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0021 SAINT JOSEPH STREET - Health
21 Saint Joseph Street Hyannis. F/R A.= 291 157 i d i II _TOWN OF BARNSTABLE I c� T p LOCATION t �c W �h�s ��° SEWAGE# ` 3-' S T VILLAGE ASSESSOR'S MAP&PARCEL INNTREMWS NAME&PHONE NO. �A(-:L4L&_)o i\r k l SEPTIC TANK CAPACITY %OOCU wY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER ,r IL Ou('�,Q, PERMIT DATE: ATE 1 I� 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 St. Joseph's St. Water ervi:Nce - J 29 2 ;4 6 8' 54 vent r: TOWN OF BARNSTABLE G' 'LOCATION .7© S'i�,e 110 r- SEWAGE#�dda-a!-3 VILLAGEYA9 idi+✓! ASSESSOR'S MAP & LOT 9 - b INSTALLER'S NAME&PHONE NO.,A2 G A1 4rAQ-.1$7 SEPTIC TANK CAPACITY iS? w- ld ® / LEACHING FACILITY: (type 3 oa q �6 size)33.5- NO. OF BEDROOMS BUILDER OR OWNER CS T P'ERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by r, d O J A �, No. 7,002—2� • Fee—5_6 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zippficactfon for Mtgo f *p5tem Construction 3permit Application for a Permit to Construct( )Repair )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address of No. / Owner's Name,Address and Te.No. Assessor's Map/Parcel R E� `�yA/r' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 1*2G1-1 Co,1-3-T Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder) Other Type of Building S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow _ gallons per day. Calculated daily flow S 9` gallons. Plan Date 05 l0 Zd Number of sheets Revision Date Title �� l sr� � Size of Septic Tank sip d I' � Type of S.A.S. Description of Soil Nature of Repairs or Alterations Answer when applicable) (3) 5 a s - ,9��� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss by s B d ,Ilea Signed Date 7 0.2 Application Approved b Date Application Disapproved fol the following reas s Permit No. Date Issued 1 2.bz )-No. Zo0- 2.' 2� r ar 4 ;, _. Fee ' A Entered in computer: V THE COMM&NWEALTH OF MAS$ACHUSETTS Yes ,.�r... PUBLIC HEALTH DIVISION -TOWNiOF BARNSTABLE., MASSACHUSETTS 01pplication for Mi5po at *p$tem Con$truction 3permit ` 3 Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) O Complete System O;In tvidual;Components i . y Location Address o Lot No. /' Owner's Name,Address and Tel.No. Assessor's Map/Parcel Z Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Al C=%'I,--Z 31 Type of Building: { Dwelling No.of Bedrooms_ Lot Size sq.ft. Garbage Grinder,(v ) Other Type of Building { No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow�`d gallons per day. Calculated daily flow S / ' gallons. Plan Date 6 io ld Number of sheets Revision Date Title - - 'f�' Size of Septic Tank Type of S.A.S. t Description of Soil 4f-2cc) Nature of Repairs or Alterations�r(Answer �when applicable) eo r~l 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 H. ealthIf l Signed `;f - _ ^. Date 7/./ �--1<0 t Application Approved by* Date Application Disapproved fo the following,reas6s/ �l ,i;�:f S Permit No. '— Date Issued 2 O " - - - - - ----------- - 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`/ �'' --a at a % > r ? � r � '^"�" ha a constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. D 5ted Installer / f 7 :` Designer _ The issuance of this permits shall not be construed as a guarantee that the systemf will function as designed. Date / - Inspector (5, ry No. 2 OG 2_ 2 Fee C�-- �j THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS � I Miopo!6ar *patent C-ott5truction permit Permission is hereby granted to Construct,( )Repair O Upgrade( )Abandon( ) System located at / S 7 j -% - 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 us t be ompl�ed within three years of the date of this ".r_mi . Date: v b !-Approved y TOWN OF BARNSTABLE BAR-WM 3 c ' Ordinance or Regulation `� ,.. WARNING NOTICE (1V Name of Offender/Manager / Address of Offender ,` . � �t , � s ,� , j4V �tiM:MV/MB Re # Village/State%Zip VA rV N � �� ( C�'t. SS# � Business Name , /p �one 20t1.-.j --i. t Business Address ", / r' ', �% �t f`J. ,' , Signature of Ern"foi�reng`Officer Village/State/Zip , } Location of Offense 09 7 j t Ulro eV L11 � Enforcing Dept/Divisi'on Offense. r Facts MANY yAA 7 � �'�� �� � _ _ a `jAAV ff�1'�J]05, �}T, �y ]1 J,/`�1 �f/,/_�' jj j����q/j J//"�,�'rfgL� Jf //`� �/! 'y'^�'•J�� 1u �AW+ ) , }i� � 1....J ! R J fze [�,./ 7a.. feel This will servenly as a warning. At{this time rio'lega � action has been`taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate' legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD ENFORCING DEPT. . -.�..... ". F'^r-!i+t.^-Y-..,.vp�..nsysn .vi.ry.f"'..N s+�r '.t-�-..+... :.....'4.• '.y..: .�- aye v"�"..�t:-^' .. -"M - TOWN OF BARNSTABLE BAR-W MON + " Ordinancle or Regulation -- WARNING NOTICE 'Name of Offender/Manage*r\ A�/ �'� � t; Address of Offender j ., `+ `�$', t y t ' -MV/MB Reg.# Village/State/Zip # + ) ,',/ N � t f f � 6-, ^Business Name j v /pm , on f,. 20 } x -1 Business....Address Signature of En.forc I ng"Officer` Village/State/Zip Location of Offense 61 ` Enforcing Dept/Divisian Offe nse FactsOp V h This will serve n1 as a warning. At this time no legal action has`beenFtaken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal iaction by the Town. } WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. -k n" Commonwealth of Massachusetts M Title 5 Official Inspection Form Subsu.dace Sewage Disposal System Form - Not for Voluntary Assessments 21 St. Joseph's Street Property Address Kirk Curley Owner Owner's.Name information.is Hyannis MA 02601 December 17, 2008 .required for State Zip Code Date of Inspection every page. 'CityTown Inspection results.must be submitted on this form. Inspection forms may not be altered in.any way. . Important: A. General Information When filling out �� forms on the U computer,-use 1.. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name r� 189 Cammett Road Company Address Marstons Mills MA 02648 enm C ity/Town State Zip Code 508-428-1779 S1 12855 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my trafining and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of ' Title 5 (310 CMR 15.000). The system: ® .Passes ❑ Conditionally Passes 0,Fails ❑ Needs Further Evaluation by the Local Approving.Authority.. December 17, 2008 Inspector's Signature The system inspector shall submit'a copy.of this inspection.report to.the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If,the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original Should be sent to the system owner and copies sent to the buyer, if applicable, and the.approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 11 � OU 08-302 Curl ey.doc•08/06 Tille 5 official Inspection Form:Su rface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 21 St. Joseph's Street Property Address Kirk Curley Owner Owner's Name information is Hyannis MA 02601 December 17, 2008 required for every page. CityTown State Zip Code Date of Inspection " B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Tank is not in need of pumping at this time. Leaching chambers had no standing water or sidewall stains. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not_ determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced-With a complying septic tank as approved by the Board of Health. *A metal;septic tank will pass inspection if it is structurally sound, not leaking and if.a Certificate of Compliance indicating.that the tank is less than 20 years old is available. ND Explain: :. ElObservation of sewage backup or break out or high static waterlevel in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): . ❑ broken pipe(s) are replaced . , obstruction is removed 06302 Curley.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 St. Joseph's Street Property Address Kirk Curley Owner Owner's Name information is Hyannis MA 02601 December 17, 2008 required for y every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken, or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is,Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with.310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: - ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that-the sys em is functioning in a manner that protects the public health, safety and environment ❑. The system has a septic tank and soil absorption system (SAS) and the,SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within'a Zone 1 of a public water. supply. ❑ The system has a septic tank.and SAS and the SAS is within 50 feet of a private water supply well. 08-302 Curley.doc 08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 21 St. Joseph's Street Property Address Kirk Curley Owner Owner's Name information is required for Hyannis _MA 02601 December.17; 2008 - every page. City/Town State Zip Code Date of Inspection B. Certification (Cont.) C) Further Evaluation is Required by the Board of Health (cost.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system.passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System,Failure Criteria Applicable to All Systems: . You must indicate "Yes" or"No" to each of the following for all inspections: Yes No Backup of sewage into facility or.system component due to.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 die to an overloaded. El or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less ®. than day flow ® Required pumping more than 4 times in the last year NOT due clogged or El - obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or ® tributary to a surface water supply. 08-302 Curley.doc•08106 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 4 of 15 d i Commonwealth of Massachusetts r Title 5-Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 21 St. Joseph's Street Property Address Kirk Curley Owner Owner's Name information is Hyannis MA 02601 December 17, 2008 required for every page. CityFrown State Zip Code Date of,Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (coot.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ® Any portion of a cesspool or privy is within 50 feet of a private water supply El well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50.feet from a private water supply well with no acceptable water,quality analysis: [this system passes if the well water analysis, performed at a DEP certified laboratory., for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be'attached to this form.]El . ® The system is a.cesspool serving a facility with a design flow of 2000gpd7 1.0,000gpd. The system fails. I have determined that one or more of the above failure ❑. ® criteria exist'as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. - E) Large Systems: To be considered a large system the system must'serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no to each of the following, in addition to, he questions in.Section"D. Yes No ❑ the system is within 400 feet of a surface drinking water supply ❑ -❑ the system is within 200 feet of a tributary to'a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection ❑ Area- IWPA) or a mapped Zone II of a public water supply well if you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes"in Section D above the large system has.failed. The owner or operator of any large system,considered a.significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate . regional office of the Department. . sal System Page 5 0l 75 08-302 Curley.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Dispo • n . Commonwealth of Massachusetts, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 21 St. Joseph's Street Property Address Kirk Curley Owner Owner's"Name information is Hyannis MA 02601 December 17, 2008 required for every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following.have.been done. You must indicate "yes" or"no" as to each of the following'. Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out.in the previous two weeks? ❑ Has the system received normal flows in the previous two week period? Have.large volumes of water been introduced to the system recently or as part of ❑ ® this inspection? ® Were as built plans of the system obtained and examined?(if they were not El available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of breakout? ® ❑ Were all system components, excluding the SAS., located on site? ® ❑. Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,.depth of liquid, depth of sludge and depth of scum? Was the facility owner (and occupants if different from owner) provided with ® ❑ information on the proper maintenance of subsurface sewage disposal systems?: The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of.H.ealth. Determined in the field (if any of the failure criteria related to Part C is at issue ® approximation of.distance is unacceptable) [310 CMR 15.302(5)] 08-302 Curley.doc•08/06 Title 5 Official Inspection.Form:Subsurface Sewage Disposal System•Page 6 of 15 - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 St. Joseph's Street Property Address Kirk Curley -- Owner Owner's Name information is Hyannis MA 02601 December 17, 2008 required for — every page. Cityrrown State Zip Code Date of Inspection D. System Information - Residential Flow Conditions: . Number of bedrooms (design): 4 Number of bedrooms (actual): 3 440 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms):- 0 Number of current residents: Does residence have'a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? Yes ❑ No Seasonal use?, ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): .Sump pump? ❑ ,Yes ® No Vacant 2 Last date of occupancy: months. Commercial/industrial Flow Conditions: Type of Establishment:. Design flow(based on 310,CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present?. ❑ Yes ❑ .No Industrial waste holding tank present? ❑ Yes ❑ No Non=sanitary waste discharged to the Title 5 system? ❑ Yes .❑ No Water meterreadings,.if available: Last date of occupancy/use: : Date Other(describe): M302 Curley.doc•08/06 Title 5 Official Inspection form.Subsurface Sewage Disposal System Page 7 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form:- Not for Voluntary Assessments \a 21 St. Joseph's Street Property Address Kirk Curley ! Owner Owner's Name information is Hyannis MA 02601 December 17, 2008 required for every page. City/Town State Zip Code Date of Inspection i D. System Information (cont.) General Information Pumping Records: Tank pumped 2007 Source of information: Was system pumped as part.of the inspection? ❑ Yes ® No If yes, volume pumped:_ gallons How was quantity,pumped determined? Reason for pumping: Type of System Z Septic tank:, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and r . maintenance contract (to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval: ❑ - Other(describe): Approximate age of all components,date installed (if known).and source of information: -Compliance date: 7/18/02 _ . rr , Were sewage odors detected when arriving at the site? ❑ Yes ®:_No 08-3U Curley.doc•08/06 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 21 St. Joseph's Street Property Address Kirk Curley Owner Owner's Name information is required for Hyannis MA 02601 December 17, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 3, Depth below grade.: feet Material of construction.- 0 cast iron ® 4.0 PVC - ❑ other(explain): Distance from private water supply well or suction.line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan):, 3, Depth below grade: feet Material of,construction ®concrete . ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is.metal, list age: years l 'Is age confirmed by a Certificate of Compliance? (attach a.copy of certificate) ❑ Yes: ❑ No ' 8.5' long x 5.2'wide 1000 gal. Dimensions: . 2„ i Sludge depth:, f Distance from,top of sludge to bottom of outlet tee or baffle 28' Scum thickness" 6" #: Distance from top of scum-to top of outlet tee or baffle - Distance from bottom of scum.to.bottom of outlet tee or baffle 12' How were dimensions determined? Measured 08-302 Curley.doc•08/06 Title 5 Official Inspection Form,Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 21 St. Joseph's Street Property Address Kirk Curley Owner Owner's Name - information is required for Hyannis MA 02601 December 17, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet.invert, evidence of leakage, etc.): Tees found intact and clear, tank is not in need of pumping at this time. i Grease Trap (locate on.site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Scum thickness Distance from top of scum to top of outlet the or baffle Distance.from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date I: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity; ' liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): is Depth below grade: r Material of construction: t. concrete . ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 08-302 Curley.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form,- Not for Voluntary Assessments 21 St. Joseph's Street Property Address Kirk Curley Owner Owner's Name information is required for Hyannis MA 02601 December 17, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No I Alarm level: Alarrh in working order: ❑ Yes ❑ No . Date_of last pumping: date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required)_ Is copy attached? ❑ Yes ❑ No,. Distribution Box,(if present must be opened) (locate on site plan): 011 Depth of liquid Ievel.'above outlet invert P Comments'(note if box is level and. distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No solids or high stains: I t Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes. ❑ No . s; Alarms.in working order. ❑.Yes ❑ No 08-302 Curley,doc•08/06 - - Title 5 Official Inspection Form:.Subsurface Sewage Disposal System•Page 11 of-15 Commonwealth of Massachusetts W Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 21 St. Joseph's Street Property Address Kirk Curley Owner Owner's Name information is required for Hyannis MA 02601 December.17, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information (Copt.) Comments (note condition of pump chamber, condition of pumps and appurtenances,_etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: Three 500 gal drywells. ❑ leaching galleries number: i ❑ leaching trenches number, length: i ❑ . leaching fields: , number, dimensions: ❑ overflow_cesspool number. ❑ innovative/alternative system Type/name.of technology: I 1 Comments (note condition of soil, signs of hydraulic failure, level of ponding,`damp soil, condition of vegetation,etc.): K Chambers have no.standing water or sidewall stains. 08-302 Curley:dbc•08/06 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments a • 21 St. Joseph's Street. Property Address Kirk Curley Owner Owner's Name information is required for Hyannis MA. 02601 December 17, 2008 every page. Cityrrown State Zip Code - Date of Inspection D. System Information (cont) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan)` Number and configuration Depth—top of liquid to inlet invert i Depth of solids layer Depth of scum layer Dimensions of cesspool - Materials of construction 4 Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I. r Privy (locate on site plan): i Materials of construction: Dimensions I: Depth of solids ----- . Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): j r: y. t _ P. 08-302 Curley doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 r' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 21 St. Jose h's Street P `Properly Address Kirk Curler---- -- Owner. Owner's.Name information is required for Hyannis _ _ - MA 02601 December 17,,2008 eve Cit /Town every page. Y Slate Zip Code Dale of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate ail wells within 1.00 feet. Locate where public water supply enters the building. St. Joseph's St. ater. Service 29 2 68 . • 54 vent r; L 1 ` Commonwealth of.Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 21 St. Joseph's Street Property Address i Kirk Curley Owner Owner's Name i information is required for Hyannis MA 02601 December.17, 2008 every page. City/Town -S-ta`te Zip Code Date of Inspection i I i. D. System Information (cont.) - Site Exam: ® Check Slope f ® Surface water ® Check cellar s ® Shallow wells P Estimated depth to ground water: 5+ r feet Please indicate all methods used to determine the high ground water elevation: ! ❑ Obtained from system design plans on record i' If checked, date of design plan reviewed: Date j ® Observed site (abutting property/observation hole within 150 feet of SAS) I ❑ Checked with local Board of Health - explain: _ r ❑ Checked with local excavators, installers (attach documentation) ® Accessed USGS database =explain: 6' USGS topo map and town GIS. s You must describe how you established the high ground water elevation: 4; Town groundwater contour map shows water below el, 25 and topo map shows property at el. 50. I i . s. - - is - p p`. t.. 08-302 Curley.doc•08106 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 15 of 15 i. L9 C,A T 10N z ) S E W A G E PERMIT NO. ' VILLAGE I N S T A LLER'S NAME i ADDRESS i U I L D E R OR OWNER DATE PERMIT ISSUED o rg � 4 S S DATE COMPLIANCE ISSUED Q Co O ' J THE COMMONWEALTH OF MASSACHUSETTS' BOARD OF, HEALTH -xJ ....... ......... ..................OF.......... ......:...................._.. t. Appl ration for Disposal Morks 11onstrur#ion rrrmi# Application is hereby de fora Ptanit to Construct W) or Repair ( ) an Individual Sewage Disposal System at: Z ---......•--.....- ......_ ........ ...... ....-•-•-� - .... - - - ----•- Location-Address or Lot No. 025 •�-- ........... ..Ow.�.------.---•----- ........... ....... •----•----------•---- -------------- .........Address......................... .... ---•-----------------•--•--- ...... ..........-- Installer Address Type of Building Size Lot._` t. o�._..Sq. feet Dwelling—No. of Bedrooms.............................. ...........Expansion Attic ( ) Garbage Grinder (1 p, Other—Type of Building ............................ No. of persons.......:..................... Showers ( ) — Cafeteria ( ) aOther fixtures -------------- ....--....................................................... W Design Flow..........1r.0..........................gallons.per person per, day. Total daily.flow................5a C?................. WSeptic Tank—Liquid capacityl- gallons Length...1.1��.. Width..60.�a... Diameter................ Depth..-.--``-..... x P .. Total Length.....................Total leaching area._...._..--.._......sq. ft. Disposal Pit No.. _ �--------- Diameter Width - Depth below inlet.___.:......... Total leaching area... Z:-....sq. ft. Seepage Z Other Distribution box Dosing tank ( ) '~ Percolation Test Results Performed by...... ,...... --.----�-:-----. Date__.._._.1.` .�.�_____________ ,tea Test Pit No. 1.:!� ..,..minutes per inch Depth of Test Pit.A.414 ..... Depth to ground fi Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth:to ground water........................ 0 :---------------� �-:____.....-•---------.......... ,_.....--------:........------.......-.---------- ;--- -•-----------. Description of Soil.._0+ ! �s..............H- 1_-.�],'C`�........ = :-- -•-•-- l ca ��-----•-------• . x ..Ceti ...N1LOtiL) ! t' ....t�. ra_... ,l.aS1..........t _ca._._.�.:i� ,T � .. V = W -•-----•--------------- UNature of Repairs or Alterations—Answer when applicable............................................................................................... ..........................................-.............................................................................=................................................................................ Agreement: - A The undersigned agrees to install the aforede'sc ibed Individual dee ge Disposal System in accordance with the provisions of iITIE 5 of the State Sanitary e— The undersi�`.,$ further grees not to place the system in operation until a Certificate of Compliance has bee issued by the and f health. ��� Signed.._._.. .....•• - -•--- •........... ......... D to 1 _...._._..... Application Approved By........ --------• .....................................•-•--•-•---•--•-•------- 1 1 Date Application Disapproved for the following reasons:............•-••--------• :..�. ..... .................•---------...-•-•--........................... •..... Date .. N i Permt No...... �. ...._•------••--• s;,... ,„ ••-•---��---.. .._..-•-----•----- Issued. Da----te-------------------------••;;#�'{`~ ' ` -•` Its L/ .1�7 Z.- THE COMMONWEALTH OF MASSACHU�$ETTS N BOARD OF HEALTH ` ti Apphration for liopo�al Works Tonotrixr#ion "rrmff Application is hereby made fora Permit to Construct (N, ) or Repair ( ) an Individual Sewage Disposal System at: � s P :�:.. �... `"..�'!°r '�::.�'!-:... = .......................................�. .................:................. Location-Address or Lot No. ................ f.,� Ow Address .W r O �-, _ �}�- a --••---•--••-••••••-••••......�= -=-...-- ---(0---------------------------•------•------ .----------......_.....___ ............ Installer Address 4- Type of Building Size Lot._I...5_y: ._Sq. feet 0-4 Dwelling No. of Bedrooms________________________________ .Expansion Attic ( ) Garbage Grinder (V/) p, Other—Type of Building ............................. No. of persons..............:............. Showers ( ) — Cafeteria ( ) Otherfixtures -----••-•--••----------------------•----•-•••••------•------•-•-----------••••-----•-------•---•------•----•----•---------•••••-•-•-------•----•------ WW Design Flow..........�!/�____.....--••-------•----•gallons per person per, day. Total daily flow-------------ems= . ----------:---•--gallons. WSeptic Tank—Liquid ca.pacityi t gallons Length.._. "P_ Width.C�_:' 4_ Diameter_ -•---_--. Depth__j'_'/.._. x Disposal Trench—No. __'. ............ Width........._......__ Total L th............. Total leaching area...... . 4_../...___....sq. ft. 3 Seepage Pit No--------_��..........._ Diameter._....C>..__..._. Depth below inlet..__...'......_. Total leaching area.... ft. Z Other Distribution box (V) '` Dosing tank ( ) ' Percolation Test Results Performed by......Z'A t'.� '! __... :..___. Date...... ............ ,0.4a Test Pit No. I_`'.�2._:.minutes per inch Depth of Test Pit----(4.14..._._. Depth to ground water_.>.�"�'�'� Test Pit No. 2`, �nuiuteper/ncla� Depth of Test Pit.................... Depth to ground water........................ O Description of Soil ,..... 7U 1. ._.�! ....... ���a1��j- D.........................► ._. j_�-1`` }......................................................................... .......... -•- tA .�C car.a-----Mom» ---T c r -'A aY ` ._ ...... W ••••-..._ ...•--••-••--••-•-•----•-•-•......................•••--•-••••••••- UNature of Repairs or Alterations—Answer when applicable___._.._...r.................................................................................. .........................=.............................................................................................................................................................................. Agreement: The undersigned agrees to install the afore es ibed Individual a ge Disp al System in accordance with the provisions of TITL% 5 of the State Sanitary e— The under, d further grees not to place the system in operation until'"a.Certificate of Compliance has bee •ssued b the health. Si. ed._.. ._ D te._.....__.. f y Application`Approved By..... .......... �"` . r} ....................................... -�_ _j D ate Application Disapproved for the following reasons------------------------••-------------------•-•-------•-----•-------•---------------..••._...-•••-•--........._ --••----•••-•..................•--•-......... •••. r-.••......._. ._...__........._•4 .... _---•'-•--------------•--..._..-•-•-•---•--'•Date--••-•----•--- Permit"No......Q.Y ?._-!_-............ ssued_...................................................... ..« .. Date THE COMMONWEALTH OF-MASSACHUSETTS ` BOARp 'OF.�; HEALTH ..........................................OF................ ............................... t'_Trrfifirtttr of Tomplittnrr THISly Tp CB�TIFY,That the Individual Sewage Disposal System constructed or Repaired by----•-_..••......... ..........•- --•.......••••-••.........__I ler -- --•--^---- --•--__.........._.._ ------- at•-•--••--•••----•-••• •--- -----------••-- .. --••-• --•-- •--•••••--•-••--•••••••-•..._•-•-•••••• -•-----••-- has been installed in accordance' with the provisions of TIT�yF 5 of �The State§Sanitary- Code as described in the application for Disposal Works Construction Permit No. Y-�..�- --/---:-----•----- dated..........................................:. . THE ISSUANCE OF0 THIS. CERTIFICATE SHALL NOT BE CONST ED S A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � ' �a, � � ,-/� �. 9 �' 1 y DATE........... + ::. 1•----••••--•••--••---• Inspector-------- -- ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .k i • ••--••-•.....•--•--.....••••.......•••............. aJ 1� _ ...-:.:..OF............................... . NoJ 7 .. FEE.:.................. Rsvos Mork Tonstrurtiotn vrrmii Permissio - hereb ranted__._.... . - y to Construct i o epair �� an Sl � t l Skm7y Disp Stem � atNo..•-••-.•••---......--•••-•--•••-•----•••-••-...--•-••...... •......•--•----------•••---------- - `l'j� Street r+�)�•/ O7 r J as shown on the application for Disposal Works Construction P rmit No.......+.77_......_-.......`......_Ij/DJ'ate�i_.__f(_i3............................. c _______.......................................... ...-------- Board of Health " DATE........... ..^......... ------------...••••- 3 t Z �03 ' 499 038 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not a for Intemation Mail Se reverse Sent to St Num Po t Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee CO) Return Receipt Showing to Whom&Date Delivered a Return Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees $ CO) Postmark or Date W7 LL W a a Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return 6 address leaving the receipt attached, and present the article at a post office service II window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the Q) return address of the article,date,detach,and retain the receipt,and mail the article. U) 3. If you want a return receipt,write the certified mail number and your name and address °' rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee,endorse RESTRICTED DELIVERY on the front of the article. 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. ro 6. Save this receipt and present it if you make an inquiry. 102595-97-8-0145 oFET Town of Barnstable Department of Health, Safety, and Environmental Services 9� 1639. �0� Public Health Division A'EDN1°�A P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health April 26, 1999. Mr. & Mrs. Jay Curley 24 Yale Avenue Wakefield, MA 01880 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410 00 STATE SANITARY CODE II MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE BOARD OF HEALTH NUISANCE CONTROL REGULATION NUMBER ONE The property owned by you located at 21 St. Joseph Street, Hyannis was inspected on April 23, 1999, by Jerry Dunning, Health Inspector for the Town of Barnstable, because of a complaint. The following violations of the Nuisance Control Regulation Number One Regulation and the Sanitary Code II were observed: 410.600: Storage of garbage and rubbish. Plastic bags of garbage at rear of property. Several old mattresses on the ground under rear deck. You are directed to correct this violation within five (5) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven(7) days after the date order is received. However, this violation must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. P + ORDE -OF THE BOARD OF HEALTH omas A. McKean Director of Public Health curley/wp/q/Is Y&Aj- Vls&Av, dti , o I? `o NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE BOARD OF HEALTH NUISANCE CONTROL REGULATION NUMBER ONE The property owned by you located at �„ I ,�`� ` � s fi' Nh was inspected on 1997, by Health Inspector for the Town of Barnstab e, because of a complaint. The following violations of the Nuisance Control Regulation Number One Regulation and the Sanitary Code H were observed: �b �oc, sr K S at You are directed to correct violations within of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven(7) days after the date order is received. However, this violation must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health M 7 PAR ] Real Estate System - General Property Inquiry] Help [ ] Parcel Id: 291 157- - Account No: 20024 Parent: Location: ST JOSEPH ST Neighborhood: 62AC Fire Dist: HY Devel Lot: 31 Lot Size: .34 Acres Current Own: CURLEY, JAY J & ANNETTE K State Class: 101 24 YALE AVE No. Bldgs: 1 Area: 1344 Year Added: WAKEFIELD MA 1880 Deed Date: 090188 Reference: 6422/266 January 1st: CURLEY, JAY J & ANNETTE K Deed MMDD: 0988 Deed Ref: 6422/266 Comments: Values: Land: 20100 Buildings: 112900 Extra Features: Road System: 21 Index: 1408 (SAINT JOSEPH STREET ) Frntg: 76 Index: ( ) Frntg: Control Info: Last Auto Upd: 050695 Status: C Last TACS Update: 091989 Land Reviewed By: Date: 0000 Bldgs Reviewed By: ML Date: 1087 Tax Title: Account: Taken: Account Status: Hold Status: Cancel [ ] Press XMT for more data Next screen [QAR ] Action [ ] Owners Name [ ] Road Index [ ) Road Name [ ] Parcel Number [291] [ 158] [ ] [ ] [ ] Firs UNITED STATES POSTAL SERVICE Postage& Mail Postage&Fees Paid USPS Permit No.G-10 o Print your name, address, and ZIP Code in this box o Public Health Dhf8108 Town of Bamstable PC..Box 534 Mmwbusetts 02601 l a; SENDER:o I also wish to receive the ■Complete items 1 and/or 2 for additional services. N ■Complete items 3,4a,and 4b. following services(for an 0 ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. g d ■p rtn i this form to the front of the mailpiece,or on the bads if space does not 1. ❑ Addressee's Address Z ■Write'Retum Receipt Re uested'on the mail ieoe below the article number. m d P a p 2. ❑ Restricted Delivery rn ■The Return Receipt will show to whom the article was delivered and the date c delivered. Consult postmaster for fee. a d 3.Article Addressed to: 4a.Article Nu ber E , 4b.Service Type V ❑ Registered a Certified Ir o W f i ❑ Express Mail ❑ Insured W G7 � /i ❑ Return Receipt for Merchandise ❑ COD � 7.Date of Delivery w p 5.Received By:(Print Name) 8.Addresse 's Address(Only if requested UJIand fee is paid) t o 'q P i Receipt f ^` TOWN OF BARNSTABLE f -7 cI7 '�a zv--la C� v �� `3e c SEWAGE # �6 -H;` ' :(�X,A 1 SON VILLAGE ASSESSOR'S MAP & LOT2 INSTALLER'S NAME&PHONE NO. ¢ rw� � SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) 'q Y4, ?d NO.OF BEDROOMS BUILDER OR OWNER f' k-- "��� Ye / PERMIT DATE:/��` "�, COMPLIANCE DATE:Z! "" 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 f v S i � t,J � u qj. ; ^- • ASSESSORS MAP N� / 3�✓J No. .� PA�\iQ IdV. .F W / Fee L THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppfication for Digool *p.5tem Construction Permit Application is hereby made for a Permit to Construct( )or Repair( an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Q I ST ,7So-c 3S � i �' :Zw-1 COAey Installer's Name,Address,and Tel.No. Designer's Name,AdZicess and Tel.No. Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow J gallons per day. Calculated daily flow --2>2�P gallons. Plan Date Number of sheets Revision Date Title Description of Soil _ bu of 6J� Nature of Repairs or Alterations(Answer when applicable) \yo® Z), 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 b is Boar Sig ed I Date Application Approved by Application Disapproved for the following reasons Permit No. �� � Date Issued ��v � � Y ..-,:. ..• .....+-rK.4 ,..„."r ��.•i t.,i^"^..»^- ,,.,r;,,,,'..�"'`sfarr`1:...* +r:...:..'-v.r..�w6:+Y,.a...e*nv°y.*.r'`JK�'"I.�w/... -..,. .*...• -sKi�.+.« No. v /�7 Fee.. L.. 1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC"HEALTH DIVISION--TOWN OF BARNSTABLE., MASSACHUSETTS . Application for Migpogal *pgtem Cow6truction Permit Application is hereby made for a Permit to Construct( )or Repair( an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. - lr Installer's Name,Address,and Tel.No., m Designer's Name,Address and Tel.No. o �5 if Type of Building: 1 Dwelling No.of Bedrooms/ = Garbage Grinder( ) Other Type of Buildin No.of Persons Showers( ) Cafeteria( ) Other Fixtures - -�_ .0 Design Flow 7 gallons per day. Calculated daily flow 3 3� gallons. Plan Date Number of sheets Revision Date Title Description^of Soil G L yA e Q_ Nature of Repairs or Alterations(Answer when applicable) _ W sYa(1 h, w ( oy� OYCK- \boo Sr-pc Y 4 w Gf Date last inspected: f 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 b 's Boar Sig ed 1 `Z- Date Application Approved by Application Disapproved for the following reasons 1-- i Permit No. 7 Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS Certificate of Compliance - THUIS IS TO C,E I Y, at th�ell,- ite Sewage Disposal System installed( )or,,.repaired/replaced(✓)on / -',F5 by 1<v � -- 1� `�s for Cv v 6�/ as SS- has been constructed in accordance with the provisions of Title Sand the for Disposal System Construction Permit dated Zl—o /�44t -� Use of this system is conditioned on compliance with the provisions set forth Blow: ol ®--®----------- No. .-.. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lwigogal *pgte'mc Con!5truction Vermit Permission is hereby granted to a 0_`Y �--��As to construct( )repair( �an On-site Sewage System loca�ed at .� 1 S 1 1 Uz-S�p4. ST 1 tic Y_ 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. All construction must be completed withi lwo years of the date below. 7 Date: /v�~ Approved b /��--' k CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) �616&A-S , hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at oZ 5 '�O�S�' S�' meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system The observed groundwater table is 14 feet or greater below the bottom of the leaching facility There is no increase in flow and/or change in use proposed There are no variances requested or needed. SIGNED: DATE: LICENSED SEPTIC SYSTEM INSTALLER rN THE T OWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. e e' r ED g V'j ` y Qr N ry\ T TOWN OF BARNSTABLE LOCATION �-f ✓/ • _ Sn'r T SEWAGE VILLAGE X/ „S„yt S ASSESSOR'S MAP & LOT - „ ., Al�' ^ INSTALLER'S NAME&PHONE NO., d 14 e- 0.ems T� S y� SEPTIC TANK CAPACITY 3 as q �� size)�3. X(3 X2 LEACHING FACILITY: (type e i NO. OF BEDROOMS BUILDER OR OWNER PERMIT DATE: Z Gr COMPLIANCE DATE: �� �� i Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland,and Leaching Facility (If any wetlands exist Feet within 30 0 feet of leaching facility) Furnished by �� 79 --36/ r. FRw.ca 20 FT MIN. TOP OF FOUND. I} 0-0-- 6.01 EL - /, 10 FT MIN CONCRETE4 SCH 40 PVC CLEAN SAND COVERSPIPE- MIN. PITCH CONCRETE 1/8'' PER FT COVER 4" CAST IRON 2" LAYER OF 12 MAX — -PIPE - MIN. PITCI-' i � � I/8"- I/2" WASHED 1/4 PER FT � STONE FLOW LINEZAuN�BErry 110� E L - c\j / MIN.EL = �/% - EL 'EL LOCATION MAPL DIST ELBOX n3/4"- 1 1/2" - ` p t,WASHED STONE '�, �'ULl oLL vLJ G °GAL, PRECAST LEACHINGBASIN OR EQUIV.SEPTIC TANK - - I BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE EL. = T PROFILE OF GROUND WATER TABLE( / / ) EL. _ SEWAGE DISPOSAL SYSTEM NOT TO SCALE DESIGN CALCULATIONS 6 - ,- . SOIL TEST NUMBER OF BEDROOMS _— DATE OF SOIL TEST GARBAGE DISPOSAL UNIT �1��_ --- j� TOTAL ES iMATED FLOW WITNESSED BY _ R . - 1FFct�D ) - __ SAL /DAY PERCOLATION RATE MIN./INCHGAL. /BR /DAY x3BR REQUIRED SEPTIC TANK CAPACITY _ 1 -.` _ GAL OBSERVATION HOLE I OBSERVATION HOLE 2 'V • t - _ _ ACTUAL SIZE OF SEPTIC TANK. _GAL. - ELEVATION = 9 ELEVATION = DrST R I f(_1 �' LEACHING AREA REQUIREMENTS Li SIDEWALL AREA �_�_ GAL /S.F r T r;_.f- d :)Uk: Salt_ � 1 h ri r c P � rz' \� I , 1 BOTTOM AREA 'j GAL./S.F. (assL a/oac � LEACHING CAPACITY ( BOTTOM + SIDEWALL) . 54 ' GAl- 4 ' ,. LrLACRESERVE LEACHING CAPACITY -��+'y•- Sy CLE.AN /,lEmuM To I� LOT 31 �R Rv C4fi1�5� 5,4NC� `rl : l5,G U 0 S F : /44 j " i_. T 2-7r 9g ® -7 Z NOTES FOUND 00 'CI' .-f I ALL WORKMANSHIP AND MATERIALS SHALL r CONFORM L TO D.E Q. E TITLE 5 AND THE TOWN OF 8A10, P L LJ} RULES AND REGULATIONS FOR SUBSURFACE DISPOSAL OF SANITARY SE WAGE 2 ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 12" OF FINISHED GRADE. -" - 3 EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY I _ _ THE SAME. MIN FRONT SETBACK REV. Y 17 - <55 MIN. REAR SETBACK �r �._ 4. NO DETERMINATION HAS BEEN MADE BY THIS OFFICE AS TO MIN SIDE SETBACK COMPLIANCE WITH TOWN ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. APPROVED : BOARD OF HEALTH DATE AGENT PROJECT LOCATION CT .31 T S ;_ PH _ST, eARIVS 1-,A6LL, /4,4. APPLICANT ,a►Fe.. x,w,,, tH OF JN OF +.�, ,. LEGEND o R JAMES I`- lAMfS �; N �,� SCALE DR BY DATE O'HE694 - '977 EXISTING SPOT ELEVATIONS 00 0 IU �•694�� RICJAR : (- �rtGL ��u X `Gir�j�t IIEAFtr JOB NO APPD. BY REV EXISTING CONTOUR - - - - - - 00 - - - - - •� - FINAL SPOT ELEVATIONS ---- SRHIIA �'' 000 FINAL C O tv T 0U R — rr✓�!-- rER� R. J. O/HE�4R/V /IVC. DRAWING SITE PLAN SOIL TEST LOCATION Al LA REG. LAND SURVEYORS- REG. SAN/TAR/ANS NO. � --- C 35 ROUTE 134 — UNIT 2 SOUTH DENNI S , MASS. OF �J LDWS ASSESSORS MAP : 191 TEST HOLE LOGS NOTES: N PARCEL : I57 �A 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH y SOIL EVALUATOR :� wz&A �"I f"t�/ 5 THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF FLOOD ZONE: -yam--WITNESS : BOARD OF HEALTH REGULATIONS. �1�} REFERENCE: tq[4 DATE: JuNg 7 24�)2 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, PERCOLAT I ON RA II E: SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO P CLASS r C p 1 L („ jQ _C� '-� L INSTALLATION. �i TH- 1 EL. 3I.'�`� TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION WEST d 'I ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE A � f lol R3�Z DETERMINATION. AM 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS SPECIFIED OTHERWISE) LOCATION MA P(W1;5) q 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A GARBAGE DISPOSAL. M P(LA4 IP C 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON 11 / A BASE OF 6"OF CRUSHED STONE. ltot I� 4� 9) P S No C.1�.ou��W1� T SEPT I t. SYSTEM DES I G N CA"- co A FILL ' fie.-P v EEO I"' ---�-- ----- /o) Ny AWawN Aei t/AZ WELL eswbw/.SO O'CA ao� r 134. FLOW E 3T I MATE U t1T= NQ5 W/l/U LSDrPgw_-o—o-S-� -�- 301t� A S� ter. 8 � �� EEIROOMS AT I10 GAL/DAY/BEDROOM GAL/DAY D 20 �` SEPTIC TANK 33.s J_ GAL/DAY x 2 DAYS - ?90 GAL 0 0 0 40' USE IC,UQ GALLON SEPT I C TANK —6 pST1% . E !l= k / �p�sK- 48 SOIL A3SORPT I ON SYSTEM 'or b6E 3) Scr1 C oi.,r -%e 6,+Sr�a Ac, L zee. r � � -..s �) � �..`— �_ � I/'f�`.4l �"�L,��✓f `°'t'° :�/i/j�1%L. (Ui,4� i1'.-L ��r�v,� JP.� I�Z 11 0'7 V 41 rN) spy 4s � t • � S 2+ �3� 2 x 2 x C�,? 1 3 7, 6 - SIDE AREA: 33. 7y � 3V �i,�t3 u4 Prr EOTTOM AREA: 33,Sx L� X o, 2-7 o NOM 9� SEPT 1 C: SYSTEM SECTION ° ° r&�' �xt5n '' � Tod� cer .31►7S .�_ _.�..__ �/ .., n 3( E 7-or- � 3t.7S' � �7,Ug to �. z -� shed sWne_ one c-) --- D-BOX 75jv �7 7 GAL 2�, Iq l�akr Est ER.23. 8Z SEPT I C TANK � _ � 45Xn iS , 1�t3 3 ZS• Z �¢ 1 Z po ubte WR she.,l Sivn,--, S. ., 7S.6s r / &(twi o+= Tii-myoc,E EL ' SITE AND SEWAGE PLAN z F�- LOCAT I ON : 2- ( 5F jOSQf# :57 ZE MEYEK 01140 r �E®SAS PREPARED FOR WAKE 610-11- MA- P DARREN M. MEYER, R.S. SCALE: l'=2U1 ` 43 VINE STREETDATE: _ - y DUXBURY, MA 02332 W DATE HEALTH AGENT (781) 585-0293 Z 1 � i