HomeMy WebLinkAbout0077 MARSTON AVENUE - Health Tr Marstons Ave
Hyannis
TOWN OF BARNSTABLE
LOCATION ')'I m,3,rs�or-% AVC SEWAGE# Z018 - 3Z4
VILLAGE Ac�r,�;�po� ASSESSOR'S MAP&PARCEL -L$$ 1'Z`7
INSTALLER'S NAME&PHONE NO. o1\ (4111) - OLS3
SEPTIC TANK CAPACITY
LEACHING FACILITY.(type) .TOO Dal (size)
NO.OF BEDROOMS , y
OWNER 5coii $ '
PERMIT DATE: j 0-�30- 1 FS COMPLIANCE DATE: tI /y I S-
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching.Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of Ieaching facility) Feet
FURNISHED BY
W
Al- zL,
AZ_ 3°'s
A3 - c
63-
1 A4- s3,
IS ' D
DS - Z3'
CL' 30 '
Cl,
D,9- 747
r t
No. Fee Il
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
21pplitatlon for Disposal *pstem Construction permit
Application for a Permit to Construct( ) Repair(✓<Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 12 Lj • l Ll B 7 er s Name,Address,and Tel.No.S,Ajj
Assessor'sMap/Parcel Z$$- )Zn f f4-A^-S T1 frloxs4o/-, AVE
Installer's Name,Address,and Tel.No.J3 4,E) EXC<xVad10/\ Designer's Name,Address,and Tel.No. Dm\m T),J c r-1c.1
14 'fca.Scrry L o Foresa_Lmlc y7,7. O6S3 R0,00 x 331 garuJia.lo,, -7 _95f -
Type of Building:
Dwelling No.of Bedrooms 4 Lot Size 19 Z OO sq.ft. Garbage Grinder( )
Other Type of BuildingTf,,�,� No.of Persons Showers( ) Cafeteria( )
Other Fixtures \
t
Design Flow(min.required) 4gO gpd Design flow provided 141,3 gpd
Plan Date .I O- Zq- 18 Number of sheets Z Revision Date
Title
Size of Septic Tank 1000 A-M 64. 0 6, Type of S.A.S.
Description of Soil rn,:e ,rn. 54 d v
Nature of Repairs or Alterations(Answer when applicable) ZO.9 Bax- oa - 20 SO L e-
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date O- Z&1%
Application Approved by Date
Application Disapproved by VV- �l��y,�2 Date r
for the following reasons fit t t^ "ffi6k 4= Mot fo -- Le, 4-- t4Ut IIL D-F 5H
('?t .I� rm t I tf S , G� �'� Tt*ued /b s0 j
a .
No. �, r ' Fee <
r:
` THE'COMMONWEALTH OF,MASSACHUSETTS Entered in compute
PUBLIC HEALTH,,DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
9ppliLatidn for Construction permit
Application for a Permit to Construct( ) Repair(%..)0,0Upgiade( ) !Abandon( ) ❑Complete System ❑Individual Components
f ,
Location Address or Lot No. I2 II 114 'a% caner s Name,Address,and Tel.No.
Assessor's Map/Parcel 7$$- I-Z'q 11/"�` `� Y) frlo�rs i o n A%1 6 j
Installer's Name,Address,and Tel.No.2 i? E1(C<xUck+0/\ Designer's Name,Address,and Tel.No.
DavC
1g *TC,0�S,_rr4 I-0 Fr-cs)blalc q7'1- 06S3 $o,gbx" 331 d",romL, 1 --7 9 _9`1
Type of Building:
i DwellingNo.of Bedrooms
� Lot Size 19 2 oO sq.ft. Garbage Grinder( )
Other Type of Building , (, A No.of Persons Showers( ) Cafeteria(
)_ �T
Other.Fixtures
Design Flow(min.required) 440 gpd Design flow provided y 1,3 gpd
Plan Date 1 O= 2 • 18 Number of sheets Z. Revision Date
Title R
Size of Septic Tank 1 000 U1\�d Eft. /2 Type of S.A.S. -
Description of Soil _v 'd
i
Nature of Repairs or Alterations(Answer when applicable) 1.1 20 _D BO)k - 3 - /'7 2Ca
i
Date last inspected:
Agreement:
(� The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in '
faccordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate*of
Compliance has been issued by this Board of Health.
Signed Date )O- Z4.1Z
I Application Approved by ( Date t
( ( ts.
Application Disapproved by ���1 ,1 �-� t —�i� Date ((% a. y'
for the following reasons — ( v� /m/�,�� �� -� i n� 1 L�G�-�'1L 0-7' -!' -4h
cf:I Sg^all - /��i�-bgtilssued
--------- I -------------- -------------------------- -- --------,---------------------- -------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS '
BARNSTABLE,MASSACHUSETTS
�ertificate�of��o�Iiarrce
THIS IS TO,CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( )
Abandoned( )by t E X C1:x 1_)0.'A 1 O/\
at `9`7 0,a r 4 o,-\ A U E has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No_;�nff-33_Cj dated {0 3 0
Installer 3 -;- _R Ex Cau,,A i n n Designer ('jam,l)f Flo k e,r 4 L4
#bedfooms Approved design flow L43 gpd
The issuance of this permit shall not be construed as a guarantee that the*system will function as designed.
Date I' Inspector Y11 M /�i -�1�,_ZL c,
--..------------------------ --_---------------_- -------------------------------------------------1----------------- - - - -
No.
r ' �Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS
Disposal 6pBtem Construction 3permit
'Permission is hereby granted to Construct( ) Repair( 100' Upgrade( ) Abandon( )
System located at oN y /1 L.�
r
and'as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:nConstruction must be completed within three years of the date of this permit.
Date (/ Approved by C
,; t �
r
Town of Barnstable
E r � Regulatory Services
Thomas F. Geiler, Director
BMtNSPABL6. = Public Health Division'
Thomas:McKean Director
pTEO MA'S
200 Main Street,. Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790=6304
Date: '1 1 - 13- IS Sewage Permit# ZolR-.3Z4 Assessor's Map/Parcel 288 - ►'z`1
Installer &Designer Certification Form
Designer: T"gr�q Installer: ,Q .3 E=moo.A;oi\
Address: P.Q. 30Y, 33% Address: 1L-17Cea berru t-w7
Aarw'.ck (Ylo.. �occs-Ic�alc.
On Jp-30- 18 Sri 3 EXeat A�o,n was issued a permit to.install a
(date) (installer):
septic system at 11 rno r-SAor- AVE based on a design drawn by
(address) .
e FIa eL4 dated 1 o 1 Zy f 18
/ (designer
V. I certify that the septic system referenced above was installed substantially according to ' fie wrv� 1e5s
the design, which may include minor approved changes such as lateral relocation.of the {fin -� betcta
distri cation box and/or septic tank. Stnpout (if required) was inspected and the soils
� p T e.d.v
were found satisfactory.
�ablz �
I certify that.the septic system referenced above was installed with major changes (i.e. was L-Ad&-JL
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow. Stripout (if required) was inspected and the soils
were found satisfactory.
DAVID
D.
staller's Sign ) tAHERTY,JR.
No. 1211
OY
(Designer' Signat. ) (Affix Desiglt Ftffhp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION.. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS :FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
q:\office forms\designetcertification form.doc
TOmm of Barnstable
Department of Rij,OU rvices
i Public Health lDivsl<on D$te 05
r 200 Mail&Street Hyannrs MA'02601
1- -Date'Scheduled;' lime . ✓ / fee Pd.--t=—�
C. Suit ba ity Assessment fr�r%Sewage Disposal
Performed Witnessed$y
},
L77�UCA,TIOlz&GENERAL INFORMATION
Location AddressNaMe !' .• v
ttfd;S, G Address
Assessor's Ma arcet q j
Engineers Name f {) yy
NEW CONSTRUCTION REPAIR Telephone#;
l
- Land Use f
1fl 7. Surface Stones ` !
I?isiances>from: :Open Water,Body' ft Possible Wet Area/�� ft Drinking Water Well _ft
L;,• : Drain Way ft, Properly Line sFZO
^ft' Other tt.'
SKETCH:(Street name'dunensions of tot exact locations oftest hoes&:pert tests locate wetlands�n"proxrmEty to holes}
"
,
DPM 6 f0f- .51..
Parent material(geologic) 'De to Bedrock I
;Depth to;Groundwater Standing Water rn Hole:.' IV Weeping from Prt Face
G
Estrmated Seasonal'Hrgit Grourxiwater LJ �
DETERNIINATION�FOR'SEASONAL HIGH WATER TABLE
�x w f
la>�thod urea _ U
Depth Observed standrng in.obs hole in: Depth to soil mottles- . rn.
Depth to.veepmg from srde of obs hole in frroundwater Adjustment ft.
Index Well# Reading Date Index Well Level Adj:factgr Adj,Groundwater Level S Z
a , eex
4I Z�1
` x ; r aPERCOLATION
. .
Observati777777777
on it
Hole# Trine st 9"
D EPi0BS'ERVAT`ION HI)LE LO � Hole#,
x :: �...
De th from Sort Horizon Sort Texture" Sbtl Color Sorl Other
Surfaoe;(m) (USDA) (viuirsell) ` a Mottliig (Stnietrire Stones Boulders.
v
onsistenc
Cv—IZ
s n.
; DEEP OBSERVATIONHOEE,LOGIole# W
ti �.
Dept}i from;. Soil"Hor�ion Soil Texture: Sor1.Color Soil other
Surface 01.} (USDA) -(Mussel]) Ivlottirng.' trce Stonas HouldeEs.
onsigom% Gravel),
hid
nx
D�EP(�►�SER�ATION�H�OLE�I.OG
W �.
Depthsfiom SorPHortzon Sdi!TextureJ: - ..,. ,So>i•Coldr soil other ,
Surface(in:) (USDA),; {Mansell) Mottling' (Structure Stoiics;Boulders.,
onsistericv.
z ,DEEP,OBSERVATIONikIOLELOG Hole##
Deptti�from- Soil=Horiion" �Suil Texture'.. '=Sorl Color Soil", Other
Surface(m:) (T9SDA)" (Mansell) Mottling (Stricture,Stones Boulders
Mood Insurance Rite Mani
11�Iz oZ
Above 50 year flood boundary -No , . Yes
Wrttitn 5t�year boundaip No Yes,
s
Withm 10(3 year flood boundary l�o Yes Pie
,
Deb"th of Natu afV OCCUCI iriL':Pervious Material s b` {f/ W"� C r ..
• pryU.1171
IF
ca
nj
rU
m OFFICIAL .E
cc 'Postage $
ti 6p1
Certified Fee
a "
C3 Return "a Receipt Fee Here (n f� (Endorsement Required) E'�e L)..
O
Restricted Delivery Fee N tIA
O (Endorsement Required) J
r-I ,
0 Total Postage&Fees
11r7 V
rU
o ; JP Morgan Mtg Aquis Corp
% Acqura Loan Services
7880 Bent Branch Dr., Ste 150
Irving, TX 75063 __
Certified Mail Provides:
o A mailing receipt i,
o A unique identifier for your mailpiece
e A record of delivery kept by the Postal Service for two years
Important Reminders:
o Certified Mail may ONLY be combined with First-Class Mall®or Priority Mail®.
a Certified Mail is not available for any class of international mail.
o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables,please consider Insured or Registered Mail.
n For an additional fee,a Return Receipt may be requested to provide proof of
delivery.To obtain Return Receipt service,please complete and attach a Return
Receipt(PS Form 3811)to the article and add applicable postage to cover the
fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for
a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is
required. J
a For an addition al fee delivery may be restricted to the addressee or
addressee's authorized agent.Advise the clerk or mark the mailpiece with the
endorsement"RestdctedDelivery".
o If a postmark on the Certified Mail receipt is desired,please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is not needed,detach and affix label with postage and mail.
IMPORTANT:Save this receipt and present it when making an inquiry.
j PS Form 3800,August 2006(Revere)PSN 7530-02-000-9047
I
COMPLETE7HIS SECTION
■ Complete items 1,2,and 3.Also complete A. Sig re
item 4 if Restricted Delivery is desired. ❑Agent
■ Print your name and address on the reve e ❑Addressee
so that we can return the card to you. , Receiv d (P' ted Na ge�fCiery
■ Attach this card to the back of the mailpie -
or on the front if space permits.
1. Article Addressed to livery address different from item 1? ❑Yes
If YES,enter delivery address below: ❑No
�I JP Morgan Mtg Aquis Corp ' nr
' % Acqura Loan Services r1
7880'Bent Branch Dr., Ste 150 3. Service Type
Irvin.g,.TX_.75063 ❑Certified Mail ❑Express Mail
13 Registered ❑Return Receipt for Merchandise
O Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes.
2. Article Number 7 012 1010 0000 2843 2287
(Transfer from service label)
PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540
I I
I UNITED STATES POSTAL SERVICE First-Class Mail
! Postage&Fees Paid
USPS
Permit No.G-10
I I
• Sender: Please print your name, address, and ZIP+4 in this box •
I
I � I
I I
I Town of Barnstable
I Public Health Division
I
I 200 Main Street {
Hyannis, MA 02601
I I
I '
I
I
i I
Town of Barnstable Barnstable
Regulatory Services Department A14meftft
"Br 111111
Public Health Division
�Ena`� 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL #7012 1010 0000 2843 2287
March 28, 2013 L
JP Morgan Mtg Aquis Corp
% Acqura Loan Services
7880 Bent Branch Dr., Ste 150
Irving, TX 75063
• ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 77 Marston Avenue, Hyannis, MA was last
inspected on 2/28/2013, by Ricky Wright, a certified septic inspector for the
State of Massachusetts.
The inspection of the septic system showed that the system "Conditionally
Passes" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the
following:
• The pump is inoperable.
You are ordered to repair or replace the septic system within sixty (6.0) days
from the date you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in
future enforcement action.
PER ORDER OF TH BOARD OF HEALTH
Thomas McKean, R.S. C
. Agent of the Board of Health
Q:\SEPTIC\conditionally passed\77 Marston Ave Mar 2013.doc
Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=21876
LJ
Al 7,
. BA NS rAtII-E- ' .«
Logged In As: Parcel Detail Monday, March 18 2013
Parcel Lookup
Parcel Info
Parcel ID I 82 8-127 TM _ _ Developer LOT 12B& 14B
Lo
Location
77 MARSTON AVENUE Pri Frontage
Sec Road, SecFrontage
Village 1HYANNIS 1 Fire District�HYANNIS I
Town sewer exists at this address;NO � Road Index J 09ii
Asbuilt Septic Scan: '
P Interactive 2881271 MapLPE-1
G
Owner Info _
Owner JP MORGAN MTG AQUIS CORP Co Owner C/O ACQURA LOAN SERVICES
Streets 7880 BENT BRANCH DR., STE 150 Street2
City IRVING ( State TX zip 75063 Country{�
Land Info
Acres 10.44 J Use Sin le Fam MDL-OF zoning 4F-1 Nghbd 0106 J
9
Topography jLeVel �' Road[Paved
Utilities[Public Wa Water, Location
Construction Info
Building 1 of 1
Year 1959 Roof(Gable/Hi _ wall(Wood Shingle
Built������ �� �Struct i P
Living(2312 —��I Roof�Asph/F GIs/Cmp I AC[None ( _
Area 1 Cover Type
Int Bed br . t �'.
Style Cape Cod Drywall 15 Bedrooms
Wall Rooms > _ 1.
10
Int
Model I`c
Residential Floor arpet Bath( Rooms
3 Fullt
Grade Avera e Heat Hot Water Total'10 Rooms
�ve 9 Type
Rooms I
stories 1 1/2 Stories Fuel Hea Gas F ation Poured Conc.
Gross5127 '
Area
Permit History _
_ ....._... --_ .......-
http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=21876 3/18/2013
l � +
.�!
�,' y? �1,'�3��, 7
;;
Commonwealth of Massachusetts .
_ _Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
77 Marston Ave
Property Address: -
JP Morgan Mtg. Aquis Corporation
Owner, Owner's Name
information is
required for every . Hyannisport MA 02647 2/28/13
page:- City/Town::.
-- - State Zip Code Date of Inspection -
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end.of the form.
Important:When filling A. General Information -
out forms
on the computer;
MM
use only the tab
1 Inspector:
key to move your
.
cursor-do not Ricky Wright
Use the return:
key. Name of Inspector
B & B Excavation,Inc.
rp Company Name
14 Teaberry Lane..
I
Company Address
Forestdale MA 02644
City/Town State Zip Code
508-477-0653 S14595
Telephone Number 4 License.Number
B. Certification
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
A 5.340�f
Title 5(310 CMR 15t000). The sysDtem approved system inspector pursuant to�Section� �
sewagep Y pp. Y p
❑ Passes. Conditionally Passes ❑ FaiUs
. .
Needs Further Evaluation by the Local Approving Authority
t
13 Inspector's Signature Date
The system inspector shall submit.a copy.of this inspection report.to the Approving Authority(Board
of Health or.DEP)within 30,days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the...
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer,.if applicable, and the.approving.authority.
""This report only describes conditions at the time of inspection and under the conditions of use
at that time..This inspection does not address how.the system.will perform in the future under
the same or different:conditions of use.
d
t5ins•11/10 Title 5 Official Form:Subsurface Sewage Disposal System.-Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 77 Marston Ave
Property Address
JP Morgan Mtg. Aquis Corporation
Owner Owner's Name
information is
required for every Hyannisport MA 02647 2/28/13
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
® One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial 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.
❑ Y ❑ N ❑ ND (Explain below):
pump and alarm not in working order and must be replaced
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
f
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°M 77 Marston Ave
Property Address
JP Morgan Mtg. Aquis Corporation
Owner Owner's Name
information is required for every HY P annis ort MA 02647 2/28/13
page. CitylTown State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes(cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ 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 ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions,exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
77 Marston Ave
Property Address
JP Morgan Mtg. Aquis Corporation
Owner Owner's Name
information is required for every Hy p annis ort MA 02647 2/28/13
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
El ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than Y day flow
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
wM 77 Marston Ave
Property Address
JP Morgan Mtg. Aquis Corporation
Owner Owner's Name
information is H annis ort MA 02647 2/28/13
required for every � p
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or ,
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection
Area— IWPA)or a mapped Zone II of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts .
A
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°M 'r 77 Marston Ave
. Property Address:
JP Morgan Mtg. Aquis Corporation
Owner:
Owner's Name
information is required for every Hy p H annis ort MA 02647 2/28/13
page. - City/Town - State Zip Code. Date of Inspection
C. Checklist
Check if.the following.have been done: You must indicate"yes" or"no" as to each.of the following:
Yes No -
El 1Z Pumping Information was provided by the owner, occupant, or Board of Health
❑ E 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?
1Z El Was the site inspected for signs of break out?
® ❑. Were all system components, excluding the SAS, located on site?.
® ❑ Were the septic tank manholes uncovered opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions,depth of liquid, depth of sludge and depth of scum?
El ® Was the facility owner(and occupants:if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal.systems?_
The size and location of the Soil Absorption System (SAS)on the site has
.. been determined based on: -.
® ❑ Existing information. For example, a plan at the Board.of Health.
El IM Determined in the field (if any of the failure criteria.related to.Part C is at issue
::.approximation of distance is-unacceptable),[310 CMR 15.302(5)]
D. System.Information
Residential Flow Conditions:
...Number of bedrooms(design)::. 4..._ Number of bedrooms(actual);: 5
DESIGN flow based on 310 CMR 15.203.(for example: 110 gpd x#of bedrooms): .
440
r.
t5ins•11/10. Title 5 Official Inspection Form:Subsurface Sewage Disposal System.•.Page 6 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
;M 77 Marston Ave
Property Address
JP Morgan Mtg. Aquis Corporation
Owner Owner's Name
information is
required for every Hyannisport MA 02647 2/28/13
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ® No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d n/a
9 ( Y 9 (gP ))�
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: Sept 2011
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
;M 77 Marston Ave
Property Address
JP Morgan Mtg. Aquis Corporation
Owner Owner's Name
information is required for every HY P annis ort MA 02647 2/28/13
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection? ❑ Yes ❑ No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no)(if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
f
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 77 Marston Ave
Property Address
JP Morgan Mtg. Aquis Corporation
Owner Owner's Name
information is required for every Hy p annis ort MA 02647 2/28/13
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
1993
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 1 1/2'
feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: >15'feet
I
Comments (on condition of joints, venting, evidence of leakage, etc.):
At time of inspection building sewer appeared to be in working order. No sign of leakage or blockage.
Septic Tank(locate on site plan):
6"
Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ® No
Dimensions: 1500 gal
Sludge depth: no sludge
I
t5ins 11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 17
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
77 Marston Ave
Property Address
JP Morgan Mtg. Aquis Corporation
Owner Owner's Name
information is H annis ort MA 02647 2/28/13
required for every y p
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle no sludge
Scum thickness no scum
Distance from top of scum to top of outlet tee or baffle no scum
Distance from bottom of scum to bottom of outlet tee or baffle no scum
How were dimensions determined? scour stick
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
At time of inspection septic tank appears to be structurally sound. No sign of back-up.
Grease Trap(locate on site plan):
l Depth below grade:p g feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other.(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 77 Marston Ave
Property Address
JP Morgan Mtg. Aquis Corporation
Owner Owner's Name
information is
required for every Hyannisport MA 02647 2/28/13
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
r
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
;M 77 Marston Ave
Property Address
JP Morgan Mtg. Aquis Corporation
Owner Owner's Name
information is H annis ort MA 02647 2/28/13
required for every y p
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened)(locate on site plan):
Depth of liquid level above outlet invert
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.):
no d-box
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ® No
Alarms in working order: ❑ Yes ® No
i
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
pump and alarm system not working and must be replaced
Soil Absorption System (SAS)(locate on site plan, excavation not required):
i If SAS not located, explain why:
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
77 Marston Ave
Property Address
JP Morgan Mtg. Aquis Corporation
Owner Owner's Name
information is required for every HY P annis ort MA 02647 2/28/13
_
page. CitylTown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 1
❑ 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.):
At time of inspection leaching is dry and in working condition. No sign of hydraulic failure
Cesspools (cesspool must be pumped as part of inspection)(locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 77 Marston Ave
Property Address
JP Morgan Mtg. Aquis Corporation
Owner Owner's Name
information is required for every HY P annis ort MA 02647 2/28/13
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M
77 Marston Ave
Property Address
JP Morgan Mtg. Aquis Corporation
Owner Owner's Name
information is required for every Hy p annis ort MA 02647 2/28/13
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet; Locate
Where public water supply enters the building. Check one of the boxes below:
hand-sketch in the area below
drawing attached separately
:VS20NT
A
$' 'REARN
I tic
-:_-=
F=
53"/1PuMPc+tAktor,e A5 = ZZ"
'B Z
C2= 311
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17
Commonwealth .& Massachusetts
_ F .Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
77 Marston Ave
^M
... Property Address:.
JP Morgan Mtg. Aquis Corporation
Owner
Owner's Name
information is H annis ort MA 02647 2/28/13
required for every; _ Y _p
ity/ own::. _
page. CT - State Zip Code Date of Inspection
- D. System Information (Cont.) V -
Site Exam:
® Check Slope:
::Surface.water
Check cellar
Shallow wells....... _. ... .
p.
20"
Estimated depth to high ground water: feet .. .
- Please indicate all methods used to determine the high ground water elevation:
Z Obtained from system design plans on record
7/28/93
If checked, date of design plan reviewed: Date
Observed site(abutting.property/observation hole within 150 feet of SAS).. .
Checked with local Board of Health -explain:
❑ Checked with local excavators, installers -(attach documentation)
El Accessed.USGS database-explain:
You must describe how you established the high ground water elevation:
also checked plan for#87 -:test hole within 100' of leaching
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•11/10 dTitle 5 Official Inspection Form:Subsurface Sewage Disposal System-.Page 16 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
GSM 77 Marston Ave
Property Address
JP Morgan Mtg. Aquis Corporation
Owner Owner's Name
information is required for every Hy p annis ort MA 02647 2/28/13
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A,'B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information— Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
e �
TOWN OF BARNSTABLE
LOCATION s )6 r- Ll SEWAGE # 73',3 q 6
VILLAGE E ASSESSOR'S MAP & LOT ® U - 1ol7
INSTALLER'S NAME.6i PHONE NO. Sa e-9-7'
SEPTIC TANK CAPACITY S U
LEACHING FACILITY:(type) /b b 0 a 40 Cs tze) �
NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No 1/
a o ...
b'
0 �
b y�
z
v
1
~4)
,j
F�s..$3 0..'.0 0.......
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
OWN OF BARNSTABLE
tipu,ia1 Works Tomitrurttun rumit
Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal
System at:
77 Marstons Ave Hyannisport
................_........_...............•----••----•-••---......-------••---•-••••......•...... -•---••••----------•-••-..........---......••••------••......•....••••__........•...............--
A Fitzgerald
Location-Address or Lot No.
......................_.......................................................................... ..........••......................................................................................
Owner Address
a ........E.---Robinson•_Septic.•Sere ce.....••••...._ ? Q QX 9$0... rl ............................
Installer Address
Type of Building 4 } Size Lot----------------------------Sq. feet
Dwelling—No. of Bedrooms......
... :...............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons.....................------. Showers ( ) — Cafeteria ( )
Other fixtures ,------------------------------------•---
W
Design Flow.......................................:....gallons per person per day. Total daily flow............................................gallons.
04 W Septic 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........................................
a
I
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water----.................--.
w Test Pit No. 2.............:..minutes per inch Depth of.Test Pit.................... Depth to ground water.....---................
a' ------------------------------------------------•----------------------...----------•....-----------.........-----............•---------••............-•----.
0 Description of Soil----sand-----------------------------------------•------------•--•.----
V ------------------------------------..............................................................................................................••--------••----•---••----------••-•--
x ----------•------------------ --------------••------------------------------------------..............-----•----------------------------------•------•---•-----•--•-•••-•---------._..............
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
...install....1....!. 500.--gal.... .ept .c--tapk P.VMP--..9-tat ip.a I....L'.Q.0.0.... al-------------------------------
Agreement: leachpit with extra stone. pump and fill old cesspools.
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersi ed further agrees not to place the
system in operation until a Certificate of Compliance has be issu t oar�of health.
L_
Signed
Date
ApplicationApproved By ............... ----- ------------------------------------------------------------_--------------_--
Date
Application Disapproved for the following reasons- -- -------------- -------------------- -- -- --------------------------- ----------------------------------------- --
- - ...................- ----------- ---- -------------------------------- -- . ---------------------- '..-------- ----------------------------------------
• Date
q
Permit No. / 3..'..3. Issued - ... ........
---------------- Dare
a ~
�� $30.00
rNo. THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
ilanpfor Dispasal Works Toes mainn lirrutu
Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal
System at:
77 Marstons Ave yannisport
.__....._------------......_.....................-------"'-----• -_.-..... ------------------------------------------------------------------------------__..-------
A Fitzgerald Location-Address or Lot No.
-- - ______—.....__........ ----------------------------------------------- ---•-----'-......-•----'-------'---'-'------'-------"--.....----'----..........._.-...._---..---
Owner ¢ Address
W W.E. Robinson Sept c__Service ------ - -® Bcax 1 Q.i9_. ?fit erbiJJ_e,..
Installer, Address
U Type of Building 4 Size Lot----------------------------Sq. feet
., Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of Building ____________________________ No. of persons____________________________ Showers ( ) — Cafeteria ( )
dOther fixtures ................................*_------------------------------------------------- --------
gn ______________gallons per person per day. Total daily flow--------------------------------------------gallons.
W Desi Flow------------------------------
WSeptic Tank—Liquid ca.pacity____________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.....................
f=I, Test Pit No. 2----------------minutes per inch Depth of Test Pit____________________ Depth to ground water........................
x -------------------------------------------------------------------------------------------------------------------------------------------------------------
O Description of Soil.sand_____-•--_-_
U ---------------------------------------------------------------------------------------•--•------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
V Nature of Repairs or Alterations—Answer when applicable-----------------------------------------------------------------------------------------------
_.install_.�'- 1--..5®0__aa1----cpkie...tank,._-Pumn._atatjQn QQQ a
Agreement: leachpit with extra stone. pump and fill old cesspools.
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The unders�iped further agrees not to place the
system in operation until a Certificate of Compliance has be-fll issu tw health.
L✓
Signed G���%'���"
Date y
Application Approved B 2Q� pt
PP PPY �7� r -s� r
Date
Application Disapproved for the following reasons:
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Date
PermitNo. ------- -3--------�`�--ry-U---- ----_-------------- Issued --------------------------------------------------------------------
__------ Date
f
THE COMMONWEALTH OF MASSACHUSETTS,
BOARD OF HEALTH
TOWN OF BARNSTABLE
Oler#ifiratee of (goxplinure
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( x )
by--- -V,j-a-F^-- Robinson _Servi.aP
. --Ins[alter
at -7---Marstons-- Ave----------Hyannisport--------------------------------------------------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No- ------ --- dated dated ....____________________________________________
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.DATE - � - '- _�--------------------------------- Inspector �7�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(� F BE-$30.00......
01sposal Works Tunstrudiutt f ernttt
Permission is hereby granted----T't- � -tz. - � �** -��.,� 1 ,. �, .................................................----
to Construct ( ) or Repair (x ) an Individual Sewage Disposal System
at No.........17---MaraJ'_nnm---A�z•P__ - M-------------------------
Street 9___��3?�
as shown on the application for Disposal Works Construction Permit No.____ � __r _ Dated__________________________________________
1 ------------------------------- Cm------------------------------------------ -
-----------------------------•------ Board of health
FORM 3650E HOBBS&WARREN.INC_.PUBLISHERS
e
No. z.6 1 i 7Fee _� .
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: l/
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ftpYication for Misposal -6pstem Construction permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System 'Individual Components
Location Address or Lot o. �,. ��1�pp5 �p/� -4\1'e O/wner's Name,Address,and Tel.No.
)
Assessor's Map/Parcel 4 v�y��f d j a ► `�O n&y 5 m i`�1 5 0g"77 8—5(,_0
I Iler' Name,Address,and Tel.No. ,( rr /� / Designer's Name,Address,and Tel.No.
fi E` oV /dn �J�d 1 y�EJ CVA
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 0 gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 15 00 90J ton Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 4eoin +
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Bo o lth.
Sign
Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. �13 Date Issued
No. Fee
P THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
application for Disposal ippsirm Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System individual Components
Location Address or Lot Avrr,'s
/) r,5'f-Q n -4141e Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel I LI G n(_y j Cn i 4) 5 01'-77 3- 5&-j 3
I Iler's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
9'8 �V(ov hor) J_0k-g77-665-3 �-
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) Ll y v gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 15 DU go Ion Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Boar. o e Ith.
Sign, Date
rf
Application Approved by ( j Date j
Application Disapproved by Date
for the following reasons
S...r
Permit No. 0(3 '2 Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certifirate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(t/< Upgraded( )
Abandoned( )by ?
at ]- nn4y� (L . i has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No..2 u r 3-/Z r dated Lj
Installer Designer r
#bedrooms A//#- Approved designnf�flo)V\ J� gpd.
The issuance o this ermit shall not be construed as a guarantee that the system will'unr �( r/i as desig 1
Date Inspector
------ - - -- --- • - - ----
No. 7 U I - ! S� Fee o d
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal *pstem Construction permit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( )
System located at -7 7 nn(Af Tole
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construct' n must be completed within three years of the date of this permit
Date ' I/6/ I Approved by J ) f ��/• les"
TOWN OF BARNSTABLE - UNDERGRUUND FUEL AND CHEMICAL STORAGE REGISTRATION v
ADDRESS OF TANK: VILLAGE:
MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) :
OWNER NAME: IV, PHONE: 76-�
INSTALLATION DATE: cl(-Jc BY:
INSTALLER ADDRESS: -CERT.NO.
*TANK LOCATION: ABOVE BELOW
CAPACITY TYPE Or TANK AGE- YRS. FUEL7CHr 'ro aLjx
TESTING CERTIFICATION PASS FAIL DATE
LEAK DETECTION [ ] CHECK IF N/ATYPE/BRAND
ZONE OF CONTRIBUTION [ ] YES [WmO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED [ ] YES [ ] NO DATE
CONSERVATION [ ] CHECK IF N/A DATE
� �� �� �
BOARD OF HEALTH TAG NO. [ � ��`(] y/ ] DATE '
-
* PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
F
i
TOP OF FOUNDATION COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM PROFILE
EL. 60.0' EL. 52,0' BROUGHT TO WITHIN 6 OF FINAL GRADE not to scale) �� Flaherty Environmental Services
INSP. PORT TO W I 6 OF GRADE
2" of III to 1" DOUBLE WASHED CLEAN SAND P.O. Box 331
4" CAST IRON or EQUIVALENT PEA FOR EL.58.0'GEOTExTILE Harwich, MA 02645
MIN. PITCH 1/4" PER FOOT FILTER FABRIC \�
a"SCHEDU 40 PVC PE 4 SCHEDULE 40 PVC PPE 774.994. 1166
LE PI 2" SCHEDULE 40 PVC PIPE
. FLOW LINE ° VENT REQUIRED O
(Arsf 2'to be level) %.
°• 5' 1%
'•' L.EXISTING 14" TO P.C. :;, •; 4 .. : , ° 56 'f `r
EL.EXISTING
' EL.50.0'f 0000000000° o 0 0
' EL 55.2' EL.55.03r 0000°o o °c000coc ''®tom°o°o°o°000°o p® o 0 0 0
(H-ZOD-BOXJ EL.55.0' 0000°o°o°o°°o°°°°O "—® ��=I� o°o°o°°°c 2_0'
•'"'• o 0 0 0
INSTALL INLETTE °o°o°o°o° O°O°O° ' " ' �4 ' „Aopope000G
ABOVE OUTLET IN °o°o°o°o°�i L.53.0'
,••!"�:••,j„.:•a�": *ems'" 'CRUSHE
0.5D STONE OR SOIL A
MECHANICAL COMPACTION BSORPTION SYSTEM
1000 GALLON SEPTIC TANK SEE PAGE 2 FOR (3) 500 GALLON H-20 CHAMBERS
(DATUM: ASSUMED) (EXISTING) PUMP CHAMBER DETAILS " 3��; WITH 4'STONE AROUND IN A 5.-0'
dr to 1, DOUBLE WASHED S ONE °`` "_ I = --
12.83'W X 36.51 X 2'D CONFIGURATION
(DIMENSIONS BASED ON LINEAR FEET) EL. 48.0'
10.0' " 40TTOM OF TEST HOLE L. 48.0' LOCATION MAP
11.9' •;y; PAVE \ �S)0 USGS ADJUSTMENT• N/A
O rvE GROUNDWATER ELEV' N/A N
t{ ,../T(H TH-2
58 o d2�' ) \
2p P
56 20. ' A9a� Ave
54
C
pD LOCUS
EXISTING
52 4 BR / NTS A ,^
DWELLING
58 `' AVI
cP
O EXIST, / D.
F R J N..
PUMP CHAMBER DECK
DECK /SHELL DRIVE/ 0• I
6
MOISTER
/ 54
EXIST.
1000 GST
tiZ DATE.'10/24/&018 REVISED:10&9/18
Tg000,
LOTS 12B & 14B
19,200 SFf ' SITE AND SEWAGE PLAN
y B BEXCAVATION, INC./
SCOTT SMITH
1
s2 77 MARSTON AVENUE
BARNSTABLE
SCALE: 1 " = 3 p' (HYANNISPORT), MA
l' REF:PB II I PG 93 PAGE 1 OF2
' -
'
�
,
GENER4L NOTES
DESIGN CAL CULA TIONS i Flaherty Environmental Services
1. ALL PRECAST COMPONENTS TO BE
Harwich, MA 02645
MINIMUM H-10 RATED. ALL COMPONENTS NUMBER OFACTUAL BEDROOMS 4
WITH ANY ANTICIPATED VEHICULAR 28' 774.994.1166
TRAFFIC TO BEH-20 RATED. GARBAGE DISPOSAL UNIT NO
2. THE DESIGN OF THIS SYSTEM DOES NOT
7-7
ALLOW FOR THE USE OF A GARBAGE TOTAL ESTIMATED FLOW
3. MUNICIPAL WATER IS AVAILABLE.
REQUIRED SEPTIC TANK CAPACITY 880 GAL.
SIZE OF SEPTIC TANK 1000 GAL. (EX.-MING)
E.
CODES AND REGULATIONS. SOIL CLA SSIFICA TION
AND REPORT ANY DISCREPANCIES TO ALARM AND CONTROL PANEL
DESIGNER PRIOR TO CONSTRUCTION OR
TO BE INSTALLED INSIDE
ASSUME ALL RESPONSIBILITY. BUILDING. ALARM TO BE ON
6. INSTALLER/CONTRACTOR IS SEPARATE CIRCUIT FROM PUMP
RESPONSIBLE FOR MAINTAINING SAFE
WORK AREA, VERIFYING ALL UTILITIES a?F x 0.68 =.4fi,9-GPD
AND N07IFYING "DIG SAFE" EL. 52.0'±
(1-888-344-7233) 72 HOURS PRIOR TO
AND 3'STONE BETWEEN(2)CHAMBERS AS DIAGRAMMED INA
7. ANY CHANGES TO OR DEVIATIONS FROM 36.5'X 12.83'X2'CONFIGURATION
(DIMRNSIONS CALCULATED USING LINEAR FEET) 1 2- PRESSURE LINE
THIS PLAN MUST BE APPROVED IN 1000 GAL. H-10 S
WRITING BY FLAHERTY ENVIRONMENTAL 440 GAL.+ SLOPE TO DRAIN BACK TO PC
FLOAT SWITCH ALARM ON
SERVICES AND LOCAL BOARD OF RESERVE WEEP HOLE
RESERVE LF-4CHING CAPACITY NIA SETTINGS:
PUMP ON
HEALTH. CHECK VALVE
8. FINISH COVER OVER COMPONENTS IS 5.3" WORKING RANGE
NOTE: DIFFERENT LOADING RATE DUE TO PERC RATE
UNLESS SHOWN PER PLAN. 5.3'
PUMP OFF
9. ALL ABANDONED SEPTIC SYSTEM SYSTEM (OR EQUAL)
COMPONENTS TO BE PUMPED DRY AND
FILLED WITH CLEAN SAND OR REMOVED SOIL EVALUATION (NOT TO SCALE)
AND REPLACED WITH CLEAN SAND.
10.ALL COMPONENTS To BE PROVIDED Evaluator David D.Flaherty Jr.,RS,REHS Evaluator.
BOH Witness. Don Desmarais,RS BOH Witness. Don Desmarais,RS
WrTHIN 6"OF FINISH GRADE. Date.- October22,2018 Date: October22,2018
1 1.ALL SEPTIC TANKS, DISTRIBUTION
CONTRACTOR TO VERIFY
BOXES AND PIPING TO BE INSTALLED
cn
FOR ALL EXISTING CONDITIONS
12.NO KNOWN WETLANDS OR WELLS 0'-16' FILL
0'-16" FILL 2 PERTAINING TO PUMP CHAMBER
WITHIN 100 FEET OF PROPOSED
PRIOR TO INSTALLATION
GISTE
16%24" NB MIXED
AND UNDER NO CIRCUMSTANCES IS THIS
PLAN TO BE USED FOR ZONING OR
BUILDING PURPOSES.
TE AND SEWAGE PLAN
Sir
14.LOT IS SHO INN AS ASSESSOR'S MAP 288 the examination approved by the Depariment of
Environmental Protection and that the above analysis
LOT 127.
has been performed by me consistent with the
15.LOCUS PROPERTY IS NOT LOCATED requirOd t-InIng 6-lq-rtfse and experience described
WITHIN AN AQUIFER PROTEC71ON G.W ELEV.NIA G.W ELEV NIA
DISTRICT(ZONE II). BARNSTABLE
(HYANNISPORT), MA
'
`.
U ` �
fy.__}�.—# a .F.._..._. r #,..._.__.;..._._..Z•...w..-A.,_.__+.�,- ._;......I.._.. __—��•.i.-.""_.^r.�""`i• � _.._...'_��'--r-�—YI •-•--t----i_.._..._1_._....f.T.—.�.._-.-: +
01
i
•--•----•-s--°--�----r--'-- ' \♦, � � '� I„_..6`�` � s` 4 � ._,_'�'_`T_,F f ;may _ .J _-y-_s -__1-_
-- [ y, i \ __,._.{ 1..- { did t f I •-�.-`�'°�'e...'-+-,{°. f+ ��, �.._.��{ L--'i•4 � Tom'-� -i---
1
` NI
t y
- y � I �• ( Ft r
i , � ` ,\ t `{�. � ..__.ti,,.4_.____,.�.,.___.;.-�_.r•._-._,.-t..-,:.--�-- #,. --1---'-�-i•----�i- --�'._- - .._..c-_ _"�__....E.. i_.�.-� �i 1 � Fi ,-_+.-'i -j•-
4 � 1
. t ...�;[_. 4 t � ` � { t i _ ; ._.....4 �.� 'yi"' '� �__d.._............�...�_........_1.-.-+-.f----. - ..-._�"`�*�^�'-.-•--.{..-..�j_._..__.y.__.-_..�._.. - � �..'.—_ _ ...a._-.^��r' •...r-
��__.__..._ $ E �'` � JY. �---,--? + -"----�"'--�- _ � _.-----. -_- `-may+• p 1 _-�,-:._-..__ _�.i._�._1._.._ 'e.--'-
f
w
• r t F. s � -� .t P � '`'--}�,'s'.i''Y i 1 i �} # ' 1 i
4.1
-.-k...--.-�•-__�..1_.... -r...._......e_�.�-.._._-.-..,r.-- �--��_ ��-..1--..._.'i�........�..-.,i..�_.i.._-��_.___1��.__ _.�•• � --5.<.Mom..__: _ _L _-_t
!!
_ �_ai -.._1._. ��.. i � } i'---.�_..___:.._,.._..) _!.__.__t.,�-.-=_�T_,. _-._.-i---�-- •---- _•_- - — sue., ',_..� - -Y-�. _.t. _�
..J-
+
tt
t ' I._._•-.rt __._�.� _.f_-...�.....�_......i:.�...t..,_.._-:}._ d j -'--. - r _,.f._._.: -�._._.... �1... ..�.._...._+_-_ y � -. � _�. _>_.....y._.._._� _
{
t `
t
p ,
---------------------
IL
t t
c F `
r
• r I 4 r ° ti P S I .I•' �_"i_'.'.-__.��.-..._•-i---.._J. »--i � i. ( -^—t-
� r
, t
r t.
f
O � 1
E ------4'"'__:'.,"_'-p.
It
76'K
Cp
4 -44
' ,__ram.�+, ! --�----•---._..—..�.— ,-i.-_' r � f
1 i
^t. T.i.-_.. ....._..-_.l.-...._._.a._._..:..�_.�.,.Y._-»..a�-�^•^t'^-'^.'-' '. -.f^,^._.-...4--+-i ..F.^.-.^'..._^�.:A a --r—.._._..,.�-__ .._.+_..6�.-�-,:.....-�.1._.........it._.._�� i # ( i � �..{+___-•
- i.�... ,..._.-..._.,._"'_r--^._1.�..___1•._.-__+_......_L_._...�--.-..a---•-t-.�_:..._._..+-..---F.-•---. 5 t^-^1'- f.'^'p'_.—.""''" _•�,._._�:'_.. f F �, N t 4
r _
t
__.1Y.1_�.r_-..._-r_"--1--._..a_�,:.(-.,-_.a_..-,__. t ,�.r�� a�•r,�� _._...i.— .._.:..�-..�_"__ �f_ .-w.__.._+_.._...e__ r tr � ._..:.��_......... �t_
7
E
._f L ..q—.-_.y _ ___.._{�--�___d�._-.. __._�l: M ��.....' '- ._.1.-eFY/ye±� r ..:_I-.._..._..ira,..«_ ...�._...«_.�.—«-I'_"V'__`--t-.--+ `�+---•�'-'- � f yy
pp t
1-5
It
�
i
717
-71
ILL
FT
4 f t (
_.1.:._a:«-.{,__-+-Yv-•--_._+-_.w.s .._ ..-. �..:.--..-.�_-_:__ } 4 ��.._...� -e _....-._l.F.._, �.--�w.^G-^ t...._ r: --,.-i� -+...} ..-� i..'_.'....'_1 4- (
6 �t"� t t p' � # #��_._._.? _.,.._t_..:_.�__..i.........x. d s ._4_..__}•___.r...v.�1..:,.._._.._.__.-,.t_.a,..k__. �,.i....��.�:.-_•--
( r t
L.,�:.._Z-_...--1�..---J_..'_{�®....... -r�-----�-#„,�»� -.._.-..a- ). ''jt�" ..._:.L_�_...r;._L. �',.:-_...+.,-�. »...,.__.._.+,.�,..--,-- F .» ..__..t-•-=-+.-._,...._.r._:..,_......i...�- tf ; L
�..-»-e.t._. ...f_ {•+----i- .. ,:-+�r�"--�' �-.,--^E � ��� t i ( � ,.�� � � �� r f � s' r _� E s I � �_...,.,t � # �-^
t � � t ..._�.._.. �"` t ! + # _.1.,;....,.. �. �.,...._,._.' �.,.:...,. r _�__....:.d..-..,:,...4�.._..t,._...-.r.�_+,..;....__:..-�-.-t:...,...,,i•_. -tt---^--�'.^—^-.'^ , r
-.� ^- ---{_""---,Jr...�=1..-..--� -�+y..�/"�^.i ..._�i-»... �-... ..-_.,I....::....-i�:-�+..._ -.,1._•.+....a �,..-! ..'_......../•..n--.».ti_,..-r•-M'-- _. t ,y`_.,_.-,L......_..1,..,.,..:;._.. + 1 (#, F �4t�..w_
-
pp
t
_ S
E # "• � � i� � � 1 � � i r # ���� }� ' A 1...._.. 1 � _.. ...,_:,._.___E-._...�.__._�_...�' " ._..fir..,._._.._-.... -�_._._... n�
i y
' .s..-...,a:.....__.1,...._...,.t�_ ._.1...... _..—.{_._._ ,_. ._.« _ ,F,........_j..._.-,�.:...... 1. �.._ r .. ».. ._. .a..... t ,.._...._..�.. s .-...�..:._.,...t..........�....«...�1($., t: 1� � �_...
r ,
r f c ♦'
t k
r ,
...�--__•..�._...___ .__. ._ {.., _..{..._... 1. _. 8._.._.e_...... t_,.._..t.....,_,i.._.. 1_ _:..f_«.-_.t,.._„-.t-...,._.i...«,..,". _-Y.,.,_-c-....._,. _._»...�.__r.F......}.._,_...i_,..._ _'$_._.._.....L:-. ....g:,....... ,.d...-...