HomeMy WebLinkAbout0014 JANICE LANE - Health 14 Janice Lane
Hyannis
A= 307 -272
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No. lC (9 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Zipplitation for Disposal 6pstem Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon�y ❑Complete System ❑Individual Components
Location Address or Lot No. 0 y YaLn i c,e_(n, 14YU06 Owner's Name,Address,and Tel.No. 6V&7 gOe/- &&6_3
Assessor's Map/Parcel 30r) to;k_ nel_ ` Fbeursy)Q �®acion P-01
-79
Installer's Name,Address,and Tel.No.5Zt-1Y)/ 9.?99 Designer's Name,Address,and Tel.No.
�r,lo/aZ o)4� �1A•- 6cu,don own
r.
Type of Buil
Dwelling No.of Bedrooms 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 an of to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date 61CAw
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. Date Issued j
No. c:�i (( /V '._ `"i Fee
_. THE COMMONWEALTH OF MASSACHUSETTS
Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF Bi4RNSTABLE, MASSACHUSETTS Yes
ftpliration for Disposal 6pstem Construction permit
Application for a Permit to Construct.( ) Repair( ) Upgrade( ) Abandon ❑Complete System ❑Individual Components
Location Address or Lot No. I y ,�Ce f1 i c-C(/), / "'• Owner's Name,Address,and Tel.No. �"7>`�. pQy_ (yg(o,3
Sane.4- ►tic. mp a�Ys� moo!
Assessors Map/Parcel 3U7 a7;,L Ora
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
44 J4 n 03� !I Gh lntClV'
Type of Buildin�
Dwelling No.of Bedrooms 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-dn-site sewage disposal system in
r
accordance with the provisions of Title 5 of the Environmental Code an not to place the system-in-operation until a Certificate of
,►
Cpmpliance has been issued by this Board of Health.
Signed Date
i
Application Approved by Date
r Application Disapproved by Date
for the following reasons
Permit No. -_),Q,/ �P Date Issued
------------------------------------------------------- -------------------------------------------------------------------------------
-.;4 .THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
:�XflsS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandonby ar ICA U(A A
at I u Ja01 r-e- I u.u.V2. 14 116 5 has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit Nq.- `` dated
Installer&tCJIJ , inS r�L��'�r,T�L Designer
T ,
#bedrooms Approved design flo�i, gpd
The issuance of this 'ermit shall not be construed as a guarantee that the system ill cfio as design �C
1. • I
Date b Inspector ��-
- - -------- -------- --------- -----------------------------
No.
_.._
Fee�
THE COMMONWEALTH OF MASSACHUSETTS s
PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS
Disposal 6pstem Construction Permit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon o<
System located at _ y Tan ice_ Lo In P 14 t i/A O r► 5
a�
M 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 b comple ed within three years of the date of this rmit.
Date S �•-® Z� Approved by
� �-
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ftphration for his oral *pstem Construrtion i3er::Ll
i
Application for a Permit to Construct( ) Repair(/ Upgrade( ) Abandon( ) El Complete System Components
Location Address or Lot No. '?v'y Lkn-,%V, iK O er'Name,A dress,and Tel.I
�`z w d
Assessor's Map/Parcel c-r`^c 5 T7o 04
Inst�allerr`s Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
�7
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(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 ealt pp
Signe Date (p k—
Application Approved by- Date
Application Disapproved by Date
for the following reasons
Permit No. �� f��(j�' Date Issued
No. - Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in mroputer.
Yes
'7
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01ppfitation for Dislaosal 6pstem Construction i3ermit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System :;Ll Components
Location Address or Lot No. �� Lin w fin., Owner's Name,Address,and Nell.. 0. `
Assessor's Map/Parcel t (�.�^t�j D - 0� `�Z��C
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
�r Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank �k�C7 6\j Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) C�
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
i
Compliance has been issued by this Board oftlealt f
Signe Date
Application Approved by Date (p
s
Application Disapproved by Date
for the following reasons
Permit No. ��lD % Date Issued
---------------------------------------------------------------------------------------------------------------------------------------
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 S�C.��, M IK-
at \SCf n C_y� c� has been constructed in accordance with the provisio of Title 5 andthe for Disposal System Construction Permit NoPq&_8C) dated W/ 4
Installer \�� � Designer
#bedrooms Approved desr flow\ gpd
The issuance of 's pe1 it shall not be construed as a guarantee that the system will fun� ofn as designed.(
Date u 6 Inspector
----------------//------------ -j---------------------------------------------------------------------------------------------------------
9 --
v Fee ? (n')
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS
Disposal 6pstem Construction permit
Permission is hereby granted to Construct( ) Repair(C� Upgrade( ) Abandon( )
System located at 7(�� LN a u.> U
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 b c pleted within three years of the date of this p it.
Date C� 1 Approved
i
e
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
14 Janice Lane
Property Address
Bank of Mellon Trust 20 Broad Street, LL2 New York, NY 1005
Owner Owner's Name
information is required for Hyannis MA 02601 November 1, 2010
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form.Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out A. General Information
forms the �/ 4
computer,
r,use 1. Inspector:
only the tab key
to move your Patrick T. Sullivan
cursor-do not Name of Inspector
use the return
key. Ready Rooter, Inc.
Company Name
P.O. Box-371
Company Address
Sandwich MA 02563
Cityrrown State Zip Code
508-888-6055 S1 12843
Telephone Number License Number
g. r
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and thabthe '
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:rsite
sewage disposal systems. I am a DEP approved system inspector pursuant to"Section 1w.340Nof
Title 5(310 CMR 15.000).The system: - A
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
November 5, 2010
Inspector's Ignature~ Date
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.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 1
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
14 Janice Lane
Property Address
Bank of Mellon Trust 20 Broad Street, LL2 New York, NY 1005
Owner Owner's Name
information is required for Hyannis MA 02601 November 1 2010
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old' or the septic tank(whether metal or not) is
structurally unsound, exhibits substantial infi(ration 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 inspecti if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is ess than 20 years old is available.
❑ Y ❑ N ❑ N (Explain below):
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 2
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
"< 14 Janice Lane
Property Address
Bank of Mellon Trust 20 Broad Street, LL2 New York, NY 1005
Owner Owner's Name
information is Hyannis MA 02601 November 1 2010
required for ,
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes(cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Healt
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
❑ distribution box is leveled or r laced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required mping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass ins ction if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
C) Further Evaluation is Requ of Health:
❑ Conditions exist which requirn by the Board of Health in order to determine if
the system is failing to protecety or.the environment.
1. System will pass unless,/determines in accordance with 310 CMR
15.303(1)(b)that the systeg in a manner which will protect public health,
safety and the environmen
❑ Cesspool or privy is urface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 3
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°r 14 Janice Lane
Property Address
Bank of Mellon Trust 20 Broad Street, LL2 New York, NY 1005
Owner Owner's Name
information is required for Hyannis MA 02601 November 1, 2010
every page. Citylrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (a d Public Water Supplier, if any)
determines that the system is functioning in a nner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil sorption system (SAS)and the SAS is within
100 feet of a surface water supply or ibutary to a surface water supply.
❑ The system has a septic tank and S S and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and AS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS nd the SAS is less than 100 feet but 50 feet or
more from a private water supply well* .
Method used to determine distance:
**This system passes if the well wat r analysis, performed at a DEP certified laboratory, for coliform
bacteria indicates absent and the pr sence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no her failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes"or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® 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 %day flow
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 4
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
14 Janice Lane
Property Address
Bank of Mellon Trust 20 Broad Street, 1-1-2 New York, NY 1005
Owner Owner's Name
information is Hyannis MA 02601 November 1, 2010
required for y
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® 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 SAS, cesspool or privy is below high ground water elevation.
❑ ® 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.
❑ ® 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. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 00 feet of a surface drinking water supply
❑ ❑ the system is wit in 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is I sated in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA or a mapped Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,
or answered"yes" in Section D a ove the large system has failed. The owner or operator of any large
system considered a significant hreat under Section E or failed under Section D shall upgrade the
system in accordance with 31 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 5
Commonwealth of Massachusetts
lugTitle 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
14 Janice Lane
Property Address
Bank of Mellon Trust 20 Broad Street, LL2 New York, NY 1005
Owner Owner's Name
information is Hyannis MA 02601 November 1, 2010
required for y
every page. Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes"or"no" as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined?(If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): 4 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 459 GPD
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 6
f -
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
14 Janice Lane
Property Address
Bank of Mellon Trust 20 Broad Street, LL2 New York, NY 1005
Owner Owner's Name
information is required for Hyannis MA 02601 November 1, 2010
every page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ❑ No
Seasonaluse? ❑ Yes ® No
5 GPD
Water meter readings, if available(last 2 years usage(gpd)): 2010=2009=29 29 GPD
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: May 2010
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203):
Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
i
Non-sanitary waste discharged to the Tit 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins-09108 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 7
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
14 Janice Lane
Property Address
Bank of Mellon Trust 20 Broad Street, LL2 New York, NY 1005
Owner Owner's Name
information is required for Hyannis MA 02601 November 1, 2010
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: Unknown
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 8
Commonwealth of Massachusetts
us` Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
14 Janice Lane
Property Address
Bank of Mellon Trust 20 Broad Street, LL2 New York, NY 1005
Owner Owner's Name
information is required for Hyannis MA 02601 November 1, 2010
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
System installed June 14, 2002. As-built and Certificate of Compliance on file at Board of Health.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 14"feet
Material of construction:
❑ cast iron ®40 PVC ❑other(explain):
Distance from private water supply well or suction line: N/A
feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
Septic Tank(locate on site plan):
Depth below grade: 2-1feet
Material of construction:
®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
Dimensions:
12'X 5.5'X 5' H-20 1500 gal.
Sludge depth:
3"
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 9
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
y 14 Janice Lane
Property Address
Bank of Mellon Trust 20 Broad Street, LL2 New York, NY 1005
Owner Owner's Name
information is required for Hyannis MA 02601 November 1, 2010
_
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle 36"
Scum thickness
1"
Distance from top of scum to top of outlet tee or baffle
6"
Distance from bottom of scum to bottom of outlet tee or baffle
13"
How were dimensions determined? Tape measure and dip tube.
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Inlet and outlet PVC tees in place. Liquid level at outlet invert. No sign of leakage.
Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
14 Janice Lane
Property Address
Bank of Mellon Trust 20 Broad Street, LL2 New York, NY 1005
Owner Owner's Name
information is required for Hyannis MA 02601 November 1 2010
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pum ed at time of inspection) (locate on site plan):
Depth below grade:
1
Material of construction: /!
❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 11
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
14 Janice Lane
Property Address
Bank of Mallon Trust 20 Broad Street, LL2 New York, NY 1005
Owner Owners Name
information is required for Hyannis MA 02601 November 1, 2010
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
0"
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.):
H-20 D-box. One inlet, one outlet. Slight root intrusion into d-box, not affecting system operation. No
solids carryover or high water staining over outlet invert.
Pump Chamber(locate on/ump
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
Comments(note condition mber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 12
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
14 Janice Lane
Property Address
Bank of Mellon Trust 20 Broad Street, LL2 New York, NY 1005
Owner Owner's Name
information is required for Hyannis MA 02601 November 1, 2010
every page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 5-Flow diffusorsw/4' stone.
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
SAS located and inspected with camera. System dry at time of inspection. No sign of past hydraulic
failure.
Cesspools(cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 13
Commonwealth of Massachusetts
Title 5 Official Inspection Form
e Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
14 Janice Lane
Property Address
Bank of Mellon Trust 20 Broad Street, LL2 New York, NY 1005
Owner Owner's Name
information is required for Hyannis MA ' 02601 November 1, 2010
_
every page. CityrFown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs f hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 14
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
°t 14 Janice Lane
Property Address
Bank of Mellon Trust 20 Broad Street, LL2 New York, NY 1005
Owner Owner's Name
information is required for Hyannis MA 02601 November 1, 2010
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
v
1 l
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t� = 3�8
1
(—' S7 �J W t
t5ins-09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 15 of 15
1
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
" 14 Janice Lane
Property Address
Bank of Mellon Trust 20 Broad Street, LL2 New York, NY 1005
Owner Owner's Name
information is Hyannis MA 02601
required for Y November 1, 2010
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
® Check cellar
❑ Shallow wells
Estimated depth to high ground water: 5
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed: 11/15/01
Date
❑ 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:
ma.water.usgs.gov terraserver-usa.com
You must describe how you established the high ground water elevation:
Test hole found ground water at elv= 11.4 (2001). Adjusted high ground water at elv= 15.2. Base of
SAS at elv=20.2. Accessed local ground water contours and topo mapping.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
14 Janice Lane
Property Address
Bank of Mellon Trust 20 Broad Street, LL2 New York, NY 1005
Owner Owner's Name
information is required for Hyannis MA 02601 November 1, 2010
every page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
ff^^ pp^^ Date: I I log 10S
f �
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAMEOFBUSINESS: L . L cieo a' 10
BUSINESS LOCATION: () /
MAILING ADDRESS: 1'.0 x 1 S�13 , - 1 Mail To:
TELEPHONE NUMBER: 0 - 0 p Board of Health
Town of Barnstable
CONTACT PERSON:4�4" r r)El ct ola .c P.O. Box,534 4
EMERGENCY CONTACT TELEPHONE NUMBER: (SOP 9, ) )- � S,3 I Hyannis, MA 02601
TYPE OF BUSINESS:' Gd)l r'_n ` (P(\/I C£
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own
use? YES X NO
This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed
envelope for your convenience.
If you answered YES above, please indicate if the materials are stored at a site other than your mailing
address:
ADDRESS: /y .S�,✓ lce Zc, I-)C, /C"noI S M/I 074LD
TELEPHONE:
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous character-
istics and must be registered regardless of volume. Please estimate the quantity beside the product that
you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS.
Quantity Quantity
Antifreeze(for gasoline or coolant systems), Drain cleaners
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salt (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet Fuel Photochemicals (Fixers)
Diesel fuel, kerosene, #2 heating oil NEW USED
Other petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Battery acid (electrolyte) Swimming pool chlorine
Rustproofers Lye or caustic soda
Car wash detergents Jewelry cleaners
Car waxes=and=polishes = -- — --- -;Leather-dyes ._,_
Asphalt & roofing tar Fertilizers
Paints, varnishes, stains, dyes PCB's
Lacquer thinners Other chlorinated hydrocarbons,
NEW USED (inc. carbon tetrachloride)
Paint & varnish removers, deglossers Any other products with "poison" labels
Paint brush cleaners (including chloroform, formaldehyde,
Floor & furniture strippers hydrochloric acid, other acids)
Metal polishes
Other products not listed which you feel
.0 Laundry soil & stain removers
(including bleach) may be toxic or hazardous (please list):
Spot removers&cleaning fluids I6-pI�J� )e �`
(dry cleaners) V
Other cleaning solvents
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
f . AS
'- COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION.
f
LtflAR ZWRN
N OF B UEPT.STABLE
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION �I .
Property r p rty Address: 1 4 Janice Lane .AP lo
Hyannis
Owner's Name: Sabino Fro ntino 'ARGIL 272 V
Owner'sAddress: 10 Paul David Wad Vic. r
Date of Inspections J
Name of inspector:(please print) W i 11 i am E_ • Robinson Sr.
Company Name: William E. Robinson Septic Service
Mailing Address: P O Box 1089
Centerville, MA
Telephone Number: (5081 775-8776
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector pursuant to Sec Aon 15.340 of Title 5(310 C\'iR 15.000). The system:
Passes
Conditionally Passes
C Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: L Date: —C3
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heatth'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.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5Inspection Form 6/15/2000 page 1
r
Page 2 of I!
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 14 Janice Lane
Hyannis
Owner: Sabino Frontino
Date of inspection: I — —
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. Sys m Passes:
I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CUR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired.The system,p y upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following statements.if"not determined"please
explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent_System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
•A metal septic tank will pass inspection if it is structurally sound,not 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
ND explain:
The system required pumping more than 4 times a year due to broken or obstrt.Tted pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipes)are replaced
obstruction is nmovcd
ND explain:
Page 3 of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A -
CERTIFICATION(continued)
Property Address: 14 Janice Lane
Hyannis
Owner: Sabino Frontino
Date of Inspection::
C. Fu r Evaluation is Required by the Board or Health:
C,on 'bons exist which require further evaluation by the Board of Health in order to determine if the system
is failing to p otect public health,safety or the environment.
L Syste will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system not functioning in a manner which will protect public health,safety and the environment:
_ Ces pool or privy is within 50 feet of a surface water
— Ces ool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System w' 1 fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is func ioning in a manner that protects the public health,safety and environment:
_ The s stem has a septic tank and soil absorption system(SAS)and the SAS is within.100 feet of a
surface wa er supply or tributary to a surface water supply.
_ The s rstern has a septic tank and SAS and the SAS is within a Zone I of a public water supply.
— The stem has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The ystern has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more front a
private w ter supply well" Method used to determine distance
"This: stem passes if the well water analysis,performed at a DEP certified laboratory,for coliform
bacteria d volatile organic compounds indicates that the well is free from pollution from that facility and the pre: nce of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure riteria are triggered.A copy of the analysis must be attached to this form.
3. Oth r:
.4 3
Page 4 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 14 Janice Lane
Hyannis
Owner: Sabino ron ino
Date of Inspection: , S C E,
D. System F 'lure Criteria applicable to all systems:
You must in tc e'yes"or"no"to each of the following for all inspections:
Yes No
_ Backu of sewage into facility or system component due to overloaded or clogged SAS or cesspool
Disch a or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogge SAS or cesspool
_ Static li uid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspoo
Liquid d pth in cesspool is less than 6"below invert or available volume is less than'/,day flow
Require pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times umped
_ Any port on of the SAS,cesspool or privy is below high ground water elevation.
Any pordon of cesspool or privy is within I oo feet of a surface water supply or tributary to a surface
water su ply.
_ Any porl ion of a cesspool or privy is within a Zone 1 of a public well.
Any po ion of a cesspool or privy is within 50 feet of a private water supply well.
Any po ion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private%-Ater
supply ell with no acceptable water quality analysis.IThis system passes if the well water analysis,
perfor ed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indica s that the well is free.from pollution from that facility and the presence of ammonia
ni'rog n and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria
are lr g.ercd.A copy of the analysis must be attached to this form.] - -
(Yes/No The system fails.1 have determined that one or more oCthe above failure criteria exist as
des ibed in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of
He th to determine what will be necessary to correct the failure.
E. Large S stems:To be cons' Bred a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd•
You mu indicate either"yes"or"no"to each of the following:
(The foll wing criteria apply to large systems in addition to the criteria above)
yes no
the ystem is within 400 feet of a surface drinking water supply
_ — the s stem is within 200 feet of a tributary to a surface drinking water supply
the s tem is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone I of a public water supply well
if you have ans red"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section above the large system has failed.The awncr of operator of arty large system considered a
significant threat rider Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304.The syste owner should contact the appropriate regional office of the Department.
4
I
Page S of l l
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 14 Janice Lane
Hyannis
Owner: Sabino Fronti o
Date of Inspection: 3—5--OS
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
Yes No/
_ _✓Pumping information was provided by the owner,occupant,or Board of Health
`V/Were any of the system components pumped out in the previous two weeks?
Y — Has the system received normal flows in'the previous two week period?
✓Nave large volumes of water been introduced to the system recently or as part of this inspection I
✓ _._ Were as built plans of the system obtained and examined?(if they were not available note as N/A)
v — Was the facility or dwelling inspected for signs of sewage back up?
v Was the site inspected for signs of break out?
Were all system components,excluding the SAS,located on site?
Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
,/Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes , no/ -
_ Existing information.For example,a plan at the Board of Health.
L11_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 CIAR 15.302(3)(b))
S
Page 6 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 14 Janice Lane
Hyannis
Owner: Sabino Frontino
Date of Inspection: 5-- '-'6
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):. 3 Number of bedrooms(actual):
DESIGN flow based on 310 CMR 5.203(for example: 110 gpd x 4 of bedrooms):
Number of current residents:
Does residence have a garbage ' der(yes or no).j�
Is laundry on a separate sewage system(yes or no):_ [if yes separate inspection required)
Laundry system inspected(yes or no):ZLCJ
Seasonal use:(yes or no):QL�
Water meter readings,if available(last 2 years usage(gpd)): 2004 — 176,250
Sump pump(yes or no):/f-v 2UO3 - 196, 500.
Last date of occupancy: 7-.5r'-G
COMMERCIA NDUSTRIAL
Type of establis ent:
Design flow(ba ed on 310 CMR 15.203): _____gpd
Basis of desi flow(seats/persons/sgft,etc.):
Grease trap p sent(yes or no):_
Industrial w ste holding tank present(yes or no):_
Non-sani waste discharged to the Title 5 system(yes or no):_
Water m er readings,if available:
Last dat of occupancy/use:
OTHE (describe):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as part f the inspection(yes or no):_
If yes,volume pumped:_gallons--How was quantity pumped determined?
Reason for pumping: -
TYP F SYSTEM
Septic tank,distribution box,soil absorption system
_Single cesspool
Overflow cesspool
Privy
_Shared system(yes or no)(if yes,attach previous inspection records,if any)
_Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
_Tight tank Attach a copy of the DEP approval
—Other(describe):
Approximate age of all components dat�stalied(if known)and source of information: -
Were sewage odors detected when arriving at the site(yes or no):
6
Page 7 of I I
OFFICIAL INSPECTION F0101—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PAItT C
SYSTEM 1NFOHAIATION (continued)
Property Address: 14 Janice Lane
Hyannis _
Owner: Sabino .Frontino
Date or Inspecllon:
DUILI)ING SE VER(locale on site plan)
Dcpdi below adc:
Materials of onstruction:_cast iron _40 PVC_other(explain):
Distance G n,private water supply well or suction line:
Comment (on condition of juutts,venting,evidence of leakage,cic.):
SEPTIC TANK: _ ocale on site plan).
Depth below grade:
Material of construction:_✓concrete metal fiberglass J,ol}etliylene
_othcr(cxplain)
If tank is metal list age:— Is age confinned•by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions:
Sludge depth:
Distance from lop of sludge to bottom of outlet Ice or battle: G�
Sturm thickness: t
Distance from top of stun,to top of outlet Ice or baffle:
Distance from bottom of scull,to bottom of outlet ice or baffle:f 6
I low were dimensions determined: G lj�'1.� C'�
Comments(on pumping recommendations,inlet and outlet ice or Mile condition,structural integrity,liquid levels
as related to outlet invert evidenced f leakage,etc.�
GREASEJ-.
:_(Iota on site plan) —
Depth bele:'
Material ouctiol ._concrete metal fiberglass�nolyethylene_other
(explain): —
Dimensio
Scum thic
Distance f stunt to top of outle►tee or battle:
Distance om of scum to bottom of outlet tee or battle:
Date of laing:Conunenlumping rcconinnendatiuns, inlet and outlet ice or battle condition,structural integrity, liquid levels
as relatedcl invert,evidence of leakage,ctc):
7
'agc 8 of I I R
OFFICIAL INSPECTION FORM-NOT Il Olt VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORA-IATION(continued)
Property Address: 14 Janice Lane.
Hyannis
Owner: Sabino Fron ino
Dale of Inspection: b
T1G11T or IIOLDING T K: ('►uik must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of eonstrucli n: concrete_metal_fiberglass_polyethylene other(explaut):
Dimensions:
Capacity: gallons
Dcsign Florot
gallons/day
Alann presAlarm level in working order(ycs or no):Date of lastComments m and float switches,etc.):
DISTIUBUTION BOX:✓(if present must be opcncd)(locate on site
plan)'
Depth of liquid level above outlet invert:
Conunents(note if box is level and distribution to outlets equal,any evidence of solids can}•over,any evidence of -
leakage into or out of box,ctc.):
o
PUMP CHANIB ocate on site plan)
Pumps in working ord (yes or no):
Alarms in working o er(yes or no):Comments(note a tdition of pump chamber,cundiiion of pumps and appurtenances,etc.):
Page 9 of 11
OFFICIAL INSPECTION.FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 14 Janice Lane
Hyannis
Owner: Sabino Frontino
Date of Inspection:,7—S G
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type v ,
aching pits,number:leaching chambers,numb_er: '✓
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.): i
CESSPOOLS: (c sspool must be pumped as part of inspection)(locate on site plan)
Number and config tion: _
Depth—top of liqu' to inlet invert:
Depth of solids la r.
Depth of scum la er:
Dimensions of sspool:
Materials of co struction:
Indication of oundwate inflow(yes or no):
Comments(n a conditi n of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): _
i
PRIVY: (loca on site plan)
Materials of cons ction:
Dimensions:
Depth of solids:
Comments(not condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
9
Page 10 of 11 '
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 14 Janice Lane
Hyannis
Owner: Sabino Frontino
Date of Inspection:3—,i`G
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.
004
a J r
s1 �
V�r ✓
� r
10
I
Page 11 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 14 Janice Lane.
Hyannis
Owner. Sabino Frontino
Date.of Inspection:
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 a tab fished the high ground water elevation:
z.
11
f
TOWN OF BARNSTABLE
LOCATION 14 JANICE LANE , HYANNIS SEWAGE Ae002- 122
VILLAGE H Y A N N I S ASSESSOR'S MAP & LOT 3 0 7/2 7 2
INSTALLER'S NAME & PHONE NO. ELL IS BROTHERS CONST
SEPTIC TANK CAPACITY ® O 6237
i LEACHING FACILITY:(type) ��.� � �IF fi;,�5° (size) �'� �f
NO. OF BEDROOMS PRIVATE WELL ORt UBLIC WATER6Lt(Z-
1
BUILDER OR OWNER S 01 A i' 0
DATE PERMIT ISSUED: —
DATE COMPLIANCE ISSUED; 1)x
VARIANCE GRANTED: es No
01
, 3
9` 1 ..�
e
5i1u� ls,�� A - 3 — '►,�,�
t�— Z--- 37.,
6- 3- 31. j
�� �E
TOWN OF BARNSTABLE ram!
LOCATION 14 JANICE . LANE , HYANNIS SEWAGE A0002- 122
VILLAGE-. HYANNIS ASSESSOR'S MAP 6z LOT 307/272
5 INSTALLER'S NAME & PHONE NO. ELL IS BROTHERS CONST Cn_ 3F�_
SEPTIC TANK CAPACITY -0 O 6237
LEACHING FACILITYA ype) F-Zo IJ/Ft%,,-o (size) J-;L`>S 'f3J �f
NO. OF BEDROOMS 7" PRIVATE WELL OR UBLIC WATER= &&jC
" BUILDER OR OWNER S clA yL p I�FGn t-i h G
DATE PERMIT ISSUED:
DATE 'COMPLIANCE ISSUED: ox
` VARIANCE GRANTED: , es No
r
O N ILA
• 4
9,1
l
�I
v� � ww
vi ,
F•
TOWN OF BARNSTABLE
LOCATION Iiy J�n r`C,Q C.n ^ SEWAGE # 99'/4/3-
'VILLAGE /T Ta n vl tS ASSESSOR'S MAP & LOT
INSTALLER'S NAME&-PHONE NO. W % f l k rn E A 6 f ri 5 a n
SEPTIC TANK CAPACITY 106a �
LEACHING'FACIIITY: (type) c`M)?.,c r5 (size)
NO..OF BEDROOMS "
BUILDER OR OWNER Fr6t41
COMPLIANCE DATE: 3-I°7-IT
PERMTTDATE: -`0"29
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
p ,
r ,
'o
4N
�. No. Fee i/
THE COMMONWEALTH OF MASSACHUSETTS
Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
ZIpplication for �Digooal *p5tem Congtructfon Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components
Location Address or Lot No. 14 ;A h t'c{ A-? Owner's Name,Address and Tel.No.
S,A, l�r�^d77�d
Assessor's Map/Parcel 1}�Ah 'T Yr1il v d A`1 X* N 1 9' 0 4V4 /h QaO
O " ��i
Installer's Name,Address,and Tfel.No. Designer's Name,Address and Tel.No.
h
Type of Building-f- - - L� r C1111 f
Dwelling '-�No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other -/I'ype of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date 0 W/o 1 Number of sheets / Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil 'S�rr S'.,T 1!�-
Nature of Repairs or Alterations(Answer when applicable) S`-OY S—eboc i 4e)e-,�
DESIGNING ENGINEER MUSI SUPERVISE
Date last inspected: INSTALLATION AND CERTIFY IN WRITING
Agreement: THE SYSTEM WAS INSTALLED IN STRICT
� ACC�ORDAi�.^ TO�FLAIdV
The undersigned agrees to ensure the construction and main a RanD o`��e ore escribed 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 be issue by s of Health.
Signed Date
Application Approved by Date
Application Disapproved for the following rea on
Permit No. Date Issued
i -, � t�ra'`�,� i.,�"H-. - •`. i �' ram^' ... i a ..irvr•i-a.r,,,,ry _- ... - -,
THE COMMONWEALTH OF MASSACHUSETTS Entered i�computer:
' Yes
PUBLIC HEALTH DIVISION - TOWN OF�BARNSTABLES MASSACHUSETTS i
fig ar g*mr(fongtruction Permit
Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System *J Individual Components
Location Address or Lot No. ' f %e1 n I' Owner's Name,Address and Tel.No.
fi w/In m t ',A IV /c �Jln(/ '
Assessor's Map/Parcel �aC 2-2
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. V
Type of Building:/
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
j Design Flow gallons per day. Calculated daily flow gallons.-
Plan Date tl/ Ul/c i Number of sheets 0 Revision Date.
Title
Size of Septic Tank Type of S.A.S.
. y
Description,of,Soil
/
r
Nature of Repairs or Alterations'(Answer when applicable) .S-e)l C 12 A--.
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 be n issue byts
of ealth.
Signed ® Date 3 on_
"Application Approved by / Date
Application Disapproved for the following rea on
U CT
Permit No. Date Issued
——————-----
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTAB.LE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( )
Abandoned( )by C'chS )—
at J' n r 'e'-e (_C, of�- yr., ,r /4":!7 has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer J= /I Designer t,o,1 f-i..a.-#h Y-G✓v'� j
The issuance of this permit shall not be construed as a guarantee that the sy to will f ction as design o
Date I p o Inspectors 1 41) ,
t ,
U
— —--�----------------------- ——
No. Fee SU
v �
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
migpool *pgtem Congtructton_Permit .
Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( )
System located at l g ✓ h 1'C / Lc, r /
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:ConstLructi n must beelcompletted within three years of the date of this pe t. fh
Date: Q j r7( l / 4��, Approved by
r e `
tel.(508)362-4541
939 main street rt 6a fax(508)362-9880
yarmouth port
mass 02675 410WO Cape engIn@el1n�
. civil engineers& land surveyors
structural design
Arne H.Ojala P.E.,P.L.S.
Daniel A.Ojala,P.L.S.
land court Timothy H.Covell,P.L.S.
surveys June 15, 2001
Thomas McKean, R.S. , Director
site planning Barnstable Board of Health
367 Main Street
sewage system Hyannis, MA 02 601
designs
Re: 14 Janice Lane, Hyannis
inspections Dear Tom:
permits Down Cape Engineering, Inc. performed inspections of the
newly constructed septic system at the above-referenced
location.
The soils removal was performed satisfactorily on 6/12 and
the system was installed in substantial conformance to
Title 5, on 6/14 .
If you have any questions, please do not hesitate to call
me.
Yours truly, ED
1 2003
Arne H. Ojala, PE, LS TOWN'01;BARNSFABLE
HEALTH DEPT.
Down Cape Engineering, Inc. --- - ----
cc: S. Frontino
J
i
'-5 112" '-5 112' 4'-3 3116"
r
o O
0 0
00
N
Kitchen �?
15'-6 7/8" 7 11 "
r
Map 307 Parcel 272
Owners: Jairo A DosSantos &
Co Rosilene A. Dos Santos
N\ r 14 Janice Lane - Hyannis
2nd floor - Main Apartment�
J
N Existing
Bedroom = �,
N Main Apartment Total Area 917.83sf
LO
- r
r
5 0 AT 8'-9 7/8" r 7 11 "N Living Room (Downstairs) 204.66sf
Master Bedroom upstairs 151.00sf .
2nd Bedroom upstairs 134.52sf.
Kitchen upstairs 178.44sf
Bathroom 43.11 sf
1/2 Bath 14.77sf
Eli Bedroom 90.23sf
Bedroom 101.1 Osf
4'=7 5/16" '=5 112' 5'-1 /16"
t
5'-8 1/2" '-5 1/2" '-5 1!2" 4'-11 15116" '-1 5f8" 9'-3f 16"
r
11'-8 7/8" gl/� Bath
th 01
1f2,
M
r
00 -
N
00 Bedroom
71f " 10'-2 7l8" 52' 1!
r
N IVS
-
�} LO - -
N
71 14'-1" — —
tv
Master Bedroom — — 13edroom
LO
LO
7 1 f 7'-10 1/2"
r
11'-9 7/8" 5 f2"
'-9 5/ "
\
3'-10 9f 6" '-5 1/2' '-5 1 f2' 12'-9 9116"
36'-4. 1/4"
a
4'-1011/16" T-4" Ij T-41'-91/ "
0 -8 �
O
00
Kitchen Ln
.o
N
00
\ .
r
15'-6 7/8" 7 2"
r / �
_ \ Map 307 Parcel 272
Owners: Jairo A DosSantos &
i-•i - Rosilene A. Dos Santos
C�4 14 Janice Lane - Hyannis
n Ground floor apartment
1n N Existing
N 00
\
ping Room r\. Ground Floor -Total Area 466.83sf
�- r
Ln ,
M Master Bedroom 134.52sf
r 2nd Bedroom 110.76sf
Kitchen 178.44sf
Bathroom 43.11 sf
6 3/4" 7 if
N
W-7 7/8 ' -51/21' 5'-1 5/8"
i
T
1
i
4'-31/2" 2'-4" 15'-71/2„ 21_6„
,/,l
7
Ln
- N �
,:;, Bedroom
7 91-811 '-2 7/81P2'-4" 3' 1/ '
/
cv
rp N\
d L
N
N
Bedroom Li
r
�p
�t
7 2" 11"-8 7/8" 11, 10 5/ 20'-
Ln i
N
h
3'-91/2" '-5 5/8 ' '-5 5/8" 12'=5 7/16." -5 1/2 '
3b'-41/4"
TOWN OF BARNSTABLE
LOCA'FIQN �y �Ki n l t ,e C-�'1 SEWAGE#
VILLAG `<_d!fo n n IS ASSESSORS MAP &LOT .
INSTALLERS NAME&PHONE NO. 11 a m w 6 n s o n
SEPTIC`:TANK CAPACITY 1000
LEACHING:-FACILTTY: (type) '�ti m IK T S (size) '� F4'
NO.OF BEDROOMS
BUILDIF OR OWNER R6041 IU0
PERMIT45ATE: COMPLIANCE DATE:
i Separationthstance Between the:
Feet
i Maxigum`Adjusted Groundwater Table and Bottom of Leaching Facility
Private Vl*6i Supply Well and Leaching Facility (If any wells exist
on site:of within 200 feet of leaching facility) Feet
Edge of Weand and Leaching Facility(If any wetlands exist
with n'30Q feet of leaching facility) Feet
Furnished by
ba
u- a ). },�
k'o� �R►
. 9�
g
No.
�i c Fee $50. 00
THE COMMONWE LTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
01pplication for �Digool bpgtem Construction Verrait
Application for a Permit to Construct( )Repair(x)�Upgrade( )Abandon( ) D Complete System El Individual Components
Location Address or Lot No. 14 Janice Lane owner's Name,Address and Tel.No. Sabino Frontino
Assessor'sMap/Parcel Hyannis, MA. - 10 Paul David Way, . Stoughton, MA
,, AV 02072
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
PO B ox 1089, Centerville, MA 026 2
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( n6
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 Alteration (Answer when applicable) Title 5 Leaching repair con—
sisting of 3 stonepacked H-20 flo diffusers ( in addition to
(existing
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 oard of Health.
Signed � L F==? Date 6—
Application Approved by Date -�.1�°'
Application Disapproved for the following reasons
Permit No. — Date Issued °"
Fee $50.00
No.
THE COMMONWE LTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE MASSACHUSETTS
ZIpplication fori.5ogaY *pgtetn Con�tructionPermit
Application for a Permit to Construct( )Repair(x*Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 14 Janice Lane Owner's Name,Address and Tel.No. Sabino Frontino
" Assesso r's Map/Parcel Hyannis. MA ��'�" 10 Paul David Way, Stoughton, MAS
,V .. 02072
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 -
PO B ox 1089, Centerville, MA 026 2
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( nO i
Other Type of Building No`ofParsons`- 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 Alteration;(Answer when applicable) Title 5 Leavbhng repair con-
sisting of 3 stonepacked H-20 flo diffusers (in additionjfo
(existing) . � P
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 oard of Health.
Signed t t Date,?—(,—
Application Approved by Date
Application Disapproved for the following reasons
1
Permit No " Date Issued y"'
LITHE CpJIAM'QNWEALTIOF MASSACHUSETTS _
Frontino
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(xN Upgraded( )
Abandoned( )by
at 14 Janice Lane, 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 SrV Designer
The issuance of this p t s Il n t),b .construed as a guarantee that the sysf wi ction as designed.
Date 47 Inspector-
-———————— — ————— ——— ——--�——— ——
No. �' -- — — --- � 4 -- Fee $50.00
J. THE COMMONWEALTH OF MASSACHUSETTS
f ( PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
I -
Frontino I=t,gpo!5ar *pgtem Con5truction Permit
r`
Permission is hereby granted to Construct( )Repair( x)Upgrade( )Abandon
System located at 14 Janice Lane
Hyannis, MA
Installer: W E Robinson Septic Sry
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-thisV er'hnit.
0-. ,
Date: t Approved b
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 3 — C — q 9- concerning the
property located at 14 Janice Lane,Hyannis. MA, 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:
1 A)Top of Ground Elevation(according to the Engineering Division G.I.S. map)
B)Observed Groundwater Table Evaluation(according to Health Division well map) ✓
SIGNED: `Z e p r DATE 3
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).
d
D
-----------------------------------------------------------------------------------------------------------------
i
i
s.
' Cti I
TOWN OF BARNSTABLE
LOCATION ,� �7 _ / / -.$�11� SEWAGE
VILLAGE s ASSESSOR'S MAP LOT �3e57�7�Z
INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264
SEPTIC TANK CAPACITY I�
LEACHING FACILITY:(type) - �I C d,.-J ,f. (sue)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER Aovt-t-
BUILDER OR OWNER .rx R 2 D - ti
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED• --)�-
VARIANCE GRANTED: Yes No r-''
d _. ---.__. _. _. j
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� 1 .
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a,
TOWN OF BARNSTABLE CPg
LOCATION j '-) - E)106✓ C c- SEWAGE# �7`
VILLAGE ASSESSOR'S MAP 6z LOT 4-!?,07o?Z�
I
INSTALLER'S NAME 6z PHONE NO. A & B CANCO 775-6264
SEPTIC TANK CAPACITY
LEACHING FACILITYAtype) l C A-I,b try-6 (size) Z/ j
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER�cc .�
BUILDER OR OWNER
'DATE PERMIT ISSUED:
f DATE COMPLIANCE ISSUED.-..-. �
,f VARIANCE GRANTED: Yes No �/
n1'
c
�h
TOWN OF BARNSTABLE
LOCATION SEWAGE# N<b,,
VILLAGE `�� �s S ASSESSOR'S MAP&PARCEL o?/Q'l
INSTALLER'S NAME&PHONE NO.
is SEPTIC TANK CAPACITY ` S�CD �\o%�
LEACHING FACILITY:(type) — iFKcxw Qa (size)
NO.OF BEDROOMS
OWNER S?,A,AL
PERMIT DATE: 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 G .
D Tr D
�9 •° A rs
17
a
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Q
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��SESSOl3S ► Ap rqo:PARCEL 0 7
ti
.
Fps... .......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
oc.P%1....... Cer» L_.........................................................
Appliratiou for Dispaiial Works Tonstrurtion Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: r
4-pa 1»o.................................. .........�---•-•-----..._........-------------••---------------------------....-----•---------
Location-Address oq Lot No.
a------------------- f. ..+� ?7� .. � � a�6 (` IYIES.------------------------..•....------.
- .
Owner _ 04
Installer Ad q� ddre
dres
d PQ
Type of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms...............................4........Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
p' Other fixtures --------------------------------•-•--•---.••..
w Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
9 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---_----_-___-__-__-_--.
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
=•-----------------------------------------------------------------------------------•-•••---.........................................................
0 Description of Soil....................................................................................................=...................................................................
x
w ------------
x yy
U Nature of Re irs r Iterations—Answer when applicablc�lN�srt_ t +� n�..l�__ffl __ Fs .......
`� 4 !._......'. _ .tl.s �t�n��i �' COiI?l � ��l�f0 ti .. ---------------
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—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
-n ed- 5?.W.
%'7iat
te
Application Approved By•--•-•-•=•-•--------- . .... mr' - /
/ e
Application Disapproved for the following reasons:................................................................................................................
..............................................................•-••---•--•••-••-••--•------------------••-•-•--••••••-••---•--•------••--•-•--------•---•--•--•---•-----•-••-•--••-•--••--•----••-------
-------_._. Issued.-•--------•------•--•---•------•--•
.------...-•--------.._. Date
Permit No....................................................... ------
Date
N. Flms....=?r?...................
t
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
l otc»?. ...... ...OF...f:�0m.....................c ..
AplifirFatiou for Disposal Works Tonstrurtion 1phrufit
Application is hereby made for a Permit to Construct ( ) or Repair (jr an Individual Sewage Disposal
System at:
................TCR.. .. ... . n iJe9r�>)t....-•-----------------•--••----•-•-- ..................................................................................................
- • ....................•- --•-
Location-Address or Lot No.
FOO)4t..... wsCt�faaa...-------•------•-•-•.............................. Jet hF�,e- . �1R��.�!�v+�
---•----•-•• •--••• .. .. a. ... a -
Owner tAddress
'ir tt) ------------------------------••---•-- t-'- 4 /.'1�G t>y .5►......�...:/n.......11..... .. ........------•-----------
Installer Address'
QType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms..................................a�__..___....Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
Q' Other fixtures -------------------------------•-•-•---•----•-
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
GG Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft.
3 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........................
G%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---_•_--...____----____.
P •-------•------------------------••-----•-----------------•---••---•--•---.._......------•--.------.........................................................
0 Description of Soil------.................................................................................................................................................................
x
U -------------------------------------------------------------------------------------------------------------------------•--------•-------------------•---------------._......--•--•-•--•------•-•-•--
..............................................................................................--------------•-----------•-------------------•-----••--------•--------- . .........................
U Nature of Repairs or rAlterations—Answer when applicable l:� a�(--�__--------_�_InG -----oc--��z_:�`n�RJz�; �-_r:--x a---'---
4-4rea.•1,�,1 .0tiox4il fl-�cr sg r5-loa�-6taf3t� ao tgvw A~�!�-:�i�Xl�_�?c ��_,���s+uI", iY,u_�__S ---------------
Agreement:
r C
The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with
the provisions of'TTx'p 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.
gned._ /• 1.t�X .t.i l p,nnr�a�:J ..... nZ,?-.R17
Date r
�y
Application Approved By.._..._.____ --�� _G✓_._..1 ! ..�..,. -------�......................
Date
Application Disapproved for the following reasons_________________________________________________________________________•--•.--...__.___.....................
--------------------------•-••---•----------------------------------------•.-•----..........-------------••--•-•---------------------•----------••-•------••----------- ...............................
- _ Date
-
Permit No.---- �C( -
--..... Issued_--•------•---•-------•••......•-------•- .
Date
�-- THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF. HEALTH
. c.,t.. ..................OF.... .. :.....................................................
(Enrtifiratr of TonapfiFaurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (y-)
by_...-------•-•--••--••... ---n-)vN--------------
r--- —" Installer
--
has been installed in accordance with the provisions of =—u—,� of The State Sanitary Cod as described in the
application for Disposal Works Construction Permit No.__._ ..... dated--------.�,-� �?�c�_�............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE®AS A GUARANTEE THAT YHE
SYSTEM WILL F N TI SATISFACTORY.
DATE -.....---------............................................ Inspector.............--- --�-----------•-------------------------•----
37
-nit � � THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
IC►W ...OF.......Ltri i40'a �,
....................................... ..............................................
No..... FEEz�A:. ...........
Uillpoutaf Works TwOn'utr ion anfit
Permission is hereby granted -1•�"1J 0 -----------------------------•--•----...............---------..............------
to Construct ( ) or Repair (K an`ndivid Sewage Disposal System
--------------•-_. .............-.............
at i�'o. .,�.� "' '�.t. ...... '1..__...... Gi11 ,5. ....._._.........._._..
Street
as shown on the application for Disposal titrorks nstruction-Pefm>t No.± t7'. Dated_._ �-------_--7-----------
�....
Board of Health
\DATE------�--U-^-------1-._>--�)--�-�5-�-------------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
4
36-4 1/4" 1
/ 1 " 1 It P ", 1_ I II 1_ 11 1 R t 1/ 1_ 11
5'-8 1/2 -5 1 l2 -5 1!2 4 11 1511 fi" -1 5/8 9 3/16 { -5 1/2 -5 1/2 4 3 3/1 fi
111-87/801 Bath-101/2
r
CIO
N
Co T Bedroom
'O 1/2 Bath c,4
` O
7 1/ " 10'2 7/8" 5 2" 5'-3 1/2 2' 1/2 Y 15'-6 7/8" V- 7 1 -
-- -------- ,;'-- --- -- �- --- E--=-- ---- — - =' Map 307 Parcel 272
Owners: Jairo A DosSantos &
f Rosilene A. DosSantos
LO
14 Janice Lane - Hyannis
2OCI floor
►�- I - - .- -} _ - - _ N n After 2"d floor Kitchen Removal
LP 14-
71/ " 14'-1" . - -
Co -_N - Master'Bedroom / - - Tv Room Dinner Ro_o N, j 2nd Floor Total Area 713.17sf
u7LO
r r i Bedroom 151.00Sf
LO
M 7 11 " f T-10 1/2" •{ 5 2" =8'-9 7l8" 7 1/ "r Bedroom 134.52sf
T N
= Room 178.44sf
- T 11'-9 7/810 5 /2" --- ---- - --
Bathroom 43.11 sf
1/2 Bath 14.77sf
TV Room 90.23sf
'-9 5/ " r Dinner Room 101.10sf
3'-10 9/ 6" '-5 1/2' '-5 1/2' 12'-9 9116" '-5 1/21 '-7 5/16" '-5 1/2" 5'-1 �/16"
36-4 1/4"
4'41/2' 2'-4" 15'-7 1/2 2'-6 4'-10 11,116 2'-47 1 1 Q"-41'-9 1/ "
o -
N 71J2 V
L!-1 `
Y F Kitchen �. .
\ 00
nBedroom L?
7 2" 9'-8" '-2 7/8 ' 2'-4" 3` 1/ 15'-6 7!8" t-r 7 2" Map 307 Parcel 272
Owners: Jairo A DosSantos &
Rosilene A. Dos Santos
- 14 Janice Lane - Hyannis
/ �, Ground floor
04�„ After 2"d Floor Kitchen Removal
`# `" Ln
N • N
Ground Floor -Total Area s
Co
Living Room 204.66sf
Bedroom LIVin Room '`
11., _ _ g Bedroom 134.52sf
r I Bedroom 110.76sf
r Kitchen 178.44sf
- -
- • Bathroom,, 43.11 sf
;a
--
7 2" 11'-8 7/8" 10 5/ 20' 6 3/4" 7 1,12"
/ //
3'-9 1/2" '-5 5/8 ' '=5 5/8 ' 12'-5 7/16" -5 1/2 ' 4'-7 7/8" '-5 1/2 ' 5'-1 5/8"
36'-4.1/4" {
i
1. .
40'-5 1/8" y
4'-7/8"
i- — — — — — — — - - — — — — — — — — — — —
- - - — — — - — "I I
CN — -- -Ln
I I ,
34 -41/4 I I Map 307 Parcel 272
y I Owners: Jairo A DosSantos &
�N N Rosilene X-Dos Santos
(14
�, I 114 Janice Lane - Hyannis
r+n I I M m Basement
I-- J N IqrNo changes
N I I r— --� c•' � � �" I I N N
fc
I Basement-Total Area 766.27sf
00
I I 1
— — — — — — — — — — — — — — — — — — — — — \ — — — — — — — — — -�
\ - - - - -i - - - - - = - .- - - - \ \
3'-4 7/8" 7'-3 1/16"•. 2' 19'-7 3/16 , 2' 5'-61t
.
,-4 718" 36'-4 1/4" i
i r 40'-5 1/8„ 1
i
C
TOP FNDN. AT EL, 23.7'
SYSTEM PROFILE TEST HOLE LOGS ESS COVER TO WITHIN 6' OF FIN. GRADE (Nor TO SCALE)
ACCESS COVER (WATERTIGHT) TO ENGINEER: A.H. OJALA, PE
/li;� MINIMUM .75' OF COVER OVER PRECAST /� WITHIN 6' OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM
22.5 WITNESS: DAVE STANTON
�c (2" DROP IN ST) 2' DOUBLE WASHED PEASTONE\ 11/15/01
RUN PIPE LEVEL DATE:
21.73 -` FOR FIRST 2' woo08uRv AVE. I
PROPOSED1500 H-20 FLO DIFFFUSORS PER(. RATE _ 2 nAl�/�S`H Locus LANTERN
21.57' GALLON SEPTIC 21.4' w ad �, s 21 7' CLASS I SOILS P# 10105 w
TANK CH- ) GAS 21.18'
BAFFLE 21.35' [� (� O CJ O
Qv)
0 21.16' o SEABROOK '^
4' 0 SIDES
( 1 1
% SLOPE) 6' CRUSHED STONE OR MECHANICAL 8o 0,96' 0 C7 C7 �;, [� LS ® ENO6D
20.2 ELEV. SEABROOK
COMPACTION• <15.221 123>
DEPTH OF FLOW = 4 SLOPE) SLOPE)1
TEE SIZES: 1 3/4" TO 1/2" DOUBLE WASHED STONE
< % < %
INLET DEPTH = 10" FILL
OUTLET DEPTH = 14" 5' 12 LOCATION MAP NTS
FOUNDATION--- 16' SEPTIC TANK 4 LEACHING B 5' D' BOX FACILITY
LS ASSESSORS MAP 307 PARCEL 272
* NOTE: THIS IS A PROPOSED INVERT OUT. VERIFY FEASIBILITY 21„ 2.5Y 4/4 19 55°
PRIOR TO INSTALLATION OF ANY PORTION OF SYSTEM WELL: MIW 29
ZONE: B
EXIT INVERT FOR BUILDING SEWER MUST BE RAISED A MINIMUM 100 ADJ: 3.8'
TO PROVIDE GRAVITY FLOW AND MAINTAIN 5' ABOVE ADJUSTED USE ADJ. WATER AT 15.2' C
WATER ELEVATION FOR LEACH FACILITY
M E D/C 0 S DESIGNING ENGINEER MUST
RVISE
2.5 Y 6/4 INSTALLATION AND CERTIFY IN
S SSST MNG
THE SYSTEM WAS INSTALLED IN RRIiCT
r' 21.0 ACCORD^,'�-E TO PLAN.
1•0 LOT 2 X
_--,
7,927f SO. FT. 23.4 120" 0BS WATER 11.4'
JANICE 0.18t ACRES 9
-�- LANE 20 I 7 TH 22 NOTES:
_ EXIST. DWELL.
TF 23.7'
/ :EPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED > 1, DATUM IS APPROX. FROM GIS MAP ELEV.
`14 I_SIGN FLOW: 4_ BEDROOMS ( 110 GPD) 440 GPD 2. MUNICIPAL WATER IS EXISTING
BENCH MARK - TOP OF 05 0 22.5 USE A 440 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8" PER F'OOT,
CONCRETE BOUND 2 20.4 + W r
EL. = 20.0' G SEPTIC TANK: 440 GPD ( 2 ) 880 4, DESIGN LADING FOR ALL PRECAST UNITS TO BE AASHO H-20
GRAVEL USE ' A 1500 GALLON SEPTIC TANK 5• PIPE JOINTS TO BE MADE WATERTIGHT.
0.0 ��, DRIVE D2,7 ECK 22.5 ,p-1 LEACHING: 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS,
ENVIRONMENTAL CODE TITLE V.
1�8 22 to SIDES: - 2(43 + 12) .96 (.74� = 76 7, THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT
9.6 2.5 0 43 x 12 74) = 381 TO BE USED FOR ANY OTHER PURPOSE.
19.5 20.0 2215 ECITTOM:
REMOVE EXIST. 1000 GAL 8• PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC,
SEPTIC TANK AND REPLACE i]TAL: 620 S.F. 459 GPD
WITH 1500 GAL. TANK 9• COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT
PROPOSED VENT (FINAL / L 1 - 12, I,SE (5) H-20 FLO DIFFUSORS WITH 4' STONE AT INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED
PLACEMENT BY CONTRACTOR WITH 22.0 FROM BOARD OF HEALTH,
HOMEOWNER) I iiV 24" SIDES AND 1.5 AT ENDS
Ct CHERRIES 10, PUMP & REMOVE FAILED LEACH PIT
19.4 0 2 (REMOVE ANY CONTAMINATED SOIL WITHIN 5' OF NEW FACILITY)
19.2 RE-LOCATE EXISTING SHED
+ 1 .7 20.3
r
7 1 p 18" MAPLE -LEGEND TITLE E 5 SITE PLAN
919.9 100.0 PROPOSED SPOT ELEVATION OF
PROVIDE APPROX. 73' OF 40 MIL LINER, 5' 20 20.1 14 J A N I C E LANE
OFF LEACHING FACILITY AS SHOWN, TOP 19.7 100x0 EXISTING SPOT ELEVATION
ELEVATION AT 21.7 , BOTTOM AT ELEV. 17.7 IN THE TOWN OF:00 �- PROPOSED CONTOUR
( HYANNIS ) BARNSTABLE
-- 100 EXISTING CONTOUR PREPARED FOR: S AB I N 0 FR ON TI N 0
5' REMOVAL OF UNSUITABLE SOIL
REQUIRED AROUND PERIMETER OF
LEACHING FACILITY, DOWN TO 20 0 20 4p 60
SUITABLE SOIL LAYER. REPLACE BOARD OF HEALTH
WITH CLEAN MED. SAND. ENGINEER
TO INSPECT AND CERTIFY REMOVAL APPROVED DATE MA SCALE: 1" = 20' DATE: NOVEMBER 24, 2001
REV. 2/19/02
off 508-362-4541
fox 508 362-9880 y
`'
down cape engineering, Inc, ARNE ARNE H.
��z ,, � �.
H. M OJALA
OJALA . o CIVIL
Na.2ti34f3
CI�/IL ENGINEERS x, _t, No.I L
LAND SURVEYORS
939 vain st. yarmouth, rya 02675 �°��------
01 -290 ARNE H. OJALA, P.E., P.L.S. ~-DATE