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Home My WebLink About0005 HIRAMAR ROAD - Health 5/7 HIRAMAR ROAD,HYANNIS A= 292 142 l 4 �y��`�q�}�E� �� ¢ ,, �r• ,. - �;. {�,�` �,�rt;° j {.. ,LL ,. •04'+-ri �,��,� 4: rr fF.,�t.. � + �� S. �• .A �rl ��1. �dp� t I+r �klf � 9 Me, A ph NOW ♦ �Of- v6y�f�r -) Ep7 b f w`#rs „�: � p7r�'rl` �11�' ti�1C'6w. 'd i(tc ,�.• rr� ;.� �r �**N c�.t'yif{E a irk'.! Z y E � F � xb f, + �5E-1.. •a •'' a .tf* � •X '*r�" ��'J� ,�+ r�wiir _�t� a=:��r h'✓s"�:'�t �pv � l r; `�"1..}.'r �,ys>�,'4�-�• +'rMS n q+�s.*''rr3}�� r - `� �"+A'�` a�'• '�y �I}�,�¢ib'.�.�. j .tea+, _k�, ,� I° 41-�i3 � *fl • `x. 'l`+,� '.r �:�, r�lS#y�' 4 Ma-. n.�•ru._ �'�s+, b"+'r �!'S�� Y•'r°'1' i'r4 "" �'' a�, �� +�„�J rY['w j b',��'!�y .' �+ +,n�tK'}fi��\ �".� � •,J d iS � of a'wyb IN f tj°-=�1. -r��' {�� 4 K.i... i �� :1 r. • 1V� �N. r J Ir E� yye '�'. k. . vr. +�. «xPu r £ ti>I 'ztJC ;fir- �y y. }'? 1r�. . r•, ,•rr Y �r �. r • C e•r ��Ta �/�?' v .Y r�- ,.,,�.^.. 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Y „ ,1 j.j%+ . 1 oil • , t* ` ✓ i IN NISI V Y ♦ its 7 �� i i t i ge x - ` cn _ V P=. � ch j f � 4 Alp � � � �i��n�� y TOWN OF BARNSTABLE BAR-w 4813 Ordinance or Regulation WARNING NOTICE / / I Name of Of A m, 0 4, rz 9-K), Address of Offender 0 Dvk 'f�'w - M MV/MB Reg.# Village/State/zip Wo P I U3 /I I M14) - Business Name 1020 am/ �M41) o ., #C Business Address SOfficerdture of forcing Officr Village/State/zip Location of Offense Enforcing Dept/'DivisionOffense/POfl W/S&a Facts l-D kote-5,96�P-CAWS I WA5 lAff G M/rff/ffC- S606 This will serve only as a warning. At" this time no legal action' has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance.. Subse,quen r t viola will. ll resule in o appropriate legal action by the Town. _ WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER I GOLD-ENFORCING DEPT. t?. , TOWN OF BARNSTABLE � LOCATION(3Y7 14,Ap m A r SEWAGE# 98- M-3 VILLAGE H V/Qiy �5 ASSESSOR'S MAP&LOT O �/�-/� INSTALUR'S NAME&PHONE NO. Ro6,n-&)ru S a,i C, 775 c?7 7 6 SEPTIC TANK CAPACITY c A LEACHING FACILITY: (type) Ct'2 -kX-X 3 (size) NO.OF BEDROOMS BUILDER OR OWNER "_ ;S W N a PERMTTDATE: 1019.1 192 COMPLIANCE DATE: 10 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 Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by k � ' C rz �h 1 E No. �� Fee$50 .00 4� - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zippritation for Mizpooal *p6tem Conmratton Permit Application for a Permit to Construct( )Repair(X-�Upgrade( )Abandon( ) El Complete System O Individual Components Location Address or Lot No. lr amar Rd Owner's Name,Address and Tel.No. — — Hyannis MA Lee Tesc-&ni 14 Dr.apper Rd Assessor's Map/Parcel Dover MA 02030 Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. W E Robinson Septic Service P 0 Box 1089 Centerville 02632 Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq. ft. Garbage Grinder(no) 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 Type of S.A.S. Description of Soil sand. Nature of Repairs or Alterations(Answer when applicable) Install Title 5 Septic consisting of 15009 tank, D-box, and four hd maximizers . 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 th' Bo of Health. Signed Date Application Approved by ��..,, Date ttl� Application Disapproved for tollo mg reasons Permit No. 9!Fs� Date Issued No. D 3 ="x» Fee$50.00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �/ • Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLEs MASSACHUSETTS Application for Oigpo5at *p6tem Conotruction Permit Application for a Permit to Construct( )Repair(XN Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 7 H lr amar Rd. Owner's Name,Address and Tel.No. 0 —7 —3 3 3 �, Hyannis -MA Lee Tesc&ni 14� Drapper Rd Assessor'sMap/Parcel Dover MA 02030 r Installer's'Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. W EjRobinson Septic Service - P 0 A.,3ox 1089 Centerville 02632 Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder(no) 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 Type,of S.A.S. Description of Soil sand. Nature of Repairs or Alterations(Answer when applicable) Install Title , 5 Septic consisting of 15009 tank, D-box, and four hd. maximizers . 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 thi o of Health. Signed Date Application Approved by Date 40-1 i Application Disapproved for follo tng reasons Permit No. �� R-:!2 Date Issued THE COMMONWEALTH OF MASSACHUSETTS Tesconi BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by at 5/7 Hiramar Rd. Hyannis has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer W E Robinson Septic Service Designer The issuance of this permit shall not be construed as a guarantee that the systlkm will function as designed. DateL= ��, Inspector t ' v No. - — 3 ---------------------------Fee50 .00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS Tesconi &.5pooal *p5tem Construction Permit Permission is hereby gra ted to Construct( ))Repair(X�Upgrade( )Abandon( ) System located at T7 H it amar R d. Hyannis lns,ta er s W t; hobinson Septic Service 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 must be completed within three years of the date of this permit. Date: o —I Approved by 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 ENGINEERED PLANS) I, William E. Robinson. Sr. ,hereby certify that the application for disposal works construction permit signed by me dated /G `oP-/— q 'r concerning the property located at 5/7 Hiramar Street, Hyannis, meets all of the following criteria: * There are no wetlands within 100 feet of the proposed leaching facility. * There are no private wells within 150 feet of the proposed septic system. * There is no increase in flow and/or change in use proposed. * There are no variances requested or needed. * If the proposed leaching facility will be located with 250 feet of any 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 Elevation(according to the Engineering Division G.I.S. map) d B)Observed Groundwater Table Evaluation(according to Health Division well map) 41 SIGNED: ] DATE LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 20-1998 (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). �. —� �"�, `� � i � � � �— � �.. j ^- � � ��'' N� �1 ,,� �� o�. �� '��', I TOWN OF BARNSTABLE LOCATION ,,�Il I4irtiqMAr SEWAGE # — (-t'3 VIL.LAGE a,A; s ASSESSOR'S MAP &LOT - INSTALLER'S NAME&PHONE NO.Irv'=/Y1 SEPTIC TANK CAPACITY L S(Y) r,A 1. LEACHING FACILITY: (type) �4 C` (size) NO.OF BEDROOMS L! BUILDER OR OWNER _ I e S CC n1 � PERMTTDATE: Jnl;-1 199 COMPLIANCE DATE: i0 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 BACK O� House COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFF Rom, 9 v �p DEPARTMENT OF ENVIRONMENTAL PR CTION ONE WINTER STREET, BOSTON, MA 02108 617-292-5 NO V f 2 5 1998 WILLIAM F.WELD 70H'NOf T COXE Governor (� S � / ecretary ARGEO PAUL CELLUCCI A .STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM £ y Commissioner PART A CERTIFICATION Property Address. 5/7 Hiramar Rd. Hyannis Address of Owner: Lee Tesconi Date of Inspection:f6—'oZG o'�;6 (If different) 14 Drapper Rd. Name of Inspector: Wm E Robinson Sr Dover NIA 02030 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: Wm E Robinson Septic Servi Mailing Address: PO Box 1089 , Centervi 1 1 ,- , MA 02632 Telephone Numbernf, 5 0 8 7 7 5_8 7 7 6 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site�sewwaa a disposal systems. The system: /s Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: Date:The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 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: AI SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. C MENTS: BI SYS EM CONDITIONALLY PASSES: e or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon co pletion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, n , 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, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, 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 25/97) Page 1 of 10 DEP on the Worid Wide Web: httpJAvww.magnet.state.me.usldep C. Printed on Recycled Paper Q, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) ` Property Address: 5 7,Hiramar Rd., Hyanns Own`r � Tesconi Date of Inspection: B) SYSTEM CONDITIONALLY PASSES (continued) � S1.1124UNT" Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed --101 ,pipe(s)�r due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the �*k I� �`Board of Health). Describe observations: -*" broken pipe(s) are replaced obstruction is removed distribution box is levelled 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) FURTH R EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: onditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the ublic 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) S TEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT T SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE EN IRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 5/7 H'r'.armar Rd., Hyannis Owner: c Date of Inspection: /G (-9 D] S STEM FAILS: You ust indicate ei;t;er "Yes" or "No" as to each of the following: 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 e failure. Yes N Backup of sewage into 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 SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _. Any portion of the 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 I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE YSTEM FAILS: You must i dicate either "Yes" or "No" as to each of the following: T e following criteria apply to large systems in addition to the criteria above: T e system serves a facility with a design flow of 10 000 d or greater (Large System) and the system is a significant hr Y tY g gP g ( g Y ) Ythreat to p blic health and safety and the environment because one or more of the following conditions exist: 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 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 requireme is of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 5/7 Hiramar Rd., Hyannis Owner: ` esCOni Date of Inspection:yd—o2 G:- Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Ye No Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks 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. As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. V _ 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. The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. V _ Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)J (revised 04/25/97) page 4 of 10 r rV l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 5/7 Hiramar Rd., Hyannis Owner: T e s C on i Date of Inspection:/!o-m=4— 9 FLOW CONDITIONS RESIDENTIAL: Design flow:46 49 e.p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents:4e Garbage grinder (yes or no): W, v Laundry connected to system (yes or no):,L:s Seasonal use (yes or no):2� Water meter readings, if available (last two (2) year usage (gpd): 9/96 - 9/97 25,4259 Sump Pump (yes or no): A- - 9/9d 22,3059 Last date of occupancy: /d 4 -9 CO ERCIAUINDUSTRIAL: Type o establishment: Design w: Gallons/day tr p present: (Grease yes or no)_ Inclustria lWaste Holding Tank present: (yes or no)_ Non-sanit ry waste discharged to the Title 5 system: (yes or no)_ Water m ter readings, if available: Last dat of occupancy: OTHER: (D ibe) Last date of occupancy: GENERAL INFORMATION PUMPING RECCOoRW and source of information: SysteK pumped as part of inspection: (yes or no)_ If yes, volume pumped: >;allons Reason for pumping: TYPE SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: /,1 aZ4,"9 Sewage odors detected when arriving at the site: (yes or no) 6f 93 (revised 04/25/97) ?age 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 5/7 Hiramar Rd. Hyannis Owner: Tesconi Date of Inspection: BUI IN SEWER: (Locat on site plan) Depth low grade: Materia of construction: cast iron _40 PVC_other (explain) Distanc from private water supply well or suction line Diame r Com nits: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:— ( locate on site plan) Depth below grade:.3� Material of construction: Vc/oncrete _metal _Fiberglass _Polyethylene —other(explain) If tank is metal, list age — Is age confirmed by Certificate of Compliance —(Yes/No) ► y , ti Dimensions: Sludge depth: C� Distance from top of sludge to bottom of outlet tee or baffler Scum thickness:( .1 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle:74_ How dimensions were determined: ,,i tom% SV Comments: (recommendation for pumping, condition of inlet and outlet tees or bps, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) �d G', .d/ ✓o < GREASE TRAP: (locate o site plan) Depth belo grade: Material of onstruction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Scum thickn ss: Distance fr top of scum to top of outlet tee or baffle: Distance fr m bottom of scum to bottom of outlet tee or baffle: Date of las pumping: Comments: (recommendati n for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evide ce of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 5/7 Hiramar Rd., Hyannis Owner: T e s C On i Date of Inspection: TIG TOR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate n site plan) Depth ow grade: Material f construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensi ns: Capaci gallons Desig flow: gallons/day Alarm level: Alarm in working order _ Yes; _ No Date o revious pumping: Comme ts: (conditi n of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (/ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids cjrryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER:_ (locate n site plan) Pumps i working order: (Yes or No) Alarms i working order (Yes or No) Comme ts: (note ndition of pump chamber, condition of pumps and appurtenances, etc.) (revised;04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 5/7 Hiramar Rd. Hyannis Owner: Tesconl t t Date of Inspection/( —;-c--9 SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type. leaching pits, number:_ leaching chambers, number. leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: i Comments: (not condition of soi`l,, signs of hydraulic failure level ponding condition of vegetation, etc.) CESSPOOLS: _ (locate on site plan) Number and configuration: 1 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 (cesspool must be pumped as part of inspection) Com ents: (note c ndition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate n site plan) Material of construction: Dimensions: Depth of olids Comment (note con ition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (reviaad 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 517 Hiramar. Rd. Hyannis Owner: Tesconi Date of Inspection: /O 9 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) G � S 1 y _ t (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 5/7 Hiramar Rd., Hyannis Owner: T e s C Oni Date of Inspection: 16,-o24—q $ Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers J Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) jL�,r j �� if-L'a'• �ov�L (revised 04/25/97) Page 10 of 10 ASSESSOR'S MAP NO. � PARCEL L0CAT10N SEWAGE PER IT NO. A M-r-R-CZ S =PJ k PILL ;GE I N S T A LLfRI NAME i ADDREStS lC L�6aS�Q, QN '--2�t C(r< B U I L D E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED 6, Q G _ 4r A ASSESSORS MAP NO: L 9 No W QJ.L .7 PARCEL NO.: - , .01, Fizi&J." '..:_ `'...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .77 . ............................. Appliratiou for j3iovoottl Workii Tome rur#ion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: ....: .. .. ......................•------•-- ........ --•-'------•-•---------••.. --•---.....---..........................•----- Location-A ress or Lot No. ................... ......-.�-�d�........... ....................................................... Address P'. Insta IZ Address dType of Building �` Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ......................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity............gallons Length................ Width_..............Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2..........._----minutes per inch Depth of Test Pit.................... Depth to ground water........................ PI ----••...--•-•----••-••--•--•-•-•-••--------••••••..............................•------••--••----•--......................................................... 0 Description of Soil........................................................................................................................................................................ U -••----•...--•-•-•-•---•---••••••••.................•---...------••.....-•--•--------•---•--•••------•--•-------•••••••.....---------•••••--•••---••••---••••••-••...----•----••--••-••......---••.._... -•----------------••--------•------•------- •------•------------------------•-•-..._...............-----•... -- sec---- U Nature of Repairs or Alterati ns—Answer when applicable_________ ____ c� . .l.TA4................ 1 --- -4:5:4 f' !�'.C?-.... Z�----------j � C� r� v:�.= ,C., Agreement: �:? 1 I— 7 W !.T k4 772"-),ff, The undersigned agrees to install the aforedescribed jpdjyidual Sewage Disposal System.in accordance with the provisions of TITI.% 5 of the State Sanitary rsigned further a re of to place the syste in operation until a Certificate of Compliance ha een _ o lth. Sig. ed ---•----- -•.................... ............ •-� , 61j!L ApplicationApproved By............... ............. -------------•--------•--• .................... -•----....-•?-fi D to Application Disapproved for the following reasons:-----••-----•---...---••--------------------------------------------------------------------------------------- --•...........................•••--------•--••••••--•••••••••-••---...-••--------•---••---.._..-•-•---•--••........-----•--••••.....--••---••--....---•-•-•---••---------------•-•-------------••-----•- Date PermitNo........................................................ issued-....................................................... Date No.�.1:r......�........ i a�.( .J.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �' v lr`r.................OF........�--...--= P. rU�>t ..... ......----•----------------•------••--------------........._........... ApVliratiun for Disposal Works Tonstrnr#inn Permit Application is hereby made for a Permit to Construct ( ) or Repair ( �< Individual Sewage Disposal System at: ..................................... ..----•------ Location-Address _ or Lot No. ........ - . _ O_wner — { �� Address w P 4 fT d y% "EF4—�i j7 c7 y�J^J Y� b �hl v..w.--.a� ;• 1 � Installer � Address Type of Building - Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( ) a~ Other—T e of Building No. of persons............................ Showers — YP g ---------------------•-•---- P ( ) Cafeteria ( ) dOther fixtures -----------------------•--------------•--------•----.....------------------------ ---•-----•---------------•--------•----------••••----.......-•---•-- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. w WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ LTq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -•--•-••--••-•--------------•-•---•-••--•--•----•-•--•....•-•------•---•-•-------•---•--•-•-•-......._...----•---•-••••-•--••----.......-•-••-•------•••----- 0 Description of Soil.........................................................-•-•-•-•-•--------...------------------------------------•-------------------------...........-•.........-•--- x U -•--••••--------•-•-••-----•••-•---------•-•..............••..............•-•••-•••-•---•-•----------•.....--•------•---•-•---•--••---•••----------•---•--•---•----------•--••--...---------•••----••••. w _ U Nature of Repairs or Alterations—Answer when applicable a: ` ' =`.:=:___ �--------------------------------------------- op, �f� t -- i. "-,..................' L g ` r am .-L 4— L. --= r - Agreement: 1 7-- ' t.�.7 ' $ �F� 1= �,e ,r 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 undersigned further a�rees•not to place the system in operation until a Certificate of Compliance has,been iss ed'byre%board of eah lth. J Sigried eYl w- D to Application Approved By. -• Ms _r p;r1i ?6< - `� 1 --------- ................................................... l_�_: Date Application Disapproved for the following reasons:.............................................................................................................. .......-•-•---•..............•-----•----............-•-------•-•----.....-------••---------..............._..........----...-•---------------•--------------------------------•-••-•-•-••----•-•---•---- Date PermitNo................................ Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................!. a OF. ra — ;1/ .................. ............... .....................E....................................... Tnrtif irate of Tompliattre THIS IS TO CERTIFY, That the Individu 1,.Sewage Disposal System constructed ( ) or Repaired by.................. sJ: :......_._._..................................... "" 4 ..._........_........_.. ..... J / I i Innsttaller at ................ .'�_�,-� _ .__ tr(r,1 r!' -�� . 41 _.._....-----------•-----------------•------.....------------..............•............... has been installAd in accordance with the provisions oT TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No... ....21 ............. dated-------- jl .. '- ...................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FU �T/ION SATISFACTORY. � DATE.................. ..�7,1 ......................................... Inspector...-------- THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH �rt'7 ...................! ..... .....OF....-'. .�. 'K i:..`- <:................................. .............. FEE.............:......... ]Disponttl Works Tontrurtion Permit Permissionis hereby granted.... :=..... -.....:f.. ............................-------------------•--•--•................................----..._.... to Construct ( ) or Re air ( ) an Individual Sewage Disposal System at No.---• 1 !� 1n�!5--.. �`�.- - 1 == ..w,C- .. ............. Street as shown on the application for Disposal Works Construction Permit No.. .f .......... Dated /........................................... .:.....`......._'..U..--.....•.... i, r Board of Health DATE............. t l= L •............................................... FORM 1255 A. M. SULKIN• INC.. BOSTON