Loading...
HomeMy WebLinkAbout0008 JASMINE LANE - Health 8 Jasm ne`Lane — Hyanni r r A= 310 93 # . � a r i u � I II ;j ti n } i - e i � o 0FYF4F Tp� Town of Barnstable Barnstable Regulatory Services Departmente;caC j • BMA RNSfABLE. MASS. Public Health Division ' m i679• Al fb MAC a 200.Main Street, Hyannis MA 0260.1 2007. Office: 508-862-4644 Thomas F:Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO i May 13, 2008 Niels Jensen 8 Jasmine Lane Hyannis, MA 02601 i i ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 8 Jasmine Lane, Hyannis, MA was last inspected on March 26, 2008;by Patrick M. O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Distribution box is decayed and leaking, needs to be replaced. You-are ordered to repair or replace the septic system within two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE B ARID OF HEALTH omas McKean, R.S., CHO Agent of the Board of Health • Q:\SEPTIC\Letters Septic Inspection Failures\8 Jasmine Lane.doc ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 P Y rY 8 Jasmine Lane Property Address Niels Jensen Owner Owner's Name information is required for Hyannis MA 02601 March 24, 2008 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector , use the return t key. Septic Inspection Services Co. Company Name 189 Cammett RoadI e 1 Company Address CJ; - Marstons Mills MA 1=1102648 Cityrrown State Zip Code 508-428-1779 - Telephone Number License Number B. Certification s� I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection ` �— was performed based on my training and experience in the proper function and maintenance of on site ®` sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: i ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority V1 March 24, 2008 Ins ector's Signature t 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. 08-58 Jensen.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Jasmine Lane Property Address Niels Jensen Owner Owner's Name information is required for Hyannis MA 02601 March 24, 2008 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. 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 08-58 Jensen.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Jasmine Lane Property Address Niels Jensen Owner Owner's Name information is required for Hyannis MA 02601 March 24, 2008 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ® distribution box is leveled or replaced ND Explain: distribution box is decayed and leaking, needs to be replaced. ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 0858 Jensen.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Jasmine Lane Property Address Niels Jensen Owner Owner's Name information is required for Hyannis MA 02601 March 24, 2008 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or' obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the 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. 08.58 Jensen.doc•08l06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Jasmine Lane Property Address Niels Jensen Owner Owner's Name information is Hyannis MA 02601 March 24, 2008 required for — every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. El ® 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 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 08-58 Jensen.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 i Commonwealth of Massachusetts Amm Title 5 Official inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Jasmine Lane Property Address Niels Jensen Owner Owner's Name information is required for Hyannis MA 02601 March 24, 2008 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? ® Q Was the facility owner(and occupants if different from owner) provided with j 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)] 08-58 Jensen.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Jasmine Lane Property Address Niels Jensen Owner Owner's Name information is required for Hyannis MA 02601 March 24, 2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 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 Water meter readings, if available last 2 ears usage d 115,500 gal. _ 9 ( Y 9 (gpd)): 158 gpd. Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied 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 Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 08.58 Jensen.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form iSubsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Jasmine Lane Property Address Niels Jensen Owner Owner's Name information is required for Hyannis MA 02601 March 24, 2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Tank pumped December 2006 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Compliance date: 3/2/79 Were sewage odors detected when arriving at the site? ❑ Yes ® No 08-58 Jensen.doc•08106 Tine 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Jasmine Lane Property Address Niels Jensen Owner Owner's Name information is aequired for y H annis MA 02601 March 24, 2008 - every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): . 1 Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): 6" Depth below grade: feet 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: 8.5' long x 5.2'wide- 1000 gal. 2 Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 28 2„ Scum,thickness 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 12" Measured How were dimensions determined? 08-58 Jensen.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 9 o1 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Jasmine Lane Property Address Niels Jensen Owner Owner's Name information is required for Hyannis MA 02601 March 24, 2008 kv . - every page. Citylrown 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.): Baffles are intact and clear, liquid level was found at bottom of outlet invert. 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight-or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): 0858 Jensen.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Jasmine Lane Property Address Niels Jensen Owner Owner's Name information is required for H annis MA 02601 March 24, 2008 - Y every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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 Distribution Box (if present must be opened) (locate on site plan): o„ Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is deteriorated and leaking needs to be replaced. no evidence of backup from pit. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 0858 Jansen.doc•08/06 Title 5 Official Inspection Form:-Subsurface Sewage Disposal System•Page 11 of 15 �. { N ' r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Jasmine Lane Property Address Niels Jensen Owner Owner's Name information is required for Hyannis MA 02601 March 24, 2608 every page. City/Town State Zip Code' Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: One 6x6 pit. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching pit was found half full with no high stains or evidence of surcharge. 08-58 Jensen.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 i i r ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Jasmine Lane Property Address Niels Jensen Owner Owner's Name information is required for Hyannis MA 02601 March 24, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Y 98-58 Jensen.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 0115 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Jasmine Lane Property Address `^ Niels Jensen Owner Owner's Name information is Hyannis _ MA 02601 March 24, 2008 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) 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. Jasmine Lane Water Service 36 21 45 I i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Jasmine Lane Property Address Niels Jensen Owner Owner's Name information is required for Hyannis MA 02601 March 24, 2008 .every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ® Accessed USGS database explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water at el. 25 and topo map shows property at el. 45. 08-58 Jensen.doc•08l06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 ' • f i oFt►�,� Town of Barnstable Regulatory Services ,AR,,STAB Thomas F. Geiler,Director 1639. �•� Public Health Division i AlFD MA'I a Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health , Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would; be listed on the "Disposal Works Construction Permit". 4 If you should have any questions 'regarding this report, please contact the certified Septic System Inspector who conducted the inspection. QASEPTIC\Disclaimer Private.Septic Inspections.DOC TOWN OF BARNSTABLE LOCATION S�-�MI r� � — SEWAGE# D:7;�5P VILLAGE 01 C-nnes ASSESSOR'S MAP&PARCEL IN KS NAME&PHONE NO. © d C1 Ll b- 177 SEPTIC TANK CAPACITY /Uoo LEACHING FACILITY:(type)' '(size) loud N0.OF BEDROOMS' 3 . OWNER 1215 ✓�S2o'1 PERMIT DATE: COM?MAW&E DATE:!71,ngn. 0 �S r , 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 Jasmine Lane ater Service: 36 28 21 45 -- -- 2 L0f•CAT ION 4(--9 SEWAGE PERMIT NO. i W j 95 /??/)I& 1-AMC '� V LLAGE r INSTALLER'S NAME & ADDRESS /l�Pi10 -M eo r WUILDE R OR OWNER DATE PERMIT. ISSUED a �o --7 DATE COMPLIANCE IS•S.UED _ a _ 7 � • R _ 1 r -1- J � No. OD Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0(pprication for �Diopo!gdY bpapm Con5trUCtion Vermit 10 �O/lacL- OXlStj Jjy D-l3ax� R_p�eh N/ cv (Al ,an9��del�T.d`✓ Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. a 1'wwe— Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ^ Installer's Name,Add less,and Tel.No.,fd8'Yam' �2�8 Designer's Name,Address and Tel.No. a�GtS e04 �a�i 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 orAlteratioris(Answer when applicable) ��%sT/G.� Date last inspected: Agreement: ' f, The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by 4kyDate Application Disapproved by: Date A for the following reasons Permit No. r Date Issued �...- :.:`yj1::J•� '.ad �-. -^—'-w•--'-w-v�-.,.•,�.s......e.>.+" x:. -��'--"--`l.sw...<:ns �,.....:..r»:.H _ No. f Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Moto l *pgtem Cottgtruction Permit . Alp/x4C GX/sreAfq O- 0,0X 2/_pl��/� /Vi.w rh �sosr9� Lo�,roT.ah Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No.ps—4120- �'��$ Designer's Name,Address and Tel.No. ✓GtS�jdLi D.� Q/4rrOS W, Type of Building: Dwelling No.of Bedrooms ,3 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 a Size of Septic Tank Type of S.A.S. Description of Soil , Nature of Repairs or Alterations(Answer when applicable) ado H Rj= �s r� d- oX /4 Y14"O/-c �OG/srTiO�! Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage,disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed I! .� Date / Application Approved by V v ♦ Date �l . Application Disapproved by: ( Dates` for"the following reasons Permit No. Date Issued \ Y i THE COMMONWEALTH OF MASSACHUSETTS 1� v BARNSTABLE, MASSACHUSETTS s, Certificate of Compliance 0-.exGC//jl9 IV-e� O_43a>( /// ..�'/�10 -eL 40C!¢TaH THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by �D,S e'04 at Jp S�,,/jy c L M y oAf0f!r has een constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Q� 0) dated Installer dQSt.,FJh O.� �/a�yG� Designer #bedrooms Approved design flow gpd The issuance of this permit shall not cons rued as a guarantee that the system will nction.as designed. ( AN A � Date ,75 Inspector / j"0 j �/ No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS O gdx w/r� <i/e/P/ -13OX I� 5 �+ lac re0.4 lioogar �&p!gtem Co 5truction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade (� ) Abandon ( ) System located at f� 0 ,4 5 Hi//V _ ta GH.e_ I 4 >�C1lGtHr1/S 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 tion m s be co leted within three years of the date of this •ermit Date Approved by - No....... lo �7 zt'` F>cs...... sr.......... THAZ COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............Town..................OF......Barns table....---------.......---------------..............._ Appliration for Biiipvii al Works Tnntrnrtinn ramit Application is hereby made for a Permit to Construct Z_ = X ) or Repair ( ) an Individual Sewage Disposal System at: ,y.W„ s Cale Hyannis, Mass. ............... .......................................................................... ........................-------------....--- ---------------.....-.............-------- . Location-Ad ss or Lot No. �.- Owner Address a ........................Spero-...T- e.&ha-r cgis•------------------------- ........5-I---Xa GQ-th-j....Ma-s-sw--------------------------------------- Installer Address U Type of Building Size Lot._l/j__5:13.......Sq. feet Dwelling—No. of Bedrooms-------------3------------------.------.---Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building. __Dvxe_ cy l_i_n --__ No. of persons........b................. Showers ( ) — Cafeteria ( ) � Other fixtures ----------------------------------------------------------------------------------------------------------------------------------------------------- W Design Flow....55..................................gallons per person per day. Total daily flow------------3_3.Q........................gallons. 04 Septic Tank—Liquid capacity._100.Ogallons Length$_!.6'.____ Width/4.'__6_'_.____ Diameter________________ Depth................ Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area_______ __ sq. ft. � 1Seepage Pit No Diameter_____._____ Depth below inlet__. !� Total leachin area_._." � s ft. -------------- P b---6....------ g .._. q. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by..Norman---Gr&ssman............................. Date___�:4..5 -7_g____..__._____... Test Pit No. ]________________minutes per inch Depth of Test Pit____________________ Depth to ground water______________ f= Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water..... ....... a' -------------------------------------------------------------------------------------------------------------------------------------------------------••---- 0 Description of Soil---------------------------Age-d±=---tp----coars-e_-_sand----------------------------------------------------------------_-.-_-__------- x c, .....................................................-................................................................................................................................................... W --------------------------------------------------------------------------------------------------------------------=---------------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL L 5 of the.State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' sued by the board o / th.. :ned ................................ ero Theohar.Zidis Date Application Approved By------------ - -------1�----- --- - ------------------------------------------------------ ..._._/_��-_?lc�-r'a; ` Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------.--------------------------------------------------------------------------------------._.._.._. Date PermitNo........................................................ Issued- 3 ./---7 ----------..-..--...-...--...-- Date .�........._..... FRic............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r ............Twan..................OF......Rarnsta.Ue.................................................... ApplirFation for 11isVnsFal Works Tonstrurfinn "ermit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal, System at: COt�as.s Circle Hyannis,...Mass.. _................... ......... -- ..................•---•--... ... Location-.Address or Lot No. Owner Address a �-dxQ---• .-_c�0_.c"-__y; .a 'G_________________________ v �i s r'�iu�?�...y�. c. k,,. r�'h .Ih. a �.�................ " Installer ; A ress U Type of Building Size Lot... lr.- �-- ....Sq. feet Dwelling—No. of Bedrooms._.__.__.___.............................Expansion Attic ( ) Garbage Grinder ( ) 04'4 Other—Type of Buildin 2_7 1 No. of persons.._.___ Showers — Cafeteria a Other fixtures -------------------••••-•--•--•. - d. - -••-•-•-••---------------•------•••--.._....--•-••••- WDesign.. Flow...5.5.................................`:gallons per person per day. Total daily flow.._.._._.__�,3l}.......-................gallons. WSeptic Tank—Liquid'capacity..�0 Ugallons Lengths V.+v-®_.._._ WidthA_i "_.._._ Diameter________________ Depth................ Disposal Trench!No_..........._........ Width_. ...._.__..___._ Total Length.................... Total leaching area..... _0._/_.sq. ft. Seepage Pit No....I............... Diameter_.__...:__. Depth below inlet..G.e�?___.___,Total leaching area.___.74 ..sq. ft. z Other Distfibution box ( ) Dosing tank ( ) Percolation Test Results Performed by-Nowtar.,�...G age;______________________________ Date...j.0_r. 7 ................. Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water____/ _.__.__. ._...____. Test;Pit No. 2________________minutes per inch Depth of Test Pit._..__..____._______ Depth to ground water.._., _.__... cw 1 . ODescription of Soil............................i,wadi=I...tt3___'marse...sand-----------------------------------------------•------------•------------•------ x W ---•-•-•-------------•••-•...----•-••-•••--••••-•••-----------••••-••••-•--•-------------••-------••----•-••-•--...•-•------------••-------------------•-•---•----•-••••--•...-•-•-•--•--•••-••=•t•-•••-- U ' Nature of Repairs or Alterations—Answer when applicable................................................................................................ --------•---------------------------•--------------•---------------•-----•-•-••••-•_._...-•---------•-•--------•-•---------•----•••---••----•-•••--•-••••-•••--••-•-•---_.._..--------••........_....._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT I-i; 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Complia1.nce has be issued byWebof hea•gned _._ .. .....••-....._'erio lc is Date Application Approved By............. �--• • -•- -----•---•._.........-•--••----......._•••----••----- Date Application Disapproved for the following reasons-------- -----------•-•--•---------------•------------------------------------------------------------------- ................••-•-•-•-_...._....•-•--•--------••--•-----••---__••••_._...__..__••--••••••-•••••._......---••-••-------------•-••-•••••••-•---------•----•-••--•-•----•-•••----_..._. Date PermitNo. =-`- .._..__. Issued-------------------------------------------------------- Date ' 7 THE COMMONWEAC44A6F MASSACHUSETTS BOARD OF\HEALTH ......................................... Terfif irate if, TompliFanrr s THIS IS TO CERTIFY, That the Individual Sewage Disposal System cont.ruc.ted.,( ) or Repaired ( ) aS.pexs�... eokaxii s........................................................ ....................•--......._.....••••--.._...._...._ Installer ' Y••---.......•---------•..._..__.. at.....................................................................................r; L rC --------•--- •--------•-•----•---•------•-------------------- has been inItalled in accordance with ie provisions of T _ ` of tate Sam Code��,E1ftA1l�d`17 fie— application for Disposal Works COnstrAtio n„Permit No.___ ...... d XF THE ISSUANCE ®F THIS CERTIFICATE SHALL NOT BE CONSTRUED AS GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � � �� ��„•. DATE.. ...-•-•-.... Inspector.....::. . .....................................•-•••--••-_...--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ` .......... :33?.....................OFDarns i b— ..................................................... � No. FEE........................ - �is��asttl nr�s. �uns#rnr#ai�an hermit Permission is hereby granted..... ------•-• ...... to Construct''( ) or Repair ~) an Ifdividual Sewage Disposal System • C -: 4. - "'? Street as shown on the application for Disposal Works Construction PVV No._. Dated....l V................................. ... tp Board of Health •° t " - DATE FORM 1255 HOBBS & WARREN, INC., PUBLISHERS _ ;�f+��!''.� �'Fifv�sN ��r..oft•�.',�Q r�N�rk �R,�c:r ►'�►NA�`N �+�,�t+s - , .. I( F.►► dlt 'Ty1 NK t .�_r� Jv.t�tt /�'T s �.R+�i� Tor a♦fro NMC►, f �` '�N+'�.d1�`y�*1,4,�:�„r(„�,tv� �, �,IrcafriW`•A!�h•/jfi`���flN,r; �,ar w.�c+r� 1+`���1,tibs 1�1r.•.4 �err Owr►t.�fIV� .., "..'"._ r. '.I .�„_Ar'� ...t .�... ...:. „`... Y � M �\ ..,,,►i,,,r wws.�o. f^ � -t�si� x-- ,�=it�a s..vA A7 0 e) 1 0 0% 1 U 1ST a O x / �! o a r o 1 �1 : 't'" c:.oastvta sraw+r re f t� �-a .SEF'T'I C K c3E �E V.CL- / r Ara srwd4E LEACH/!;'Cr Ja17" D�S< G�1! Cam/ TEMP/A /YO- vF .t3EpRUolr1S � •�- GAL• PEe D,q y ' 330 Td rA� �Ai�y FL ate: 3�EGA 1 EAG N iN G �9�EA r'n v�1�.E^.D: ao L p T G ,ems 'fir-- I` `7- Siof wACC. A x Z-S= 407 Borax+ Ate* 500 �• 4�'�3 9 pU 4,48v _ 'r 7 JJ �I ! 5C. S 4AWT1C Al S'Q I G 5 _ CMG G �'J �'• r�.,�-+r �t ,�`,` °�} ;try fly fEs� L64C4A r Ijb �, . C>wsFu.�•u�G. p�T GC•/vEc_ i �',Fc - Soys �TC1t W/ 73,0,AJ E U / w- I if a U Al �. ��•Pi►v ��•�cc ' •�'� _ o __ vim% 3 4�,pp J !a NI IQ r, l_ AI Q i.✓3�Ec rED �y : f'.Poi'oS�� I>l'd�EL L ING Z gz4j6M6,c Al }- --- M of s' i MOIMAAN Y.•l f � G SEM o AAtA4�MAN M.�4 N C'R©.SS'M,41V R E• I Illo 121"',1 f V 844 • .