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HomeMy WebLinkAbout0170 LINCOLN ROAD - Health 170 Linca n ova ' Hyannis,`@ r F - L A = 270 051 , 1 } i .i4 l ^TOWN OF BA.9NSTABLE LOCATION I 0 �/1 �( ► � SEWAGE # VILLAGE ASSESSOR'S MAP &LOTD 1 0 —61 INSTALLER'S NAME&PINE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: I I Q l O 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 M 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 .� 4 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION a F , p 1 d ly ti y! TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION C� Property Address: 170 LINCOLN RD HYANNIS,MA 02601 Cp (�- 0 J t Owner's Name: JEFF LYONS Owner's Address: BOX 64 HYANNISPORT MA.02647 Date of Inspection: 1/10/01 Name of Inspector: (please print) JOHN GRACI Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET,MA..02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspect ed'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 5 inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes _ Conditionally Passes _ Needs Furth Evaluation by the Local Approving Authority t Fails Inspector's Signature: tur Date: 1/10/01 The system inspector shall submit 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. ,I Notes and Comments THE SYSTEM PASSES TITLE V INPECTION. RECOMMEND PUMPING THE SYSTEM NOW AND EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE,RECOMMEND RAISING COVERS TO SYSTEM. ****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. 'ritip 5 InmPrtinn Fnrm ril5nnnn 1 Wage 2 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t` PART A CERTIFICATION(continued) Property Address: 170 LINCOLN RD HYANNIS,MA 02601 Owner: JEFF LYONS Date of Inspection: 1/10/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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: THE SYSTEM PASSES TITLE V INPECTION. RECOMMEND PUMPING THE SYSTEM NOW AND EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE.RECOMMEND RAISING COVERS TO SYSTEM. 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. n/a 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: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a 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'ot Health): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a .7 r Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 170 LINCOLN RD HYANNIS,MA 02601 Owner: JEFF LYONS Date of Inspection: 1/10/01 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 Healthdetermines 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 arid',SAS and the SAS is within 50 feet of a private water supply well. _ 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 de `ftme distance n/a "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia i 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: n/a 9 i', Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A " } CERTIFICATION(continued) Property Address: 170 LINCOLN RD HYANNIS,MA 02601 Owner: JEFF LYONS X Date of Inspection: 1/10/01 , D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ 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 ''/z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nLa. X Any portion of the SAS,cesspool or privy is below high ground water elevation. _ X Any portion of cesspool or privyl 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 I 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. [This system passes if the well water analysis,performed at a DEP 4 certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free ' from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or '<`= less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be ;' f`•. ?. attached to this form.] '* (Yes/No)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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of surface drinking water supply r X the system is within 200 feet ol'N.'tributary to a surface drinking water supply i 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 If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered ,r "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 #:i should contact the appropriate regional office of the Department. >;i T r ., d Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 170 LINCOLN RD HYANNIS,MA 02601 Owner: JEFF LYONS Date of Inspection: 1/10/01 Check if the following have been done.:You must indicate"yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been,introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site? X _ Were the septic tank 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? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems'? • t The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _ X Existing information. For example,a plan at the Board of Health. X _ 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(3)(b)] t' 5 Page 6 of 11 a OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 170 LINCOLN RD HYANNIS,MA 02601 Owner: JEFF LYONS Date of Inspection: 1/10/01 FLOW CONDITIONS RESIDENTIAL 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:3 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no)';NO Seasonal use: (yes or no): NO ,, Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a ' Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title'5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records f.i, Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons 3-How was quantity pumped determined?n!a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _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 130 approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: APPROXIMATELY 20 YEARS OLD Were sewage odors detected when arriving at.the site(yes or no): NO t'15 Fi f Page 7 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 170 LINCOLN-RD HYANNIS,MA 02601 Owner: JEFF LYONS Date of Inspection: 1/10/01 BUILDING SEWER(locate on site plan) Depth below grade:30" Materials of construction:_cast iron =40 PVC Xother(explain):20 PVC Distance from private water supply well or,suction line: n/a Comments(on condition of joints,venting,.evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) W Depth below grade: 24" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: I000G L 8' 6" H 5' 7" W 4' 101." Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle:32" Scum thickness: 2" 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: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND. RECOMMEND PUMPING NOW AND EVERY TWO YEARS40 PROLONG THE SYSTEM'S USEFULL LIFE. GREASE TRAP:_(locate on site plan),. Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a 4�11' i 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 170 LINCOLN RD,HYANNIS,MA 02601 Owner: JEFF LYONS Date of Inspection: 1/10/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:_(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a 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.): n/a ;Gy PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a .i i. , R r 'Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C r " SYSTEM INFORMATION(continued) Property Address: 170 LINCOLN RD HYANNIS,MA 02601 Owner: JEFF LYONS Date of Inspection: 1/10/01 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a :leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a .innovative/alternative system Type/name of technology: n/a Comments(note condition of soil;°signs'of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT HAD 2'OF LEACHING LEFT AT THE TIME OF THE INSPECTION. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a " PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a III U - r , f Wage 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 170 LINCOLN RD HYANNIS,MA 02601 Owner: JEFF LYONS Date of Inspection: 1/10/01 SKETCH OF SEWAGE DISPOSAL-SYSTEM Provide a sketch of the sewage disposal system including ties to at least two pe manent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. l_ b o • 1 �P I LI ?age 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 170 LINCOLN RD HYANNIS,MA 02601 Owner: JEFF LYONS Date of Inspection: 1/10/01 t> SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of.Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain: n/a You must s describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 12+FEET e� � c � z� � N 0 8 o� Q � o Z Property Location: 170 LINCOLN ROAD MAP ID: 270/051/// Vision ID: 20023 Other ID: Bldg#: 1 Card 1 of 1 Print Date:09/09/2003 08:38 'U"T L v D:. o A ro car f ly ssEs OPEZ,KAREN 1 Level 2 blic Wate:1 aved Description Code Appraised Value Assessed Value as RESLAND 1010 106,200 106,200 801 170 LINCOLN RD SH)NTL 1010 29,400 29,400 YANNIS,MA 02601 eptce SIDNTL 1010 1,000 1,000 Barnstable 2004,MA AdditionalIS Owners: Account# 176972 Plan Ref. 058/099 Tax Dist. 400 Land Ct# er.Prop. #SR Life Estate ♦ ISION DL 1 LOT 38 Notes: `, DL2 GIS ID: 20023 Totall 136,6001 136,600 NamI1, ASSLSSMRRN7S I>1 OT2 OPEZ,KAREN 14285/304 09/28/2001 Q I 109,900 00 Yr. Code Assessed Value Yr. Code Assessed Value Yr. Code Assessed Value_ IG BLUE LTD PARTNERSHIP 12097/215 03/02/1999 U I 1 1B 2003 1010 37,700 002 1010 37,700 2001 1010 37,700 IG PINK LTD PARTNERSHIP 11641/167 08/18/1998 U 1 1 1B 2003 1010 30,900 002 1010 30,900 001 1010 30,900 YON,JEFFREY A&JENNIFER S 11610/108 08/03/1998 Q 1 37,000 1B 2003 1010 1,000 OTTER,GLENN T 4812/024 11/15/1985 U 1 1 lA OTTER,GLEN 1471/706 Q 0 Total: 69,6001 Total: 68,60 Total: 68 600 Year T e/Descri tion Amount Code Description Number Amount Comm.Int. , APPR�AISEDAL f ,ZTMMAR�' � ` Appraised Bldg.Value(Card) 29,400 Appraised XF(B)Value(Bldg) 0 Total: Appraised OB(L)Value(Bldg) 1,000 Appraised ...., ,1 .... OTES .. a, >_. �' ,. , ctal Land Value (Bldg) 06,200 S Lan Value 1 Total Appraised Card Value 1369600 Total Appraised Parcel Value 136,600 Valuation Method: Cost/Market Valuation et Total Appraised Parcel Value 136,600 UILD' P: ITT COITGE I �S� OK Permit ID Issue Date Type Description Amount Ins .Date %comp. Date Comp. Comments Date I ID Cd. Pu ase/Result 56599 10/18/2001 OB Out Building 1,000 1/1/2002 100 4/30/2003 PT 00 eas/Listed 5/13/2002 PT 00 eas/Listed 4/7/2002 MF 12 Outbuilding Insp Only 7/15/1990 ML 6 3 B# Use Code Description Zone D Frontage Depth Units Unit Price I.Factor S.I. C Factor Nbad. Adi. Notes-Ad lS ecial Pricing Ad'. Unit Price an Value 1 1010 Single Fam RB 4 0.18 AC 170,000.00 4.08 5 1.00 0104 0.85 106,200 Total Card Land Units 0.181-ACI Parcel Total Land Area: 0.18 ACI Total Land Valu 106,200 Property Location: 170 LINCOLN ROAD MAP ID: 270/051/// Vision ID:20023 Other ID: Bldg#: 1 Card 1 of 1 Print Date: 09/09/2003 08 Element Cd. Ch. Description Commercial Data Elements Style/Type 36 Cottage Element Cd. Ch. Description Model 01 Residential Heat&AC Grade D Below Average Frame Type UST aths/Plumbing Stories 1 1 Story Occupancy 0 eiling/Wall ooms/Prtns Exterior Wall 1 14 Wood Shingle /o Common Wall 12 2 Wall Height 10 Roof Structure 03 able/Hip Roof Cover 03 sph/F GIs/Cmp Interior Wall 1 05 Drywall � � �` 2 Element Code escrlpt:on actor 18 nterior Floor 1 14 Carpet Complex 2 Floor Adj Unit Location Heating Fuel 3 Gas BAS Heating Type 5 Hot Water Number of Units 25 BMT C Type 1 None Number of Levels /o Ownership Bedrooms 3 3 Bedrooms 2 athrooms 1 I Bathroom G4Sfi/MAT II, T ( ,. ` 10 1 Full nadj.Base Rate 69.00 Total Rooms Rooms Size Adj.Factor 1.52794 Bath Type Grade(Q)Index 0.73 8 Kitchen Style 20 Adj.Base Rate 76.96 Bldg.Value New 54,411 Year Built 1950 ff.Year Built (VP)1956 rml Physcl Dep 46 uncnlObslnc 0 onObslnc 0 Percentayv 1010 Single Fam 100 Sp ecl.Cond. ode Spec]Cond% Overall%Cond. 54 eprec.Bldg Value 29,400 Code Description LB Units Unit Price Yr. Dp Rt %Cnd Apr. Value SHED Shed L 120 8.00 2001 1 100 1,000 44 Code I Description Living Area Gross Area E .Area Unit Cost Unde rec. Value BAS First Floor 612 612 612 76.96 47,100 BMT Basement Area 0 612 61 7.67 4,695 UST Utility Enclosure 0 96 34 27.26 2,617 Ttl. Gross L b/Lease Area 1 6121 1,3201 7071 Bldg al:1 54,4111 rV, Town of Barnstable OF 1FIE Regulatory Services Barnstable do Thomas F. Geiler, Director ;mericaCity Public Health Division III BARNSTABLE, MASS. �, Thomas McKean,Director Zoos 163y. A`� 200 Main Street FD MA'S Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 9, 2010 Robert T. MacNamee P.O. Box 64 Cummaquid, MA.,02637 RE: Assessors (map-parcel) 270-051 As of October •1, 2006 a new rental registration ordinance was put into affect requiring all property owners of rental units to register their rental units with the Town of Barnstable Health Division. According to our records, you own the rental property at 170 Lincoln Road, Hyannis 02601.,Enclosed is an application. Please use a separate application for each rental unit you own. Should you need more applications, they are available online at• www.town.barnstable.ma.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate 2010 fees included. Please contact me to schedule inspection of the property as soon as possible. If there are tenants presently occupying the property please provide the contact information being sure to include a daytime phone number for all tenants. For your use an occupant's permission form has been included to allow for inspections to be performed in the tenant's absence. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of $100. Each day of non-compliance,is considered a separate offense. Should you have any questions,please feel free to call 508-862-4072. Thank,you in advance for your cooperation. Teresa Wright z Division Assistant Health Division,.. Direct#508-862-4072 4 Health Master Detail Page 1 of 1 f Health Master Logged In As: TOWN\wrightt Health Master Detail Monday, Aug Application Center Parcel Lookup Parcel Septic Perc Well Fuel Tank Parcel: 270-OS1 Location: 170 LINCOLN ROAD, HYANNIS Owner: MACNAMEE, ROBERT T Business name:' Business phone: _ Rental property: F] Deed restricted: F--J Number of bedrooms : of Contaminant released: F j Fuel storage tank permit: Fi- S Parcel Changes l Return to Lookup Y Parcel Info Parcel ID: 270-051 Developer lot: LOT 38 Location: 170 LINCOLN ROAD Primary frontage:60 Secondary road: Secondary frontage: Village: HYANNIS Fire district: HYANNIS Sewer acct: Road index:0895 Asbuilt Septic Scan: 270051_1 Interactive map t� Town zone of contribution:WP (Wellhead Protection Overlay District) State zone of contribution:IN Owner Info Owner: MACNAMEE, ROBERT T Co-Owner: Streetl: P 0 BOX 64 Street2:' City:CUMMAQUID State: MA Zip: 02637 Count Deed date: 11/10/2004 Deed reference: 19233/072 Land Info Acres: 0.18 Use: Single Fam MDL-01 Zoning:.RB Neighborhood: 010` Topography:Level Road: Paved Utilities: Public Water,Gas,Septic Location: Construction Info Building NoYear Built Gross Area Living Area Bedrooms Bathrooms 1 1950 1320 612 13 Bedroomsl Full Buildings value:$54,200.00 Extra features: $0.00 Land value: $97,900.00 x I http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=270051 8/9/2010 f THE roy. Town of Barnstable Regulatory Services BAMSTABM y NAM �* Thomas F.Geiler,Director 039. ♦0 Public Health Division Thomas McKean,Director 367 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 September 11,2003 Ms.Karen Lopez 170 Lincoln Road Hyannis,•MA 02601 Dear Ms.Lopez: This letter is being written to state that your dwelling located at 170 Lincoln Road,Hyannis is a 3 bedroom house and always has been a three bedroom house. The Town of Barnstable' s Assessor has walked through the house and has noted that the dwelling is a three bedroom dwelling and all town records reflect as such. In the Health Department files is.a sketch of the dwelling along with a copy of assessor's record. Any further questions please call the Health Department at 508-862-4644. S' ely, A e �S l Donna Z.Miorandi,R Health Inspector COMMONWEALTH OF MASSACHUSETTS = EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED SEP 1 7 2003 TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 10 MAP O w PARCEL ner's Name: ° - Owner's Address: LOT Date of Inspection: Name of Inspector: (please print)rA%!'_+Naa 01(���nh'�� Company Name: Mailing Address: 1 I ' Ulm iW11 Telephone Number: 50.! 36a y!)qz ' °aL675 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 Section 15.340 of Title 5(310 CMIZ 15.000). The system: Passes Conditionally Passes Needs Further:Evaluation by the Local Approving Authority Fails Inspector's Signature: �' Date: 16 107, 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. Notes and Comments 0^o7b ****This report only describes conditions at the time or 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 5 inspection Form 6/15/2000 page 1 f Page 2 of 1 i OFFICIA L INSPE _ , .INSPECTION FORM NOT FOR OIt VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 7� Owner: Date of Inspection: 3 Inspection Summary: Check A,B,C,D or E/;ALWAYS complete all of Section D A. System Passes: have not found any information Nvhich indicates that an of the failure criteria 15.303 or in 3 10 CMR 15.304 y na described in 310 CMR O Cx1SI. Any failure y criteria not evaluated are Indicated below. Comments: 11 in ke b' Ae n e 4 r�e.� s• Syetom f:nndiNonnl 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 tlfe 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 Cet7ificate 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 o-fBoard of Health): broken pipes)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 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: 2 Page 3 of I 1 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 110 aQ Owner: _ Date of Inspection: 0 n 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. Sy"em 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. Svstem 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. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more front a private water supply well". Method used to determine distance "This system passes if the well water analysis, performed at a DE1'certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: T17© Owner: Date of Inspection: Fi Q3 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 G"below invert or available volume is less than ''/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS, cesspool or privy Is below high ground water elevation. �l Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. �Y Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. ]This system passes if the well Nvater analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] (Yes(D)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 systern owner should contact the Board of Health to determine what will be necessary to.correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes" or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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—I WPA)or a mapped Zone I1 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. 4 Page 5 of 1 1 OFFICIAL INSPECTION FORM -NOT FOIZ VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date of Inspection: C 3 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? _ 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 o. Was the site inspected for signs of break out ? V _ 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: • Yeses no . 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(3)(b)) L 5 Page 6 of 1 I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: Date of Inspection: 3 RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 1 10 gpd x K of bedrooms): Number of current residents: Does residence have a garbage grinder(yes o n _ Is laundry on a separate sewage system (yes o� : [if)'es separate ins ection rec aired] Laundry system inspected — } I p l p (yes or no):— Seasonal use: (yes or n Water meter readings. if available(last 2 years usage(gpd)): a00 3 �3 &Oc) Sump pump(yes o no : , Last date of occupancy: O a y a I Oc70 " ----- _ COMMERCIAL/INDUSTRIAL 'rype orestablishmcnt: Design flow(based on 310 um 15.203): Basis of design flow(scats/persons/sgft,etc. gpd Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use:_ OTHER(describe): Pumping Records GENERAL INFOIZMATION �-. Source of to information:"par _s� W pp y— , �Odb Was system pumped as part of the uts�ection (yes or _ �o�e� 9' If yes, volume pumped: gallons -- How was quantity pumped determined? y Reason for pumping: — TYInE OF SYSTEM t/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): ' Approxinasc of all corn onents, date installed(if known and source of information: Were sewage odors detected when arriving at the site(yes oro 6 • ' I'age 7 of I 1 OFFICIAL INSPECTION FORM - NOT FOIL VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: �OAAAaom � ��� Owner: i Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain): Distance ff6m private water supply well or suction line: Comments(on condition of joints,venting, evidence of leakage,etc.): SEPTIC TANK: V(locate on site plan) Depth below grade: 1$ii Material of construction::i/-concretc_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: A L Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness:_'1�.4 Distance from top of scum to top of outlet tee or baffle: 6 A0 Distance from bottom of scum to botf outlet tee or baffle:it How were dimensions determined: Una nMJe%n sA n Q_ Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): �/ -� GREASE TRAP:_(locate on site plan) Depth below grade:_ 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 i • Page 8 of I 1 OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFOIZMATION(continued) Property Address: i-)D Owner: Date of Inspection: 1IM03 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 ))olycthvlcne other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Commante(condition of alnrnn ntul float awituhas, etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) 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.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): 8 Page 9 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM_ PART C SYSTEM INFORMATION(continued) Property Address: 1'20 Owner: - Date of Inspection: Uotoa SOIL ABSORPTION SYSTEM (SAS): L/ (locate on site plan,excavation not required) If SAS not located explain why:. Type � � ✓ leaching pits, number: ` — 6 Y 6 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.): 0 Qn�� ^�- � � -'Tj�3� � 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 or 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.): 9 Page 10 of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: -20 Owner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including tics to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Po a 3y ' 0 0 �Li a a6' 6 „ o a uu 10 Page I 1 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PAR'r c SYSTEM INFORMATION (continued) Property Address: J10 MQ Owner: Date or Inspection: (0 p 3 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water;5 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 documentat�) Accessed USGS database-explain:C' ('O 4/p� ` zLt4 You must describe how you established the high ground water elevation: i I1 TOWN OF BARNSTABLE LOC 4I /c A) 1�� —- SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALL R'Si*AME 6�;PRONE NO. ` A & B CANCO 775-6264 SEPTIC TANK.CAPACITY LEACHING FACILITY:(type) J-P l UU 6 (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC-_W_ATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: /' O 20 TARIANCB GRANTED: Yes No -C �p fi it a Z e t r J I No.._ .....�.jtl.� Fxs .......... _ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH OF................ ------------..._...........----•- , r ApplirFation for Dispaii ai Works Tonstrurtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (toll an Individual Sewage Disposal System at: .......... ?�� . 5 .................................................... •--.... ............. Locat'on-Address or Lot No. ........ �' , F1 Yy�.- - - �' ............................... ....................................... ............................................ Owner Address -----------------------•-•........------.......-- ----- ---- e Installer Address QType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............... ..........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ..... No. of persons............................ Showers — Cafeteria a' Other fixtures .................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test PiTe�oRisults-----_-_minutesmedr mch Depth of Test Pit.....................D Depth to Da __.__._.•-_•••..__.......-.........._.. ground Y P p ep gr nd water--------------------- Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+' •--•-•-•--••--•••------------•-••----•-•--••..........................•...........----•------.------......................................................... 0 Description of Soil..................................................----•-•----....-•--••-----•-•-----------------------------------------------------------------------•-------••--•--•- -------------------------- ------------------------------------------------------------•-----.....------ ........ rr . U Nat re of a airs or Alterations—Answer hen^applicabl _l��_� .. �... ._.....�__.I a k................I. ------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITl1L 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beewisjued by the oa d of health. Signed-- ------------ ..................................... Date Application Approved By............ ..8,trlti �..� ---------' s..r3<1Q-...... J Date Application Disapproved for the following reasons---------------------•-----------....-------------------•----------------------------------...-•-•-••--•-.------ ..............•---••••-•.....---•-•--........-•-------••-----...--------------•---•-------...---•._......•--•--••-••----....-------- ----------- ------------------ -- ------ -- - - Date PermitNo........1 Q_...M Y"(1------------------------ Issued....................................................... Date FNo.._...1.. ...» s$......�'0.....:......._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. ... ..........0F.................... . .,.P......---.._............._..--- Appliration for Disposal Works Tonstrnrtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: 1............4.1�1 . ;`_. Location-Address or Lot No. ......................»--.................................. ------._......_................... ..._....... ..... -• ................. Owner Address — Ad re s t . ________....._........................................................................................... .... ... ... ...... ...._. Installer Address dType of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) pa Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures --------------- -----••----••-• • WDesign Flow............................................gallons per person per day. Total daily flow........:...................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ 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........................ Rr' ..................................... •••-......... --------------- ••--•.__..----•-•---------------- ------- •--•------------------------- -........... ....... 0 Description of Soil........................................................................................................................................................................ V ------------- •--------- •----------------- -------------------- ------- ----------------- •-••--------------- •------------ •------ •------- -----•------------------------•-----•••-•----- W -----•-•--------•...............•-••--••••••-------••--•-•-•---•---•••---•-...••-••--•••-...........•-••••......•------•••••-•-•-••••••••••--••-•-•------••---••-••-••--••••......-----....---------•- U Nature of Repairs,or Alterations—Answer when applicable'_t!--_f_:.. 't r'4 �:_^F---=------- ---=-- -c-.-.!^-r._1-;--'?'_:..'d_.._. ----- . a 1 r Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of LITL'r. 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. Signed ' :-� �! -/_ . i . Date Application Approved BY ��._.... = ---------- --------- --- iat •• Application Disapproved for the following reasons------------------•--...-----••-•-----------•--------•-••-----••--------........................................ -•--...--••----------------------•--.........------------.....--------........-------------•----.........._.....--------••------------------------------------------------••-•---•---------•----......--- Date CC�� PermitNo.......l._��..� �-9 .... Issued---------------•-------------..__.........-----........ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrfifiratr of TuntpliUnrr THISXS TO CE That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) --•-----------------••--- ---•------ -----------------•---_______________----••---••----____-_---________-__---------•---•----•--------------- ,nn nn Installer at....................... `.. .........JR. � --�-w�-t- ------------------ -----------•-----•--•-•--•---------•---•-•-----------_____--------------- has been installed in accordance with the provisis of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No w...•-•- --_-------- dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................••----•---•---...---•••......--.._..------..--•- Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................O F.............. . •-----.... FE N 4....... .......... 0..A............. Disposal Works orks Tonstrudion rrmif Permission is hereby granted.... '.rb----4P1,444 -------•-•-----------------•-------•--........................................................ to Construct or epa�.c�' an Individ al Sewage Disposal System at No... �-_- 1 .. Street as shown on the application for Disposal Works Construction Permit -•yf --•--- Dated.......................................... �{ �) ..................... .� .....__. .......................................................... /.f! �v.......... Board of Health DATE...........----------- -•------- FORM 1255 HOSES & WARREN, INC.. PUBLISHERS go L C.A1i1,004 SEWAGE PERMIT NO. VILLAGE 6(oa INSTALLER'S NAME i ADDRESS co I U I L D E R OR Oa, DINER DATE PERMIT ISSUED DATE COMPLIANCE , ISSUED ix, j �� � � � (Q lJ � � � �� I' � � .. �. © � '� � � Q� 1 .� '�� ©^ /_ , _ , I �� ti F$� ��( b� No.........` �..... F�s...�.... �� C9 THE COMMONWEALTH.OF MASSACHUSETTS aD ' BOAR® OF HEALTH, OWn - i ApplirFa#ion for UhipaaFal Works Tanstrnrtinn Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: •-- -� ........................................ Location-Address or Lot No. ------- ------ ...... ........... ....................................................Own r dfess �..��.-:..�CtCC) �.4S-.� jC '3�; .........C -�'1�U��a/.. ...................................... Installer Address— Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures -----------------------------••• - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.... .............. Depth below inlet..................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation' TeRi................minutes sultsmd by r e --••---•. Date........................................ Test Pi No Pe inch Depth of Test Pit................... Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil---------- ..... x 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 TITI,4 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has keen issued by the board of health. Signed.... ;�? ._--t/V•�1 ........ •- D �•• ate Application Approved BY •--------------------------•--------•--................---•- Date Application Disapproved for the following reasons---------------••---------•--•-------------------------•----••-------------------------••-•......-•---•---••-••- ..........................1..---.......-------------------•--.......---•-•------•--------...---------------•-----------•-------•.-------------• ..................................................... 1 ............................... Date Permit No.............................................-........... IssuecL----�-+-°1---- Date No........................ r2 o THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -. -- ApptirFation for Dispoiial Works Tontrurtion famit Application is hereby made for a Permit to Construct ( ) or Repair (X an Individual Sewage Disposal System at .....1`1 2C1'���... . I. .a- _____________ -----_._____-___------- --_____----------_-___-_.--:_ -- Location-Address or Lot No. 'i 1 Owner r - -•--•-. �`,.. .... ........ . Address----•--•-•-----............._..........--•- J I Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria Otherfixtures "---"-----"---"-------------"--•---•-------•----------•---.....---------""------"-----"-----=-------------...-•---....._...... .........._...... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I---:.............minutes per inch Depth of Test Pit____________________ Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground. water........................ u+ •-------------------------- .----------------•----•••--------------....._....__ ---------------------•----------•------------•--------- ______ xDescription of Soil.. ::: ............:......:.....•--. -••--i-•-••-•--•----•-----•-------------"-"---"-----""-----•-•--------------"-------------------•-•-...----------•-- V ..............•---••-•---••----•--••._.....------------------••-----------------------•......._----------•---•-------••------•-••------•-------......................................................... W ------------------------------"---"-""--------"---"--------------"--•-----------"------------------•------- - ="""•----•------•----•-------v;Z --•-•-•-••---•---•------------•------------•-- U Nature of Repairs or Alterations—Answer when applicable___-___J._`...`_)_-` __.___ : '.!___ _________________________________________________ ------------------"--•------•---------------•---•--•----•--•---•---...------------------.........-•-----------------------._...---"------"----------•---•----"--------•--..__.._.._..--•-------.....---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT?:%, 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. T Signed ---------------•--- 3 Date ApplicationApproved By................................................................................................... Date . � Application Disapproved for the following reasons_________________________________________________________________________________________________________________ J� .........................................................................:......................................................................................•-------------•---•----------..... ,F. Date PermitNo.............:........................... ----------- Issued_....................................................... Date THE;COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH J ,.... .....r+`fi.: :'. OF........... ........................................ �dtifiratr of TompliFanrr THIS IS TO CERTIFY, That th'e Individual Sewage Disposal System constructed ( ) or Repaired ( 4 ................. .................................. , Installer f�1 � i --------------------------- - ----------------- as des ribed in the r.. 2_ application for Disposal Works Construction Permit No. R dated.-- '-.rl-. .�______________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. = .0ATE :Inspector h} k .{r. e,� ;k.. 5 F y -c, 'ris Y r�^e"`d'?; '�a ^k._ rrP"',4" ,°`,wi;` ,"�'• _ ..._ ___ s k�": - �.. y .r.•`1 +K '.;R�3S. a :y. S"`'".t.'�mytfl•:N.n Ftw-5,74t€-�n� ay - uxK..:.r...:m1..�..,._.��.+ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , ......... FEE........................f -.:. ,:.,�i��rax��a1-, oa`;����on�t�nrti�n rrnait • . . . . Permission is hereby granted...... �� ....-_-•.. !:_...... , �1�. to Construct ( or Repair (/)an Indivi ual Sewage Disposal System r at No.. /..� '. -l/J( / J J i t.. ` ( I + ( icy /1 �. .. :-----------•--•-----••-•----_•-_••- J••--••------ •-- - •-- - Street.._.---• ..,,/•--- as shown on the application for Disposal Works Construction Permi o____________ _____ abed....SP'._���. : .._........ .......................- Board of Health DATE..- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS •"��_