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Home My WebLink About0025 SYLVAN DRIVE - Health 25 .SYLVAN DRIVE, HYANNIS Mon y A=.289'7058 i !J e o i ' ° I o i F i� ° v c a ° e i o a J l Town of Barnstable Inspector Health Ins OFTHE tp� Office Hours ti Regulatory Services 8:30-9:30 Thomas F.Geiler,Director 1:00—2:00 + IAMSFABLB, MASS. �� Public Health Division ArfD t��A Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT- SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: Address: h a Map Parcel Name: Af Phone#: 77f- 2a. How many bedrooms exist at your property now? 2b. Are you planning to add any bedrooms? If yes, how many?� 2c. How many bedrooms total are proposed at this property (including the amnesty unit)? 2d. Please include a copy of the floor plans for the entire property - showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or NO If.thedwelling is connected to public sewer,skip,questions.#4 through#9.below... ,./ 4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? W/o c 5. Is the dwelling connected to an ONSITE WELL or to UBLIC WATER? r _ 6. Is a disposal works construction permit on file? i YES ror NO 6a. If yes,how many bedrooms were approved according to this permit? r=' Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES NO .8. Is there an engineered septic system plan on file at the Health Division? YES nor NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO --------------------------------------------------------------------------=----------------------------------------- FOR OFFICE USE ONLY The Public Health Division has no objection to bedrooms at this property. Special Conditions: 4' 11 co,,,- -5ha k C rQ z -3 d �' it -66 YA-,4- G Signed: Date: ?/15; )y Q;/health/wpfiles/amnestyapp 11 McKean, Thomas From: McKean, Thomas Sent: Tuesday, December 21, 2004 5:27 PM To: Dillen, Elizabeth Subject: RE: New Amnesty Applications- Problems 1) 829 Osterville-West Barnstable Road, Marstons Mills—Jo-Ann Bergeron There is no septic system record on file for this address. A DEP certified inspector would have to be hired to complete an eleven page report and submit it to the Health Division. 2) 25 Sylvan Drive-Joseph Hamel The septic system was upgraded in 1997. The new system was designed for only three (3) bedrooms(with four infiltrators) as listed on the disposal works construction permit issued at that time. However, the applicant is requesting approval of three bedrooms plus a private office room. This private room is considered a bedroom according to the State Environmental Code, Title 5 definition. The applicant shall be required to remove the private room -he may provide a five feet opening without doors to this room to accomplish this task. i TOWN OF BARNSTABLE ✓� LOCATION 25_5Z4�_ 14r a 112V,W,1..S SEWAGE # VILL,.GE &XVIOWI/5 ASSESSOR'S MAP & LOT t _e INSTALLER'S NAME&PHONE NO. �v/'>`a� �� 77/y��p SEPTIC TANK CAPACITY IS'dd LEACHING FACII,ITY: (type) K1f.��r�ti nrJ «l - (size) *-7'X NO.OF BEDRO / - BUILDER 0 0 R ✓1 PERMITDA `�� 7 COMPLIANCE DATE: Z ' 1 -0(7 Separation Distance Between the: .r j 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) S r Feet Furnished by J. a � _ _r � ��„ A Z 8 �F �� w - - - - - _ . � �, �_ � � �.- , 7 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Migozal *pgtem Corttruction Permit Application fora Permit to Construct( )Repair( )Upgrade(Or)Abandon( ) LJComplete System ❑Individual Components Location Address or Lot No. C �� Owner's Name Address an Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. - !_,f3w Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(- D Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow !/2 gallons per day. Calculated daily flow 3—W gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /6--eV Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued this Bo o ealth. Signed —Date Application Approved by Date — 10s Application Disapproved for thUollowi4 reasons Permit No. Date Issued .r! . t ".'w;`ie^"'�'w�- �ti,:{.r: +y'��f:_",v.+n•«�....»...'..-=»a;-+cvi:�;...�.�r��e:T.`.^'w7r-�...�.►...:..r, . .,W.:ww^- ".i»•i.W..,:�:.v,.�..., � f .., - t��is t 72.��- No. Fee t a THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 7 2•. Yes PUBLIC-HEALTH DIV� ION ;°TOWN OF BARNSTABLE, MASSACHUSETTS ZIpp ication for Miopaal *pgtem Construction Permit r a Application fora Permit t4 Constructs J)Repar( )Upgrade(✓)Abandon( ) 11Complete System O Individual Components Location Address or No., C-5 v v�� r " Oyner�SF7ame Address an Tel.No. J / Assessor's Map/Parcel , /�cel b" Installer's Name,Address,and Tel.No. • Designer's Name,Address and Tel.No. 7 71--9399 Type of Building: Dwelling No.of Bedrooms �,3 Lot Size sq. ft. Garbage Grinder( D Other Type of Building Cy� l eWCe No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow //11112 gallons per day. Calculated daily flow 3 gallons. Plan Date Number of sheets Revision Date % Title Size of Septic Tank Type of S.A.S. Description of Soil N Nature of'Repairs or Alterations(Answer when applicable) 1'�_)/_l/ e r l Date last inspected: 1 Agreement . -'��.�k 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 this B 0 ofhlealth. Signed ,r Date Application Approved by 1 Date - Application Disapproved for theVollowi4 reasons ' E Permit No. �/ Date Issued THE'COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired ( )Upgraded(� Abandoned( )by ,�o/ aGorf�/ Lomas 7" at Z 5� ✓�`�!/!!�1 /9, ;IewI77,5 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. - ?l dated Installer AO/�1v1�`/ Designer The issuance of this pe shall not be construed as a guarantee that the systqn will function as designed. Date ( � Inspector — ------- ` ---------------------------- No. /e� Fee �_T o THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLE, MASSACHUSETTS Mwi5pogal *pgtem Construction Permit Permission is hereby granted to Construct( Repair�� )Upgrade( k/ Abandon( ) System located ate//!/1t�7 )n, and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this(permit. Date: - / Approved by �l b �, S J 0 �L I � NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH 4ND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT ON ITHOt I' DESIGNED PLANS-) that the apt,iication `or dispcsai wor>:s constructicn, germ.it SziQ?le0 '-,ti i,e dated ��9/� conc 71P__' he Croce= located at �>Ial "/S met- _i': tG: O�ViIla C feria: Y - -. -ter. - csc ea ram.:: - - - - —' �i0NEi� : DATE: 9��t LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWV OF BARNSTABLE ti'Lti1BER [Attach a sketch plan of the proposed system. Also if dte licensed installer posesses a certified plot plan. this plan should be submitted].., y i- 4� q:health fot r_ w 1CKi �M101ti rr a a 0 . 0 +vr, �.W-T . t oe, ocm 2 L�� +� SubJ9ct to easements and restrictions of record. � � 7o C !mil U� QC7Jr-'(. Crossland Mortgage D R 'F-E� �Cp 10 AM� eelan N{nna MORTGAGE INSPECTION PLAN 6L, ( T1NAT 11E um�OLD EarneUffr 10 1 115 Qy.9wwv1:;p LL( == Ot AN MU"MM M AI N U@%M0W T ACM t�O11t kUM aL RW C W dWAAlm AAA MRW W 9 8Y/ fM1 W re V I > TOWN OF BARNSTABLE LOCATION ZJ�Sy �l �jl. /��!/�/9�-5 SEWAGE # 7' yff i'..1ULAGE / ylti>il/S ASSESSOR'S MAP& LOT 5 -9�P5 e INSTALLER'S NAME&PHONE N0. SEPTIC TANK CAPACITY /SwyGa�- -LEACHING FACILITY: (type) Tel4(J,,A J (site) kX X Id'x-Z 1 NO.OF BEDRO / . BUILDER O R (�✓I�t�' PERMIIDA --lee COMPLIANCE DATE: CT1� -Cl7 :. Separation Distance Between the: s, I ::.'Maicimum 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 J f 'within 300 feet of leaching facility) S Feet Furnished by o a� ` L i v � r t I r ; r a c z O rim rim v r r 3 c N C . r C � w 4A C'f �f 39 i a , 4 i u _ S is q / 1 1 � - 4 t i � A J No............... -Q. Fxz.... ..:..... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALT ..../.. ....... OF.....! : . . . ................................... ApplirFatiun for Dispimi al Forks Tonutrudiun 11trutit Application is hereby made for a Permit to Construct ( ) or Repair ( &-j"an Individual Sewage Disposal System at: ......tr......... . . . .... .......... . ............ .4., ......--•---•-----------..........---•--...-- ... Location- ddress or Lot No. - .............................. ........................... ... . ........................................................ Owner T Address 40 --•....................................... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling-AKo. of Bedrooms.................................. .Expansion Attic ( ) Garbage Grinder ( ) 'L Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures -----•------------------------ . Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. WSeptic Tank—Liquid'capacity......__....gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........................ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date.------------...............--------.... Test Pit No. 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........................ --••-•--•------••• -------------•----------......------.........-------------•------------ ---------------- •...... ----------- -......... ......... O Description of Soil - -------------------------- U :: ........... W U Nature of Repairs or Alterations—Answer when applicable _.__ _.__ ��,1..-__..__.� .�`-!Jl�l1.......__. ------------------------------=----_-------------------••---•---._...----------------•---................---------------------------------------•-----------------------•------------.....--------------- Agreement: ,The undersigned',agrees to install the aforedescribed Individual Sewage Disposal System Iin accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued b he and o health. Signed.. ------ ---- Date ApplicationApproved BY ------------•---------•-• ---- ----------------------------- ... Date Application Disapproved-for t ollowing reasons:...................................................:.......................................................... _ ...............•-----•-•----------------•---------------=-----•---•--------------........---•-------------'---------------•--------------------------......----------------------•--•-----------•...._.... Date Permit No....... �-� -------.----•--- Issued--.......... - .1._�. ,.� _ ..._.... .. - Date -----•---•-------- �. S THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH rr „ ............... vg,?fr�N............0 .................................... Appliration for Dispnsttl Works Tonstrizrtinn "[anti# Application is hereby.made for a Permit to Construct ( ) or Repair (.,,�J-an Individual Sewage Disposal System at: .......................•---.....-----•--- "'' Location-Address or Lot No. .-; ..... ---•--•--•--------•---•••--.......-•-......--- + �/ r' wner t „r Address �- ---.......cam:„1__....a ----•-----•--•---------------•----•------------•-•------•-----••••- Installer Address Type of Building Size Lot............................Sq. feet Dwelling-ZNo. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T ,yp'e of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) d 'Other fixtures . W Design Flow............................................gallons.per person per day. Total daily flow............................................gallons. WSeptic Tank=.Liquid capacity_.__._..__._gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter..................... Depth below inlet.................... Total leaching area..................sq. ft. Z' 'Other Distribution box (t f,) Dosing tank ( ) Percolation Test Results' ' Performed by......... Date........................................ —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........................ ...................................................................................................................................... 0 Description of Soil......... �. . . . --•------•------------------------•-•---•-----•---------------------------------------------------------------------------••-•----------- V --•-•-••••-•--••••-••-••••-••--------•.....---•-----••••••••--•--•-----------•••-•------------•----•----•---•-----•-•-•.....•-•----••••••------•---•--------•- .................................. = ------•------------------•-•------•..._----��--•-------....••- - ,i' U Nature,of Repairs or Alterations—Answer when applicable-___;/._,....Lem _141014........... � _. �/�/______._... Agreement: Tbe. undersigned agrees to. install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in, operation until a Certificate of Compliance has been issued b the board o health- C s S� ftrj d IA Signed..t: ." ''"��1.......�!`:.: c- `` y .. b. Date. ..+ Application Approved BY - 1 l -S�-. V'' ----•---------------------- ��// Date Application Disapproved for t e ollowing reasons:.......................................................................................----------•-•------•-•. Date Permit,No.._.._�_ .'.s1�.� - Issued_-•----• ;y Date , t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /41e.' '�. .........OF..... r ir,�'��R:a�i✓:....... ........................ Trrtifiratr of 4ampliattrr THIS �d ERTIFY, hat the Individual Sewage ! i�posal System constructed ( ) or Repaired (G by ._-;_�. . : �' r ........ , r? �� ---------- <12 ----•.......... .........•--•---------•-••--•--•---------......-----•-•--._...._.._ Installer tf ��,� has,been installed accordance with the provisions of TLT'!F p 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._okc:.A.44_................. dated_..... ------- .................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO U S A GUARANTEE THAT THE SYSTEM WIL FUNCTION SATISFACTORY. b� . r.- DATE.... ••--'~ ' ••........................... Inspector--------_... '..._... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /r.' �p/r�'{''e.....OF........ 1 No......................... Disposal nrkn Tuno#rttr##inn rrnti� Permission is hereby granted........'-``-7-%/........ .rs; ...... ---- r. ............................................. to Construct ) fRepair (-/ an ;Individual Sewage Disposal System at ' Street {{ as shown on the application for Disposal Works Construction Permit No. '' k G__ Dated.....�.---!......IS.............. r. a o ealth DATE------.-------••-: ......... .................. FORM 1255 A. M. SULKIN, INC., BOSTON 1 Cry"/ E , i Pa i o i r I 1 i 8 J. � I f-A PA Bs i � { rL- . . . . VIC S 1E . . J lr '- If TT ABU Ni W-L - J �,y` J6 V ( �. In , • i ► - r : t j� + ' I tT s F : J-j± i �f l i 11 • i a • L ti 5 .e�w.,y ..„.. .. .'4^ —' .'r:�� ._. was••.. .._ � � <. .�• i II *� f lr.' i1 : I ! ' 1 , • Ii