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HomeMy WebLinkAbout1167 PHINNEY'S LANE - Health 1167 Phinney's Lane 4 Hyannis P -- , I A = 274 011 i i I ri I I' i t I i i Y TOWN OF BARNSTABLE LOCATION _-���� 71/ ixX�R,re— SEWAGE # VILLAGE ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO.I __. SEPTIC TANK CAPACITY t3XQ ru LEACHING FACILITY: (type) 1 S brt h(p 1 I (size) NO.OF BEDROOMS 1 BUILDER OR OWNER PERMPTDATE: ��� /a�` COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by D-F= 3a` fix=56' rc C-N= D�N=33` Cc--I 66� fir=91 � RC>; l RQ ;� �. U.S.POSTAGE>>PITNEY BOWES )wn of Barnstable S iblic Health Division ®® 0 10 Main Street ZIP 02601 $-000.46 -�annis,MA 02601 '�. 02 4Vtl 0000336455 AUG. 0$. 201.7. /Alp, AYTAJ� (07- P `� �- tI - e va.r' amti c �P gt, ew R ;I,-^a.i.17 d a I.-,=3o �r tr M �:K:.Q nfr "� P:[�-61.'�a_.'j�F:F^•C>'e_ ''II'' ,,yy A B CC TO R W q q 05 1 a4T-r�w:1_ �se:121 f 6.1.1. �:�.� t1�t1:1;;9�.1°9 111 11.111t1a .,1 a � eve �a�r� � 1„1 °'t [i1' 11 i 1t1"11t"""F11'is1 1`I'1a11' fE'11`a�' A i ... . • A. Signature a.•C&r plate ftems'1;2,and 3. ❑Agent ' 1 a Print your name and address on the reverse X ❑Addressee. So that we•ean'return the card to you. N B. Receiv b nted Neine) C: Date of Delivery in Attach this card to the back of the rilai�plece, l ot-on the front if space'permits: D. Is delivery address different from item 1? 0.Yes 1.,Article Addressed to: r r a Alf YES.enter delivery address below: ❑No 3., Servic 'y,e ♦Ib3,1 p�Mail.Express@) p Adult Sign ❑R istered Mallrm III�III�I I II I�IIIIII�I'lII III'IIIII II III�I III ❑Adult Signatu _feted De liv Reliveered Mail Restricted ail ❑Certified M ® Delivery ❑Certified Mail.Restricted Deli 9590 9402 2480'6306 777183 very Return Receipt for Merchandise ❑Collect on Delivery p Signature Confirmation^" -m Collect on Delivery Restricted Delivery ❑Signature Confirmation nsured Mail Restricted Delivery 3 0 0 0 01 4 9 9 0 2 8 9 2 insured Mail Restricted"Delivery 7 015 17 (over$500) Domestic Return Receipt P$Form.3811;July 2015'PSN 7530 02 000-9053 1 17 8/1 / Al Arguello 1-1167 Phinneys Lane Centerville, Ma. 02632 Al Please be advised that I have scheduled repairs to your apartment beginning on Monday 8/14/17 at approximately 9am. The work will include the following; 1) removing the sheetrock on the wall that has the black smudges on it and replacing it with new sheetrock, 2) repairing the crack in the living room ceiling and 3) removing and replacing the flooring in the area where the flooding occurred. The work will take approximately 2 days to complete possible longer depending on how much flooring needs to be replaced. You are responsible for disconnecting and removing all your personal items from the area as we cannot be responsible for any damages should we have to move your items. I understand this may be an inconvenience to you however these are issues that need to be taken care of. Should the date and time be unacceptable or inconvenient for whatever reason you should contact me as soon as possible in order to reschedule the work at a later date. Charlie Pisacano Boix 126 Hyannisport, Ma. 02647 CC. Tim O'Connell Barnstable Health Inspector Certified Mail:7015 1730 0001 4990 2892 o�t"f rati Town of Barnstable o� Regulatory Services + BARNStABM v MASS, g Richard Scali,Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 8, 2017 Charles Pisacano PO Box 126 Hyannisport, MA 02647 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWNOF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 1167 Phinney's Lane Apt 91 Hyannis, MA, was inspected on August 8, 2017 by Timothy B. O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted in response to a complaint filed with the Town of Barnstable Public Health Division. The following violations of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements Observed cracks within the ceiling within the living room area. Observed mold like substance and chronic dampness on walls near bathroom entrance. Observed chronic dampness under flooring throughout apartment. You are directed-to correct the violations listed above within (30) days of your receipt of this notice by repairing ceiling. You are directed to correct the violations listed above within (15) days of your receipt of this notice by removing all' sources of chronic dampness from flooring and repairing flooring as needed. You are directed to correct the violations listed above within (7) days of your receipt of this notice by removing.all mold likes substances and sources of chronic dampness from bathroom door way entrance area. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. However, said violations must be corrected within twenty four hours regardless of any request for a hearing. Non-compliance will result in a fine of$100.00 per violation. Each day's failure Q:\Order letters\Housing-Motel Violations\1167 phinney's 8-7-17.doe to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE,BOARD OF HEALTH . h cKean, R. ., CHO Director of Public Health Town of Barnstable Q:\Order letters\Housing-Motel Violations\1167 phinney's 8-7-17.doc TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date Time: In Out Owner Tenant I Address Address ` 0 Compliance Remarks or Regulation # Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service �w 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents _ r^ 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17.Temporary Housing 18. Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspector L-0:::n U- lf Public Building such as Store or Hotel/Motel specify here r TOWN OF'BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date Time: In Out Owner ' Tenant Address Address Compliance Remarks or Regulation# Yes / NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities ' 6. Heating Facilities r- 7. Lighting and Electrical Facilities 8. Ventilation 9: Installation and Maintenance of.F�cilities ,.,-�� ., . ._ ,..-�..,� 10. Curtailment of Service 11. Space and Use `f y- 12. Exits 13. Installation and Maintenance of Structural r Elements -� Af w . 14. Insects and Rodents ' 15. Garbage and Rubbish Storage and Disposal s t ttA_ r"+ t 1 16. Sewage Disposal rt 17.Temporary Housing gum t4! 18."Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms r Number of Vehicles Allowed (max) Number of Persons Allowed (max) 14 �"" +� Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here Hazardous Materials Inventory Sheet Checklist 4ajDate Physical Street Address-Check database to ensure it exists Working Phone Number Actual Amounts -( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials) Storage Information - location of storage, how long is storage for? If none, note that. Disposal Information -where and who? If none, note that. Applicant Signature - understand what is listed and noted Staff Initial -'any questions, know who to ask Vehicle Washing/Rinsing? -provide a vehicle washing policy and ! explain it -note that it was given 't r Attach the Business Certificate with your sign off and comments "The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. YOU WISH TO OPEN A BUSINESS? t. . For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you. must do by M.G.L.-it does not give you permission to operate.) You must'first obtain the necessary signatures on this form'at 200 Main St., Hyannis, ~ . Take the completed form to the Town Clerk's Office..1'st FI., 367 Main St., Hyannis, MA 02601 (Town'Hall) and get the Business Certificate that is ' required by law. DATE: Fill in please:, ;3h�a�t.;� ;,t,;;',�;;�,.y,=�i• ,��F APPLICANT'S YOUR NAME' S: BUSINESS YOUR HOME AD RESS: TELEPHONE # Home Telephone Number NNA MM EO F COR?OR E OF NE BUASTIO ` YPEDF - t., w; - D S - O E CC ATI N I H. +i ••il J AODRESS.DF;'B1�51NESS.., ::.. ,,: ,. :. .. ... . MAI?/PARCEL;IVUIVi6.. es cI .. Town'of When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Barnstable. This form is intended to assist you in obtaining the information you.may need. You MUST GO TO 200 Main St. -(corner of Yarmouth Rd. &Main Street) to.make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM S. 10 R'S OFF E MUST COMPLY WITH HOME OCCUPATIGN This individu I'ha e 'n e' en e t r q 're nts that pertain to this type of business; RULES AND REGULATIONIS. FAII_URE TO. COMPLY MAY RESULT IN FINES uth r' Si at re** : . OMMEN ir J }: } 2. BOARD OF LTH : r This individual he infor of pe t mquire is that pertain to this type of business. Autrize S nature** MUST COMPLY W)1H"ALL ho ; COMMENTS: uw�eRDOUS M/>,TERIAI—S.Lli' �NS. S, CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing`requirements that pertain to this type of business. Authorized Signature* COMMENTS: • fi _ Date: / ;Zz/ TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF'BUSINESS:j;(, Cf &„\+,knn z BUSINESS LOCATION: hy\ !2T AF+9 ry&4 iP$CVtll P INVENTORY MAILING ADDRESS: JA �-� ��I TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: 9 a V-) -1 V)9 INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt&roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED-- Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT I CANARY COPY-BUSINESS App i =it's gnature Staff's Initials �y YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates.[cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town [which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1 FL., 367 Main Street, Hyannis, MA 02601 [Town Hall) DATE: 8 6 � ` � Fill in please: " NRA �. APPLICANT'S YOUR NAME: �v C3� CJ BUSINESS YOUR OME ADDRESS: 4 V1N y x # C Z 6 :. � ---�� TELEPHONE # Home Telephone Number NAME OF NEW BUSINESS TYPE OF BUSINESS. � ' IS THIS A HOME OCCUPATION?.. YES n.NO . . Have you been given ALftom-the bull" ADDRESS OF 4 MAP/PARCEL NUMBER 4 A�°2 a� ar1n�S When starting a new business there are several things you to n compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO�T0,2. ain St. - (corner of Yarmouth " Rd & Main Street) to make sure you have the appropriate permits and.licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFI This individual has been inform f any permit requiremVrftttq6V4� this type of business. OCCUPATION R UL_ES Authorized Signatur COMMENTS: 2. BOARD OF HEALTH This individual has bee formed of the ppfrffi eq �ents t pertain to this type of business. Athoriz90 Signature** COMMENTS: . 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been-inform d of the licensing requirements that pertain to this type of business. ' t? Au orized Sig ature** COMMENTS: • Y� I Hazar us Materials Inventory Sheet Checklist ate Ph sical Street Address-Check database to ensure it exists orking Phone Number tual Amounts-(le.gas being used to fuel machines,thinner to clean brushes all count as hazardous materials) yf orage Information-location of storage,how long is storage for? i If none,note that. posal Information-where and who?If none,note that. piicant Signature-understand what is listed and noted Staff.Initial-any questions,know who to ask Vehicle Washing/Rinsing? -provide a vehicle washing policy and explain it-note that it was given Attach the Business Certificate with your sign off and comments "The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. t J .�. TOWN OF BARNSTABLE Date:0$ TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: U� BUSINESS LOCATION: 44 )-a - LMENTORY MAILING ADDRESS:Aldq C6 ta M r,, TOTAL AMOUNT: TELEPHONE NUMB J CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: Rki&`-G Ga.,MSDS ON SITE? TYPE OF BUSINESS: `,OcAriy�2 INFORMATION/R�COMMEND IONS: OQ Fire Distri t: Waste Transportation: Last shipment of hazardous,waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. �a LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic " ~ or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) LC Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's �Lwai varnishes, stains, dyes �o�� Other chlorinated hydrocarbons, Lacquer thinners I (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor&furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (� (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE LOCATION AI -, /S .(.AA,e, SEWAGE # VILLAGE �Pu -•y1 ASSESSOR'S MAP &LOT D J Jk11 INSTALLER'S NAME&PHONE NO S I r�ickiki--1Uc. c3tia SEPTIC TANK CAPACITY LEACHING FACILITY: (type) !S�scT�I OP e (size) NO.OF BEDROOMS l 3 BUILDER OIL.OWNER PERMITDATE:TWOa- COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by g • I GCS-br�is h a ^ 0Lo0 °I !1rr �= t� � tLL 33 c3 �' s a �i I"9 VDL1Y U j- C) cr c o I a c7 0 �I at � v rr FORM 30 C,,_ HOBBS&WARREN'M THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN DEPARTMENT � �V -' ©Ski-._— P`�/� � abcl ADDRESS TELEPHONE 4 Address l(6`7 �t �WIV 'S M-IV C --Occupant Floor / Apartment Na_ /1 --No.of Occupants Z- No. of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units-- nits No.Stories Name and address of owner_ W1PLE-5 Q1 S4 AJ 0 4,n ��ZAA.'P 4C-41- Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers.- Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M c2oors, indows: S Z)F Doo£' Ajo—, r4/ 50I(C) Roof SCRN Aero /a Z>jSK. I� 552. Gutters, Drains: f s5/ - N_>L� "� �Cpb?F I Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: L"HlP/' ddJl/SS/N U/✓aCL�tt/ F�n,�// 5-0 Obst'n.: Hall loo Wal CCeiin Sol='T -ro To etcH— Ci":A-GKED Pt4sS q/C SCE Hall Lighting: Hall Windows: , HEATING imne s: S-&Vb De AV .a/ 10 351(Jq) en ral ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: M l 351AJ& OR-EK7r, IcqL 6ACEPt to PLUMBING: Supply Line ❑ MS ❑ ST ❑ P W ine: -M T13Tul3 0 CLpO5 t'b -5LOW Lmy& 124) W.Tanks Safety and Ven _ f55/A1rr ��L Er ELECTRICAL Panels, Meters,Cir. s NC- jfr;tt-r COVPA 135-t(,I-) 0 ❑ 220 Fusing,Grn : -nlo V4FAITIL,477W 416 Lro AMP: Gen. d. Distrib. Box: -- 8Ao(<E VANIT .410 W^ g-co n. Basement Wiring155If�1 C tgio(.Ek I:hIINY9��4t /U DWELLING UNIT Ventil. Lgtng. Putlets Walls Ceils. Wind. Doors Floors Locks Kitche athroo 14EAj vi t //v°T U4/ 6b q/O ico Pant o (4) Den Li ' oom edroom 1 146 V6- z_1jt /D //V Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect..- Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual t'n: General Wilding Posted Mo olaw 's ,�,,,e s Htp SI oors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS IGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES Y." A INSPECTORfitu¢f TITLE A.M. DATE fQ 3 TIME 3 'C??(� P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. .. .,.:.r... , ...F:;.,, .. -. _. ..,:. :;,v .... .e.a.-,,.q �--w:..«<.-,.�ws,.•A,.*�,�'yx'vj. , - .mf•r. .�,� y�+. F, ur.+n,,, ;r- ` ;,�• f ,c; �w;rr^:��'^.�.v!ai. ��:Tr'�b,z �w:�. ,,,,u,., •.,g.w,+.. .:_,.,,.:,r,,...�t.... .,., ,-� 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following-conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises..This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter it, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed'as a determination that other violations or conditions may not be found to fall within this category. Nor,shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. E, (C) Shutoff and/or failure to restore electricity or gas. i (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. - _ -- (E) Failure to provide a safe supply of water. - (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply'with any provisions of 105 CMR 410.600,410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. - . a (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public f� Health Regulations.for LeadPoisoning Prevention and Control, 105 CM.R.460.000.. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation,,or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment'to health or safety. (L) Failure to install electrical, plumbing, heating and gas'burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure tolmaintain `such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire,,,burns, shock, accident or other danger or impairment to health or safety. , . , J .1- - •�_--(M) Any defect in asbestos material used as insulation or-covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required.by 105 CMR 410.482. T i(0) Any of the following conditions which remain uncorrected for a period of five or more days following,the�e to.or. knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin andshower or bathtub as required in 105 CMR 4.10.150(A)(2)and 410'.150(A)(3)or any ' defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in.105 CMR 410.750(A)through (0)shall be'deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner . to remedy said condition within the time so ordered by the Board of Health. i i . , TOWN OF BARNSTABLE LOCA110N SEWAGE-# VII.LAGI ASSESSOR`S AkP"& LOT 7--7 V'61/ INSTALLER'S NAME&PHONE N Na v t a vrnos _�ofc-S LI - Sat SEPTIC TANK CAPACITY �iT/� oD 4aIS Greed Eacti LEACHING FACILITY: (type) 11 .IZQ'dg1 f pl r�It S (size) 166 X 13 NO.OF BEDROOMS- A tht a_ BUILDER OR OWNER Va y Sold PERMITDATE: 6 l G 10 J 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) Ne A p. Feet Furnished by �d CIO [13 �L-I 9J sb - � 4L. - fL = 9 El t Nt. 1-h = 58 �5 = � 91, : L 911 W Z$ �.S- t V VL p. No. god +^ / Feed .- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yew PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for Oi5pogal *pgtetn Congtruction Permit Application for a Permit to Construct( )Repair(grade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. Jf 6'� _f h 1Aney S Lae Owner's Name, and Tel.No. Assessor's Map/Parcel C-ZAJ Qttii I J e lbouq i to Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �c CM1 Shor4 •P.E. CA�A's -Gvc,kli>Jq � 'P o. l "Por ,4 W £'ems 10-411 euAa s Type of Building: Dwelling No.of Bedrooms 0 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( Other Fixtures Design Flow %4 30 gallons per day. Calculated daily flow [4 3q gallons. Plan Date' 1,30 Number of sheets Revision Date /Title Size of Septic Tank I Type of S.A.S. IS Description of Soil t ;;t? Nature of//Repairs or Alterations(Answer when applicable) R PY/• c� sg ah C_ [11IYA AJIeIAJ 7�I/, it'' & e. ,Q-IIC— Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed Date 4 7 Application Approved by pu .,it'ire Date Application Disapproved.for th ollowing reasons Permit No. 0U U/—`>'/ Date Issued .2&a r� £NO. d O — J I rl � t�' Y tL '` Fee d- it THE @OMMONWE'ALTH OF MASSACHU.SEIiTS Entered in computer: ct YeL—y'� PUBLIC HEALTH DIVISION,-,TOWN OF BARNSTABLE, MASSACHUSETTS'' r... . apip, ,icatt�orY for Otgpogal *pgtem Congtruction Per, it Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) LJ Complete System ❑Individual Components " Location Address or Lot No. //(�"� �/jirl�ey �� Owner's CAMAddres's and Tel.No. Assessor's Map/Parcel ceo.rfprut 1, s ti Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. fASh's "rruck,�J91Wc . Craiq S 414 "P.E, s 0. Box:; .'P0 1Aril - Type of Building: Dwelling ;No.of Bedrooms 1 3, Lot Size A sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( } Other Fixtures , Design Flow %1430 gallons per day. Calculated daily flow 4 3y gallons. Plan Date l—mil an Number of sheets Revision Date } Title Size of Septic Tank- ,3 CCU 0.4 J. Type of S.A.S. PS J)rr jp11S! Description of Soil Nature of Repairs or Alterations(Answer when applicable) 3tn,Are �x� Send c Sus�-e ty zeabc- Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed N Date 9 Application Approved by s ,ro Date t Application Disapproved for Ajollowing,reasons 1` _ r Permit No. .2 U of- y/� Date Issued THE COMMONWEALTH OF MASSACHUSETTS ,. BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(✓ )Upgraded( ) Abandoned( )by at 2 S a, •7l' has been constructed in accordance with the provisions of Tid 5 and the for Disposal System Construction Permit No jk1j-111r dated-16 a Installer Designer The issuance of thi permit shall not be construed as a guarantee that the syst m ill fu ction as d i ned. Date o Inspector ` NO. Q 00 ��S� Fee SO THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Itgpogal *pgtem Congtrurtton permit Permission is hereby granted to Construct( )Repair(✓)Upgrade( )Abandon( ) System located at //F,2= Zot let Is �\ and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of thi ermit. Date: G ! J 7 Approved by d TIME COMWNWULN 60 MAt3 OHNIfts f'" th co"'', " sl`' Pi Lle. HEAOIA DIii1MON -tOWN OP 9ANOtAbLS,MASSY OMUSSTTS Apotitationo,log U00,604t 6potelft tottottottiolt vatfift I f �' Applicitioii tai Peittdt to irbitfdntct( )Itepitir( )tjpO&(,rj AbiiWoii( ) O Complete gystetit O lndMdiial Coviponeiitt LoceAoo AAto of iA Igo. // e-7 PH ,.-�n e y.s Lq Owoer•i �nie,Addiai and Tei.Nqq C 4e h t e v, //a f 1(07 K Ca/� Y G 7rWf" Aiilbi6or'd Nti�plPif I 2 7 c/o C. '70A 1f Coll ;77Z t -7r iiiWiet N".Addreii,ied Tol,No. Mi4flWA Nimh.Addreii Bad ibl.No. ✓ Ct, Soo^ 4Z/o Q Typi f;f$iilldln �sy s T—�.>r/ .T' s Q 8 3 98 1�3i i Dwblling y Lot Size 7Q-02'31 q.R. OArhsge Grinder othbr "It, "4 /, No.of Persons v $liovirei Es(eEe � dthbi Flxi+iibe I'iEe1gM)Fluff // gallons pet diy. O dculatiii!daily flow Aiti bf►tt /!/( hlumJ>Et al fiheets '/ � Revisioe/Date 'I ltld Pro e S C�-l• se �. ma's./. .� �`O ✓ V of ', a /1""41 tiN S Z Site of 5e060'Ilinit Y 0 CO 4.3 a o G ,Tglse of S.A.S. /3'wd G'x 2 ' •CE-.y e/,e 7iZg��y c v, Dficrlpllotl bt boll. n -���//� ,• .T �.S w . 49..;/�'.� -7 c. e76 Cc�i u.-•. _5 y-Z o� �_ti 1. [Vilttrh!oft>gepolit�a&i�Aikt�doi3b(AiifiwEt+fvheii applicabit~) �e-.� /G ����� •/..�c� sy�s�e:,_, Date Bost Imottted: A•.a �iEis�t lbe undetsigh6d igtees to imuti thfs c,bhstrotuon and miiritatiieb of the afore described oii-kite O*oge disposal•system in iccorditiici*ith tha ptoviitoni of hdi 8 of the l3imri o-hinftntil Code find hot to place the gmblrn in opotobti until a Ccttifi- ciite o�CompJiiiiic�h:�limed lefitibd b .. bf l#efilih. WOW- Date,_.__ Appii"Obti Apptov6d D , � ' � Appliciititih bliftppioOd tot the(6llo*lh reasoni CI0r.141 GJUl IJ,t6 DUO 7FJ4J4'L LJut11.1.JUIA HI'JU I.,UP+If'HI'1r' h-'HL7t E'JL 00 THE C6MMONWEALTN 60 MAWaHU iftS itercA iri co>i 0tei: OubUd. WALTN WASION :tOWN OP 1WINISTAOL5,MAOWNUStTTS Apphtfitidif for 0406#41 Opat t conottittion vatfift Apohei Lori 6 i perttdt to Constiuct( )Abowk( )UpOA oo A wott( ) ©complete gyttetii D tndividiiet Components t iiciiloii Addir,u of t,d t to. // e. 7 PG, ,.1 n e yes Lq `17 ,Additki Yid?tit No. cenZe v. /� /9 « s &VL&4V Asi6iwes MipWPaiobl 2 7¢ C� Vol / !Oa a leitdllei'i Neuds,Addieie,Yiid Itil.No, D6^4iii' 1 Nkni,Add"Yiid Tim,No. Ty"bf bdikl * Sys T—�.� 7" Sa8 3 98 93/ / I?vi+ellitig v Lot Size 70_aca+sq fl. Oatbase Grindet(--f Othar Type:of Biillding iy No.of Person§ 2 c Showot Othb:Fittttt89 twigh // Atons r day. Catcolat8d Bail how //a a 8 per Y y gallons. j Date t �.on Niftbret of bviil6tt Date -� 'l�tla Prop o s C+-� •se Z` � ,f��rS -.. . � i � /g.�..f0 r O ti�l cf h +•���a �s /��e� / ,�7H�j•s L SttC ot Septit I" 3 0 oa 4 0 0 0 0 _ o o a Type bf S.A.S. !3'sc/a G x z ' t,F,�c, 7!ZF�voy a ✓ Del 4floa bf 0dh ` `• 7- , - 1.C. '.4g �moo--•,sy S c:-a�. �. �r id/ lVhhw 61ii bpalii biAlfamdo,fil(Ahmi when dppilcible) ,.?, � /G C P ��•/�a/ ,s�.y, date twat inspeM: Agi�ieieiEbfi iM tiiideislgtied agrees,to tfiwie thb coristrtiction&nd himfitadiicc bf thi Afate de'setibed wt-sitb BOwage ditposal sy"stem in accoidaiicb with thb ptovisiom of Title of the tirMkdtime itA1 Code end Not to place the syitetn in operat9ad ubdi a Cettifi- oath of Compliiki h1%bad 1��Ubd b bf 1#ealih. glgiied Date Applieatloii Appiovad by Apptioation D144006%d tot th6 t'ollowiiig iedsbi b pertitit No.Zgc'L g-. L - fititd TNd 60MM6NWIALfi 60 MAGO MHU60 t;i NARNATABLIt MANAONUMt—TO r THIS N TO CER`t'tFY; that the 08-s tb SKest Dispos&t 8ym6in C(3iiStNctbd( )Repined( )Upgtaded W ) Abaiidbmd( )by at 114- h I —, e L 4 ti C < <-,�c— l/c has 66ti cotidiritc,W lit acccoirldnce with the ptoviiioiis oftitle 3 land the tot bispaial syitem Construction permit M O f- datw". IhitAtltzt. iaaiigner C r g r S r� S �, �_r r.. �'�'; The issuancd of Wk t*itnit shill riot b6 comtrubd ris a ghats W6 that the syatein will N ictioti as designed. bate INspectot - ME 60MMONNALM 60 MAAWHUM i OUBLid MALIN t�IVA16N 4 NARNOUBLE,MAMACNUSMO • i��o�cor �p�t�trt �ott�ct�i�ctiott �i'ttfit sx��-E� .r petthlsatoh is hotbby kMt6d id Coiastrurt( . )ltipialt( )t1p&de W)Abandon §906tii located at 1147 L •s tie e ir rr te- aed m hic*fibed iN&eboo Application for Diipoa d Systbm ConkiNctilbb peiiitit.Thb applicant iecogtifiet his/her duty to cotiiply with ti&i eitd the fdilowing total pioviaions tit ip&hd t6hdidon5. t%Wcicd!Cotiatnitdo i teat 4 co .'pl id W thlti NO Oki 61 ails data tit this t. ` i lisle: Apprdvbd by i =-Wj ffln TOWN AM LOCATION bN. v& WAGE: 'S 7-7 0 VELLAGE--C g&�tzl ASSESSOR INSTALLER'S NAME'& PHONE > CAPACITY SEPTIC TANK -A 44d LEAcHiNd FACUTY: (tyPe) (size) log k, i.3 NO. OF BEDROOMS rApts BUILDER.OR OWNER Va tj PERMUDAlt:,11 b.I oil COMPLIANCEDATE: ce'Be n the: Separation Distance twee, Maximum Adjusted Groundwater Table to ithe Bottom of Leaching Facility Fee Private Water Supply.Well and Leaching Facility,(If any. we lls exist' o site or.within 200 feet of:4eaching.facility) t Edge-of,Wetland and Leaching Facility(If any wetlands exist lity) n .WJI 300 feet of.leaching' faci a h Feet Furnis hed by --777- A 3 Y7 5' -7 W -71 C71— t3l T:�7;2-,' ,FQ �J W -f 0 TO Town of Barnstable P# p Department of Health,Safety,and Environmental Services . �t Public Health Division Date e O� 367 Main Street,Hyannis MA 02601 BABNEMABr.e, + t t639• � ">Fpta Date Scheduled ® Time Fee Pd.`- j . Soil Suitability Assessment for Sewage Disposal 1, Performed By: C r C4<5s � • 5 f7 G e— ' 'W ithessed By: Da h•'+ 0. r4'1• eJ r G✓id'/ .... LOCATION & GENERAL;INFORIYIATION . ,> Location Address j/ �} ) Owner's Name Address �r• %�a�'-ss M•4 /CYMAI�3 •�z673 Assessor's Map/Parcel: 2 74� / - Engineer's Name Cr'-g r NEW CONSTRUCTION REPAIR X Telephone# (SG eJ /e > �f ate' >• , F• i Land Use 1Z es/4eh It,' •e I Slopes(%) ) t'a' { ' '- Surface Stones �✓� Distances from: Open Water Body ft 'Possible Wet Area; '� '`� ft Drinking"Water Well ��­ft l Drainage Way ft Property Line It Other } a 'ro ft SKETCH:(Street name,dimensions of lot,exact locations of test.holes&,perc.(ests,locate wetlands in proximity to holes) TIN • tea.• - Ln � Parent material(geologic) e 4 Y'V C r' Depth to Bedrock G� Depth to Groundwater: Standing Water in Hole: n/p 7 e— Weeping from Pit Face 'OVo­7 L Estimated Seasonal High Groundwater t)ETERMINATION P,OR SEASONAL,HIGH.VVAT R'TA13LE ::::. ............::.......................-...................................................................................................................................................................................... : '�'� f ... .. ;`.Scthod'Jscd: Depth Observed standing m obs.hole• in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well#__.__._. .Reading Date:.-- Index Well level_ Adj.factor,_ Adj.Groundwater Level .. PEItCOLATL4N TEST �'�' lJate::. . �;jme Observation 2 49Q)-s Hole# Time at 9" f7*Ir Depth of Perc �L', G81 riG 7�•• Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak Rate Min./Inch Z � G Site Suitability Assessment: Site Passed ✓ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant DEEP OR ERYATIOI �IOEE LOG oIe#` Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface On.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.°oGravel) r it A ., G' rG.wC/ r-"V e v./at < oa.�, s L 4& C -7 8 4 it To z ,�- r4 DEEP OBSE...............-...RVA.. TI... ON HOLE LOG Hole ............................. ... .... ..................... ......................................... . . .: Depth,from_ $oil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. C nsi tent /o Gravel Jet ,9 S 434M. ' 140 YA 78 G t .safta 5.der l �$�� G Z FfnP CQ vl DEEPOBSERYAT'ION HOLE LOG ole .. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. C nsistenc °°Gravel) DEEP OBSERVATION.HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil......:....................Otherr Surface.(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistenev.°o Gravel i• Jw f, 1 Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No— Yes Within 100 yeartlood boundary No_ Yes Depth of,Naturally Occurring Pervious Material Does at feast four feef of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Xe-5 If not,what is the depth of naturally occurring pervious�material?"y' Certification . a a . I certify that on AX o v 9¢ (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature Date 1�.3 o� TOWN OF BARNSTABLE LU ATION jjkl Ah ra,» e SEWAGE # 7J a VILLAGE ASSESSOR'S MAP LOT INSTALLER'S NAME Si PRONE NO. gi a -16 4.Z SEPTIC TANK CAPACITY /rand Gk l LEACHING FACILITY:(type)! .(size) .2elvd 6:*,l NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER Mato.hT 1-ci. DATE PERMIT ISSUED: DATE COMPLIANC ISSUED: a.. "1. _ - VARIANCE GRANTED: Yes No �! �l 1 .. LA n ' J w s Board of Health Town of Barnstable P.O. Box 534 vZ r7. H FEB....P.*............... . HYa- nr,2s,,.1\AassachusAtts MMI ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........OF....Rar)441e. ......... ............ ----------- ....................................................._......................... Applirathin for BiBpaaal Works Tomilrurtion "truth ,Application is hereby made for a Permit to Construct or Repair (*) an Individual Sewage Disposal System at: .......................... AAAoQ................................................................. . ca .. ......... - Location-Address or,4.ot N9 4t Der U 1% ......................... ... ----------------------------------*......**......... ............. .... . ....11. ................................... 4t..6...... .......................I..O..w..n..e.r........................................... .................... Address .. �6 , cc . 3T6 Oda� 45A.......................... Installer AddreA Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...........................................Expansion Attic Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( ) Otherfixtures ------------------------------------------------------------------------------------------------------------------------------------------------------ Design Flow............................................gallons per person per day. Total daily flow........ ...................................gallons. P4 Septic Tank—Liquid capacity............gallons Length________________ Width________________ Diameter__.____-________ Depth_________.__._-- Disposal Trench—No_ ____________________ Width.................... Total Length.__.__._____.___.___ Total leaching area....................sq. f t. Seepage Pit No_____________________ Diameter_._.._.._.._._.__.._ Depth below inlet____.__..._..._..._. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) - Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit________..___...____ Depth to ground water_____-_______________--. (i, Test Pit No. 2................minutes per inch Depth of Test Pit______.._._________. Depth to ground water------------------------ P4 ............................................................................................................................................................ 0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------ �4 U .............................................................................................m...............................................................................................---------- ---­-------------- ........................................................................................................................................................K......................... U Nature of Re airs or Alterations—Answer when applicable.7'00 40 ..... ...................... .................................................................................................................. J .. .................................... en Agree ent: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i 1 T 1E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed.... R.64...(1 12-21-_$a..... ............ ............. . Date Application Approved By................ . ........1�.. ......... Date Application Disapproved for the following reasons:........................ .................................................................................. ......................................................................................................................................................................................................... Date PermitIssued ................. ....................................... Date Fss....:..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................... ...........................OF..................R Applirta#ioat for Uiipog al Morse Tong rur#ioat runfit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage. Disposal System at: •---.....--•---...................................•----.....------..........-----------------•--- .....------------------...--------....------------•-----...--•---------------•-••----------------- _Location-Address _ or Lot No. .. Owner Address W Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms..................................... .Expansion Attic ( ) Garbage Grinder ( ) ............. No. of persons............... Showers — Cafeteria p., Other—Type of Building .............. p ( ) ( ) 0.1 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--___._--_----_____.---- Ga.l Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---_-_.-._-.._____-._--. P4 ------------•---------------------------------------------------------------------------------------...................................... •--•--------------- 0 Description of Soil........................................................................................................................................................................ U --------------------------•---------------------------------------------------------------------•--------------------------...----•---------•-•---------•--•----------•-------------------......-------- W -------------------•-----------•--------------------------•---------•-•-----•-..._..----------------------•----------•---------•--------•--•--•-----------••--------------•-----------••---------------- VNature of Repairs or Alterations—Answer when applicable.`__-__t.__-__.:`___-_: --- % r ................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of:T T L.' y g g p y 5 of the State Sanitary Code— The undersigned further reel not to Lace the system in operation until a Certificate of Compliance has been issued by the board of health. Signed..... ................. � / - r . •-------------------------••-------------------------• ................................ Application Approved By................ `"..� U-,,."'� --•-----.�`- �a} -y�S ------ --------------------------------- Date Application Disapproved for the following reasons-.............................................................................................................. --------------------•------------...-----....---....-----•---•---------------------------•...-----------------•--...---.._..----- =-------•----------------•-----------•-----•---------•------------ G� Date PermitNo.------Q_-C2.-�7=�^-v---------•--•----------_ Issued....................................................... l�atL THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trdif irttte of ToattpliFaata THIS IS TO CERTIFYThat the Individual Sewage Disposal System constructed ( ) or Repaired b 1' e--.-r ..... ;�r.E?�1`.............. Installer ° e.. at 7 -.��'�........ ..-• ------------ �R...-r�---------- ........................................................... has been installed in accordance with the provisions of TIT AE 5 7o f he State Sanitary Code as described in the ............ dated________________________________________________ application for Disposal Works Construction Permit No...._..�5 THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................... ..................... Inspector---------........ ------------------------------•------.----_----- t THE COMMONWEALTH OF MASSACHUSETTS h BOARD OF HEALTH No.._b.Q.. . ..� ........:....................OF................................_.............._..................................... �! ./_> FEE........................ Diopos a1Q orb iota #rt ion rruti Permission is hereby granted.............. �r.._...� `C to Construct ( ) or Repair ( ) an Individual rage Dispo al System at No................ _l_G 7..._ Street as shown on the application for Disposal Works Construction Permit No......^ ... Dated.......................................... Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS Commonwealth of Massachusetts yam` Executive Office of Environmental Affairs Department of *oP, � �st' Environmental Protection 9 9 Wllllam F.Weld Governor �9 Trudy t:oxe Secretary,EOEA David B. Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 1167 Phinny' s Lane CERTIFICATION D&D Realty Trust v - t-- v� �'1 Property Address: `"'--`Y"��-T'`� � (,L 1 5 Address of Owner: D. Camp Trustee Date of Inspection: 1 1 —2 9—9 5 Y (If different) Name of Inspector: W.E. Robinson Sr. Company Name, Address and Telephone Number: W.E. Robinson Septic Service P.O. Box 1089 Centerville MA CERTIFICATION STATEMENT ��77 55 ••777 I certify that I have personally inspected the sewage dispbs3l s�sterh�t this address and that the information reported below is true,acarate and complete as of the time of inspection. The inspection was performed based on my,training and experience in the proper function and maintenance of on-site sewwaa a disposal systems. The system: L/Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: 1�t44L Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 regnonal office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to.the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, , or D: AJ SYSTE ASSES: 1 have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. BJ SYSTEM CO DITIONALLY PASSES: One or more sys components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not deter ined (Y, N, or NO). Describe basis of determination in all instances. If"not determined", explain why not) _ The septic nk is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as ' approved y Board of Health. ,. (revised 8/15/95) 1 One Winter Street • Boston,Massachusetts 02106 • FAX(617)556-1049 • Telephone(61/)M-5500 Printed on Recycled Paper 9 v j SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1167 Phinny' s Lane Centerville Owner: D&D Realty Trust/D.Camp Trustee Date of Inspection: 1 1 —2 9—9 5 B]SYSTEM CONDITI01tlALLY PASSES (continued) _ Sewage ba up or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or du to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Healt broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced _ The system require pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with a proval of the Board of Health): broken pipe(s) are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environm nt. 1) SYSTEM WILL PASS UNLESS BOARD F HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLI HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 0 feet of a surface water Cesspool or privy is with' 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOAR OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MA NER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The cvstem has a septic tank and soil absorption system and is within 100 feet to a surface watei supply or tributary to a surface water supply. _ The wstem has a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank and soi absorption system and is within 50 feet of a private water supply well. _ The systen, has a septic tank and s absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water alysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility a d the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm• D] SYSTEM FAILS: I have determined that the system violates one o more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The oard of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system c mponent due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the s rface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1167 Phinny' s Lane Centerville Owner: D&D Realty 'Trust/D.Camp Trustee Date of Inspection: 1 1 —2 9-9 5 D) SYSTEM FA (continued): tic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liqu depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Requir d pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Num of times pumped Any po ion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any p ion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. A portion of a cesspool or privy is within a Zone I of.a public well. An portion of a cesspool or privy is within 50 feet of a private water supply well. _ portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no accep le water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform cteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteri pply to large systems in addition to the criteria above: The design flow of syste is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment bec ise one or more of the following conditions exist: the system is wit iin 400 feet of a surface drinking water supply the system is J6. O. et of a tributary to a surface drinking water supply the system is itrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water The owner or operator of any sull bring,the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 ase consult the local regional office of the Department for further information. r (revised 8/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1167 Phinny' s Lane Centerville Owner: D&.D Realty Trust./D.Camp Trustee Date of Inspection: 1 1 -2 9-9 5 Check if the following have been done: _Alo�umping information was requested of the owner, occupant, and Board of Health. _'None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _As built plans have been obtained and examined. Note if they are not available with N/A. LThe facility or dwelling was inspected for signs of sewage back-up. -/The system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. All.system components, excluding the Soil Absorption System, have been located on the site. 1/fhe septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. �he size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: .1 1 67 Phinny' s Lane Centerville Owner: D&D Realty Trust/D.Camp Trustee '.. Date of Inspection: 1 1 —2 9—9 5 FLOW CONDITIONS RESIDENTIAL: Design flow: 126 U stallons Number of bedrooms: Number of current residents:/0�'� Garbage grinder(yes or no): Laundry connected to system (yes or no): Y Seasonal use (yes or no):�l/ Water meter readings, if available: Last date of occupancy:! COMME CIAUINDUSTRIAL: Type of es blishment: Design flow: allons/day Grease trap pr sent: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary was discharged to the Title'5 system: (yes or no)_ Water meter readi s, if available: Last date of occupa cy: OTHER: (Describe) Last date of occup ncy: m GENERAL INFORMATION PUMPING RECORDS and source of information: G/e•b A,- L.C/ j 3 Oi 4,/ 6 u�Sit e� � : G' System pumped as part of inspection: (yes or no)�3/ If yes, volume pumped. eallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool ' Overflow cesspool v Privy Shared system (yes'or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) (revised 8/15/95) $ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1167 Phinny' s Lane Centerville Owner: D&D Realty Trust/D.Camp Trustee Date of Inspection: 1 1 —2 9—9 5 SEPTIC TANK:_ (locate on.site plan) , t Depth below grader Material of construction: t/concrete _metal _FRP—other(explain) Dimensions: 67'7 -1 Sludge depth: , Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 3 ` Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of in et and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) 0 L GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _con rete _metal _FRP_other(explain) Dimensions: Scum thickness Distance from top of scum to to of outlet tee or baffle: DIStdnCP from bottom nt rum t� h nm.Ot Otl!IPt tee Or baffle: Comments: (recommendation for pumping, conditio of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc., (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1167 Phinny' s Lane Centerville Owner: D&D Realty Trust/D.Camp Trustee Date of Inspection: 1 1 —2 9—9 5 TIGHT HOLDING TANK:_ (locate on 'e plan) Depth below g de: Material of const ction: _concrete metal _FRP—other(explain) Dimensions: Capacity: al Ions Design flow: allons/day Alarm level: Comments: (condition of inlet tee,. ondition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: D Comments: (note if level and distribution is equal, evidence of solids carr?,o•:er, evidence of leakage into or out of box, etc.) PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, con ition of pumps and appurtenances, etc.) (revised 8/15/95) 7 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1167 Phinny' s Lane Centerville Owner: D&D Realty Trust/D.Camp Trustee Date of Inspection: 1 1 2 9—9 5 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: / leaching pits, number: 3 leaching chambers, number:_ leaching galleries, number:_ leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) CESSPOOLS: _ (locate on site plan) Number and configuratio Depth-top.of liquid to inle invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: indication of groundwater. inflow (cesspool m t be pumped as part of inspection) Comments: (note condition of s ' 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 hyd lic failure, level of ponding, condition of vegetation, etc.) (revised 8/15/95) B r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1167 Phinny' s Lane Centerville Y Trust D D&D Realty .Cam Owner: � P Trustee Date of Inspection: 1 1 —2 9—9 5 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' ' V "C J d v �o s V ✓.,r r � I DEPTH TO GROUNDWATER Depth to groundwater: J. feet method of determination or approximation: 10 is (revised 8/15/95) 9 TOWN OF BARNSTABLE �� _F � LCc:A'IIflN SEWAGE VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. ' I SEPTIC TANK CAPACITY LEACHING FACILITY:(type} (sue) NO. OF BEDROOMS ' PRIVATE WELL O fUDBLIWATER - BUILDER OR OWNER I DATE PERMIT ISSUED:DATE COLIPLIANCE ISSUED: ZL— /O// `go VARIANCE GRANTED: Yes No I . . �1 (,� � (h ... b.• _T � •� 3 t ± ►� � I' . � .. h e �.r _ yy ._ � :1T v � j„ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Application is hereby made for u Pero/it to Construct ( ) or Repair ( ) an Individual. Sewage Disposal S�stem at: ?Z. .. � �= �mm� � � - _, 4_7_1 - -4 - Z __ �& .... .......... Ins ler Address � Type, Size Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( ) Other—Type of Building ............................ No. ufycronoo---------_--- Showers ( ) -- Cafeteria ( ) Otherfixtures ..------------.._-----------------------_..---.-------'------------------'-- Deuign Flow............................................gallons per person per day. Total daily flow............................................ Septic Tank—Liquidcapacity -_'em}bna Length................ Width................ Diaoetcc._----.. Depth................ Disposal Trench--No .................... Total Total {t. Seepage Pit Nu---_--.-- Diameter.................... Depth below inlct_------'-- Toto area..................sq. f t. Z Other Distribution box ( ) Dosing-tank ( ) ~~ Percolation Test Results Performed 6y.......................................................................... Date........................................ Test Pit No. L-.—_---mioutraperinc6 Depth of Test I`6--------'- Depth to ground water......................... �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description mf Soil........... ---'-----------------------------------'---'----_- __-_-_--.—__'----.__'--___--__'___.---'----_-_-_-----'--------'-'_-------------'--'__---'----_ -_--_---_—_'_- ._ - '_--_-_-__—.—_--__ -- �� DJu�or� c� ����a or Alterations _' .���'—������k..� __'.� _____ Agreement: ' The undersigned agrees to install the afore6esoibe6 Individual Sewage Disposal System in accordance with the provisions of TITLE j of the State Environmental Code—The undersigned further agrees not to place the systemin� operation oz�l a Certificate o6Coozoli has been issued � Signed -- ---------------- . -~----------- -------��------ | Application Approved 8' ---' ------------~p� //­,/­­V__?�' | D�w Application Disapproved for the following� reasons: ------' .............................................----------------_-_---- ------------------ ----------------- tu. Ai_5-/0 No.-- FE$... ,.......-�............... "_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ,I VVp trattun for 11tipustti Works Tongtrur#tun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: - ...... ........�._... .:c!�!���a:. .:.......................... l ,a��r��f'� -- �/L//r i%�l t� ........ --- --- L'Lo,fi6h-Address `or Lot No ...... .. /.I..n/C................................... ...........•...................................................................................... t �_ Ow er Address .............. � ';/'C���C/,9 .'�_7.5_ ✓�, dra /-GC` .............•---.._.......x��--•-- �� Inst�ler Address U Type�O�X' uilding �w Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------------------------•------------•--•--••••----------•-----•-•---•---•-••......-•---•-•••--•-••••••••. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 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 ( ) a Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ D Description of Soil......... = '1�{;�t ..._.•_..._._.... -------------------------------•-----------------•••••.....---- k,, \ .-_•_________________________________•_•.•_.._._._.__._.___.____......._.-_.-•_.•••._.-___.--...._.._..___--•.___•__.___..._.____.-_..___.....__......___...--...•._.•-__._.•..•.......___.__._._•...._.. = ".......:.:........ U Nature-of Repairs or Alterations-Answer when applicable----'-. y � -•------•-------------------•------••-----------......------------------......-----•---------..........--•••-----•••••-......--•••-•--•------••••••---------•----------------•--------..............._. Agreement: 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 undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. . Signed . _ X ------ Date Application Approved BY .............S-'1.V11 ,... •.,- - " '�-- ---............. .......... J \� 1 ° , Date �1 Application Disapproved for the following reasons- ------------------------------------------------------------------------------------------------------------------------------------- ---------------------.............----------------------------------------------------------------------------------------------------........... ............................................. --------------------------------------- Permit No. °ems......9/1_ (d Issued -.__... Date ...._V.........---�y Date 1 V THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cferttft ate of C�urayli xrtre THIS IS TO,CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (,,) Installer j f�.-,..------.--�/��J 'Jam,,—�•--��_ ty��f ` /� (//'��/^J at _....__.._.._`. -`..IQ Ct................1 ^r9?'-.YAM. aL�:_.._.._�...( / n ^ -I K-e................................................................................................................. 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. .......... /1----..:_��� .. dated ..-; -p�------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ( DATE. = --Uf- .......................................................... Inspector .....: ...r. ........................ E COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TKO-W.N OF BA:�RSTABLE FEE. Disposal arks Tunstrudian anti[ Permission is hereby granted....------. ...............��.:: . to Construct ( ) or Repair (1k)" an Iiil ividual Sewage Disposal System atNo..---.......�A../.:.'"a....---- ._ i..,.�, ,.,.. -` a , A.r .---••------------------•---.............--------•---................. U Street / as shown on the application for Disposal Works Construction\P rmit No.:.............O. Dated.......................................... DATE. � -- � Board of Health .............Y., ../..................................... FORM 36508 HOBBS 6 WARREN,INC.,PUBLISHERS 1 BENCHMARK 20 FT. MINIMUM FROM CELLAR SOIL TEST P � 8 6 4 TOP OF FOUNDATION DATE OF SOIL TEST 10 FT. MINIMUM FROM SLAB OR CRAWL SPACE �+ y,� rZ � a,,. R ,rr, ELEV. _ /l�w0 10 FT. MINIMUM SOIL TEST DONE BY (ASSUMED) WITNESSED BY l0 aPJ NA /a«o A15PI — 2e HOCI . CLEAN SAND 4•PVC VENT PIPE MANHOLE 4" SCHEDULE 40 PVC PIPE 24 HDq OBSERVATION HOLE I ELEV.- 9 7. 9 MANHOLE 4" SCHEDULE 40 PVC PIPE 2e HDCI LOAN AND SEED PAINTED FLAT DARK Comm MIN. PITCH 1/8" PER FT. coy MANHOLE GREEN OR BROOM PERCOLATION RATE 1 2 UWANCH ATSd-C 8 INCHES MIN. PITCH 1 8 PER FT. / 2 LAYER O F I COVERS �"• O�"TWE IS REQAA FILTER DEPTH HORIZ TEXTURE COLOR I,IOZ-I pI•IE;g ,1S = - UIRED w sTaaaE S, � A / ram.. 4" CAST.IRON PIPE 9S 4 2 ELEV a7� A Y (OR EQUAL) MINIMUM _ MAx PITCH 1/4" PER FT. an d y / oY e 60 FLOW LINE 3'MAX _L_. pa ELEV. = 9 '�. 2�'f 10" \- i [j FLOW LINE ELEV.113.2' o. a CI 'TMIN. = 93.�S 10" 118 ADD ELEV. -TMIN. _ 211 0 0 0 0 0 0 0 0 0 _ �jQOG T ELEV. — L VEL o 0 0 0 0 0 0 0 0 0 0 o T o 7/4 ELEV. BAFFLE ELEV. = 93.G 7 GAS ELEV. = 9 3.3 3 6" SUMP ELEV. 3./G o 0 0 0 0 0 0 C M a �,U.N r' `Q HBAFFLE DISTRIBUTIONy _ o o a o 0 0 0 ELEV.- g0-.5 0 2 S-^ BOX (DD/3J 9'. 12 fH?O 500 GAL DRYWELiS(OR EQUAL) I G S Gr r d✓ 3000 GALLON (T) BE PLACED ON FIRM BASE) TO BE WATER TESTED WrMMXNEINA 17000 GALLON IF MORE THAN ONE OUTLET 13 T, 1oG�x 2'DEEP TRENCHFORMATION I„ No WATER ENCOUNTERED AT /`f ELEV.- 93.E SEPTIC TANK LDEPTH TEEIQUID OUTLET ,, ,, (TO BE PLACED ON FIRM BASE) SOIL ABSORPTION h ti�,4 DESIGN CALCULATIONS s is?".E-M � o.1 4 FEET 14 INCHES SEPTIC TANK c " ZONE 5 FEET 2 INCHES TWI WAASSHED STOh1E SYSTEM (SAS) � INDEX NUMBER OF BEDROOMS /o 6 FEET 24 INCHES ADJUST GARBAGE DISPOSAL UNIT NO 7 FEET 29 INCHES 3 FEET 34 INCHES TOTAL.ESTR ATED FLOW #1 SEWAGE DISPOSAL SYSTEM 'PROFILE USGS PROBABLE WATER TABLE ELEV.- (I l0 GAL./BR/DAY X /o BR) //00 GAL./DAY OBSERVED WATER TABLE( / / )El".- REQUIRED SEPTIC TANK CAPACITY 2 -2J-00 GAL.NOT TO SCALE BOTTOM OF TEST HOLE ELEV.- r's.8o ACTUAL SIZE OF SEP'TLC TAME c -3000 G OobGAL. - � 7-4 �` ^� �.�12 s SOIL CLASSIRCATION I o g5;1 5 � DESIGN PERCOLATION RATE < 5 MLNAN.\ � �C.rlo�/ :�.�. ��zJ 4< < o �s o.v�.y �� ter- � ���T� EFFLUENT LOADING RATE 0.74 GAL/DAY/S.F. -� LEAC NG AREA 13 x/o 4 t z x 2 3 6 /6S- SQ.FT. \ � � �9trro �►_J � /.2v VATc �F� �L�CE F'�7� „'-A.S: �-;r o \ � A LEACHING CAPAC71'Y AREA X RATE) 13 72 GAL./DAY 0 -1 \ �"Q �E-.ST �iesax .7-4)) � \ RESERVE LEACHING CAPACITY ^'/A GAL./DAY NOTES: 0 Y`a,l \ 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. g� TITLE 5 AND THE TOWN RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 6" \ O OF FINISHED GRADE.�- - 6 \ 6� \ e 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF \ \� WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 6 R ,O et �F-�' --, C Sys T--E 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED Q UNDER EA OR WITHIN 10 FT.OF DRIVES OR PARKING AREAS. f �O\ ' 4. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL BE MOkTARED fi4 PLACE.': �r �'� ` 9 � \ ,I 5. NO DETERMINATION HAS; BEEN MADE AS TO ,COMPLIANCE WITH 0 vow \ g6. \ DEEDED OR ZONING REGLk ATIONSrOWNER/APPLICANT IS TO OBTAIN ' o Z SUCH DETERMINATION FROM APPROPRIATE AUTHORITY.. LEGEND: 6. UTILITIES SHOWN ARE APPROXIMATE . ONLY, . EXCAVATION CAS L 11L40r To EXISTING SPOT ELEVATION 00,0 CONTRACTOR IS TO CALL "DIG-SAFE" AT_1-888-344-7233 AT LEAST 72 �� ;. �O{ Z EXISTING CONTOUR 00---- HOURS T COMMENCING WORK ON SITE. J� 9'1 'j, k5 �.E LO G A T�?; FINAL SPOT ELEVATION 00.0 \ y 1 ;g 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS O FINAL CONTOUR 0 SITE CONDITIONS PRIOR TO COMMENCING WORK OW SITE.SITE. ANY � \ SOIL TEST LOCATIONUTILITY POLE _ bit�m� 96' O' Dg-L/6 - VARIATION IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN 2 \lOor/I noUs ro \ \ wA v TOWN WATER �W W� ENGINEER IMMEDIATELY. kln of g sro r- - - \ CATCH BASIN �N J 8. PARCEL JS IN FLOP. ZONE C 9 _ 6 �" 9 2 -� IVI a / �` 9 a�V 641 ao�\O� a�� �\ I ,Q I g6�� CLEAN NUT CA 10. EXISTING SANITARY DISPOSAL SYSTEM TO BE PUMPED AND REMOVED CESSPOOL C.P. Q OR FILLED IN WITH SAND. 6 1.ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER,AND 41 I \ OP ,\ _ 16 -A �� �.N,� FOR A MMIMUN OF 5 FEET FROM AROUND THE SOIL ABSORPTION sr/ fi I \ 4�\ 3��`: ,� �� ss SYSTEM, AND BE REPLACED WITH SAND AS SPECIFIED W 310 CMR O o I v wr \ I "'o�� ROBIN o 15.255:(3)(LE.TITLES)IF ENCOUNTERED BELOW S.A.S.PIPE INVERT. 2 Svc .�-s.A,s a � LLIAM L A/V O 1= S E}� /C S%S 7'�' 05 i4 IL N P T- M 1 I 1 ri�27•3� _ 3 _ aP APPROVED: BOARD OF HEALTH ° SO � I 1 �..� ASS/DP��'__E-.z., •+.�.` SURVE Ca 5 \ O I IC9 f DATE AGENT Lo � PROPOSED SEPTIC DESIGN' � 1 W m N 0 1 O 1 \ n FOR SEPTi c S Ys7--E Z ,a \� V A L v ,/-t O H N S 6 7- z o�2� 00� 9g0 O Z Ott\l\ /y ✓cv� , `-� '�'' �3 � sr O Q / II 1 � z PROJECT I G 7 'l7`�I/N E �" `S 1 A!v E / $ OP�.,..n G . < C -JvirC__"- 1-1//L I 9g. s�c.K,.ti 1 r ZT / �Ba+ 04 P�S OSDiE'e to, PROFESSIONAL ENdf iR / I H•`� S 508- P. O. BOX 1044 235 GREAT WESTERN ROAD Bro t0��� 1 O 1 ,rO� I�it a/AY D ���q 398-8311 SOUTH DENNIS,MASS. 02660 DATE /I O PC� \ - 4/O \\ \ REVISED JOB NO. oaC4 \ 1 LOCATION MAP REVISED [ SHEET /OF Z 0 1999 CRAIG R. SHORT, P.E., I BENCHMARK SOIL TEST P 9ar. TOP OF FOUNDATION 20 FT. MINIMUM FROM CELLAR _�_ /a/z4/a a /�• 10 FT. MINIMUM 10 FT. MINIMUM_FROM SLAB OR CRAWL SPACE DATE OF SOIL TEST SOIL TEST DONE BY �' r�4 q • -S of t`P� ELEV. q_ WITNESSED BY Da hoe��/ (ASSUMED) MANHOLE CI-6►N SAND 4•PVC VENT PIPE OpyQI$ 24 HDCI PAD FLAT DARK OBSERVATION HOLE 2 ELEv.- 9e. 4 SCHEDULE 40 PVC PIPE MANHOLE 4" SCHEDULE 40 PVC PIPE -LOAN AND SEED PERCOLATION RATE < 2 / MIN. PITCH 1/8" PER FT. f�vERS GREEN OR BROWN qVZ) CL,6-fty cv-r- �L 99, -1 a MIN. PITCH 1/8" PER FT. IdINJINCHATGo_7Z INCHES 24• HDC� Z'LAYER OF V 11'H CARBON FILTER DEPTH RIZ TE7CTURE COLOR MOTT. OTHER • (G, Q. MJWH 1/i'TO L1201 TWICE 1S'REQUIRED COVERS WASHY ST�tE . d I I c a /C Y/e A/o 4" CAST IRON PIPE 1 may. 3 A _sue 41a (OR EQUAL) MINIMUM rc 9dZ t I ELEV. 9y.3MAX -m a 7 PITCH 1/4" PER FT. 6. 3o a 4 o a-'tt 7j FLOW LINE H2O sx�Ei r Y i�'O �-' C o a rs e y ,i ���rr�r ELEV. 9 -f 2S r 10" FLOW UNE ELEV.-9?A' H2O 0- 1 Sa�+d 7$ 7/4 —i MIN. 10" o i ADD ELEV. = 9-3,7S —TMIN. ELEV. 93•'(c 22.0" `� o o c3 0 0 0 0 0 0 o p o r a v e ELEV. = 54• O GAS " .LEVEL o 0 0 0 0 0 0 Cl c �( c r4, BAFFLE ELEV. 73, L 7 GAS ELEV. 9 2. / 7 6 SU P• V. -: 9Z.0 0 o o co a o a Co 0*24 C Z rH eJ wr. H 2 O BAFFLE c r5 0 0 o c� o to _e�Ev e9.o± H2O DISTRIBUTION ; - ` EiEV. (TO BE PLACED ON FIRM BASE) BOX (DB/7;',9'/•3� /�-H20 5000ALDAYWELi.S(ORF,Q(IAI,) /G8 G►r'u r�r 30007 GALLON TO BE WATER TESTED WrM STD IN A ^ �7 3U�4 GALLON IF MORE THAN ONE OUTLET x 4+ �7,5 x 2'Dt1sD TRF1dCHFOIWATION No WATER ENCOUNTERED AT / ELEV.- SEPTIC TANK LIQUID OUTLET n• (TO BE PLACED ON FIRM E41SE) A-1 - N DEPTH ME4 FEET 14 INCHES SEPTIC TANK z 3/4•Tr�t �• SOIL ABSORPTION sl•Iovw,_> ZONE DESIGN CALCULATIONS 5 sT--�/�? � 6 FLEET 24 INCHES Twic W SYSTEM (SAS) ADJUST GARBAGE DISPOSAL INDMC NUMBER OF UNTP NO 7 FEET 29 INCHES a FEET 34 INCHES _ / TOTAL ES1IMATED FLOW gJ• \1�` USGS PROBABLE WATER TABLE ELEV.- W14 (110 GAL./BR/DAY X /3 BR.)_ /430GAL./DAY S PROFILE Z SEWAGE DISPOSAL SYSTEM OBSERVEDw A _E W `f� WATER TABLE( / / >ELEV. �' NOT TO SCALE 7iF1, g BOrr() I OF TEST HOLE ELEV.- REQUIRED SEPTIC TANK CAPACITY Z Z 8 G o � vl\f ACTUAL SIZE OIL SEPTIC TANK 2 -3000 4 oa0G,• �wS0,/ SOIL CLASSIFICATION�BOX 534 DESIGN PERCOLATION RATE < SI IN AN.T T � I S .� ' F/ /4 z/4.v CES 2p �rzGMon L ,D , EFFLUENT LOADING RATE 0.74 GALJDAY/S.F. \ 6 h0 e(538)�j ssa�hUSE s S EF C T'i o �5': 2 z l �9 L v s c�N L y 3 'c F c o v�rt LEACH NG AREA 9 x 74 ' I- /70 X a /93 7-SSQ.FT. n 5 p �g (508)J 334 4 ��Q�, O V o—_M_ S E P 77 C .S � -S 7-e--e J \ p \ 9�6 LEACHING CAPACITY AREA X RATE) 1438 GAL./DAY 937-TA.7-4) A /• / S C/oT/ C TA /VKS ACITY �' A A o�� � � � \ `\ g 'I �e�Q v�'•S'r,E� RESERVE LEACIITTIGCAP / GAL./DAY NOTES: 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. g1 \ \ TITLE._S AND THE TOWN RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 6" �_ 6 �g6\ OF FINISHED GRADE. -�.-__ \ 3. .ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF, WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED \ $1 g \ �g II' ` UNDER OR WITHIN 10 FT.OF DRIVES OR PARKING AREAS. >o. ` \ \5 O es SPT/C 4 ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL BE SH Q SERE €,e7 �� MORTARED IN PLACE. gj . E WITH 5 .NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE\ _02 ,m, o vEy O Z g6 \ DEEDED ORZONMG REOULATI(ltib liltii�lEic//+i'ri.ii,.ur w .•• o \ SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 4 o sF f \\ LEGEND: 6. UTILITIES SHOWN ARE APPROXIMATE ONLY EXCAVATION p � O O-�s � \ \ \ GASL !ti/,ar T`h QE EXISTING SPOT ELEVATION 00,�0 CONTRACTOR IS TO CALL "DIG- AFE" AT I.888-344.7233 AT LEAST 72 EXISTING CONTOUR ----00---- HOURS PRIOR TO COMMENCING WORK ON SITE. 7J`►� f 9� �, y6 f��L.C�Gfi 7",I!_=0 FINAL SPOT ELEVATION Fob---61 T . CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS FINAL CONTOUR SITE CONDITIONS PRIOR TO COMMENCING WORK ON .SITE. ANY ° bits' O g6a Q \ SOIL TEST LOCATION VARIATION IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN J7)ln0 \ \ �x�/E UTILITY POLE -0- ENGINEER IMMEDIATELY. ' ,\ Por Us 6 b v �! TOWN WATER -mW w g -ro r Y CATCH BASIN /®\ ..8. PARCEL IS IN,):�.00D ZONE C O 6!� C.GAS LINE ��'"/ 9. LOT IS SHOWN ON ASSESSORS MAP 274AS PARCEL. g \ CLEAN OUT 10. EXISTING SANITARY DISPOSAL SYSTEM TO BE PUMPED AND REMOVED O co 8� g®9 i y g CESSPOOL C.P. Q OR FILLED IN WITH SAND. 5' 11.ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER,AND O� g '6 =� t ,� ^ ' FOR A MINIMUN OF 5 FEET FROM AROUND THE SOIL ABSORPTION .(� �� fafp a l4 t�of rr,�s / I \ �, SYSTEM,.AND BE REPLACED WITH SAND AS SPECIFIED IN 310 CMR O I v� T 0 c� ROE7IPI cy I5.255:(3)(IE.TITLES)IF ENCOUNTERED BELOW S.A.S.PIPE[NVERT. e h /11 a V •� i�d CR3 iCF : f�LlAM .� S4�OR i s art, � , � F S / S ST�"� 9 L o .EPT c y I 4 En m ��1 APPROVE Z7483 ., D• BOARD OF HEALTH 1L s O n -� o r z a�,�-''� vE S R O G S t 'R U ! It rya 8y \ 0 , 4✓.mac. IC'9 f ,I�� ov ) �,3 9 DATE AGENT 34 gg• g 0 O 1 3 11 C E ann's sachusetts O2do 9g® �,� I 5 1 I �, POSED SEPTIC DESIGN Fax( ) 775-3344 s�s� S / I in 1 W PRO 1 FOR ' Phone 08) 790-6265 ��, � - � ®�• �\�pV�`\ e�� I . 111 N �- 0 0 1 VAN -.TOHNSOJul /1 0 p s,-2 / I I' 11'. w PROJECT 1 G 7 7�1f JN/v -.7 1 /v �•- ! s ti.,« - - f HL-n.w y � PRROFESsNA EO. 6N P.E. N•c4' P. 0.BOX 1044 235 GREAT WESTERN ROAD rr c D . 'y sos- $ O I op-g6� z. '�U 4�wA y t tti� 398-8311 SOUTH DENNLS,MASS. 02660 \ \\ \ DATE I I / /O O SCALE 1 n o 2O i \ 0 \ \ \ \\Noo REVISED JOB NO. ' �8 REVLSF.D �! LOCATION MAP,,. SHEET 2OF Z -- - ! 01999 CRAIG R. SHORT. P.E.