HomeMy WebLinkAbout0074 FERNDOC STREET - Health 74 Ferndoc Street . --�
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• COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
V `
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: marz JAN
Owner's Name: e i town
Owner's Address: HL.At
0 60i
Date of Inspection: a 0`a U3 1
\ 1_ MAP
t)'L P��C �2
Name of Inspector: (please print) M►t'�i1[3c,P( nLkb vt z L
Company Name:
Mailing Address: y
Cam.
Telephone Number: g Q 4 0-
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:
V/Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: ao Date: a-'l o
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 y2� A.) J� fYt � � unnr� n,w2.�
****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 I
Page 2 of 11
i
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: "1 y .�y?jlf,4m
Owner: CT
Date of Inspection: 1 'a�;. n 9-1
Inspection Summary: Check A,B,C,D or E/ALWAYS complete a&af Wr-V-14 ;.
A. System Passes:
11 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 lemming 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 eater 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
distribubm box is leveled aarntpince d
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):
li broken--pipe(s)are replaced
obstruction is removed
ND explain:
2
Page 3 of 11
i
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
�—Property Address: -�Ll IgAN1��) (24
Owner:
Date of Inspection:
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 03(1)(b)that the
system is not functioning in a manner which will protect public health,safety and a 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�rsh
j
2. System will fail unless the Board of lle Ith(and Public Water Supplier,if any)determines that the
system is functioning in a manner that prot is the public health, fety and environment:
_ The system has a septic tank and soil abso lion system AS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface wale upply.
_ The system has a septic tank and SAS and the SA s within a Zone I of a public water supply.
_ The system has a septic tank and SAS and th AS is Within 50 feet of a private water supply well.
_ The system has a septic tank and SAS an the SAS is less than 100 feet but 50 feet or more front a
private water supply well". Method used to/determine distance
"This system passes if the well watery�Zalysis,performed at a DEP ceof ed laboratory, for coliform
bacteria and volatile organic compout5ds indicates that the well is free from�ollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than pm,provided that no other
failure criteria are triggered.A copy of the analysis must be attached to this form
r �
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: 7y �luup`�!Y'
Owner:
Date of Inspection: a1,
D. System Failure Criteria applicable to all systems: -a,•
You must indicate"yes"or"no"to each of the following for all inspections.
Yes No
Backup of sewage into facility or system component due to overloaded or 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 pi'clogged SAS or
cesspool
_ Liquid depth in cesspool is less than 6"below invert or available volume is les3
-times
%:day flow
_ Required pumping more than 4 times in the last year NOT due to clogged oj'obstructed pipe(s).Number
pumped j
Any Krtion of the SAS,cesspool or privy is below high ground water glevation.
Any po 'on of cesspool or privy is within 100 feet of a surface water,supply or tributary to a surface
water sup -
Any portion a cesspool or privy is within a Zone 1 of a public ell.
Any portion of cesspool or privy is within 50 feet of a privas�aler
ater supply well.
Any portion of a c spool or privy is less than 100 feet but gr than 50 feet from a private water
supply well with no ceptable water quality analysis. [Th' tem passes if the well water analysis,
performed at a DEP ified laboratory,for colifor acteria and volatile organic compounds
'indicates that the well is ee from pollution from t t facility and the presence of ammonia
nitrogen and nitrate nitro is equal to or less t a 5 ppm,provided that no other faifane eriterin
are triggered.A copy of the a lysis must be a ched to this form.]
(Yes/No)The system fails. I have dete ' ed that ne or more of the above failure criteria exist as
described in 310 CMR 15.303,therefor the stem fails. The system owner should contact the Board of
Health to determine what will be necess o correct the failure.
E. Large Systems:
To be considered a large system the system ust serve a fa ' ' with a design flow of 10,000 gpd to 15,00.0
gpd•
You must indicate either"yes"or"no"to�j ch of the following:
(The following criteria apply to large syst6msinsothe )
yes no
the system is within 400,feet of a surface drinking water supply
the system is withhn 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Imerim Wellhead Protection Are —IWPA)or a mapped
Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threa j.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
II� 15.304.The system owner should contact the appropriate regional office of the Department.
4
Page 5 of 11
d
OFFICIAL INSPECTI.ON FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: ±
e
Owner:
Date of Inspection:
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
i/ 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)
t/ _ 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?
V _ 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
V/_ 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 1 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: k^j
Owner:
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL
Number of bedroo s(design): Number of bedrooms(actual):'
DESIGN flow based o 0 CMR 15.203(for example: 110 gpd x#o�droams):
Number of current residents:
Does residence have a garbage grin es or no):
Is laundry on a separate sewage system(ye no): [if yes separate inspection required]
Laundry system inspected(yes or no):—
Seasonal use: (yes or no):_
Water meter readings, if availabl t 2 years usage(gpd)):
Sump pump(yes or no):
Last date of occu y:
COMMERCIAL/INDUSTRIAL
Type of establishment: 1A61U M L,pp,
Design flow(based on 310 CMR 15.203): Qpd
Basis of design flow(seats/ ersons/sgft,etc1,
Grease trap present(yes=: I
Industrial waste holding tank present or no):—
Non-sanitary waste discharged to the Title 5 system(yes o nn
Water meter readings, if available: 0WO — $a"ROO&0- 1 — �c� cj pb .
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION '.
Pumping Records
Source of information: q 6
Was system pumped as part of the inspection(yes oro .
If yes, volume pumped:_gallons--How was.quaptity 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 cturent operation and maintenance contract(to be
obtained from system owner)
Tight tank _Attach a copy of the DEP approval
Other(describe):
Approximate a e of allsnponents, date installed(if known)and source of information:
Were sewage odors detected when arriving at the site(yes or io
6
_ Page 7 of 1 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
oo
.(mil
Property Address: �y h )r'
Owner: 1
Date of Inspection:
BUILDING SEWER(1 cate on site plan)
Depth below grade:
Materials of construction:_cast iron _ other(explain):
Distance from private wat y well or suction line:
Comments(on ion of joints,venting,evidence of leakage,et .
SEPTIC TANK: ✓(locate on site plan)
Depth below grade: aO" " n An�ri. t:o� eM
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: �j C)C) q 14-,)p
Sludge depth: .a
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness: OP
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottouLof outlet tee or baffle:
How were dimensions determined:�a, Jwt�,Q �a _
Comments(on pumping recommendations,'inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
.t
rA&
p�" �p n _ r n
�TA�
jCi �v M A"-"..�nN.REn site plan) CJ
Depth below grade:_
Material of construction:_c ete_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 outle rtfe or baffle:
Date of last pumping: .
Comments(on pumping recommen ons, inlet and outlet tee or baffle condition,struc 1 integrity, liquid levels
as related to outlet invert,evid a of leakage, etc.):
7
y
Page 8 of I I
0
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: `7 y
Owner:
Date of Inspection: Haa
TIGHT or HOLDING K: (tank must be pumped at time of ins ection locate on site Ian
P )( plan)
Depth below grade:
Material of construction: concrete etal fiberglass_pol ther(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order es or no):
Date of last pumping:
Comments(condition of alarm an oat switches,etc.):
V
D RIBUTION BOX: (if present must be opened)(locate on site plan)
kA O
Depth of liquid level above outlet invert:_C>
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, et c. :
PUMP CHAMBER: (locate,on site plan)
Pumps in working r(yes or no):
Alarms in working order or no):
Comments(note condition of p c am r,condition of purttps and appurbeoanaes,etc.):
8
Page 9 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 29"1QZ2 �
Owner:
Date of Inspection:
SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type � J
leaching pits,number: 1 b 6
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.):
n _
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and ca figuration:
Depth—top of liq ' to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes o):
Comments(note condition of soil,signs o draulic failure,lev of ponding,condition of vegetation,etc.):
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of il,signs of hydraulic failure, level of ponding,condi ' n of vegetation,etc.):
9
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: "I �,�
Owner:
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at kast two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
— P5I
C�
A_ l �a,
3 C6 a a r�
a 30 O
3 �y�
10
e
Page 11 of 1 I .
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: { Q
Owner:
Date of Inspection:
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water-1 feet +,vo..
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 nLust describe how ou a tablished th hi h ground water elevation: "
11
oFE� � Town of Barnstable
Department of Health, Safety, and Environmental Services
9'"R` ��
1639. Public Health Division-
♦0
p'EDN10�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
March 26, 2001
Mr. Charles Buckler
I I6.Ridgewood Ave
Hyannis, MA 02601
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
The property owned by you located at 74 R Femdock St., Hyannis,was inspected on
'March 23, 2001 by Donna Miorandi, 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:
410.602 Old abandoned above ground tank, piles of old wood, many mattresses,
and old furniture.
You.are.directed to correct the violation of 410.602 within twenty-four(24) hours 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 T BOARD OF HEALTH
Thomas A. McKean
Director of Public Health
Health Complaints !
23-Mar-01
Time: 8:30:00 AM Date: 3/23/01 Complaint Number: 2757
Referred To: DONNA.MIORANDI Taken By: BARBARA SULLIVAN
Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH
Article X Detail:
Business Name: Charles W. Buckler
Number: 74 Street: Ferndoc Street
Village: HYANNIS Assessors Map-Parcel:
)
Telephone Number:
Complaint Description: See attached. Piles of rubbish, wooden
structures etc.
Actions Taken/Results:
Investigation Date: Investigation Time:
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TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
O
unsatisfactory- 4.Manufacturers
COMPANY.-t, (� io Ll�L (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS -79-/ I-e✓w cr-c- Class: 7.Miscellaneous
66 Am W:-n- QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils: 7-5 pL
waste motor oil (C)
new motor oil(C)
14-1-F P�
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous:
349
e aZ�
DISPOSALIRECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply 4SO& S ba
O Town Sewer r c Qvt 4t Ai/ ° 1�y `,j �, �,f
�On-site QPrivivate rLvA vs ed �, ad- ri.IVer.3o1,
3. Indoor Floor Drains YES_—NO.NO / " i 40 / , . � krkcl a-a- SC
O Holding tank:MDC_ /�
Q Catch basin/Dry well �� � OR
O On-site system
4. Outdoor Surface drains:YES—Z- NO_ ORDERS:
Q Holding tank:MDC ®A V(eLaM a o G< �r&e i `&.
O Catch basin/Dry well 06 re. ° V} (, cM d ( -jL/C-5-le 0 f"
11
O On-site system
5. Waste Transporter
Name of Hauler Destination",,
� uct Licensed?
_ YES N4
2.
0 C IAI� Ll V
P n(s) Interviewed Ins ctor Date
TOWN OF BARNSTABLE
LOCAnot4 YvJhoz.- 4p. SEWAGE #
VILLAGE Il.1S ASSESSOR'S MAP & LOT 5�/ 32 47
INSTALLER'S NAME & PHONE NO. ta.�• I�ytr�Spl � 3�N�98 F
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) Trr (size) 1000 1! *"
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER '_?LAQ;L4
BUILDER OR OWNER U)00P-I�i--h►ey coc e kynaes t31dGlU-��
DATE.PERMIT ISSUED:
DATE COMPLIANCE ISSUED.
VARIANCE GRANTED: Yes ✓ No
")aw
♦v
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G TOWN OF BARNSTABLE
LOC.ATION7y / AW- Oc c �� JG�9G��1 �p,SEWAGE #
VII:LAGE ASSESSOR'S MAP & LOT2y_�S -)7
INSTALLER'S NAME & PHONE NO. L/
SEPTIC TANK CAPACITY 60-C
LEACHING FACILITY:(type) (size) � � ClCd' .
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC W TER Pug
BUILDER OR OWNER AA'Oo ,5 l' � PCr L O,
�5u� J
DATE PERMIT ISSUED: /U`6 -88
DATE COMPLIANCE ISSUED
VARIANCE GRANTED: Yes ✓ No
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No.-- ��rr ccv 38►39 S?
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
®.wul....................OFr Ae�..lsTAr$.c..............----•-----•--•-•--•-•-----
Appliration for Disposal Works Tonitrnrtion rumit
Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address or Lot No.
Owner Address
6Jc Pr�Q-K aex'-i('... �3S-6 a=-,r- �'t��-+� S• � .�,,.�S
,.� - ------•-------••--•-- •------•-•--------------------------•--------...dres'-----1 .1---:----.----.....------
� Installer Address �
Type of Building Size Lot_._.-_..-l -____.._.
U Dwelling—No.No. of Bedrooms............................................Ex ansion Attic�-+ g— p Garbage Grinder_(�
aOther—Type of Building No. of persons...ZQ__ 41 .__... Showers Ad) — Cafeteria 46
dOther fixtures ---------------------------------------•----------•---.-•-----•-----•-•-----••--•----------
W Design Flow.........Y~.............................gallons per person �er day. Total daily flow._._._3bQ............................gallons.
WSeptic Tank—Liquid..capacity A=..gallons Length.8-&__'1_. Width.-.An c?... Diameter-----__.. Depth..5.�-S_"
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area...................sq. ft. ,
Seepage Pit No........)........... Diameter.__...Ai........ Depth below inlet...3j.5........ Total leaching area..ZA V_...sq. ft.
Z Other Distribution box NE1 Dosin tank (1y6
Percolation Test Results Performed by AX"CEf� _ 4.._�1�1��........................ Date..,ZtZ&.&Y................
,aa Test Pit No. I...12------minutes per inch Depth of Test Pit-_-�Q..._....__._ Depth to ground water____8...............
(i, Test Pit No. 2...42......minutes per inch Depth of Test Pit....1.1............ Depth to ground waterA0.T.FE.A4CO4ZL4%tXW
O Description of Soil......0.,2... A!!�. .tf f3 Qk 4......._2.-.1.0...!M Cif. ...........................................
w
------------------- - .....1.� _.. ems? ? `aS?.l. ........z•=-•.a......!!''� 5�4 1( ..............................-------------
VNature of Repairs or Alterations—Answer when applicable...............................................................................................
----------------------------•-----------------------•------•-------•-------------•......------------------...-------------------------------------------------------------------------•--•-•......•---
Agreement:
The undersigned agrees to install-the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has(een ssued b board of health.
Signed--- 6L __
-•--•----...ZG
Date
Application Approved By...........3 V---- ..�-_„
Date
Application Disapproved for the following reasons---------------------------------------------------------------•------ --------------------------------..•••••-
-••--•----------•-•-••--•-----•-------------•---....----•-------•------•---••--•-•------....-•---•----•...-•----•--•----------------•--------•---•------------------------•-•-•-------------••---•-------
Date
PermitNo.......?3. -L,5 .............................. Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTI�PTIFy ESIGNING ENGINEER MUST SUPERVISE ITING
cam--- INSTALLATION AND CER
f � k1 .SYSTEM WAS INSTALLED IN STRICT
ILL<! ..........O F............ . ........ ...
�rrtifirtt#r of Tompli�ic��RDA'f�TCE Tfl PLAN•
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (,)dor Repaired ( )
by....... 1.dt, - ...... f cry......•----------------------------------------------------------------------------------------------------------------------
I taller
at. ..... ` '0--------------------------------------•----------.-----------------
has been installed in accordaric with t e provisi
ons of TITI 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No------21.T n.16............... dated-...............................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector.....................-............................................................._
e
No.... THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
u,1.! ....................OFA..?-� A.`�- - .. .....
Appliration for Disposal Workii Tonstrnrtinn ami#
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at: 1 )
�_!_` .1 4tYar L�'i�C u 1 �i �_G t� ��
•••-- ----------•�..........................
........ .... . ... .
2 Location.Address or Lot No.
C_N A w 5 ver, t:�?_ ..._ �. 6 �.-j v,l o A jc t
•- -------------------•- - ----------
Owner Address
a W`��1� �ji+7►w �I�ub ..-• ..........
.......... .....
Installer Address
Type of Building Size Lot........?_AL. ._.. .
U Dwelling No. of Bedrooms............................................Ex ansion Attic�-+ g— p Garbage Grinder_('"�
aOther—Type of Building __________________________ No. of persons__._. ..... Showers (R c) — Cafeteria (��
dOther fixtures -----•------------------------•-----------------------------------------------------------------------•-------
W Design Flow........... ............................gallons per person per day. Total daily flow......3.c)o...........................gallons.
f .�
WSeptic Tank—Liquid capacity.�UQ�gallons Length..�-_�z_:__. Width_.L1_'__t 9'... Diameter___-`____ Depth...
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No.........A---------- Diameter....... :........ Depth below inlet..... _5------- Total leaching area...���. ---sq. ft.
Z Other Distribution box (YC)5 DosiV tank (t
~' Percolation Test Results Performed by..__C2.lax�: _ ._l �c .... .......................... Date....2". ."
W m minutes per inch Depth of Test Pit.... O Depth to ground water .
Test Pit No. 1____�? ____ !_______________ ..............ri, Test Pit No. 2...LZ._....minutes per inch Depth of Test Pit.....)J........... Depth to ground water-_ U _ .40
a ----------------------- - ---- - -----------------------•-----------•----------•-•-------•--•-----•-�------------------------•--------•-----------------------
O Description of Soil_____-� ? o�w - ....... ..........................................
v ------------------------------•-------u-=.�------ .... --- ---•- = 1 ( 7_ tt \ ...........................................
W
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
---------------------------•--•---------------------------•-----------•---•--------.......------------•----••---------------------------------•---------•------------------------------•-------•...----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITI.4 5 of the State Sanitary 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.
Signed...................................................................................... ....................................----......
ig Date
Application Approved By------------ ---- --- - « ............................... .......� .....
Date
Application Disapproved for the following reasons:----•--------------------------•----•---------------•-----------------------•-----------•-•------......--_...._
.........-•---------------------------------•------•-------------•---•-•-----------------...-•-----------------------------•---------...•---••---------------------....................................
_ Date
PermitNo.-------!!-. .'1 ............................. Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............OF............ .o....!......... .. ...................................
�ntifiratr of Tumlilittnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ("Aqt or Repaired
by ------------------ -------------••-•-•--------...._..----....._...---.......--•---...........-•-•--•...................--.---
In aller
at..---------- -r ► -----f V-'... ------•---------------•--•------------....._.
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-------y1_._n__l.`6.............. dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........-•----•.............•----------•---........_•---..............---------- Inspector....................................................................................
THE COMMONWEALTH, OF MASSACHUSETTS
BOARD OF HEALTH
........c+C t!L............OF....... /�
No... .._...1.-J.. FEE.....��. .........�..
Bisposal/ arks Tomitrudion famit
Permission is hereby granted---------- / ........ R ------------------------------------------------------••---............-•------•---
to Construct (�< or Repair ( ) an Individual Sewage Disposal System
at No...........ke_T.....�----`"-��---�---�----.�:.Cz.•r-a-�.......... W -�-c-1------- --- ---- - �--� -cx�x�:�
Street
as shown on the application for Disposal Works Construction-.Permit No.__ ..........................................
a
Board of Health T
------------------
DATE__---------- __C.2.. ..................................... ?
FORM 1255 HOBBS*&,WARREN. INC.. PUBLISHERS a�
BAXTER & NYE, INC.
Professional Land Surveyors and Civil Engineers
812 Main Street a Osterville, Massachusetts 02655 a Tel. 508 428-9131
WILLIAM C. NYE, P.L.S. - President PETER SULLIVAN, P.E. -Vice President-Engineering
RICHARD A. BAXTER, P.L.S. -Vice President
October 1.4 , 1988.
Board of Health
Town Hall
367 •Main Street
Hyannis , Ma 02601
RE: Septic -System I•ns•pection
C. Buckler , Ferndoc Street & Joaquim Road_
Members -of the Boa-rd;
This letter is to inform you that the septic system has
been i.nstall•ed at t•he above noted site and is in su•bsta•ntial
compliance with the plan dated February 1.9 , 1987 and revised to
.March 21 , 19.8 8 .
The only item remaining to be done is to bring manhole
frame •an•d covers to •grade.
If you. have any questions or comments please do not
•hesit•at.e to contact this -office.
Very truly yours ,
t hen A. •Wilson P. E.
Baxter & Nye, Inc .
cc : C. •Buckler 4�l► aAg`
Woodside Park. Corp.
���® STEPHEN
'1. ALLYN
1
'vV+!LSOiV h�
?io.30216��,+
e�3a0c� GIs -
MEMBERS OF
CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS I AMERICAN CONGRESS ON SURVEYING AND MAPPING
MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS