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HomeMy WebLinkAbout0439 LINCOLN ROAD EXTENSION - Health 439 LINCOLN RD. ,EgT.. , HYANNIS A= 271-026 a 1 Town of Barnstable Department of Health, Safety, and Environmental Services "ki SAMSTABM Public Health Division FD""p�a 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 509-790-6304 Director of Public Health r TO: / V I G�✓�� cd1A 920al C LaMS DATE: /""b /7, 9c� T6 L}yCMA(S MA-- c72�O1 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you loc t 39 Lin c/cw as a—nts inspected on 997 by �' a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: � - St (A. GroS i�c�so DJ +- n r V, n You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (fin days of receipt of this notice. You are also directed to bring the septic system into compliance within / ays of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health gUdth�fi1®Wt1,5L&, i V Commonwealth of Massachusetts---,- Executive Office of Enviroiiniental AffanIN - Dept. of Environmental Protection rad One winter Street, Boston, fl 21�08 dt�'�,E�VE0 John Septic ' D.E.P. Title V Septic Inspector ,0�1 I�-2 7I 1��i- ' Oz6 Sep 5 1997 P.O. Box 2119 q OF8ARN t Teaticket,MA 02536 i:TyDr pstr (508)564-6813 WILLIAM F.WELD Governor A ARGEO PAUL CELLUCCI Lt.Governor ti SUBSURFACE SEWAGE DISPOSAL SYST TION FORM PART A CERTIFICATION Property Address: 439 Lincotn Rd.Ext.Hyannis Address of Owner: Date of Inspection:9/4/97 (If different) Name of Inspector:John Grad Mrs.Jarvis I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _ Passes This inspection is based on criteria defined in Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system is _ Needs Further Evaluation 8 the Local Approving Authority performing at the time of the inspection.My inspection does Y pP g y not imply any warranty or guarantee of the longevity of the X Fails t septic system and any of its components useful life. Inspector's Signature: Date: 9/4/97 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer;if applicable and the approving authority. INSPECTION SUMMARY: Check A, B.C,or D: Al SYSTEM PASSES: _I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal, is cracked,structurally unsound,shows substantial infiltration or exfiltiatioli,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/27/97) One Winter Street • Boston,Massachusetts 02108 9 FAX(617)556-1049 . Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property AddresS: 439 Lincoln Rd.Ext.Hyannis Owner: Mrs.Jervis Date of Inspection:9/4/97 _ Sewaae backup or.breakout.or. hiah.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken, settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT`. _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The.system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: Y�must Indicate either"Yes"or"No"as to each of the following: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. _X— Discharge or ponding of effluent to the surface of the ground or Surface waters due to an overloaded or clogged cesspool. -X— SAS is in hydraulic failure. (revised 04/27/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 439 Lincoln Rd.Ext.Hyannis Owner: Mrs.Jarvis Date of Inspection:9/4/97 DI SYSTEM FAILS(continued) Yes No X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X — Liquid depth in cesspool is less than 6°below invert or available volume is less than 1/2 day flow. X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped X Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. —X. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy Is within a Zone 1 of a public well. __X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: _ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply _ X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further Information. (revised 04/27/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 439 Lincoln Rd.Ext.Hyannis Owner: Mrs.Jervis Date of Inspection:9/4197 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: — Pumping information was requested of the owner,occupant, and Board of Health. X None of the system components have been pumped for at least two weeks and the and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X — The system does not receive non-sanitary or industrial waste flow. _X_ — The site was inspected for signs of breakout. X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened, and the Interior of the septic tank was Inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge, depth of scum. X _ The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. X Existing information. Ex. Plan at B.O.H. X Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is unacceptable)(15.302(3)(b)) (revised 04/27/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 439 Lincoln Rd.EA.Hyannis Owner: Mrs.Jervis Date of Inspection:9/4/97 FLOW CONDITIONS RESIDENTIAL: Design flow: o g.p.d./bedroom for S.A.S. Number of bedrooms: 2 Number of current residents: t Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available:(last two(2)year usage(gpd): n/a Sump Pump(yes or no): No Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL: Type of establishment: n/a Design flow:o gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present: (yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: n/a Last date of occupancy: n/a OTHER:(Describe) n/a Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped in the lest year. System pumped as part of inspection:(yes or no)No If yes,volume pumped: o gallons Reason for pumping: n/a TYPE OF SYSTEM Septic tank/distribution box/soil absorptions system X Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) I/A Technology etc. Copy of up to date contract? Other: APPROXIMATE AGE of all components,date installed(if known)and source information: 1963 Sewage odors detected when arriving a1 the site: (yes or no) No (revised o4/27/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 439 Lincoln Rd.Ext.Hyannis Owner: Mrs.Jarvis Date of Inspection:9/4/97 SEPTIC TANK:_ (locate on site plan) Depth below grade: n/a Material of construction: concreate_metal_FRP_Polyethylene_other(explain) If tank is metal, list age o . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: n/a Sludge depth:n/a Distance from top of sludge to bottom of outlet tee or baffle: n/a Scum thickness:We Distance from top of scum to top of outlet tee or baffle:n1a Distance form bottom of scum to bottom of outlet tee or baffle: n/a How dimensions were determined: n/a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) n/a GREASE TRAP:_ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_metal_FRP_Polyethylene_other(explain) Dimensions: n/a Scum thickness:n/a Distance from top of scum to top of outlet tee or baffle:n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping,va Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) n/a BUILDING SEWER: (Locate on site plan) Depth below grade: 2' Material of construction:_cast iron_40 PVC_other(explain) Distance from private water supply well or suction lin0own Diameter: 4• / (;Vamments:(conditions of joints,venting, evidence of leakage,etc.) (revised 04/27/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 439 Lincoln Rd.Ext.Hyannis Owner: Mrs.Jarvis Date of Inspection:9/4/97 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: n/a Material of construction:_concrete_Inetal_FRP_Polyethylene_other(explain) Dimensions: We Capacity: n/a gallons Design flow: n/a gallons/day Alarm level:—n/a Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: n/a Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) n/a PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_Yes Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) n/a (revised 04/27/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 439 Lincoln Rd.Ext.Hyannis Owner: Mrs.Jarvis Date of Inspection:9/4197 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,if possible: excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: n/a Type: leaching pits,number: n/a leaching chambers,number:n/a leaching galleries,number: n/a leaching trenches,number, length: n/a leaching fields, number, dimensions:n/a overflow cesspool,number:We Alternate system: n/a Name of Technology:_n/a Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) n/a CESSPOOLS:x (locate on site plan) Number and configuration: one Depth-top of liquid to inlet invert: 4" Depth of solids layer: 2" Depth of scum layer: 1" Dimensions of cesspool: 5'x5' Materials of construction: block Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection) n/a Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation,etc.) Cesspool cannot handle 1/2 of days flow. System is in hydraulic failure system fails. PRIVY:_ (locate on site plan) Materials of construction: nfa Dimensions: n/a Depth of solids: n/a Comments:(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) n/a (revised 04/27/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 439 Lincoln Rd.Ext.Hyannis Mrs.Jarvis 9/4/97 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) (revised 0427/97) page ! of 10 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 439 Lincoln Rd.Ext.Hyannis Mrs.Jarvis 9f4l97 Depth of groundwater 12 Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property,observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and Charts (revised 04/27/97) Pays 10 of 10 Town of Barnstable Department of Health, Safety, and Environmental Services BAlMUBM Public Health Division MAM 1639. .� 367 Main Street,Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health a TO: Mr.Jarvis DATE: February 17,1998 439 Lincoln Road Ext. Hyannis,MA 02601 ORDER TO COMPLY WITH 310 CMR 15.00,THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 439 Lincoln Road Extension was inspected on September 4,1997 by John Graci,a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5(310 CMR 15.00)due to the following: • Liquid depth in the single cesspool has less then six(61)inches below invert or available volume was less then 1/2 day flow. You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office(Town Hall, 367 Main Street, Hyannis)that will bring the septic system into compliance with 310 CMR 15.00,The State Environmental Code,Title 5 within thirty(30)days of receipt of this notice. You are also directed to bring the septic system into compliance within sixty(60)days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings,onto the surface of the ground,or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE OARD OF HEALTH Thomas A.McKean,RS.,C.H.O. Agent of the Board of Health q\health\dbfiles\title5i.doc TOWN OF BARNSTABLE �G LOCATION 1 h dlh /Z�F'X!. SEWAGE # 1I7-G 3 9 VILLAGE A ASSESSOR'S MAP & LOT,� INSTALLER'S NAME&PHONE NO. `177-O? . �ase-A e- C 4n-oS SEPTIC TANK CAPACITY _1S90 Gam% LEACHING FACILITY: (type) (size) 2 S X l 3 1 2"' �I NO.OF BEDROOMS 3 BUILDER OR OWNER .�69uro PERMIT DATE: !l-3 7 COMPLIANCE DATE: l l- G - 97 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 _ . s_ "'� �/ .r n S $ C . ` • ,hh ,o�h b� � y i -7 y 7i(�7 No. Fee _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: i es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYicatiou for Migogar 6potem Con6truction permit Application for a Permit to Construct(z.,Oepair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Z 3 q /�4 e o/� Q6I X-r Owner's Name, ddress and Tel.No. 7%I iZ yH 2 '42myMoho� JarVIS Assessor's Map/Parcel a Installer's Name,Address,and Tel.No. q7-1—r?`S0C/ Designer's Name,Address and Tel.No. Joi-IP4 13oi41-0S Y ,1/ Type of Building: Dwelling No.of Bedrooms �_ Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank / Type of S.A.S. Description of Soil 5ja",,1 Nature of Repairs or Alterations(Answer when applicable) ri'// 15Y A bv�D C� r9p®©� tv�T� C_'./,5011 ,YA Zj5 r14// /S'oo 6a3/ S°% 2 - Soo fa,vL L a-yes fi a G/��l��f^ cv%1J� y `S7oht i4r�oyv�< 2 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date i Application Disapproved for the following reasons Permit No. Date Issued / 7/ . �6 No. Fee .-THE'COMMONWEALTH OF MASSACHUSETTS Entered in computer. e PUBLIC HEALTH DIVISION -aTOWN Of BARNSTABLEs MASSACHUSETTS 01pphration f �r °g of ar pgtO > o'ngtrurtton Permit ' #Al Application for a Permit to Cons ct(�epatr(i/��'Upgrade( )Ab on Ind ) El Complete System ❑Individual Components Location Address or Lot No. Z/3 It Lj pYh �� X r "} Owners Name,aa�ddress and Tel.No. 'Ir/l it 47 2 . h Gj4gwo i.1 4 gy�one�� jorV/,5 y a Assessor's Map/Parcel t I` "'� Installer's Name,Address,and Tel.No.�,f/7 —O'3 Designer's Namea Addr se s and Tel.No. e WI ZI .s, 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 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 _54,"J Nature of Repairs or Alterations(Answer when applicable) "m CrSsgoo! U/,t/i f1, 04 J,,,, T4 s rsa// /soa 6,*1 f T 2 - boa Go,/. LEaGl is�o G�iNs�s�%r cv:lti 4/ 'Stagy t r4royi;,-1 2 Phi 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 operationNuntil a Certifi- cate of Compliance has been issued by this Board f Health. + 3 Signed Date ,,, Application Approved by Date Application Disapproved for the following reasons 4 Permit No. , 7 L� Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS , Certiftcate of Compliance THIS IS TO CERTIFY, that the On-site Sewa a Disposal System Constructed( G•}Repaired ( )Upgraded( ) Abandoned( )by /= oo�.sF_/ t//�/= o at /'S has been constructed in accordance with the provisions of Title 5 and.,the for Disposal System Construction Permit No. dated Installer ✓os e_*424 0" /3arr e7S Designer ✓os gyp! be doeo-OS The issuance of this permit shall not bd construed as a guarantee that the system will function as designed. Date Inspector ti - THE COMMONWEALTH OF MASSACHUSETTS T PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS , f Migpogar *pgtem Congtrurtton Verna Permission is hereby granted to Construct( )Repair(c+Ypgrade( )Abandon( ) System located at Y-1 J L i ry c U N /� r X 1,, f�UAhN/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:Construction must be completedwithin three years of the date oft 's-pe Date: // / Approvo2by � d 1 Q/7/77 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) hereby certify that the application for disposal works construction permit signed by me dated l/— 34x-Y'7 , concerning the property located at y9 <� ash �� /�y���.<s meets all of the following criteria: • There are no wetlands located 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 within 250 feet of any wetlands,the bottom of the proposed leaching facility will n9t be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) 6_ B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED DATE: / LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER_2,rZ-- [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:cert �► t J a �tYfGohl J IF_X7% �e f 0 P Spa° T� NOTICE: This Form is to be used for the Repair of Fa,itcd e/ S )tic Systems Only i .. 1 CEIt'rIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONS'I'KUCI'ION I'E[tNll'l'(AVI'['IIOU'I' DESIGNED PLANSI I, hereby certify that the application for disposal works construction permit signed by me dated ti— 4 —97 , concerning the property located at y 39 /,14, c meets all of the following criteria: A,,*�—Thcre nre no wetlands within 300 feel of the proposed septic system • N/'Thcre arc no private wells within 150 feel of the proposed septic system 4 vic observed groundwater inble is 14 feet or greater below the bottom of the Wching facility p�There is no increase in..(low and/or change in use proposed • There are no variances requested or needed. SIGNED: DAT13: // —3 27 LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN On HARNSTA13LE N"ER l_ ]Attach a sketch pinn of the proposed system. Also if the licensed Insteiler posesses a certified plot plan, this plan should be submitted]. TOWN OF BARNSTABLE LOCATION L�he o�ti Fk(. SEWAGE # VII.LAGE Nu�oserJ/4 ASSESSOR'S MAP & LOT IV 0 2 G INSTALLER'S NAME&PHONE NO. _1177-O?Vl JAscp4 Uc 84 v -5 SEPTIC TANK CAPACITY )SP o G � :` `LEACHING FACILITY: (type)1 Soo (size) 2 S ::`. NO.OF BEDROOMS 3 BUILDER OR OWNER '5 44'1-0 PERMIT DATE: _l l—3—4 7 COMPLIANCE DATE: l l- G — f7 `: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 teaching facility Feet :? Famished by a . s 4 -01 No....U=.I----- MIND .............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ­-_� olko ..................__Ialm........OF........XXIMMIX.......Barwsl0le.......... Appliration for Disposal Works Tonstrurtion Prrutit Application is hereby made for a Permit to Construct or Repair ( X) an Individual Sewage Disposal System at: -.439...Linwln'.JU i�------------------------ -------------------------------------------------------------------------------------------------- Location-Address or Lot No. Will. -Ziatlis........................................................ ...Rd.A...HY-AiliaLs....... ............. Qe d Owner Address f4A & B_Ces.sp.o.ol Service 128 BishoDs Terrace. Hy................ ......... .... .......................................... ................................................................ ...... N-1 Installer 9Q Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms..............3...........................Expansion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons.____?.................... Showers Cafeteria 04 Other fixtures ...................................................................................................................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid'capacity............gallons Length................ Width._.__..._______. Diameter................ Depth_______..__._._. Disposal Trench—No_.................... Width___._._...._______._ Total Length_.____._.._.___.___. Total leaching area...................sq. f t. Seepage Pit No..................... Diameter_.____.__.._.___.___ Depth below inlet.___..__..___._..... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutesperinch Depth of Test Pit._____________._____ Depth to ground water.________.._____._._.__. 4 Test Pit No. 2................minutes per inch Depth of Test Pit.____.._________._.. Depth to ground water._____.__...____._____._ 04 ........................................................................................................................................................ 0 Description of Soil---------------.Sand............................................................................................................................................. U ........................................................................................................................................................................................................ .................... ---------�­....................................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable-AnOtAII&U.0-n....0;f...A...1'..Q.0.0...gAlion...... -stone__.packed...pre*vLaast---leach...pit...(.o.y.e:rlfbw)_,-------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TLITiZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be/en�is�sued�tide b Ith. e o Signed-A&.A-X ..................................................... .....V Application Approved By.................................................................................................. .............. ............ dat"79 Date Application Disapproved for the following reasons:.............................................................................................................. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Date Permit No.........79 Issued_ ........................................ ......7/1.3/7.9............................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................... able........................................... .�Zolrin.........0 F.........BarnS.t Tntifiratr of Toutpliattrr THIS IS TO CERTIFY, That the Individual Sewage Dis sal System constructel �or Rg�ired. X) , 16, b ....&A...B...(; 128 Bighopa errace, Hy y a. 6DI ...................................... In 1 -- Raymond Jarvis ln Rd. Ext. HYMA ....Uft at......4.3.111APA.................................... �P. .................................................... has been installed in accordance with the provisions of TITLE: 5 of The State Sanitary YMs described in the application for Disposal Works Construction Permit No.... .- 779 ........ ' dated................. .............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................................... ............... Inspector.................................................................................... t $5.00 Fxs..4p]p g..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH = ................. . Ta ►n. ...OF........Xnawlix------Barns_table---....... ApplirFation for Bispoii al Works Tonotrurtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: .439.... ...........H-Jannis........................ ................................................................................................. Location-Address or Lot No. .Ra=.an.d._JarrLs........................................................ .d.3�9... inc.o n...Rd......Hvenni-s.............---....•......... Owner Address aA--�--8- CessAool...Se;ry�.c-e................................. .128..Bisho.pjs a=ace_,---ci yannis............ Installer Address UType of Building Size Lot.......................... S. q. feet Dwelling—No. of Bedrooms..............3............................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Buildiii No. of ersons....2..................... Showers — Cafeteria 0.1 YP g P ( ) ( ) Pa Other fixtures ----------------•--------------- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank-,Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal,Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No-----------------_- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test )1 No. 1................mmutes per inch Depth of Test Pit.__.__.............. Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a+ --------•---••--• ..............-------------------------- •---------- --- -........ ODescription of Soil...............Saad------------------------•--•---------------------------------------------------------------::•--------------.----------------------•--------- W UNature of Repairs or Alterations—Answer when applicable insta.11a.t-Lori...of_..a...1.,.0.0.0-..gallon....... stone...packed...pre. cas-t-.l-each...pit...4.avesl ow)... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of SIT J_ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issuedb t boar 1�th Signed.. %�C ................ .....7A/ 9__.... Date Application Approved°By.....------•-•--- -= ?113/79.._.. Date Application Disapproved for the following reasons:............................................................................................................. ........--•---•-----•......::......................•-•-----------•--.........--------------•----------------•---••-•-....--•-----------•--•------•---••-••------••------•-- •••••........ Date Permit No.......7-9-......................: = Issued......7/13/79 Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ ....:.: ...........OF........Baxnstabl e.................. : .................... �g.�rrti irtttr of Tumpiiatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Re a' ed (X ) by..A...&...R..C.e8P.Deal...Saryice.,...128---Bishopq--- errace� iyannisr ao 02601 at....4 9...Ui1C.Q1n-..Rd. . xt, HYannist...M�.. -Raymond Jgxvf e --------------------------------------•----- has been installed in accordance with the provisions of TITLE j of The—State SanitaryZ a scribed in the application for Disposal Works Construction Permit No...79.-.._._...OKV—i ._.._... dated .�A_3 ........................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..........................•-•--•--............-----•-•....---•-•••-............ Inspector....:_.............................................................................. THE CON¢QNWEALTH OF MASSACHUSETTS r BOARD OF HEALTH {A.. .�r :.......0 F.....urns tabl e No.....7: .._..x/,x FEE$5.00........ 00fvaii al Vorkv Tonstrnrtion Vamit Permission Is hereby granted A B Cess ool Service, 1- --••.-.Bi.sho. ps Ter, Hyannis --- "-------- -------- -------- ..-•-- ---- ........•. • ..........-------- to Construct .(, ) or RepairX ) an Individual Sewage Dis osal System at No439L...Liheoln...Rd..---.UXt.�.......Hyannis -'--�MMPAd-••Jarvis•--------•.......... -- as shown on the application for Disposal Works Construction PerStrttNo7Q' _•_':_`__._ Dated..__7�13�79 . --•--•......•........ :. --------•--- A�-. a DATE -------------------------- FORM 1255 HOBBS &.WARREN. INC.. PUBLISHERS