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HomeMy WebLinkAbout0034 GENERAL PATTON DRIVE - Health G'34 GENERAL PAT.TON RD. ALHYANNIS AA-3%292 Q 133 : e " l i I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for'Voluntary Assessments Property Address -e v- 14� JCe Owner Owner's Name information is q a� required for every /'/ page., City/Town State Zip Code Date of Inipection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important.When filling out forms A. General Information on the computer, / use only the tab 1. Inspector. // ►�//► key to move your /� Q✓''T I v lJ Pi /ll cursor-do not use the return Name of Inspector key. � v � L? C� Company Name PO �� •, Company Address COs�-�G � :. City/Town � ��J� � State Zip Code i Telephone Num License Number B. Certification 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 C R 15.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority o Inspector's ignature Date The s st m inspector shall submit a co of this ins ection report to the Approving Authority Board Y P PY P P PP 9 nh+ ( .. of Health or DEP) within 30 days of completing this inspection. If the system is a sharedsystem,.6r 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. ? � .-T, C:) ""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. Rif I 151m; 1 ino Tithe 5 Ofrrcial Inspection Form:Subsurface o System•pne 1 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments A.V7 Property Address PI'le M le v- A Owner Owner's Name , information is ✓1 A4 �02. 6 O �� oZoZT111 required for every � page Citylrown State Zip Code Date o1finspecMn B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) Syste asses: 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. Check the box for"yes" "no"or"not determined" (Y, N, ND)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 orexfiltration 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. ❑ Y ❑ N ❑ ND(Explain below): t t5ins•11110 Title 5 Offal Inspection Forth:Subsurface Selvage Disposal System•Page 2 of 17 X Commonwealth of Massachusetts Title 5 Official Inspection Form OEM Subsurface Sewage Disposal System Form- Not for Volunta Assessments Property Address r2wIt2 l/ �j'-- ✓�/C-F Owner owners Name information is 60 �� �� required for every page. Cityr town State Zip Code Date o nspedi B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ 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, setUed or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 t5ins•11/10 Title 5 OfrMW Inspection Forth:subsuAaoe sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments CTe Property AddrI Owner Owner's Name / information is N f � required for every page CitylTown State Zip Code Date o nspedi B. Certification (cont.) 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 fecal coliform bacteria indicates absent 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. D) System Failure Criteria Applicable to All Systems: 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 ❑ ca/ 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 El than depth in cesspool is less than 6" below invert or available volume is less than 1/Z day flow t5ire•11/10 Tdle 5 otricW Inspection Form:Subsurface Savage Disposal System-Page 4 of17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments Property Address Se V/Ce1 /'WW1��✓ Owner Owners Name / 4/4 d_60/ information is � h.4/f / � required for every State Zip Code Date Inspedi n pie. City/Town B. Certification (cont.) Yes No E] obstructed 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. a 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. ❑ [� ny portion of a cesspool or privy is within 50 feet of a.private water supply well. ElAny 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,forIfecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ r,/ The system is a cesspool serving a facility with a design flow of 2000gpd- ❑ [q'/ The system falls. I 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: To be considered;a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. 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 El ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—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 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. 15ins•11/10 Title 5 Official Inspedlon Forth:Subsurface Sewage Disposal System•Page 5 Of 17 i Commonwealth of Massachusetts Titles Official Inspectimon Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owners Name information isQoZ 6 0/ -I required for every ��t 'L page City/Town State Zip Code Date of nspedio C. Checklist 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? 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? �❑ 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: ❑ 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(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms(actual): � e(/ DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms).- 15ins•11/10 TAB 5 Ofrisl Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not,for Voluntary Assessments Property Address &Vqlev Owner Owner's Name information is /�C/7a H Q�z 0/ ?a �i required every d for eve page Citylrown 9L State Zip Code Date of} pectin D. System Information Description: I ' Number of current residents: Does residence have a garbage grinder? ❑ Yes D No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ao Laundry system inspected? ❑ Yes �o Seasonal use? ❑ Yes Q No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): ( Grease trap present? ❑ Yes'❑ No . t Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Isms•1 Vio Title 5 Official Inspection Form:Subsurface Sevege Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for V ntary Assessments )-eljov 2 Property Address • �etM�e✓ � s e�v�c�s Owner Owner's Name informations Qd 60 required for every page Cityrrown State Zip Code Date of Ins pe ion D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General lnforrnation -/ Pumping Records: VP 10 ! Source of information: Wass stem pumped as part of the inspection? Yes ❑ No Y P If yes, volume pumped: gallons ���� G✓ How was quantity pumped determined? Reason for pumping: Type of S em: 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/Altemative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11110 Titis 5 Of ciai inspectim Forth:Subsurface Sewage Dsposei System•Pege 8 0 V Commonwealth of Massac husetts Title 5 Official Inspection Form ' Subsurface Sewag(ee Disposal System Form- Not for VVoolunta Assessments 2 Property Address i�v SSA �e►'v/cep Owner Owner's Name - information is required for every page Cityrro,�n State Zip Code Date of I pedio D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 02 ©p /_ 4&1-1, 7L 610/J, Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): Depth below grade: feet Material of constructi�40 ❑ cast iron PVC ❑other(explain): l 0 Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 2zl- Depth below grade: feet Material of struction: ncrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 1 C G G✓ cf v`� rc LA �- lt4 C;4 If tank is metal; list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No n PV Dimensions: Sludge depth: t5ins•11110 title 5 official inspection Form:subsurface sewage Disposal System-Pape 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form- Not for Voluntary Assessments .2 v� Property Address 2rMl,°✓ � S ✓lam/C2S Owner Owner's Name information is R��/S �� �� 117,;a required for every page CityfTown State Zip Code Date of pedion D. System Information (cont.) Septic Tank(cont.) 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? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,,evidence of leakage, etc.): ll -I p� I✓�S 20� io h . l Grease Trap (locate on site plan): Depth below grade: feet 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: Date 15ins•11/10 Me 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Volun ary Assessments 3 L� 61e✓lorci Property Address d Owner Owners Name information is / G 0V1 1 f A/1 Q'�6 O required for every page City/rows State Zip Code Date of 4 spedion D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (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: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): 'Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 15ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 i Commonwealth of Massachusetts Title '5 official Inspection Form ' Subsurface Sewage Disposal System Form- Not for Voluntary Assessments Property Address Ple v4i e e �e�vicc� Owner Owner's Name /I /�//� information is N/f/-f /p / 102a required for every S page Cityrrown State Zip Code Date of 16spectiAn D. System Information (cunt.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): A/C Pump Chamber(locate on site plan): Pumps in working order ❑ Yes ❑ No Alarms in working order. ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins•11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page U of 17 • Commonwealth of Massachusetts Title 5 Official 1 nspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address �ewl��r Se-�S e✓�lce Owner Owner's Name information is a A,� f A114 required for every page. Citylrown State Zip Code Date oft pedio D. System Information (cont.) Type: Soo �-G 1149 1,1 C�C107 4�r S� e ❑ leaching pits number. ❑ 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.): a�d��► a �� !vze �1 Cesspools (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 ❑ No 15irm•11110 TAIe 5 O@dai Inspedion Form:Subsurfew Sewage Disposal System•Page 13 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Volu tary Assessments P1 �� ✓�e� Property Address /,e;V*"l1-e✓ Owner Owners Name � Ainformation is ,1 4 if Q�(p D required for every page Cityrrown State Zip Code Date of fitspectio D. System Information (cunt.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(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.): ,Sins-1 Ili 0 Title 5 Official Inspection Forth:subsurface Sewsge Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage eeLDisposal System Form -Not for VoluntaryAssessments Property Address 54e L-s- ,Se f//CeS Owner Owner's Name information is G ��f U Qa 60/ C21 required for every page'. City/Town State Zip Code Date of lKspectioh D. System Information (cunt.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where p is water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately t5ins•11/10 Title 5 Otrreiat Inspection Form:Subsurface Se%apa Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title - Official Inspection Form Subsurtace!Sewa'g!e Disposal System Forth Not for Voluntary Assessments Property Address Owner Owners Name information is required for every page. cityr town State Zip Code Date of I pedio D. System Information (cunt.) Site Exam: ❑ Check Slope �� ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water. feet / Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local-Board of Health-explain: 4, ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: 4 C1-e�� I�10✓1 lDV'i �✓ ciYl.��✓- Before filing this Inspection Report; please see Report Completeness Checklist on next page. 15ins•11110 Tdle 5 Official Inspec ion Forth:Subsurface Sewege Disposal S/slem•P89e 16 of.17 • \ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface I Sewage Disposal System Form - of for Voluntary Assessments C7 P1 Property Address ASS Owner Owner's Name, /J l information is .14j-f required for every page City/Town State Zip Code Date of I lion E. Report Completeness Checklist inspection Summary: A, B, C, D, or E checked dnspection Summary D (System Failure Criteria Applicable to All Systems)completed 0211"Systlem Information—Estimated depth to high groundwater ketch of Sewage Disposal System either drawn on page 15 or attached in separate file S i 4 1 i t5ins•11/10 Title 5 Otricial Inspection Form:Subsurface Sevmge Disposal System-Page 17 of 17 I 1/6/99 NOTIME- 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) hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at G�-�Q19L_P�TJ—�/�/ meets all of the following criteria: This failed-:ystem 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 percdia'ion rate is less than or equal to 5 minutes per inch. u There are no wetlands within 100 feet of the proposed septic system JThere 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 lof 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] J If the S.A.5 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) v B) G.W. Elevation +the MAX. High G.W. Adjustment . DIFFERENCE BETWEEN A and B SIGNED : DATE: 13 — [Please Sketch proposed plan of st on back]. NOTICE Based upon the above information, a repair permit will be issued for—3—bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert ,+ 1., �. �$,s r- .. � l AsBuilt Page 1 of 1 TOWN OF BARNSTABLE / �ON SAL042 7W SEWAGE # VILLAGE,/r7`l / S ASSESSOR'S MAP& LOT Y o — INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ZXJa LEACHING FACILrl-Y: (type) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: 3U"U t Separation Distance Between the: I Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by r a$ http://issgl2/intranet/propdata/prebuilt.aspx?mappar=292133&seq=1 6/10/2013 TOWN OF BARNSTABLE , , n LOCATION 3 4�E/V�FR%TM� SEWAGE # 0/ `— VILLAGE / 'S ASSESSOR'S MAP & LOT �o INSTALLER'S NAME&PHONE NO. /r SEPTIC TANK CAPACITY LEACHING FACILITY: (type) r,,g. NO:=OF.BEDROOMS BUILDER OR OWNER PERMITDATE: 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 I ��` �• / 4 Od `'b\.. v � � '� � r n No. 3 Z :sue. . ,' Fee V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes/ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for Mfgpool *pgtem Congtruction Permit Application for a Permit to Construct( )Repair(G')Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No-3( 66A16VL PPMV Owner's Name,/A�ddrress and Tel.No. 39 av6q#C.Wrrw Assessor'sMap/Parcel `y`i" -RIWAR60 ��,L.1118 77 `�`!!'' 6 -q3o- /41 Installer's Name,Address,and Tel.No.B ,� W 4cIOTTC Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 33b gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 6/9LZ6k<1 t[� Ch�i9ih jQ 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 Cocle and not to place the system in operation until a Certifi- cate of Compliance has been issued this Board X11h. .Signed Date Application Approved by Date f'1 ­01 Application Disapproved for the following reaso s Permit No. Z 7 Date Issued J f N.. �' a• ::.Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:. Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 4 Zipplicatibn for Mt!5pogaY pgtem Construction Permit Application for a Permit to Construct( )Repa r(v)Upgrade( -)Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No3S ,aEk0,0L`PPTr6y Owner's Name,Address and Tel.No. 3[/ Assessor's Map/Parcel MAP ,,,,^^ 133 6 _ O` Qq I Installer's Name,Address,and Tel.No.IBPJ �c!/ar7C Designer's Name,Address and Tel.No. ao�REE�P GIIZ(n��sr�5 /1'l ius . ; Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building M— No. of Persons Showers( ) Cafeteria( ) Other Fixtures I.,( / Design Flow � gallons pef day. Calculated daily flow' ' • gallons. Plan Date Number of sheets Revision.Date Title Size of Septic Tank Type of S.A.S. Description of Soil: r Nature of Repairs or Alterations(Answer when applicable)_L/?'77ACL, Q,500 6,19ZZO / 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 issue0y this Board alth. Signed Date —el Application Approved by f Date Application Disapproved for the following reas s f r,Permit No. Date Issued --0 t� .. {` THE COMMONWEALTH OF MASSACHUSETTS ` BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO C TIFY, that the On-site Sewage Disposal System Constructed( )Repaired ((/)Upgraded( ) Abandoned( )by "R,/ 1%0 rT6 at _ u 6&ZaAl an7-101V A0. has been constructed in accordance with the pr visions of Title 5 and the for Disposal System Construction Permit Nol dw dated,:5 —o�S=G� Installer P1191V A�40 r7l Designer The issuance of th=31 hall not be construed as a guarantee that the sy t ill f rio s desig d. Date Inspector No7..Or711—� �. 7 t � �/� 2 ! 2— /j�---------------Fee . )C/ JHE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 't.5pogar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair(LI)ffUp�grade( )Abandon( ) System located at S Q 6!2 � AL 847TC/ i` Q and as described in the above Application for Disposal'System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction ust be ompleted within three years of the date of Date:~ Z R 0/ Approved b a\ Y f l/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) hereby certify that the application for disposal works construction permit signed by me dated J ' —fit , concerning the property located at �j [— P ��/ meets all of the following criteria: y 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 JThere 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] v If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen (14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) ,(] B) G.W.Elevation +the MAX. High G.W. Adjustment. .0 &P DIFFERENCE BETWEEN A and B / -7 s t_ SIGNED : DATE: t — [Please Sketch proposed plan of . st on back]. NOTICE Based upon the above information, a repair permit will be issued for—3--bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert 5 0 l a ; , TOWN OF BARNSTABLE LOCATION 66�&4L PP 7761Y SEWAGE # VILLAGE. &MAI: ASSESSOR'S MAP & LOT_ `�q — ...INSTALLER'S NAME&PHONE NO. A*X YG SEPTIC TANK CAPACITY LEACHING,FACILITY: (type) -,fan NO. OF BEDROOMS BUILDER'OR OWNER A PERMITDATE: 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 200 feet - -of leachingfaciLi facility) Feet ,, Edge of Wetland and Leaching Facility (If any wetlands exist ..within 300 feet of leaching facility) Feet '::Furnished by 6ACK Town of Barnstable Health Department 367 Main Street, Hyannis, MA 02601 Office 308-790-6265 Thomas A.McKean FAX 508-773-3344 Director of Public Health May 20, 1996 Fernando Silva 8 Tyler Road Lexington, MA 02173 i 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 34 General Patton Drive, Hyannis was inspected on May 9, 1996 by Christina Kuchinski, R.S. Health Inspector for the Town of Barnstable because of a complaint. The following violations of the Town of Barnstable Rental Ordinance Article 51 and the Sanitary Code II were observed: 410.482: The smoke detector in the house was not functioning. 410.501 B : The front entrance exterior door had a large gap at the bottom left side i between the door and the door frame. The tenant stated that water comes in through the door when it rains. 410.501 A : The left side window in the living room had one cracked pane bf glass. 410.501 A : The window in the mudroom did not have any glass provided. 410.500: The wooden door frame in the kitchen was splintered and part of the wood was missing. 410.351: The electric outlets in the bedroom at the rear of the house had child safety plugs in them that had been painted over. Tenant had no access to the outlets. 410.500: •The ceiling paint of the rear bedroom was peeling. 410.351: The toilet mechanism was not functioning properly due to the flushing mechanism falling of the handle. i 410.504: The grount between the wall tiles of the tub area were starting to peel. 410.280: The window in the bathroom would not open for ventilation purposes. 410.351: The light fixture in the hallway to the bathroom had no protective globe. 410.500: The paint was peeling and chipping from the window frames in the living room. 410.501: The front bedroom windows would not open. 410.500: The ceilling and wall paint were peeling in the front right side bedroom. You are directed to correct the violation of 410.482 within twenty-four (24) hours of receipt of this notice by installing an operational smoke detector. You are also directed to correct the remaining above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, this violation 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. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PER ORDER OF THE BOARD OF HEALTH '` ` Th�McKean Director of Public Health cc: Todd Sargent ,. iJ t 1 4'� ' F t it " ' l 0,44 PL IS/ C)/ MrAft. ��►-Ka n�o .�i va ,x Lek;A,5-favj, rYM 0.2 / ')3 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 p bra(�-, Ah ow The property owned by you located at was inspected on s- �916 IM by GftkI t2S Health Agent for the Town of Barnstable because of a complaint. The following violations of the Town of Barnstable Rental Ordinance Article 51 and the Sanitary Code II were observed: i Y,e 40''\�4- S+a,+6 '1—( wad-e— Cam t% il%L dm, w L-1 V-04 ex-S'- y/D,sol CAJ 71.e �641 C,,,� o-f- Y-kss> . y l v. so/CpJ 7-h8 0.1 k.LIA.) �s R r q1j) 3� �e �r "r e, ash e � �b - 7Pl �y v� �, �y a4-e use 7'-o ., { - ` ` 0(,D4 (.tJ a�Pl Q Le Lcro 4110. 56)0 /c y yt You are directed to correct the violation of within 24 hours of receipt of this notice by 10 S+C ( <<v�f � You Are also directed to correct the remaining above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of I lealth 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 (lay's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. Enclosed are citation numbers due to violations observed on PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health Town of Barnstable FORM3D Hoess a WARREN,INC.NOV.1979-IM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH N CITY/TOWN — o c DEPARTMENT 36 ? Wa-te ADDRESS w n�, >?/ TELEPHONE Address �� �n�� l�`'�'��f� Occupant Floor Apartment No: No.of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units No.Stories Name and address of owner emarke Reg. Vlo. YARD Out Bld s.: Fence : Garbage and Rubbish Containers: Drainage Infestation Rats or other: Sot L. co STRUCTURE EXT. Steps,Stairs, Porches: rGc,� Dual Egress:and Obst'n.: n ,d-4t22M ❑ B ❑ F ❑ M Doors,Windows: -d" �'D I, Roof 1 Gutters, Drains: p es, A-0 Walls: Foundation: VV-4---, , Chi'mne : BASEMENT Gen.Sanitation: Dampness: ,� r Stairs: Lcw 1 C S „!� 9 Lighting: I _( STRUCTURE INT. Hall,Stairway: / Obst'n.: , _I,.p #1I , Hall, Floor Wall,Ceiling: U" sfr - Hall Lighting: / OR-to Hall Windows HEATING Chimneys: - I Central ❑ Y ❑ N E ui ..Re air TYPE: Stacks,Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: , 1 „ H.W.Tanks Safety and Vent s ELECTRICAL Panels, Meters,Cir.: L/7c& , ❑ 110 ❑ 220 Fusing,Grnd.: / AMP: Gen.Cond. Distrib. Box: w Gen. Basement Wiring: At DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors o r Locks , Kitchen / P , Bathroom Pantry Den 1 V t V-Do YL, Living Room L f _ Y l , Bedroom 1 / _ _ A - � Bedroom 2) D7W I KA -U Bedroom 3 i r l Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: bef1J _ ,,, I r Stacks Flues,Vents,Safeties: , rf1,4,rc Kitchen Facilities Sink wa- C)f Stove Bathing,Toilet Facil. Vent.,Plumb.,Sanit'n.: Wash Basin Shower or Tub: Infestation Rats,Mice Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE-- OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." 1 - ' INSPECTOR A 6 ,l l tITLE �r �A MD DATE TIME `�' P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may.endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of these items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.000 through 410.499 state minimum requirements of fitness for human habitation, any violation has the potential to fall within this category in any given situation but may not do so in every case and therefore cannot be included in this listing. Failure to include shall in no way be construed as.a determination that other violations may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of the violation(s) pursuant to 410 CMR 410.830 through 410.833 nor shall it affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 OIR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shut-off and/or failure to restore electricity or gas. (D) Failure to supply the electrical facilities required by 105 CMR 410.250(B); 410.251(A), 410.253(A), 410.253(B) and the lighting in common area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. .(F) Failure to provide a toilet and maintain a sewage system in operable condition as required by 105 CMR 410.150(A)(1) and 410.300. (G)_ Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by an object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450 and 410.451. (H) Failure to comply with the security requirements of 105 CMR 4110.480(D). (I) Failure to comply with any provisions of 105 CMR 410.600 through 410.602 which results in any accumulation of garbage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of lead-based paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regualtions for Lead Poisoning Prevention and Control 105 CMR 460.000. (R) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or dafety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted .plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilities as are required by 105 CMR 410.351 and 410.352 so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any of the following conditions which remain uncorrected for a period of five or more days following- the notice to or knowledge of the owner of said condition or conditions: (1) lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either operable. (2) failure to provide a washbasin and a shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3) and any defect which renders them inoperable. (3) any defect in the electrical, plumbing, or heating system which makes such system or any part thereof in violation of generally accepted plumbing heating,• gae-fitting, or electrical wiring standards that do not create an immediate hazard. .0), failure to maintain a safe handrail or .protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A) and 410.503(B). (5) failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (N) Amy other violation of Chapter II not enumerated in 105 CMR 410.750(A) through (M) shall be deemed to be a condition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the board of health. ; ] PAR ] Real Estate System - General Property Inquiry] Help [ ] Parcel Id: 292 133- - Account No: 203283 Parent : Location: 34 GEN PATTON DR Neighborhood: 63AD Fire Dist : HY Devel Lot : 39 Lot Size : . 17 Acres Current Own: SILVA, FERNANDO R & MARIA A State Class : 101 8 TYLER RD No. Bldgs : 1 Area: 933 Year Added: LEXINGTON MA 2173 Deed Date : 090185 Reference : 4731/216 January 1st : SILVA, FERNANDO R & MARIA A Deed MMDD: 0985 Deed Ref : 4731/216 Comments : Values : Land: 17700 Buildings : 21300 Extra Features : Road System: 34 Index: 595 (GENERAL PATTON DRIVE ) Frntg: 122 Index: ( ) Frntg: Control Info: Last Auto Upd: 050695 Status : C Last TACS Update : 011287 Land Reviewed By: Date : 0000 Bldgs Reviewed By: ML Date : 0987 Tax Title : Account : Taken: Account Status : Hold Status : Cancel [ ] Press XMT for more data Next screen [PAR ] Action [ ] Owners Name [ ] Road Index [ ] Road Name [ ] Parcel Number [292] [134] [ ] [ ] [ ] I , J �4t Health Complaints 02-May-96 Time: 12:37:32 PM Date: 5/2/96 Complaint Number: 163 Referred To: CHRISTINA KUCHINSKI Taken By: CHERYL PAOLINI DUTRA Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: Number: 34 Street: General Patton Drive �� Village: HYANNIS Assessors Map_Parcel: a-9 Complaint Description: Tenant is complaining that the toilet&sink do not drain or flush properly. The doors are missing bolts. No smoke detector. Water floods in through the front door. Paint is Actions Taken/Results: Investigation Date: . Investigation Time: TTT 1 oFVIE r Town of Barnstable Department of Health, Safety., and Environmental Services snxxsenBL& .039 Public Health Division 9� i63q `0�' P.O. Box 534, Hyannis MA 02601 Office: 508-8624644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health March 26, 1999 Fernando Maria Silva 8 Tyler Road Lexington, MA 02173 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 BOARD OF HEALTH NUISANCE CONTROL REGULATION NUMBER ONE The property owned by you located at 34 General Patton Drive, Hyannis was inspected on March 22, 1999, by Jerome Dunning, Health Inspector for the Town of Barnstable, because of a complaint. The following violations of the Nuisance Control Regulation Number One Regulation and the Sanitary Code II were observed: 410.602: Piles of garbage, old tires, and other debris on the ground in the rear of the dwelling and at the side of the dwelling. You are directed to correct violations within forty-eight (48) 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, this violation 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. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PER ORDER OF THE BOARD OF HEALTH (::_ A. McKean Director of Public Health silva/wp/q/order/Is `7 3 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 BOARD OF HEALTH NUISANCE CONTROL REGULATION NUMBER ONE The property owned by you located at 14 Co vm4 P )Or kl was inspected on Health Inspector for the Town of Barnstab e, bec use of a complaint. The following violations of the Nuisance Control Regulation Number One Regulation and the Sanitary Code II were observed: q I O. (yo1 . . � &A, +� ow + ram., ,. R oc� Z.,� Ad You are directed to correct _ violations within < 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, this violation 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. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health PAR ] Real Estate System - General Property Inquiry] Help [ ] Parcel Id: 292 133- Account No: 203283 Parent : Location: 34 GEN PATTON DR Neighborhood: 63AD Fire Dist : HY Devel Lot : 39 Lot Size : . 17 Acres Current Own: SILVA, FERNANDO R & MARIA A State Class : 101 8 TYLER RD No. Bldgs : 1 Area: 933 Year Added: LEXINGTON MA 2173 Deed Date : 090185 Reference : 4731/216 January 1st : SILVA, FERNANDO R & MARIA A Deed MMDD: 0985 Deed Ref : 4731/216 Comments : Values : Land: 17700 Buildings : 21300 Extra Features : Road System: 34 Index: 595 (GENERAL PATTON DRIVE ) Frntg: 122 Index: ( ) Frntg: Control Info: Last Auto Upd: 050695 Status : C Last TACS Update : 011287 Land Reviewed By: Date : 0000 Bldgs Reviewed By: ML Date : 0987 Tax Title : Account : Taken: Account Status : Hold Status : Cancel [ ] Press XMT for more data Next screen [PAR ] Action [ ] Owners Name [ ] Road Index [ ] Road Name [ ] Parcel Number [292] [134] [ ] [ ] [ ] L0­16AT10N S E W A G E PERMIT NO. po ► (S ll 2 VILLAGE I Oft TA LLER'S NAME b ADDRESS S U It 0 . R OR-, OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED cb � 1 r 1 � II ------------ � 1 6 No....$ ..... Fxs..$...10 .00..._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..............Town.................OF............Aa=Staue................................................... ApplirFativaa for j3hipos al Works Tutu itrurtivaa Vasa t d�r Application is hereby made for'a Permit to Construct (" ) or Repair ( X) an Individual Sewage Disposal System at: . 34 Gene ral .Patton Drive,.Hyannis.,._.MA 026 01 • .......... .... ... ...-•----•••--------------•••••-•.._......----•-------•--•--...................................... Location-Address or Lot No. Jan F�arrer 34 Ge>Qere __ ttQn..I?x,_ -- - ..... .................................. ...lI�anx�.s.,...MA...._Q?.6iD1 A & B Cesspool Owner Address 001 W p Service 128. op Bishs Te) ._-Hy�,rm�..:NA. Q26Qa,. a -•-----•---••...........................•---- ....-----------..........._.......... ••... .. .... • re , ---- Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms................................2............ Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................. No. of persons...1:....................._ Showers (` ) =Cafeteria ( ) PL4Other fixtures -------------------------- -------------------------------------------------------------------- ------=------------------------•-------..__......_... W Design Flow............................................gallons per person per day. Total daily flow.JK......................F...............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. 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........................ R+ ------------ ---------------------------------------- .................................•••••---------•--•-•-----------------•••••............-•-•------- .......-•-----•.----- x W -•--•-•••••..............................................................................•----. ...-----••--------------....._...._.........-----...-------•-------------...............--•-••--•------- UNature of Repairs or Alterations—Answer when applicable..iristallatiorL..of..a._.1,.QDIl..gallon,....szRta.e---tank with all-•new--schedule..# 4..P.Y.0 Rzg�.:.............•-.....------------------------------------.......------------.. ` Agreement: -_-The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance,with the provisions of TI'l12 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 b�the board of healt Signed = 3/21/83•-- . r._ ate - Application Approved B yDate Application Disapproved for the following reasons-.....................................----------------------------------------------------------- ....:••- .....................•-------•---....----•--•--------------•-••--•---•-•-•------------......-•-----------.-----•--•--------•-----------•••---•--•-••---•--•-----•----••-------•----------•---••••---•---- te Permit No....... ....../y/......•..................... Issued-........3/21/83.................nau--•---. Date Y a, Fss.. 1Q.Ola... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH •.............Town.--..-...........O F.............Barnstable---............_-......._.-..-...---•-•---•---•--- _ Z pphrFa#ion for Disposal Works Ton,strnrtinn Frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: .......... Fitfr I} �i@; Ry�$ n1s; �?A 0>?€?di................................... g -•--•----•----...---••----•--•-•---•----•---------••- Location-A ress or Lot No. dart l't� a ........ ____________________________•-•--•---•-•------•- 34•-General--Patito�r••I}r d----Flyat ie—j--?-A-----G221641-- Owner Address W .........•--••• �'•-----...A--�-.A..Cesspool-•�et�lae--•................: i•2&....lshops�-•�'ez�aoe�Aaa��'��..�..-•-42641--•-•---- aa Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms..............................2...........Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons.._.1...................... 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................ 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......................... GT, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ..---•-•._...-•--------•--••-•-•--•••---••-••••••-•••-•-•..........••-••••-••-••-•-••..............•......................................................... 0 Description of Soil.................Safd.............................................................................................................................................. x V = W ••-•••••••••.............•--•--••--•---•---•--------••••••••••-•----••-•-•-••---•••••••••-••-•••••-••••-•-•-••••--•--•.....••••••---•-••--•••••••••••-•••••------•••-•-•••••••••••••••••-•-•--------••_. UNature of Repairs or Alterations—Answer when applicable.__I:netal-lat-ion...©f_-a---I-j00G--g&1.1on----sept-ie••tank ---------w1th all--.near--sehedttl-e--#4d--PVE3---pl-pe-i------------•-----------------------------------------------------------------------•-------____.__________- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersig d urther agrees V lace the system in operation until a Certificate of Compliance has�e n i tied by the bo / _ - — Signed...................................... --- ------------------ .. ....... � !-.. ......_ Date ApplicationApproved BY..................._..................=....................................••---••---•---••••-•-- =---------------3/21/83--••-•- Date Application Disapproved for the following reasons:.......•..................................................................................................... Date � Permit No.........83--.... -................................. Issued..........3/-2J-/$3............................ Date THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEA�LTH. ............... •`,'I'OWPt.-......OF.......... .BEW.Mtable.............................................. Trrtifiratt of Tnmplianre THIS IS TO CERTIFY, That the Individual-Sewage Disposal System constructed ( ) or Repaired ( �� bY-•_--A..&__H-_C.esssp.aol_Bererica,.._12fl_.Bishops...Tsrraca,..Hyannis,___MA-----02L01........................._______________ Installer at......34_..General... at on__D3:1ye.,.._HYannis.---A--._D2.60t__!n..Jan_fir-........................................................ has been installed in accordance with the provisions of TITLE r of The State Sanitary Code as-described in the application for Disposal Works Construction Permit No.__83-__� �____________________ dated.....3-/-2-+.1.�3....:.::_=:r.:::......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE i�HAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............31211$3................................................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OFt3 EALTH 8 ��!! .. ......................T.=..........OF...............Bar stable........................................... 0.00 No....__�-._._.... FFE._.....$ �. Disposal Works Tonstrifrtion Vrrmit Permission is hereby granted...........................A__&.R_-_Cesspoo1-.3e=1ca•----•---------••---•.......................................... to Construct ( ) or Repair ( 30 an Individual Sewage Disposal System at No.........34--(aemral__P.atton_.Dra-,...II,Yannia,-.BA......02601-----Jan__Furrar.................................................... Street as shown on the application for Disposal Works Construction Permit No....83r.......... Dated______________3/21/83........... ----- ....................... '•--•••-••-•••-• - --------------------------------------- DATE - Board of ealth' ` -- ----•••-••-••-•--3.21183...---•••••-••-••••-.._..._•--••-••--•........ .•max FORM 1255 HOBBS & WARR1W-INC°.;�BLISHERS