Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0005 SUNNY-WOOD DRIVE - Health
�4 7 Melbot l,e Road -- l ` - 5A unriywood Hyannis A= 273 - 236Llf K1 M � o 0 D Q } o a •N y� 92 Commonwealth of Massachusetts ,lp Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments -t-I / M 5 Sunnywood Dr. C Property Address `y Barber Drywell Inc. 270 Communication Way Owner Owner's Name information is ✓ required for every Hyannis MA 02601 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in iany way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information Sly !358 on the computer, use only the tab Paul C. Martin key to move your Name of Inspector cursor-do not Cape Cod Septic Services Inc. use the return Company Name key. 350 Main Company Company Address West Yarmouth MA 02673 City/Town State Zip Code remo 508-775-2825 S15016 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 1 2/4/2019 6 In pector's Signa ure - Date 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 / Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v� 5 Sunnywood Dr. Centerville, MA 02632 Property Address Barber Drywell Inc. 270 Communication Way Owner Owner's Name information is Hyannis MA 02601 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 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: System in working condition. 2) 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. Check the box for"yes", "no" or"not determined" (Y, N, ND)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. ❑ Y. ❑ N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts 1p Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments • 5 Sunnywood Dr. Centerville, MA 02632 Property Address Barber Drywell Inc. 270 Communication Way Owner Owner's Name information is Hyannis MA 02601 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N FIND (Explain below): ❑ obstruction is removed ❑ Y ❑ N FIND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): I 3) 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. a. 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 5 Sunnywood Dr. Centerville, MA 02632 Property Address Barber Drywell Inc. 270 Communication Way Owner Owner's Name information is Hyannis MA 02601 required for every y page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ 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. ❑ 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 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 must be attached to this form. c. Other: 4) .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 t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �V 5 Sunnywood Dr. Centerville, MA 02632 Property Address Barber Drywell Inc. 270 Communication Way Owner Owner's Name information is Hyannis MA 02601 required for every y page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or 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. ❑ ® Any portion of a.cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [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.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. 1 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. 5) 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 the questions in Section CA. 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 l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 r I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 5 Sunnywood Dr. Centerville, MA 02632 Property Address Barber Drywell Inc. 270 Communication Way Owner . Owner's Name information is Hyannis MA 02601 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: 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 available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® El information 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 Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] l5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments . 5 Sunnywood Dr. Centerville, MA 02632 Property Address Barber Drywell Inc. 270 Communication Way. Owner Owner's Name information is Hyannis MA 02601 required for every Y page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 110x4= 440gpd Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage d N/A Vacant 9 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Est 2015Date l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 ,s Commonwealth of Massachusetts Ip Title 5 Official Inspection Form rlo Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 5 Sunnywood Dr. Centerville, MA 02632 Property Address Barber Drywell Inc. 270 Communication Way Owner Owner's Name information is Hyannis MA 02601 required for every y page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: "Last date of.occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: No records Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped:. gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 I I ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 5 Sunnywood Dr. Centerville, MA 02632 Property Address Barber Drywell Inc. 270 Communication Way Owner Owner's Name information is Hyannis MA 02601 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® 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 maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1988 Per BOH records Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): " Depth below grade: 31 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): +10' Distance from private water supply well or suction line: feet Comments ('on condition of joints, venting, evidence of leakage, etc.): Line checked with sewer camera and was found to be clean, properly pitched with no sign of root intrusion. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System.Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form .�' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 5 Sunnywood Dr. Centerville, MA 02632 Property Address Barber Drywell Inc. 270 Communication Way Owner Owner's Name information is Hyannis MA 02601 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 21"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000Gal Sludge depth: 4-6" Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 3-4" Distance from top.of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Estimated Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1000Gal tank in good structural condition. PVC tees in place. Tank at normal operating level. Covers 21" below grade. l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 5 Sunnywood Dr. Centerville, MA 02632 Property Address Barber Drywell Inc. 270 Communication Way Owner Owner's Name information is Hyannis MA 02601 required for every y page. City(rown State Zip Code Date of Inspection D. System Information (cont.) 7. 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 tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑.metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts ,lw� Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ., 5 Sunnywood Dr. Centerville, MA 02632 Property Address Barber Drywell Inc. 270 Communication Way Owner Owner's Name information is Hyannis MA 02601 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm 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 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 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.): H-10 DB-3 with 1 line in and 1 line out in fair condition. Box showing some wear but walls are intact. Minimal solids carryover. No sign of overloading or hydraulic failure. Cover 30" below grade. l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form _ la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;v 5 Sunnywood Dr. Centerville, MA 02632 Property Address Barber Drywell Inc. 270 Communication Way Owner Owner's Name information is Hyannis MA 02601 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order,system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located,. explain why: Type: ® leaching pits number: 1-6x8 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system I Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 5 Sunnywood Dr. Centerville, MA 02632 Property Address Barber Drywell Inc. 270 Communication Way Owner Owner's Name information is Hyannis MA 02601 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 1-6x8 Leach pit with stone. Pit found dry during inspection. No evident staining. No sign of overloading or hydraulic failure. Cover 10" below grade. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth.of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 5 Sunnywood Dr. Centerville, MA 02632 Property Address Barber Drywell Inc. 270 Communication Way Owner Owner's Name information is H annis MA 02601 required for every y page. City(rown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 118 Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments I 'L ji 5 Sunnywood Dr. Centerville, MA 02632 Property Address i Barber Drywell Inc. 270 Communication Way Owner Owner's Name information is Hyannis MA 02601 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building..Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5insp.doc-rev:7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 5 Sunnywood Dr. Centerville, MA 02632 Property Address Barber Drywell Inc. 270 Communication Way Owner Owner's Name information is Hyannis MA 02601 required for every y page. City(rown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: +14' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Hand auger 4' below bottom of dry pit with no water encountered. Bottom of pit at 14'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 5 Sunnywood Dr. Centerville, MA 02632 Property Address Barber Drywell Inc. 270 Communication Way Owner Owner's Name information is Hyannis MA 02601 required for every y page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 1.5: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Assessing As-Built Cards Page 1 of 2 W`A/TOWN OF BARNSTABLE LOCATIONS `� i I �.li / .;/ WAGE# ,'_ V / VILLAGE Y'1 /(e" ASSESSOR'S MAP& LOT�73� 231 INSTALLER'S NAME Sr PHONE NO. J l PP �L� L41,e, SEPTIC TANK CAPACITY_ 100o LEACHING FACILITY:(type) /Q T /wbC (j(' ( (size) NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATERAbl_*) o BUILDER OR OWNER YU(-C, ;��,.s -�% �i; l c DATE PERMIT ISSUED:. DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No i I I I 60 � G It, http://web.townofbarnstable.us/Departments/Assessing/Property_Values/HMdisplay.asp?... 1/24/2019 iU.S. Postal � - CERTIFIED MAIL,,, RECEIPT (DomesticOnly; . Insurance Coverage Provided) m CO For delivery UFICIS • F�ation visit our . L t www.usps.c U • me ul Postage $ 37 p Certifled Fee 9 �U �JdSn O Postmark p Return Reclept Fee ' C Here (Endorsement Required) ?J ♦ r-3 Restricted cO (Endorsement Required)Fee �� ,`0 ` i �z� Total Postage&Fees $ � m E3 Sent To S��_c_Q✓ C v�✓le �` 34reet,Apt No.p.. --•--•---------------- ---............................... orPO Box No. vn/Iy_ e S v e wog--• Qt 4 �—`' - .. Z/P+ F 'L/ o a 6 3 PS Form 3800,June 2002 Certified Mail Provides: A mailing receipt ra�a�aa)aooa eunr'ooac uuod Sd ■ ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for tWo years Important Reminders: • Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. M rp.q� ■ For an additional.fee,,a Return Receipt may be requested to provide proof of delivery".'To obtai"eturn Receipt service,please complete and attach a Return Receipt(PS Form 8811)�to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,la USPS®postmark on your Certified Mail receipt is regwre0 • Fo'r, an additional''fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ■ If a postmark-on-the Certified Mail receipt is desired,please present the arti- cle at the post,office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. Y t<y ti�.- a 7�r Z3� Certified Mail#7003 1680 0004 5458 3497 Town of Barnstable Regulatory Services anrsrAe» * Thomas F. Geiler,Director Public Health Division C-t� A14W Thomas McKean,Director / 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Sandra E. Humey November 1, 2005 5 Sunny-Wood Drive Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE. The property owned by you located at 5 Sunny-Wood Drive, Hyannis, was inspected on October 28, 2005 by David W. Stanton R.S., Health Inspector for the Town of Barnstable, and Russ Wheeler, Building Inspector for the Town of Barnstable, because of a complaint. The following violations of the State Sanitary Code were observed: 105 CMR 410.400(A): Minimum Square Footage: 3 occupants in illegal apartment. The :minimum 450 square feet of habitable floor space was not observed. 105 CMR 410.351: Owner's Installation and Maintenance Responsibilities: The bathroom floor was "soft" and several floor tiles were observed cracked. 105 CMR 410.500: Owner's Responsibility to .Maintain Structural Elements: There is chronic dampness present in the bathroom as observed by all the mold present on the wall behind the toilet. 105 CMR 410.452: Safe Condition: The walkway to the illegal apartment was unsafe, with loose bricks and a PVC pipe sticking out of the ground observed. 105 CMR 410.100: Kitchen Facilities: No kitchen sink or stove provided. 105 CMR 410.351: Owner's Installation and Maintenance Responsibilities: Several light switches were observed without face plates. 105 CMR 410.351: Owner's Installation and Maintenance Responsibilities: The shower is inoperable. 105 CMR 410.482: Smoke detectors: No smoke detectors were provided in this illegal apartment. The following violations of the Town of Barnstable Code were observed: Q:Order letters/Housing violations/5 Sunny-Wood Drive.doc & 232-5 of the Town of Barnstable Code: Assessors records indicate you have at least 4 bedrooms at said location. You are limited to 3 bedrooms at said location per septic permit 1988-162. & 353-1 of the Town of Barnstable Code: A large pile of rubbish was observed in the back yard. It is noted that there are no building permits on file with the Building Department for this illegal apartment. You are directed to correct all of the State and Town of Barnstable Code violations listed above within thirty (30) days of your receipt of this notice by obtaining the necessary building permit(s) to remove the illegal apartment, by reverting the property back to a three bedroom dwelling, and by removing and disposing of the rubbish in the backyard properly to a licensed facility. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. + ORD +R OF HE BOARD OF HEALTH Thomas A. McKean, R.S. Director of Public Health Town of Barnstable Cc: Building Department Hyannis Fire Department Jennifer Kelly, Tenant Q:Order letters/Housing violations/5 Sunny-Wood Drive.doc McKean, Thomas From: Crocker, Sharon Sent: Tuesday, December 06, 2005 3:18 PM To: McKean, Thomas; Stanton, David Subject: Hearing on Housing-5 Sunnywood Dr, Cent I spoke with Herb Loch, atttorney for Sandra Hurney. He was not expecting to go to meeting. He asked if we could postpone putting it on agenda. He feels the tenant will move. The tenant originally sued landlord in small claims on "alleged claims that Landlord owed him money for work"to combat the rent due. Tenant signed agreement to drop small claims and Landlord agreed to drop rent due. Tenant said he would move out Dec 4. This has not happened yet but attorney hopes to see him move shortly and asks if we can wait before having a hearing. Certified Mail#7003 1680 0004 5458 3497 oYY Town of Barnstable �. Regulatory Services nA>�aysrAB>.e Thomas F. Geiler,Director NAfiS o;pyA' Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Sandra E. Hurney November 1, 2005 5 Sunny-Wood Drive Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE. The property owned by you located at 5 Sunny-Wood Drive, Hyannis, was inspected on October 28, 2005 by David W. Stanton R.S., Health Inspector for the Town of Barnstable, and Russ Wheeler, Building Inspector for the Town of Barnstable, because of a complaint. The following violations of the State Sanitary Code were observed: 105 CMR 410.400(A): Minimum Square Footage: 3 occupants in illegal apartment. The minimum 450 square feet of habitable floor space was not observed. 105 CMR 410.351: Owner's Installation and Maintenance Responsibilities: The bathroom floor was "soft" and several floor tiles were observed cracked. 105 CMR 410.500: Owner's Responsibility to Maintain Structural Elements: There is chronic dampness present in the bathroom as observed by all the mold present on the wall behind the toilet. 105 CMR 410.452: Safe Condition: The walkway to the illegal apartment was unsafe, with loose bricks and a PVC pipe sticking out of the ground observed. r 105 CMR 410.100: Kitchen Facilities: No kitchen sink or stove provided. 105 CMR 410.351: Owner's Installation and Maintenance Responsibilities: Several light switches were observed without face plates. 105 CMR 410.351: Owner's Installation and Maintenance Responsibilities: The shower is inoperable. 105 CMR 410.482: Smoke detectors: No smoke detectors were provided in this illegal apartment. The following violations of the Town of Barnstable Code were observed: Q:Order letters/Housing violations/5 Sunny-Wood Drive.doc § 232-5 of the Town of Barnstable Code: Assessors records indicate you have at least 4 bedrooms at said location. You are limited to 3 bedrooms at said location per septic permit 1988-162. 4 353-1 of the Town of Barnstable Code: A large pile of rubbish was observed in the back yard. It is noted that there are no building permits on file with the Building Department for this illegal apartment. You are directed to correct all of the State and Town of Barnstable Code violations listed above within thirty (30) days of your receipt of this notice by obtaining the necessary building permit(s) to remove the illegal apartment, by reverting the property back to a three bedroom dwelling, and by removing and disposing of the rubbish in the backyard properly to a licensed facility. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S. Director of Public Health Town of Barnstable Cc: Building Department Hyannis Fire Department Jennifer Kelly, Tenant Q:Order letters/Housing violations/5 Sunny-Wood Drive.doc AV ARDITO, SWEENEY, STUSSE, ROBERTSON & DUPUY, P.C. ATTORNEYS AT LAW 25 MID-TECH DRIVE, SUITE C WEST YARMOUTH, MA 02673 (508) 775-3433 Telephone (508) 790-4778 Facsimile Edward J.Sweeney,Jr. Thomas P.Carpenter Michael B.Stusse Kelly S.Jason Donna M.Robertson Herbert F.Lach,Jr. Matthew J. Dupuy Tracey L.Taylor Charles M.Sabatt Girard C.Brisbois Charles J.Ardito P.C. November 9, 2005 Board of Health Town of Barnstable Attn: David Stanton, Health Inspector 200 Main Street Hyannis, MA 02601 RE: Petition Requesting Hearing Before Board of Health Your notice to Sandra Hurney, 5 Sunnywood Drive, Centerville, MA 02632, dated November 1, 2005 Dear Gentlepersons: r I represent Ms. Sandra E. Hurney in this petition requesting a hearing before the Board of Health on the above notice to abate which she received on November 4, 2005. The reasons for this appeal are that most of-the violations were caused by the tenant Jeff Fregeau or his co-occupant Jennifer Kelley a/k/a Jennifer Kelly. Most of the conditions mentioned in the notice of violations were not observed by witnesses prior to Fregeau and Kelley moving in during the late summer of 2005 for what was supposed to be a three or four week stay. Prior to complaints being made to the Board of Health, Ms. Hurney tried to do an eviction herself and, as many people do, made some procedural errors necessitating her coming to me. Therefore, I also represent her in a new eviction proceeding against Mr. Fregeau and Ms. Kelley. Ms. Hurney is 71 years old and Mr. Fregeau's conduct has caused her a great deal of anxiety, emotional upset, and is aggravating her health problems. In the meantime, she will attempt to address her concerns to the best of her abi ity. Z o $ � A W D Please call me if you have any questions and thank you for your anticipated cooperation in this matter. i Very truly yours, Herbert F. Lach Jr. HFL/b j p enc. cc: Sandra Hurney, 5 Sunnywood Drive, Centerville, MA 02632 I ARDITO, SWEENEY, STUSSE, ROBERTSON & DUPUY, P.C. ATTORNEYS AT LAW 25 MID-TECH DRIVE, SUITE C WEST YARMOUTH, MA 02673 (508) 775-3433 Telephone (508) 790-4778 Facsimile Edward J.Sweeney.Jr. Thomas P.Carpenter Michael B.Stusse Kelly S.Jason Donna M.Robertson Herbert F.Lach,Jr. Matthew J. Dupuy Tracey L.Taylor Charles M. Sabatt Girard C.Brisbois Charles J.Ardito P.C.. �®P� FOR YOUR 9NF0R►,r�AT90N November , 2005 TO: Jeff Fregeau and Jennifer Kelley aWa Jennifer Kelly 5 Sunnywood Drive (side apartment) Centerville, MA 02632 NOTICE TO TERMINATE TENANCY AT WILL AND FOR CAUSE Please be advised that I represent your landlord, Ms. Sandra Humey. You are hereby notified to quit and deliver up at the end of the fifth week (Friday, December 16, 2005) of your tenancy, beginning after this notice, the premises now held by you as tenants, namely: 5 Sunnywood Drive (side apartment) Centerville, MA 02632 Reasons for the termination of your tenancy for cause are that your oral tenancy at will agreement expired, failure to pay rent, failure to maintain dwelling unit in a clean and neat condition, causing property damage beyond normal wear and tear, taking occupancy under false pretenses, making misrepresentations to the landlord, dumping building materials and trash on the property, constant traffic in and out of the property, speaking and acting toward seventy-one year old landlord in a threatening manner, causing her additional distress by banging on her windows. and making false claims. Make all payments to me and not to my client. Please be advised that any monies delivered by you will be accepted on account for use and occupancy only, and will not be construed to create any new tenancy in the premises. I do not wish to mislead you. Your tenancy is being terminated for many reasons and even if you pity the use and occupancy due we are still terminating your tenancy at will and for cause in accordance with this notice. Your tenancy is also being terminated for failure to pay rent in the amount of S2.100 for the period September 2, 2005 to November 4, 2005 including -Notice to Terminate Tenancy at Will and For Cause, Page 2 $500.00 for the weeks beginning October 21, 2005 and November 4, 2005. You must continue to pay your use and occupancy of$250.00 per week due on Friday of each week until you leave. Any such payment does not cancel or effect this notice and will not i create any new tenancy. I NOTICE OF IMPORTANT RIGHTS TO CONSUMERS Pursuant to the Federal Debt Collection Practices Act, a consumer debtor is required to be sent the following notice: (1) unless the consumer, within thirty days after receipt of this notice, disputes the validity of the debt or any portion thereof, the debt will be assumed to be valid by the debt collector, (2) if the consumer notifies the debt collector in writing within the thirty- day period that the debt or any portion thereof is disputed, the debt collector will obtain verification of the debt or a copy of a judgment against the consumer and copy each verificatiodorjudgment will be mailed to the consumer by the debt collector, and (3) upon the consumer's written request within the thirty-day period, the debt collector will provide the consumer with the name and address of the original creditor, if different from the current creditor. You should be aware that the Act only applies to consumer debtors and that this thirty-day period does not delay the bringing of legal action. This is an attempt to collect a debt and any information obtained will be used for that purpose. We will seek treble damages for any harm done to the property during this eviction, and for any costs, including attorney's fees. You are directed not to contact or communicate with my client in any way, but to communicate only with my office. I am researching whether Mr. Fregeau has committed elder abuse upon Ms. Hurney. She has health problems and Mr. Fregeau's conduct is aggravating those problems. We will pursue all available remedies if he does not stop communicating with harassing, Ms. Hurney. I suggest you retain counsel immediately so that you are properly advised of your rights and duties in this matter. Herbert F. Lach, Jr. Ardito, Sweeney, Stusse, Robertson & Dupuy, P.C. 25 Mid Tech Drive, Suite C West Yarmouth, MA 02673, (508) 775-3433 cc: Thomas A. McKeon, R.S.. Town of Barnstable Public Health Division, 200 Main Street, Hyannis, MA 02601 cc: Hyannis Fire Department. 95 High School Road Ext, Hyannis. MA 02601 cc: Ms. Sandra Harney y J _ cry. SaooD Sur-v.N Y � 1 407 4 uJ a to jo ,oe*per IN Li __ 2 I J i 3 J a 'j 1; 4? � 1 A c� I J 1 O � P' �JD o � J 2 Cb a v J fo x n � v° ztz 7.7 W`wt/TOWN OF BARNSTABLE 4 LOCATION ,��, Af 7 AM' "'°'�"• 1 WAGE #/�fu r �+ 7 2-7 2 VILLAGE `,� ,�= �(� ASSESSOR'S MAP & LOT / 3 Y - INSTALLER'S NAME & PHONE NO. J f Q Giat/G�L � 9� I SEPTIC TANK CAPACITY coo � LEACHING FACILITY:(type) / 6# L (size) �- NO. OF BEDROOMS _ PRIVATE WELL OR PUBLIC WATER a AC 4 - BUILDER OR OWNER S � AY DATE PERMIT ISSUED: �� DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r �n THE COMMONWEALTH OF MASSACHUSETTS OARD OF HEALTH- .......... w . ppfiration for Dtipuaal 3Vurks Tonotrurttun famit Application is hereb ma a for a Permit o C ruct ( ) or Repair ( ) an Individual Sewage Disposal System at: $L AA y-W o!c •--.-1. .. Y� :.s.. .......................................... JC.... cat A Ce C....................... . -.yf� � 1,...C.L:!�(.....Or. t iew.iS.... :X...... Cr� Owner Address ................................... Installer Ad ss UType of Building Size Lot. .....� ..Sq. feet . Dwelling—No. of Bedrooms.................5_......................Expansion Attic ( ) Garbage Grinder ( ) pa., Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) j a Other fixtures ---------------------------- - W Design Flow..........1.162...... ................gallons per person per,day. Total daily flow.......3e.6........................gal)on. WSeptic Tank—Liquid capacity/i70.gallons Length... .. ._... Width....V_710 Diameter________________ Depth.5...._.... x Disposal Trench—No......_ ... Width........ , Total Len h_-..p �.._____. _.__._ gt Total leaching area------ sq. ft. 3 Seepage Pit No............I....... Diameter....... ) __. Depth below inlet.....3r-.(_� Total leaching area....2.-.6Y..sq. ft. Z Other Distribution box CX) Dosing tank ( ) G aPercolation Test Results Performed by.........4:�r P..% ---- pa..... .. Date....�_Q.�11 .� ....... Test Pit No. 1......9.....minutes per inch Depth of Test Pit..../..2Z....._tepth to ground water........................ fT4 Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................ p+ ............................... Description of Soil-----/..-Psio-J.....0-:�.......7)Q--. f:... .........,/ R� � _..d 1 / _ ---------------------------------------- U Nature of Repairs or Alterations—Answer when applicable.................................................................................._............. ------------------•••-•-••-----•--••••----•-•---•--•--------•-•...•-•••=-•---------•--............--•...---•...--••----...------•-•-----•----------•••-••-----------•------------•----................. Agreement: L The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with' the provisions of TITLE 5 of the State Sanitary Code—.The undersigned further a rees not to place the system in operation until a Certificate of Compliance has en 'ssued b the b and of1h Signed-- .. ..... - --- - -_- -------------------------------- ------------- Date Application Approved By.............. A ........................................... ..... '---_!l-�..8-V-----... Date Application Disapproved for the following reasons:-------•------------------------------------------------------••-----------------------.....----•••-•........._ ..-------•------------------------•---------•-----------•----------------.....------------...........-------........_.......----.....-----••--- ........................................................ Date PermitNo........... -------------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS OARD OF HEALTH 1 ......... aw...................OF................ v�. .S...TivL..... :.:........... Appliration for Disposal Works Tonutrurtion rrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .... .Y�Y.YG..Q._..�J.��.F.canl. %C�eL.... .................. . ...r � 7h ...°` iY� �s.... ..._..... .v erAddress a /�lt' ......0....&)LO.Z-1 L.----------------------------------- . ... /��. sr6l, S-:c . / �jel Installer AddAss Type of Building _ Size Lot.J_%I..2-.S�..Sq. feet Dwelling—No. of Bedrooms.........................................Expansion Attic ( ) Garbage Grinder ( ) aOther Type of Building .............................No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ......... .-...-.-•.---•-------•--•--------------•----- --------------•-••-----....---------••---•--•---•-----.----------.-------•------------------ W Design Flow.......... 40................__,gallons per person pr,Oay. Total daily/0or....... 3�.O.......... ga WSeptic Tank—Liquid*capacityJCl-______.gallons Length.-___..6..... Width.... .'_____. Diameter................ De th. '......... x Disposal Trench—No...... ........... Width........J.+�._... Total Length..-._5 JYN .. Total leaching area..... sq. ft. Seepage Pit No........ ....... Diameter...... . ,...... Depth below inlet..... Total leaching area....1;451..sq. ft. Z Other Distribution box Dosing tank 0.4 Percolation Test Results Performed by.........6XI.-e....�? ------ �.. _.GU..- Date....1f�.1.�r..1��. ....... �� Test Pit No. I......r..77.....minutes per inch Depth of Test Pit..._/..Z...._._ epth to ground water..........:......... .... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----------•-- .......__ ... D Descri Description of Soil__. � .J.. .--- T��.-..- �r� - 1 .. .. f ��Gl�g ---...... P i ...3...r1 4;----z4w.' n.... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ............................-..........................................................................................................................•-----------.._..._.. ................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of TITIE>' 5 of the State Sanitary Code—.The undersigned further a rees not to place the system in operation until a Certificate of Compliance has en ' sued b the b and of Signed---... ••.•. .. ............................... .............. .......................... Date Application Approved By........ - -.. .t. :.a' ... ........................................ .............. ....... Date Application Disapproved for the following reasons:............................................................................................................_.. .............................................•--......-----........--•-•---•------•-----•--.......---.......---....--•---......---•-•----.....---...------..........-----........-••-•.......--•••-•-•-- Date PermitNo..........&a...... ............._.-_ Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... ,...........OF................e_:r, ors-. s:`i:.c............................ (9rdif uttte of Tomplianrr THIS IS TO CERTIFY at the Individual Sewage Disposal System constructed (>) or Repaired ( ) by.......: .. e�.� . -----•-•••...................•--- -••...........:......-••--•-----•--•-•...........--•---.................._....._. •--�� n -- Inst tall er at ��P.1._._.. I...�t...... ?�t�, t.F- '6( _"'-................................................................... has been installed in accordance with the provisi ns of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.....S."L:...+?.6..&............ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C STRUED AS A GUARANTEE THAT THE SYSTEM WILL F TIO n/ I•SFACTORY. DATE...... ..... ......S...-•-•.................•----------...... Inspector. - . • ----. ...----................-•-•----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.... g.�.�20` .. Fs. ...........OF........... ^!± 1`--------------•---..................... FBs...7.�...- ... Disposal Works Ton,s#rurtiun Vern fit Permission is hereby granted.............. .. ..-------•---------------------••---•-----------------------------•---- �1\srfir"",."'-=—'C:--..to Construct } or Repair ( ) an In ividSewage Dirsal System ' atNo........................ Street as shown on the application for Disposal Works Construction Permit No.. �[_:l��-_ Dated.......................................... ....................................... y ----•--•...................................... oard of Health DATE.......................... �'/!. .. ....................... FORM 1255 A. M. SULKIN, INC., BOSTON r THE COMMONWEALTH.OF MASSACHUSETTS BOARD OF HEALTH TOWN BARNSTABLE ...........................................OF..............................!........................................................... Appliration for Disposal Works Tonstrurtion "rrmff V Application is hereby made for a Permit to Construct X) or Repair an Individual Sewage Disposal System at: Lot 47A &w09 Phinney' s Lane ........................................................................................ .......................................... Location-Address 0 0. .................................................................................................. ............................................. —--------*...............................Owner Address ................................................................................................. ................................................................................................... Installer Address 18 ,258 Type of Building 3 Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder (io PL4 Other—Type of Building .............................No. of persons............................ Showers Cafeteria P., Other fixtures ................................................................................................................................ .............*..........Design Flow.....110................................gallons per person per day. Total daily.flow......3.30...............................g�allons. Septic Tank—Liquid'capacitylOO.Q..gallons Length..8-'-:M6."... Width-42=10" Diameter................ Depth.5.,-74".'.. Disposal Trench—No..................... Width............:_:..... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No.....L.............. Diameter.....12-....... Depth below inlet....3-67...... Total leaching area...251.......sq. ft. Other Distribution box (X ) Dosing tank Percolation Test Results Performed by.... S Consultants- Date...10/9/84 ....... ... .................................. .....T............................ Test Pit No. I..... .........minutes per inch Depth of Test Pit ........... Depth to ground water Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water._____... OF ................................................................................................................................ 0 -3' rIbp and subsoil 3'-9' Sand and gravel ROGER tiN Description of Soil...TP#1 0 ......................................................... --------PAUL �4 coarse to -f ...!�- F. --------------------------subsoil, 3-9' sand NIEWICZ ...................................................................................................... a MICK U andrse to . .....N6.-3C14120 qravel' 9'-12' coarse fine sand ----------------................................................................................................................................................................ .... ...GIVjL U Nature of Repairs or Alterations—Answer when applicable....................................................................... ...... ........................................................................................................................................................................... ........... EN Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in rdance wit j I. the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance 'issb d by the bo health........ .. Signed Dat ApplicationApproved By...............................Q.`........................................................ ................ ....I.............. Date Application Disapproved for the following reasons:.............................................................................................................. ......................................................................................................................................................................................................... Date Permit No....... .................................... Issued_...- ... ................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... TertifiraU of Toutpliaurr THIS IS E ERTIFV, 'Zhat theIndividual Sewage Disposal System constructed or Repaired b ......................1. .77125� ............................................................................. y ....................................... Installer at...Z-0-74-�-,1-77-4 ------- rdan-' ............. F described in the has been installed in accordance ce with the provisions o: TITLE 5 of The to Sanitary C�Ae as descr—i application for Disposal Works Construction Permit No......................................... dated_.....__._-_-.____..............._....._.__..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......I Inspector....7,;r....................................................................... .................................................. --------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF..................................................................................... ov No......................... FEE..._.................... Disposal Works 05onstrurtion '"rrmit Permissionis hereby granted.............................................................................................................................................. to Conqrpct or Re *r an Indivi9ual Sewage DispospJ System X at ...... t c t as shown on the application for Disposal Works Construction Permit No Dated...'.-4291/..................... ............... .....0.. 2.......................................................... Board of Health DATE. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS Fes ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN...........................O F....B ARNS T AB LE ..................................................................... App.firFaftou for Dhipoii ai Works Tonotrur#iun "trnti# Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: Lot 47A .&�Phinney's Lane . .. .. .... ...... -----------.. _......---••-----•---••--•-••-----•--.........-•--•----.....................................••---- Location-Address or Lot No. ......................—.......................................................................... ............................................. ..................•••--•-.....................__.............------............................_. Owner Address W a •-------r Address ............. - Installer Address Type of Building Size Lot...l$_s 2 58--------Sq. feet Dwelling—No. of Bedrooms............:3._.._............_.._..._...Expansion Attic ( ) Garbage Grinder f ) '4 Other—T e of Building ...... No. of persons............................ Showers — Cafeteria Oa Other fixtures ----•------------•--•-••-•••-•......-•---•......•• . W Design Flow.....Z1©..............................;_gallons per person per day. Total daily flow......330...............................gallons. WSeptic Tank—Liquid'capacitylooj}..gallons Length_a+_..6!!... Width.41...10!! Diameter................ Depth.5!..,4!1-__. x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area...................sq. ft. Seepage Pit No..._1-------------- Diameter.._.1.a........... Depth below inlet....3r6.7....... Total leaching area---aS1........sq. ft. Z Other Distribution box OC ) Dosing tank ( ) a Percolation Test Results Performed by.._C.r7l_..00d..Stnvey..�t1�tS...... Date...1Q.19,�9�.................... ,.� Test Pit No. 1....2.........minutes per inch Depth of Test Pit...13._.......... Depth to ground water.......................... (i Test Pit No. 2................minutes per inch Depth of Test`Pit.................... Depth to ground water........... -------------•--------------•------•----------------------------------••...........---•-•---••---•--....................................... O Description of Soih_ 1_.0-3.'..-`; ?P ._ b ,j...3'-9'... _. .. Me R ER yo _. ad tQ...fiue.js ...TFA2..0-3-1---� P.and..S.UbMiL..3s --------- o� P jL and. �_ c = d -• MIH IEW ICZ -g ` ---------------------------- ----- ....No--aoazo U Nature of Repairs or Alterations—Answer when applicable.......................................................................... I --CIVIL p Agreement: �N r The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in ac an the provisions of TITI. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in���/7� operation until a Certificate of Compliance has been issued by the board of health. ! Signed.....................................•-••--------------------........-----•-----_•-_.. ................................ Application Approved By.............. ..............•---- .: .......clln -----•..................••---••------.. ........................................ Date Application Disapproved for the following reasons:............................................................................................................. --------•-•...........................•-----------.......-----------------•--.................-----------•-------•-------------._....--•--------------••--------•-••-------------...------•-------_------ Date Permit No..... -'-9-K-�•-----....... Issued.------•-------••-•••- . '. .................... ...... Date s THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .0. ..........................................OF..................................................................................... Tnr#if irFa#r of Tuntplt anrr THIS IS T-O,ggRTIFY, That the Individual Sewage Disposal System constructed ( or Repaired17 ( ) by.................... .......... � ii ......................................insca ' if :i/i f &W....... 7���i f:� - s of�b�has been installed'in'accordance with the provisions o TIT1 5 of The Sta e Sanitary Code as descry in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �,f.� • DATE......1.4�5/�'!.................................•-----•••-----=.. Inspector...-------..---...------------------------.....----•----•-••-•---•--•-...---....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF..................................................................................... ov No......................... FEE........................ Disposal Works Tnnotrudta'n rrnti# Permission,,ip hereby granted............................................................................................................................................... to Construct ( ) or Repair ( ) an Individual Sewage Disposal System i �� ri 7 DJ//F- _J � �'/✓ l��StreetFl "I�� O �/ !�/ / / — r' `1 as shown on the application for Disposal Works Construction Permit INV..................... Dated...... .................................... Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS