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HomeMy WebLinkAbout0065 GREENWOOD AVENUE - Health -- 65-G-reenwood Avenue Hyannis P A = 289 101 I � I� I' r } I� ` D F I; � h I. r p( t I t{, i v c F P No. �2 1 ' O Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpliLation for 33isposal .6pstem Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon ❑Complete System ❑Individual Components Location Address or Lot No. ��� �.� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 7y��3G"Gy�l Installer's Name,Address,and Tel.No. G yvt :Ke.i Designer's Name,Address,and Tel.No. C� �, Sad-77 -G��� Type of B ilding: \t� Dwelling No.of Bedrooms A k Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd 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) 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 Certificate of Compliance has been issued by this Board of He l Signed Date a oc� / Application Approved by Date JJJ Application Disapproved by Date for the following reasons Permit No. 9 : ( Date Issued WIL No. Fee�' THE COMMONWEALTH..,O.F'MASSACHUSETTS . Entered In computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS c Zipplitation for Disposal *pstem Construction Permit f Application for a Permit to Construct( ) Repair( ) Upgrade( ) Ab '< ❑Complete System [IIndividual Components Location Address or Lot No. �j(?ti{y�Ba Owner's Name,Address,and Tel.No. n ..�. , 77y-83L•GY6� ' Assessor's Map/Parcel,V & -1 4 Installer's Name,Address,and Tel.No. //0Fj2,.4 :Ke", Designer's Name,Address,and Tel.No. Cone- C, s'vg-776, Type of Biuilding: �S Dwelling No.of Bedrooms /" jk Lot Size sq.ft. Garbage Grinder( ) Other. Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures p_ Design Flow(min.required) w gpd Design flow provided A gpd t 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)_��T t S �.►� I ice) fie'C.4 _ e v t/'' z* , Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system mi accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He Signed _ Date Application Approved by !� Date 2 J Application Disapproved by Date ` for the following reasons !�L' �Np� Date Issued� Permit No. • COMMONWEALTH OF MASSACHUSETTS - r¢' BARNSTABLE,MASSACHUSETTS, Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandone )by !a Ac ��� —C/l f . - _ at S j/f— ds� jjye__ 4 yawn,L:5 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. (' (�''dated t f 2 Installer A�� �— Designer #bedrooms l" Approved design fl,.00' gpd The issuance of this permi shall not be const -ed as a guarantee that the sy to tnfLi 'ion as design . ::� Date > j!/�/ ( ,_ Inspector ------------- No.. ��l, "1 1 Fee 7 r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( )) System located at 6rC dV^t�G1#01 v V.- and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. t �� Date I ILA I Z( Approved by � c Town of Barnstable Inspectional Services Department • RUMSTABLE - Public Health Division MAM 0,jo- � 200 Main Street, Hyannis MA 02601 Office: 508-8624644 FAX: 508-790-6304 Thomas A.McKean,CHO March 2021 Jair F. Souza 65 Greenwood Ave Hyannis, MA 02601 RE SEWER CONNECTION°D:EADLINEXXPIRED> 65 Greenwood Avenue, Hyannis A= 289401 Dear Property Owner, Your sewer connection deadline has passed Please contact the Public Health Division Office to provide an update relative to the status of property's 'connection to public sewer (i.e. contractor name, DPW sewer connection permit number, anticipated connection date.) If you would like to request an extension, such request must be in writing addressed to the Board of Health (200 Main Street Hyannis, Massachusetts) or e-mail Sharon Crocker at: sharon.crockerktown.Barnstable.ma.us within fourteen(14) days. Sincerely yours, �L- o-)— Karen Malkus-Benjamin Town of Barnstable Health Division Coastal Health Resource Coordinator karen.maikus(cD,town.barnstable.ma.us � I S�:z 1 AsBuilt Page 1 of 1 r TOWN OF BARNSTABLE LOCH-nON CAwdod SEWAGE # VILLAGE,MlaAol-s ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.�OtIC c R• rown SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS Bbl& e;�aR OWNER �2a_OIe16f�. PERMUDATE: • COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Furnished by 4 OFFICIAL INSPECTEON FORM-NOT FOR VOLUNTARY ASSESSMENTS g()MNIPACE SF,PIAGF DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(toetleeed) .. preycrry Addrw:63 Geeeeood Aw alma Owwaar'e Noma Gm d— _ OwarliAddreas; .. - Dete ofta �lR6W _ SorTCU Op SZWAGZ DISPOSAL SYSTZM _ aaMeAofihn—ardiWWrymm twl°dmg d*0Xm p ymapmak:•t.aam aft wets wuaia too fact Loam MEae P6 war �t 13 t-a 7' 4C g3-s3 CA-tit' 03 C.3•-38' ° s o a http:Hissg12/intranet/propdata/prebui It.aspx?mappar=289101&seq=1 3/2/2012 McKean, Thomas From: McKean, Thomas Sent: Wednesday, March 08, 2006 10:08 AM To: Taylor, Madeline Cc: Weil, Ruth Subject: 65 Greenwood Avenue HISTORY In 1983, only three bedrooms were approved for this property. The building permit was issued for a five room house (three bedrooms maximum). In 1985, the Board of Health adopted a Regulation restricting the number of bedrooms to 330 gallons per acre per day. This site is restricted to the existing three bedrooms; no additional bedrooms would be allowed. Sometime around 1992, the basement was finished into an illegal apartment according to a complaint letter in the building department files. However, this property is only 0.25 acre located within a nitrogen sensitive area. No additional bedrooms would be allowed according to the State Environmental Code, Title 5, because this is such a small parcel within a nitrogen sensitive area. On July 21, 2000, the failed septic system onsite was repaired. RECOMMENDATION TO DENY APPLICATION It is my recommendation to deny this application for five bedrooms at this property. 1 Town of Barnstable Health Inspector OF'THE Tp� Office Hours y�P� do Regulatory Services 8:30—9:30 Thomas F. Geiler,Director 1:00—2:00 saxxsrwac.E. "9. ,.� Public Health Division TED �s Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-63C AMNESTY PROGRAM APPLICANT- SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: Address: #MNA01 Map G� Parcel I D I � Name: 6k7g— ... Phone #:ffljq "ov0 2a. How many bedrooms exist at your property now? 2b. Are you,planning to add any bedrooms? N If yes, how many? 2c. How many bedrooms total are proposed at this property (including the amnesty unit)? 2d. Please include a copy of the floor plans for the entire property - showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label . each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES cr ONO f_ Ifatl7e dwelling is,connected to pulalic sewer,skip,quesons##4 through#9 below, s 4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells W p) 5. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER? 6. Is a disposal works construction permit on file? YES or NO 6a. If yes, how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES or NO .8. Is there an engineered septic system plan on file at the Health Division? YES or NO t 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO ' ------------------------------------------------------------------------------------------------------ -- FOR OFFICE USE ONLY o. The Public Health Division has no objection to 'J" le rooms at this,property. Special Conditions: ' Signed: ,__.. Date: O;/health/wpftles/amnestyapp r 1 rvg,qo-t Ott - -- -- - I GN�O�19NIA17 -10 n 1 � Uti t tIiIIII i ID A I-Auivolcygoom T . Mway f °Ft► r°,,� Town of Barnstable Regulatory Services + BAMSPABLE, 9 MAN. Thomas F. Geiler, Director �A 079. ♦0 lED MA'S A Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 September 29, 2005 Mr. Jair Souza 65 Greenwood Avenue Hyannis, Ma 02601 Re: lower level apartment in a single-family district To Whom It May Concern: . After inspecting the premises at the above-referenced address, I found that the lower level of the home has been converted into a apartment. Reviewing the files it appears that the area in questioned has been an on going problem even before you purchasing the property. In order to correct this matter,you can convert the space back into a single-family dwelling by removing the kitchen and bedroom(s) or you may apply by application through our department for a Family Apartment(copy enclosed). Please contact this office within fourteens (14) days from the date listed above. -Sincerely, Russell Wheeler Local Inspector of Buildings Cc: Tom Perry, Building Commissioner David Stanton,Board of Health ♦ )I '� r r�,yy a +",� - -!x_. � �*':v'�,3 [n.. .,. r ex � „ a. �• I �u.� l�r.•aea �a A" i 7 t . �. '� �'` is- .7 i +►'" a Y - M Oni" of ne r "•-# d� F f iN ,� � m0.r�J� 1 t,� Apo-, � . a ew 41 } f ", i i _ �' ;♦ sip!F. I ' 33 ! - , ..Te _ jji`b4 . -' ■ 7�F'` r .F ter. _.. � :.. .. If R. a��d. �f 4,fir�r .. { r 0 side, �renw©od Ave, Hyanri'is, septic,tank cover 'DS , ` ry'' , �� _r•" y .rv'"� �, f��.. _ k . 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'7 e� �t?�i� �'t- _ a7t Jr• •t i �4 =sn • ` 1 (�fi{� .'� �'{�`� o 'r �•-:._ v c :+y r � Q 0,3 3 y R , o , • S't y 'q u.. �, Y� ��h ���q�f 4•^�"TN 9u"S. � � ��� J•', � r G it a k §[w j $Y` 's�' i€�PT+'�*�i x �5'-�.,'ti:�,g�r:sri a w * �� � � �.�k•- ,ey' °4� .t6 !c�'�";, r�i ' 't �.� N�'ay¢r' �•.,'m x.-�# .x F,. �-+'F'. 7*''�' 3"�yr. .,9 f �, .:lJ J ,•, wz... yf R.: �" d..�. *, 5� * �� t:�, 5•.. � a °� { ''� 'fn� tR' ,€ 'r� _Y� t ,, y •.�^w r �-'ax .�a 4 r �`�# x `�'�. � �:.' Yd �:'� �a, ,^.� '1 "rys'F�' ..s . ��.i �+ •6 ANC.. '� 4 A 155 — - - - Imo; CARBON MQDXIDE ALARMS MUST BE IN,TALLER PER SSACHUSEAi Bt]XD I EVA EWED laP,i NS r •`ALE BUIL ING DEPT. DATE G1 7- 3C:D20r�.� ��T1ENTFig DP6ATH12 0OM */DA E . nsiRES A,Plc REQUIRED FOR PERMITTING a' IGITG E 3ATNtZO0�t7 r ATTENTiON: c i .ASSACHUSETTS LAW REQUIRES 0�! CARBON MONOXIDE DETECTORS IN ALL RESIDENTIAL.DWELLINGS. /57 ITIO ADD N � _... TO_THE FIRE ES ECl IE , THE 'NST LLAT'ON OF S �-P�M6j(4. O DETORS, IN A ,CORDANCE WITH CMR 31.0 WILL.BE i n r rs l3UIL.DING P IT - G. �`�- �S3 so171-111 Y5 4c LV1NC-1P O/v, AV Xo(L f K I T-GH E:N s L) 1 ZI ry )Q-ooM Q3 i � 75 %2 77 f 4 l i •-i Certified mail: 7003 1680 0004 5458 3466 r , Town of Barnstable Regulatory Services an� mass>acN. Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 September 30, 2005 Jair Souza 65 Greenwood Ave Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE. On September 26 2005, Health Inspector David W. Stanton, R.S. and Building Inspector Russ Wheeler investigated a complaint regarding overcrowding at the property owned by you located at 65 Greenwood Ave, Hyannis. The following violations of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage was observed: 310 CMR 15.352: Increases in Design Flow to System. Seven (7) rooms were observed being utilized for sleeping purposes. This is an increase from the septic systems approved capacity at this location for Five (5) bedrooms only, permit number 2000-431. This property is located within a zone of contribution to public water supply wells, and a nitrogen sensitive area. No more than Five (5) bedrooms maximum are allowed at this property. You are directed to correct the violation listed above within thirty (30) days of - ur receipt of this notice, by eliminating two of the rooms used for sleeping purposes so. a total of only five (5) rooms are utilized for sleeping. You must obtain a building' permit to eliminate the privacy of a bedroom by removing a wall or by installing a minimum 5' cased opening without doors to eliminate the privacy of a bedroom. The "TV Room" in the basement shall be converted back to a "TV Room" by removing the two beds from that room. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance will result in the issuance of a non-criminal ticket citation of $100. Each days failure to comply with an order shall constitute a separate violation. PER ORDER OF TH BOARD OF HEALTH 7 _7L3� -�r1�� Thomas A. McKean, CHO, RS Director of Public Health QAOrder letters\Septic\65 Greenwood Ave,Hyanjdoc 1 COMMONWEALTH OF MASSACHUSETTS t A�d i EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION �a a \y 4 y+^y TITLE 5 OFFICLkL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 65 Greenwood Ave Hyannis R Owners Name: Gaudette Owner's Address: �-•pry - t Date of Inspection:5/26/05 S2 Name of Inspector: (please print) Douglas A.Brown C0m08nt,1NT8me: Douglas A.Brown Septic Inspections `= Mailing Address:P.0 Box 145 c -' Centetrille,MA 02.632 c,n } Telephone Number:508-420-4534 -- CERTIFICATION STATEMENT I certify tlydt i tiave 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: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector-'s Signature: Date: 5126105 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving, authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. Thug 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 Revised on 16/31/2000 r Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SLIUSERFACE SEWXGE DISPOSAL SYSTEM WSPECTION FORM PART A CERTIFICATION (continued) Fropert-y X",rns: 65 Gceenvwd Ave Hyannis Owner's Name: Gaudette Owner's Address: Dare of Inspection: inspection Summary:Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information winch indicates that any of the failure criteria described in 3 10 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 Pase'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 following statements.If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health, *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pa&%u1sq muL if(withaggrovat Qf the Board of Health): broken pipe(s)are replaced obstruction is removed Page 3 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SURSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 65 Greenwood Ave Hyannis Owner's Name: Gaudette Owner's Address: Date of Inspection: 5/26/05 C.Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _the system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone I 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 systempasses if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of..the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 64 Greenwood Ave Hyannis bwner`3 Name: GrmYdette Owner's Address: Date of Inspection:5/26/05 D. System Failure Criteria applicable to all systems: You must indicate "yes or no to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool K Liquid depth in cesspool is Iess than 6"below invert or available volume is Iess than 1/2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. K 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. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. k Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] NO (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 3 10 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• You snuaJ iudi-cate eitbax"yes"ax w to each of the following. (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered yes'm 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 Page 5 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 65 Greeneood Ave Hyannis Owner: Gaudette Date of Inspection: 5/26/05 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks ? X _ Has.the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X Was the facility or dwelling inspected for signs of sewage back up? X Was the site inspected for signs of break out? X. Ware all system components, excluding, the SAS,located on site? X _ 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? X 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 X Existing information,For example, a.plan at the Board of Health. X _ 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 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM INFORMATION Property Address:65 Greeneood Ave Hyannis Owner's Name: Gaudette Owner's Address: Date of Inspection. 5/26/05 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 5 Number of bedrooms(actual): 5 DESIGN How based on 3 10 CMR 15.203 (for example: 110 gpd x# of bedrooms): 550 Number of current residents: 0 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NA ®,� � s_(��{ - 3'3,CM� Seasonal use: (yes or no): NO OrA Water meter readings,if available(last 2 years usage(gpd)): &-/9~C �2 Sump pump(yes or no): NO Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow(based on 310 CUR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): _ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): NO If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system awner) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 2000 A.B.CANCO Were sewage odors detected when arriving at the site (yes or no)? Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 65 Greeneood Ave Hyannis Owner's Name: Gaudette Owner's Address: Date of Inspection: 5/26f05 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTICTANK:_ (locate on site plan) Depth below grade: 0 Material of construction: X concrete metal fiberglass polyethylene _other f explain) — —If tank is metal list age: _ Is age confirmed by a Certificate of Compliance(yes or no): _(attach a copy of cettificalo Dimensions: 1000 gal Sludge depth: TRACE Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: TRACE 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.)- chambers were opened and are dry at this time GREASE TRAP;_(Jocate on site plan) Depthbelow grade:_ Material of construction:_concrete_metal fiberglass_polyethylene_other (explain): Dimensions: Scum thickness_ Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(Qn_pumping recommendations;inlet ari&outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert;evidence ofrl,eakage,,etc.): Page 8 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 65 Greeneood Ave Hyannis Owner's Name: Gaudette Owner's Address: Date of Inspection: 5/26/05 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan; Depth behswz grade•. Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capa(,it�j•. gallons Design Flow: gallons/day AAdarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of las,Wniping. Comments(condition of alarm and float switches,etc.): DISTRIBVTION BOY: (if present must be opened)(locate on site plan) Depth of liaid level move outlet invert: 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of )eakage into or out of box,etc.): PUMP CH&MI RFI>t: (locate on site plan) Pumps in narking order(yes or no): Alarms in working order(yes or no): Comments mote condition of pump chamber,condition of pumps and appurtenances,etc.): '1 Page 9 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 65 Greeneood Ave Hyannis Owner's Name: Gaudette Owner's Address: Date of Inspection: 5126105 SOIL ABSORPTION SYSTEM(SAS): _(locate on site plan,excavation not required) If SAS not located explain why: . Type 1 leaching pits,number: X leaching chambers,number: 4 A/2/r / x 1 leis.,&q galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: irsYsaati�tefalternati�ae system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): chambers were opened and are dry at this time CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-tap of liquid to inlet invert: Depth of solids layer: Depth of vaam layer. Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Cemmeshs�uote condition of soil,signs of hydraulic failure,level of pending,condition of vegetation,etc.): J PRIVY: (locate on site plan) Materials of construction: ` 'Dimertsio�s I Depth of solids: Comments(note condition of soil;signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 65 Greeneood Ave Hyannis Owner's Name: Gaudette Owner's Address: Date of Inspection: 5n6105 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. C _ Li 03 C-3 `36j p ` 0 Q Page 11 of 11 OFFICIAL INSPECTION FORM-' NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM ] INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 65 Greeneood Ave Hyannis Owner's Name: Gaudette Owner's Xddress: Date of Inspection: 5/26/05 SITE EXAM Slope: Surface water: Check cellar: Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: TOWN OF BARNSTABLE LOCATION 19:5 K .4Ike, SEWAGE jo VILLAGE 1 S ASSESSOR'S MAP 6z LOT INSTALLER'S NAME PHONE NO. A & B CCAD= 775-\6264 SEPTIC TANK CAPACITY ,/AQ:2(J �i��/lam reny) e- LEACHING FACILITY:(type)41 Al. �►, size)�oZ X/�al o� NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER O OWN _0f? InLAWled< DATE PERMIT ISSUED: ® -too' DATE COMPLIANCE ISSUEDz VARIANCE GRANTED: Yes No W -C 4� � y- �, `�� �� � � K, 1 _.r"� r TOWN OF BARNSTABLE. LOCATION� /Pet&,)�, t�.�eyJ 4 M SEWAGE #: ' VILLAGE %S ASSESSOR'S MAP & LOT. f INSTALLER'S NAME & PHONE NO. A & B CAW6' 775-6264 SEPTIC TANK CAPACITY ,/j9Q0 4//ZK) .CGX%S4 r[,' J LEACHING FACILITY:(type) 4/ 614 ellm► 6eeysize)6/ X/3af p1 F NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OC DATE PERMIT ISSUED: © OV DATE COMPLIANCE ISSUED. �- S. VARIANCE GRANTED: Yes No 7. 3y - i 1 i 1I i f No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: \ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2ppficatfon for Mfgpogaf *patent Con5truction Permit Application for a Permit to Construct( )Repair( ,)<pgradeq( )Abandon( ) 0 Complete System El Individual Components Location Address or Lot No. &S 6_1^.cre,�lw6 �ry Owner's Name,Address and Tel.No. Assessor's Map/ParceI a g 9_ /0 1 GM �ocQy 6(Yats It Installer's Name,AddressA-&(BNrANCO Designer's Name,Address and Tel.No. 350 Main Street /VIA uV. Yarmouth, MA 02673 Type of Building: Dwelling No.of Bedrooms 57 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number"of sheets Revision Date Title Size of Septic Tank /ooy eci r6'k% Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when ap licable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of th. Signed Date 7- �'a Application Approved by ZJ Date `7 ZI T wW Application Disapproved for the following reasons Permit No. 'U.y"y—4 3 1 Date Issued TOWN OF BARNSTABLE LOCATION 09 f �6PP�AJ UtJ(Y>� AW, SEWAGE # y r VILLAGE I S ASSESSOR'S MAP 6z LOT INSTALLER'S NAME S& PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY /&VO 41/6K) LEACHING FACILITY:(type) �.�/. �_,t/AM�Sc��size)�/ozX NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER O �/�e DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No i I No. �.�� Fee .5 U / V THE'COMMONWEALTH Entered in comuter:OF MASSACHUSETTS P # Yes �c PUBLIC,HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIPPItcation for Migooar *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( 4pgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. k Owner's Name,Address and Tel.No. r Assessor's Map/Parcel a 8 _ / 1~f'yCIM VtA.0 _ ` Installer's Name,AddWs1%n j§TeJnl C0 Designer's Name,Address and Tel.No. 350 Main Street �I W. Yarmouth , MA 026ZR Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ioo o e r;rr Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Ulf C✓�4 /Pac/7 erAf/Y1LJC/ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of�eqth Signed i Date Application Approved by crz Y. Date Application Disapproved for the following reasons Y Permit No. _Zff� `y 3 1 Date Issued /' Z -Z,6,� --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS ,Z gc�J ��� BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( ' Upgraded( ) Abandoned( )by 0 at Gdu ) r A L,� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.U71 �l I dated 7 t! 7.trUJ Installer Designer The issuance of this permit all of be construed as a guarantee that the Sys in ill function a desi ned. `' � iDate r � Inspector � �--� — No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwtopooai Opotem Conotruction Permit Permission is hereby granted to Construct( )Repair(v-1'6pgrade( )Abandon( ) System located at ( S� f e r c,,c%o 5�7 Y-17 1 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 completed within three years of the date of this permit. Q ` ' Date: Approved by �--'/ R t 1/6/99 NOTICE: This Form`&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) , f 1 i 1 hereby certify that the application for disposal works t construction permit signed by,me datedF 7- a I _ c, , concerning the ; property located at (S '`�S✓-ce�t>ZAI"d /1C,4t meets all of the following criteria: "0 ° 1 The failed system is connected to a residential dwelling only. There are no commercial or business ¢ uses associated with the dwelling. S ✓• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system ✓• There are no private wells within 150 feet of the proposed septic system v"o There is no increase in flow and/or change in use proposed • There are no variances requested or needed. The bottom of the proposed leaching facility will not be located less than five feet above the maximum.adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] If the S.A.S. will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: i A) Top of Ground Surface Elevation(using GIS information) 3y• S B) G.W.Elevation +the MAX.High G.W. Adjustment. g;1. DIFFERENCE BETWEEN A and B SIGNED : J � ..,.,,� DATE: ?- J f• w o [Sketch proposed plan of system on back]. 9 health folder:cert ,r f; 1 \Y a i V j! F I 4 _ o 0 _v_r�LS?f ra } _ zg av 1E3 RECEIVE® JAN 1 G Z003 TOWN OF EiAr (STABLE t HEALTH DEFT. y ' "� bf° g Fp � a 0-RINI`�%. OT 0 ���S.x'B.s Y�S=`�C.�.�.. OFF MAP 2�9 < < Name: r PARCEL '. - LOT 23:'ct3 cxL'cia�.S`: 4 a �h l � r CERT IFIC 10 s �"v'L�2�S�"c`-^v'-",_,r,,�'+-$+°J.'"..r-�.:il�•"�.,.,""cy+r 't''?�-v rt �'w3._' `a=-�,;�:F^T- .. ==cte as wf tom--*t me LS -i s' =`=.�= Fr" tile_,_rQ L,_ isF.� cma a and<m S.T'rcmamcce�of Sri Sewage.iiTs'3C53�S�'CT-'vf'�.2 2a�� 3 ' £3?`s Cr$i� � ;vF tss: =TTe s '-s :,£ '5-34,�!' �z Tit- ^?gi' � ?^r �'s° Tie-$Ly-��?= �aSS� .. cl—dzdom-^a.:?V passes A`TI`"_017-i_ Fails 's Signature: y,i 3:4 ia°tS of GCixxi ffi 335 4n i >� S S_'cww Svr: ' L'Z= c j�5: fS T i3=>it; 3. :.=gpd --TAT.,y"V' L.r w'�4 i. S aem ow -si�?,!a $thmrz,the re—punm 5e" i0 2 S*S O,'v: � i s '�� S S': O_i_:suye , -T az �� _ems+' t n B y i z Ncmes'and t�.tis:sTe'-e.ts s*�z-� .r`?': 3»`gi; ' 4m5 f *}ma's i ^cws z"��- 3 �� s ? vt This% � �� �3 e�i ad —'�how fie mar-,11 penfer �r'a'`°�s?����thes'e�a�aa 33�sa '"��s s ,may i SUMUIR—FACER SEWAGE P�FA. I AO Deft a bspecda-a-- a Sim com�'.� �y pG. = t0—e ar More sys—m. compa.memm pa.:$'ed- lie�,"�"�7!;�sT.t cc'Yr?-ple '-C3i�L'�'`�'a."'��I�._+E�t,"-mast L?i 3=:cS -.�'�'V•"G vl Boat Y-.5_TICS or i_`3i� 2 a�r%,%N�RD)k z'he 50T h 1�3'�loow' 5—e z"�i.win'3- a t�i Tile 5e#m alai S'c...iT over MV j e rs 0;6-Q,.-the �(WI.-r°�her me 0 or wfl`s unso': d `s ��s.0 m Or �'i�'G3�:5�%£ 'J" •, `2.'.'a immbeum—''..i'y'mT Vries pass"sp if— m ema:Se3G t4 w -g=',�.• c� g i z5 stn1 aL"T �d= zci the T,e.---_k is es ?s�`i'lot r - Ob 5�`;tS" �zp M •a"e,' :x,.i. pipe(s)or xw$lz".�en.seMe ...M B se s -DsY /'f r """�'�,u'�3i,,�,,.�v F?��-A�>'"-�•:��,',�""..�''�' ����L �..�'',� aSC vi(with apix 1'a .7'ti of�nt,* i V L`JSa,.z: NY t1 Lm: s - 01 FOR V OLErTN AIRYOFFICLAI AR :��.•�s" �-:�-�-�� �wR'�mac.: o 4— s - 2_ y e �•e- � w C;dizc"ms e'°.4-v aica reqri:-5L.w x�F+�Y` c$d`{�1 ii CC Ci's' u __Jim i£d, a'3icz?3Z T"� Z? hi tnvimmmem 4_ Sl'Ss.-'g^._i Ca Lei 4 wd CAL 63p� .c YL's�1t is...RL.lZiG"�-c�.Y' vA:P .. i5 �.V`�ll�+..-�„.vt the ram_i_.is�3 �11�F2:s�Ym Gam.�T^i''_.fl'Sm-,4-- WhichTi''�L>�l�'�o..w.: ✓�$Z 9'�w�GSZK..�,���',t�L.�i'.S�T.the Stre'm wiLl La} ei3=rC:i tie B�:as d of th Pal V;02ter 3c"ppli'£.k',ff auy)deetermines tt-ml,the system m Is 2��2T`�a�:�-y'that' - "be;Dablk healer Safety z—md envi a°._`--'Y2.s- Svfss'`":has a s-"-Fti—,U- J:� �°"SSOxvi2t� S aT(Sis-,znd:see SAS is S iEC d cT C � ..�rhz S AC S vr_ !G__ ;3i c The Sr-x has a.. and,SAS sc`it1 thz-SAS is yc-_c=; 50 tom' ez of,a vivzm v.-41— Z is4 C v�31:-� _ic acsaa=d SAS aad.�&AS is l�a�Lz F :� iw'y1 ei�i.�l�J _�..�:�l is+.C'3� ��'�. a T.t�well wa..a maa �S,p»'lic:s:. a=,±;..Y Cam' ' ,�i t--:i'» _"'s_1 �^�> -- ^'- • a smr�i:3vm `3...-.f_'£%-wv or PSS this=.5 Ppt:_, - ift� c i_ A^�i5�'oft:--am;=—t Rs i�=.'M xm W .a�'_e- i� t�z 'l^"�T' Ctber. 4�M .iL` -'-LAi - A 'APE -um. f s ue.• z f 2e of. U� Yon — 4 �Ly :cs � �..�- .des. �"''�".:L:�.rc.�..� =i g�..t�.x.�'���13T. �t�••3.; �"YT��'� �«�"L�^.�J�i �- _.ems a�.'s'�''a..,($S� --��'Y 3'`�`"„�,�'"C�' ��`ce'. ��`-�✓.S h v-�`'.'�s.�3i..��s� of �s�l.. or privy -A^Y -,?cesspow-'r^��p6npy�'+Vr"s."`` 19 .�,aer�. b Uic .._...._ .,� ^r`'-�'-'�-iL�'.C3i 2�vs` E.S��.�'¢�,�a i'���c�.' ��Y."k'..��yy� "•-��''-�?`..�=r'�'��"vs���. sys*e-m�e ids 2,r�^�L'• "4�e G. ws .r�,�.,�'�:�'��.�' .+7 35 a".--i av oz-kw 5 '_� be sysxsx tm the�'$ 4 �-"�.r"z�;��,`-'+�_'�3_��"�f`w 3...�C.-5�• s=Gf?�?�'��*��N"'� cr"'i-y,�-> Uri Sic G_....aw+~Y' "�•a ` :3'a`�'...-"_^."""zi=�s '�c'«�rr-�,•,�--' zG — 4:0 S�,r�q•--'s�+` c'. ay -:'+'..it�e syz—,.�m-3seds .�'�'-rr�^ �.-•«. G�' x"a...ti : �Y`r`'.V'-s ,t " � ' �Ste' €•- V* T Tr^ '"c!1 �- ear-;01 11 jl' 'd""' .£S .g' ' 3 ,Y_-- 0'i "'C..R"iT00U,NT;!URY,cg.sS,Sx&SI.hiZ.tu'O•' S . S SUPI A EI SEWAGE DISPOSAL syl-ci��U-N-SPuw=11-ON FOR F1 B CHCKIJU d cb,11--FL if Me ivy22>N�'�w -�.i�:.vas=_V rJ::"-..r�`'T'3��n.wi-"..3'a."b�S-'d�'�S7'��to ;-t3T he T_Ol!q_ v--s-a es -No _ ..�_y ,—=s provided�v_S�'y ov., a .s �•��v.�c_.io s�4 a �eal-ch in =era v� :lac uIe SySCz—_­rece?Ved T=omma( L-'-_ in the Previous¢-o ----dC pe —_ . 'vVene zs b* 2 M`?s vfzhe s vim'v'bmiz'Ied and ems?s Y i et`ism^c az><c'd iG e nth'-as�s T as- _.._ 3^C's,'reilms .nu��ed T T_Signs of SLVxage back up� Was e 5sie I;nS ?Ce~ °xI-or Si^�»� 0t SL'ea.K£..F;? �+ Jl f:ere Z{ syv_— " �'L;ne-IT_S, X£`'-''_ding:..'`e SAS,iocatmed^z site 'hroe:e the 5.�`T_-—k M—als.:-aleS Ci?Sf�E"�.'', r tee_^yzc_s?"sh?e irae:ior of ti:...-e mnk ire_pe'S.. ^r`_-he Won2�..jocn C L-,-ig2_r'lieS t}_'ice. ...I•Z:M-Ila= Of G.z?�':�TJ^, T?L'z �'�?�+�L'�:'n L` ��C:. <t�' �Oi S'si?r�and depth 3i S"ss:n vi25 if� cam_.i> c`�^e�(and -he and:lom-ton%;t-_Scill Al bsorp-t-ora stem(SAS-) he Sale bas b.5'-d ca- es n ,.n_s-azi3O:3. .v-+".+a—_Ty=Cy''- 'r - r Fa "it+Xir z+ II t5'sr. f T�.1"'S�:e??s:.the melt^'-its any Ci�"ie ��'�z2'L'C;'?T_�'i f�c`:�SL'='2�- �- or � _ M v Z Q d - F ION, No vim --im ' ss n f L s� a in as "? -of- env _si ^- 0 Cesspool Tight vvpy of i T ;TAR-Y : �C.l?.s�j�'-� � FOR'_ � SUBSURFACE �rGd-eOACI)00 u�'. 4 belo v ;made - �,�-;s„ r.<rd�.:.:; -c��r S`�..t 'Geed Or t..+.'�Lcz".'`zit ir"'-.>L. _ .L SiC:: Y' �'��',L'LC" �.f�,;..,.E Y✓�"�L'' ��` ��r�-S?4G T,��`3V.Q"3zy=L-••r'_•'�• j.^ - 0,7 ..�.>i ni'•-ter- Zrrt"i? COD',Yes �i s age I LT i✓3i�Jt'S: L 00 ct, 04 or _ J5 D$szcice t �".`.G�m r'i�"dkuu-,.:L'---,t-.'�,Tm£y>'/ti�'_'sw v x; 1�-- flow were 'eak65 v aid €nt �arc{�T.; or✓ za a" r3iY. u:�c1 _S iPt�" wrtt e i aw to d of > n}/c(� en—c""L a33a�/��IIIIXXXX � ;tip pj C F C3 Su'LsG'�On� _TC+ii s w ET �acsG:,�: _ s Rrce S vM.taP Of Jam.' ,<ECS Q'c� or baffle: s i-niez and omip-:let vi a—Me coo! :Liam Su 3%a^,z--a . id Dam of last ppvmping� �vm�*'en Iv srS V `1a vZzi��i r�3� mel..w4�ry lei .c,. G•�...;- i VW 7 OT z �+'✓ Erj, �R `c' i..�3 -URFACE u 's ry P,,; 4 SON i :"., ovy -a leveh co �+..aa""Ys va ":-S�JiI+'"_tC_ a.z':.T�•^.s^'•:v,+' 2i4'�"3{.�:z.:, 'G £WSik 3isis v_ i ;—fie isv'��?U :?' 7. ¢j 4Dr so): . i z - FOR3'' ; ° ASS - :.0'n'�_-ice'` Y: i=S rams: &4r.iii8— �SION is SAS O 3 T�- ieaca 5oi s,is—OE_., �y-•«�-�'�'b'�:J..tiFL:.tS.±�i t - - -t ,y, t`_ S,z C1 w s le C '`.:.��?•^.:.sngi signs v^'_byrd-mi3Y�:a:�z , '_ r,:.vi- � GAA�t!p 1a[E,Jb/�1J asp ; s ; - On De^yi 4 v soiids la�". Depth of ��e s5i2's33 o /f low f yam:^_no)- ixs pia_ Tt ':C 3 �,,-t-�+�.a•s- (},y r'�'a�" •--_ � rjiL �..�i"rw i�-.J?z 3`�i.��•�r^�*.,,;R u'3'iiwt^:.^.'a=`v��' -_ yv.�.Ta-c�S'-.$£.�.:{�1'G4 f.�Yi �`L..ram Si'.'...-.'fir" `'s-•_�L:S G'.� . - og sot. c�:r yr1-Rc i;c ra i'v �F, --i i orka peg tj PCMG- - ,30 i f I of �- - lZa > 4 G yS 9 aherC t S.Tw">fC,_3.": vTi'3'i'-t_rS l-i•"L".L.a. �t?4'C.�. .. :wC:1 ii. - �r...w.�f' ' �.s�.S:�' 9 tom.. ...._ i �ir�. sy�—.i Ga' �L��.2.':��'.iT.y oz- :a ' .:. ry .. > �3v V m23ci fjc-w you e5tab'=5'v`the high ground W2ivs e evat2v_"_ TOWN OF BARNSTABLE LOC".":ON ecc'lc'idod -4ye SEWAGE # VTnLLAGE W04,01V-5 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE N0.—boycl.a's R• row SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS B OWNER aa4io%-,4-tL-- 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 / OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS I SUBSURFACE SEW AGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:H a Ave Y Owner's Name: Gsudctte Owner'aAddress: Date ofUspectioo:5726/03 S[4ETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to az least two permanent reference Ia�mads a bencbmatks.Locate all wells wuhin 100 feet Locate where public water supply codes the building. Al-3 u t G '1 aS-23 03 G3�38' A � o q 2 o j r` O , r i V AL - CommorlweaM of MO=' Chusetts John Grace -Executh/e Office of ErWor mer'ttal Affdrs D.E.P. Title V Septic Inspector Department, of -= - =- P.o. Box 2119 _ Te MA 2536 D EnYronmental Protection (508).564-6813 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A '�+ CERTIFICATION. A&C E 65 Greenwood Dr. annls Address of Owner: .Property Address:. HY - _ - �. 15�9� W _ Date of Inspection:8l919B (If different) dD lay,_ Name of Ins pectoT:John Grace Mrs.Eck. Company Name,Address and Telephone Number: r. CA CERTIFICATION STATEMENT true, a accurat e w s reported be low i the sewage disposal system at this address and that the information p certify that I have personally inspected g p Y Ic P Y and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper funct ion and maintenance of on-site sewage disposal systems. The system: X Passes _ Conditionally Passes _.Needs Further E aluation By the Local Approving Authority. Fails inspector's Signature: , Date: 819[96 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B.C, or D: A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated.are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair, passes inspection. Indicate yes,no, or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined",explain why not) The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiltrabon,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved , by the Board of Health. (revised 11115195) One Winter Street • Boston,Massachusetts 02108 •-FAX(617)556-1049 • Telephone(617)292-5500' SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) - Property Address: 65 Greenwood Dr.Hyannis - Owner:-. Mrs.Eck - -Date of Inspection: - _ Sewage backup or breakout or high static water level..observed in the distribution box is due to a broken, - settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed _- distribution box is leveled or replaced _The-system.required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): - broken pipe(s)are replaced obstruction is removed 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool,or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has,a septic tank and soil absorption system and is within a Zone 1 of a public water _ supply well. The system has a septic.tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has aseptic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria volatile.organic compounds indicates that the well is free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm. 3) OTHER D] SYSTEM FAILS: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure: Backup of sewage in facility or system component due to an 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 cesspool. SAS is in hydraulic failure. (revised 11115195) 2.. - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued). Property Address. 65 Greenwood Dr.Hyannis. - Owner: Mrs.Eck - - Date of Inspection:8/9196 p] SYSTEM FAILS(conttnued) _ - Static liquid level in the distribution box-above.outlet invert due to-an-overloaded or clogged SAS or,cesspool. _ 'Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. _ Required pumping more than 4 times in the last year-NOT due to clogged-or obstructed pipe(s). - Numbers of times pumped - - Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. _ Any portion of a 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. privy is within 50 feet of a private water supply well. Any portion of a cesspool or _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no well has been analyzed to be acceptable, attach copy of well water analysis for acceptable water quality analysis. If the coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 1o,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area (IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11115195) 3 _SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM _- PART B -CHECLIST ----- - Property Address: 65 Greenwood Dr.Hyannis - - Owner: Mrs.Eck Date of Inspection:819196 Check if the following have been done: - x Pumping information was requested of the owner,occupant. and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been.receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ x As built plans have been obtained and examined. Note if they are not available with N/A. x The facility or dwelling was inspected for signs of sewage back-up. x The system does not receive non-sanitary or industrial waste flow. x The site.was.inspected for signs of breakout. x Alf system components, excluding the Soil Absorption System, have been located on the site. x The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees,material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. x The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. tv evis 1 II (r ed 11! 5f95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _ PART C SYSTEM-INFORMATION Property Address: 65 Greenwood Dr.Hyannis - Owner: Mrs.Eck -- Date of Inspection:819196. _ - _ - FLOW CONDITIONS ... �- R ESIDENTIAL: - _ Design flow: 330 gallons - Number_of bedrooms: 3 Number of current residents: 1_ - _Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes — - Seasonal use(yes or no): No Water meter readings, if available: Na Last date of occupancy: nta COMMERCIAL/INDUSTRIAL: Type of establishment: rda Design flow:a gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system: (yes or no) No Water meter readings, if available: n/a Last date of occupancy: n1a OTHER: (Describe) Na Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped in the last two years System pumped as part of inspection: (yes or no)No If yes,volume pumped: 0 gallons Reason for pumping: n1a TYPE OF SYSTEM X Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes,attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known).and source information: 1985 i Sewage odors detected-when arriving at the site:(yes or no) No - (revised 11115195). SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART C - SYSTEM INFORMATION(continued) — - Property Address:. 65-Greenwood Dr.Hyannis Owner: Mrs.Eck Date of.lnspection:919196 -- v - - -SEPTIC TANK:V X _ (locate on site plan) Depth below-grade: 4' Material-of construction:X concreate=metal FRP_other(explain) Dimensions: L S'6•H 5'7"W 4'10' Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle: 24' .Scum thickness:6' Distance from top of Scum-to top of outlet tee or baffle:6' - Distance form bottom of scum to bottom of outlet tee or baffle: 12' Comments: (recommendation for pumping; condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage, etc.) Septic system is structurally sound.Recommend pumping system every two years for maintenance. }} t GREASE TRAP: (locate on site plan) Depth below grade: Na Material of construction: concrete_metai_FRP_other(explain) Dimensions: n1a Scum thickness:n1a Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle: n1a Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) nla I (revised 11115/95) . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART C SYSTEM INFORMATION(continued) Property Address: 65 Greenwood Dr.Hyannis _ Owner: Mrs.Eck Date of inspection:819196 TIGHT OR HOLDING-TANK: - - (locate on site plan) Depth below grade: Na _ Material of construction:_concrete_metal FRP other(explain)- Dimensions: nla _ Capacity: n/a gallons Design flow: n1a gallons/day Alarm level.- n1a Comments: (condition of inlet tee, condition of alarm and float switches, etc.) nla DISTRIBUTION BOX: x (locate on site plan) Depth of liquid level above outlet invert: Liquid level with bottom of pipe Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.) D-box is structurally sound. PUMP CHAMBER: _ (locate on site plan) Pumps in working order.(yes or no). Comments: (note condition of pump chamber,condition of pumps and appurtenances; etc.) nla (revised 11/15195) vSfil 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _ PART.C _ SYSTEM-INFORMATION(continued)- -- Property Address: 65 Greenwood Dr.Hy"s Owner: Mrs.Eck Date of inspection:819/96 SOW ABSORPTION SYSTEM (SAS):X -intrusive methods) (locate on site plan,if possible; excavation not required,but may be.approximated by non If not determined to be present, explain: nla Type: - _ - leaching pits, number: TT_coo gallon leach ptt _ - leaching chambers,number;n1a leaching galleries, number: n/a_. leaching trenches,number, length: Na leaching fields, number, dimensions:nla overflow cesspool, number:n/a Comments:(note condition of soil,'signs of hydraulic failure, level of ponding, condition of vegetation, etc.) The sas is structurally sound and functioning properly. CESSPOOLS:_ (locate on site plan) Number and configuration: n1a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: rda Dimensions of cesspool: nta Materials of construction: n1a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection) n1a Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Na PRIVY:_ (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: nta Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PrivyComments. (revised 11115195) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -PART C SYSTEM INFORMATION(continued) Property Address: 65 Greenwood Dr.Hyannis _ Owner: Mrs.Eck _. _.Date of Inspection:819196 SKETCH OF SEWAGE DISPOSAL SYSTEM: — include ties to at least two permanent references landmarks or benchmarks locate all wells.within-1001 - 50 o DEPTH TO GROUNDWATER Depth to groundwater. 12 feet method of determination or approximation: USGS Maps and Charts (revised 11115195) 9 LO-C AT ION SE GE PERMIT N0. to VILLAGE IKSTA LLER'S NAME i ADDRESS 1,6 Up t U IL D E R OR OWN ER � O AT' E .PERMIT ISSYED "�__�_,��� DATE COMPLIANCE ISSUED a � 1 �s 0 r � . i G 1 1 1 LA I" jig � 1 I W 30.................. ......................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH -- ............OF...... i/.. 8 ......................... ApplirFa#ion for Dispas ai Vurkfi Tomitrurtinn Prrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal SSystem at ,�cc ..... .................................5 •......------••----•--•••..._.......... .�3�-•.............•---•--................. y7 Location-Address or Lot No. ¢- ... ...... aA�vRsl S- »»..., /` SJr Address Installer Address d Type of Building Size Lot__ ®® ..Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers 1 — Cafeteria Q' Other fixtures ............................... ... W Design Flow............. ................... ..gallons per person per day. Total daily flow.......... 3®.__._........._..... WSeptic Tank—Liquid capacity-/Wa.gallons Length. .G'.... Width.50C."K°_'._ Diameter................ Depth..r. _y x Disposal Trench—No. ....................Width.................... Total Length.................... Total leaching area....................Sq. ft. Seepage Pit No......... ..:......-Diameter......AP ..... Depth below inlet.......4......... Total leaching area..?-7-----sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1.4... ....minutes per inch Depth of Test Pit--- `..... Depth to ground water........."".......... Test Pit No. 2L..Z.....minutes per inch Depth of Test Pit.-/` ....... Depth to ground water...."................... ------------------------------------------------------------------------------------••---................................................................... -° Z4" 7`a S®�c. � Lv' -'`� . r.cam....s O Description of Soil- ---- ��......`-... ------------------- U ....................... •---•--•••--•---------------•-----•-------•-•-•---•--------------------•--•----•-----------------------------•--=------------------------------•--••-•---•-•-----•-•--................................. U Nature 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'T'_YT4, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en issued by the board of health. Sign ..... ... ------•---• Date Application Approved BYlefollowing ...'-................................................................... Date Application Disapprove o reasons--------------------------------------------------------•----------------------------------..Da e............. ------------------------------------------------------------------------------------------•--•------- Date PermitNo......................................................... Issued-....................................................... Date o._ , .= �.............. _ Fss, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........f..t.—!. ✓.............OF...... ��t/5-T // ,�__...................... Appliration for DiopuoFal Vorko Toatotrurtion tirrmit Application is hereby made for a Permit to Construct (L-- or Repair ( ) an Individual Sewage Disposal System at: • — •............................................................. ..... ....-•-•-•------......._................... --------•--•........._..__..........•.... Location-Address or Lot No. 7. . �iC'/ji�i------....................;✓� C IG .J CS /� ��r/ I.s/oa t� ...... �ti.si S .. -••••.................--•--•---.------ ..........--............................................ --• .�•-••-----•..............-- Owner' Address W Installer Address UType of Building Size ........Sq. feet f Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building 1 a yp g ____________________________ No. of persons___.__......._...__..__.__.. Showers ( ) — Cafeteria ( ) Otherfixtures --------------------------------......................_.............................................................................................. W Design Flow..........._4Z .......................gallons per person per day. Total daily flow---------- - �...................._gallons. W Septic Tank—Liquid capacity Cgh:a..gallons Length�__ ....... Width._:'4.�.... Diameter................ Depth................ x Disposal Trench—No. .................... Width............ Total Length.................... Total leaching area___.................sq. ft. Seepage Pit No..................... Diameter.....ZP. Depth below inlet......-'_.......... Total leaching area.j�l.7......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1 z:...Z .....minutes per inch Depth of Test Pit.. !fi-. Depth to ground water........................ 44 Test Pit No. 2f5.-_Zn.....minutes per inch Depth of Test Pit.Z!f!.......... Depth to ground water-___ '.............. 0 •------•-•---••------•--•-•-•---•--•--•••-•••-•---••-•••••-•-•--••--••-•-•................••-----•••......................................................... Description of Soil....K>...- 1 '4- J v v�c � G.a rs-ry 2 EI '�- 5i G f7C zv t% ^/C x -------------------- -----•----•-•-----------------•---••---------------------------------- --------- U ... iG /r,74 ' 17"le 5. r ir-10 -------•-----------------------•--•-----•-••---•-•-•--------------...---------------•-----•--------------------------------••-----------•-••--------------------•---•------••---•....... W ------------------- ------------------------------------------------------------------------------•----------------------------------------------•----------------------------•••••••................. M. Nature 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 TTT1E 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. i ne g �..� w D •- C Date Application Approved BY Date Application Disapproved a following reasons--------------------------------------------------------•---•----------------•--------------•---••---••.......--- .................................................••-------------•-------•--------.......----••--•--- -•-•---•---•••--•-•••--•----•----...---•••••---••••--•---••-•••-•-•-•••----•••-•-•-•---........ Date PermitNo......................................................... Issued................-... ................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............... ►�/f✓.......OF.........!1! ;-. i!.'.).�� CC .........•.......................... wn ifiratr of Toutpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (L--�'or Repaired ( ) by... ........r...........I................. r ....................................................................................................... Installer at --•---------------------------•------------ . has been installed in accordance with the provisions of ; TLC 5 of The State Sanitaraoa . e- ibed in the application for Disposal Works Construction Permit N �.�_�.�_-�............... dated _ ......................... THE ISSUJ N E OF THIS CERTIFICATE SHALL NOT BE CONSTRII AS A GU RANTEE THAT THE SYSTEM Wl NCTION SATISFACTORY. DATE..... Inspector... •--- -•----------.-•-•-------------•---------------------------------•-.----- THE COMMONWEALTH .OF MASSACHUSETTS BOARD OF HEALTH ry . .. ... ...................... FEE.... ............... Diopooul Works Tonotrttrtion rrmit Permissionis hereby granted--- ........................................ ------------------------••--•-------•....------.......•-••••..................--•••- to Constr or Rep ' ( ) an Individu SevTposal System at No�.�.�'� 1r! CS ............................................ Street as shown on tVapcatio for Disposal Works Construction Permit No........ . ate ........ ................... r Board of ealth DATE--- �' ......... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS SNIT / of Z sNE�T� 1 � 1 ti3 1 OF 6 1Q"� �rV 7'flp of P.¢opos _ O 23 1AD1 1 -1 ZI O S&-PWC I // /o o ca►cN O n,,u�c 4z� � � q � ,�•p �'o EXisrl�vC- ELCV. 7bp of CON e. —-- TvW/v Wq y Al woDO A1/ENv E w.a�c S TE RL,,9 Al SCALE /'�=3o DArr TuGy /B/�iB3 l�LA� .2BF: ,6&-7Av G G n7' 3 3 , yS S/<oWiv ON 3t OF i9 �G4'v Fo.fe� �: le /E, f-�.i r v 6 ° ��D NRva N• BACoN .eEco�eD� PZ-84 38 PG. 9/ T C--A¢T/GY 771H'r 7;•1E P/zo�os�D TPW6Z4,1A1G +r SNoWni oN Tl/iS PL4+v Cv�/Fae�73 Yb 771E 0�+f•81�ti 5671g•9e nG �G7yv/2��s irS aF 7y/Er' 7V Wn/ aF BA�e�✓s7/98C /CfIA2D G�CMG- A? Py��. L4rvD Jt AZVd'yoK SHt-�T Z �� Z sNE�TS TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS •': 4' CAST IRON 12"MAX. MW77MM12"MAX. • • PIPE (OR 4"ORANGEBURG(OR EOUIVA T EQUIV.)— MIN. PIPE- MIN. I LEACH PITCH 1/4"PER. PITCH 1/4"PER.FT. PIT PRECAST ° LEACHING o' NVERT ' e EL..2,7..53.. INVERT INVERT : . ��; PIT OR SEPTIC TANK �,S DIST. > S;; EQUIV. e INVERT EL..7,,Y•.. . . . BOX EL.Z -r ' : >x /coo,. ., GAL. INVERT � iv a :� " o; EL.z3.�3.?r.. vL INVERT W W .;.. 3/4 TO I V2 EL...r...• do u WASHED STONE ,,,' �o s � I{�._ (� `• ter.,i�.co :.: 6'DIA. —f� � PROR LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE SOIL LOG WITNESSED BY : DATE .��?7.�e3... TIME:! � i JAcp43/, BOARD OF HEALTH TEST HOLE I TEST HOLE 2 S7 "f��u !e.f/At.C, $, ENGINEER ELEV. . 24.Cc. . . . ELEV. .I!�Co. . . ALG7� •loo� 8 IN T-,z7ewAvr DESIGN DATAtt. ZZ40zz.Go 3 NUMBER OF BEDROOMS r1.`D�F�Nt' SgvD SA"'� TOTAL ESTIMATED FLOW :33Q . . GALLONS/DAY 96" Lit. AC440 9t BOTTOM LEACHING AREA . 7A-fq. . SO.FT. /PIT Si K.0 u .SIDE LEACHING AREA . .11619- -0. . . . . SOFT/ PIT Five `ivE GARBAGE DISPOSAL (50% AREA INCREASE) S.4+ep Ss►+�o TOTAL LEACHING AREA SQ.FT PERCOLATION RATE �S MIN/INCH LEACHING AREA PER PERCOL�47" ON kArE . c3.. SO.FT Na .WATER ENCOUNTERED NUMBER OF LEACHING PITS . APPROVED . . . BOARD OF HEALTH 7�!4 •'��` •G!`�3rtwC o�! .9G .S/ ;� DATE . . . . . . . . AGENT OR INSPECTOR �nr EDWAR OF Sq LoT 33 . . . . . . . "` mp1A9 a �o PETITIONER