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HomeMy WebLinkAbout0102 QUAKER ROAD - Health 102-104 QUAKER ROAD, HYANNIS A=310-301 LOT 33 t 1 I i o � e � I i f I I TOWN OF BARNSTABLE LOCATION Q CACt k-0_r YOU SEWAGE# VILLAGE va.try,5 ASSESSOR'S MAP&PARCEL :3p INSTALLER'S NAME&PHONE NO. C�e �M6 ]� (/08) c��GB o2�(LO SEPTIC TANK CAPACITY (g-) 1,606 out tvv�lCg LEACHING FACILITY:(type) Al S (size) x "K K1a I/.V� NO.OF BEDROOMS OWNER `j Wes Pot PERMIT DATE: ]O-N—I d .COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) • Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY W civ w. L No. to — I� Fee THE COMMONWEALTH OF MASSACHU5ETTS ' Entered in computer: PUBLIC HEALTH DIVISION _- TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rpprication for Migogal 6pgtem Congtruction Perron Application for a Permit to Construct( ) Repair( ) Upgrade(s-<Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. /Qoc �U it ��( � Owner's Name,Address,and Tel.No. o Assessor's Map/Parcel J�t� "� (ft I d Installer's Name,Address,and Tel.No. C44 ,Amme,Address and Tel.No. �� q Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) LJ LI gpd Design flow provided q LIT gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date f 0� (!2 Application Disapproved by: U Date for the following reasons Permit No. 7 nIO� L Date Issued I o—1 !' l No. 0�0 ��'.- Fee400, � THE COMMONWEALTH OF MASSACHU,IE.TTS- Entered in computer: ' N i T s Yes PUBLIC HEALTH DIVISION ;,TOWN OF BARNSTABLE, MASSACHUSETTS plifation for M.i5poal *p!5temi Cow6truction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(cv_Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /Qo2 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 3/6 O� / a �J� �r7 Installer's Name,Address,and Tel.No. L" - �npQA_W_ame,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures �/ Design Flow(min.required) y L L'y gpd Design flow provided 1 LIT 6 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil. Nature of Repairs or Alterations(Answer when applicable) i Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in. accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed _ E Date. Application Approved by Date la_f-/ w Application Disapproved by: Date for the following reasons o Permit No. (9 010— `l)-O Date Issued tl V-1 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 (r/d e4_e a at C7�— /� (� )(���o�i has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. d9c)(0- W�0 dated 1 d_1 () Installer 04,e G ¢--•' � �, Designer�C;AAA p�' 0 #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will f notiod s designed. Date � Inspector UY Itiv_ "A-0 o- No. ;010 '" �� Fees' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwigogal *pfstem Construction permit v Permission is hereby granted to Construct ( ) Repair ( ) Upgrade Abandon ( ) System located at G";L — /p i 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 this pe�paax. Date 0 ` rt r �� � Approved by Dec 15 2011 5 n: 10PM HP LRSERJET FRX P, 1 DEC-15-2011 16:46 Fror:9RRNST HEALTH 15M7906304 To:%5083982206 Town of Barnstable Regulatory Services _ Thomas F.Geiler,Director Lx L Public Health Division Aso• , Thomas McKean. Director 200 Main Street.Hyunnis,.NIA 02601 Office: 508-8624644 Nu: 548-790•630,1 Installer& Designer CertiBcatitl n Form Date: Ol OS It Sewage PenulO Assessor's Mapll'urccl Designer: �e,r. t719ttflter' address: pox qg l Address: On _ wns issuccl a permit to install a Idate} (snstullerl� septic system ar_ based(in a design drawn by (a�idras) �r{ 1 e eAr dated—_.. /j 0 (ctcsi srner} X 1 certtty That the sel:t:c system rderenced above was installed sub) tantially according to the design, which may° include minor approved charges such as haeral reimation of he distribution lox antt"&septic tank, I cer:ifv that the septic system referenced above was installed with major chan,"es {i.e. greeter than 10' lateral relocation or the SA.S or an-. Vcnicttl relocation o"any Coll i:o►tent of the septic sysrem) but in accordance with State do Lneal Regialntioms. Plain n Viginn or certified as-buili by``desi,:rT to fnliow. - p M. Z (k,taller's Signature) No. 1140 r i;ner'S Sienanu•e) (Affix Nsionur's Stamp Here) PI.,EASE RETUJIN TO HARNSTADUE PUBLIC HEALTH DIVISION. C'F1111F'IC'A11 OF COMPLI&XCE WILL NOT RE INSUP.n L1fVm I0TH THIS FORM AND 6S-BUILT CART) ARF. RECEIV-1)IiYJ:H Ak*!S'TABLE EUIILICHEALTH DIVISION. 'THANK YOU. LI I ICuhh/ti.ptiClC)esiL't>es C'eriificad00 P01n�.tb.d�'Aec - i P# k-2 Town of Bdi ni.stable. Department of Regulatory Services • Public Iealth Division Bate 7 6� uasrset$, ,KAS& �s 200 Main Street,Hyannis MA 02601 3 ~lfD I,A/2t� .i Date Scheduled a �' 'Time Fee Pd. L , I ,foil Suitability Assessm'eni fop Sewage Disposal Performed By: / Witnessed By: LOCATION & GENERAL INFORMATION Location Address 'i Owner's Name NLi1l Y /�► ct�• �J g t 2-?YY Address e �IS/ ` G✓ �f tb4;Ant5 !'� 61 UJ Assessor's Map/P4rceL I Engineer's Name ��1 K 4,— So' c: _ •3i� Telephone# 5� - '2 Pc 7-2-- NEW CON5IRU#ION REPAIR Land Use f"" Z_ ` "" Slopes(4'0) v �'� Surface Stones Na'J'W Distances from: ()pen Water Body v � ft Possible Wet Area t ft Drinking Water Well ft e� ft . Other Drainage Way l ft. Property Line ft SKETCH:(Street name,dimensiodsbf lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) I � 25.75 17.33' r a rN-2 I Parent material(geologic) t�C'� Depth to Bedrock Iw Depth to GroundwaWr. Standing Water in Hole N i Weeping from Pit Face j I Estimated Seasonal i 4igh Groundwater 1 DtT- ERMINATION FOR SEASONAL HIGH WATER T"L,E Method Used: Depth C1bperved standing in obs.hole: n, Depth td Sblr Adjusth In• in. ordundwnter AdJuetment �• � Depth to weeping from side of obs.hole: I p�,0rnundwnter level,,,,e, Index Wet!#_ Reading Date Index Well levt1 ---- Adj.f.l0tor,� �� PERCOLATION TEST . Date Tl!ne Observation " Time at 9 ..--•---- .Hole# i Time at 6" Depth of Pere G�p Time(9"-6n) Start Pre-soak Time.@ — End Pre-soak Rite MinJlnch I Site Suitability Asse¢sment: Site Passed Site Failed: Additional Testing Needed(YIN) Original:.Public k_e$Ith Division Observation Hole Data To Be Completed on Back— ***If percolafiibn test is to be conducted within 100' of wetland,you must first notify the ek prior to Barnstable C4#servation Dildsion at least one (1) we beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other .Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel DEEP OBSERVATION HOLE LOG Hole# ^tom Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel) DEEP OBSERVATION HOLE LOG Hole# +� Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel DEEP OBSERVATION HOLE LOG Hole# �a Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. ra I F Flood Insurance Rate May: Above 500 year flood boundary No_ Yes __ Within 500 year boundary No 2L Yes Within 100 year flood boundary No_� Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist_in all areas observed throughout the area proposed for the soil absorption system? 'z-S If not,what is the depth of naturally occurring pervious material? Certification I certify that on 0 `N (date)I have passed the soil evaluator examination approved by the Department of Environ ental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 3.10 CMR 15.017. Signature 1 C/\_ �'' Date ' vo Q:\.SEPTICIPERCFORM.DOC I L TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION v, Date /a 31 -08 CUr-"b • Time: In 9 4A Out Owner 9 4e,6J) %r-,)A 33 Tenant OC40+ Address B, aV 8 Address /(j7 Qt,4t r(," MnWYV',) r 1N4 �a b dl 5��— rl I �e xis �`i` Compliance rj� Remarks or Regulation# Yes 7 NO Recommendations tl� - 2. Kitchen Facilities ML MLD CeR:_._------ 3. Bathroom Facilities 4. Water Supply h�o 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing 18. Driveway Width 19. Number of Tenants Observed 0-0� X 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 �v Inspector If Public Building such as Store or Hotel/Motel specify here _ TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION q s Date /3 —3)- 08 w r� Time: In � oA Out / • 1C x Owner �`1 6ui —9U J� <:0E-22L 333�n Tenant O<-(�' /Ry 13t9 ��oVl� Address 1;1a Address VY14 �� b G Sad- a �'�7` Compliance �� Remarks or Regulation# Yes 7N0 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 ` F ,. _10. Curtailment-of Service - - = 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents t 15. Garbage and Rubbish Storage and Disposal ` 16. Sewage Disposal 17. Temporary Housing f'1/ 18. Driveway Width 19. Number-of Tenants Observed 3 t ov{ x i t PART II 37. Placar�in' g of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed aO Inspector _ If Public Building such as Store or Hotel/Motel specify here f L i HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS FORM30 C&w BOARD OF HEALTH CITYITOWN a DEPARTMENT 2 �G Ma� ,� �Z ANti► S ADDRE S TELEPHONE Address /CI Z O LA) Karl Xd/ �Occupant Floor l Apartment No. wf—�—No.of Occupants___ No.of Habitable Rooms 0 No.Sleeping Rooms 7, No.dwelling.or rooming units No.Stories Name and address of owner ? 0'l f AU� u, I-, !s S L (1/V 4.�,^, 1✓(�} GzCo0 Remarks Reg. Vio. YARD Out Bld s.: Fences: �y(1 nrn.-1 S. AA Garbage and Rubbish c Z.(010( Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: QI Hall, Floor,Wall,Ceiling: Hall Lighting: _ Hall Windows: \ HEATING Chimneys: Central ❑ Y Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: upply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 0 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Su .Ten.,Gas,Oil, Elect.: c s, I ties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Lh CJJ C4 U S"T ZIP Locks on Doors: 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 SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES PERJUR " 7��INSPECTOR < TITLE L Al.'tti ,L A.M. DATE O TIME �� (� P A.M. THE NEXT SCHEDULED REINSPECTION A.l �� P.M. 'v 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 II, 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. (C) Shutoff and/or failure to restore electricity or gas. (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. i (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. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 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. t (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrioal•wiring standards or failure to maintain such facilties as are required by 165 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. (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. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice 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 and shower or bathtub as required in 105 CMR 410.150(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- ry 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. C, FoRM30 C&W Hoessa WARREN i"" WTHE COMMONWEALTH OF MASSACHUSETTS 'BOARD OF HEALTH CITY/TOWN DEPARTMENT A rya �a F-e11� ADDRESS TELEPHONE J ?C.�n Address d Z-- *�vL.. �t�l �Occupant Floor- -' Apartment No./No.of Occupants �- No. of Habitable Rooms4t No.Sleeping Rooms_- /' No. dwelling or rooming units No.Stories Name and address ofowner CAS,TL4- Z 'LitAN " "ItJ? � 5uf Z� � L, Pf S( I 11N 26 Z Z44 9 )" ' A a,rna, J Y--LA GZCo01 "� Remarks Reg. Vio. YARD Out Bld s.: Fences: . N f S AA � Garbage and Rubbish ( G Z. 3f Containers: V` Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: I ' Walls: ' Foundation: \.' Chimney: BASEMENT Gen.Sanitation: Dampness: Ivy \ . Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: j �J / Hall, Floor,Wall,Ceiling: ( \ (/ Hall Lighting: / Hall Windows: " \ HEATING Chimne s: 1. -_ �� Central..:.❑_Y _�- . _-E Ui °Re air -- ,.._ TYPE: Stacks, Flues,Vents: r . PLUMBING: Supply Line: 4'. - ❑ MS ❑ ST ❑.P .'% Waste Line: H.W.Tanks Safety and Vents ELECTRICAL Panels, Meters,Cir.: r ❑ 110 ❑ 220 / Fusing,Grnd.: AMP: I / Gen.Cond. Distrib. Box: r/ Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantryr Den Living Room "�. Bedroom 1 Bedroom 2 Z.t) Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: __—Stacks, Flues;-V-0 ts-Saf-ties: ° ,Kitchen Facilities / Sink Stove F4 Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: 3 Egress Dual and Obst'n: General \Buildling Posted Locks on Doors ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS.A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE f OCCUPANT AS-DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER.THE PAINS AND PENALTIES OF PERJURY" M1 INSPECTOR ` TITLE ' �'�i< ,. A.M. TIME DATE 11 y r- I i � f� '.V P.M ' �0. A.M. PECTI THE NEXT SCHEDULED REINSON `/�, P.M. • ti 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 II, 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 b 105 CMR 410.201 or improper ventin or use of a space heater or water heater as ( ) P q Y9 P prohibited b 105 CMR 410.200 B and 410.202. P Y ( ) Y or gas. Shutoff and/or failure to restore electricity (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. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 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 as-burnin facilities in accordance with accepted plumbing, heating, ( ) . P 9, 9 9 9 P P 9, 9, gas-fitting and electrical wiring standards or failure to maintain 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. (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. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice 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 and shower or bathtub as required in 105 CMR 410.150(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. �¢ 3 FORM30 C&w HOBBS&WARRENTM THE COMMONWEALTH OF MASSACHUSETTS BOPRD OF HEALTH r CLOWN �f a EPARTMENT Palk) il) i S GP RESS "fE 4„M Sv9"0� jj,, ` 1 LEP NE Addresslog Yf-� Occupa /V, Floor Apartm No. No.of Occupants— a V ��/ No. of Habitable Rooms No.Sleeping Rooms No. dwelling or rooming units N .Stories Name and addre s of ow r P r P® 6:"Q&9 Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage r Infestation Rats or other: ,Q STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMB Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Livin Room Bedroom 1 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 and Obst'n: General Building Posted Locks on Doors: 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 IN PECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALT F E R ." INSPECTOR TITLE �I 50-9 DATE TIME P M IR A.M. THE NEXT SCHEDULED REINSPECTION P.M. 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-11ave the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 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. f (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. (C) .Shutoff and/or failure to restore electricity or gas. (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. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 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 to maintain 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. (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. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice 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. - • , . 1 (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(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. r � FORM30 &W HOBBSB WARREN TM THE COMMONWEALTH OF MASSACHUSETTS B RD OF HEALTH CXT /TOWN a Da TMENT jj l�, (� TELEPMON �/FF.. �/ t Address I�Y uty CAP/✓ _ OccupantAVII 0`/ ILLo V/ Floor Apartment No. No.of Occup t v0d aw, Vaza I/,O, /� No.of Habitable Rooms No.Sleeping Rooms 1 r�r `�{��V® No.dwelling or rooming units o.Stories Ol �6 v Name and address of owner Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: 1 Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows.-- Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central 0 N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink NJIDOF- Stove' Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: 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 INSPECTI PORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTI M INSPECTOR TITLE p / M. DATE TIME C 1 A. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 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 11,, 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 410.186 and 410.160 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. (C) Shutoff and/or failure to restore electricity or gas. (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. (J) The presence of Ieadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 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 to maintain 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. (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. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice 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 and shower or bathtub as required in 105 CMR 410.150(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. i (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. �o o M 4 ' TOWN OF BARNSTABLE LOCATION 02 m/42 V Ca k—e r- SEWAGE # — VILLAGE LA ASSESSOR'S MAP &LOT NSTALLER'S NAME&PHONE NO. 10 r J[-'A d"l— SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 5/o'k /D (size) M.OF BEDROOMS BUILDER OR OWNER 1 i_ 1"/�4In 4 PERMIT DATE:-'2�� �J COMPLIANCE DATE:—9 G"2 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 facili Feet Furnished by<� ,��2 A 4-N �.. oil rj U � ` t I) t .' t i ' I OL ID tj n .Nl� a S W� t 1�No. � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �Z Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pphration for ;Di5pont *pztem Con5truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Rol Owner's Name,Address and Tel.No. Assessor's Map/Parcel `Q.c� C3c��c 22i(� �t�v:�S;11✓1�sS; cs2G©� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) t'�:�cc9• Ce S'i �� �1nv,p1 -e�.,.e. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed Date '1-2 rf— '5L Application Approved Date JF-7 Application Disapproved for the following reasons Permit No. J Date Issued TOWN OF BARNSTABLE LOCATION Ouak-er Rd1 SEWAGE # D--. V-? VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. Qj!', �u11_T CG Rye— 77/.� SEPTIC TANK CAPACITY /SGD��Tyr LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER 1�7,1 PERMITI)ATE: 712_e,,Z 7 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 facili� Feet Furnished'by� �'�`-��� 10 lot/ 13 Fo _?5 4 � I 13 to o: 29 6" A to (3 /3 to G 3P, ;�to F TO iq.ro G 432� G O TOWN OF BARNSTABLE L.00AT10N SEWAGE # �T= 3 C�U�fC'e t� R� V1i.T GE Z&aa=A 99L ASSESSOR'S MAP& LOON INSTALLER'S NAME&PHONE NO. /I C , 24? SEPTIC TANK CAPACITY /$Dio:�4 Ten, . LEACHING FACIUM (type) YOA /D (size) NO.;OF BEDROOMS BUII:pER OR OWNER Cit�ya a� < •7 1 PERMITDATE: 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 i Within 300 feet of leaching Feet Fu.rTushed bYnr'�' '` - � i I k I c 6� 9oi�l �I 4d 04v 90 �f 4 I (� Feep No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: f 's, Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for Migpogal *pgtem Congtruction permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System O Individual Components Location Address or Lot No. l'O2—`b4 Qv,4 I�eR Owner's Name,Address and Tel.No. Assessor's Map/Parcel .314�- I��nstta`ller`�'s`N,,aa�m-�e,Address,and Tel.No. Designer's Name,Address and Tel.No. ; Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title i Size of Septic Tank Type of S.A.S. DescAliti n of Soil Nature offRepairs or Alterations(Answer when applicable) �w�i� CcS�ep!�t\5 4-%}1 - -fit , Date last inspec ed: 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 issued-bby this Board of Health. Signed +•'Gam— Date ' "2 Application Approved Date `�'•" yi'�,_ Application,Disapproved for the following reasons T. Permit No. _ Date Issued .. — ---------------------------* ------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CE*Pe th t the On-site Sewage Disposal System Constructed( )Repaired ( ) Upgraded Abandoned( )by (/ C15 G at A4 P 44 /�/ r �ti'L.S has been constructed in accordance with the r�o���'ons f Title 5 and the for Disposal System Construction Permit No. r -A dated Installer " ,�4 h#0T'�- / Z G GVe Designer r r The issuance of this permit shall not be construed as a guarantee that the syste will function as designed. Date Inspector --------------------------------------- NO. Fee "''41) THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ligpogal 6pgtem Congtruction Vermit Permission is hereby gra ted-to Construct( )Rep '.( )Upgrade( 4)Abandon System located at { and as described in,the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title And the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this54-it. Date: r. � � Approvedfby ' NOTICE: This Form .is to be used for the Repair of Failed Septic Systems Only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, Rabe- �• �",1����,� , hereby certify that the application for disposal works construction permit signed by me dated ICA-C(1'1 , concerning the 1 Crz— t Oy property located at !tee- cQ o,-,I, meets all of the following criteria: here are no wetlands within 300 feet of the proposed septic system V- There are no private wells within 150 feet of the proposed septic system v. The observed groundwater table is 14 feet or greater below the bottom of the leaching facility L' There is no increase in now and/or change in use proposed 4• There are no variances requested or needed. SIGNED : ` DATE: y LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER Ct`r [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. Ft t� to`, �. 0 �o 7- 4X-g i-c mil„ C(„"b e cS S -+�►.�-- LEGEND PROPOSED CONTOUR c^� a ® PROPOSED SPOT GRADE " 9c ROUTE 28 EXISTING CONTOUR ROUE 28 SITE + 96.52 EXISTING SPOT GRADE T W— EXISTING WATER SERVICE BENCH MARK TEST PIT D A ICIA R . Q L 3 P FOUNDATION T OF O 4 6 y ELEVATI0 N — 52. 31 4k a ;ti 3 BARNSTABLE GIS DATUM q6 , Insp Ports J N.T.S x.= LOCUS MAP , `pis GENERAL NOTES: . ti. / `` 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL C Y BOARD OF HEALTH AND THE DESIGN ENGINEER. y ti 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS / I e i OF THE STATE ENVIRONMENTAL CODE, TITLE 5, AND ANY APPLICABLE •, - ` TH-2 LOCAL RULES AND REGULATIONS. - o TH `--_i_ 5O PROP. I ,000G 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR a � Q 1 \ TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE • , . 7 ,"S SEPTIC TANK DESIGN ENGINEER. �-j o 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING O FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN Z ENGINEER BEFORE CONSTRUCTION CONTINUES. EXIST. 'I ,000G 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. O 15 f t X DER � SEPTIC TANK 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF p THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF ��P \\ O O �/ I HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. -A qQD ' 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. N r1 O 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED \ W Z 4 APPROX. LEACHING TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. Z r LOCATION (NOTE I O) 9., IT SHALL.BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 1 / CONSTRUCTION. UTILITIES SHOWN ARE APPROXIMATE. C I / z- 0 I ! 10. EXISTING LEACH PIT TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5.i / LOT i FILL WITH CLEAN MEDIUM SAND. m / 11. .48 HOUR NOTICE FOR ENGINEER CERTIFICATION N z, / AREA = 13814 S f - f 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY / AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY O I -{ -� 13. NO PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING 14. ALL PIPING TO BE 4" SCH 40 0 1/8-/FT (UNLESS,SPEC. OTHERWISE) 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A GARBAGE GRINDER ORIV'EW AY II 16. NO WETLANDS°WITHIN 100 FT. OF PROPOSED-LEACHING , 6 17. PROPERTY IS IN ZONE II. 50— 139 4 fi r. MAP.•310 'LOT.- 301 PROPOSED SEPTIC SYSTEM UPGRADE PLAN N o. 1140 14 "' ' 102- 104 . QUAKER ROAD, HYANNIS ' MA. Af6� Edo Prepared for: Great Western Trust SURVEY REFERENCE: Engineering by: Surveying by: SCALE DRAWN q DARRENM.MEYER,R.S. ECO-TECH E1VY. 1 =20 OMM CERTIFIED PLOT PLAN BY: BARNS. SURVEY CONSULTANTS f ; PO Box98f DATED: JANUARY 1968 (508) 364-0894 PATE: CHECKED SHEET NO. EAST SANDWICH,MA 02537 5o6-362-2922 09 09 10 DMM 1 of 2 k ' RESIDENTIAL D W E LW N G PROFILE NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS NOTE: TO PREVIEW -BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:46.0 ELEV. TOP ExlsnNc rANlc PROPbsED rANK NOTE: MAGNETIC TAPE TO BE PLACED OVERALL COVERS FOR RIMETER DISTANCE OF THEFS.A.' AROUND THE FOUNDATION INSTALL RISERS W/IN 6" OF FINISH GRADE INSTALL RISERS W/IN 6" OF FINISH GRADE (Existing) = 52.31 PROPOSED D-BOX PROPOSED S.A.S. EL.50.5t EL.50.5t EL.50.0t EL.50.0t INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. ` F.G. EL: 48.50t F.G. EL:48.50(MAX.) .Y L - 20' L = 1O'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) • 4" SCH 40 C 0 S=1% (MIN.) 0 1X (MIN.) (MIN.) to a ® S� IX (MIN.) e 4"SCH40 PVC 4"SCH40 PVC °' �• EE'TS ARE TO BE to TEE's ARE TO BE 14 n .r 4"SCH 40 PVC INV.= 47.59 4' SCH 40 PVC s g• a 1 SAE NVERTO w FILTER Exist. Invert INV.=47.40 w FILTER • PROPOSED INV,=46.05 5 ROWS OF 4 UNITS AT 6.25'/UNIT + 0.75' WEDGE = 25.75'/ROW EXISTING 1,000 GALLON SEPTIC TANK dim a INV.-47.15 INV.=46.25 INv.m47.64 PROPOSED 1,000 GALLON SEPTIC TANK DB5(H2O) INV.=45.1 t SOIL ABSORPTION SYSTEM (PROFILE) GAS BAFFLE TO BE INSTSALLED ON OUTLET TEE AS MANUFACTURED BY 18" OF COMPACTED FILL ABOVE CHAMBERS FOR VEHICLE TRAFFIC TUF-TITE, ZABEL, OR EQUAL RESTORE VEGETATIVE COVER NOTES: 1 CONTRACTOR SHALL VERIFY ALL EXISTING BACKFILL WITH CLEAN PERC SAND TO TOP CHAMBERS PIPE INVERTS PRIOR TO CONSTRUCTION. 2) NEW TANK AND D-BOX SHALL BE SET LEVEL AND TRUE e, '.;.; .?,: "•:' '%'" OF 75" TO GRADE ON A MECHANICALLY COMPACTED SIX , �4s` INCH CRUSHED STONE BASE AS SPECIFIED BREAKOUT=TOP ELEV.=45.50 S IN 310 CMR 15.221(2). INV. ELEV.= 45.11 DA y 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTTOM ELEV.= 44.17 V EXISTING SUITABLE MEYR 4) GAS BAFFLE W/ FILTER TO BE INSTALLED ON OUTLET TEE 2.83' MATERIAL No. 1140 AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. 5' MIN. ABOVE BOTTOM OF 5) REPLACE EXISTING 1,000 GALLON SEPTIC TANK WITH 2O00G T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH 5 x 2.83' = 14.15 (6.92 PROVIDED) USE 5 ROWS OF 4-ADS16008D /STEM _ (2 COMPARTMENT(1500g/500g)SEPTIC TANK IF FAILED, BOTTOM OF TESTHOLE EL.=37.25 - BIODIFFUSER (H2O) UNITS-NO STONE SANITAR��'� 76" DAMAGED, OR LESS THAN 1,000G IN CAPACITY. _ W/ CONTOURED WEDGE (2nd 1,000g tank would not be needed) SEPTIC SYSTEM PROFILE `Qv PR LE TYPICAL SECTION N.T.S. N.T.S. DESIGN CRITERIA SOIL LOG 13021 11.2� :_ 16" NUMBER OF BEDROOMS: 4 BEDROOMS TWO FAMILY DWELLING DATE: AUGUST 13, 2010 I' SOIL TEXTURAL CLASS: CLASS I DESIGN PERCOLATION RATE: <2 MIN/IN SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. #1614 - �.� 34" � DAILY FLOW: 110 G.P.D. X 4 BR WITNESS: DONALD DESMARAIS, BARNSTABLE BOH= 440 GPD DESIGN FLOW REQ'D: 440 G.P.D. Elev. TP-1 Depth Elev. SECTION END CAP TP-2 Depth GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 49.50 0" 49.25 -0 16"" ADS 160OBD (H-20) BIODIFFUSER UNIT LOAMY SAND LOAMY SAND PROPOSED SEPTIC TANK: 49.08 tOYR 4/1 5" 48.75 10YR 4/1 6„ MODEL 16" HICAP 440 GPD X 2.0 = 880 GPD, USE 2 1,000g TANKS IN SERIES. B e LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT (WHICH ALSO MEETS 2-COMPARTMENT TANK REQUIRMENT FOR MULTI FAMILY USE) LOAMY SAND LOAMY SANDtOYR s/8 1oYR s/8 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY EFFECTIVE LENGTH 47.34 26" 47.17 25" SIDE WALL HEIGHT 75 DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. LEACHING AREA REQUIRED: (440)/0.74 = 594.59 S.F. C C DISTRIBUTION BOX: 5 OUTLETS (MINIMUM) OVERALL HEIGHT 16" MED. SAND MED. SAND OVERALL WIDTH 34" 4640 TRUEMAN BLVD PRIMARY S.A.S. 2.5Y 6/4 2.5Y 6/4 13.6 CF UALLUAR HILLIARD, OHIO 43026 CAPACITY USE 5 ROWS OF 4 - 16 ADS BIODIFFUSER 160OBD UNITS(H20) -NO STONE (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC. AND EXTENDED 0.75' W/ CONTOURED WEDGES t BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.70 SF/LF OF BIODIFFUSER) PERC 045.1 7 PROPOSED SEPTIC SYSTEM SITE PLAN (BIODIFFUSERS) 20 UNITS x 6.25 LF x 4.70 SF/LF = 587.50 SF ► 102- 104 QUAKER ROAD, HYAN N I S, MA (CONTOURED WEDGE) 5 ROWS x 0.75 x 4.70 SF/LF = 17.63 SF 37.50 144 j 37.25 144" TOTAL AREA = 605.13 SF PERC RATE <2 MIN/IN. ("C" HORIZON) Prepared for: Great Western Trust DESIGN FLOW PROVIDED: 0.74(605.13 GPD/SF) = 447.8 GPD > 440 GPD req'd NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN JOB. NO. DARREN M.MEYER,R.S. ECO-TECH ENV. NTS D.M.M. • I, Darren M. Meyer, R.S., CSE, hereby certify that 1 am currently approved by MADEP pursuant to 310 CMR 15.017 pOBOX981 (508) 364-0894 to conduct soil evaluations and that the above analysis hoe been performed by me consistent with the DATE CHECKED SHEET NO. EAST 508-3 requirements of 310 CMR 15.017. 1 further certify that 1 have passed the Soil Evol. Exam in October, 1999. SANDWICH,MA 02537 08-3t32-2922 09/O9/1 O D.M.M. 2 of 2