HomeMy WebLinkAbout0233 FAWCETT LANE - Health 233 FAWCETT LN., HYANNIS
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS .
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address• 223 Fawcett Lane
Hyannis
Owner's Name: Odvan Hernandez
Owner's Address: 49 Paulette Terrace
outh
Date of Inspection:-ym Name of inspector:(please print)' W i 11 jam E_ •Robinson Sr.
Company Name: William E. Robinson Septic Service
Mailing Address: P O Box 1089
Centerville, MA
Telephone Number: (5081 775-8-776
CERTIFICATION STATEMENT
1 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 7Seton 15340 of Title 5(310 CMR 15.000). The system:
asses
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: j��, Date: r�
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health-or
DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.The original should be sent to the system owner and copies'sent to the buyer,if applicable,and the approving
authority.
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 I 1 j
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued).
Property Address: 223 Fawcett Lane
Hyannis
Owner: Odvan Hernandez
Dale of Inspection;_ Q.. /ci
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. Syste Passes:
l 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. yytem Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
repave .The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer es,no or not determined(Y,N,ND)in the for the following statements.if"not determined"please
explain.
e 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 t wk 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
indicatin that the tank is less than 20 years old is available.
ND expl in:
bservation of sewage backup or break out or high static water level in the distribution box due to broken or
obstru pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with
approv I of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND plain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
pass in ection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND expla n:
r Page 3oril
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:223 Fawcett Lane
Hyannis
Owner: Odyan Hernandez
Date of Inspection: . ~O s
i -
C. Fu her Evaluation is Required by the Board of Health:
_ C nditions exist which require further evaluation by the Board of Health in order to determine if the system
'is failing protect public health,safety or the environment.
1. Sy tem will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(b)that the
sys em 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. S stem will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
syste 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.
Other:
3
Page 4 of l l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 223 Fawcett Lane
Hyannis
Owner: Odvan Hernandez
Date of Inspection: — —�
D. S rem Failure Criteria applicable to all systems:
You m st indicate`yes"or"no"to each of the following for all inspections:
Yes
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%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 f^_ct from a private Kato
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.l
(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 Systems:
o be considered a large system the system must serve a faci!ity with a design flow of 10,000 gpd to 15,000
pd.
ou must indicate either"yes"or"no"to each of the following:
( ue following criteria apply to large systems in addition to the criteria above)
ye 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 y u have answered"yes"to any question in Sectim E the system is considered a significant threat,or answered
"y "in Section D above the large system has faikd.The maner or operator of arry large system considered a
sig ificant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15. 04:The system owner should contact the appropriate regional office of the Department.
, 4
Page S of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 223..Fawcett Lane
Hyannis
Owner: Odvan Hernandez
Date of Inspection:
Check if the following have been done.You must indicate`Yes"or"no"as to each of the following:
Yes No
r/Pumping information was provided by the owner,occupant,or Board of Health
/
v 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?.
V 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 NIA)
/ Was the facility or dwelling inspected for signs of sewage back up?
v
Was the site inspected for signs of break out.?
_ Were all system components,excluding the SAS,located on site?
L-/ 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?
P g P
t/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 j
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))
P
C
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Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 223 Fawcett Lane
Hyannis
Owner: Odvan Hernandez
Date of Inspection: —
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):. Number of bedrooms(actual):_
DESIGN flow based on 310 CMR 5.203(for example: 110 gpd x#of bedrooms): ty b
Number of current residents:
Does residence have a garbage ' der(yes or no): k o
Is laundry on a separate sewage system(yes or no)�7LU [if yes separate inspection required]
Laundry system inspected(yes or no): �
Seasonal use:(yes or no): v
Water meter readings,if available(last 2 years usage(gpd)): 2004 — 88, 500
Sump pump(yes or no): 2003 — 82, 500
Last date of occupancy:
COMMERCIA NDUSTRIAL
Type of estab' ent:
Design irreadings,
ed on 310 CMR 15.203): gpd
Basis oow(seats/persons/sgft,etc.):
Grease nt(yes or no):_
Industriolding tank present(yes or no):_
Non-raste discharged to the Title S system(yes or no):_
Water ings,if available:
Last dapancy/use:
OTHEbe):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped asp of the inspection(yes or no): i C)
If yes,volume pumped:_gallons--How was quantity pumped determined?
Reason/for pumping:
TY ,i 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/Altcmative 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 to talled(if known)and source of information:
Were sewage odors detected when arriving at the site(yes or no):
6
)'age 7 of I I
�d
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORAI
PART C
SYSTEM INFORMATION (continued)
Property Address: 223 Fawcett Lane
Hyannis
Owner: Odvan Hernandez
Date or inspecllon: 1,_b
DU/tamcnIs
SEWER(locate on site plan)
De grade.
Ma construction:_cast iron _40 PVC_other(explains):
Disccm private water supply well or suction lute:
Coon condition of joints,venting,evidence of leakage,etc.):
r
SEPTIC TANK: locate on site_( plan)
Depth below grade: Z
Material of construction: ✓concrete metal fiberglass_polyethylene
_othcr(explain)
If tank is metal list age:— Is age conGrnted•by a Certificate of Conppliarrce(yes or no):_(attach a copy of
certificate) b s
Dimensions:_ �=} is '-t
Sludge depth: s s
Distance from top of sludge to bottom of outlet Ice or baffle:
Scum thickness: 0 _ t p
Distance from top of scum to top of outlet tee or baffle: t n
Distance from bottom of scum to bottom of inlet tee or baffle �
I low were dimensions determined: caw
Comments(on pumping recommendations,inlet and owlet tee or baflle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,a c.):
CREASE TRAM' _(locate on site plan)
Dcpth below dc:_
Material of a struction:_concrete_metal_fiberglass Jtolyetltylene_other
(explain):
Dirncnsion .
Scum thic ess:
Distance ont top of scum to top of oullct Ice or baffle:
Distanc from bottom of scum to)bottom of outlet Ice or baffle:
Date o last pumping:
Conut cuts(on pumping reconunendations,inlet and outlet tee or ba(lle conditiunn, structural integrity, liquid levels
as re Icd to ou(lct invert,evidence of leakage,etc.):
7
'age 8 of 11
OFFICIAL INSPECTION FORM—NOT I101t VOLUNTARY ASSESSMENTS
SUBSUIVACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 223 Fawcett Lane
Hyannis
Owner: Odyan Ugrnandez
Date of lospection:
TIGHT or 1 OLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth bclo grade:
Material of construction:_concrete_metal fiberglass_polyethylene oQter(explaut):
Dimensio s:
Capachy. gallons
evUcsign ow: gallonslJay
Alann cscnt(yes or no):
rm Alarm Alarm in working order(yes or no):—
Date o last pumping:
Conut cuts(condition of alann and float switches,ctc.):
DISTIUBUT ON BOX:—(if present must be orncd)(locate on site plan)
Depth of 'quid level above outlet invert:
Conune is(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
Icakag into or out of box,crc.): l3�j p'
(s lac.
PUMP CIIA/E . (locate on site plan)
Pumps in wor (yes or no):Alarms in wor(yes or no):Cornments(non of pump chamber,cundition of pumps and appurtenances,etc.):
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued) ,
Property Address: 223 Fawcett Lane
Hyannis
Owner: Odvan Hernandez
Date of Inspection: —6
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,ezcavation'not required)
If SAS not located explain why:
Type ,..
caching pits,number: j
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/altemative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.):
CE/ons
LS (cesspool must be pumped as part of inspection)(locate on site plan)
Nuconfiguration:
De of liquid to inlet invert:
Delids layer:
Deum layer:
Dis of cesspool:
Maf construction:
Indof groundwater inflow(yes or no):
Co (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY- (locate on site plan)
Mater als of construction:
Dim nsions:
De h of solids:
C ents(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
9
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Page 10 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 223 Fawcett Lane
Hyannis
Owner: Odvan Hernandez
Date of Inspection: .- -8
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.
. C .
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Page 1 I of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 223 Fawcett Lane
Hyannis
Owner. Odvan Hernandez
Date:of Inspection: 9-2-1—
SITE EXAM
Slope
Surface water
Check cellar.
Shallow wells
Estimated depth to ground water 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:
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
11
TOWN OF BARNSTABLE °e
LW.,ATION SEWAGE # -;igdOO ---�O
V3LLAGE c!am/I /�r ASSESSOR'S MAP& LOT42XnX
INSTALLER'S NAME&PHONE NO. �
SEPTIC TANK CAPACITY 0 D
LEACHING FACILITY: (type) t (size) ��
NO
. BEDROOMS
BUILDER OR OWNE
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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No. (1 Fee /
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �/
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Zipprication for �Miopool *potem Construction 3dermit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. G' ? `1 "V�, Owner's Name,Address and Tel.No.
Assessor's Map/Parcel 1
- l`'�0 / 10
Installer's Name,Address,,anndTel.No. ` Designer's Name,Address and Tel.No.
A-c
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 j 3 d ` gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date `
Title
Size of Septic Tank O 0 0 Type of S.A.S. L( h—,Pt �W.Q
Description of Soil j y YL erg
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Board Heal
Signed Date .. 0
Application Approved by Date 2 ZOU✓
Application Disapproved for the following reasons
Permit No. 7-o-r-o w-3 3 0 Date Issued
C
No. IXJ!! Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓
Yes
PUBLIC HEALTH DIVISION -TOWN,OF BARNSTABLE, MASSACHUSETTS
Application for Mi!5pool *p5tem Con6truction Permit
Application for a Permit to Construct(rr )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. t Cn �C� `� Owner's Name,Address and Tel.No.
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I
Assessor's Map/Parcel �d r G r CP—
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms 4 Lot Size 23 sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 330 ` gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title � A
Size of Septic Tank S G Type of S.A.S. r-rti t c.. oic
y
Description of Soil i'
r
Nature of Repairs or Alterations(Answer when applicable) ru I S tl s'
'46
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Boardrqf Heal
Signed Date
Application Approved by - - Date 2 "64_1
Application Disapproved for the following reasons
r
Permit No. '330 Date Issued G
--------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( ) Repaired(Upgraded( )
Abandoned by /\A, <
at �- Fact.,_-e ti has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No 7-4"- 33 dated (i - Z - 7,OOd
Installer Designer I .-> n
The issuance of this permit sh not be construed as a guarantee that the systemrwdl."funcdon as desYgned. J 3.
Date / l� / Inspector � �////A 1� !1 J �r�
No. G� � ���---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
lwigogaf *pgtem Congtruction 3dermit
Permission is hereby granted to ons ct( )Repair( pgrade( ) b ndon( )
System located at �-3 � e '� c 41
✓1't's
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:Cons ctio must be completed within three years of the date of this permit.
Date. , Approved by
1/6/99
NOTICE: This Form Is To Be Used For the Repair Of.Failed
Septic Systems Only.
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
I, Alt-, (�e cs�s/' , hereby certify that the application for disposal works
construction permit signed by me dated 0 O , concerning the
property located at LIq meets all of the
following criteria:
• This failed system is connected to a residential dwelling only. There are no commercial or business
uses associated with the dwelling.
• 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.
• 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) �P
B) G.W.Elevation +the MAX.High G.W.Adjustment.
DIFFERENCE BETWEEN A and B
SIGNED : DATE: LD d
[Please Sketch proposed plan of system ck].
NOTICE
Based upon the above information,a repair permit will be issued for bedrooms maximum. No
additional bedrooms are authorized in the future without engineered septic system plans.
q:health folder:cert
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TOWN OF BARNSTABLE
LOCATION t'4Lvc e L SEWAGE # 00oO
VILLAGE 1-(4 G ern ASSESSOR'S MAP &LOT"- /
INSTALLER'S NAME&PHONE NO. ir-e- L 'P_ct r�l
j SEPTIC TANK CAPACITY d
LEACHING FACILITY: (type) L4 t 4r, w � 04e-(size)
NO. OF BEDROOMS t �iG ter,
BUILDER OR OWNER, its • V e
PERMITDATE: COMPLIANCE DATE: �V C/
i
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
j 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
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Town of Barnstable
* Brut"ABA E.
• Department of Health, Safety, and Environmental Services
9� ' ��� Public Health Division
�fOnAA'�A P.O. Box 534, Hyannis MA 02601
Office: 508-862-4644 Thomas A.McKean,RS,CHO
FAX: 508-790-6304 Director of Public Health
April 21, 2000
Anna M. Veara
233 Fawcett Lane
Hyannis, MA 02601
ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL
CODE, TITLE 5.
The septic system owned by you located at 233 Fawcett Lane, Hyannis was inspected on
April 12, 2000 by Donna Miorandi, R.S. Health Inspector for the Town of Barnstable.
The inspection of your septic system showed that your system has failed under the
guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following:
• Raw sewage overflowing onto ground in backyard.
You are directed to hire a licensed Town of Barnstable septic system installer to submit a
sketch diagram of a proposed system to the Town of Barnstable Health Division Office
(Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance
with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen
days of receipt of this notice.
You are also directed to bring the septic system into compliance within thirty (30) days
of receipt of this order letter.
You are further directed to maintain the system by hiring a licensed septage hauler to
pump the septic system to prevent discharge of sewage or effluent into the buildings, onto
the surface of the ground, or in to surface waters.
Any person aggrieved by any order issued by the local approval authority may appeal to
any court of competent jurisdiction as provided for by the laws of the Commonwealth.
P OFT BOARD OF HEALTH
Thomas A. McKean, R.S., C.H.O.
veara/wp/q/Is
;Poll
�P��ptHEl � Town of Barnstable
y �T
Department of Health, Safety, and Environmental Services
* BARNSTABLE,
MASS.9� : ,�� Public Health Division
6.1
P.O. Box 534, Hyannis MA 02601
Office: 508-790-6265 Thomas A.McKean,RS,CHO
FAX: 508-790-6304 Director of Public Health
A 33 �
ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRO�yN TAL
CODE, TITLE 5. � ;,
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The septic system owned by you located a was ii1spected on by
7'o�vl o
The inspection of y ur eptic system showed that yo qsstjemCaMsai e under the
guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: 07
You are directed to hire a licensed Town of Barnstable septic system installer to submit a
sketch diagram of a proposed system to the Town of Barnstable Health Division Office
(Town Hall, 367 Main Street, Hyannis)that will bring the septic system into compliance
with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of
receipt of this notice.
You are also directed to bring the septic system into compliance within thirty (30) days of
receipt of this order letter.
You are further directed to maintain the system by hiring a licensed septage hauler to
pump the septic system to prevent discharge of sewage or effluent into the buildings, onto
the surface of the ground, or in to surface waters.
Any person aggrieved by any order issued by the local approval authority may appeal to
any court of competent jurisdiction as provided for by the laws of the Commonwealth.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, R.S., C.H.O.
Agent of the Board of Health
q\health\dbfiles\title5i.doc
TOWN OF BARNSTABLE
LOCATIONtiQ _SEWAGE # � 1
VILLAGE L�}yGr k,,-L i ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO. C 40--e_
SEPTIC TANK CAPACITY / 6-A, Cj)o L�crJ
LEACHING FACILITY:(type)Q Re_-r a sT— '��' (size) f
NO. OF BEDROOMS-PRIVATE WELL c _PUB IC Rl
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH�
TOWN OF BARNSTABLE
Appliration for Diupuual Works Ton rrm bate
Applicatio is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at: o
Location Addr s or Lot No.
... 5..................
Add
•---._..... l_ f �"�J .ner - . .1:.�'r.. "' ...! •`/ �F_1 ............
V S _•_________... �_ ..1.
Installer Address
d Type of Building Size Lot________________ q, feet
Dwelling—No. of Bedrooms......3........._.....................Expansion Attic ( ) Garbage Grinder ( )
a'4 Other—T e of Building No. of ersons____________________________ Showers
YP g ----=----•-----------•-•---- P ( ) — Cafeteria ( )
P4Other fixtures ...-•-•----•--------•------•-•--------•--•---------•------•...........................•-•-------•--•--•--••-•-----•--•-------•-•••-------------------
W Design Flow_______..._.5_.��. ..................gallons per person per day. Total daily flow-------7:Y .�)......................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.....J-------------- Diameter...1_0......... Depth below inlet---(0.`__..._._._. Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'~ Percolation Test Results Performed by.......................................................................... Date........................................
1
�
Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
Test Pit No. 2___.............minutes per inch Depth of.Test Pit.................... Depth to ground water........................
W ------------------
---------------------------------
•---------------------------
-••-----•--------. ------
•----------------
----_..................
•-•---•-----
0 Description of Soil........................................................................................................................................................................
W
U Nature of Repairs or Alterations—Answer when applicable.___- Pz' __.dJ_Alta'< .............
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 issued by the board of health.
• .
1 .Si ned .::: A a .......... ....
APPlication AP B Dace
ProvedY - ------- � :..-.. -:9....--�t - .-- ----�----- ----- -------------- -------------------.
Date
Application Disapproved for the following reasons: . .........................\ ,.--........---........----................. ------------ .....................................
.................................................. .. ...........
--------------------------------
..
Permit No. y ..1 ... Issued -�f - L- --
No... ........ a'`` Fxs._. . ..__..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appltra#tlatt for Disposal Hijark,5 C��tt� �tr�t�a�tt rrntt#
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at:
- ..... ................. .............................................
,,..,Location_Add re3s or Lot No.
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WS ner� �(..,. _S:'_1. �• __LL �L-..........................................
Installer Address `
UType of Building -� Size Lot............................Sq. feet
�., Dwelling—No. of Bedrooms___...- ...............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures -------------------------------••---------------'--------'-'---••"--'--'----------------------'---'-"--......---.........--•'•-•-'--..........••••.
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......I-------------- Diameter----LO....... Depth below inlet...�_t........_.. 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........................
Gi, Test Pit No. 2................minutes,per inch Depth of Test Pit.................... Depth to ground water........................
P4 --------
•....................................................................................................................................................
0 Description of Soil........................................................................................................................................................................
x
w
Z. Nature of Repairs or Alterations—Answer when applicable...__ .....�_ ............
............... .--- tt e • .........`/�� --...".....................
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 issued by the board of health.
- .. a ,�-a
Signed ....... ...... :. _ ... -
�, Date
Application Approved BY 1 �...C-.-.... ----_„......--
Date
Application Disapproved for the following reasons:: ..----------------------------------------------------------------------------
1
-------------------- ------------------ -- -- -n..... ..-....
/ Date
Permit No. ...'' --.... ; Issued - ... d . -..t . ...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
GelL tifi ate of Tomplianrt
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( c- -
by ----------------------------------------Cy-J 4 L--t.9t�... —-------------------------------------------------------------------------------------------------------...:.
Installer
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at ------------------------------- �— '1 C. 'ir. -- Yam. (t / ......... .......------------
has been installed in accordance with the provisions of TITLE 5 T e State 1 onmental Code as d rsc�ibed in
the application for Disposal Works Construction Permit No. ...-.� 1 �"'�yZr dated ..... v/� '�'"
....
-- ......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAR ANTE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
1�DATE....... ..................... Inspector ------..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE < �
No. ..... FEE...
..................
�t��r���tl �rk� C�����rttr#uart� �ermi�
Permission is hereby granted...............0 kq
�..� t:4r� f" C
to Construct ( ) or Re air ( an Individual Sewage Disposal System /
atNo.................. -•-_ ---- _ •P ==..." ------------------- ... - K'�'4 S 1.... �......._
Street Y"r, r'
as shown on the application for Disposal V\orks Construction Per it IVo.__.v,-/.1;__.A. }- d--___ -
........:...........
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Gf Board of 'ee h
DATE........----'f r .------ --------------------•--•-• J /
FORM 36308 HOBBS 6 WARREN.INC..PUBLISHERS •?�1 ""
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