HomeMy WebLinkAbout0063 DOLPHIN LANE - Health 63 DOLPHIN LANE, HYANNIS
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Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Department of Environmental Protection
One Winter Street, Boston MA 02108 (617)292-5500
TRUDY CORE
Secretary
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 63 Dolphin Lane, West Hyannisport,MA Name of Owner: Jerry Wokik
Address of Owner: Same
Date of Inspection: April`21, 2000
Name of Inspector: (Please Print) James M.Ford
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
Company Name: James M. Ford
Mailing Address: P.O. Box 49, OsterviUe, MA 02655-0049 Map. 268
Telephone Number: (508)862-9400 Parcel. 179
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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
✓ Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
2
Inspector's Signature: Date: April25, 2000
The System Inspector shall submi a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection. The original should be sent to the
system owner and copies sent to the buyer,if applicable,and the approving authority.
NOTES AND COMMENTS
revised 9/2/98 Page Iof11
Printed on Recycled Paper
SUBSURF&CE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 63 Dolphin Iane_ West Hyminisport,MA
Owner: Jerry Wojcik
Date of Inspection: April 21, 2000
INSPECTION SUMMARY: Check A,, G or D.
A. SYSTEM PASSES:
✓ I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure
criteria not evaluated are indicated below.
COMMENTS:
B. SYSTEM CONDITIONALLY PASS]-
_ 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.
Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not.
The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or
the septic tank,whether or not metal, is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.'
Sewage backup oi'breakout'or high'static water level:observed in the distribution box is-due'to.broken-or obstructed pipe(s)
or due to a broken,settled or uneven distribution box. The system will pass inspection if(with'approval of the Board of
Health)
broken pipe(s)are replaced
_ obstruction is removed
distribution box is levelled or replaced
The system required punk more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced _
obstruction is removed
revised 9/2/98 Page2of11
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 63 Dolphin Lurie, West Hymznisport, MA
Owner: Jerry Wojcik
Date of Inspection: April 21, 2000 R
C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)
THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
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 AND SAFETY AND
THE ENVIRONMENT: -
_ The system has a septic tank and soil absorption system(W and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well,unless a well water analysis 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. Method used to determine distance (approximation not valid).
3) OTHER
revised 9/2/98 Page 3of11
J
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 63 Dolphin Lane, West Hymuiisport, MA
Owner: Jerry Wojcik
Date of Inspection: AprU 21, 2000
D. SYSTEM FAILS:
You must indicate either"Yes" c-w "No"as to each of the following:
I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this
determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sew-age into facility or system component due to an overloaded or clogged 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
cesspool
Static liquid level,in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6" below invert or available volume is less than'h day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion.of a cesspool or privy is within a Zone 1 of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
You must indicate either"Yes" or"No" as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone H of a public
water supply well
The owner or operator of arty such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
office of the Department for further information.
revised 9/2/98 Page 4of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 63 Dolphin Lane, West Hyannisport, AM
Owner: Jerry Wojcik
Date of Inspection: April 21, 2000
Check if the following have been done: You must indicate either"Yes"or"No" as to each of the following:
Yes No
✓ _ Pumping information was provided by the owner,occupant,or Board of Health.
_ m components have been for at least two weeks and the system has been receiving normal flow
✓ _ None of the system wmpo pumped y g
rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection.
✓ _ As built plans have been obtained and examined. Note if they are not available with N/A.
✓ The facility or dwelling was inspected for signs of sewage back-up.
✓ _ The system does not receive non-sanitary or industrial waste flow.
✓ _ The site was inspected for signs of breakout.
✓ _ All system components,excluding the Soil Absorption System,have been located on the site.
✓ _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for conditions of baffles
or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. _..
The size and location of the Soil Absorption System on the site has been determined based on:
✓ Existing information. For example,Plan at B.O.H.
✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)
(15.302(3)(b)].
✓ _ The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of
SubSuuface Disposal Systems.
revised 9/2/9'8 Page 5of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 63 Dolphin Lane, We-w Hyannisport, MA
Owner: Jerry Wojcik
Date of Inspection: April 21, 2000
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 110 g.p.d./bedroom.
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
Total DESIGN flow n/a
Number of current residents: 2
Garbage grinder(yes or no): No
Laundry(separate system)(yes or no): No; If yes, separate inspection required
Laundry system inspected(yes or no): No
Seasonal use(yes or no): No
Water meter readings,if available(last two year's usage(gpd): 1999-80,250;gals.,1998-20,250 gals.
Sump Pump(yes or no): No
Last date of occupancy: Ciurrently occupied.
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow: ead(Based on 15.203)
Basis of design flow
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:
OTHER: (Describe) _
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
Never Pwnped-per owner.
System pumped as part of inspection(yes or no): No
If yes,volume pumped: gallons
Reason for pumping:
TYPE OF SYSTEM _
✓ Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
I/A Technology etc. Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components,date installed(if known)and source of information:_ Mar. 14195-per as built card.
Sewage odors detected when arriving at the site: (yes or no) No
revised 9/2/98 Page 6 of.11.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 63 Dolphin Lane, West Hyamusport, MA
Owner: Jerry Wojcik
Date of Inspection: April 21, 2000
BUILDING SEWER: _
(Locate on site plan)
Depth below grade:
Material of construction: _cast iron 40 PVC _other(explain)
Distance from private water supply well or suction line
Diameter
Comments: (condition of joints,venting,evidence of leakage,etc.)
SEPTIC TANK: ✓
(locate on site plan)
Depth below grade: 6"
Material of construction: ✓concrete _metal _Fiberglass _Polyethylene _other(explain)
If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(Yes/No)
Dimensions: 1000 gal.
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: 3" '
Distance from top of scum to top of outlet tee or baffle: 8" _ '•', `
Distance from bottom of scum to bottom of outlet tee or baffle: 13"
How dimensions were determined: Measuring stick
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.) The inlet tee and outlet baffle were present. The liquid level was even with the outlet invert. There were no signs
of leakage.
GREASE TRAP: None
(locate on site plan)
Depth below grade:
Material of construction: concrete _metal _Fiberglass _Polyethylene _other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
revised 9/2/98 Page 7of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 63 Dolphin lrie, West Hym zisport, MA
Owner: Jerry Wojcik
Date of Inspection: April 21, 2( r
TIGHT OR HOLDING TANK: None (Tank must be pumped prior to,or at time,of inspection)
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm present: ;
Alarm level: Alarm in working order: Yes_ No_
Date of previous pumping:
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX: ✓ `"
(locate on site plan)
Depth of liquid level above outlet invert —
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) The box was located but not
dug up. There were no signs of failure in the nit.
PUMP CHAMBER: None
(loca
te to 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.)
revised 9/2/98 Page 8of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 63 Dolphin Lane, West Hyannisport, MA
Owner: Jerry Wojcik
Date of Inspection: April 21, 2000 `
SOIL ABSORPTION SYSTEM(SAS): ✓
(locate on site plan, if possible;excavation not required, location may be approximated b non-intrusive methods
P Po �l Y aPP Y )
If not located,explain:
Type:
leaching pits,number: I-4'x 6'
leaching chambers, number:
leaching galleries,number:
leaching trenches,number, length:
leaching fields,number,dimensions:
overflow cesspool,number:
Alternative system:
Name of Technology:
Comments:
(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.)
The pit had 6"of water on the bottom. There were no signs of failure. The bottom to grade was approximately 6'.
CESSPOOLS: None
(locate on site plan)
Number 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(cesspool must be pumped as part of inspection).
Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
PRIVY: None
(locate on site plan)
Materials of constriction: Dimensions:
Depth of solids:
Comments:
(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.)
revised 9/2/98 Page 9of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 63 Dolphin lane, West Hyannfsport, MA
Owner: Jerry Wojcik _
Date of Inspection: April 21, 2000
Map: 268
Parcel: 179
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
01
3-
revised 9/2/98 Par 10of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM. INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 63 Dolphin Lane, West Hyannisport,AM
Owner: Jerry Wojcik :' '`
Date of Inspection: April 21, 2000 ry
NRCS Report name
Soil Type
Typical depth to groundwater
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to Groundwater 29+/- Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observed Site(Abutting property,observation hole,basement sump etc.)
Determined from local conditions
✓ Checked with local Board of Health
Checked FEMA Maps
Checked pumping records
Check local excavators, installers
✓ Used USGS Data _
Describe how you established the High Groundwater Elevation. (Must be completed)
Using the Barnstable topographic and water contours maps, the maps were showing approximately 29' +/-to groundwater at
this site. Using the Cape Cod Commission Technical Bulletin, the high groundwater adjustment for this site(MIW 29, Zone C,
3100)was 3.9'.
This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty
or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,
written or implied, relating to the system, the inspection and/or this report.
revised 9/2/98 Page 11of11
TOWN OF BARNSTABLE Fr
tom,
LOCATION fj� �o%�'� �a�� SEWAGE # '9
W.
VILLAGE /y ,s v�f _ ASSESSOR'S MAP & LOT �$-I
INSTALLER'S NAME 6i PHONE NO. jtU�r+
SEPTIC TANK CAPACITY 00
LEACHING FACILITY:(type) ipi--
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER Joyey LI/p lt
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: — I' - %J`
VARIANCE GRANTED: Yes No t/
� �
/-�� C � i2`c ''
v 8-� _ �s,
e-�" = 3S
�.�
M'
ASSESSORS MAP NO:
PARCEL NO.
THE COMMONWEALTH O
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratioit for Di-wipmi it Work,i Tonitriir#ion 1rrmi#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
.'� �1y�--..'1...... 1 ------- ----- ------------------------------------------------------------------------------------1
!'r •Location-Address • r Lot No.
--- ---°..-�=�•--._.... -�..5 "` f0�_._ '. ��,ii�. 4 0/1751,16 .._
Owner Address
Installer Address /� Y�7
Type of Building / Size Lot--- __________________Sq. feet
.-4 Dwelling— No. of Bedrooms-_-__�`--,e---_____-__ __. -Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures _______________________________ _ _
W Design Flow___________________________________________gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity)®W__gallons Length________________ Width---------------- Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No--------------_--__ Diameter...........--------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Gz,t Test•Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 •------------------------------•----------------------------•-•--------•••-••-•••••••-------•-----•-.........................................................
0 Description of Soil........................................................................................................................................................................
U •--------------------------------------------------------------------------------------------------------------------------------•------• ------•.--•-------•••----- ..,--.
9R�
.................•----------•-.-•-------•---------------------•_----__--____.--__---_-------------------------------------------- --_-__---_-------_---•-•-_--- --___ _.-____-•_-_____
UNature of Repairs or Alterations—Answer when applicable.-.____-.-........... ... .-_''____._.-.::_.__:.:<,:._._...... ..........................
....................••-•--•--..__._..--•--------•--.._.._.__..._._..._._.._•--•-----•----------------------•-_..--------'--'----......._..-------------------......-•---.-.---•-----•-...___^----.-_--.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a,Certificate of Comp 'anc s b en issued b the board of health,.
Signed .... ........ ................. C ` �.
.......................... ........................................
� to
Application.Approved B .........:............ �.. ---------Y :✓.. !'......... -.''1
Date
Application Disapproved for the following reasonr: ................................
................. . ..-.--.................... .............1........................ .................
........... ................................................ ................--....................................... . . ..............................................-- ----------------------------------------
Date
Permit No. 1 `'. .e�� _.................... Issued ......... �.p' .�L�.. ....
Date `
r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Uhi-potial Workii Tomitrnrtinn remit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
.............. .....c...... fi�S/*/Jai
r Location-Add...s or Lot No.
Je/v e.. = vaTc� iT ............................ //S (�f`r2 5l..ly?�lii� 17J'9......OJ75'h_...._.
f Owner Address
a ......................P.........................++ T(J --•----- _....-•-•--••---•------•-••--.. ..------
Installer Address
U Type of Building ll Size Lot__�J.Y6 3......Sq. feet
Dwelling—No. of Bedrooms...._. e_____ -- _ _ -Expansion Attic ( ) Garbage Grinder ( )
`1 Other—Type of Building ---------------------------- No. of persons............................ Showers — Cafeteria
QI Other fixtures .....................
w Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity ft V---gallons Length________________ Width---------------- Diameter----.----------- Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No...................... Diameter-------------------- Depth below inlet............_....... Total leaching area............_.....sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
a Test Pit No. i................minutes per Inch Depth of Test Pit.................... Depth to ground water--------------,.........
44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water.........................
Rr' .................. -•-------••---._....._-•-------•------•................•-•------•---..._..----------•----------•-------•-•--•••-.._....-----••••----_----.
.0 Description of Soil........................................................................................................................................................................
x
w
UNature of Repairs or Alterations—Answer when applicable................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance%s ben issued by the board of health.
Signed ��....f ....a��� -----------------------
3�/�—9.5`
------------------------------
te
Application Approved B,y'. .... ---- �---�'.�... �....... ^'
Application Disapproved for the following reasons: ...................................... ...................................................... ....................
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- ----- -----------
Dace 7
Permit No. -- -�� ---------------------- Issued --------- ��' " Z�y-
I Dace
`--- —
��---—— — - ——————————————————————— —————— -------------,_,
THE COMMONWEALTH OF MASSACHUSE17S
BOARD OF HEALTH
TOWN OF BARNSTABLE
Q-19difiratr of Ginjiliance
THIS IS TO CERTIFY, That tthj Individual Sewage Disposal System constructed ( ) or Repaired ( )
-------------------------------------------------------------------------------------
Instanec
at ...... � L? �'� ��! ------ fT/,r ..;,... ...� -----------------------------------------------------------
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. _. 1�`- . ----- dated -.4
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE. .... ......
....... ... Inspector ------------------_\'}------
..... �..�_'.l� - .... - .... --
-----------------P—r---- -----------------------sI -----------------------J
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�y TOWN OF BARNSTABLE
No.2 Z-/� FEE.Z��
ispu ttl Norkii Tunotrudinn rrntit
Permission is hereby granted------ -fC. .........Ae_/_ l.....................................................................
to Construct �)`or Repair ( ) an Individual Sewage Disposal System
at
Street
as shown on the application for Disposal Works Construction Permit No. __���_� e d_.�%�__." .�:
..........
.! BoVo
f Health
DATE ` .> _-�.�>.�.._,_..•'-----•-=-•-•------•-••-•--•---•----_... i
FORM 36508 HOBBS A WARREN.INC.,PUBLISHERS
yATa r
5146L-E F�tIL`( 3 $E W-a>Mf
� �r4 E I✓T I M F 2
'PAIL,-( FL oW - I I O GPD x 3 =
5EPriC TAIJL _ 330 e.P- x 150 '7. 495 vPD
lY7 I od GALLo" S£-PTlC T ii►-•IIC L c�T
DISPOSAL PIT 1 oO c ALL61--,
SIDEWALL A = I5o sF b.=-L_PH ,l_a LA " E-
BOTTOM AarA = 113 s F W.. +-I y A ti-1,-1 1 S Pc, 12T
113 K 1 . o 0 1 1 3 447D, M f1 P 2(o L c T I "7�i
TOTX�L�,16N = 4s`d 6p1i,
'TOTAL DAILY E~1.ON/ = 33a G P D
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jH OF 41,
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iA SULLIVAN
L.P. }" No. 29733
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F";STER�� , '4 l l-L A-biAGr--"* L HAliF .
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TOWN OF BARNSTABLE
TH E Taw
OFFICE OF
BA"STMM i BOARD OF HEALTH
MA66. aj
00,e,039, `gym 367 MAIN STREET
'FO MPY P"
HYANNIS, MASS.02601
April 8, 1994
Daniel James
c/o Baxter & Nye, Inc.
812 Main Street
Osterville, MA 02655
Dear Mr. James:
You are granted a variance from the Board of Health Interim
Groundwater Protection Regulation limiting sewage flows to
330. gallons per acre in certain Zones of Contribution to
public water supply wells.
This variance will allow you to install an onsite sewage
disposal system at 63 Dolphin Lane, West Hyannisport with
the following conditions:
( 1) The septic system must be installed in strict
accordance to the submitted plan.
(2) The designing engineer must be onsite and
supervise construction of the onsite sewage
disposal system and must certify in writing to the
Board of Health that his design has been strictly
adhered to prior to the issuance of a Certificate
of Compliance.
(3) The dwelling cannot have more than three (3)
bedrooms. Sewing rooms, dens, lofts, mudrooms,
enclosed porches, finished cellars and similar
type rooms are considered bedrooms according to
the Department of Environmental Protection.
(4 ) The onsite sewage disposal shall be pumped every
three (3) years and written certification
submitted to the Board by a licensed septage
hauler.
(5) The dwelling must be connected to public water.
(6) The dwelling must connect to town sewer when the
Board determines its availability.
(7) This variance expires on May 1, 1995.
JAMS
L_ _
This variance is granted because it is one of the few
remaining vacant lots in a developed area. The lot is
13,469 square feet. It is the opinion of the. Board that the
installation of another septic system in the area will not
significantly alter the poor quality of the groundwater in
the area.
Very truly yours,
J eph C. Snow, M.D.
A ting Chairman
Board of Health
Town of Barnstable
cc: John Ellis
Daniel James
Eo
12' 0"
T- KITCHEN
8' 0" --�
ti
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0
0
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zo
60
LIVING ROOM
DINING AREA
�-�-- 6' 6" ----�
IL -- 304 0"
BEDROOM 2
BEDROOM 1
0
zo
CAI
BEDROOM 3
30' 0'°
2ND FLOOR PLAN
SCALE 1/4" = 1'
BAXTER & NYE, INC.
Professional Land Surveyors and Civil Engineers
812 Main Street •Osterville, Massachusetts 02655 Tel. (508) 428-9131
FAX (508) 428-3750
WILLIAM C.NYE, P.L.S.-President _
_ PETER SULLIVAN, P.E. -Vice President-Engineering
RICHARD A.BAXTER,P.L.S. -Vice President
March 14 , 1995
Joseph C. Snow, M. D. ; -Acting Chairman
Town of Barnstable Board of Health
367 Main Street
Hyannis , MA 02601
Re: Variance from. B.O.H . Interim Groundwater Protection,
Regulation at 63' Dolphin Lane, W. Hyannisport,, Ma . ,. .
Letter dated Apri1 8 , % 1994
Dear Dr . Snow: ;.
On March 1.3., 1995 I visited the 'above-referenced site and
found the onsite sewage-system being installed in substantial
compliance wAth Baxter & Ny Inc . site plan dated 03-08-94 .
-I woul-:d- request a Certificate of Compliance be issued .
Very truly yours ,
- Baxter, & Nye Inc .
Joh R. Ellis , P. L.S.
copy: Daniel James
Jerry Wojcik
JRE:s'lg -
MEMBERS OF
CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS/AMERICAN CONGRESS ON SURVEYING AND MAPPING
MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS