HomeMy WebLinkAbout0093 OAKVIEW TERRACE - Health 93 Oakview Terrace
Hyannis - P ' p
A - 268 291" + OS a
_ r
I
103.28' N
PROP.
DDI TION
PROP.
H.C. RAMP EX.
pc� DWELLING EX.
MBLU 268-291 PORCH
93 OAKWEW TERRACE
HYANNIS, MA O@LP
O
EX.
H.C. RAMP TANK
O
110.56
�O LOT AREA 10,652 SF
EX. DWELLING AREA— 1328 SF
EX. LOT COVERAGE= 12.5%
PROP. LOT COVERAGE=13.37
SEPTIC FROM ASBUILT
ON FILE AT THE TOWN
-. HEALTH DEPARTMENT
CERTIFIED PLOT PLAN
GALLANT RESIDENCE
I CERTIFY THAT THE IMPROVEMENTS SHOWN of N 93 HYAN TERRACE
P�t� gss9 HYANNIS, MA
HAVE BEEN LOCATED BY A FIELD SURVEY. �� cy DRAWN: Res
c� G DATE: "
9-18-2013
ROBE R, JOB #• SO48
o SYKES SCALE:1 =20' DWG. CPP
No. 35418 EASTBOUND
(� LAND SURVEYING
�Q�F��i •����� P.O. BOX 442
ROBB SYKES, RLS. DATE FORESTDALE, MA 02644
�/ 508-477-4511
TI (39's
-\ COMMONWEALTH OF MASSACHUSETTS
= EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
MAP °ZG
PARCH
LOT
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: ?3 Duk v i�u.l
Owner's Name: �,,,u (�, %NC 1�.17,N, Sr. RiFC ,��®
Owner's Address: 93JJ ClaA✓-ek-1 A Hiepac e
Date of Inspection:/Lv— S-0,5 No p 4 2003
Name of Inspector: (please print) 7b4 n A du 141 T�wHEA�BARNSTq
Company Name: vA-� a lrr ��di hve StY�� HDEpT BCE
Mailing Address: 2 W a441 ST
NA's mn s
Telephone Number: 508 - 112S - 7779
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 tide-'5(310 CMR 15.000). The system:
4----,'Passes
Conditionally Passes "
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature�bmit
0 Date: /O —O�
The system inspector shall 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
****This report only describes conditions:at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspecti.on Form 6/15/2000 page 1
Page 2 of 11 '
OFFICIAL INSPECTION FORM—NOrPOR'VOI UNTARYASSESSM-NTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(c=tinued)
Property Address: �3 c�«/s✓r tub l vrvrc ze-
Owner• 904 a Hof A 401- A7/6I �r
Date of Inspection: /O f— a3
Inspection Summary: Check A,B,C,D or E/ALWAYS complete sH 4S*dWp.P
A., /System Passes: .
1/ I have not found any information which indicates.that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. .
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please
explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank faihme is imminent:System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance.
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or breakout 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 rgA4ced
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 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL:SYSTEM INSPECTION FORM
{. PARTS; .
CERTIFICATION;(continued)
Property Address: 9:5 O k v1 tw
Owner' P".q /w�G/9r ✓ ��.
Date of Inspection:
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass.unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
—The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_ The system has a septic tank and SAS and the SAS is,within 50 feet of a private water supply well.
_ 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 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.
3. Other:
3
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT,FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL;'SYSTEMINSPECTIONY. OWL—%-
PART:A
CERTIFICATION.(continued) ;
Property Address: 93 OaA vi e✓ T~cer
f! 1,1.17 's y/
Owner: l�o.,al 3, /J//�
Date of Inspection:
D. System Failure Criteria applicable to all systems:. . ..;;
You must indicate"yes"or"no"to each of the following for all inspectio*
Yes No
�/ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
t,- Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
I/ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
r/ Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow
_✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
Any portion of the SAS,cesspool or privy is below high ground water elevation.
_ --Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
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 fromzprivate water
supply well with no acceptable water quality analysis. [This system passes if theirell-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
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.]
_O(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
_ _ 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.
4
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL:SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
yRhail /
Owner:
Date of Inspection: _ Za oy3
Check if the following have been done.You must indicate`yes"or"no"as to each of the following:
Yes No
Pumping information was provided by the owner,occupant,or Board of Health
// Were any of the system components pumped out in the previous two weeks?
Has the system received normal flows in the previous two week period?
v 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)
41 _ Was the facility or dwelling inspected for signs of sewage back up?
&-I-_ Was the site inspected for signs of breakout?
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 jSAS)on the site has been determined based on:
Yes no
V _ Existing information.For example,a plan at the Board of Health.
1� _ 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)J
5
Page 6 of 11
OFFICIAL INSPECTION:FORM-NOT FOR OLUNTARY ASSESSMEA"i'S .
SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION FORM
PART C
SYSTEM.INFORMATION
Property Address: `13 EU�/sv:zdc.�i rJTvrpw 1
- n i,Cr�e1i y/i /I•�/7
Owner' ppn u� /y'G�v�yc�✓ r.
Date of Inspection: /0—,5 —O 3
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): `3 Number of bedrooms(actual):
DESIGN'flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 3 30
Number of current residents:1_
Does residence have a garbage grinder(yes or no): A/v
Is laundry on a separate sewage system(yes or no): ,/a [if yes separate inspection required]
Laundry.system inspected(yes or no):
Seasonal use: (yes or no): Mc7 ,( 7
GC-0-5z-Water meter readings,if available(last 2 years usage(gpd)): /bn wok = V/Z �P�� '
Sump pump(yes or no): /
Last date of occupancy:
COMMERCIAL(INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
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):,
GENERAL INFORMATION
Pumping Records
Source of information: z114,roc,;-41
Was system pumped as part of the inspection s or no) a
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. j'
_Shared system(yes or no)(if yes,attach previous inspection records,if any)
_Innovative/Alternative technology.Attach•a copy of the current operation,and maintenance contract(to be
obtained from system owner)
Tight tank _Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components, date installed(if known)and source of information:
Were sewage odors detected when arriving at the site(yesor no): A/
6
Page 7 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 93
Y�,rJrj%S / Al
Owner: e-19V4" T,-�
Date of Inspection: /o- $— 03
BUILDING SEWER(Locate on site plan)
Depth below grade: 3 2 /
Materials of construction:_cast iron 40 PV _other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK:_(locate on site plan)
Depth below grade: o
Material of construction: concrete_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: $ 5
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle: 23"
Scum thickness:
Distance from top of scum to top of outlet tee or baffle: d/
Distance from bottom of scum to bottom of outlet tee or bade:
-How were dimensions determined--
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet i-n}�vert,evidence of leakage,etc.): 1 S4
t, /y
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
Page 8 of 11
OFFICIAL INSPECTION.FORM.=.NOT F:ORy.OLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPQSAL SY$TEM.INSPECTtON FORM.
PART C. .
SYSTEM INFORMATION(continued)
Property Address: �3 (�ah'v�jry %Terra c�
Owner: wfi 125 mc 17 ..,-
Date of Inspection: -//9
TIGHT or HOLDING TANK: (tank must be pumped at time of impec9on)(iamean site plan)
Depth below grade:
Material of construction: concrete metal fiberglass Polyethylene 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: '
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: es (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: o"
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of bbox,,etc.):
f�!,d.� �J a i S' O�'��e�s�.'' /1,� :ShCf�►� .I�Gc1C N,� _o/- Sp���s eNY y y!/!�'
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.
S
f
gage 9 6f 11
OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE:DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: ?J .Oa/t
Owner: o/+c,1r>t 5z
Date of Inspection: /D — — O3
SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required)
If SAS not located explain.why: ..,!
lan how y �� :e `oc<z/� %� m� 4POO I-eae4 ,f
2/s . ,., .
Type
t/ 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.):
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)
( P )
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 I 1
OFFICIAL INSPECTION FORM—NO'fFOR VOIUNTAItY ASSESSMENTS
SUBSURFACE SEWAGE DISPO&6Y SYSTEM INSPECTION FORM
PART.0 .
SYSTEM INFORMATION(continued)
i Property .�
p rty Address: � D..a �v 1
w .T�'i'uze— .
Owner:
Date of Inspection %0—3- o7- . ,s
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate'all wells withia.100 feet.Locate.where public water supply enters the building. .
V
3 II
5
10•
f
Page I fbf11
OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBS,URFACE::SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 93 0e,kL,ie`& T!'•riG•e
-on 1"$ ' AJ117
Owner: voh a/ A-f fir uv J*,
Date of Inspection: /O—
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 2 ' feet
Please indicate(check)all methods used to determine the high ground water elevation:
i
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators,installers-(attach documentation)
✓Accessed USGS database-explain: U sad Mud elf'
I
You must describe how you established the hi�h ground water elevation:
1 r ell, o f
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LG'''ATION 9 o �' /Qw 7`�r`rrc� SEWAGE #
VILLAGE ASSESSOR'S MAP &.LOT06W X9-1
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY I�C�IT
LEACHING FACILITY: (type) Izecicl+A (size) 6 f�'
NO. OF BEDROOMS 3
BUILDER OR OWNER
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching fac ?'ty) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
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LOCATION , . SE AGE PERMIT NO.
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INSTALLER'S NAME i ADDRESS
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,- BUILDER OR MMER
DA T E PERM-IT ISSU E
; DATE COMPLIANCE ISSUE `S
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTHq5 -
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C�. ............OF.....!. .. 1� ..v../ ...—...................
Appliration for DhipusFal Works Tonotrnr#'ton Prrutit
Application is hereby made for a Permit to Construct (x ) or Repair ( ) an Individual Sewage Disposal
System at:
at,o - 'ddress r No.
(t .[....d..L� .l ..........
Owner ...................................•-•---•_.Address
Installer Address
Type of Building Size Lot__/6./ 6_. -.?Sq. feet
Dwelling—No. of Bedrooms.............2________________________ Expansion Attic ( ) Garbage Grinder ( )
A4 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fi es .•-••-•••-•-••-••-••-•••-••-•-•• -
d --------------
W Design Flow________._.s--_-L1.....................gallons per person per day. Total daily flow....._._..__._______-________.__________•___gallons.
WSeptic Tank—Liquid capacity............gallons . Length________________ Width................ Diameter..._..-._._._--. Depth................
x Disposal Trench—; ) -------------------- Width.................... Total Length.....................Total leaching area....................sq. ft.
3 Seepage Pit No..___,--------------- Diameter................---- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing to ( ) 99
aPercolation Test Result Performed by......... �'?-P-1l ... �f..�C���__ Date.__.
Test Pit No. 1___�.�.minutes per inch Depth of Test Pit____________________ Depth to ground water................
--------
4q Test Pit No. 2.... :- minutes per inch Depth of Test Pit____________________ Depth to ground water............. ........
9 ...........-••--------------•-------•--••• r j � sF -- ----.... ................................
O Description of Soil---�_y.�%..._�•. 1..::!:.. ..J_a
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 iIT?U 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 V board
S' e . ��a =LIL'- ..._ .....................................thealth.
/U.c?.. _�..�,
Date
Application Approved By___.',...
Date
Application Disapproved for the following reasons--------------------------------------------------------•------------------------------------••------•-••----_._
-•------••-•-••••••-•--•••-••----•------... •••--•------
Date
PermitNo......................................................... Issued-.....................................................
-
Date
No.._......�`3`.....- Fns... d..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
le.................
.;tu�----------..OF.................
Allpfiration for Uiipoatal Vorkg Tongtrnrtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair '( ) an Individual Sewage Disposal
System at:
J
_..Y ................ ..r..
Ownera = Address r��._.1. • ------------------------------------------------------------- -•--.....-----------.......•..------... --...------..........----..........,.......
Installer Address ,�
U Type of Building Size Lot_./01 _2?i.__._Sq. feet
Dwelling—No. of Bedrooms.............. __________________________Expansion Attic ( ) Garbage Grinder ( )
4 Other—Type e of Building No. of ersons......�-.............. Showers
f� YP g ----------•----------------- P Cafeteria ( )
P4 Other fixtures -----•--•--------- ..................... :..
.< .--•---•-•••-•-•-•--•--•-••-----••-•-•-•-••••-•---•-•-•-••-•••-•.................•----••••......-•-•--
w Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
x ---•---••-•-•--• Width................. Diameter................ Depth.,...............
Septic Tank—Liquid capacity Length
Length____________________ Total leaching area_.__._____.____::.__sq. ft.
Disposal Trench—No..................... Width...__._...........__
Seepage Pit No--------------------- Diameter..................... Depth below inlet..........:.......... Total leaching area..................sq:ft.
Z Other Distribution box ( ) Dosing to ( AR:t
jPercolation Test Result Performed by...._..__ 13UA f 0-75: • -----• ............. Date:. _ _.•_ /...
Test Pit No. L_._ _ .minutes per inch Depth of 'Test Pit.................... Depth to ground water.........................
(14 Test Pit No. 2_...___.__. iinutes per inch Depth of Test Pit.................... Depth to ground water........................
W .....__. /. -----•--•--•........ .. ......�__ - t........................
O Description of Soil--- "° es& �` a�'u, �s /- ----� --- C . .... ..................
w
UNature of Repairs or Alterations—Answer when applicable.......... ...................................................................................
-•--------------------------•-------------------------------------------------------•--••-------•---------••-•••------------------------------.........................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System,in accordance with
the provisions of TIT T E 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.
S' .ne • . ......---••-------------------•--•-•--•-------------......
Dal
Application Approved BY • = } >
Date- --•----------------
Application Disapproved for the following reasons---------------•--•---------..•..-------------------------------••--------.-•••----•--•-•--••......•-•....•••...
.................•--•----.....---•----------•------------•---•----------------.--•---------------------....------------------------------------------------------------................................
Date
PermitNo......................................................... Issued-..................................................:......
' Date
THE COMMONWEALTH OF .MASSACHUSETTS
BOARD OF HEALTH
To"�..t1.111......OF......... a '•z Yf•"" J!-•� ............
C�rrtifiratr of Toanplitanrr
THIS 1,5 at the Individual Sewage Disposal System constructed ($ie�,..or Repaired
b .......... .1 u'. / ................ ....................-.....
/ / ''' �' Inst er .
at...Z£a:?-''"..... .....lQ--- .,e�-[�'a--�t�'u' --f ...........#X,1�"�� ��.�f--.__ ------•--
has been installed in accordance with the provisions of '" 5 of The State.Sanitary Code as described in the
application for Disposal Works Construction Permit N ------ ---------7_�.�..._... dated__..��_--_..%�'..- -�4_.....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE , < 5 i C 8� Inspector*
_•.,_.. _ _ �l T �� �
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No............. °_' .. FE ,�.. ............
' �o��1 or �on�trnrtion rrntit
Permission is hereby granted. A- ...............................................................-......................._....
to Construct (al or. Repair ( ) an Individual Sewage Disposal System
at No.•--•-�
-
as shown on the application for Disposal Works Construction Perm' No..._ ..:_._. 4a,ted_. `
,. ..�
.- -----•---• ............................... Board of Health
DATE ---------•---------------- =--
FORM 125HOBBS & WARREN. INC., PUBLISHERS
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NO _ SPOT ELEVATION OxO : CERTIFIED PLAT P A �
I N0 CONTOUR ---
18I11EQ SPOT ELEVATION 95
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ENSINEfRING- CO, INC,)
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CLIENT /
I CERTIFY THAT THE0
i TE E REGISTERED JOB NO. v 4T \BUILDI�IB SHOWN.,
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CIVIL° • LAND' • _;1 � ,
i�" CONFO.&US TO TMi� 0 1
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HYANNIS, MASK. SHEET_ .y OF
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INVENT AT BUILDING 97 FT.
INLET ,S�PT/C Y.4N/C 1 V FT O/i4M. C CAE 7r1B1/L.4TlON�
FT -
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SOIL LOC9
TOTAL ArJ7f %,Cr'ED F40AoV GAI..I�r 60/L TEST#/ SOIL r STr 2
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t NUMAR OF 404CMUV4 P/r •erLEY. 9 �t�Y. �TL� OF SOIL TEST
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TOWN OF BARNSTABLE
LOCATION //9.3 SEWAGE# Rep— 737
VILLAGE ASSESSOR'S MAP & L6T!6$—.29/
INSTALLER'S NAME&PHONE NO. u" kMOw-"
SEPTIC TANK CAPACITY /®04
LEACHING FACILITY:.(type) 44k�al /OOm (size) 6
NO.OF BEDROOMS
BUILDER OR OWNER 70(40
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the'
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 9 .i Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching far'-ty) Feet
Edge of Wetland and Leaching Facility(If ar4.wetlands exist
within 300..feet of leaching facility) Feet
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LOT 44 / o LOCUS
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10.20 11 i \ BEACH ROAD
58,40"E
N76 o 69.6' �ETiN LOCUS MAP
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LOCUS INFORMATION
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G !' \. PLAN REF: 340/92
TITLE REF: 17898/198
POSE ��� PARCEL ID: MAP 268 PAR. 291' a
10.2 PRO W GR ETW ZONING: RB /"WP WIND EXPOSURE: B
GARAGE G FCOMMUNIIY PANEL 250001-0008-D DATED:07/02/92 '^
UP OLE'
2�•0 - _ �� \ APPROX. CERTIFIED PLOT PLAN
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10 2 - v\ LOCyo
I .— o / j (FOR PROPOSED GARAGE
�; _ i oRo�Nj LOCATED AT:
#93 � �!�-5 �� 93 OAKVIEW TERRACE
EXIST.'
DWELLING HYANNIS, MA.
PREPARED FOR
LOT 46 PHILLIP & CATHERINE
AREA=i o,652f S.F. GALLANT
LOT 45 0
LOT 48 JANUARY 23, 2014
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GRAPHIC SCALE SURVEY, INC.,
20 0; 10 20 40 B0 141 ROUTE 6 A.
SALT POND BUILDING:
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P.O. BOX 1729
( ;IN FEET ) SANDWICH, MA. 02.563
1 inch 20 ft.
BUS:(508)888-3619 CELL:(508)527-3600
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10 ° ° Note:These plans are for the sole purpose and
N j j m GAPIZZI HOME IMPROVEMENT Phillip and Catherine Gallant
v o w 1645 Newtown Road q3 Oak View Terrace HP RAMP ADDITION use of Gapizzi Home Improvement and are not
Gotuit Massachusetts Hyannis Massachusetts HP BATHROOM ADDITION to be distributed or used for construction other
than by Gapizzi Home Improvement.
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