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Home My WebLink About0017 HIRAMAR ROAD - Health 17=19 1 ramar Road Hyannis F/R A = 292 139 'i e �C3 i. • O m0 C3 0 F F I C I A L U S E �j ErCertified Mail Fee OSM, � $ Extra Services 8 Fees(check box,add fee as approprtate)Retum Receipt(hardcopy) $aRetum Receipt(electronic) $� ❑Certified Mail Restricted Delivery $O ❑Adult Signature Required $ ❑Adult Signature Restricted Delivery$ O Postage � Total Postage and Fees r Sent To r=1 Jo I L L' C C3 Streeta r 11ee-- -- --o ---- ox . ................................................ Apt.N No or lyp. 7 >11 CityAat-.-T.. .............. .... ..... .. . ,.,.,. �� 02- 675 Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this,., delivery. USPS®-postmarked Certified Mail receipt to the •A record of delivery(including the recipients retail associate. - signature)that is retained by the Postal Service— Restricted delivery service,which provides 1 for a specified period. delivery to the addressee specified by name,erg to the addressee's authorized agent. Important Reminders: Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which •Certified Mail service is notavailable for requires the signee to be at least 21 years of age, intemational mail, and provides delivery to the addressee specified:1 ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mail service:However,the purchase (not available at retail). of Certified Mail service does not change the •To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark If you woulQlike a postmark on •For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for F, the following services: postmarking.If you don't need a postman on this -Return receipt service,which provides a record •Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply F., You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt;attach PS Form 3811 to your mailpiece; IMPORTAM:.Save this receipt for your records. Ps Form 3800,AprO 2015(Reverse)PSN 7530-02-000, 7� ` OfSFIf l� A Town of Barnstable BAR"STABLE ` Inspectional Services Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 r January 7, 2019 Jon E. Stetkis 113 Nottingham Drive �� Of— Yarmouthport, MA 02675 NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNST-ABLE BOARD OF HEALTH REGULATIONS,NUISANCE CONTROL REGULATION NO. 1 The property owned by you located at 17/19 Hiramar Road was visited on January 7, 2019 by Timothy B. O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted in response to a complaint. filed with the Public Health Division. The following violations of the Town of Barnstable Board of Health Regulations, Chapter 54 Building and Premises Maintenance were observed: 54-5 Storalle and Removal of Rubbish, Garbage and Refuse A large amount of bags of household garbage, bottles, trash and other assorted debris were observed on the back of property. You are directed to correct the violations within fourteen (14) days of receipt of this order letter by removing debris from property. 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. However, these violations must be corrected within twenty four hours regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of$100.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OFT ARD OF HEALTH oackVan, R:S. Director of Public Health , Town of Barnstable Citizen Web Request Page 1 of 3 e g 4 Monday,January 7 2019 Application Center Logged In As: oconnelt Citizen Request Application Logoff Route to Users Search Requests Create Requests Request Information Request ID: 59877 Created: 1/3/2019 8:54:17 AM Status: Assigned To Staff Assigned To: O'Connell,Timothy Health Office Anonymous: Yes Request Category: Chapter 54-5 : Rubbish and Garbage edit Routine work: No Estimate: No edit Date scheduled: edit Estimated 1/17/2019 Change Estimated Dec January 2019 Feb Completion Completion Date: Date: _ Y r30 r3l Tue Wed Thu Fri Sat t _ 1 8 9 10 it 12 15 16 17 18 19 20 21 22 23 24 25 26 — — — — — — — �'' 27 28 29 30 31 1 2 — — — — — — — 3 4 5 6 7 8 9 Created By: Soto, Kathryn Priority: Medium edit Health Office Citation Numbers: edit Requestor Information Requestor Request DETAILS: LOCATION: 17 HIRAMAR ROAD Hyannis, Ma 02601 Request Parcel Number Map: 292 I Block: 139 7 Lot: 00_ 0 See forwarded email regarding trash. -- This property has not been registered in several years. Parcel Lookup Email: Edit Requestor Information Track Request Progress http://itsqldb/CitizenRequest/WRequest.aspx?ID=59877 1/7/2019 Health Master Detail - Page 1 of 1 s fer Logged In As: TOWN\oconnelt Health Master Detail Monday,January 7 2019 Application Center Parcel Lookup Selection Items I Parcel Septic Perc well Fuel Tank i Parcel: 292-139 Location: 17 HIRAMAR ROAD, Hyannis Owner: STETKIS, ]ON E 1 Business name: Business hone: I Rental property: ❑ Deed restricted: ❑ Number of bedrooms 4 Contaminant released: ❑ Fuel storage tank permit: ❑ Save Parcel Changes Return to Lookup Parcel Info Parcel ID: 292-139 .�.�..._.� ...�� Developer lot:LOT 64 Location: 17 HIRAMAR ROAD Primary frontage:60 Secondary road: Secondary frontage: village:Hyannis Fire district:HYANNIS Town sewer exists at this address:No Road index:0723 Asbuilt Septic Scan: 292139 1 Interactive map Town zone of contribution:AP (Aquifer Protection Overlay District)State zone of contribution:OUT Owner Info owner: STETKIS, JON E Co-Owner: streets:113 NOTTINGHAM DR Street2: city:YARMOUTH PORT State:MA zip: 02675 Country: Deed date:11/5/2009 Deed reference:C189989 Land Info Acres: 0.27 use: Two Family zoning:SPLIT RB;HB Neighborhood:. 0104 Topography:Level Road:Paved Utilities:All Public,Gas Location: Construction Info[Building NdYear Boil.,Toss Areallivincl Arealsedroorns Bathrooms 1 11945 11476 11440 Bedroom 2 Full-0 Half Buildings value:_$84,300.00 Extra features: $1,200.00 Land value: $85,600.00 http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=292139 1/7/2019 Legend Road Names 9. r yy 2 11''a ✓ r t f �a CA.'• �wM q•�.s..r *?�Y,rr"#'7�'dl' "' jj d"'a, '' tY. •, 's ,. ea-w -e Y - � ) , ,ems �. 'a #` ��•a f' 1.1 -. A'I`y��t Lpo F 4d•. _ ..° � � :.._,,.,,,,,..,,w..-�a. ->�. -w'4 , }SA�-� ,rr.-,_�„1; �^wwe. ..1aru..-�. T - 'ka ,I M C� t, -�G3 �tl ~v#"" ,�r ,a m,,...m...m,s.............. ..x.-.... .L��f��7. _.r. •...r... -... -�.:.,.d, ��it � ... ,- -.-..—.,.., ..-, �. -_- G7 v" 9 ' F n,.N„�.�,�^�,,. ""� � _ — y � �'�Ate' ^,K-�' �" 1' � # � ' r ��, �� •��.�' a o = x Aw `'4 101 Slow � Mb'i' °lr"+t'® �yl Ll t ti a' .b)D V Map printed on: 1/7/2019 This map is for illustration purposes only.It is not Parcel lines shown on this map are only graphic Town of Barnstable GIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.They are Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA 02601 O 21 42 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the map 5o8-862-4624 reflect current conditions,and may contain such as building locations. Approx.Scale: 1 inch= 21 feet cartographic errors or omissions. gis@town.barnstable:ma.us TOWN OF BARNSTABLE LOC4:ION / 7 / // ,,-,A 2 SEWAGE #Zaa 3 11 VILLAGE �'��S ASSESSOR'S MAP & LOT I'Q2 — 1 3 INSTALLER'S NAME&PHONE NO. A&Z W"'o T SEPTIC TANK CAPACITY / S` LEACHING FACILITY: (type)��3(v C (size) �7'�6 X // �►' NO. OF BEDROOMS BUILDER OR O R �� "� 20 y✓ PERMIT DATE: 114 03 COMPLIANCE DATE: 1 O Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 a No. V 3— Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: L.," Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,Zipplication forigogaY *V)AAbandon etr� Cor��tructfonerrnit Application for a Permit to Construct( )Repair( )Upgrade(. ( ) ❑Complete System ❑Individual Components Location A dress or Lot No. Owner's Name,Address and Tel.No. Asse or'sMap/Parcel a 3 __] & rdne Installer's Name,Address,and Tel. o. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building D e 4C X No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �� gallons per day. Calculated daily flow / F gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) /s0 o T 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 s Boar Health. Signed Date Application Approved by 4 Date / Application Disapproved for th following reasons. Permit No. 206 3' �ut� Date Issued / U t _, „ z } Fee THE COMMONWEALTH OF.MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION TOWN OF BARNSTA BLE,.ABLE., MASSACHUSETTS Zipprication for Migaaf 6pgtem Construction Permit 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. Asse os� is Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 5-OT 53 Type of Building: Dwelling No.of Bedrooms • 14/ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building Dv2/g X No.of Persons Showers( ) Cafeteria( ) Other Fixtures C — Design Flow G/ gallons per day. Calculated daily flow /Ji gallons., Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. ,--� Description of Soil Nature of Repairs or Alterations(Answer when a plicable) Date last inspected: Agreement: The undersigned agrees to ensure the constructIfied 6aintenance 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_by4his Board f Health. Signed 4 f Date /3 Application Approved by S . x Date / Application Disapproved for t119 following reasons :. : . n� Q6 3-„� Permit No. 2 Date Issued / U THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by at / /S 1-IZ R k7 d3 2 has been been constructed i accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.-�2 3 -306 dated / d Installer Designer The issuance of this p`e/a it shall not be construed as a guarantee`that the sys millrfunction as a igned. Date 7 U InspectorL- H , r a No. V O03' 0L Fee S (] THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS igogar *pgtem �on�truction hermit Permission is hereby granted to Construct( )Repair(grade( )Abandon ) System located at / 5 /GI/& A .^-i pit 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:Con tru Z . n must be completed within three years of the date of this permitel . Date:_ / 3 Approved by Z5. TOWN OF BARNSTABLE LOCATION 17 IA SEWAGE #ZOO 3 it ie3z VILLAGE /q IV AI -j ASSESSOR'S MAP & LOT 2�2 13 L INSTALLER'S NAME&PHONE NO. Ate w eo SEPTIC TANK CAPACITY f � LEACHING FACILITY: (type) 7 3(vv (size) 6 X NO.OF BEDROOMS , BUILDER OR 0 R �� 13"9 20 PERMITDATE: '� 3 COMPLIANCE DATE: Separation Distance Between the: i Maximum Adjusted Groundwater Table and 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 t � 1 i ET i EE CMIMONWEALTII OF MA)SACCUSE I1'S` i i �� ` .. L'XECU 1.1.�-L OT'I It-'.L OF ENVIRONAIEWYAI, I'FAI =--"r llla�nli't'�11L,N'1' O:?' I'�.(�T�'l..itONl1IGN'1-','�-L �'It0'I'1+,C`I'IUN .�` FAILED INSPECTION T'I1'J 5 OFFICIAL INSPECTION l�OltAl—NOT 11Olt \'OLUN'I'A1tY ASSESSAIIENTS SUBSURFACE SE`VAGI DISPOSAL SYSTEM FORM PART A CERTIFICATION �4`r At N rd is zq 213q Property Address: 17/19111RAMAR itt)i;**N-�.-S:�E,AIA 02630 Owner's Name: BARON Owner's Address: 17/19 111RAMAR RD BARNSTABLE, MA 02630 Date of Inspection: 8/29/02 x . . Name of hispcetor: (please print) JOHN GRACI Company Name: SEPTIC INSPECTIONS I1)(,. Mailing Address: T.O. BOX 21 WFEA'TICKET, NIA. 02536 Telephone Number: 508-564-6813.EAX 508-564-7270 CERTIFICATION STATEMIEN i I certify that I have personally 1nSpcclCd ;l:r:sewage disposal system al this address a ld that the information reported below is true,accurate and complete as ofthe time of the inspection. 'f'lle. inspection was f.ctformed based on my training and experience in the proper function andunainlena►ice of oil site sewage disposal systcuis. 1 ant a DE],approved system inspector pursuant to Sccliou 15.340. ,1f"i itic 5(310 CA1R 15.000). The system: _ Passes' _ Conditionally 1101--Ses Needs Ptartlle'a.valuation by the Local,approving Audio;ily X Pails �/ Inspector's Signature: �1 _ Date: ; i29/02 l; 'file system inspector shall submit a opy 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 regiona! office of the DEP. The original should be sent to the system owner and copiessent to the buyer, if applicable and the approving authority. , Notes and Comments r " SYSTEM FAILED TITLE V INSPEC ION. LIQUID LEVEL 1N LEACH PIT C I',OVER PIPE. PIT D HAS NO EFFECTIVE LEACHING LEFT4N-IT. ****'Phis report only describes Colld;;ions at the lime of inspection anti twticl file Conditions UI Ilse 111 111111 lillll'. 'this inspection does not address how the sys em will perform in the future under ti,c same or different conditions of use. T;rlr S Incnrrtinn Fnrm F/I S/If)nn l I Page 2 of I I OFFICIAL INSPLCTI.ON [+ORAL—NOT l'OIt VOLUNTARY ASSESSIMEN.4 S l'V'AGE DISPOSAL SYS`A.,Al SUBSURFACE S Rir`�1'l C'( (ON 1''i1ltA`I. PART A CEIt'1'�l''ICA1T'ION (continued) Property Address: 17/19 ILIRA111AR RD BARNSTABLE, MA 02030 Owner: CARON Date of Inspection: 8/29/02 Inspection Summary: Check A,B,C,D or E/ALWAYS compete all of Section 1.) A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CNIIt 15.303 or in 310 CN1R 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTUAI FAILED FITLl%V INSITCrION1 . LIQUID LUVEL IN LEACH 1'lT C 1S OVF,R PIPE. Prr I) HAS NO EFFECTIVE LEACII1NC LLFT IN IT. B. Sy°stem Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. ` n/a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits II substantial infiltration or exGltration or tank failure is imnineut. System will pass inspection if the existing tank is replaced with a complying septic taiik 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: n/a n/a 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 {lealth): _ broken pipe(s)are replaccd _ olistcuction is removed _ dist'ribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4ftimes a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of health): _broken;pipc(s)are replaced _obstruction is removed t. ND explain: n/a i Pigje 3 of I OI'1?ICIAL INSPECTION FORM - NOT FOR N'OLUNTARY ASSESSMENTS SUBSURFACE SEIVAC , DISPOSALS SYSTEM INSrECTION ITORM l.'ART A CE 'I';F ICATION (continued) Propr.rly Address: 17/19 IIIRAMAR [ill BARNSTABLE, MA 02630 Owner: BARON Date of Inspection: 8/29/02 C. Further Evaluation is Required by the Board of health: _ Conditions gist 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 i)f11calth determines in accordance with 3W CAIR 15.303(1)(b) that the system is not functioning ill a manner which will protect public health,safety and the environment: 4 j, I _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 teet oGa bordering vegetated wetland or a salt marsh i I _ 2. System will fail unless the Board os I eallh(and Public Water Supplier, if any)de(crnrines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a sepfic'tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface'%vatcr 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 lit"O SAS and the SAS is within 50 feel of a A: ate water supply well. _ The system has a septic tank'and SAS and [tie SAS is less than 100 feet bui 50 feet or more Gom a private water supply well**. Method used to determine- distance n/a **"this system passes if the well ww[c.r analysis, licrfurmed at a DEP certified laboratory, lur coliform bacteria and volatile organic compounds indicates that the well is fine from pollution fk)ia; that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no Wher failure criteria aie triggered. A copy of the analysis must be attached to thisiform. 3. Other: n/a Page 4 of I I O.FI.T(CIAL INSPEC'TIOI'1 FORM—NOT FOIL VOLUNTARY ASSESSAIEN'TS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CE10 FICATION(continued) Property Address: 17/19 111RAMAR RD BARNSTABLE,n'IA 02630 Owner: BARON Dale of Inspection: 8/29/02 0. System failure Criteria applicable to all systems: You m_uq indicate"yes"or"no"to each of the following for all inspections: Yes No _ Backup of sewage into facility or syslean component due to overloaded or clogged SAS or cesspool _ X Discharge or ponding of effluent to the surface of the ground or surface waters due to all overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an ovvcrloaded or clogged SAS or cesspool _ X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow X Required pumping more than 4 times in the last year IVOT due to clogged or obstructed pipc(s). Numbcr of limes pumped n1a. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspoiil`oi-privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is'within a Zone l of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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. ITlris system passes if the well ;eater analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from,tirai facility and the presence of ammonia nitrogen and nio-ate nitrogen is equal to or less than 5 ppm, provided (hat no other failure criteria are triggered. A copy of the analysis must be attached to this form.) X _ (Yes/No)The system fails. 1 Have determined that one or more of the above failure criteria exist as described in 310 CNIR 15.303, therefore the syste n fails.I'he 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 must indicate either"yes"or"no"to each of the following: (The following criteria apply to largesystems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply t _ X the system is within 200 feet of a tributary to a surface drinking water sul-piy X the system is located in a n►trog is sensitive area(Interim Wellhead Protection Area— 1 WPA)or a mapped Zone 11 of a public water srij►ply well If you have answered;'yes"to ally question in Section E the system is misidered a significant threat,or answered "yes" in Section D above the largc.syslent Itt s_,failed,The owner or operalor of ally Inrge,sysleart Considered n,significant threat under Section E or failed under Section D shall upgrade the system in accordance v ith 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. A Page 5 of I 1 ' , t OP'FI.CIAL INSPECTION FORAJ.-NOT FOR VOLUNTARY AS"_iLSSM[;NTS SUBSURFACE SE WAGE DISPOSAL SYSTEM INSPI?CTION F010,1 PART B CIIECIMST Pro?erl y Address: 17/19 1IIRAI\•IAR RD BARNSTABLE, MA 02630 I J Owner: BARON Date of Inspection: 8/29102 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 I lealth 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 '? 4 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 _ Were all system components,excluding the SAS, located on site ? X _ Were the septic tank nvinholes uncovered, opened,and the interior of the rant.inspected for the condition of the baffles or tees, material of construction,dimensions,depth of liquid,dcpth of sludge and depth of scum X _ Was the facility owner(�nd.occupants if different from owner)provided with information on the proper mail miance of subsurface sewage disposal systems .a ij at 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 I lealth. X _ Determined in the field (if any, of the failure criteria related to Part C is ai issue approximation of distance is unacceptable)(310 CIvIR 15.302(3)(b)j ,a a r, w 5 Page 6 of OFFMAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SE`VAGE DISPOSAL SYSTE'Al INSPECTION FORM I'A RT C SYSTs.,M INFORMATION Property Address: 17/19 111RA1lIAR RL BARNSTABLE, MA 02630 Owner: BARON Dale of Inspection: 8/29/02 FLOV'd CONDITIONS RESIDENTIAL Number of bedrooms(design); 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CN9R 15.203 (for example: 1 10 gpd x 11 of bedrooms): 4,10 Number of current residents: 8 ; Does residence have a garbage grinder(yes or no): NO is laundry on a separate sewage system()tes or no): NO [if ties separate inspection required] Laundry system inspected(yes or no): NO Seasonal use:(yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): n/a I� Sump pump(yes or no): NO 0Z �)C Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL dv 03�� q� D Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc:;: n/a Grease trap present(yes or no): NO Industrial waste holding tank present (yes or no): NO Non-sanitary waste discharged to the Title c system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a 0111Ell(describe): n/a t GENLRAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes, volume pumped: n/agallons-- Ilow was quantity pumped determined? n/a Reason for pumping: n/a ti TYPE 017 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) _limovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _'bight tank Attach a copy of the�DEP ai-)proval Other(describe): n/a tin Approximate age of all components,date installed(if known)and source of information: 1945,SYSTEM 1987 BY OWNER Were sewage odors detected when arrivipg at the site(yes or no): NO f. 6 Page 7 of I I OFFICIAL INSPECTION FORA) —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SE«'AGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM 1iVFORMATION(continued) Property Address: 17/19 IIIRAMAR RD BARNSTABLE, MA 02630 Owncr: BARON Date of Inspection: 8/29/02 BUILDING SENVER(locate on site plan) 7 Depth below grade:30" Matcrials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: u/a Continents(on condition of joints,venting,evidence of leakage,etc.): T01VN 1VATEIt SEPTIC TANK: X (locate on site plan) Depth below grade: 24" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes of no): NO(attach a copy of certificate) Dimensions: 150OG L 10' 6";Il 5' 7" W 5' 81.. Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness: 4" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet lee or baffle: 14" 1-loxv were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC"TANK AND ALI,COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY 'ii CVO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a . a Material of construction:_concrete_metal fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: u/a Connncails(on pumping reconuncnilatiotis, inlet and outlet ice or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): i n/a t ar a1 Page 8 of I I OFFICIAL INSPECTION FORNI—NOT FOR VOLUNTARY ASSESSMENI'S SUBSURFACE SEAVAGE DISPOSAL SYSITNI INSPECTION FORIM PART C SYSTICAI T N.FORMA'TION(continued) Property Address: 17/19 MIRAIMAR RD BARNSTAIILI , RIA 02630 Owner BARON Date of Inspection: 8/29/02 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locatc on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a 3.Y DISTRIBUTION BOX:X(if present must beopened)(locate on site plan) Depth of liquid level above outlet invert:LEVEL WITH BOTTOM OF PIPE Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box,etc.): D-BOX IS STRUCTURALLY SOUND. PUMP CHAMBER:-(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): n/a 0 t t, I t 5 R , Page 9 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSL;SSAIENI'S SUBSURFACE SEN AGE DISPOSAL SYSTEM INSPECTION FOtIAI PART C S'VSTEA t NI1.01MIATION(continued) Property Address: 17/19 HIRANIAR RD BARNSTABLE, NIA 02630 Owner: BARON Date of Inspection: 8/29/02 SOIL ABSORPTION SYSTEM (SAS): X (locale on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 2 „/a leeching chambers, number: n/a n/a leaching galleries, number: o/a n/a leaching trenches, number, length: ttla n/a I;aching fields, number: tt/a n/a overflow cesspool, number: tlla n/a ( innovative/alternative system Type/name of technology: uda Comments(note condition of soil, signs of Hydraulic failure, level of ponding,damp soil, condition of vegetation,etc.): LIQUID LEVEL IN LEACH PIT C IS OVER PIPE. L.EACI1 PIT D HAS NO EFFECTIVE LEACHING LEFT IN IT. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site pl,N) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or nip): NO Continents(note condition of soil,signs ofi-ydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): n/a t > � 4 Page 10 of 1 I OFF[CIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSINENTS SUBSURFACE SELVAGE WSPOSAL SYSTEM INSPECTION FORM PART C SYSTEM UNFORMATION(continued) Properly Address: 17/19IIIRAMAR-RD BARNSTABLE, MA 02630 Owner: BARON Date of Inspection: 8/29/02 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 buildil1g. 01 Cl '� ,S U } to Pagc. I I of 1 I OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSI'ECTION FORM 1.'AJIT C SYSTEM iNFORAIATION(continued) Property Address: 17/19 111RAMAR RD BARNSTABLF', M.A 02630 Owner•: BARON Date of Inspection: 8/29/02 . SITE EXAM _Slope _Siu-face Nvatcr _Check cellar _Shallow wells 4 . Estimated depth to ground water 10 feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- [f checked,date of design plan reviewed: n/a l'ES Observed site(abutting propertyiobservatiou Bole within 150 feet of SA`;) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 10-+- FT. f t t TOWN OF BARNSTABLE LOC, rz k�f4rt, E SEWAGE #-87-536 VILLAGE�y&,J,,} 1 ASSESSOR'S MAP & LOT r INSTALLE.R'S NAME & PHONE NO. �,��,�,� SEPTIC TANK CAPACITY '4 ®C:) LEACHING FACILITY:(type) �`zj-7_ -Cas-r (size) NO:'OF BEDROOMS Z,--P PUBLIC WATER BUILDER'OR OWNER S DATE PERMIT ISSUED:,' Q ,3.. ° DATE COMPLIANCE ISSUED: --lit VARIANCE GRANTED: Yes No �� e. r No...97s.135_ FEB.....s .. � THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH --------------tlbzc F............ .. ApplirFaffou for Eligpnstal Workii Tomtrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ndividual Sewage Disposal System at: Location-Addres r or Lot No. - �..�G-ll.J/r�A2 TG -----------------------•--•-•-•-•- 'a--.'+..l .....----•--------••-----•-------•----•----....------.....---...........••---- Owner ^' Address Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms..................................... .Expansion Attic ( ) Garbage Grinder ( ) �+ aOther—Type of Building ............................ No. of persons......................... Showers ( ) — Cafeteria ( ) Q' Other fixtures - -------------------------................................... WDesign Flow...........................................gallons per person per day. Total daily flow.-----_..................._.................gallons. 11:4 Septic Tank—Liquid capacity__---_......gallons Length\.............. Width........_------- Diameter................ Depth............. Disposal Trench—No. .................... Width.................... Total Length......._............ Total leaching area--------------------sq. ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area._................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~" Percolation Test Results Performed bY-----------------...................................-...........-......... Date............................ Test Pit No. 1................minutes per inch Depth of Test Pit-.-................. Depth to ground water................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit__-_.__............. Depth to ground water---_.................... 9 ............-....-------...................-.....................................................................-.......................................... 0 Description of Soil..................................................................................................... ------------------••-------------••-••--••.................. W U .......................................................-...........................................-.............................................................-....................................... M ......................------------------------------------------------------------•------•-•-----------•------- ---------- ----r......--- U p t Pp �� `"� -- Nature of Repairs or Alterations—Answer when a hcable____ .�� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of p 5 of the State Sanitary Code— T e ersigned further agrees n o p a stem in operation until a Certificate of Compliance has been t Sign --- --- ------ ................ .............. ------- ---- ••-........ .......... � .. ate Application Approved By--- --.. .....'... --------------------------- .......... Date Application Disapproved for the following reasons-......-...............-......................................................................................... ---------------------------------•-------------•--- .................................-.................................................... .................-............--......... Date Permit No.......Tr.-2- ya ............... Issued-....................................................... Date 4� THE COMMONWEALTH OF MASSACHUSETTS BOARD O� F HEALTH `. ......---..."O F........... *a�,��%�-0,s�1i�.-... ,Apure#inn for Uiipuiitt1 Workii Tonotrnrtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( 4t"` ndividual Sewage Disposal System at: _ ................__.-_.7.._.--.-....._.._. ...__.__....c........_....._! ...._.._..... . t.Q.....- � ._..:.. "! Location-Address or Lot No. ............ .................................... f ��::..... ..-- - .------•.........................•--•----•-----•----...................._..... Owner a .____....�,. .. . � Add.r ess .__....._._.. ......... .. ..____.__._.....___.__. !... .... ....................................•-- Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------• . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 04 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No-----------------_- Width.................... Total Length.................:.. Total leaching area.-_____.-.•__-------sq. ft. Seepage Pit No.--_-____--_--.-_-- Diameter----------------_-- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date......................................... aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_-____--_____-__-____--. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-••------•----------------•••-•-•-•--------•-•------------•---•--...............------------.........------•-----•---._............................--•--_... 0 Description of Soil........................................................................................................................................................................ W •----••---------------------•------•--•--••-•-•---•-----------•--••--...-••••---...---------------------•-•---- •. -•-•---•---••--••------•----------•---- ............ VMature of Repairs or Alterations—Answer when applicable.___. 1 a J N N � "i- --�-- -------------- --------- ---------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 7 of the State Sanitary Code—" -undersigned further agrees n6t to place ystem in operation until a Certificate of Compliance has been is Q Sig etI�_�.::... ... ..... . lJ......... Date Application Approved By--------- - --'---*.... .....'=`'""'"'"'------..----•----•--------------- - -t--------- ? Date Application Disapproved for the following reasons:.............................................................................................................. --•-•--••-•••-•------••--------------------------------------•••----••--....--•--•----•-------------...•.•-•--•-•........----------------•-••--•--•-•-•--•-••-•-•--...-----•--•--•----•----------••••-•- Date PermitNo.__..�.. .. ....:��:.:2�-`� --------------_ Issued-........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7e_11 GL^`� ...OF.....` _:. . . n Trrfif iratr of Tomplianr THIS IfTO ER IFY, That the Individual Sewage Disposal System constructed ( ) or.Repaired,k-) by `r ,,,ai � ...-•---•^--------'-Installer at----------•-------•---------•----------•----•-•----•----------•----------------------------•---------------•--------•--.--------•-------------------------------------------------------------------- has been installed in accordance with the provisions of TI T iL j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No....._8____a________,.___. ............ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE................... .....1 II-).............................. Inspector..... . ...- ----------------------•-•----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH tit - 0 Disposal Workii Tomi#ri ion autit Permission is hereby granted..........y '--e c"_-- to Construct ( ) or Repair _ an.,Individual S wage Disposal System at Street as shown on the application for Disposal Works Construction Permit N61...._ - }r__ Dated.......................................... ------------ ----------- '<=-.cc__r�_.Lac—:. <.. .<-"' -------•--•---------•---------•---. C" Board of Health DATE-- . • 1.�................................................. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS L • 4 OWN OF BARNSTABLE LOCATION 2d ! SEWAGE # Gc) VILLAGE ASSESSOR'S MAP 6z LOT c�v INSTALLER'S NAME & PHONE NO. ��5��1 SEPTIC TANK CAPACITY 1ST LEACHING FACILITY:(type) 3 C (size) X$ NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER Pu�L� BUILDER OR OWNERl/`Y►�1 1 �yXS� n ''�1 DATE PERMIT ISSUED: �� al-PC) DATE COLIPLIANCE ISSUED: VARIANCE GRANTED: Yes No _ ___ � 3 . � �� .� N Op, � � x � o ` W � �. .� �, N �� N � . o 0 �, , ; �`' - -- P — No...R S-19 X Fim...`.......�......_ THE COMMONWEALTH OF MASSACHUSETTS F.= o BOAR® OF HEALTH 't__ ...............OF........... ...I.....0 Allp iration for UiipnsFal Works Tonstrurtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (><) an Individual Sewage Disposal System at: l _..... .............. __.... -....-----�,7 � _ . ....Li�— N oca d §sLot - - RG - - Cl/ .......................... •- ... W Address a ----------- ................'� �............. Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p-, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ____________________________ _ W Design Flow.............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total,leaching area--------------------sq. ft. Seepage Pit No___________ _________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by....................................................................... Date.............................`-•------- .4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---•----------------------------------------------------------------------------------------•-------......................................................... 0 Description of Soil........................................................................................................................................................................ x U xW --------•-•---._....---•••-•-------------------------------------------------------------------------•----•--• �------------------ ----------------------._...•--•-•--•-- � ____________U Nature of Repairs or Alterations hen applicable__ �_� --------- Agreeme pl T u dersigned agrees to install the afores ibed Individual Sewage Disposal System in accordance with the p vis' ns f 1 5 of e State Sanitar de—The under 'gned further agrees not to place the system in op ati un r ' to Compliance has b issued by the b r of h lth. 1 gned-------------- -------------------•------- ........... ........'.................�J - Date Appl* o pp oved By.............................. -----------•. -------------- _----• •-•---- Date Ap i tion Disapproved for the following reasons-- -------------------------------------------------------------------------•---------------------.....--------- ----------•----------•------------------------------.....---•---•.._._._...------------•-------------..._---------------•------------------•---•---------...-----------^ Date -----•----•-...._..--------•--- QS Permit No........ �`a....`�^.--` ... Issued '--- -� - ate Date No.. ::'. ..... Fizz..........................._ THE COMMONWEALTH OF MASSACHUSETTS f BOARD OF HEALTH .... �U?+! OF.. .rrr .ra � ................... .............--------........................................... Appliratioit'jor Disposal Works Tonstrnr#ion Frrmit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: 1 ...........'.�= -• —•-•••--•`�_Loca �, ,.I.rC....__• •.............. —4............................................. • or ............................................ ..•__•---•-•--.............__ a !J o C J t0 Address �` ....; .............. --..._..--••............. ................. ............... .................. ...........................................................f:. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures --------------------------•---------..........._.........:. •...................•__...-•--•------•-••---•------------•--..... W Design Flow............................................gallons per person per day. Total daily flow..........................__................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter....... ._._. ____ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No..................... 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........................ rX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 .....-----••------------•........................•-•----........._............._......•................................................ 0 Description of Soil.................................................................................................................................................. U --------- ------------------------- ......_....------------------------ ------- --•-------•---••--•-------...---......--•-•-------••---........-----...--------...--•-----•-•-••-------------- • --- U Nature of Repairs or Alterations—Answer hen applicable Q _..f.r�'-�t!__ ..... ...... _..r! � ....... lc......� � .. 3.. ,�. 5?..,a.a.. 2°�u,�.C..:c..:..............................•--... .._..... -.....--•-•---•--...............----•-----•-. •---- Z --- _.. Agreeme T ndersigned :agrees to install the aforede—ribed Individual Sewage Disposal System in accordance with the p ovi ons of T I/�,. 5 of he State Sanitary ode— The undersigned further agrees not to place the system in op rats u it er t Compliance has b > sued by the beC;Zof lth. f, n Signed.`. -' �` ...... r' ............. A lir o A ove B r at` Date Ap Ii tion Disapproved for the following reasons. •---......•-••----......-•......................•----•---•-•---------------•-•-----...._.....-----••-------- --•-- ...------•=--••.......•__-----•...........................•-----•---------•-...-••--•••----------•'--......._..-•-•-----•-----------••••-•----------••-•-------------............-------••------- Date Permit No....... t��: '. _! . -------------------------- Issued... �" �::� .. � Date THE COMMONWEALTH OF MASSACHUSETTS BOARD- OFF`HEALTH G OF a� c� )L ....... ......... { (9rdifirtttr of Tomplianrr THIS IS TO CERTIFK, That the Individual Sewage Disposal System constructed ( ) or Repair) by ..._.... . ...................Installer........._.._._........-•---•---•----..........--••-------•------•....._...........------._... at.._•---_. . �f C'fe€ (! r!fac, 4 has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as des ribed in the application for Disposal Works Construction Permit No.....�5------- —....... dated........ .............. THE ISSUANCE✓6F THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARUNTE THAT THE SYSTEM WILL F NCTIO SATISFACTORY. DATE.........:....... ..... .............................. Inspector........ ......-•--•--• ---•-------•- ... ............................__ THE COMMONWEALTH OFOMASSACHUSETTS 1 BOARD F HEALTH / CS G No..... ......" .... ..:............,t..a `..........OF...... ... ...................................... FEE... �..... Disposal Works Tons#rrur#ion rrmi# a < Permission is'hereby granted....._ :. ..(AUK. / _ _ .._.. toonstruct ( ) orRepair�V) an Individual Sewage Disposal System Street . as shown on the application for Disposal Works Construction Permit o.g�1 _. Dated....... ated..__ �-_� �gs----•-- ......................... ................... .......----------------------_ .� DATE........... — � -Sc�" "---•--•---•------------------------ Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON ! ASSESSORS MAP : 2q2 TEST HOLE LOGS NOTES: PARCEL : 1) THE INSTALLATION MUST BE IN SUBSTANTIAL, COMPLIANCE WITH \ SO I L EVALUATOR : i Mt e- RS C THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF FLOOD ZONE : WITNESS : �OT A�k D ��YB L -_. BOARD OF HEALTH REGULATIONS. ^v� , REFERENCE : C I b 7 DATE : of 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, / h PERCOLATION R SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO INSTALLATION.ASS A: SJIU U_A y F� TH- I y, 3 TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE A �( A�n�' IU,/123/ DETERMINATION. 4) ALL PIPING TO BE 4" SCHEDULE 40 (.� 1/8 "/ FOOT. (UNLESS SPECIFIED OTHERWISE) LOCATION MAP(N.r.S) 1' ��ND v r� ►1 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A _?,2 �p GARBAGE DISPOSAL. L� co 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) C SA�o 2,5 MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON I ! f '.Q% A BASE OF 6"OF CRUSHED STONE. 1/,8tt .Z2 2 7 ._ _ - `.`l &_j?,&uTZ_tn t 7 2 � l?vrf c� 2b 86 fb ',�i SEPTIC SYSTEM DESIGN �� l�v ,,�,��: ,��,,t ,�-�- , ; �rZ�;r�asF-,� ��r>ti,Ne FLOW ESTIMATE !�) jj U 4 .1 v F l.-��'. �,s_ '� / ,f7�lQ./�57� ram,,I t= �';;' r /�i r! �// �E� •, %'f r 1 '1�'E C7 AD T : �� BEWOOMS AT GAL/DAY/BEDROOM - f40 GAL/DAY SEPTIC TANK �40 GAS./DAY x 2 DAYS - UCH GAL 7p� _ USE > GALLON SEPT I C TANK -tij�cJ - Et. �y,�o ' SOIL ABSORPTION SYSTEM \\ a � l-7) 1-6 (a PV k�cAsr, CgAA-4WS Lr Tux I e iti'Li j ii S DE AREA yL 1l 4- ll / x 2 v �0, 7 J ti x�ST yl BOTTOM AREA:-- CU, 7 y - 37Y, 3 V I t� — — — — ► �--� SEPT I C SYSTEM SECTION ' y�Gal� 3 6 -_-.._ .__ ID 3 r�2 - 36 _ }�o �— --- CAS 3l4�s _ �' �' ._ 6kGt,�rti��f_ r, flid � y _.� -Boxy 31•2s _I=1 3�, Eo =' ye'�.-- f YZ . TSU� GAL � Gtkr�1 f.s1` -- SEPT TANK �F�lrtro/h� ) -- �, 3o. ,, iyz OF"'� - Q ff-y7tr SITE AND SEWAGE PLAN o� DA m 'M LOCATION : No. 1140 �7 STS '4 ITARI�`� �� -a6 PREPARE( FOR : k 0 SCALE : /0 �� r W DARN M. MEYER, R S. DATE . ?_ s a o 43 VINE STREET DUXBURY, MA 02332 W DATE HEALTH AGENT (781) 585-•0293 2