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Home My WebLink About0014 OLD TOWN ROAD - Health (� ®van ad Y r ],,Hyannis 267 067002 •` �. //ri/IIP�[lGm UPC 17734 # Now Rom„ HASTINOO.ON v 1 � t B ji \,! TOWN OF BARNSTABLE LOCATION" -V)A/ c/ SEWAGE# VILLAGE AS�E/SSOR'S MAP&PARCEL o2Ce7 0 p� .INSTALLERS NAME&PHONE NO. i G SEPTIC TANK CAPACITY $ oir- FwL r LEACHING FACILITY: (type) ('24(e �C�e,�(size) NO.OF BEDROOMS - OWNER 7/,v ,s✓ � , 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 facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ,. fv T '� r - 67/®fv2 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS � r DEPARTMENT OF ENVIRONMENTAL PROTECTION s` TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: Owner's Name: Owner's Address: Date of Inspection: F cl- /;z w Name of Inspector: (please print) fY""dd��. ✓/>yi�l� Company Name: D zl,,.,f-s 4-*,,dgc.6.ga C Vs%. Mailing Address: ;-Z-!/ n//-> Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of 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 15340 of Title 5(310 CMR 15.000). The system: asses ' - Conditionally Passes Needs Further Evaluation by the Local Approving Authority ; Fails rti Inspector's Signature: Date: rj—/Z -d. The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****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 Inspection Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: ' Date of Inspection: 4—/2 —a(o Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I/ `I ha not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: F 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: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: /y e Owner:• Date of Inspection: 9— C. Further Evaluation is Required by the Board of Health: 0 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: A( 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. WThe system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. /qL The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has aseptic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria 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 forma 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: �y �/e✓� i✓��d Owner: V.�.s�c�►}� �.c Date of Inspection: 9 /,2-—O D. System Failure Criteria applicable to all systems: You must indicate`yes"or"no"to each of the following for all inspections: Yes No ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool 4,-Slischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ` Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool &,"Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow �/ftequired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number f times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. J�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. :E-- 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/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 appl o large syste 'in addition to the criteria above) yes no the system is within 400 eet of a surface drinking water supply the system is wi eye of a tributary to a surface drinking water supply the system is 1 ated in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone H of a p blic 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. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: /Y &a a"I"4 Owner: Date of Inspection: 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 —,'— �ere any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? a'Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system components,excluding the SAS,located on site? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? 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: Yes�e— Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner Date of Inspection: 4—1.2- FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): Z- DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): -2-'2 O Number of current residents: 2- Does residence have a garbage grinder(yes or no): V0 Is laundry on a separate sewage system(yes or no):_"if yes separate inspection required] Laundry system inspected(yes or no):�O Seasonal use:(yes or no):&U 9 82 �7 Water meter readings,if available(last 2 years usage(gpd)): 02 !� Sump pump(yes or no):X10 Last date of occupancy: Alt;0 COMIVIERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/pe sons/sqft,etc.): Grease trap prygs, *_ Industrial waspresent(yes or no):_ Non-sanitary d to the Title 5 system(yes or no): Water meter rlable: Last date of o OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: A61 A-U Aa 1 AB L1;, Was system pumped as part of the inspection(yes or no): s If ves,volume pumped: gallons--How was quantity pumped determined? sr. i�Tim Reason for pumping: C&SS PLO L Shj syer-c.r/"c,n/ C-41'r- 1'1q. TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool �verflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):A Title 5 Inspection Form 6/15/2000 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: /t-/ vxcY %Gzca..� /�, *2444,: 10� Owner: 1�.,l.►L.c�e.rfi Date of Inspection: 9—fA—v a BUILDING SEWER(locate on site plan) Depth below grade: / Materials of construction:_cast iron PVC_other(explain): Distance from private water supply well or suction line: wazic Comments(on condition of joints,venting,evidence of leakage,etc.): <C.COac ' dam.,.. ail` . .Lpi SEPTIC TANK:A(lo'c'a//t--e on site plan) //o 02 Depth below grade: 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: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP:Abocate 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.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 1� Date of Inspection: 9 0 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/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:Ljoif present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: Ablocate 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.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 70-z" Owner: I -s d�c ' Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type / eaching pits,number:_ 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: 42,' Depth of solids layer: f'0 Depth of scum layer: Dimensions of cesspool: &K 6 Materials of construction: CowcXc�,-c Z c"CA Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: 0(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.): Title 5 Inspection Form 6/15/2000 9 f U; Page 10 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: t Date of Inspection: q—Z,2^ 6'1�, SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. Title 5 Inspection Form 6/15/2000 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ,,rr/SYSTEM INFORMATION(continued) . Property Address: /`� U Zoe", .--- e Owner: Date of Inspection: q—/2 —a G SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water ele ation: Title 5 Inspection Form 6/15/2000 11 5.00 81 /..� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T.o1n...........OF........Ba3:Mt,&UP..._._..._.__ Iu i n for larks Tvn,0 ivn ��ermt# ppphcaton is;hereby made for a Permit to Construct ( ) or Repair ( x) an Individual':Sewage Disposal Systeta at 6 Old T own Rd , HYaiuy s ° MA �.........__...._____.._.._._ ----- [jam t N4 ort, I'I� r --. r.00at1oII eaaiC35 _ 4 Old Town Rd-, ice'`.`nn�'�_SP wank Laverty ---- A &B Cesspool Ser°v`�ice 128 Bisho Terrac , ya.nnis, MA PS name •--------'...- i�w�«: Size Lot L... Sq. feet Type of Building Crarbage £ -Ex pans* Attic :� No: of Bedrooms. - — Pa ( ) — ) ( ) Grinder (. ) Dwelling ° Cafeteria - Type of Building — No.'of persons —_ _-.__ _..__._..__. — 5h owers � Other— --- --- _.� --_._._ ----- �� Other fixtures _ _--».--- _. ons er erson day TOE daily flo D Design:.Flow_»___ -- --- --- p P P�._ ----- > , loos Length Width _ nameter Depth f Septic Tank—Liquid'capacity-- Total leachn area -------- -----sq• ft. Width_ ___ ----_.Total'Length?:— I Disposal Trench—No.__._ ------ - q ft. Diameter Depth below inlet-- .�. e Pit No:_--.._.--_--. Total leaching area ,S_ £ether Distribution box ( ) Dosing tank 2 Test Results:: Performed by w ---------------- ----- Depth_:.:.�._.w . ate. ------.- •--- D a< sz Percolation:. _... +# 4 Test Pit No. 1 .: minutes per mch Depth of Test Pit_-•-- --- --= Depth to ground water 1 utes,per uncli Depth o t..._ .. __.. t u water--------------------- 2 f Test Pi Depth o ground Test Pit No. _min TDption of Sarni •.._.-_ --- -._.». -- - --�- - _.__ --------- hcable_installation of ___•-------•-- ----__ __. or rations Amer when app __.---_-------_------ ----- -- ----- Nature o, - ------------------ ------_ a 1,000 ga 3 Agr a Di sal'System m accordance with ry � Y red ees to install the aforedn'bed :Ir►dreiduai Sewag ees not to lace:the system in �f s� 5°tlne State Sam€ar3T Code The zu3der �gn ed forth P d the a Certificate of Comp}nance has by - �. A —�T� / .: ¢�ppincation roved By - 1 �� _ Date PP. s Application Disapproved pr the 16. Permit No._ ...__._.__....._._._— Date — THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH: T oitII OF.......BR.Y't1E ,eb1F? _... farr#ifrttr of fa11utItnr�e Dis osai S-stem construe ed ( ) or Repaired (X ) THIS IS TO CERTIFY;.That the Individual Sewagep �' ool Serrric® 128 Bisha�B Tsx'raae H�+annis, :NlA 02 Ol ..__._.__ by..A&:BB_Cessp_ ------------ 9-8-1 �...._. .- - ��VA Laverty .;:.____--------•----..____ ._._ _--- 6 Old T otan -^� at_ _----------------- has been.:mstalled m accordance with the provisions of ITIE 5 of The State Sanitary 2 ,�s described in the aficztztsn fo; Disposal Works Construction Permit N dated S� g/ -------- az� � ,yk,� x ,, ��TRE ISSUANCE:O>` THIS �CERTIFICIlTE 5}4AlL i�QT SE CONSTRU'ED AS A GUARANTEE THAT THE �` µ�4.. ... :cvcTEtii 1l�1LL.FUPICTIONT SATISFACTORY. ,> - - Page 1 of 2 t1530 ROBERT B. OUR CO:, INC: u�Va� 27.304 CESSPOOL BUILDING • CLEANING 9-18-93 ..INVOICE DATE - ALL TYPES OF MACHINE DIGGING FILL • HARDENING • LOAM GREAT WESTERN ROAD+PA.BOX-982•NO.HARWICH.MASS 02645 .IOB LOCATION. :wneen sannacfu. ded Town Road PARGEi� SOLbann c a Port, TO:. ` J YOUR ORDER{ SALESMAN TERMS 9 NET/70TH PRO7G - p TICN PRICE .. AMOUNT a bx8 :b dock Poo Z, pc.pe down 3' 5epc`ayaxem cona.caa o No Change {�vund at openag �eveZ, and adxd pneeaaz avQJc�eow pc , atone, � ound � � P�-Pe,dawn 3� Tbua ayaJ.em aPpecuca 0 6e wonfung on;9 18=93. t Thca .c vlbpee ,con .ne{y.�eeta the eraVr e►vt co nd.Ltc o n 61 the- b ys em and •cb' nox a guacawtee. asai2ctune P: e an conditcon o� #J�.e .a,yatem A-C - 26' � 8 C D CAPE eusWse FORMssa Yua+Ourn MA.-TES.l.00.e924072 IGM1743H 3 aY fs j j � � f g - *e r �i G� licit 7 1 RAM AM v . � t' ��•' u fi .'��. _Es--i��5 ,yea� - - � �: �'" �: 1 g rMing qq.,9m. J�f 0 Ac, Py r��> • _� , v i LOCATION SEWAGE PERM f� Old,-Town Rd. 81- � VILLAGE West Hyannisport, NA 02672 INSTALLER'S NAME & ADDRESS A & B Cesspool Service k` 128 Bishops Terrace, Hyannis, MA 02601 � BUILDER OR OAR a Frank Laverty 4 Old Town Rd., West HyanAir ps ort o F 02672 DATE PERNXr ISSUED s129181 DATE COMPLIANCE ISSUED ti . I rt, Q �I Ica. a / '.,s oo� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... ...........T.own............OF........Barnstable...--------------------_--.......................... Appiiratinn for Dhgpmai Workfi Tnntrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal System at: 6 Old Town Rd. ,, Hyanni sp ort, EA .... _ - • • .................................................. .....•---•----................................................................................... Location-Address or Lot.No Frank Laverty 4Old Town Rd., Hyannisport, MA. ......................_.......................................................................... .....................................................-............................................ W A &B Cesspool Service 128 Bishops Terrace, Hyannis, MA ,-1 -•--•---- ........ Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.--......2................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons-_--------.---3--------- Showers ( ) — Cafeteria ( ) Q, Other fixtures ...--------•--•----------------- . W Design Flow.............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width_-------_--------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----------_-------- Diameter.................... Depth below inlet....---............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-� Percolation Test Results Performed by.................•------------•-•---•------------•---•-------•......---•-- Date........................................ ,.4 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water...................--... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........---...........-- •--------------------------------------------------•-------••---•---------------••-••.....••-.--•............................................................ 0 Description of Soil-------------- Sa.rd............................................................................................................................................... x -- -------------------- - -----------------------------------------------------------------------------------------------------------------------------------------------------------=----------------- - U Nature of Repairs or Alterations—Answer when applicable--installation of a 1,000 gallon pre-cast, ------.Stone_-packed_-leech pit (overf]ow�-------------------------------------------------------------------------------------- ----_-----_---•--•----- Agreement: The undersigned- agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T i:L.:" p of the State Sanitary Code—The under igned further agrees not to place the system in operation until a Certificate of Compliance has&bn.;sned bythe bo ea1t11.Signe ......... --•-----••- Date Application Approved B Date Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------•-----••-••----•- ----------•---•-------------••-•--•-•---...-•---•--•-------------------------------...--------------•--•---•--••-------------------------------------------------------• ............................... Date Permit No.......$ ....................••-----•----•--------•--- Issued---------5�2901-----------.-.:-----•---•---- Date r � I No----61mg-73... Fms.. - ...5.00....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................T own............OF.......Barmtable-----------------------------.._.-..--.._..------------ Appliratiou for Diipnjal Workfi Tate rurtiou thrutit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: 6 Old T own Rd..,. H�!anni sport t 1 A . ......_... ....._ ... Location-Address Frank Lavert� 4 Old Town Rd HAM'tJNsp ort, YA .. ----- -----------------------------------------------------------------•--......................--.-•--- W A &B Cesspool Service 128 Bishops Terraces %annis, NA .-•----• ............. Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.__.....2.................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons---------------3---------- Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------- - W Design Flow............................................gallons per person per day. Total daily flow.......................-....................gallons. WSeptic Tank—Liquid:capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench— No- -------------------- Width.................... Total Length.................... Total leaching area-____-_--_------sq. ft. Seepage Pit No------------_------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-� Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water---------------------- ( Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 •----•---•---------------------------------•--•-------•-------------......-----......---------------..............-.......................................... 0 Description of Soil...............Sard................................................................................................................................................ x W VNature of Repairs or Alterations—Answer when applicable._in�t8llatiori of a 1,000 gallon pre..cast, .......Stolle..1AokeC1 ea.ch__�it_.(oyerf1gg).t................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE, p5 of the State Sanitary Code—The under igned further agrees not to place the system in 1 operation until a Certificate of Compliance has been issued by the b ealth. Signe /....... --------- j Date - Application Approved BYo -.... ......... � � Date Application Disapproved for the following reasons:..................................................................................•---..__......_........_.._... .......................................-................................................................................................................................................................. Date Permit No....... 1.-........................................... Issued_........5/ 9/ ,r Date \ THE COMMONWEALTH OF MASSACHUSETTS ti BOARD OF HEALTH ........................T g1wn......O F.......Farnstable........................ C15rrtifirahr ,af Tont ftaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (X ) by A & Cesspool Sexvice�.128 Bishops Terrace H nnisz MA 026Q1 ........................... nstall r at----6 Old- T own._Rd_.., Yyannisport� MA nk Laverty has been installed in accordance with the provisions of TI'PIZ j of The State Sanitary ode as described in the application for Disposal Works Construction Permit Nc Z"...�.�.-�____________________ dated S_29I8..._.._-_.--.---_..__...___.._.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........-6` �81 Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T own.........OF.....Barnstable Miyosat 19orkii Twilmarmupit rrutit Permission is hereby granted........ CesSpool••ServiCel--128._Bishops_.Ter._x___Hyannist...P�iA...02601 to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at No............. d Town -Rd.,...jj a;an isport, NA Frank I�avertY....... Street as shown on the application for Disposal Works Construction Permit No.$Z'............ T ed.._.._______5�2g1..8..:............. .................................... , DATE........V------- 81--------------------------------------------------•- oKarl of Health FORM 1255 HOSES & WARREN. INC., PUBLISHERS Telephone(508)432-0530 INVOICE ROBERT B. OUR CO., INC. INVOICE NO. 27.304 CESSPOOL BUILDING • CLEANING ALL TYPES OF MACHINE DIGGING _INVOICE DATE 9-18-93 FILL • HARDENING • LOAM GREAT WESTERN ROAD•P.O.BOX-982•NO.HARWICH,MASS.02645 JOB LOCATION: F Doneen Sannacki # MAP '0.2d Town Road PARCEL �' SOLD Hyannis PoAt, MATO LOT --- YOUR ORDER NO. SALESMAN' TERMS SHIPPED Vlr♦ NET/10TH PROX. DESCRIPTION PRICE AMOUNT - Septic system consists ob a 6x8 btock pool, pipe down 31, bound at opeAating tevet, and a 6x6 pnec"t ovetitow pit, h No ChaAge .6tone, bound 1 butt, pipe. down 3Z' . This system appearus to be woxking on 9-18-93. This inspection %egect6 the cuAAent condition o6 the .6y.6tem and .is not a guarantee ass to the 6utuAe ti6e on condition o6 the .6 y.6tem. A-C - 26' A-D - 42' B-C - 36' B-D - 28' d B A C D CAPE BUSINESS FORMS-SO.YARMOUTK MA-TEL 14BOP892-0572 189817.8H ORIGINAL INVOICE