HomeMy WebLinkAbout0110 DOLPHIN LANE - Health 110 DOLPHIN LANE
HYANNIS
A = 268 034
TOWN OF BARNST.ABLE
LOCATION �/tJ GI JAL - �G+s— SEWAGE # Z����2 Z
VILLAGE 0VOT ASS OR'S,MAP & LOT 2(-'?'
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY _
LEACHING FACILITY: (type) < (size) `t`�r 916 )-I
NO.OF BEDROOMS
RUELDER OR OWNER C>\,
P�E RMTTDATE: /2— 7— COMPLIANCE DATE:
Lp-dration 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 feetlof leaching facility), Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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-7 ZZ. `: `,_ Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZppYication for DigpoOl *pgtem Cottgtruction 3dermit
Application for a Permit to Construct( . )Repair(grade( )Abandon( ) O Complete System X rndividual Components
Location Address or Lot No./�� Q �t/ G. � �j Owner's Name,Address and Tel.No.
a
.Assessor's Map/Parcel - /,g
Install Name,Address,and Tel Designer's Name,Ad ress-an 1 4 el.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow 31-n gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S. G,4 d_3 �—
Description of Soil rc-At2� 5wiso
Nature of Repairs or Alterations(Ans er when applicable) r.31\
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 S of the Env' nmental Code and not to place the system in operation until a Certifi-
cate of Compliance -en issu d by this Bo d ea
Signed Date
Application Approved by Date 1 7
Application Disapproved for the following reasons
Permit No. —24-M "7 Z 7-- Date Issued 1 Z-- 7 '"
No. - Fee "3
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
2pptication for Migonl bpetem Construction Permit
Application for a Permit to Construct( )Repair(grade( )Abandon( ) ❑Complete System ndividual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
Assessor''s'Map/Parcel O— d 3 � )p v I n S X
Install IN, Address and Tel Designer's Name,Address and r el.No. p
Type of Building:,:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(. )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
' Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank !Fe-' S 4✓ ' UGC � A-, Type of S.A.S. 4 �
Description of Soil Y�_.-- co A�t F-5e—SY`)
Nature of Repairs or Alterations(Ansyver when applicable) &-K FLA =4 K, Cr,A f al
CA.- ` S� t� S- e / s yvl,L(,.a.
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 provisio le 5 of the Env' onm ntal Code and not to place the system in operation until a Certifi-
cate of Compliance as•beenlissu�d by this
Signed -" Date
Application Approved by Date I,Z ' 7
Application Disapproved for the following reasons
• 'Permit No. Z" Date Issued 2---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CE �, at -site Sewa Dispos_a�System Constructed( )Repaired( )Upgraded(V )
Abandoned( )�bry�, � -- '—
at 1v �w.A-�S �' has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No 7VO-M— _2 2 dated /2—7—
Installer Designer 1_
The issu c Hof his pe '''t sh`ajyJ�1 not a cca t/yruJe`d-as a guarantee that the sys�te�im'wXj ill function as designed.
Date �� � t 1 � r Inspector���.
(J 1 � Z--------------------------
No. Fee
O q THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
ig oga[ �p�tem notruction Permit
Permission is hereby granted to Construct( )Repair - )Upgrade( )Abandon( )
System located at d ,
cat.✓Ll� ., G l
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this p t. (' -
Date: �Z_ — 7� Approved by 1
1/6/99
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only.
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL V
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
n �
hereby certify that the application for disposal works
construction permit signed by me dated Z�r C�V , concerning the
property located at Y-) Lvuz meets all of the
f
following criteria:
This failed system is connected to a residential dwelling only. There are no commercial or business
/ uses associated with the dwelling.
The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
There are no wetlands within 100 feet of the proposed septic system
• There are no private wells within 150 feet of the proposed septic system
There is no increase in flow and/or change in use proposed
There are no variances requested or needed..
y The bottom of the proposed leaching facility will not be located less than five feet above the maximum
adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when
applicable]
'• If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed
leaching facility will not be located less than fourteen(14)feet above the maximum adjusted
groundwater table elevation,
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information)
B) G.W. Elevation +the MAX. High G.W. Adjustment. = 2 Z
DIFFERENCE BETWEEN A and B / T_
SIGNED : / Ci DATE:
[Please Sketch propo,9d plan of system on back].
NOTICE
Based upon the above information, a repair permit will be issued for bedrooms maximum. No
additional bedrooms are authorized in the future without engineered septic system plans.
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Town of Barnstable
Department of Health, Safety, and Environmental Services
A 59. Public Health Division
P.O. Box 534, Hyannis MA 02601
Office: 508-862-4644 Thomas A.McKean,RS,CHO\
FAX: 508-790-6304 Director of Public Health 1
December 10. 1999
Stuart &Eleanor Glovinsky
124 Bellington Lane
Creve Coeur, MO 63141
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY
CODE H, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51
The property owned by you located at 110 Dolphin Lane, Hyannis, was inspected on
December 8, 1999 by Glen Harrington, R.S. Health Inspector for the Town of Barnstable,
because of a complaint. The following violations of 105 CMR 410.00, State Sanitary
Code H, Minimum Standards of Fitness for Human Habitation were observed:
410.351: Fireplace flue was observed to be inoperable (stuck in open position).
410.351: Bathtub drain was observed leaking into basement.
410.351: Hot water heater was observed leaking onto basement floor.
410.452: Kitchen exterior stairs were observed to be broken.
410.481: No posting of owners and property manage s;name, address, and telephone
number.
410A00: Bulkhead stairs were observed to be rotted and cracked.
410.500: Bulkhead doors were observed not to be watertight:
410.500: Bathroom and rear first floor bedroom floors were observed to be rotted
due to water damage.
410.501: A storm window was observed to be broken adjacent to the kitchen egress.
410.504: The tub wall was observed to be loose (no seal along back rim of tub).
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You are directed to correct the above listed violations within seven (7) days of receipt of r�.
this notice.
You may request a hearing if written petition requesting same is received by the Board of
Health within seven (7) days after the date order is received. However, these violations
must be corrected regardless of any request for a hearing.
Please be advised that failure to comply with an order could result in a fine of not more
than $500. Each separate day's failure to comply with an order shall constitute a separate
violation.
PER ORDER OF THE BOARD OF HEALTH
omas A. McKean
Director of Public Health
cc: Jim Maguire
cc: Building Dept.
,a
glovinsky/wp/q/ls
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oFIME ti Town of Barnstable
snxxsrns[.e,
Department of Health, Safety, and Environmental Services
' � Public Health Division
P.O. Box 534, Hyannis MA 02601
Office: 508-862-4644 Thomas A.McKean,RS,CHO
FAX: 508-790-6304 Director of Public Health
E P a
4102W 1999
12 L( I3ellrws{s� Cam
Cre-ve 60evr , A4 ® G 3l {
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY
CODE II,MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51
!to 0a 1j0hin Nya',"
The property owned by you located at AiAkwW Lane, Genterrifie , was inspected on
, 1999 by Glen Harrington, R.S. Health Inspector for the Town of Barnstable,
because of a complaint. The following violations of 105 CMR 410.00, State Sanitary
Code II,Minimum Standards of Fitness for Human Habitation were observed:
410,W/351: o bre,—,-eA da bk t"p/-eA-P-h le CSA,,4 "ti op-c�
410.351: 3�>i t,fvb d, a ;. H.c�s o bje"e4 ,
410.351: * 4 w a.,d-e1. (-a.a.�e.-`/�6.�C� d �J���c at. �e QaCc ��,.LJ/c y,,..�-o' la�j��+•o�•� �iar,
—i.1/O' � �, ry^�`� 'e- X-�l(i✓ �cl-W if-S �/v-Qtit.. ��f�rY?/` � i0�. �t'C� a
j q,�ld,�fl
410.481: �(/e yo o s '^� 0 G.i 2�� an,e�. �J �, „-,{� vvt rt n a��;-1 eta 4.,t 40-
:
410.500: S 4-%.. 3 4L,,-
5
410. vl�G a 0� G�,$rJ-✓ Gve�,t c>lv Se r e�. �v l® e �v 4 le.. di ff
410. l3 a-.�'�.n av�w� oln�� r C.ct„ t•j¢ °1'�u w �e Gu-w� �l rrrS Gv Z e d�1*-�''e
410. S w LY.✓ way cJ 4 f(,rL�rr.Q 4v ( e. 4,k
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You are directed to correct the 4enwiming above listed violations within seven (7) days of
receipt of this notice.
You may request a hearing if written petition requesting same is received by the Board of
Health within seven (7) days after the date order is received. However, these violations
must be corrected regardless of any request for a hearing.
Please be advised that failure to comply with an order could result in a fine of not more
than $500. Each separate day's failure to comply with an order shall constitute a separate
violation.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean
Director of Public Health
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FORM30 HAW HOBBS&WARRENrn THE COMMONWEALTH OF MASSACHUSETTS
C '
BOARD OF HEALTH
T.ja,,.l^S`Era,1�l,P
CITY/TOWN
wMea V4,
o DEPARTMENT
ADDRESS
h I / TELEPHONE
Address J t d[ A^�_^L� t-'t f �Occupant, i � 4il �v e,
Floor Apartment No.—_ _No.of Occupants Z
No.of Habitable Rooms__No.Sleeping Rooms y--
No. dwelling or rooming units ] No.Stories___—
Name and address of owner_54_LLGw-`'_� ®ts`v4f Y-._��LI�1�i►� +L r�y�,_o e ��
11
C+r'A i 11 e, Rea(-H-- r "d ;M ' k4l — 7 73-3) 9 Remarks Reg. Vio.
YARD Out Bld s.: Fences: em
ru c4,-vt-5
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches: _C+sLiO ✓d d_S er CVLe a(i
Dual Egress:and Obst'n.: ,4c-W� e_Y •Spa ire 6d,Pg. ",_ 4��Zl x
❑ B ❑ F ❑ M Doors,Windows: fit ,.,, rut tom+ ' GA ; /
Roof
Gutters, Drains:
Walls:
Foundation: gviu 1✓2A" . h bw x
Chimney:
BASEMENT Gen.Sanitation:
Dampness:
Stairs:
Li htin :
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceilin : ✓ =v(, .b wo. d&44, S�
Hall Lighting:
Hall Windows:
HEATING Chimneys.-
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents: ��� tn� ct�� T3'/
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line: TVIa cjvaN., 0-a(e,) I
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen. Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Pam)
Kitchen a
Bathroom
Pantry
Den
Living Room
Bedroom(1)
Bedroom 2
Bedroom 3
Bedroom 4
Hot Water Facil. Su .Ten., as Oil, Elect.: i Z, E 'vlc ®�
Stacks, Flues,Vents,Safeties:
Kitchen Facilities Sink ---e9
Stove -.dt<-
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: 1P W4 IlAve 9ovd G4,r b lei
Wash Basin,Shower or Tub: v ev co — 4100, i5 ev d BUD )e
Infestation Rats, Mice, Roaches or Other:
Egress Dual and Obst'n:—4
General Building Posted 04-' t mdzn,^(-- ��Lw 'aLvtes
Locks on Doors: ftiu,n�
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE
AUTHORIZED INSPECTOR.(See Over)
"THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIES OF PERJU "
INSPECTO ° TITLE
DATE j2 — / / TIME cT 3® P.M.
THE NEXT SCHEDULED REINSPECTION P.M.
e
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410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or
impair the hoadh, or safety and wm||'hoing of person or persons occupying the premises.This |iohog is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter||. 1O5CMR410.100 through 41O.02O state minimum requirements of fitness for
human hubitatmn, any other violation has the potential to fall within this category in any given specific situation but may not doxo
in ovary case and therefore is not included in this listing. Failure to include shall in noway be construed as determination that
other violations orconditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
hou|1h official to order repair o/correction of such violation(s) pursuant to 105 CIVIR 410830thmugh 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
`
K\> Failure.10 provide a supply of water sufficient in quanhty, pressure and temparatum, both hot and uoW. to meet the ordinary
needs of the occupant in accordance with 1O5CIVIR410.180 and 410.18O for a period of24 hours mlonger.
(B) Failure toprovide heat aorequired by 105CMR 410201 or improper venting m use ofospace heater or water heater as.
prohibited by1O5CMR41O.2O0(B) and 410.2O2.
(C) Shutoff and/or failure to restore electricity orgas.
(D) Failure topmvidomo electrical hmi|itiow'mquimdby1O5CIVIR410.250(B). 41U.251KV. 41O.253 and the lighting in com-
mon amarequired by 105CIVIR410.254 .
(E) Failure 0z provide a safe supply o/water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CIVIR
41U.15O(A)(1)and 41O.30U.
(G) Failure to provide adequate exits, or the obstruction of any oxi1, passageway orcommon area caused by any object,
including garbage ortrash, which prevents egress in case ofan emergency 105 CMR 410.450. 410.451 and 410.452.
(M) Failure 10 comply with the security requirements of 105 CMR 410.480(D).
(|) Failure Vo comply with any provisions of1O5CIVIR410.6O0. 410.6U1m41U.8O2 which results in any accumulation ofgar'
bago, rubbiah, filth or other causes ofaiokn- oawhioh may provide a�od source or harborage for rodents, insects �or other pestso/othonwia000nkibuveVnauoidon�ortothoomouionoroproadofdisouso.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105CIVIR400.000. (See M.G.Lo. 111 6DVD 190th�ough199.)
_(K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment Vo health orsafety.
_
(U Failure to mota|| eleotrioa, plumbing, heating and gas-burning facilities in accordance with accepted p|umbing, hoadng,
duo-fitting and electrical wiring standards or failure to maintain such faoi|Uew as are required by 105 CIVIR 410.351 and 410.352.
eoaotn expose the occupant or anyone else tofire, Uumu, ohook, accident or other danger or impairment to health or safety.
`
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CIVIR 410.353.
(N) Failure k/provide u smoke detector required by 105CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition o/conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
nr any defect that renders either inoperable.
(2) Failure Vz provide a washbasin and shower or bathtub ao required in1U5CIVIR410.15O(A)(2)and 41U.150(A)(3)orany
defect which renders them inoperable.
(3) Any dafooL in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted p|umbing, heating, ganU8ing, or electrical wiring standards that do.not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch ba|oony, roof or similar place ao
required by 105 CIVIR41O.5O3(A)and 410.503(B).
(5) Failure Voeliminate mdaNs, ooukmaohem, insect infestations and other pests aorequired by 105CIVIR410.550.
(P) Any other violation of 105 CWR 410.000 not enumerated in 105 CIVIR 410750(A)through <O>yhu|| be deemed to be a con-
dition whiohmuyondangorormate/ial|yimpairthohouhhoroufetyundwmU'baingodan000upantupon1hohai|ueofthemwnev
to remedy said condition within the time ao ordered by the Board ofHealth.
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Health Complaints
07-Dec-99
Time: 2:00:00 PM Date: 12/7/99 Complaint Number: 2165
Referred To: GLEN HARRINGTON Taken By: GLEN HARRINGTON
Complaint Type: CHAPTER II HOUSING
Article X Detail:
Business Name:
Number: 110 Street: DOLPHIN LANE
Village: W. HYANNISPORT Assessors Map-Parcel: 268/034
Complaint Description: PROPERETY IS IN SAME CONDITION AS IT
WAS TWO YEARS AGO. THE OWNER AND
PROPERTY MANAGEMENT NEVER FIXED
ANYTHING AS PROMISED. THERE IS A
HOLE ROTTED IN THE BATHROOM FLOOR,
ETC.
Actions Taken/Results:
Investigation Date: Investigation Time:
1
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DOM,
.............
LOVINSKY,STUART 101
GLOVINSKY,ELEANOR 1 00001632
.................-
124 BELLINGTON LANE « 0701,
CREVE COEUR
.OVINSKY,STUART
27900 6 0000000000
JL_j DOLPHIN LANE
Unassigned Road Name
CRAIGVILLE REALTY CO
BOX 216
WEST HYANNISPORT, MA 02672
OFFICE: 508 775 3174 .FAX: 508 771 5336 PERSONAL: 508 775 3533
E-MAIL: martin@capecod.net
December 15, 1999 RECEIVED
Town of Barnstable
Box 534 6 1999
Hyannis;MA 02601 TwvN Or 13ARNSTA13LE
HEALTH DEPT.
ATTN: -Thomas A. McKean
Director of Public health
RE: 110 Dolphin Lane
Hyannis,MA
Dear Mr McKean:
In.reference to the address shown above, the landlords, Stuart and Eleanor
Glovinsky,has instructed me to proceed with all dispatch to correct the deficiencies
listed in your date to them dated December 10, 1999.
To that end, my workmen have scheduled immediate repairs as follows:
410.351: Fireplace flue-was observed to be inoperable(stuck in open position)
Hot water heater was observed leaking onto basement floor
Kitchen exterior stairs were observed to be broken
410.481 No posting of owners and property managers name, address and
telephone number
410.500 Bulkhead stairs were observed to be rotted and cracked
Bulkhead-doors were observed not be watertight
410.501 A storm window was observed to be broken adjacent to the kitchen egress
I anticipate those deficiencies will be corrected prior to the expiration date given in
your letter. -
Due to the probable extent of repairs required and the necessity of coordinating
= same with the current tenants at sufferance,we ask that an extension be granted on
the items listed below:
410.351 Bathtub drain was observed leaking into basement
410.500 Bathroom and rear first floor bedroom floors were observed to be rotted
due to water damage
410.504 The tub wall was observed to be loose(no seal along back rim of tub).
We are currently interviewing contractors for prices and schedule of availability.
We will notify you in writing when we have a definite time.
The landlords have asked me to make it.clear that proper notice of these deficiencies
was never given to the landlords and/or their agent(s).
Notification of the Barnstable Board of Health is a blatant retaliation by tenants
James Maguire,Anthony Ruspantini and Ted Maguire to notice to quit the
premises for nonpayment of rent as far back as September, 1999.
Nevertheless,we are aware of our obligations to the Town of Barnstable and will
proceed with haste to meet them.
Very truly yours,
RECEIVED
Martin C. Traywick, Owner
Craigville Realty Co U1-1, i 6 1999
Agent for S. and E. Glovinsky
TOINN Oa BARNS 'AbLE
HEAO'el i DEPT.
LOCATION --,., +� SEWAGE PERMIT NO.
�D� try Lin
VILLAGE '(
(o'&-s+ �'t�d9-Yl r1 i S po r+
INSTA LLER'S NAME i ADDRESS
BUILDER OR RUM-
DATE PERMIT ISSUED
•3
DAT E. COMPLIANCE ISSIUED
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No..81......S!90_ Fmc $...5..00.........
THE COMMONWEALTH OF MASSACHUSETTS
SOAR® OF HEALTH
............................Town....OF........... ernstable.....................................................
Appliration for Dispniiaal Works Tinvolrurtivit ranfit
Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal
System at:
110 Dolphin Lane, West Hyannispoitr MA 02672
............__ .................------------•---.................---...---•----.........................-----••.
Location-Address or Lot No.
Golvinsky 126 Fairway Ave, .Verona, N.J. 0704.4-
..-- ... ............. ..................................
A icr Address
& B Ces ......................................................................... BishopsTerrace,-•-----••-•-••••----.p..------••--•-------....... ............................................
Installer Address
Type of Building Size Lot............................Sq. feet
aDwelling—No. of Bedrooms-------------3_.-_.--...------._-----.----Expansior4Attic ( ) Garbage Grinder ( )
p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
G4 Other fixtures ................................ .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by......: ..... ....--.. Date....-•----. •--••-•--•--•-----••••.....
aTest Pit No. 1................minutes per inch Depth of Test Pit................__.. Depth to ground water........................
i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
........................................-..................................................................................................................
ODescription of Soil.....Sand--------------------------------------------------------------------------------------------------------------------------------------------------•-•:
x
x ••-•-•••-•-•----------------•-•••-•--••-••--••---•••---••--•---•----••-••--------...---•--••••--•--•-•--••••-•-••--------••••--•------••-•---•-----•----•••--•-•--••-•-••....-•---.....--•...--.......
0 Nature of Repairs or Alterations—Answer when applicable.ins_tallest,ian...of..a_.l,0jaQ_.gallan...pre--cast.,
rf].QW)............................................................................................................t.... .....
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned &irther agrees not to place the system in
operation until a Certificate of Compliance ha bee issued by the b ealth.
Srgn $ 1� �._...
-- -- -- ------------------- -• .•-----•--
Dat
Application Approved By-•--• `'1 •-------: .. . ... P................•-•------- � 1 $�,.:•.......
Date
Application Disapproved for the following reasons:.................................................................................................................
....................•------...---•------.............-------•---------------------••---•-----••••--....
Date
Permit No.:_81.'..._...._.
8 21 81
•...................•-----------•--. � Issued..---............:----�--=- ---•-•---------•--.......
Date
....5.°.00........_
THE-COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............T own....OF..........Barnstable
ApplirFation for Elispoo al Works Tontratrtion rrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal
System at:
110 Dolphin Lane, West Hyannispott, 1'A 02672
........... -.......... ............. ....................................... ..._......-•-•----•-•-....--------...--•--•--------------•--------.................-.........-•--
Golvinsky Location•Address 126 Fairway Ave, `g:�*lao; N.J. 07044
.................. .....••---•••----...-----•--------•---.......---••--•---•......--........... ..........--......................................................................................
W, A & B Cesspool Serv% 121 Bishops Terrace dd7l nnis, YA 02601
-----------------------------------•-•-----....----..............----------•----•-----•-••------• .....•............................................................................................
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms................Dwelling— ( ) 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............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
14
Percolation Test Results Performed by.......................................................................... Date........................................
4 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
ri Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 ---•--------------------------------------------------------------------•--------•-•-•-•---......---.........................................................
0 Description of Soil.....Sand _
x
V -•-•••.............•-•---••----••••-•----•••-•---•------•-•-••----•••-----••---•-----•••......•-•-----•--•-•---••-•---•-•--•------••-•••------•--•-•••--••-----•------••••--......--•-----••-•••--.-----
W
x installation of a 1,000 gaY on pre—ca.s.E
U Nature of Repairs or Alterations—Answer hen applicable.................................:.............................................................. .
stone packed leach pit (overfl owj.
-----------••. •.....-•--•------•---•--•----•---••----•--•-••••-------•-•----•---•.....----•-••-•••-•--•------....-•--•----...•--•-.
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
operation until a Certificate of Compliance ha been issued by the bold o lth.
Sign ................................
Application Approved By......
Date
Application Disapproved for the following reasons:-----•.........................•-----------------------•---•-----------------------------------•------------••-
------••---•-•-------••-•-•......._.•• -••--•-----•----....---•-•--•••-•---•--•-•--.._..--•-•---••-•••--•-•••••--•-••----•••-----•-•••---•-••••---•--•-•-----••--...............................
te
g/21/81
Permit No......................................................... Issued-----.....--•••-•-•-- —
. ------------------- a.---•----
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town Barnstable
......................OF.................I...................................................................
Trrtifiratt of Tontplittnrr
THIS I TO CERTIFY Thai the I * l 1 Sewag Dis osal stem oust to or Re
A - B Cesspool Servce, k Tishops �'err�ace, yann�s0 t `bk0�1 - �0 -
by............................•-•-...--•-•-•..._......-------•----------.............•--••-•S--r�--•-••-----•-...••-•••-•-•----•-.............•--.....•--......_.._........................---•-•--_....
1-10--Dolphin Mane, West Hyannisport, ,4gta°t52672 - Golvinsky
at----------- ---------------- ------•--. •------• ................---------.
has been installed in accordance with the provisions of TIg jEr 5 of The State Sanitary Code8L, ed in the
application for Disposal Works Construction Permit No.......c _..%f!t1............._.. dated---.._-___._-_._//__........_......_._..__.._.....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...............
.-- Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
T own Barnstable .00
No.....��v...... FEE........................
Biiponal Workii unfit
A B Cesspool Service
Permission is hereby granted. ................ ......... ----- S
to Construct j0 D o ph�71ai�1,n o, estn Hyann3 po ; l ipo 2 — C olvi I.nsky
atNo..---------11--------------•-•-••-•---••----•-----•--.........-•----......-•--•-..........---•--.------------ ....---------------------...--•-------------------.....------......----•-.........
as shown on the application for Disposal Works Construction Permit Street
No.._....31 ....... Dated.._....8/21/8..
�1 8/21/81 :� Healt-.....-------------------------------------
"� Boar�'o'f h
DATE................................................................................
` FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS