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HomeMy WebLinkAbout0081 WOODBURY AVENUE - Health 81 WOODBURY AVENUE,HYANNIS A.= 307:053 } i 0 7;g77 yE No. Fee (/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS RppliLation for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon A/0 Complete System ❑Individual Components Location Address or Lot No. 3/ f-23 Owner's Name,Address,and Tel.No. 50;6 3617"e7 9")S Assessor's Ma /Parcel U a 3 N' vtA,�y� � Jnlny f441Y4Ji LL V_v P 55 U3foGd Installer's Name,Address,andTel. o. , .2(, Designer's Name,Address,and Tel No. �o ��n ,-'per r au� it U � . Type of Building: Dwelling No.of Bedrooms ' Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1 U(.Q1Y1 eQXd�1 �n n G��Cn�t 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 Enviro ode and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Si Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 00 00 6 Date Issued `/1-? I `?,,6 1,6 �d Fee�Ci h THE COMMONWEALTH OF MASSACHUSETTS ' Entered in computer: Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS N ftplitation for -Misposaf 6pstpm Construction permit W Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(WO Complete System ❑Individual Components + Location Address or Lot No.$' } 3 Owner's Name,Address,and Tel.No. 56);S 34-9' `7 S-2 Assessor's Map/Parcel U r) b -3 i4�(t t vL a) 4)�'6 1 521 n ZU 04!y4�k 5 U,PO, A6X 102-4 All A valoG/ Installer's Name,Address,and Tel.No. 0s-'/P y- 8j�?(, Designer's Name,Address,and Tel.No' r;ko lot, Cons oU �" n dLP Gotfo Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1 1117� ��� �nrlleL C�1 Date last inspected: Agreement: / The undersigned agrees to ensure the construction and maintenance of the afore described.pri-site sewage disposal system in accordance with the provisions of Title 5 of the EnvirrifaRode and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Si - Date Application Approved by !/ Date �/=7 Application Disapproved by Z., Date for the following reasons Permit No. 6 Date Issued l I Zip 1 kj THE COMMONWEALTH OF MASSACHUSETTS 4 BARNSTABLE,MASSACHUSETTS Certificate of Compliatire THIS S TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned W)by 0r4., at 3 u)orA t7t)t'u ye /Y i/dr n CS has been constructed in accordance /with the provisions of Title 5 and the for Disposal System Construction Permit No. Vb—706 dated Installer ('4. kc, 'c, :7�c- Designer #bedrooms A Ak Approved design A&w n AM gpd The issuance of this p ''JJ it shall not be construed as a guarantee that the system wil' �� ctio s designed. Date ( (I"o Inspector ! —s� _______________/___i______________________________.___________._____.______._________________________________._______.______________--`______ No. I/' 00 Fee &2, THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem ConstrULtion wWrmit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon(� System located at 51 +--a'3 (I a t,n 1 and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 / Lzo/1p Approved by AsBuilt Page 1 of 1 �-• TOWN OF BARNS.TABLE rr LOCATION 81 &.83 WOODBURRY AVENUE SEWAGE # ` to VILLAGE___E�, ASSESSOR'S MAP & LOT :3Q�.(Jy'3 INSTALLER'S NAME & PHONE NO. ELLIS BROTHERS CONST. CO. 362-6237 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) P iT X (size) I e o 0 NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER BUILDER OIt� �Lc q�TAN DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: I a C 1 VARIANCE GRANTED: Yes No t� i i http://issgl2/intranet/propdata/prebuilt.aspx?mappar=307053&seq=1 8/16/2016 i Town of Barnstable Barnstable Epp SHE Tp�� Board of Health j e' j 9'A`MASS E' Hass. � 200 Main Street, Hyannis MA 02601 1,639. � �prEG MA'S 61 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi March 21, 2016 Altair and Shinzo Miyagusuku 81 Woodbury Avenue Hyannis, MA 02601 RE: Extension Granted / Sewer Connection 81 Woodbury Avenue, Hyannis A = 307 - 053 Dear Mr. and Ms. Miyagusuku, You are granted a ninety (90) day extension,until June 21, 2016, to connect your dwelling, located at 35 Point Lane, to public sewer. This extension is granted because you stated you needed additional time to secure funds from the County Loan Program and/or other sources. Please contact us in early June or mid-June to let us know what is the status of the sewer connection at your property. You may either attend the June 14, 2016 meeting of the Board of Health or telephone our Administrative Assistant Sharon Crocker at (508) 862-4644 to provide this information. Sinc ely, i Wayne iller, M.D. Chairman TOWN OF BARNSTABLE BOARD OF HEALTH M Q:\WPFILES\Miyagusukuj81 Woodbury Avenue Hyannis.docx Official Website of The Town of Barnstable Property Lookup Page 1 of 3 Select Language 1 Assessing Division Property Lookup Results - 2016 367 Main Street,Hyannis,MA.02601 <<BACK TO SEARCH<< Print Friendly Owner Information - Map/Block/Lot: 307 / 053/ - Use Code: 1040 Owner Owner Name as of 1/l/15 MIYAGUSUKU,ALTAIR F&SHINZO Map/Block/Lot G15 MAPS P O BOX 1823 307/053/ Property Address HYANNIS,MA.02601 81 WOODBURY AVENUE Co-Owner Name Village:Hyannis Town Sewer At Address:No GIS Zoning Value:RB Assessed Values 2016 - Map/Block/Lot: 307 / 053/ - Use Code: 1040 2016 Appraised Value 2016 Assessed Value Past Comparisons Building Value: $137,500 $137,500 Year Total Assessed Value Extra Features: $31,900 S 31,900 2015-$274,100 2014-S 274,100 Outbuildings: $0 $0 2013-$273,300 2012-$272,800 Land Value: $108,200 $108,200 2011 -$269,300 2010-S 269,100 2009-S 357,700 2016 Totals $277,600 S 277,600 2008-S 359,900 2007-$359,100 Residential Exemption Received=$90,000 Tax Information 2016 - Map/Block/Lot: 307 /053/ - Use Code: 1040 Taxes Hyannis FD Tax(Residential) $671.79 Fiscal Year 2016 TAX RATES HERE Community Preservation Act $52.40 Tax Town Tax(Residential) S 1,746.56 $ I 2,470.75 Sales History- Map/Block/Lot: 307 / 053/ - Use Code: 1040 History: Owner: Sale Date Book/Page: Sale Price: F MIYAGUSUKU,ALTAIR F&SHINZO 2001-03-01 13601/193 $182800 PACH ECO,SHANE M 1999-06-18 12349/27 $129000 CHAMSARIAN,E MATTHEW 1997-04-30 10726/282 $112000 MCCARTAN,DAVID M 1997-04-30 10726/281 $1 MCCARTAN,DAVID M&GERALDINE&BARTOLUC1981-04-09 3266/284 s0 Photos 307 / 053/ Use Code: 1040 I � http://www.townofbamstable.us/Assessing/propertydisplayscreen l 6.asp?ap=0&searchparc... 3/22/2016 Official Website of The Town of Barnstable - Property Lookup Page 2 of 3 4 Sketches - Map/Block/lot: 307 /053/ - Use Code: 1040 AS Built Cards:Click card#to view:Card #1 1 Constructions Details - Map/Block/Lot: 307 /053/ - Use Code: 1040 Building Details Land Building value $ 137,500 Bedrooms 4 Bedrooms USE CODE 1040 Replacement Cost $185,840 Bathrooms 3 Full-0 Half Lot Size(Acres) 0.33 Model Residential Total Rooms 8 Rooms Appraised Value $108,200 Style Duplex Heat Fuel Gas Assessed Value $ 108,200 Grade Average Heat Type Hot Air Year Built 1969 AC Type None Effective depreciation 26 Interior Floors Hardwood Stories 2 Stories Interior Walls Drywall Living Area sq/ft 2,268 Exterior Walls Wood Shingle Gross Area sq/ft 3.360 Roof Structure Gable/Hip Roof Cover Asph/F GIs/Cmp Outbuildings& Extra Features- Map/Block/Lot: 307 / 053/ - Use Code: 1040 Code Description Units/SQft Appraised Value Assessed Value FPL3 Fireplace 2 story 2 $9,900 $9,900 BMT Basement-Unfinished 1092 S 22,000 S 22,000 Sketch Legend Property Sketch Legend 82N Barn-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor,Living Area FTS Third Story Living Area(Finished) SOL Solarium BMT Basement Area(Unfinished)FUS Second Story Living Area SPE Pool Enclosure (Finished) BRN Barn GAR Garage TQS Three Quarters Story(Finished) CAN Canopy GAZ Gazebo UAT Attic Area(Unfinished) CLIP Loading Platform GRN Greenhouse UHS Half Story(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UST Utility Area(Unfinished) FCP Carport KEN Kennel UTQ Three Quarters Story (Unfinished) FEP Enclosed Porch MZ1 Mezzanine,Unfinished UUA Unfinished Utility Attic http://www.townofbamstable.us/Assessing/propertydisplayscreenl 6.asp?ap=0&searchparc... 3/22/2016 f Official Website of The Town of Barnstable - Property Lookup Page 3 of 3 FHS Half Story(Finished) PIRG Pergola UUS Full Upper 2nd Story (Unfinished) FOP Open or Screened in Porch PRT Portico WDK Wood Deck PTO Patio 3Print Friendly lContact iDirector of Assessing 'Jeffrey Rudziak P508-862-4022 F 508-862-4722 c i8:30a.m.to 4:30p.m. Helpful Links to Downloads t Abatements SALES LISTINGS Barnstable FD Residential C.O.M.M FD Residential 1 r Commercial-Ind ustrial- Mixed Use Cotuit FD Residential Hyannis FD Residential jI Townwide Condominium � 4 W.Barnstable FD I i I Residential f j Department of Revenue I I i 1 Exemptions i Parcel Consolidation i Questions about values Town Tax Rates i Town Land Use Codes 'Helpful Maps All Town Maps jFlood Insurance Maps Property Maps i 1 Owned and Operated by The Town of Barnstable-Information Technology Home I Departments&Services I Boards&Committees I Residents&Visitors I Doing Business I Town Calendar Phone Directory 1 Employment I Email Town Hall http://www.townofbamstable.us/Assessing/propertydisplayscreen l 6.asp?ap=0&searchparc... 3/22/2016 (ITEMS FROM 1/12/16) FOR MARCH 8. 2016 . I. Hearing — Sewer Connections: Stewart Creek Properties overdue for sewer connection Continued Items from Prior Meeting. A Matthew & Catherine Conley, Hyannis owner— 35 Point Lane, Hyannis CONTINUED TO MARCH 8, 2016. The Health Division had been told that they were working with Doug Brown. Mr. McKean will check with Doug Brown for verification. The Board voted to continue this item to the March 8, 2016 meeting and requested a letter be sent stating the Board's disappointment of their absence and inform the owner that the Board will consider additional action be taken if they do not attend in March. A. Altair & Shinzo Miyagusuku, Hyannis, owner= 81 Woodbury Ave, Hyannis CONTINUED TO MARCH 8, 2016. Mrs. Miyagusuku notified the Board that she was not able to attend due to her medical appointments on Tuesdays in Boston. She will try to reschedule her March appointment. (Mr. and Mrs. Miyagusuku speak Portuguese and need a translator.) The Board granted a continuation to the March 8, 2016. B. Jeffrey Coombs & Gail Clear, Connecticut, owner— 23 Keating Road, Hyannis CONTINUED TO MARCH 8, 2016. No one present. The Board voted to continue this item to the March 8, 2016 meeting and requested that a letter be sent asking if their two properties (86 Seabrook and 23 Keating Road) are both rentals. If so, please register, and state the Board did not receive a response from the owners for the January meeting and the Board will need the owners' presence or an update of the status. C. Amy Loi Everett, Ohio, owner— 56 Seabrook Road, Hyannis CONTINUED TO MARCH 8, 2016. Amy Everett was not present. She emailed the Board, explained has two properties in this area, connected one, was turned down from loan through Growth Management due to her income level. She is trying to obtain a different loan and just learned of County loan. Board voted to 1) continue to March 8, 2016 meeting for update and if this is a rental, they request she register it. !I Ice : 6he �eP�ar Via, � s�;Gtl�s t- i/l ��`°n vex She Q�t1d Gl� � ¢e a p ' CO IL IC13 M Postage $ Ah A 0 2 60 I Certified Fee f 'Postmark C3 Return Receipt Fee •" Here 0 (Endorsement Required) Restricted Delivery Fee (�C? C3 (Endorsement Required) SQ O � RA Total Postage&Fees f IV :2- Sent To }Gt h i n 2 d p Street,Apt.No.; (� or PO Box No. --------------------- ---PJo�c----tom 23------------------------------ Crry,State, +a Certified Mail Provides: o A mailing receipt o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: e Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. o Certified Mail is not available for any class of international mail. e NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For. valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)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,a USPS®postmark on your Certified Mail receipt is required. e For 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 Deliveryt o 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. ' PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 f ( ■ Complete items 1,2,and 3.Also complete IA. S' n turitem 4 if Restricted Delivery is desired. ` ❑Agent 1q Print your name and address on the reverse ❑Addressee so that we can return the card to you. . Receive (Printed ame) C. to of Delivery ■ Attach this card to the back of the mailpiece, �< 1 7- or on ther front if space permits. 21 1. Article Addressed to: D. Is delivery address different from item 1? 13Yes 11 If YES,enter delivery address below: ❑No A +z:u r f 5h,n z a �i��q�s 3. $epiceType ertifled Mail® ❑,Priority Mail Express' v 2(0 O 1 ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. (Transfer nsferle uom 7014 1200 0001 0358 5098 (Transfer from service lab � PS Form 3811,July 2013 Domestic Return Receipt i UNITED STATES POSTAL SERVICE F;rst-Clash Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4®in this box* I K.lNl I I Town of Barnstable I Health Division 200 Main Street Hyannis,MA 02601 I I l Town of Barnstable Barnstable ABAmed Regulatory Services Department I a cap j •ARNSfAHM I& �m Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7014 1200 0001 0358 5098 February 9, 2015 ALTAIR& SHINZO MIYAGUSUKU P 0 BOX 1823 IMPORTANT NOTICE HYANNIS, MA 02601 Map & Parcel: 307- 053 DEADLINE APPROACHING According to our records your dwelling at 81 Woodbury Ave., Hyannis, MA, should be connected to public sewer on or before 3/30/2015. This is a reminder that all permits need to be in place before this date to be in compliance: 1) Septic Abandonment Permits ($ 25) are issued at the Public Health Division, 200 Main Street, Hyannis. The old septic system must be either removed or filled in due to future safety concerns. This may be done by the same contractor who connects you to the sewer. 2) Contractors, approved to perform sewer connection work in the Town of Barnstable must obtain and file a Sewer Connection Permit with DPW-Water Pollution Control Division, 617 Bearse's Way, Hyannis—contractors, please call Dave Anderson at(508) 790-6244. LIMITED TIME FOR SAVINGS. ON GRINDER PUMP The Department of Public Works (DPW) is still offering grinder pumps at no charge, if you obtain your permits and connect to sewer promptly. (This can save you thousands of dollars, but this offer will expire.) Please note: You must pay the installation cost of the pump through your own contractor. FOR ANY QUESTIONS/ASSISTANCE: Len Gobeil at the Town Manager's Office is available to provide you with direction you may need in reference to the Stewart Creek Sewer Connections. You may contact him at 508-862-4701. Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health SENDER: COMPLETE7HIS SEC,TION ":j COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. §i n t item 4 if Restricted Delivery is desired. 1 Agent ■ Print your name and address on the reverse XAA U0 A ressee so that we can return the card to you. B' Rece�d by'(Printe am C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. ----- `D. Is delivery address different from item 1? ❑Yes ALTAIR& SHINZO MIYAGUSUKU If YES,enter delivery address below: ❑No � P,0.'BOX 1823 HYANNIS, MA 02601 MA 0 13. Se Type Certified Mail ❑.Express Mali APE - 4 2013 ❑Registered UKReturn ve6Fi;r—M--e—mRWise ❑ ❑ Insured Mall C.O.D. l �L 4. Restricted Delivery?(Extra Fee) - ❑Yes 2. Article Number USP 7 012 1010 0000 2848 1346 .(Transfer from service IabelJ PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540; 7 UNITED STATES POSTAL SERVICE First-Class Mail PO a&. Fees Paid Permit No.G-10 I • Sender: Please print your name, address, and ZIP+4 in this box • _ 1 Sewer Connect Public Health Divsion �O Town of Barnstable ` 200 Main Street Hyannis,MA 02601 f I � I j I I I m a co Co C Postage $ `Oc' O Certified FeeIM r O ReturnReceipt Fee it LPft.&M C3 (Endorsement Required) Here Restricted Delivery Fee Q (Endorsement Required) LISPS M Total Postage&Fees $ (p •�( r M, ►a ALTAIR& SHINZO MIYAGUSUKU rC3� P O BOX 1823 HYANNIS, MA 02601 i Certified Mail Provides: o A mailing receipt n A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: e Certified Mail may ONLY be combined with First-Class Maile or Priority Maile. o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)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,a USPSe postmark on your Certified Mail receipt is required. o For 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". o 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. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 I - �r Town of Barnstable Barn Regulatory Service Department 1�'�C j s BARNSTABLB, 039. __Public_Health--Division- 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7012-1010-0000-2848 -1346 March 28, 2013 ALTAIR& SHINZO MIYAGUSUKU P O BOX 1823 IMPORTANT NOTICE HYANNIS, MA 02601 Map & Parcel: 307- 053 The Department of Public Works informed us that public sewer lines are now available in your neighborhood. According to our records, your property has a septic system. This letter directs you to connect your dwelling, at 81 Woodbury Ave., Hyannis, MA, to public sewer on or before 3/30/2015. The old septic system must be either removed or filled in due to future safety concerns. This may be done by the same contractor who connects you to the sewer. Septic Abandonment Permits ($ 25) are issued at the Public Health Division, 200 Main Street, Hyannis. Failure to comply with this Board of Health Order may result in a complaint against you, in a court of law. For additional information pertaining to the sewer connection, please see the reverse side of this page. PER ORDER OF BOARD OF HEALTH as cKean, S., C. . . of the Board-of Health Cc: Barbara Childs,WPC/Roger Parsons,Town Engineering, DPW Enc. QASEWER connect\Letters Stewart Creek Sewer Connects\MAIL.ING L.etA Sewer 2Pgs Merged 3-28-13 Yr2015.doc _....... _ ._ .._...-_ __Public Health Division_ .______--.._ -____-_--_------___-_. _--_- -March 28,_2013 - - - - -- ADDITIONAL INFORMATION AND REMINDERS FROM OTHER DIVISIONS: SAVINGS AVAILABLE/GRINDER PUMP: A reminder to those of you who need a grinder pump for your connection: Department of Public Works (DPW) sent you a letter in December 2012 stating the town, for a limited time of two years, only from the receipt of the DPW letter, would provide you with the pump at no charge. (This can save you thousands of dollars.) Please note: You must pay the installation cost through your own contractor. Please make your contractor aware of this, if interested. Also be aware: this is a shorter deadline than the Public Health Division's deadline on the reverse side of this page. SAVINGS AVAILABLE/PERMIT FEE: The Town offers a waiver of the residential sewer connection fee of $420.00 for those properties that connect within two years of the receipt of the DPW December 2012 letter. LOANS: For loan(s) available, please see the enclosed brochure, or see the town website: http://www.town.barnstable.ma.us/cdbg (under the "CDBG Programs", see "Sewer Connection Loan Program). For loan specific questions, you may contact Kathleen Girouard, Growth Management, at 508-862-4702. CONTRACTORS: Information on Licensed Sewer Installers is available on our web site at www.town.barnstablc.ina.us/PubIicWorksTech/sewerinstallers. Contractors, approved to perform sewer connection work in the Town of Barnstable must obtain and file a Sewer Connection Permit with DPW-Water Pollution Control Division, 617 Bearse's Way, Hyannis-contractors, please call Dave Anderson at(508) 790-6244. FOR ANY UEST-IONS-/.ASSISTANCE:.___ Len Gobeil at the Town Manager's Office is available to provide you with direction you may need in reference to the Stewart Creek Sewer Connections. You may contact him at 508-862-4701. QASEWER connectEetters Stewart Creek Sewer ConnectsNMAILING L.etA Sewer 2Pgs Merged 3-28-13 Yr2015.doc 1' _ _T ' JJ // ////���� NAME 0 OFFEArk, [Iq - YAr�US_Ff BAR 5138 TOWN OF AD -OFOFF��R�' °. b r y/� JA �,� N BARNSTABLE CITY, A P C D E/^i�� 9 /( TL/#1iVr 3AY1" tHE IDS d - W MASS LL 1 639• �0$ t r O .erED MpY• W TIME AND DAT y10 TION J n LOCATION F VIOL TIO J ,/ 1 f LZU NOTICE OF .M i 1,U.)o . t K f � Y 7" / /�!Y SIGff PURE 0 ENFORCING ERSO f , EN G G DEPT '1BADG *0. w VIOLATION �` � '1. �. o OF TOWN REBY ACKNOWGE RECEIPT OF CITATION X c , ED ORDINANCE Unable to obtain ature q ffender. //,', I— / THE NONCRIMINAL FINE FOR THIS OFFENSE IS SAL 10 W Date mailed _ � W OR YOU HAVE THE FOLLOWI ALT R ATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPITON(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD. W REGULATION a (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, LU before:The Barnstable Town Clerk,367 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk, a P.O.Box 2430,Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. (2)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT, FIRST BARNSTABLE DIVISION,COURT COMPOUND;MAIN STREET,BARNSTABLE,MA02630,All:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. (31 If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature ..^.......+m.-... ss...:�..ri. .;L'.. r :?.t.P's.*-.•nm. r .�ys..-T.f....-`.- C p a..k; ...,y,: �..,..,r., rr TOWN OF BARNSTABLE BAR-W 3804 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager ('.*- f)` s# /.,o mf v/r:7/rAA/_0dob Address of Offender twom 11 �, ]`8 '� 1 VMV/MB Reg.# Village/State/Zip SS# Name � 14pfpq, on20aj Business Addressfi oa �"ll�� � Si"gfidtur'e of Ent rcirig'Officer Village/State/Zip Location of Offense f , 11)0(7-) { Y VC:.. -Y VIQ ,, Ae-� L04V �1 ITII . Enforcing' Depyt./jDvision : Offenset.� Facts 11V (�'� `N.0 Mn 1)4 y .p C-1 2A%PA 6--rr M- _- This" will .serve only ras al war q1 V, ning. P.t this time no legal 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. r*t.. r �.-.ra TOWN OF BARNSTABLE BAR-W i Ordinance or Regulation WARNING NOTICE M& Name of Offender/Mana erA0 '*',S. . . f , g , Address of Offender , f `I a *# � !4' `e Ydrlhly MV/MB Reg.# Village/State/Zip Business Name warn%pm, oon2p Business Address , "1 Sig-nature of Enf'orcirig 'Officer Village/State/Zip k , Location of Offense 0/ Enforcing'Dept/}Division Offense44 �""' } Facts ' fii N d) h / .. '- of3 This will serve onlyyas'a warning. At this time no legal 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. a.....,.�>,.,•..,..,.::-:. h,'�ss.a _ ,� .;;F C' ,::.- .:"f;..w �.r�;.",-xf-w`-r..>�r--4:TM';;t-a-^r-'n x; i �n--"`—w7. -air,......, .. ..�:1-�..•1+.�fi+,".r.}ten.rn "' .. 'e -.:. ...,, rj r -.1:w TOWN OFBARNSTABLE BAR—W 3775 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager ( , r"a Address of Offender 1 ;_.J Pj'i_t 0 i` MV/MB Reg.# J� .H Village/State/Zip ! 1 �^ 4 ! Business Name ram.° am/p !,,on f L 2Q9 /f ,,� ` ; Business Address / {, a tr/ V '.,. `/ S°i'gnature of Enforcing Officer`} 'yf G/ Village/State/Zip , Location of Offense UNAk:. YVA0115) .a«�� �.i( 1��V Enforcing Dept/;Division Offense Facts0 U+� 1-5,V _ f This will "serve' only as" a warning. At this' time no legal action has been- takein. 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. n:,-•.-.,.. �..--- Ys*..�.r•,,.,Fo-.,..,,-t.�.,,r'3, ,f!'....._. �.'^?' -^:<'c r .Tm....,--""- a - r p: c -cr � *r',:-T "1��, -. `rr.----r•---t.. fix-.,;`.. .:,} TOWN OF BARNSTABLE BAR-W 3776 Ordinance or Regulation f WARNING NOTICE Name of Offender/Manager Address of Offender ° :✓ � � F MV/MB Reg.# Village/State/Zip V t 01i' ` F/I4 / # f r d Business Name Ff /pm, on ^jfl 20`, Business Addressr Signature of Enforcing Officer+ : Village/State/Zip Location of Offense = t .� � T7�i Eel • a'. ,,`�r .. � , . wit01 Enforcing Dept/Division' .Offense # i t, .�. # 1 i FactS .fsy� �'�`- This will serve only as" a -warning. At this time no legal 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. }tr.{- ,'417VA •w n -c} +ter �.. ' r { ✓ � z`� € _`_ �..s �'�'` tt j� t'6.'-•' 'X, ;, ��"$,,�:. +�k"t= - a;. :;.�i'i �� #„�v� `k- ri^�°t�-"f�� k .rt3'r t��� y�';�� vl ,: ' � Yarmouth�<©isposal ArEBa" t " .0 CKET : a' 11, ou606 Forest Road1 fl.' Yarmouth,, MA t?2664 ,r € r 1NEIGH ASTER INS TIME INr "• 14:07 00�4t�t 0 ,' :t x ATE OtTf � , TIME O.UT s . jk- ROLL OFF a ^x T -• Y 'r J��'t�P hSl4 : v NIN Scale. 1 Gross Weight 4440 LB�": 'Inbound Cash ticket I. 4c , . � Manual: Tare.-Weigh�t 43C�0 3 . 'Net"6 i cah t 140 LB w -4+q OTY.M.Iff �, ` UNIT ESCRIPTION ,* �, 5:MA:-AR4TE *$ EXTENSIONYA 4FEE„ ' TOTrAL 0 '<1 TON C!D f� i MCI. 0 0c a 10 00 10.0 EACH MattlDxSpr lFurrn; �� Q 35 1St7, � � � 0:0 15�OI:J sas �.�,h+' f�5 €�� �� 'u^ k= K12,� tit.,}, r-N�r," p�.;;,, . tiri tsFd..'r, Sfl�Fs'�` '.'T�`' . t• `' 'r-�_. ,z.d,''rs .N, t �,..�yi.. a4 4 >F C,z :.:'-irY," i - •;r.,•. Xw,�:tJfR'�,r ;.•� Y f au t, �} • .�•-a i{r . 1� �i7+• - ''->�r� cr s - t t 4 .� "�# t��. �`i ^F' y� -.F f � �Ii ,1�+.`4.s:...a rs,.� - � �,:. '.. � ,,� a.aG.�,.,. `��r, +j.��- .+ �.� ? �,/el ��"'y�` s a� �`:"' ,� •h�'i� - Y ��. '%`I d h,�-; �Y4 ask t ` a�t� $ / i %ftr'• t z NDEREb BEY 1btJ'0�? Y7. "Qr en j'7 d a 5 (r /�Y t ■ 1 yr �j.* /� u w /Q T rf-�,T. - j ./ a wee G:�F�I�. a,Y T"Y III,FytS 6i .T.O} � 111 a� rt 'k N# 1, VAIPI,C/-AN,VLy' , Clo ec! 7FianksgIV49g, Chr.iStmas" " an t" New=t,Year rDay. h ^� a Closed at noo�n+r on Jul ' 4t: h. . o 1 nay; luor,eds een_-W 't ,bu1s'a't .Fh- calEclr .o: s7 r e� vr• s s -�j >< -^ , R'K +g 7� bn.k"• '{' 1 `4 {� 's -ryu�iSy+' .,' ;. v, � S.Xi,Y f ��,,„„A2► `' y"••°.t,,� a �' ,�y�w u,�y R. /, � � t", ,Y, 'w����i �.: -r , ;• �SIGNATIJRE•rIti�* h� `r �� • F f r � � Q � 3 Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of 4 FF �F�f10* Environmental Protecti n �0N o 1Alllc�ov ii► TaWeldF.W. � Q rge��9inuidy cog f ArW Paul Celluccl David hs u.damn« 3 o� 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM o 5 3 PART A - CERTIFICATION Property Address: 81 & 83 Woodbury Ave, Hyannis, MA Addressorowner. Mrs. McCartan Date of Inspection: a '1-0, ') (If different) 1 0 7 Ch i c k e r i n g Rd Name of Inspector. W.E. Robinson SR Dedham, MA 02026 Company Name,Address and Telephone Number. ( 5 0 8 ) 7 7 5-8 7 7 6 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA CERTIFICATION STATEMENT 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-si;Pwaals e disposal systems. The system: _ es _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspeotor's Signature: lJ t, I r Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A,B, C,or D: A) S YSS PASSES: I have not found information which indicates that the m violates an of the failure criteria as defined in 310 CMR 15.903. any system y Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal,cracked, structurally unsound,shows substantial infiltration or enfiltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street a Boston,Massachusetts 02108 a FAX(617)U6-1049 a Telephone(617)29 -UN i�Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) Property Addrew 81 & 83 Woodbury Ave, Hyannis, MA Owner. Mrs. McCartan Date of Inspeotion: ; 44 - e B]SYSTEM CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distribution boa is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 C] THER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: -Conditions exist which further evaluation require by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 3) OTHER "V (revised 11/03/95) Z • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 81 & 83 Woodbury Ave, Hyannis, MA Owner. Mrs. McCartan Date of Inspection: D] SYSTEM FAILS: have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the Backup of sewage into facility or system component due to an overloaded or dogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is lase than M 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. — Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. )LARE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone U of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with.the groundwater treatment program requireme to of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information., (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST property Address: 81 & 83 Woodbury Ave, Hyannis, MA Owner. Mrs. McCartan Date of Inspection: d__A.I—Q Check if the following have been done: lumping information was requested of the owner,occupant,and Board of Health. ✓ZNone of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. (/As built plans have been obtained and examined. Note if they are not available with N/A. �/The facility or dwelling was inspected for signs of sewage back-up. 1/The system does not receive non-sanitary or industrial waste flow JZ4he site was inspected for signs of breakout. +/system components,excluding the Soil Absorption System, have been located on the site. --&.Ae septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge, depth of scum. _011 size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. L/l/be facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAddreae: 81 & 83 Woodbury Ave, Hyannis, MA Owner. Mrs. McCartan Date of Inspection: 1— 41_ FLOW CONDITIONS RESIDENTIAL:- Design flow:G G 0 gallons Number of bedrooms: c! 1, Number of current residents*uL;1 Garbage grinder(,yes or no): Laundry connected to system Ves or no): YL?,3 Seasonal use(yes or no):`� 1995 - 1 4 1 0 0 cubic f t. Water meter readings,if available: cubic ft. Last date of occupancy: 9 COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow:_p1lons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non4anitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORD apd source of information: /d System pumped as part of inspection: (yes or no)_ If yes,'volume pumped: gallons Reason for pumping: TYPE OSYSTEM ✓ 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) Other(explain) APPROXIMATE AGE of all components, date installed(if known)and source of information: Pt� Sewage odors detected when arriving at the site: (yes or no)A (revised 11/03/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddrem 81 & 83 Woodbury Ave, Hyannis, MA Owner. Mrs. McCartan Date of Inspection: a2- L/-q SEPTIC TANK.V (locate on site plan) Depth below grade: /0 Material of construction:_L14ncrets_metal_FRP_other(e plain) � b� Dimensions: 9- 10 Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: /G Distance from top of scum to top of outlet tee or baffler_ Distance from bottom of scum to bottom of outlet tee or baffle: ` Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) T�°h-l� /(i i CG•' a s L n. G E TRAP._ (locate on site plan) Depth be ow grade: Material f construction:_concrete_metal_FRP--other(explain) Dime Scum Disteaoe from top of scum to top of outlet tee or baffle: Distat from bottom of scum to bottom of outlet tee or baffle: Comments: (recomm tion for pumping,condition of inlet aad outlet toes or baffles,depth of liquid level in relation to outlet invert,stnuhual integrity, evidence f leakage,etcJ (revised 11/03/95) 6 0 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address: 81 & 83 Woodbury Ave, Hyannis, MA Owner. Mrs. McCartan Date of Inspection: TI OR HOLDING TANK:_ (iocate site plan) Depth w grade: Mate ' of construction:_concrete_metal_FRP—other(explain) Dimensions• Capaci gallons Design ow: gallons/day Alarm 1: Co nts: (oo Lion of inlet tee,condition of alarm and float switches,etc. DISTRIBUTION BOX:" (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP C BER:_ (locate oa plan) Pumps in rking order(yes or no) Commen R ' (note co tion of pump chamber, condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 81 &. 8 3 Woodbury Ave, Hyannis, MA Owner. Mrs . McCartan Date of Inspection: SOIL ABSORPTION SYSTEM(SAS).—Z (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits, number: leaching chambers,number:_ leaching galleries,number• leaching trenches,number,length: leaching fields, number,dimensions: overflow cesspool,number: Comments:(note condition of soil,signs o hydraulic failure, level of ponding,condition of vegetation,etc.) 16 f6-0 �� t0 _ .i- b c C LS:_ (locate site plan) Number an configuration: Depth-top o liquid to inlet invert: Depth of so layer. Depth of layer: Dimensions f oesspool: ls Materia o construction: Indication of groundwater: ow(Cesspool must b pumped as part of inspection) Comments: condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.) PRIVY: (locate on plan) Materials of nstruction: Dimensions: Depth of solids Comments:(n condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) (revised 11/03/95) g f� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddresa: 81 & 83 Woodbury Ave, Hyannis, MA Owner. Mrs. McCartan Date of Inspection: 1 L)—cj r1 SKETCH OF SEWAGE DISPOSAL SYSTEM: include.ties to at least two permanent references landmarks or benchmarks locate all wells within 100' I 1 b3h�ti� I 1 Ll b � 5 nU I L � n i DEPTH TO GROUNDWATER Depth to Voundwater:��)---"V feet method of determination or approximation: (revised 11/03/95) 9 a j-� COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS John Grad DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 81-83 WOODBUWRY AV. HYANNIS MAP 307 PAR 053 M n D L6 Name of Owner MATHEW CHAMSARIAN /j® Address of Owner: 130 CHUCKLES WAY MARSTON MILLS MA.02648 Date of Inspection: 6/24/99 Name of Inspector:(Please Print)JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) J U N 2 7 .1 1999 Company Name: n/a �� to"OF N Mailing Address: n/a OF Telephone Number: n/a 1 E CERTIFICATION STATEMENT ------ 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 inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes . The Inpection is based on criteria defined in Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system is Needs Further Evalufjor the Local Approving Authority performing at the time of the inspection.My inspection does Fails not Imply any warranty or guarantee of the longgevity of the septic system and any of Its components useful life. Inspector's Signature: Date:6/13/99 The System Inspector shall s 9mitpy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING SYSTEM EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 81-83 WOODBURRY AV.HYANNIS MAP 307 PAR 063 Owner: MATHEW CHAMSARIAN Date of Inspection:6/24/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: n[a 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. n1a The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. nla Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced nta The system required pumping more than four 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 revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 81-83 WOODBURRY AV.HYANNIS MAP 307 PAR 053 Owner: MATHEW CHAMSARIAN Date of Inspection:5/24199 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of 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 SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance n(a-(approximation not valid). 3) OTHER nLS revised 912/00 i i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 81-83 WOODBURRY AV.HYANNIS MAP 307 PAR 053 Owner: MATHEW CHAMSARIAN Date of Inspection:6/24/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped nta. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 81-83 WOODBURRY AV.HYANNIS MAP 307 PAR 053 Owner: MATHEW CHAMSARIAN Date of Inspection:6/24/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and-the system has been receiving normal Flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [1 5.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 81-83 WOODBURRY AV.HYANNIS MAP 307 PAR 063 Owner: MATHEW CHAMSARIAN Date of Inspection:6/24/99 FLOW CONDITIONS RESIDENTIAL: Design flow:_4411 g.p.d./bedroom Number of bedrooms(design): 4 Number of bedrooms(actual):4 Total DESIGN flow: 44Q Number of current residents:2 Garbage grinder(yes or no):MQ Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no):M Seasonal use(yes or no):M Water meter readings,if available(last two year's usage(gpd): nLa Sump Pump(yes or no): NQ Last date of occupancy: xi& COMMERCIAL/INDUSTRIAL Type of establishment: nLa Design flow: nLa gpd(Based on 15.203) Basis of design flow: nLa Grease trap present:(yes or no):M Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ Water meter readings.if available:n& Last date of occupancy: WA OTHER: (Describe) Wit Last date of occupancy: n& GENERAL INFORMATION PUMPING RECORDS and source of information: nLa System pumped as part of inspection:(yes or no):NIQ If yes,volume pumped Wit- gallons Reason for pumping: it& TYPE OF SYSTEM XSeptic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: n& APPROXIMATE AGE of all components,date installed(if known)and source of information: NEW SYSTEM WAS INSTALLED IN 1993 PERMIT 93-631 Sewage odors detected when arriving at the site:(yes or no): NQ revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 81-83 WOODBURRY AV.HYANNIS MAP 307 PAR 063 Owner: MATHEW CHAMSARIAN Date of Inspection:5/24/99 BUILDING SEWER: (Locate on site plan) Depth below grade: 2 Material of construction:_ cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: TOWN Diameter: nLa Comments: (condition of joints,venting,evidence of leakage,etc.) nLa SEPTIC TANK: X (locate on site plan) Depth below grade: 2_ Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) nla If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): No nLa Dimensions: L 10'6"H 5'7"W 5'8" Sludge depth: Z! Distance from top of sludge to bottom of outlet tee or baffle: $L" 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: M How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND,RECOMMEND PUMPING SYSTEM EVERY ONE TO TWO YEARS GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) nLa Dimensions: Wa Scum thickness: n& Distance from top of scum to top of outlet tee or baffle:jiLa Distance from bottom of scum to bottom of outlet tee or baffle n& Date of last pumping: n& Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) nla revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 81-83 WOODBURRY AV.HYANNIS MAP 307 PAR 063 Owner: MATHEW CHAMSARIAN Date of Inspection:6/24/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: Wit Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) nla Dimensions: n[a Capacity: n/a gallons Design flow: n(a gallons/day Alarm present: NQ Alarm level:jala- Alarm in working order:Yes_No_ NQ Date of previous pumping: n(a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert:LIQIUD LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) DISTRIBUTION BOX IS STRUCTURALLY SOUND PUMP CHAMBER: NQ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NQ Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n& revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 81-83 WOODBURRY AV.HYANNIS MAP 307 PAR 063 Owner: MATHEW CHAMSARIAN Date of Inspection:5/24/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: nLa Type: leaching pits,number: 2-1000 GALLON LEACH PITS leaching chambers,number: .oLa leaching galleries,number: jiLa leaching trenches,number,length: nLa leaching fields,number,dimensions: Wa overflow cesspool,number: Wa Alternative system: Wa Name of Technology: ji& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PITS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.ONE PIT WAS FULL AND ONE PIT WAS EMPTY CESSPOOLS: - (locate on site plan) Number and configuration: nla Depth-top of liquid to inlet invert: nta Depth of solids layer: Wa Depth of scum layer. n& Dimensions of cesspool: n& Materials of construction: n& Indication of groundwater: Wa inflow(cesspool must be pumped as part of inspection)n& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nta PRIVY: _ (locate on site plan) Materials of construction:nta Dimensions:nta Depth of solids: n& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n& revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 81-83 WOODBURRY AV.HYANNIS MAP 307 PAR 053 Owner: MATHEW CHAMSARIAN Date of Inspection:5/24/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a 7 o i 0 revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 81-83 WOODBURRY AV.HYANNIS MAP 307 PAR 053 Owner: MATHEW CHAMSARIAN Date of Inspection:6/24/99 NRCSReportname: n/a Soil Type: n1a Typical depth to groundwater: nta USGS Date website visited: n& Observation Wells checked: MQ Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions _ Checked with local Board of health Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS AND VISUAL-12+FEET revised 9/2/98 Page 11 of 11 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .............. �....OF.............................Cn......�-&h -t----_-----_----- Appliration for Disposal Works Tonstrur#ion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ("')-'an Individual Sewage Disposal System at: �'al C:✓cCs�6crr p "ice � / .vo%..... ------------N--.-----------------------------•----------- ovation Address o .. ----•------------------------------'----:..�...`.Q...-----...---................------------. V........... ... a Owner 7. ..................................................�i►�/Ad .LJl� Vat��� Installer Address Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) f4Other fixtures ---------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity,"-0" ''s.gallons Length................ Width................ Diameter---------------- Depth---------------- x Disposal Trench—No..................... Width ...... Total Length..........- Total leaching area....................sq. ft. Seepage Pit No.....`Z--........ Diameter.----------------- Depth below inlet................ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by------------_----- ..................................................... Date........................................ ,� Test Pit No. 1................minutes per inch Depth of Test Pit.........---.----... Depth to ground water.........--------------- f� Test Pit No. 2................minutes per inch Depth of Test Pit..........------.... Depth to ground water........-._..-_-.---.-- ------------------------------------------------------------------------------------------------------------------------------------•--•--•-•--•'----------- 0 Description of Soil......................................................................................................................................................................... x - V -'-----'-•---•------------------------------------------------'-•---•---•----••---------••-•----'•-------•---••---•-----•------------------•-...-•------------------------------------------------------ W x -------------------------------------------------------- ------------------------------------------------------------------------------------------------------------ ------- p U Nat of Repairs or Alteralions—Answer when applicable....--PO..(l�%-v G)--.--- ......... ...- . _Y.. ----------- ---- ---------- --------------------------- ------------------...---------------------------------------------- Agreement: The:undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of Zealth. Signed .. ` �l �------------. '-----. Date Application Approved By..................'ZI "2� , --1 -- ------------ - - 'Dat Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- -------------------•-•-•-----------------------------...----- ------------------ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r< , - OF...... .......,.j•... t" , ter o -� r .a ,---,..,,.., f .,_------------------ App iration for 3iiiVasttl 10orko Tonotrur$iou 'bruit Application is hereby made for a Permit to Construct ( ) or Repair (.o-4. e an Individual Sewage Disposal System at: .......................... .." "s-s.:.- .._.__:x`a ....... s .�._. ...,.<._._ .... ........................................... ................................................... F Location Address . v •f or Lot No. .._ .. _.—. ............................................... v` ---------------- .Owner _, Address W .f P ----••-•-------------•----............... I� IL Y Y/sR CF...... e. .......................... _____________ �,....... ...•._. _ j' Installer Address d Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) `k Other—Type of Building No. of persons____________________________ Showers — Cafeteria P I Other fixtures ------------------------------------------- W Design Flow.............................................gallons per person per day. Total daily flow............................................gallons. _9- Septic Tank—Liquid capacity.._._,.-,,",_gallons Length______________ Width___-____-...____ Diameter................ Depth-_..______.... Disposal Trench—No................_.... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----c am.._._._._ D.iameter... ----------- Depth below inlet...:. .:......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) W Percolation Test Results Performed bY........------••-•---•••-•-•••••--••••--••••-•-•••••-•-••-......-•••••-•-- Date........................................ Test Pit No. 1................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........................................................................................................................................................................ U ----------------------------------------------------------------------------------------------- -------•---•----•-------••-----------------------------------------•-...------------------------------. W -- --- -- -- --- ----------------- U Nature of Repairs or Alterations—Answer when applicable.____...x ._ ___ � 4v ,. ______________ _. f Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of<the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed r °' •------- . Date Application Approved BY . ............. - - Date Application Disapproved for the following reasons: ----•------------------------•••-•••••••-••---------• ---•----••••••-•------- •---------------•--•-•---•------------•-•-------•-•------•-•••----••-•••-----•--•--...-----••---•-•-•------------•------•-------------•----.....-•------------------•---•-••--•....••------------------ Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........• .. .?.. 5 f .... ............ c f Tatifiratle of Toutphaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired r by ` w�A - . Y�� . 7.. -------- Installer ` f ti,.3 s e;; %-- r'+, y rr =` _------•-----•-- has been installed in accordance with,/the provisions of Article XkI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...... ...v, . ---•••......--•-•• dated---------� ;z L=per THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.-----....... ••• V ----------------------------------- Inspector---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r p rt O F y ------------------- �•,, - .;•. .x~ a,. ............ .... ,: x t 6 ,� FEE.,~ Permission is herebygranted ., g ........................................................... to Construct. ( ) or Repair (L•fin` Individual Sewage Disposal System at No t._ -�� 1 -�.- d� ................ '' -- ------------------- ' m Street as shown on the application for Disposal Works Construction Permit No _ - .€y`, ._ Dated___. __.E'fw� F DATE. Board oti Tiealth ;� i =�:� ------------------------------- �;t FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS TOWN OF BARNSTABLE LOCATION 81 & 83 WOODBURRY AVENUE SEWAGE # 13 — 63D VILLAGE HYANNIS, ASSESSOR'S MAP & LOT '36 7- 063 INSTALLER'S NAME PHONE NO. ELLIS BROTHERS CONST. CO. 362-6237 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) P tT' x (size) la o e, NO. OF BEDROOMS PRIVATE WELL O ` PUBLIC WATER BUILDER O O t�Le.va�"T'AN DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: aL. VARIANCE GRANTED: Yes No t/ i oQ o o �_.LAZI Ph �_ YC �6-7 b APPROVED THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE �b Apphratinn for Dbjpmial Works Towitrnrtinn raind Application is hereby made for a Permit to Constrllct ( ) or Repair (✓) an Individual Sewage Disposal System at: ..: ` -�°'--'^'�'`- -I,�va�vx� ��--- ----------- -----------••----•--•$........................... ..................... �— n,n- „ r`Lot No. b� s� fi/ d � ✓ 1 �i Owner ddress.,, .__ jr = Installer Address UType of Building Size Lot............................Sq. feet .-� Dwelling— No. of Bedrooms------------________________________________Expansion Attic ( ) Garbage Grinder ( ) - aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 04 Other fixtures ............................... . . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. C4 Septic Tank—Liquid capacity........___gallons Length________________ Width................ Diameter................ Depth................ 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit----------_......... Depth to ground water........................ GZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ... ••----------------------- ---•--•--------------------•----------•-••------------•---------..._._.__._.._._...--•-•--...---------•----.._...--------_-__-- 0 Description of Soil........................................................................................................................................................................ x M ------------------------ ••------------ ------------------- •--------------------------------- -•............. •------------ •--• ---------------------------------- •----------- ...---------------._... W ••--•---------- ----------------------•-------•-----------......------.._.._._..._..----••----•--•----••----------. UNature of Repairs or Alterations—Answer whe a licable. _._.._ ..._.. _ P � _ � � PP • �•�•--�--��------------lr��.�.�?.... �L---•--_-��....�.----- 2 ?- ��f ..._f6? �0 �'fi_.. Q � --------.� .�/!i�--------• Agreement, The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental de—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h een issued by the boa d of health. Signed . .. ............ .............. ....... - ....... ........y....................... Daze Application Approved By ............. .�` '"` ......... . ...._.......... ... ..a..-...��.� ............... Application Disapproved for the following reasonr.• ............... e ...._.... -- .. ._............. .. ........... ......................................................... . ......... Dve Permit No. .......75......&..3./------------------- Issued ........................D..a c tee. . -1.,.,�.-...�._-FiC:.-...-rt�<w.`.w.as.-�...�..�..w..sv�.r........,r.,w�-.->.w..__..--..,-�..:.:,.r. +.�-....:.....:.-.w.�w.--.,--._.•,.--•.-..- .�•r-•""-- '..-^^�� - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -3TOWN OF BARNSTABLE Appliratiun for Diripwial Wurkii Tunutrnrtiun Vatnit Application is hereby made for a Permit to Construct ( ) or Repair (V) an Individual Sewage Disposal System at: 0 -33 ._.......__ L, : ---•• ----•f-•----•---..._ ..__ -•-• -- )Imi \dd r.f�'Gs j ` or Lot No. Owner Address Installer Address d Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms...............���__.--------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons------------------------- Showers ( ) — Cafeteria ( ) 04 Other fixtures ---•-••-•---------------------•--___--•----•---------•--------------------------------- ------------------------------•----•----•-•------------------ w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 04 Septic Tank—Liquid capacity------------gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No. .................... Width.................... Total Length..................._ Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter-----------.-------- Depth below inlet.................... Total leaching area..................sq. ft. Zt 'Other Distribution box ( ) Dosing tank ( ) •.' Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (s, Test Pit No. 2................minutes per inch Depth of Test Pit--------_........... Depth to ground water........................ a ••••••••••••-----------•--•-••-••••••••••••••----••--•••-----•-----•-•-•------------------------•--...------...._.._......-•---._.......__.......----...--••- ODescription of Soil.....................................................................................................------•--•------------•---------------............__...--------••- x w U Nature of Repairs or Alterations—Answer when applicable.�....�.. __ ___ /�?�__._��!� _.__...G�__:._/........ .. : . 7-" _-- ' __._r / �'�' ------via --------- J .� "�r✓ ............................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has"b"'een issued by the board of health. Signed -...._.-.......-.- !.✓...'-�-�1...... - _Y r Dare 2, Application Approved By ........I.... -------------------------------- °�-...---...--------------"`---` Dare Application Disapproved for the following reasons: ..................................:..................................................... ....... . ........................................................ . ...... .............. .............-......................-............ . . ..........-- ......... . ................... �� Dace PermitNo- ------------/.... ......6.3./---- ---- ---- Issued ...........--...--.......................................-.-........ 1 Dare ---------------._.---- '---------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certifirate of I.LIImplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( V ) y .... mot /.:.� t.�-- .- ate.S .-.--.. c��✓-�..-�=-------- ---- ....--.._.........._........... ........... .......... ............................ ....... b .rf_:._... at ...........7 . ....' ...... -1......���N.---Uf:/. ...���1 ..., C..j C..... .._..... .. .........................- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ....... .�..--.. dated ...... _.._..._....- .................... `~ i THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE . SYSTEM WILL FUNCTION SATISFACTORY. DATE....... ---.....1.. '` �r--.. t. ....._......................._... Inspector ...........-a..,., ) .................__..............--... .. ... ..... --------------------------------------------------------------------_--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH G f TOWN OF BARNSTABLE FEE._":_...C�' >: . 3�iu�uuttl ur�u �unutr�rtiun rrmit Permission is hereby granted 1------ to Construct ( ) or Repair (1I an Individual Sewage Disposal System _ at No.. ... '_ �� Z '_a_ ' -^�`�; ! ?" r / .. - Mr" 1 {---------------•--•--•--__--____ �'l , Strcet as shown on the application for Disposal Works Construction Permit No.7_�K,3. __`Dated....................................:..... -----------------,\ ................ --------------------------••-- / I�/ (�'1 Board of Health DATE.. / --------- �✓ FORM 36508 HOBBS 6 WARREN.INC.,PUBLISHERS