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HomeMy WebLinkAbout0173 FAWCETT LANE - Health 173 Fawcett Lane Hyannis F/R .270104 TOWN OF BARNSTABLE ' Q �G LOCA71ION 17, C1 (A-ce �� L- 6`L SEWAGE # :.? �I 3Z �2 VILLAGE 4 '1 / ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. t9 RC SEPTIC TANK CAPACITY /0 ®p LE: CHING FACILITY: (type) 4d7 1tM�—O PS (size) / r k ,3 I NO.'OF BEDROOMS • _ BUI LDER OR OWNER E6 l A Q �S �a PERMTTDATE: COMPLIANCE DATE: ZA L/ Separation'Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist 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 r �t r. cb Fee THE COMMONWEALTH OF MASSACHUSETTS Es4ared in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zfpprtcation for 30tgpool *pgtem Construction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) O Complete System D Individual Components Location Address or Lot No. 1 1.tJ Owner's Name,Address and Tel.No. Assessor's Map/Parcel lk,7O Q q 17 3 r0&/c,e, H- L Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size 1010 DO sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons i Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 gallons per day. Calculated daily flow 3 gallons. Plan Date Cl _ f� Number of sheets Revision Date Title Size of Septic Tank 10040 Type of S.A.S. �,� L h "t f-aC-Lt-®r5 Description of Soil �� `� 1_ �►�'l Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued y t ' oard of Health. Si ICU Date Application Approved Date }D Application Disapproved for the following reasons i Permit No. GQPA:Z ^ Date Issued i^-�.:..-,.+.Jv«-.rr,:., - _�. �fi:T .. viuY,. ., s -•-T r-^.�,., „, .-. -.. ,.^+er..��;.�^ .ti ,.. r. .. �'i.,v•..Try'�".,^fi<:K•.,f...__Y "ry°�.... t"v4�,l � a rr�d.'r ,...:.�:.^r _'^� - Fee w�. -� Entered in com uteri V THE COMMONWEALTH OF MASSACHUSETTS p yes ,PUBLIC HEALTH DIVISION - TOWN OAF BARNSTABLES MASSACHUSETTS r 1 a Zippftcation for M!5poml 6potem •Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 17^� '' w Owner's Name,Address and Tel.No. Assessor's Map/Parcel 1Z`7 O /O q 17 Installer's Name,Address,and Tell.No. Designer's Name,Address and Tel.No. #_ 0<:) v 1 c.Q Nl cc S U ii Type of Building: Dwelling No.of Bedrooms Lot Size 10)O 0.0 sq.ft. Garbage Grinder( ) Other Type of Building �S No. of Persons .J Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow Q gallons. Plan Date `� O Number of sheets Revision Date Title Size of Septic Tank O Type of S.A.S. Description of Soil r 4 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been-issue d-b this-Board of Health. Si ned ''-� Date Application Approved b Date �- r Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO C T th t the,pn-site Se e Di posal System Constructed ( ) Repaired (� )Upgraded( ) Abandongd( )b�a l l;.c�•►�S T' U G. t 0 l'1 at 17� "� e has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. t400 �O z dated Installer Designer The issuance of pbj permit shall not be construed as a guarantee that the s}'Mem lilunction s de igned: Date �1`1 • Inspector k' i - i ———— ——-———— — No. Fee j' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS 'Wi5po5ar *pgtem Construction Permit Permission is hereby granted to Construct( )Repari Upgrade( )Ab n onL ) System located at -7 3 CA 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 conditiQthis Provided: Co st ction most be mpleted within three years of the datee i�Date: � Approved b i TOWN OF BARNSTABLE LOCATION 7.� G loLL-�t SEWAGE# a VILLAGE !l� s'l j? S ASSESSOR'S MAP &LOT �O`1 INSTALLER'S NAME&PHONE NO. IeC �@"tS -7 J 3 10'2' SEPTIC TANK CAPACITY l d ®® LEACHING FACILITY: (type)- 1h I I`S (size) I X w NO.OF BEDROOMS-- \ BUILDER OR OWNER � � � OS �a PERMTTDATE: a2 0 COMPLIANCE DATE: �2- Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by N- � .. , 1 J I VI419 FAILED INSPECTION COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENT _u �'ni�C�t ►®Clr S F P 1 4 2004 LOT TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION i Property Address: 173 Fawcett Lane Hyannis, MA 02601 01 Owner's Name: Eulina Costa ' r Owner's Address: M Date of Inspection: September 3, 2004 vs > Name of Inspector: (Please Print) ,lames M. Ford V7 & Company Name: James M. Fordco f Mailing Address: P.O. Box 49 tv r— M r T7 Osterville,A4A 02655-0049 Telephone Number: _ (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes NeA Further Evaluation by the Local Approving Authority ✓ Falls Inspector's Signature: Date: - September 8, 2004 The system inspector shall sub it 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t PART A CERTIFICATION (continued) Property Address: 173 Fawcett Lane Hyannis, AAA Owner: Eulina Costa Date of Inspection: September 3, 2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I 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. 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,ND)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 structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection 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. ND explain: 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. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 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 ND explain: 2 Page 3 of 1 I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 173 Fawcett Lane Hyannis, MA Owner: Eulina Costa Date of Inspection: September 3, 2004 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 public health,safety or 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 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 feet 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 1 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 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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 173 Fawcett Lane Hyannis, MA Owner: Eulina Costa Date of Inspection: September 3, 2004 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ 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''/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped . ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes (Yes/No)The system fails. 1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. 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) 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 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 173 Fawcett Lane Hyannis, MA Owner: Eulina Costa Date of Inspection: September 3, 2004 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 Board 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 this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS, located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ _ Existing information, For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15,302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 173 Fawcett Lane Hyannis, MA Owner: Eulina Costa Date of Inspection: September 3, 2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: I Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required) Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons-- How was quantity pumped determined? 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) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed 2117195 -per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 173 Fawcett Lane Hyannis, MA Owner: Eulina Costa Date of Inspection: September 3, 2004 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _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: 12" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 Qal. Sludge depth: -- Distance from top of sludge to bottom of outlet tee or baffle: -- Scum thickness: -- Distance from top of scum to top of outlet tee or baffle: -- Distance from bottom of scum to bottom of outlet tee or baffle: -- How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): The liquid level was above the outlet tee, backing up from the leach pit. 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(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 173 Fawcett Lane Hyannis, MA Owner: Eulina Costa Date of Inspection: September 3, 2004 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: eal lons Design Flow: eallons/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: Above 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.): The D-box was under water. PUMP CHAMBER: None (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.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 173 Fawcett Lane __Hyannis, MA Owner: Eulina Costa Date of Inspection: September 3, 2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: I -4'x 6'(600 QaIJ w/4'stone-per as built card leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): The liquid level was above the top of the pit and up into the riser. The leach pit was in hydraulic failure CESSPOOLS: None (cesspool must be pumped as part of inspection)(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(yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 173 Fawcett Lane Hyannis, AM Owner: Eulina Costa Date of Inspection: September 3, 2004 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. Q 3 i9 a -7 3 yo a 10 Page 11 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 173 Fawcett Lane Hyannis, MA Owner: Eulina Costa Date of Inspection: September 3, 2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 15 +/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Usinv Barnstable topographic maps and water contours maps, the maps were showing approximately 15'+/-to ground water at this site. i This report has been prepared and the system inspected and failed 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. 11 TOWN OF BARNSTABLE LOCATION / 3 /�O« C 4 r 6 SEWAGE # -3 VILLAGE -Z ASSESSOR'S MAP & LOT, .r,-- INSTALLER'S NAME & PHONE NO. Rd I `? 1-9 77 "t SEPTIC TANK CAPACITY G-ram L ACHING FACILITY:(type) 4-1 t'" (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER i1 BUILDER OR OWNER DATE PERMIT.ISSUED: / -/ 3 DATE COMPLIANCE ISSUED VARIANCE GRANTED: Yes No \� `'' `�. � _ C.�, � �� � ��� �... _ t � -�1 �1 v ., �-Ad - � -_� .�; .�, gill` - — - -- � i No.... ----•• F�a 3....0 0............. THE COMMONWEALTH OF MASSACHUSETTS a ' BOARD OF HEALTH TOWN OF BARNSTABLE Allpliration for Diripootti Worlai Tonotrnrtion Vann# Application is her made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at: NBC 10 1-73. Fawsett Ln Hyannis ................•..........----• •-•----------------•----•-----•-----------------•------•---------...._..........-•---•---•-----•-- Jake Heroian Location-Address or Lot No. Owner Ad css W W.E. Robinson Septic Service P.O. Box 1089 Cen erville Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling— No. of Bedrooms._..3-------------------_...--..........Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water...................---.. Gx Test Pit No. 2................minutes per inch Depth of Test Pit...........-------_ Depth to ground water....................-:-. ------------------------------------------------------------------------------------•--......................................................•-----.....--•-- ODescription of Soil..................sand...................................................................W U ....----•--•-----•---...-•-•----••--------•-------•--------•-•••-•-••---•--•----------•-•••-----------•-•------------------•-•---•----------•-•--•-.....-•----•-•-•--••-••--•---•-•-•------•--•-•-------. w -- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable.-..Ins.ta.1-1---an...a.ddi tionaL---overf.Low....--. -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-- 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 has been ' ue y the board of health. Signed .. t ���J-- -7�J ... ..... ^J Date Application Approved By ....... D ...... .... -- ............. Date Application Disapproved for the following reason • ............................... ----------------- ---------------- --- --------- .. - ----.-------------- ------------......-- ---------------............... ... - ----------------Date................. Issued Permit No. ...:./� ......... ----------------------- �. ace �i No.._. ... _•-- / Fps.30..............00............... THE COMMONWEALTH OF MASSACHUSETTS 'BOARD OF HEALTH � TOWN OF BARNSTABLE Appliratioit for Dh-,Vv!3tt1 Work.5 Tonotrnrtion ramit Application is her, ,y made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at: ���� Jra&ReFawsett Ln Hyannis ...........................................••---•----------•-------------------------------------- --------------•-------•-----------------------••--•-------......----------------......---------••- Jake Heroian Location-i\ddress I or Lot No. w W.E. Robinson Septic Service P.O. Box 1089 C ndtgrville Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No-of Bedrooms---__3 ------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' 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 ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ Test Pit No. 1----------------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........................ DDescription of Soil.................. aTId.................................................................--------...---•---•-----••----••---------•--•-•-•--•---•------------•-•- x w UNature of Repairs or Alterations=Answer when applicable---- nstall---an---additional-„overf,low....... 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 has been sue by the board of health. n Signed ------- 1 . .. ----------------------------------- � 7 ................ ,� Dare Application Approved By ---j �f ..... ..f� ( 7,-/11 + _ .............. �e----- --- --.----- .� - Application Disapproved for the following reason:c1----------------------------------------------------------------------- ---------------------------------------------------------- ------ ----------------- --------------....._ "'--- -------'------'--------------------- -------- ............--------------------......................... / Dace Permit No. ----j,-- -'"r -- ........ ..._ - Issued ..... / �� -----­ ----- are _ i ———--———�—— —-———— ————————` r_————.—————————————.——— —————`——— ——`————— - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C'lex#tfiuttte of C�nmpliance THIS'IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X ) by W.E. Robinson Septic Service ------------------------------------------------------- ---------------------------------------------------------------------------- r„ 173 Fawcett Ln Hyannis Insroller at .............. ... .................... .... __... -------- ---------------...--------------------.............---------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE ?e! t te� Environmental Code as described in application for Disposal Works Construction Permit No. _.I� ... + "... dated .._------------------------------------------ the THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. J ,, _ � DATE..........mom• ._- /... ---...__1..- 1�.. . -..... Inspect r--'1<�=r1. ------------- ----------- ------------------------------------------------------ `-------. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 30.00 No. ...:.. FEE........................ DifiVoo�tl orkii Toni#rur#lon rrmit In .E. Robinson Septic Service Permissionis hereby granter-------------•.----- --•-•----•-•-•-----------------••--•-----------------••--•---•--•-••--.......•-••••--------••••......•-•.........._.. to Construct ( ) or Re a r ) an Individual Sewage Disposal System 173 Fawcel! Ln Hyannis atNo............................................................................................................ ------------------ Street (� / as shown on the application for Disposal Works Construct'o�n/P.erim No-__�_1�v:_,: Dated.................. ...c_.._....._.._._.... %i/L .... - �f, �1 filar-.------------------- J �✓ ' B'ard'o Health DATE............. -= P FORM 36508 HOBBS alc WARREN,INC..PUBLISHERS THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................OF....7� ........................... �irtt ila� for M-4poiitt1 Works Tomitrurtiod Urrutit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: •-•-- ..... ......._••. --•-•-• - Location-Address y� or Lot No. ..7Y.1.J�-••------—3`.L T� ---•-----------------•-- --- .... .1 4 .................................................................... (:yer Address ( ............................................. ..-•---•.... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( . ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a 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........................ GT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P, ------•-••---------------•-•-----------•••-----------•-----•-------------•--................................................................................. 0 Description of Soil.........................................................=............................................................................................................... U ------•--------------------------------•-••... ------------------ •--------------------- •------------------------------ --------- •----------------------- ------ ••------------------------------- ----•--------------------------------------•-------------------------------------.............-........................................................................................................ U Nature of Repairs or Alterations—Answer when applicable...:__.__:--_-- !�(-_-__•-------,�t oo ........................... Agreement: The undersigned agrees to install. the aforedescribed Individual Sewage Disposal System in accordance with the provisions of AI TIE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance s been issued the board of health. Sign .---•- -- tTZ� E........ l _... ` Dae Application Approved By................. -c.�...'�j_ _..L2t�s��.A.e...,,�-•----------•-•------ Date Application Disapproved for the following reasons------------------•--•-•---------•---•-------•-------•-...__.................................................. --•.................•------••--------•------•---•-•-----•.-•-•••-•------------------..........-•-•--••••.••••-•----------•••----------•------•--...-•---•--•----------•-•------••----•--•--------------- Date Permit No....... 'S` __"_a�...� ---•------------ Issued------------------------•-----•---...... .... Date --------------. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _ Z)•!l�J.V..................OF.... ........ ..............`-�---.....---------...---------- App iration for Disposal Works Tonstrurtion rrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( Individual Sewage Disposal System at: .............. ................................... .' _ Location-Address - •.•-or Lot No. -------•- �r ..�. ......................•------------•--------.-.----.-- ....:S. ....... :. Less . . Qwner Address a �L a 1 vJ -1__C k 4 7 c Installer Address dType of Building Size Lot............................Sq. feet U 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............................................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........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 94 •--•-•---....-••---•••••--••------•-----••-•------••....................•-_.. ..-----•------•............................................................ 0 Description of Soil.......................................................=-•.........................................................................................-•--•---------------• W U •--------------------------•-•-----•---•••-••----•----..................-•----------•---••.........----••-•-----------------•-----••----•-----------•••-•••--•--------•------.....-•-....--•----•-.•--•- W UNature of Repairs or Alterations—Answer when applicable.......A_.....�j"�r��L.............�-DOD ..........k:4A(k..)tk...... ........................................Z.........�-.€-'f._........:S7aW£J Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of TITIS 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance been issued by the board of health. Signed:-- ..: Q.:!h........................ -vim j f Da e Application Approved BY . .......... .�..Gc .............S _l.:.. �----•-•-•------------- Date Application Disapproved for the following reasons:.........................................................................•....-•---•------.._.............--- ....•---------•................•---------................---.....---••-••-----•-•......----•---•--.............................._...--•-•---------•-------------•-------•--........--•---•--••-•-------- Date PermitNo.-----. ............... IssuecL....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH E�r'C v�� R t- . fanrtifiratr of Toutplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by........ ......E ................•-------•----•--.....----------••---•-----•-•---------=-•-----•-----•---•-... ....-.---.--..-..-....-..--------..-...-...................... Installer -- �.. -- ---------•------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.............. _-__;L - dated.............. ................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................... �- '-�0.....--•---•--••-.._........ Inspector--••----...�....ND••-----••-------•----.....--•.._....•.............. THE COMMONWEALTH OF MASSACHUSETTS G BOARD OF HEALTH \ l}. ...::1.��.!�..................OF....�>?�j\vl iJS�!r�.��i`.�.......................---... FEE. .No..... ... ...o`.... Disposal Works Tonstrixrtiott Vlerutit Permission is hereby granted........ �.v 1 t"'. �C'�� 7 ......................••-------......-.........----........................................................•- to Construct ( ) or Repair ( " an Individual Sewage 14 Disposal System at No...9B 1........_.Via.�!i�U .!1.1.......Z�..............•------- �`✓.�i/ Street as shown on the application for Disposal Works Construction Permit No...09-),?-S. Dated.......................................... r ��•'� ..................................... nL._W.........•-•----•....---------••---...._..._..... ?' Board of Health DATE.................... ---•MI.9n-'rr-----....-----................... FORM 1255 A. M. SULKIN, INC., BOSTON L TOwn of Barnstable y r` o Regulatory Services Thomas F.Geller,Director Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax 508-790-6304 Installer&Designer Certification Form Date: �,►� 2 Designer: �' g Installer: ArCII Address: . -4 Address:on as issued a permit to install a (date) (installer) septic system at .173 ased on a design drawn by (ad s) dated b ( esigner) I-certify that-the septic system referenced above was installed substanti the design, ally according to w�iich may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes,(i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State.&Local Regulations. Plan revision or certified as built by designer to follow. i 's Signature) (Affix Des Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALT$ DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UMM BOTD THIS FOItNI AND AS- BUILT CARD ARE RECEIVER BY THE.BARNSTABLE PUBLIC HEALTH DIVISION. TANK YOU. Q:Health/Septic/Designer'Certification Form ASSESSORS MAP: -4270 TEST HOLE LOG PARCEL: / NOTES: SOIL EVALU TOR://� �)10 �.T �- FLOOD ZONE: 0,5 -- WITNESS: V�QI" � 1 __ REFERENCE: Qbecl:> �.9n�k5� r> / DATE: ATIM1f�i� f 1) The installation shall comply with Title V and Town of Barnstable Board of _> � ',, / PERCOLATION- RATE: Health Regulations. F " 1-- -� 3;7i w�p,, 2) The installer shall verify the location of utilities, sewer inverts and septic G e/L77/ /� _ _-_-/7/ _ _ �' + -373 components prior to installation. lj TH- 1 TH-2 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. I- 4) This plan is not to be utilized for property line determination nor any other purpose other than the proposed system installation. 5) All septic components must meet Title V specifications. 6) Parking shall not be constructed over H10 septic components. MAPS 8 ;,•5'6 � 7) The property is bounded by property corners and property lines as depicted. LOCATION w r's� j� a> _ / 8) The property owner shall review design considerations to approve of total number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed approval of the 4 number of bedrooms. G. 9) The existing cesspools shall be pumped and backfilled per Title V Abandonment Procedures. 10)Proposed leaching is to be within 36 inches of grade or provide venting or cut h Q lJ�t� y� grade as permitted by the Board of Health. 11)System components to be 10 feet from water line. 12)Septic tank to be a minimum of 1000 gallons. If tank is less than 1000 gal., SEPT I C! SYSTEM DESIGN then replace with 1500GST. q U G CA FL0W ES`{f I MATE _ i r 2IE> ' I3ED�00MS AT � �� GALIDAY/BEDROOM - GALIDAY �3 z�' SEPTIC jANK 'I'�GAUDAY x 2 DAYS • milGAL © \ USE u GAILON SEPTIC TANK 401 L AS. ORPT 1 ON SYSTEM .< Jam. [/_710f ,;,�i` 5 , L �G +�� 3 f t `'�U 1W ,OE AREA: �-•., �f `- fl Bk= TOM AREA: t � _ SEPTIC; SYSTEM SECTION I t¢� - _ 6 k . Of _ GAL R I, SEPTIC TANK c C, Iwo xdie X SITE AND SEWAGE PLAN LOCATION : + 1-7 , P PREPARED FOR :. , 1_Z412 •691pfleL 0 Z SCALE DAV I D B . MASON FS DATE: DBC ENVIRONMENYAL DESIGNS s EAST SANDWICH . MA W DATE HEALTH AGENT ( 508) 833-2177 W 2