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Home My WebLink About0015 POINT LANE - Health 15 POINT LANE,HYANNIS A=288 173.002 C i i 4 I 11 r j I 7/)112- OF BARNSTABLE LOCATION% D�19sz SEWAGE# VILLAGE ASSESSOR'S MAP&LOT/'73:UD Q NAME&PHONE NO. /1 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) i �/J (size) NO.OF BEDROOMS 1,2 BUILDER R OWNER 0 PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility j� 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 Facili If any wetlands exist within 300 feet of 1 a hin facil' Feet Furnished O 1 Y ti r �tr Town of Barnstable Barnstable Board of Health BARNS[ABLE, M+S& g 200 Main Street, Hyannis MA 02601 2007 s6;q. Office: 508-8624644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi July 15, 2015 Ms. Rosemary Butler 15 Point Lane Hyannis, MA 02601 RE: Extension of Time to Connect to Public Sewer 15 Point Lane Hyannis, MA A= 173-002 Dear Ms. Butler, At the July 15,.2015 meeting of the Board of Health, you were granted an extension to connect your home located at 15 Point Lane, Hyannis to public sewer. This home must be connected to public sewer when/if the property transfers to another owner. This extension is granted because you stated you cannot afford to finance this project at this time. Sincerely yours, f f . yne iller, M.D. Cha. an Board of Health Town of Barnstable I Q:\WPFILES\SewerEXtensionBUtlerl5 Point lane Hyannis.doc. 1 1 + July7, 2015 Information for Board of Health Hearing Rosemary Butler 15 Point Lane, Hyannis, MA 02601 Widow Working part time ` Receiving Social Security Living alone at 15 Point Lane Map and parcel: 173-002 I realize that the hook-up to the system is of benefit to me but I do not understand the financing and the paper work which is required. I cannot afford to finance a project like this at this time. I have been told I may not sell my house until this hook-up takes place. Although I have no intention of moving at the present time and I do know.this is necessary, I need direction on how to go about this. Thank you for your patience. Rosemary Butler -30 . May 18, 2015 Thomas A. McKean, R. S. .,C. H. 0. Agent for the Board of Health 200 Main Street, Hyannis, MA 02601 Dear Sir, I am requesting a show cause hearing before the Board of Health. I live at 15 Point Lane Hyannis MA--- map and parcel: 173-002. 1 am a senior citizen and I am on Social Security. I would like to explain my situation to the Board of Health in order to show cause. Please notify me of my appointment for this hearing. Thank you. i t 116semary Butler IF -:, -%-, tMME ti Town of Barnstable Barnstable BARNSTAHM Board of Health MAss. I ' 'b39' e`0� 200 Main Street, Hyannis MA 02601 f0 MA'1 y 2007 OFFICE: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi Rosemary Butler, 15 Point Lane, Hyannis, MA 02601 ACKNOWLEDGEMENT: June 16, 2015 Re: 15 Point Lane, �Jl annis ghis is to acknowledge receipt of your request for reconsideration of your deadline to connect to town sewer. riankyou. Your item will be on Board of Health Meeting on the: CHANGE OF DATE, b t Tuesday,July 7; 2015 (Not July 14th) You, or a representative for you, is expected to be present to answer questions the Board may have. Meeting Location: Town Hall, 367 Main St, Hyannis Hearing Room, Second Floor CHANGEeOF TIME „ ._ �4.bdH 6 30 P.M Approximately three days prior to meeting, an agenda will be sent out to you— once it is available. It will also be available on line at the town website: www.town.barnstable.ma.us Go to ..."Boards & Committees > Board'of Health - or Go to Official Agendas Any questions, please call Sharon Crocker at 508-862-4739. Thank you. QA.AGENDAS BOHUet Receipt of BOH Submission 15 Point Lane,Hyannis-2 July 14 2015.doc r Ttia° May 18, 2015 Thomas A. McKean, R. S. .,C. H. 0. Agent for the Board of Health 200 Main Street, Hyannis, MA 02601 Dear Sir, am requesting a show cause hearing before the Board of Health. I live at 15 Point Lane Hyannis MA--- map and parcel: 173-002. 1 am a senior citizen and I am on Social Security. S3—l73 II would like to explain my situation to the Board of Health in order to show cause. Please notify me of my appointment for this hearing. Thank you. i �osemary Butler J e'P�`oSc (sir C �J i F I Town of Barnstable Barnstable O,r Board of Health j a D 200 Main Street, Hyannis MA 02601 2007 OFFICE: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi Rosemary Butler, 15 Point Lane, Hyannis, MA 02601 ACKNOWLEDGEMENT: June 16, 2015 Re: 15 Point.Lane, Huannis 9iis is to acknowledge receipt of your request for reconsideration of your deadline to connect to town sewer. giankyou. Your item will be on Board of Health Meeting on the: CHANGE OF DATE:: Tuesday,_July 7, 201 , (Not July 14") You, or a representative for you, is expected to be present to answer questions the Board may have. Meeting Location: Town Hall, 367 Main St, Hyannis Hearing Room, Second Floor CHANGE OF TIME: 4:00—6:30 P.M. Approximately three days prior to meeting, an agenda will be sent out to you— once it is available. It will also be available on line at the town website: www.town.barnstable.ma.us Go to ...`Boards & Committees > Board of Health - or - Go to Official Agendas Any questions, please call Sharon Crocker at 508-862-4739. Thank you. QAAGENDAS BOMet Receipt of BOH Submission 15 Point Lane,Hyannis-2 July 14 2015.doc P -O IIKE °wti Town of Barnstable Barnstable nAnNSTABLE, Board of Health "�'er'caM t` `9 MASS. t I�Q - 4'prfa µ.t 9. %, 200 Main Street,Hyannis MA 02601 V 2007 OFFICE: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 . Paul Canniff,D.M.D. Junichi Sawayanagi Rosemary Butler, 15 Point Lane, Hyannis ACKNOWLEDGEMENT: June 16, 2015 lie: 15 Point .cane, �fyannis This is to acknowledge receipt of your request for reconsideration of your dead fine to connect to town sewer. Thankyou. Your item will be on Board of Health Meeting on the: Date of: Tuesday, Jul , 015 You, or a representative for you, is expected to be present to answer questions the Board may have. Meeting Location: Town Hall, 367 Main St, Hyannis V7eaig Room, Second Floor Time: If 00—6:00 P.M. Approximately three days prior to meeting, an agenda will be sent out to you— once it is available. It will also be available on line at the town website: www.town.bamstable.ma.us Go to ..."Boards & Committees > Board of Health or- Go to Official Agendas Any questions, please call Sharon Crocker at 508-862-4739. Thank you. k I QA\AGENDAS BOH\let Receipt of BOH Submission 15 Point Lane,Hyannis-2 July 14 2015.doc Barnstable Town of Barnstable P # Board of Health j e1G8C j ISA nM SA O D 9 MASS. g. 163 o µ 9..t>`0 200 Main Street, Hyannis MA 02601 200'7 OFFICE: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi Rosemary Butler, 49 nue, er ce ey Heights,NJ 07922 ACKNOWLEDGEMENT: June 1, 2015 lie: 15 point cane, Jf ay nnis This is to acknowledge receipt of your request to review with the Board the above-mentioned property available to be connected to=townaewer,1 Thankyou. Your item will be on_,Board of Health Meeting on the: Date of: Tuesday, July 14, 2015 You, or a representative for you, is expected to be present to answer questions the Board may have. Meeting Location: Town Hall, 367 Main St, Hyannis Hearing Room, Second Floor Time: 3:00—6:00 P.M. r Approximately three days prior to meeting, an agenda will be sent out to you— once it is available. It will also be available on line at the town'website: www.town.barnstable.ma.us Go to ..."Boards & Committees > Board of Health - or- Go to Official 'Agendas 'Ariy'question§,:please'call.Sharon Crocker at 508-862-4739. Thank you. j I QAAGENDAS BOH\let Receipt of BOH Submission 56 Long Beach Rd Cent May 12 2015.doc aas"' _� _ Qryanct�..-stuyosu+aa .. of �� Town of Barnstable R 9 . Public Health Division v BARN STABLE, • 200 Main Street MASS. 1V1 �'y/� xx p9 ^y y � '1.4 J�N r� �.�� Hyannis,MA 02601 ZIP 02601 00 .48 02 1 fN 000 1383424 JUU 04, 2015. \Y Rosemary Butler r. 49 Barker Avenue Berkeley Heights, NJ 07922 j F:E-v' RK TO 7-CEISOE1R A T TE sSd P T'c V I O T id 9i9 t2i.W N- "Ebi:aav�. d ` "f ; 4a tani.�u:.uaaia'ei'giee pa�9se e,g�i a° � 'i' ie li -i@a� aeii m it BORTOLOTTI CONSTRUCTION,INC. 765 WAKEBY ROAD,MARSTONS MILLS,MA 02648 NO R�cfl ® 508-771-9399 508-428-8926 FAX: 508-428-9399 V '0 199 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ftyip AID PART A CERTIFICATION 19 Property Address: Date of Inspection:l/-,:?/'9S— Inspector's Name.- Own s Name and Address: CERTIFICATION STATEMENT-, I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection.The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site sewage disposal tems. The System: disposal Conditionally Passes Needs Further Ev tion By the Local Aproving Authority Fails Inspector's Signature: Date: The System Inspector shall submit a copy of this inspection report to the Approving authority within tlur- ty(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 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 1VIMARY• A)SYS PASSES: /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. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system,upon comple- tion of the replacement or repair, passes inspection. Indicate yes,nor,or not determined(Y,N,OR ND).Describe basis of determination in all instances. If not determined",explain why not. The septic tank is metal,cracked, structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup or breakout or high static water level observed in the distribution box is due } to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): N t _1 - t, r SUBSURFACE SEWAGE DISrOSAL SYSTEM INSPECT ION FORM PART A CERTIFICATION(continued) 't Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced r to br oken or obst ructedpipe(s). 'n more than four times a year due pumping The System required Y YP P g approval of The Board of Health The system will pass inspection if(withpp :) Broken pipe(s)are replaced Obstruction is removed C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by The Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 WATERa� SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 Feet to a surface.- water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less K than 5 ppm. j D)SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health;< r should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clog- ged SAS or cesspool. P� Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 q P day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped -2- SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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 I of a public well.' Any portion of a cesspool or privy is within 50 Feet of a private water supply well. Any portion of a cesspool or privy is less than 100 Feet but greater than 50 Feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: The system is within 400 Feet of a surface drinking water supply The system is within 200 Feet of a tributary to a surface drinking water supply The system is located in a nitrogen sensitive area Interim Wellhead Protection Area (IWPA)or a mapped Zone 11 of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the following have been done: _Pumping information was requested of the owner,occupant,and Board of Health. _k/None of the system components have been pumped for atleast 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.. 4/As-built plans have been obtained and examined. Note if they are not available with N/A. -The 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. __Allaystem components,excluding the Soil Absorption System,have been located on site. " 1 The septic tank manholes were uncovered,opened,and the interior of the septic tank was in spected`for condition of baffles or tees,material of construction,dimensions;depth of liquid, depth of sludge,depth of scum. 3 _The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods.; p 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) Y The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C. SYSTEM INFORMATION - FLOW CONDITIONS RESIDENTIAL: Design Flow: allons Number of Bedrooms: 2 Number of Current Residents: Garbage Grinder: Laundry Connected To System: %GS Seasonal Use:_ �7 Water Meter Readings, if^ailable: Last Date of Occupancy: COMMERCIAL/INDUSTRIAL: A/C C Type of Establishment: Design Flow: gallons/day Grease'Trap Present: (yes or no) Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings,If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION PUMPING RECORDS and source of informatii n:�f/'9 /02 g 1661 Ale / System Pumped as part of inspection: NUJ If yes,volume pumped: gPons Reason for pumping: TYPE F SYSTEM: Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy ' Shared System(If yes,attach previous inspection records, if any) Other(explain): APPROXIMATE jGE f all components,date installed(if kn wn)and source of information: Sewage odors detected when arriving at the site: -4- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: c Depth below grade: ii Material of Construction: V concrete metal FRP_Other (explain) Dimisions:_ , -',Y(g' ,K %' Sludge Depth: Scum Thickness: Distance from top of sludge to bottom of outlet tee or baffle: 3 5— Distance from bottom of scum to bottom of outlet tee or baffle: )/ Comments: (recommendation- for pumping,-conditioii of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert structural inte rity,evidence of leakage,et .) �S Q /lhoD Ci'C. 6iJ oZi G !G (26urlys vC ° LT 4vA/ e- ff " GREASE TRAP:_ Depth Below Grade: Material of Construction: concrete metal FRP Other (explain) — — — — Dimensions: Scum Thickness: Distance from top of scum to top of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) TIGHT OR HOLDING TANK: Depth Below Grade: Material of Construction:_concrete metal_FRP Other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm Level: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX:1 Depth of liquid level above outlet invert: �i')C Comments: (note if evel and distribution is a 1,evi nce of solid carryover evidence ofleakage' to or u of x,etc.) fie^ tD PUMP CHAMBER: Pump is in working order: Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) -'5- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS): (Locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive I ethods) If not determined to be present, explain: Type: Leaching pits, number: 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 n 'ng,condi 'on of vegetation, etc.) CESSPOOLS: Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of Cesspool: Materials of construction: Indication of groundwater: Inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soilk, signs of hydraulic failure, level of ponding,condition of vegetation,. etc.) PRIVY: A 6 Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) -6 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include des to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. O V m Ce DEPTH TO GROUNDWATER: Depth to groundwater: / y Feet J O Method of Determination or Approximation: t -7- X Health Master Detail Page 1 of 1 s x� aekI1' ;�41`F Logged In As: TOWN\malkusk Health Master. Detail Wednesday,July 1 2015 Application Center Parcel Lookup Selection Items Parcel Septic Perc Well Fuel Tank Parcel: 288-173-002 Location: 15 POINT LANE, HYANNIS Owner: BUTLER, ROSEMARY Business name: _ ^� _ Business phone:I Rental property: F, Deed restricted: r Number of bedrooms Contaminant released: r Fuel storage tank permit: r 'Save PaParcel Changes � a _Return to Lookup Parcel Info Parcel ID: 288-173-002 Developer let:LOT 15A Location:.15,POINT:LANE Primary frontage: Secondary road: Secondary frontage: Village:HYANNIS Fire district:HYANNIS Town sewer exists at this address: No Road index: 1289 288173002_1 Asbuilt Septic Scan: 2881730022 Interactive map Town zone of contribution:AP (Aquifer Protection Overlay District) State zone of contribution:OUT Owner Info Owner: BUTLER, ROSEMARY Co-Owner: Streetl:4 BAKER AVE Street2: City:BERKELEY HEIGHTS' State:NJ Zip: 07922 Country: Deed date:2/15/1996. Deed reference: 10054/193 Land Info Acres: O:23 Use: Single Fam MDL-01 Zoning:RB Neighborhood: 0106 Topography: Road: Utilities: Location: Construction Info Building No ear Built Gross Area Living Area Bedrooms Bathrooms 1 1984 3776 1704 2 Bedroom 2 Full-0 Half Buildings value:$158,100.00 Extra features: $36,000.00 Land value: $126,100.00 �1- 1. 9913 http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=288173002 7/1/2015 I - 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS): (Locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: Leaching pits,number: Leaching chambers, number: Leaching galleries,number: Leaching trenches,number, length: Leaching fields,number,dimensions: Overflow cesspool,number: Comments: (note condition of soil, signs of hydraulic failure level of h 'ng,condi 'on of vegetation, etc.) � -/'�S '. C' v / ^�� CESSPOOLS: Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of Cesspool: Materials of construction: Indication of groundwater: Inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soilk, signs of hydraulic failure, level of ponding,condition of vegetation,. etc.) PRIVY: h Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) -6 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references,.landmarks or benchmarks. Locate all wells within 100 Feet. 1. G DEPTH TO GROUNDWATER: Depth to groundwater: f y Feet , Method of Determination or Approximation: lO,E'/�jDfe� �'O 1,15 act r -7- AsBuilt Page 1 of 1 7WN OF$AItNSTABLE y LOCATION i SEWAGE# VH.LAGE /ASSSES 'S MAP LOT/73.co Q NAME&PHONE NO.Z?o SEPTIC TANK CAPACITY M.0K LEACHING FACU=:(type) NO.OF BEDROOMS-C. BUILDER ROWNER = 221✓-- I— tK 1 PERMTTDATE: COMPLLANCE 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 Faciljoqff any wetlands exist within 300_fcet of lvaqhin facil' Feet Furnished t °� —�/ i .t http://issgl2/intranet/propdata/prebuilt.aspx?mappar=288173002&seq=1 7/1/2015 AsBuilt Page 1 of 1 v APO LOCATION SEWAGE PERMIT NO. -.3// VILLAGE I N S T A LLER'S NAME & ADDRESS � IUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 21 ,9 26 http://issgl2/intranet/propdata/prebuilt.aspx?mappar=288173002&seq=2 7/l/2015 73 L O CATION SEWAGE PERMIT NO. Xv T Fy-,31/ VILLAGE INSTA L,LJER'S/ NAME & ADDRESS i I U I L D E R OR OWNER I � DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED i ZY 12 o i �1 `1 .. � �' .� � \�� w �. � � � �1 ti � L �� r 14 1V No.: .._...._..... F s..... .............. ` THE COMMONWEALTH OF MASSACHUSETTS f BOAR® OF HEALTH ...........................................OF................................ , ppliration for Disposal Works Tonstrnrtinn Prrmit Application is hereby made for a Permit to Construct (A or Repair ( ) an Individual Sewage Disposal Sys em at / s :... ...................... ��t�.... ... .... Locatio - d ss / g ✓ or�e�.4T�Qr.d...................... .... ✓,, � !.... .....os . � f - Ine f Address .... Installer Address Type of Building Size Lot_/�y. _� ___Sq. feet Dwelling—No. of Bedrooms��._��_ ________________________________Expansi�on�ttic ( ) Garbage Grinder ( ) '4 Other—Type e of Buildin /7L1. __e....... No. of persons .................... Showers — � yp g - p (�) Cafeteria ( ) dOther fixtures ..-----••--••-•--------------•------------•••---- ....------•--•--------......_....------•-••--•-------••-----••-------------.....------...._---_.... W Design Flow____________ ______________________________gallons per person er day. Total daily flow-___. Z__°T_....._.._...___..._..__.gallons. WSeptic Tank—Liquid capacityT�4a..gallons Length___-....... Width�2 ....... Diameter................ Depth............ x Disposal Trench—No..................... Width................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter...&._........_--- Depth below inlet---L, _........... Total leaching areal .1_......sq. ft. Z Other Distributiowbox (V) Dosing-to ( ) `" Percolation Test Results Performed by.� .l9. 1•�.__ ............... Date-�._ ..��____._.._.. Test Pit No. 1........ �.-AN per inch Depth of Test Pit__f`�Y_ Depth to ground wa er.l 0- C " GX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ . 0 Description of Soil..�� Q C1C1. S D.tf1 -----------------------•------------------------------------•----------........----•---- V -----------------------•------------------_-_-__-_-•------------------------------•---------___-----___"---------------------••------------------------•-----------•----------•-•---------•-----•••------- -----------------------------------•-- --- ------------------- U Nature of Repairs or Alterations—Answer when applicable.......................-- .. ...............•---.......----------•••••--------•----......_..------•-•--------...-------_-•.-•• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE; 5 of the State Sanitary Code—The undersigned further agrees not to place the system in oper ion unt• Certificate fof Complian e has been i ued by the board of health. Signe �: '--�'.:� - ........... pplication Approved y----- �/ --------------------•-•-----------••••--------•-_..... ---------- -- - ate Application Disapproved t e following reasons:................................................................................................................ ......-•-•----------------------------------•------...---------•-•--....---------------•---------•-•------••--••-•._........._._...-----•--•---•---------•••---••-•--•---- ......................... Date PermitNo......................................................... Issued-.-•--•-------------------......_..__-_.... ^---• ---•--- Date No,M •^�-- =•--- `F>s...rwe. j.." ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... ............................OF............................._......... Appliration for Disposal Works Tonstrurtion famit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Y / L ...................... f� -atio dres % 14470�- o er •• _/ Address � � c �!.. � <�,��/ ....... ��1--------------------------------------------------- � Installer - Address Type of Building Size Lot............................Sq. feet �. Dwelling—No. of Bedrooms...--._ _______________________________Expansion Attic ( ) Garbage Grinder ( ) PLI Other—Type of Building _ j _f.. ...... No. of persons._..�.................. Showers Cafeteria ( ) p" Other Wures ........................ . W Design Flow........ ._.2, ......................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 ( ) ~" Percolation Test Results Performed by--- t._�n. ............................. Date.------•----_--- Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ RI' ---- ------------- - ----------•---••-•---•-•--•------..-----------•-----------..-•-•-•----------..-.•-----------•••--•-•-•-••--••-- O Description of Soil...zz_/7 1'_.� n -tom___________________________ --------•-------------•---------•--------•-------•--...........-••.••---- x c, -----. w UNature of Repairs or Alterations—Answer when applicable............................................................................................... ..------•-----------••------•--------•-----------------------•-•--------•--•---------••---••----...-----•---------------------------•--------------------------•-•--•---------------------•---•••-•••--• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with ' the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate ofKefollowing e has been issued by the board of health. gned_. Application Approve Y---•- 3 a !__....... .-•----•............... Date Application Disapproved r t reasons:------•---------------------•-------------------------••------•------------------------------------------------- •--•---••......•-----•----••--•--•-•---....--•---•----•----•--••-•---•-----•--•--........-•-•...-•--•-••.••---•-•....--•••----•-----•-------------••••---------------------•----•--------•--••....-••--- Date ' Permit No......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... ....: .....................OF.................................................................................... Trrtifiratr of wrrmpffiturr TH IS TO . RTIFY That the Individual Sewage Disposal System constructed ( or Repaired ( ) by .. --•.................... ....---...-•-•-•------••--•--•---•----------•-•--•--............---- ^, r. Installer at...7;,� .. .. ............. has been installed in accordance with the provisions of TIT r e of The State Sanitary C d as de ib d in the application for Disposal Works Construction Permit No._ _. ._ r-____.eft...... dated ...... ........................... THE ISSUANCE OF THIS CERTIFICATE SHAL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................... .......... inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH L/ f ................OF.._.........................-------••-•----.....-------•-------...................... N . FEE._...'r........................ �ts�r ork �ans#rt ion rrutit Permission is hereby granted.. ------------------------- ----.......... ------------ ---------------- to Construc or;Re air ( ) 1 Se r Isposal System atNo f ,C, _---------- ............................................................ Street as shown on the application for Disposal Works Construction Permit '.. ............. Dated.......................................... ------••-•..... •.. ........................................................................... DATE................................................................................. Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON POINT LANE. Town 'ilay 401 Wid C E3 el.:Zo.ai �0 �, �� 100 Exp. LOT 15A iO a95 f;Nl, yH �� s� � !, d 0 1-6 ,o Pit d a �y...� Stone f ]'ro-u-sed Lv 01 S of Desi„n Flora-y! � \ ! � - D-30li - �0- DWe11..i.nrJ y 1,000 G.S.T. \i j T.? _� \\ 4 t NO S C LEE NI SUALE ^fin?i LAIN�� ,,,,F L.�� I 'OR J tP S EESTFOI `.� 13ei.n- I 15a as sho�,,m on i,1-. r d<>ne for Dorothy ?, . Igo, dated 3/27/L4 by .i�. Cape i ^;nfy:ine_ri Centerville, Pass. 7levatio!A shown are in :feet above assumed ;I ;. A... . _i-ate :4 4 ' ll-te-----------------------Aent . -3�.r••nstabl� -�_�,.�....'"u--f TuCT . I P-3150 3/22/84 TOp 12" ' of I Oar \G .. FRA K ., :. Chi=_12YNa 823" � y FRANK 7 No hater encounted , Vdt. by Mr. Gifford