. Geiler,Director MAS9� ' 3 10g pTE6 9. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. QASEP f IC\Disclaimer Private Septic[nspections.DOC' COMMOTV T AJ T OF MASSACHUSETT.S �0 EXECUTIVE OFFICE OF E� — Z RO���'�-�I'_�. DEPARTMENT OF EI\�TRoN-MENT% - 1 �ROTECTIO\ TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSNIENTS SUBSURFACE SEWAGE DISPOSAL SYSTE_VI FOR PART A CERTIFICATION J Property Address UV 1'7 'gSs C/rc le— Owner's Name: �/j�/Soh 260/ Owner's Address: - �? n r _vf t r Date of in _AZ_ Name of Inspector: (please print) 1 %-4- m Company Name: A Mailing Address: p a Telephone Number 3 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.Tlie inspection was performed based on=-rev training and experience in the proper function and maintenance of on site sewage disposal systems. I am a I?Ep approved system inspector pursuant to�Sec " 15.340 of Title 5(310 CMR e disposal Ile s�-stem: L� pas ses Conditionally Passes Needs Further Evaluation by the Local Appro-��ing Authon.y Fails Inspector's Signature: .V 4 1 eud Date: The system inspector shall submit a copy of this inspection report to the A roving ,_DEP)within 30 days of co letina pp Author (Board Qfilea,,n or mp this inspection.If the system is a shared system or has a design ro- o f gpd or greater; the inspector and the system' ystem owner shall submit the report to the appropriate regional of`c= DEP. The original should be sent to the system owner and copies sent to the buyer,if a• li bl _ ` ° ;t author ty. ?p_ca�ie and the a pp ro vin Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at t time.This inspection does not address how the system will perform in the future under the same or different conditions of use. efferent Title 5 Inspection Form 6/15/2000 page 1 r Page 2 of 11 OFFICI_AL INSPECTION FORM—NOT FOR V OLLN T.ARY ASSESS-MENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORT PAR?A CERTIFICATION(continued) Property Address: O N1 ^515- Cf ►� // Ghni Oymer• 10 p Date of Inspection: l—lot_. Inspection Summary: Check A,B,C,D or E/AL`VAYS complete all of Section D A. Syste�t Passes: have not found any information which indicates that any of the failure criteria described in 310 CAR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 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. Answer yes, no or not determined(Y,N,\TD)in the 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 structuraLv unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will_pass i=ection 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. N`D exnlain: 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. Svstem will ease inspection if(t. approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced 1\71) explain: The system required pumping more than 4 times a year due to broken or obstructed pipe{s), pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 33 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESS-jIENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM E.SPECTIO-IN7 FORA PART A 91052 CERTIFICATION(continued) Property Address: CJ � CO Owner: Air A+0 CVI- Date of Inspection: j Id,_ p C.. Further Evaluation is Required by the Board of Health: 'Y Conditions exist which require further evaluation by the Board of Health in order to d.terr ne if ive s;:stl i. is failing'to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CNIR 15.303(i)(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 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 et 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 I 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 laboraton. for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from hat f acihty a:td 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: Titles C Tnoncn+inn Win, �/l G Mnnn Page 3 of i 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUIVTTARY ASSESS AJE�-TS SUBSURFACE SEWAGE DISPOSAL SXSTEM INSPECTION FOR-AT PART A CERTIFICATION(continued) Property Address: �� �O✓`I of Ci✓� Owner: Date of Inspection: C..j Further Evaluation is Required by the Board of Health: /I/ Conditions exist which require further evaluation by the Board of Hearth in order to dete i- e if the s sten is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 1-4.303(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 bcrde 'nn Cr vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that `protects the public P healt h.h,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 u s pply 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-rater 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 feel but 50 feet or more song 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 coli_form bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammo g _P ammonia nitrogen and nitrate nitrogen is equal to or less than c pprr arolided that no other failure criteria are triggered.A copy of the analysis must be attached to this form 3. Other: •e Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESS--VTEN TS SUBSURFACE SEWAGE DISPOSAL SYSTEM]UNSPECTION F'OR�I PART A CERTIFICATION(continued) Property Address: �� N // /IGS N Owner: �L,`j i,v 01 Date of Inspection: A System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No/ Bazkup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ I-' charge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or `'ged SAS or cesspool v Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS o= cesspool t/— 1uid depth in cesspool is less than 6"below invert or available volume is less than,day flow Required pimping more than 4 tunes in the last year hOT due to clogged or obszucred 42pe(s).Nu_nber Hof 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 �u ater supply. y portion of a cesspool or privy is within a Zone 1 of a public well. _ y portion of a cesspool or privy is within 50 feet of a private water supply we1_i. 5 Any portion of a cesspool or privy is less than 100 feet but greater than 50 f et from a private Rater supply well with no acceptable water quality analysis. [This system passes if the well rater analvsis. 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 eyist as described in 310 CvIR 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 Mth a design floes of 10. gpd to 15,GGG ged - You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) es no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinlcing water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection.yea—I ;Rk) 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; eat. o_ate;-eyed "yes"in Section D above the large system has failed.The owner or operator of any large stem,considered a significant threat under Section E or failed under Section D shall upgrade the system in C-VS m,ce? d 15.304. The system owner should contact the appropriate regional office of the Department T't;a � jn encrt,nn �n+m C.!l:/7llnn Page 5 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLLT-IN'TARY ASSESSNIENTS SUBSURFACE SEWAGE DISPOSAL SYSTF.7T INSPECTIOti FOR,, PART B CHECKLIST Property Address: ORS/Q CO v7 ,�fS C! ✓' Ann i Owner a"" " 6�o Date of Inspection: �d Check if the following have been done.You must indicate"yes"or"no"as to each of the follo-r nz: Yes o 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 no- al flows in the previous two creek period? ----Have large volumes of water been introduced to the system recently or as part ofthis ins ection? Were as built plans of the system obtained and examined?(If they were not available note as %A1 — Was the facility or dwelling inspected for signs of sewage back up? c/ 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. Yes o , ✓� 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 a��.ox`aE;on of dis`�rce is unacceptable) [310 C\ R 15.302(3)(b)) rr` Trio :Tncrar*;nn >~.,,,,, wit c»nnn f Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESS:vfE-NTS SUBSURFACE SEWAGE DISPOSAL SYSTEM I-NSPECTION FORM PART C SYSTEM IiTORMATION Property Address: Owner: 61 0 Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):� Number of bedrooms(actual): DESIG',flow based on 310 C�IR 15.203(for example: 110 gpd x-of bedrooms): q�0 ?'umber of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no):�[if yes separate inspection required; Laundry system inspected(yes or no):�D Seasonal use: (yes or no): //0 Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no): Last date of occupancy: G //�✓� COINUMERCLAL./LNDti STRIAL Type of establishment: . Design flow(based on 310 C-MI R 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 INFORIMATION Pumping Records Source ofinformation: �Do1 U l�vvie,,— Was system pumped as part of the inspection(yes or no):/j/V If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYP SYSTEM Septic tank distribution box, soil absorption system Single cesspool _Overflow cesspool _Priory 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 c on.-acr;to 0e obtained from system owner) Tight tank —Attach a copy of the DEP approval Other(describe): Approximate a`;-Qf all omponents, date installed(if known)and sourc�m{�lion: / GN� ®11 1Ito L S 00 Were sewage odors detected when arriving at the site(,yes or no):It-0 O� T;tlo TTCT Pn}inh Fn TM �!7 GMnnn , Page 7 of i I OFFICIAL INSPECTION FORM—NOT FOR VOL€ -N 1 ARY ASSESSAMNTS SUBSURFACE SEWAGE DISPOSAL SYSTEM I'V�SPECTION FORM PART C ,p SYSTEM INFORMATION(continued) Property Address: O r Owner: / C" Date of Inspection: 0' BUILDING SEWER(locate on site plan) Depth below grade: 0 G Materials of construction:_cast iron _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage;etc.): SEPTIC TANK:—(locate on site plan) Depth below grade: av Material of construction:_ ncrete—metal_fiberglass_polverhylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: r—'X -T Sludge depth: Q , Distance from top of sludge to bottom of outlet tee or baffle: 02 Scum thickness: Z/ — :!�'" 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: /"o Comments.(cn pumping recommendations,inlet and o et tee or baffle condi o structural integrit%, liquid levels as r lated to outlet invert evidence of leaka_Qe.//etc.) t1 r /fie C N7 r'ae✓r c�Q , U �/ G vi d v► N Q G GREASE TRAP:�cate on site plan) Depth below grade:_ Material of construction:_concrete_metal fiberglass_polyethylene other L31 fin C-- (explain): — — Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition stiuctzral n_eg-- > as related to outlet invert, evidence of leakage,etc.): ``-� °e-s Talc e 7^erel.tinn 17...-.+. �h ehnnn Page 8 of i i OFFICIAL, INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAI, SYSTEM L\'SPECTION FORA PART C SYSTEM INFORMATION(continued) Property address: 0< o4"+ s,rf r Owner: .p Date of Inspection: 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(ex-ciain): Dimensions: Capacity: gallons Design Flow: gallons./day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches;etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: �Q✓.�'?G, �� Comments(note if box is level and distribution to outlets equal;any evidence of solids cam over;any e«dense of leakage or out of box; etc. PUMP CHAMBER: �4_ (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber;condition of pumps and appurtenances; etc.): Titlo �Tncnortinn �nrm �/7 S!7nM � R Page 9 of i 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNIT-A-RY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECT70N FORZI P_A.RT C SYSTEM INFORMATION(continued) Property_Address: Owner:�ti.�J�,p C7 " Date of Inspection: h alp SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type h Gil G�y 42r leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches, nurnber,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 ofponding, damp soil, condition of vegetaE<on; etc. : / C/�'O,,�, � O b+ l � J /r-r/N Z/ ✓[ O v /q r CESSPOOLS:�sspool must be pumped as pail of ins ection)(locate on site plan) \umber and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure,level ofponding,condition ofvegetaaon etc): PK1�'Y: (Iocate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition o vear—a o� e>c.?: . 7'itlo C Tn cncrtinn 1=nr.r (�/1 i/�nnn O r Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VO7LUNTARY ASSESStiIENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued; Property Address: �J CJ 6 -�� - Owner• tn. , Date of Inspection: _ ©� SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landr_-arks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building. LJ 14-3 _ 39 a � � . a3 T;tlo C T+crortinn �nrm !/7{/7Mn 10 r Page I 1 of 11 OFFICIAL INSPECTION FORM—NOT FOR YOLUN .CRY ASSESSA1E'_-",'TS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR AI PART c SYSTEM INFORMMATION(continued) Property Address: �Ie Owner: Date of Inspection: SITE EXAM Slope Surface water �Check cellar Shallo«-wells Estimated depth to ground water eet Please indicate(check) /g h ck all methods used t e. .( ) o determine the hl�h ground water eI,.�at=on. Obtained from system design plans on record-Tf checked;date of design plan revdev ed: h�O site (abutting property/observation hole w'thin 150 feet of SAS) th local Board of Health-explain: �ra r, 7—H V/tt-e Checked-vzth local excavators; installers-(attach documentation) Accessed USGS database-explain: You must describe ho.Xv you estab ished e high ground Rater elevation: O ��N✓f �.✓p .40 c e— T r4lA 1 7ncx crtinn 1 nrm 411 v�nnn 11 i No ' x Fee S^!i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes 2ppli>cation for Migpo#a1 &p#tem Con.5truction permit Application for a Permit to Construct( )Repair( grade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. / � Owner's Name,Address and Tel.No. �� Co rn •�'� .ss �: � �. � i.�.rsri,� 6.r�zaY yov,.. Assessor's map/Parcel f 5 v:"'C Y Installer's Name,Address,and Tel.No. Designer's Name,Address and TeL No. /7' �i <� Z,. 2 ,2 v BEY-2 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder�i V Other Type of Building No.of Persons Other Fixtures Showers( Cafeteria( ) Design Flow gallons per day. Calculated daily flow Revision- 'sion.Date. � i J gallons. Plan Date Number of sheets Title Size of Septic Tank '=x+s7!- l a C / Ty of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 17P S—f O G.� A e iZ L,—� 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 b this Board of He Signed Date / Application Approved by e �Ja Date I U Application Disapproved for the oIlowing reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance 0. THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ) Upgraded Abandoned( )byZff F: ( } at �� _�v 9 J / has been constructed in cordance with the provisions of Title 5 and the for Disposal System Construction Permit No.�12d 2_-2 ,2 Installer �2 dated / U �..� 3 � Designer The issuance f this permit shall not be construed as a guarantee that the syst will f Date f� �I nction as designed.�i t�, Inspector . 4 ifUl a t,Yd.'"1 rahal+' „m'3 3'ftaf+7� uhi: h srs.Aih't'T :4 t ax,.I3'-°`•,•z ,fsx. .u_ s. i. ;it �,ts y+3h .0 ay�ni�i�.-N. 4 NAME�9 d FENDER V •h,.a .•�� ��f"? r �_..>x•�_`:.� i � �'r �t11F► �b ER�A+T �4 1' N �". c ra'M h •r; �" " I,r a;a. P�`1 •a-..�.tA:. '" Pa. '.00n� a a + .•.. t rfyy#��a+Wrp.�{{ y � � f'. P. 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Y a cltatlnz Fjeann '4 r,r4¢ xg f a f $ r f ss :',�L Y t �. ter+ b 3� 3` � ��i(h ��k�? hxEx�i�s3 k#TM � �n4Cwfi ,� s'"`S�i '• 'Yra; a i, ..fi t Yam?-- vs.ta Nam-..abua�.a,,- p v ;a:r � �fxc .,,;O YU�e .sr-aka uts'.s;a.�n ' rtoo.=c c.,:..;.as.-fb1 ef��ve •� a'"' tI ry� (3f o tag o: eaboH ° r�lserz°�to[egw„sZ he�orl: n �iisgr fjy Su fad�to�a Pe,B doi�theao.•90 Pa,7!Y �� eT - at , Alf � t r "4h�an d't � run �platmaeaia�aln ° si, t s_ a.a: � � 8 a a` a¢Cs� s kn 4✓���'.. ��s` � .,tt� t' L1 A� r � '. eta t k fM-�" X�y'^'+ 'M k< a a!7K Ne, '„" y• y,.btlrFr ` fir ,@@" � .,.. aasT; . 4 I '�� r r���ra �°� see t" "`tie guntY,��:�,� I . -,r:.€.. . :a . � } "siL yt:U 54K1w_ wd^.seS... s ' rr Health Complaints 12-Apr-05 Time: 10:20:00 AM Date: 4/11/2005 Complaint Number: 18025 Referred To: DONNA MIORANDI Taken By: SHARON CROCKER Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: UNSANITARY CONDITIONS Business Name: Number: 88 Street: COMPASS CIRCLE Village: HYANNIS Assessors Map_Parcel: Complaint Description: PERSON CAME IN TO SAY LOCATION HAS 3 UNREGISTERED VEHICLES IN YARD AND THEY ARE FILLED WITH TRASH. Actions Taken/Results: DZM investigated and took pictures. There are 10 cars on the property. One truck on site has trash and paint related wastes. DZM shall send out a warning or a ticket to owner, Vilson Rubio. Investigation Date: 4/11/2005 Investigation Time: 2:30:00 PM 1 McKean, Thomas From: McKean, Thomas Sent: Wednesday, September 22, 2004 9:18 AM To: Geiler, Tom Subject: HEALTH REPORT OF BIRST INSPECTIONS/SEVEN PROPERTIES-Sept. 21, 2004 The following properties were visited on September 21, 2004: - 5 George Street- Refuse violations observed, holes observed in siding of dwelling, $100 ticket citation issued 9/21/04 to owner, Winona Kostic, order letter to be prepared today,follow-up Monday Sept. 27, 2004 - 27 George Street,4 health violations observed including illegal basement bedrooms without second means of egress, insufficient number of smoke detectors, 4-$100 ticket citations mailed 9/22/04 to owner, Hermes Santa Rosa, order letter to be prepared today - 47 Suffolk Ave. , no housing violations observed, verbally ordered owner to remove carpeting and construction materials from rear yard,will follow-up on Monday September 27, 2004 - 88 Compass Circle, nobody onsite to allow inspectors inside for an inspection, history of violations regarding illegal finished basement bedrooms according to BLDG, reinspection needs to be scheduled, rubbish violation observed, $100 ticket citation mailed 9/22/04 to Vilson Rubio. - 184 Compass Circle, refuse violations observed; $.100 ticket citation handed to Lynda Lamb 9/121/04. - 63 LaFrance Avenue, nobody onsite to allow inspectorso inside, no violations observed outdoors, attempted to call owner this morning to set-up meeting appt.,.left message on her answering machine (508 775-6527) - 118 Wagon Lane , 3 violations observed including illegal,basement bedrooms without second means of egress, 3- $100 ticket citations mailed 9/22/04 to owner Israel DaSilva & Lea SM;order letter to be prepared today 1 Health Complaints 11-Apr-05 Time: 10:20:00 AM Date: 4/11/2005 Complaint Number: 18025 Referred To: DONNA MIORANDI Taken By: SHARON CROCKER Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: UNSANITARY CONDITIONS . Business Name: Number: 88 Street: COMPASS CIRCLE Village: HYANNIS Assessors Map_Parcel: Complaint Description: PERSON CAME IN TO SAY LOCATION HAS 3 UNREGISTERED VEHICLES IN YARD AND THEY ARE FILLED WITH TRASH. Actions Taken/Results: Investigation Date: Investigation Time: t i 1 I 1 Health Complaints 16-Jul-03 Time: 1:45:00 PM Date: 7/7/2003 Complaint Number: 4145 Referred To: DONNA MIORANDI Taken By: JOAN AGOSTINELLI Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: UNSANITARY CONDITIONS Business Name: Number: 88 Street: COMPASS CIRCLE Village: HYANNIS Assessors Map_Parcel: Complaint Description: MORE THAN 15 CARS/TRUCKS. GRASS IS NEVER CUT. MATTRESSES ARE ON THE LAWN COVERED WITH TARP. OVER- CROWDED. PEOPLE ARE LIVING IN GARAGE. ONE BATHROOM. 12/ 15 PEOPLE LIVE THERE. PEOPLE ARE CONSTANTLY BRINGING OVER OTHERS TO STAY. Actions Taken/Results: No grass in front but grass is very tall in back. Six cars on the property and garage windows are covered up. Referred to building. Saw no mattresses on ground. Investigation Date: 7/7/2003 Investigation Time: 3:40:00 PM 1 Barnstable Assessing Search Results Page 2 of 2 Land and Building Information Land Building Lot Size(Acres) 0.23 Year Built 1978 Appraised Value $128,100 Living Area 1080 Assessed Value $ 128,100 Replacement Cost$126,969 Depreciation 13 Building Value 110,500 Construction Details Style Ranch Interior Floors Carpet Model Residential Interior Walls Drywall Grade Average Heat Fuel Oil Stories 1 Story Heat Type Hot Water Exterior Walls Wood Shingle AC Type None Roof Structure Gable/Hip Bedrooms 3 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 1 Bathroom Total Rooms 6 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL1 Fireplace 1 $2,600 $2,600 BRR Bsmt Rec Room 800 $3,500 $3,500 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) I http://www.town.barnstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing... 4/11/2005 ��oFto Town of Barnstable N s Department of Health,Safety,and Environmental Services '+ BARNSTABLE, "� 1639. Public Health Division 9� 0�' PIED p, 367 Main Street,Hyannis MA 02601 Office: 508-8624644 Thomas A.McKean FAX: 508-79076304 Director of Public Health Mr. Vilson Rubio July 31, 2003 88 Compass Circle Hyannis, MA. 02601 NOTICE TO ABATE VIOLATIONS OF 310 CMR 15.000 STATE ENVIRONMENTAL CODE, TITLE 5 The property owned by you located at 88 Compass Circle, Hyannis, MA. was inspected on July 29, 2003 by Donald Desmarais, Health Inspector for the Town of Barnstable, because of a complaint regarding a noise complaint. The following is a violation of 310 CMR 15.000 State Environmental Code, Title 5. 310 CMR 15.00. There were nine bedrooms located at the residence, along with a couch in the kitchen. However, the existing septic system capacity is designed for only four bedrooms total. You afe ordered to remove the four bedrooms-located in-the-basement and have only one bedroom in the garage (with building department approval)'on or before Monday August 18, 2003. A re-inspection is scheduled to be held on Tuesday August 19, 2003 at 10:00 a.m. You may request a hearing before the Board of Health if written petition requesting it is received within seven (7) days after the date the order is served. a- You have also been found to be out of compliance with the Nuisance Control e�. Regulation No. 1. You are ordered to remove the large pile of leaves and branches on the north side of the property along with the pile of mattresses and bog springs on the east side by Friday August 8, 2003. Non-compliance could result in a fine of up to $100.00.. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF 7 BOARD OF HEALTH Thomas A. McKean Director of Public Health TME Tqy, Town of Barnstable MRNMBLE, Regulatory Services MASS. 039. Al fD MA'S A Thomas F. Geiler,Director Building Division Tom Perry Building Commissioner 200 Main Street, Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 March 5, 2003 Vilson Rubio 56A Cedar Street Hyannis, MA 02601 Re: 88 Compass Circle, Hyannis Map 310 Parcel 402 Dear Mr. Rubio: This office is in receipt of a complaint at 88 Compass Circle, Hyannis, regarding trash, mattresses, and unregistered vehicles in the backyard. I have notified the Barnstable Police Department of the unregistered vehicles. The Barnstable Board of Health has been notified of the trash, etc., in the backyard. The complaint stated ten vehicles parked all over the yard, but as you will notice in the enclosed pictures, there were only three cars when I inspected today at 10:30 a.m. This office looks forward to your cooperation in cleaning up this area. If we can be of any assistance, please call 508 862 4038. Sincerely, Ralph L. Jones Building Inspector RLJ1lb Enclosure Q030226a Towns of Barnstable Regulatory Services P�• 6 Thomas F.Geiler,Director * BAMSrABLE, MASS.g6 P i639. ,02' Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038. Fax:. 508-790-6230 COMPLAINUINQUIRY REPORT Dater -(9 J�t�3 Rec'd by: Complaint Name: Map/Parcel Location Address:_ _f rn pa9S ,�Y� �►n•� Originator Telephone: it 7 Complaint Description: FOR OFFICE IlSE ONLY Inspector's Action/Comments Date: Inspector: Additional Info.Attached Q:forms:complaint °FINE l Town of Barnstable B„ ,STAB,� ; Regulatory Services MASS. g • $ .q s6g ♦� iOlE Thomas F. Geiler,Director Building Division Tom Perry Building Commissioner 200 Main Street, Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 February 26, 2003 Mr. Larry Young 115 Squantum Street#102 Quincy, MA 02171 Re: 88 Compass Circle,Hyannis Map 310 Parcel 402 Dear Mr. Young: This office is in receipt of a complaint at 88 Compass Circle, Hyannis, regarding trash, mattresses, and unregistered vehicles in the backyard. I have notified the Barnstable Police Department of the unregistered vehicles. The Barnstable Board of Health has been notified of the trash, etc., in the backyard. The complaint stated ten vehicles parked all over the yard,but as you will notice in the enclosed pictures, there were only three cars when I inspected today at 10:30 a.m. This office looks forward to your cooperation in cleaning up this area. If we can be of any assistance, please call 508 862 4038. Sincerely, Ralph L. Jones Building Inspector RLJ/lb Enclosure Q030226a a�t � 1 L�'{:��y.� �1`�`\�.. •! r �._'�,..t...i X7,�� q,a � k #e'�• °f h^�� S d 'r<<!�Fr✓ ,Y� e li: ^e•y � •'�) td. �4{y`'� 'dirt / A.c:✓ v �,s r'� fsjQ ��. sf ,tr£.r.Fj:.� A � . i cr �1:�♦\ b, � i t� e� R!i. ,�br. 'i1 �j�1s. i" ��1 r• �aC , �R , v._,Rga�� ," + �- ha yg�,�\\ y• t.+�(p'�' +�+'rP Fra'o RFS"'. '-yr `1 �1 Mn y�j! ii '�tc 4e� ;1,:••�� :tB }V� '�, pp' o- '�°�� '�. r -ti• ;t41da��9R SRrr�!�'<St.. �' � ��;1�� �i N� t9 "a ��.�. ``'d:,A i'• s�t -: rr���i.B f:p i.,;..?•i�e�CR.rL�.",rl� � 9� f �, v y��'Q$�,`�� �r..• �!'+ PgE,i\s`�qR`�1 �i�,i 1�• i:� .£ � _"y� t4�,.����� R � � -��-• � e�,.,0 �S ��,�,�jpr 'her�§ ,,,;, :1 . • '�•,"++tiny,•;�+14a�\\�q���,��u�����. '" @ .. fix'~' ''. •.1. a' f- .,fl °'``t4 � '9"�': t w=,w�..r. j a m y A••t•�w� �.' `� ,, +a� s'?•e 'e'� h`'Ct��v I�f �iv�!� q ��r'r'+%� 5� � 1 `` 14 A•`o :'� a i' .�i• r P Y/,'�,}7 rr ®,.e jp•i ?'!;sy- , +, tE. �.�'�.� .® fig 9 e"?*s��`y D' a ti >,. 4 F s�v��v�.� (+ti;„:• r r'� ?:` .'�y I `�. �„„ `�tAtA+ <*.�.� � � -t ,� v R'�`�.o�'�", '• � t h 3 ya�•,' r ��7 '�+�.� •��: �I :zy. `� � � � prwr it�� � to �t�.a�ia FSt�*� �En�� '� 4ni / � rS � I~�• - F . ?�v.,�1�� 41 � r - �i,F[. v! 1 n t�'SrS`di�� •v i - � F � .• •ha ,r;q•#*ry ✓ � f - Pzter '+,/rw r l "a' w;�9Fs a r.e., ''• _ �' +d,��' Tt F` ' '".` �• ,''3• A: ?-`rt' 7 AT ,_. t: i': �; ` e t _" , u Ily1•'i c - _ 1 i s + r a - .r " -«� tl®+^ '< s� �• � -rya °, '.� � 11 iMi�� • � °0o ° o CA � o Od MCII i t ji TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION, I I-� Map Parcel Application # �� Health Division Date Issued Conservation Division `;Application Fee Planning Dept; Permit Fee` Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address F 1 �' _SS G I r . Village.. Owner Address Telephone' 7 L) 7 L 1 g8 Permit Request Rep►v./ A 3_VZ 12- )e ILI rxvL� �� T otst- J '� T L�' Gv i�1 / Ack 3 ZXIZNC"'`U"�n�A -5 Square feet: 1 st floor: existing 0?0proposed 2nd floor: existing proposed Total new ' �t5� m Zoning District. Flood Plain Groundwater Overlay Project Valuation 17, 000 Construction Type fm_ rA Lot Size t 3 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation, Dwelling Type: Single Family . Two Family ❑ Multi-Family (#units) Age of Existing Structure 7q Historic House: ❑Yes XNo On Old King's Highway: ❑Yes ❑ No Basement Type: gull ❑ Crawl ❑ Walkout ❑ Other Basement Finished'Area(sqK)— 00 _ ` Basement Unfinished Area (sq.ft) umber of Baths: Full: existing_ new Half: existing new umber of Bedrooms: existing —new otal Room Count (not including baths): existing rJ new First Floor Room Count Heat Type and Fuel: KGas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes 7�,No" Fireplaces: Existing_.New Existing wood/coal stove: ❑Yes 11(No a` Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:)(existing ❑ new size 3"Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization. ❑ Appeal # Recorded ❑ Commercial ❑Yes &No If yes, site plan review# Current Use Re�, io"N4 5��j(c r-4,.% Proposed Use _SA APPLICANT INFORMATION D "n ill �t%`r (BUILDER OR HOMEOWNER) Name Kbr Re::J kj Telephone Number �W- 7 L17 ` q(kY Address License # PIL�Mu,* yL4 A Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Ju SIGNATURE DATE 6 Date: _ /q— TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: P_AA -qq AC14V S?-=, ?7r �����'✓`�� BUSINESS LOCATION: 99 COA&A 9 QA f lyf9.�'S A11A MAILINGADDRESS: Mail To: TELEPHONE NUMBER: riot `771 �7 5180 Board of Health — Town of Barnstable CONTACT PERSON: Sn 8 ;2_ep �2090 P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601 TYPEOFBUSINESS: Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADD E S: fa1�/�S .�✓ G/ i TELEP V LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's #V Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids Al 711X liioR I-C (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date: �!lvlm2 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: CG �I�✓�.ni� C'Onn ��/yI/ BUSINESS LOCATION: 0J? �70AA j A,S S G�,� //l�!l�✓n/�'S �n A Q��o/ MAILING ADDRESS: Mail To: TELEPHONE NUMBER: 7 71 5/,2/ Board of Health Town of Barnstable CONTACT PERSON: &2,; P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: S •7 ;7/ y 7 Hyannis, MA 02601 TYPEOFBUSINESS: --GiFA,d Does your firm store any of the tox or hazardous materials listed below, either for sale or for you own use? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(forgasoline orcoolant systems) Drain cleaners MAp NEW USED Cesspool cleanep§kRCEI Automatic transmission fluid Disinfectants LOT Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor& furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids A/O R-A&AZ /l o vs1 //0LU (dry cleaners) "ACA le�eoozlc T Other cleaning solvents S a �, S u// 41a Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS i �r*f .:�i .'�e�w.•.:�t;�,3:.=.:. ice-.' ,, E 1 bate: XJV k V 2 G s TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM r �j NAMEOFBUSINESS: ,a✓�✓; /� �^'�; BUSINESS LOCATION: %C h G j MAILINGADDRESS: Mail To: j TELEPHONE NUMBER: ' %! ` '/ Board of Health Town of Barnstable j CONTACTPERS.ON 0 P:O. Box 534. EMERGENCY CONTACT TELEPHONE NUMBER: � '' "' ', Hyannis, MA 02601 TYPEOFBUSINESS: Does your firm store any of the tox or hazardous materials listed below, either for sale or for you own ,. use? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. ' If you answered YES above,please indicate if the materials are stored at a site other than your mailing address ADDRESS: TELEPHONE: LIST OF TOXIC..AND HAZARDOUS.MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be.registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antif reeze(for gasolineor coolant systems) Drain cleaners 3!Q NEW USED Cesspool cleaners 4od Automatic transmission fluid Disinfectants Engine and radiator flushes. Road Salt (Halite) ,.,,.,„ ., Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED. (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel - Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer). lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Deg_reasers_for driveways_&_garages_ ,Wood preservatives (creosotb) .. . .. - ,Swimming- Battery acid.(electrolyte),. _ _ g pool chlorine Rustproofers Lye;or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint& varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners - (including chloroform,formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be.toxic or hazardous (pW�a list): Spot removers& cleaning fluids N,/ rnL fi , u #0/l� (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS �Ayer i, { „ 1+•,,,�,": .pia', i . 1 IRA Y ru F I C I ni Postage $ • �+ / CC.., Certified Fee as 3 P it. eceipt Fee v 7 5 ere 0 (Endorsement Required) p Restricted Delivery Fee O' O (Endorsement Required) w M Total Postage&Fees $ C— Sent TO V�GSew\ Street Apt.No.; O or PO Box No. „-- -.:- 1 - - --- - -----.. ...- �, Q J-•=--- O C/ty,Sfate,ZIP+4 Certified Mail Provides: ,e A mailing receipt a A unique identifier for your mailpiece o A signature upon delivery a A record of delivery kept by the Postal Service for two years " Important Reminders: - o Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. -_ 1 � o Certified Mail is not available for any class of international mail. 4'r, o NO INSURANCE COVERAGE IS PROVIDED.with Certified Mail., For valuables,please consider Insured or Registered Mail. �5. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,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. a For an additional fee, delivery may beytestricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ®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. PS Farm 3800,January 2001 (Reverse) 102595-M-01-2425 i SENDER:'C6MPLETE THIS SECTION COMPLETE THIS SECTION.ON DELIVERY. ■ Complete items 1,2,and 3.Also complete A. Signs e item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by(Printed Name) . C. D e of elivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1 Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No I � 00 ap 3. Service Type LAyan'h t S 1 1 Pr , CW6ertified Mall ❑Express Mail 9 1 ❑Registered PitReturn Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7001 1940 0004 9042 1.1662 (Transfer from service labs . PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-1540 I UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 i • Sender: Please print your name, address, and ZIP+4 in this box • I I FTME Tp�, Town of Barnstable ~O RAMSrnsLE, Department of Health, Safety,and Environmental Services 9� MA 6 q ,0� Public Health Division ATED"A°�A 367 Main Street,Hyannis MA 02601 Office: 508-8624644 Thomas A.McKean FAX: 508-790-6304 Director of Public Health Mr. Vilson Rubio July 31, 2003 88 Compass Circle Hyannis, MA. 02601 NOTICE TO ABATE VIOLATIONS OF 310 CMR 15.000 STATE ENVIRONMENTAL CODE, TITLE 5 The property owned by you located at 88 Compass Circle, Hyannis, MA. was inspected on July 29, 2003 by Donald Desmarais, Health Inspector for the Town of Barnstable, because of a complaint regarding a noise complaint. The following is a violation of 310 CMR 15.000 State Environmental Code, Title 5. 310 CMR 15.00. There were nine bedrooms located at the residence, along with a couch in the kitchen. However, the existing septic system capacity is designed for only four bedrooms total. You are ordered to remove the four bedrooms located in the basement and have only one bedroom in the garage (with building department approval) on or before Monday August 18, 2003. A re-inspection is scheduled to be held on Tuesday August 19, 2003 at 10:00 a.m. You may request a hearing before the Board of Health if written petition requesting it is received within seven (7) days after the date the order is served. You have also been found to be out of compliance with the Nuisance Control Regulation No. 1. You are ordered to remove the large pile of leaves and branches on the north side of the property along with the pile of mattresses and box springs on the east side by Friday August 8, 2003. Non-compliance could result in a fine of up to $100.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF T BOARD OF HEALTH Thomas A. McKean Director of Public Health TOWN OF BARNSTABLE LOCATION (ll�`` f �''',/»Ss �� SEWAGE # )—®C>0 S �2 VILLAGE ASSESSOR'S MAP & LOT 310 101 INSTALLER'S NAME&PHONE NO.z/f SEPTIC TANK CAPACITY EX s 7. 9 LEACHING FACILITY: (type �5'op NO. OF BEDROOMS BUILDER OR OWNER /—�4- PERMIT DATE: G/� �- COMPLIANCE DATE: b 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 tv- ui w j a 0 Fee S THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Mooml opotem Construction 3permit Application for a Permit to Construct( )Repair( C-)Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 77 Co — 4 9 .s s C. 2 0 �e r�i.g.1A1� L..q�t a Y Yu v f _ Assessor's Map/Parcel � �{CJ � U ii✓G Y /rr 13 a.:L� 7 / Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. /9'2L /7' P.192.12CLe1 /11 4 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder kIV5 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow `71 gallons per day. Calculated daily flow �s —7gallons. . Plan Date Number of sheets Revision Date Title Size of Septic Tank '=,r sT�-, a a o G�/Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ���� ��i s Gv 7 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 Certifi- cate of Compliance.has been issued b this Board of He Signed ,- Date Application Approved by ` �/a Date / u 02 Application Disapproved for the ollowing reasons Permit No. Date Issued rr No. ���. �J ��" - '�, Fee -SAC} WE., s _ t.,. .. ba .} r c "Entered in computer: ' ^ THE COMMONWEALTH•OF,MASSACHUSETTS=-�.. /, Yes PUBLIC HEALTH,DIVISION -TOWN OF'BARNSTABLE, MASSACHUSETTS Zipplicatton for Oi.5vooat 6' otem Coriotruction Permit ' rade Abandon( ) El Com lete,S stem ❑Individual Com rn . Application for a Permit to Construct(j )R�epatr( �g ( ) P ,Y _ Poets.. Location Address or Lot No. Owner's Naine,Address and Tel.No. Assessor's Map/Parcel 441 S ,i/7 a Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. f9 2 t �o ✓ ? '`l-v _0 9 2 2 L.v /11 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage GrinderVVf Other ape of Buildings No.of Persons Showers. Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow y- `7, ✓ gallons. Plan Date f Number of sheets Revision Date Title Size of Septic Tank/ x 47 /o 0 o G.a/_4_111Type of S.A.S. Description;of Soil, Nature of Repairs or Alterations(Answer when applicable) PF P1,Q1£ /'/i t c vilk .QaiOL.S /lh7i e.,,e ice/ 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 this Board of Health. ^ Signed r ='ice. Date / -2 \� Application Approved-by I Date / u Application Disapproved for the ollowing reasons K Permit No.?do? ��. Date Issued 0 THE COMMONWEALTH OF MASSACHUSETTS �. ` . BARNSTABLE MASSACHUSETTS ` Certificate of Compliance L THIS IS TO CERTIFY, that the On-site Sewage Dis/posal System Constructed( )Repaired.(` )Upgraded( ) l/� y. S % C 4 Abandoned( )by � at S �� -y C s r �� 2 r` V1 s has been construct)eZA in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.'Dpo 2-a�.Z dated fo Installer Designer Aj ya 117_<>'c 2 The issuance pf this permit shall not be construed as a guarantee that the � he syst• function as esigne E i Date spe or .f - n " �. ,. No. ?�� ^7�Z R�n7r Fee ' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS , 1 1i5poga1 bpgtetu Congtructton Permit ,. Permission is hereby granted to Construct( )Repair( Upgrade( )Abandon( ) System located at 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 folloyving local provisions or special conditions. Provided: Construction must be completed within three years of the date of this pe . 't. Date: ��G Approved by TOWN'OF BARNSTABLE. LOCATION. FIT ro''7r,-»SS SEWAGE #,,10c ' VILLAGE I71'�iv.�.' ram- ASSESSOR'S MAP & LOT j INSTALLER'S NAME&PHONE NO./�°�c �.vs! 5 7.� 3 6 SEPTIC TANK CAPACITY s �•�-g /o DU (i-A ��,z!S" LEACHING FACILITY: (type 5�'n t✓�-'' Sr�S - (size),3 3 J2 IV NO. OF BEDROOMS - BUILDER OR OWNER'-/-4 4:,,4 PERMITDATE:: q _ COMPLIANCE-DATE: � Separatign 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 wi"thin 200:feet of je.aching fadillty) Edge-of=Wetland and Leaching Facility (If any' etlands_ezist within 300 feet of leaching facikity) __Feef Furnished by 77 LI � n b _. /9 F z- 3 IM& l� w No .....�5............. ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH cd Appliration for Dhipoiia1 Workii omitrn.rttun Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an .Individual Sewage Disposal Syst t 52. •---••----- ••--- - • ca ion-Addr s .......:� ....... . ... - ..-••...._......-- = -Address ---------------------- -a W nstaller Address � - Type of uilding Size Lot..../0 e"...S q. feet aDwelling—No. of Bedroom ---...�.............................Expansion tic ( ) Garlfage Grinder ( ) p, Other—Type of Building of persons....___._ _ ( ) ( ) a Showers — Cafeteria QOther fixture ----- •-------•--••--------••- -------------------------------------- Desi n Flow.............. ....----------------------gallons per person eft d .y Total ly flo .___....._ ..........___ gallons. ---------------- ------- WSeptic Tank—Liquid capacityl gallons Length _____ Width. -.1 Diameter________________ Depth................ x Disposal Trench—No. .................... Width... ............... of Length........... - Total leaching area--------------------sq. ft. Seepage Pit No....____.�__.___ _. Diameter.___..__ Depth below inlet._ ___. Total leachin area.s/./.. ._ z Other Distribution box (I) Dosing tank ( ) � g r sq. 7X Percolation Test Results Performed b (��. ~ . ---- Date<��-- Y C�/�` yf Test Pit No. 1................minutes per inc Depth of Test Pit.................... Depth to ground w er_____-_--_______---_--- (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water a ....................... Description of Soil -- ( �+r ... x UW -•-•-----•------........................................................................................................................................................................................ Nature of Repairs or Alterations—Answer when applicable............................................................................................... I .--•••-••------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITi 1E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee sued by the boa health. Signed --------• ----------------------•-•------- Date Application Approved BY ._.. ••--. Date Application Disapproved for the following reasons:------•------••---••--•-------.............................................................-----e............_ -•------------•------•...................•---•------------......---•-•--------------....---••-------•-•--•----------------•-•----•--••-•---••--i•- ----------------- ............................ Date Permit No......................................................... Issued....... f,2•-- Date No....................... Fss....... ,.�.."..^....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH;: ---OF....../. Appliration for Dinpo,oul Work i onitrur#ion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at - - f r}:, t; z fa .. .i" '.. ....._ -.ar: J, - {e .!''.�t` .......--. //- ._ _ .. ocaiion-Addr s M or Lot No ..............f fell. .. —`''`.*_�! ay3 ? f. ........ fd �ac .. .a.cr .. 1 .. ..... ow s e Address W� =- --- u......_._._.. .,„i.. Installer � Address Type of Building Size Lot...., 49,,e ,: ,-..Sq. feet U Dwelling—No. of Bedrooms...... Expansion tic ( ) Garbage Grinder ( )1, aOther—Type of Building f �1; �, io. of persons._ Showers ( ) — Cafeteria ( ) Otherfixtures .._..._.. --------------------------• ........................................... Design Flow...... ..... gallons per person pee dy< TotaVd#y 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.. r- ---_--_-- Total leaching area., .f; sq. ft. Z Other Distribution box ( ) Dosmg tank ( ) ''' Percolation Test Results Performed by.- 4 ........... Date°';r��` •tea Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground, wee ....___'............. (i Test Pit No. 2................minutes per inch Depth of Test Pit.__......_.......... Depth to round water- _ = P P P g � '-��. i,. Q+' a ` ._.. ' f�.. r• -� ...• xff._ ...-•-•....••...................... ...•- DDescri Description of Soil_-....-v?rt ftFy � . < ,... ....................................... W VNature 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 TIT1E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operati until a Certificate of Compliance has beeri/issued by the board,of health. Signed - ----•- -------------------------------- Date Application Approved By.......... •- .. .. . Date Application Disapproved for the following reasons:.............................................................. =................................................ .........................................----------•-----•-•------„---------................................................................ Date PermitNo......................................................... Issued---------••--••--------•-----_ .. - Date THEtOMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH, Wrtifiratr of Touilifitanrr THIS IS TO CERTIFY, That.She Indiadual Sewage DisposalSystem constructed ( -or Repaired t w J` v by-.._.. .�._ ......._ . � _ :- ....................................................... Installer at- ••---..` ------- ',.. ................................................. has been inst Iled;in_accordance with the pro�sions of r of Tlie State Sanitary CeMas describedin the application for Disposal Works Construction Permit No. _ .._._. -----------•-- dated_.... THE ISSUANCE OF THIS ,CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. f DATE.... ....,... ----• ••--••. •....:4 ....... ........... Inspector----•---------------- ------ ----------•--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l= FEE ..................... . in oo�t1 kn Tonntr ion.Vanti# , Permission is hereby granted._ °'` `; ° � ~'� _:.. .....---.-•-•- --•- ------c - - to Construct O or Repair ( ) an Individual Sewage D sp sal System atNo. 1......... < -- -- -------•--• ................... ......... � � Street as shown on the application for Disposal Works Construction P In. N __ .. __ ___ Dated---- "-` ............. oar of Health DATE...... ._'` ` ...................................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS P- ' No... ::_. . Fss.. ... ..._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �� � TOWN OF BARNSTABLE Appliratilan for Diipngal Works Tnnitrn.rtiun ramit. Application is hereby made for a Permit to Construct ( ) or Repair (D:0 an Individual Sewage Disposal System at: ............------------- DYE �` S 1,�iU��G'�� •!`5----- .. .......... Location-Address or It No. Owner Addre Q_-.�1..'-•••--•••cl_d ..........��"- f� Y:_ 6_..._._. ----....... Installer Address Type of Building Size Lot__,.1SI- QA.._:_Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building ________ No. of persons____________________________ Showers — Cafeteria a, Other fixtures -------------------------------- - -------------------------- W Design Flow.................. ................gallons per person per day. Total daily flow.............._�3 ...............gallons. WSeptic Tank—Liquid'capacitye 64Agallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.............. Total leaching area....................sq. ft. Seepage Pit No........._�____ Diameter-------- Depth below inlet....6___________ Total leaching area..................sq. ft. Z Other Distribution box (-<) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fT Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -------------------------------------------------------•------------._.........-•---....---• -------•--- O Description of Soil......... _Ks -----C=A:7n....Z� 4_�51�<._ x W ----------------------------------------------------------------------------------------------------------------------------------------------------C7 `'". U Nature of Repairs or Alterations—Answer when applicable..........00,6 ----_ -_-____ _ __ `-! --- _. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance be n issued by th oard of health. Signed ------- --------- ---- ----- ------- Application Approved By --------. (� ---- --- S ...-- Date Application Disapproved for the following reasons- -----------------------------------------------------------------------------------------I -------------- -------------- --------- ------------------------ ------------------------------------------------------ ------ ----------------------- ---------- ----- --------- --- ---- ---- -- ---------------------------------------- Due Issued -------------------------------------------------------- ------ Permit No. ....... �'. Date r � No....9 Flns.. ..-..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTHiQ � TOWN OF BARNSTABLE ._.:.-_... art. Applirafion for Disposal Works Tnnstrnrtiun Vprrmit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: ................. GAn......n.�i ........ ...................................... - Location-Address or Lot No. .. Owner _ Adddrress W �1rJ� - lQTl, �� ^J`S = -71�`�- LtJr14 '-.� ? ......�%��.� J.11�': Installer Address d Type of Building Size Lot..,Z5:4104:: Sq. feet U Dwelling—No. of Bedrooms.....................2.................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures W Design Flow................�`� .................gallons per person per day. Total daily flow..............���Q............_._gallons. WSeptic Tank—,'Liquid capacity 444�gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench*No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........r�__-- Diameter......�Q..... Depth below inlet.... ........ Total leaching area..................sq. ft. Z Other Distribution box (<) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date----.....---.........------------------ aTest Pit No. 1..�'...........minutes per inch Depth of Test Pit____________________ Depth to ground water........�.........____. G Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water................ a ------------------;----------------------------•------.............----------------......_.................................................................. O Description of Soil-----= = s-�...----- ........ x W ------------------------------------------------------------------------------------------------------------------------------------------------------------------ •...... -------= VNature of Repairs or,Alterations—Answer when applicable..._...�.�.Q....... l}l�l_. . ..fr'� ?_�. Agreement: , The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certi{'cate of Compliance ha be n issued b the -oard of health. 14 Signed ---------- --------- ----------- -------- ---- ------�-- - - �--- ------------ ..... r Dare g Application Approved By ~---------° N . ..... ...,t... ..------------------------------------------------- ....... ..'. Application Disapproved for the following reasons: .........:............................................................................................................................ ......................................................... .----.----..----.........--.....---....----...----...-----.--......--.-----..--- ---....--..---................................. -- ------- Date ...... Permit No. l ... Issued Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH s TOWN OF BARNSTABLE Certifirate of Compliar>re THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (,V,, ) by .............. .............................................. . Installer at ... ..............................................................F.dr.......... Io. - 5.. � 1 -... ....... �.......; / has been installed in accordance with the provisions of TITLE 5 of The State Enviroonlfiental Code as described in the application for Disposal Works Construction Permit No. ....�/!!�_,'2_ .................. dated ..... ................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................1K ---.1.................................................... Inspecto ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.....1.!••_--��-.i FEE.�-�'1�..-.r. Disposal Works Tuns#rnrtivit f rrutif Permission is hereby granted....................FFn.. a' 7......... ! 'J. ? P!�C7TD ............................ to Construct ( ) or Repair (per') an Individual Sewage Disposal System atNo.......................:.:........ a l-. .... Street 99 as shown on the application for Disposal Works Construction Permit No,l� ..... Dated.......................................... ........................ ........................................................ DATE............�-�--�-�'..r_.�..................................... Board of Health FORM 36508 HOBBS of WARREN.INC..PUBLISHERS i { t fd�lY• �Y� 1 -F/NiSH G'QADt�• '�aXb _�.._..--_—_-- .- � _ j' �tN4SN G'Q,4�� �►N/SN G9TAZ��°` - _ .-. i OvBR -ri4 nAK = '¢7K5 OVEQ p/T z 4-4oX0 i TdP oFFgv�.v. c�Ev 4•�3s15 _� - �itfi'��1ItVd'�,6di��'J1'aYl�vl��//l,�/!T`!l� •� ti � k .z. tuN G _ 3p DI+v6L.LlNCr -r--�---- � '' �.T�_._r... . ---- --�j.___ { •�yr . -_ G-' -PSA9TiOV6 ' T i6 AO 4tX� Co�v�. D IS-r LS o x p --� AO !PE!a�t'GEn t o 1 � c �sH.�rs sra.ve� .SEAT!C TAN K -• —A r P S rA&Z.,c a o l t 1 110 o C C I A9077 s.At O oOr P/r eAV _ jg�t.E'r• s 38 .NOT ro Sc.e,c E _ L E'A C fir'!ltOG JC'/T G,44, 4�7E.e Z>,,y : f 7-©7-A G v,414,Y AZ OW_ 3 0 i <i t uf► .�- % ,4 �i u 2,')7 Low 3D/ r:►') I ' x tL —7 A Ilk' L .3 N L O P rY) oyT goy tcoo w� 71 � 7qw SU3S0/< E seen � m�''7 I U M � •''ti � 9 f A44 ?. K'),)B �•��� f ,, `i G L�f�l4�: /4G�Z�.5 !Z„�=..9 L.?� T2rlST Ile, Sd /�f2�vadr1 A4JOSS Ow ASSESSORS MAP: �jIO TEST HOLE LOGS NOTES: rlgi PARCEL: 40Z e,� 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH np%�' SOIL EVALUAT,OR:f.�F� key ,/4. 6yy-j R'S, HIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF C / L� FLOOD ZONE: C A WITNESS : N /k BOARD OF HEALTH REGULATIONS. R EF ER ENCE: F V,(oi b l DATE: �,TQN1g 7 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, �'4S2S '�► 2'� PERCOLATION -RATE: 17 M t N wc'4 SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO CLASS :' SotL, LT = 0►7y 5p 42_ INSTALLATION. TH- I E,.3047 t TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION a ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE DETERMINATION. LOAMY 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS Fj Sip IOy(2 S�� SPECIFIED OTHERWISE) f LOCATION MAPO„ µ�rxuMy7,�i7 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A Ci S'l�t> 2,S,/6/4 !2t-)-17 /A GARBAGE DISPOSAL. qG" Z2.4 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) AE bI V LA MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON Cy S0 -2.Sy 7�4 A BASE OF 6"OF CRUSHED STONE. 7) 6X1577kg GE m F,R's T )15E' PuA Auc KO ' 14(f'' — -18.`t7 FILL EY) Wl CL05:'J MID - SA+�J p P 2?1TLE V, Alo 4,2ouNDWA 2 9) b KNPw .��tirL�ica�_. �1.�t 2-CO!-6F_fieo!'os€r� SEPTIC ' SYSTEM DESIGN 'or— Ppwpcs A4 . FLOW E5� 1 MATE /aj /4 Lh_! Jq-N T't � .b►.�� K1�OST1't13t� N ,o. #-. �eFz,� o�s Rt'9110094E-a. BEDROOMS'_ AT Ila GAL/DAY/BEDROOM - 440 GAL/DAY SEPTIC WANK 440 GAL/DAY x 2 DAYS - GAL G 0 bl A-S;S C— USE �O:�-D GALLON SEPT t C TANK -EXISTt/ly- IZ ,S7a7st, ��"hNk',. jam- F.&/11446> 6i>4e of P"PsmC"r' lafiM�K,� a,� vNDc�2s'�ZEYJ. SOIL AVORPTION SYSTEM �' 4` • I ¢'S_7r�NtF_ am `x 2Y' S!DE AREA:_ 2 +13� 2.3k2 r 0.7`-/ = /37.61 3p ,� u _...� --- BC TTOM AREA: 33,5 x I'3 v 0.7Y = 3Zz,2'7 I Z ' SEPT i C SYSTEM SECTION ok 31 �• raw A� 4 B� , 33 X�sn P r tt� .Iz. C C..Ital(.� I �� J L�rwH ITSi�_ TUF=L-t. .:>2 ao 7br EL,3 Ga A Go�/ers Wen 6,,ate 3 D,S D. ` I n n r Sti fade -^�-�,�.....�, .Q J �1 hall �t.. 28•y7 2= ubleWeskEel$ ( a Z`�. h 6'St�e z b a `,,� -�' ` D-BOX 28,33 I 10,2co �cKTrN4 t 4 2+ 1 I -y'°'�„ GAL 28.So ��t/cr•Iresf t� I_7 �3 Ti 7 �. SEPTIC C TANK �-���evehess 2 S • y� S laT1 T ►, �i vole C,x1 s77AJy 27,�7. 3/-/z Uo �30,ate' � �ub'sti�cl 5�c •/" / orr-awr or- T s rat c or FSITE AND SEWAGE PLAN LOCAT I ON : r3 CU/Lt�ft SS C� GG.C.; l PREPARED FOR : GH1t/S12ya774A/ a ®sA � 0 SCALE: (� DARREN M. MEYER, R.S. W 43 VINE STREET DATE: s DUXBURY, MA 02332 DATE HEALTH AGENT (781) 585-0293 Z