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0132 WOODLAND AVENUE - Health
132 Woodland AVenue'Extension , . r. .. Hyannis Y v h t kxi ' ar+tyr A=269—263 ` . -', 1 ! i V LGoo Jim 1 ne inspector Man 5085349919 page 1 0®p r - i��ti W&3 Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form- Not for Voluntary Assessments E f' 132 Woodland Ave Property Address ' Nancy Feroci Owner Owner's Name information is required for every Hyannis MA 02601 7-11-16 page. Cityrrown - State Zip Code Date.of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. E Important:When A. General Information filling out forms �/ - on the computer, 11734 ``�gtiunlll►rpp� use only the tab 1 Inspector; .�`����, t41 OFMgS k,, = key to move your =yi "" cursor-do not use the return James D.Sears 't*= JAMES 'yN" key. Name of Inspector. o; SE _ARS �-r= Ca ewide Enter ris c es LL p p *� � Company Name ��'•, RT►F� A� 153 Commercial Street ��������s.rN...... y Compan Address t . h Mas ee - p MA 02649 C II !To y wn State Zip Code 508-477-8877 S1623 Telephone Number License Number t B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 f Title 5 310 C °MR 15. ( 000). The system: ® Passes ❑ conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority �•4�¢di ��� -- 7-11-16 espector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. "This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6l16 Title 5 Official Impaction Form:Subsurface Sewage Disposal System•Page 1 or 17 a U _ t t cv t v CL:Jo jim i ne inspector Man 5085349919 page .2 s Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 132 Woodland Ave Property Address r Nancy Feroci Owner Owner's Name information is - required for every Hyannis MA 02601 7-11-16 page, CItylTown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E l always complete all of Section D A) System Passes: s ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are r indicated below. Comments: The system is a 1000 Gal. Tank D Box and pit t r B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the.Board of Health, will pass. Check the box for"yes", "no" or"not determined"(Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old" or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance Indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): l5ins.doc•rev.6116 Title 5 official Insaecbon Form:Subsurface Sewage Disposal System•Page 2 of 17 Ju L 1 1 cv 1 u jim i ne inspector Man 5U85349919 page 3 f E Commonwealth of Massachusetts Title 5 Official . Ins pection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 132 Woodland Ave Property Address - Nancy Feroci Owner Owners Name information is required for every Hyannis _ MA _ 02601 7-11-16 page. City/Town State Zip Code Date of Inspection B. Certification (coot.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.)-. ❑ Observation of sewage backup or break out or high static water level in the distribution box due t to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health).- El broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑. broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (E)iplain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland.or a salt marsh 15ins.doc-rev.6/16 Title 5 Offaal Inspection Form:Subsurface sewage Dt3posel System•Page 3 of 17 1 1 Kula ccou Jim i ne inspector Man 5085349919 page 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments E .•� 132 Woodland Ave Property Address = Nancy Feroci Owner Owner's Name information is required for eve ryH Hyannis MA 02601 7-11-16pa e. City/Town _- State Zip Code Date of,lnspection B. Certification (cont.) t 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, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary ryto a sur face water supply, ' ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance; "* This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal - coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due,to overloaded or clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in is less than 6" below invert or available volume is less than %day 7 flow p, -- t5ins.doc•rev,6118 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 r JU t t o jim i ne inspector Man 5085349919 page 5 i= Commonwealth of Massachusetts t Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 132 Woodland Ave Property Address Nancy F-eroci Owner Owners Name information is required for every H annis MA 02601 - - y 7 11 16 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public 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. P q ty This Y I system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, _ provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] . i� ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El Elthe system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the _ system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t51ns.doc-rev.5/16 Tltls 5 Official Inspection Form'Subsurface Sewage Disposal System•page 5 of 17 :L1J0 JIM i ne inspector Man 5085349919 page 6 Commonwealth of Massachusetts t Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - 132 Woodland Ave Property Address - Nancy F anc Owner eroci _ Owner's Name N. information is required for every Hyannis MA 02601 7-11-16 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate ° es" or"no" as o y t each of the followin g: 9• Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ® Have large volumes of water been introduced to the system.recently or as part of this inspection? ® Were as built plans of the system obtained and examined? (if they were not available note as N/A) Z ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: - ® ❑ Existing information.For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) 1310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 i t5ins.doc rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 6 or 17 GG.JO Jn n I ne inspector Man 5U85349919 page 7 Commonwealth of Massachusetts E N Title 5 Official Inspection Form E Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 132 Woodland Ave Property Address Nancy Feroci Owner Owners Name information is - required for every Hyannis MA 02601 7-11-16 page. Ctty/Town State Zip Code Dat e of In s ection D. System Information p Description: The system is a 1000 Gal, Tank D Box and pit Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No = Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No = Seasonal use? ❑ Yes ® No = Water meter readings, if available (last 2 years usage (gpd)): 2014-87,000GaIs Detail: 2015-91,000Gal's Sump pump? ❑ Yes ® No Last date of occupancy: Present = Date Commercial/Industrial Flow Conditions: L Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis-of design flow(sea ts/persons/sq.ft., etc.): Grease trap present? El Yes ❑ No Industrial waste holding tank present? El Yes ❑ No Non-sanitary waste discharged to the Title 5 system? Lk ❑ Yes ❑ No Water meter readings, if available: l5ins.dac••ev.6116 _- Title 5 Official Inspection Form:Subsurface Sewage Disposal Syst=m-Page 7 of 17 s cc:jo jim I ne inspector Man 5085349919 page 8 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . ,r 13 2 Woodland Ave Property Address t Nancy Foroci Owner information is Owners Name _ required for every Hyannis MA 02601 7-11-16 page. Clty/Town State Zipcode Date of Inspection p In D. System Information (cont.) Last date of occupancy/use: Dale Other(describe below): General Information Pumping Records: Source of information: 09/ 11/ 13/ 15 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ` ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page a 0f 17 LV LLJO J11 n i ne inspector Man 5Ubb349919 page 9 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 132 Woodland Ave Property Address Nancy Feroci inform Own -Nancy is Owner's Name required for every tennis page. CitylTown MA 02601 7-11-16 State Zip Code Date of Inspection D. System Information (cost.) Approximate age of all components, date installed (if known)and source of information: 1985 Permit#85 - 155 /7-2016 New D Box i3 Line. Were sewage odors detected when arriving at the site? ❑ Yes ® No 1= Building Sewer (locate on site plan): - Depth below grade: 18" feet Material of construction.- El cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet = Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. Septic Tank (locate on site plan): Depth below grade: G" _ feet Material of construction: ® concrete ❑ metal ❑ fiberglass g ❑ polyethylene , ❑ other(explain) - If tank.is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No ` Dimensions: 1000 Gal, Precast H-10 Sludge depth: 1" t5insAoc•rev.6116 _ Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 GGJo Jim 1 ne inspector Man b08249919 page 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for VoluntaryAssessments ments 132 Woodland Ave Property Address Nancy Feroci Owner Owner's Name information is required for every Hyannis MA 02601 7-11-16 page. City(Town -- State Zip Code Date of Inspection D. System Information (cont.) 1 Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 29 Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 8„ Distance from bottom of scum to bottom of outlet tee or baffle 17' How were dimensions determined? Asbuilt- Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank and cover's at 6" below grade. Inlet baffle, outlet tee. No sign of leakage or over loading F Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass 9 El polyethylene, ❑ other(explain): Dimensions: _ =t Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 15ins.doc•wi.6/16 Title 5 Official Inspeclion form:Subsurface Sewage Disposal Syslen•page 10 of 17 Y i t i ie tl uNecwr clan outi5,3499j 9 page 11 Commonwealth of Massachusetts; Title 5 Official Ins '„'ection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments • ry 132 Woodland Ave ` Property Address E Nancy Feroci Owner.information is Owner's Name required for every Hyannis page. Cityffown MA 02601 7-11-16 Slate Zip Code Date of Inspection D. System,information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass 9 ❑ polyethylene. ❑ other(explain):. Dimensions: Capacity: gallons Design Flow: gallons per day - Alarm present: ❑ Yes ❑ No Alarm level: — Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): t ' f i _ "Attach copy of current pumping contract(required), Is copy attached? ❑ Yes ❑ No 15ins.doc-rev.6/16 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 cc.Jy .nfn i ne inspector Man 5U85349919 page 12 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 132 Woodland Ave Property Address ` Nancy Feroci Owner Owner's Name information is required for every Hyannis MA 02601 7-11-16 page. Cltyfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage Into or out of box, etc.): D Box is 16" x 16"-1' below grade wlcover at 6". Box is new 7-2016 w/one line out Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No' Alarms in working order: ❑ Yes ❑ No'* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): r If pumps or alarms are not in working order, system is a conditional pass. - Soil Absorption System (SAS) (locate on site plan, excavation not required).- If SAS not located, explain why: 15lns.doc•rev. Title 5 Official Inspection Form:subsurface Sewage Disposal System•Page 12 of 17 CU 1 U cc;Jy Jim i ne inspector Man b085349919 page 13 Commonwealth of Massachusetts 5 Title '_ Official Inspection Form ._ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments F r 132 Woodland Ave Property Address Nancy Feroci Owner Owners Name information is required for every Hyannis MA_ 02601 7-11-1.6 page. City/Town State Zip Code Date of Inspection i D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number; ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: E ❑ overflow cesspool number: -- ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): _ Leaching is a 1000 Gal. precast pit w/2' stone. Pit at 30" below grade w/cover at 16". 2'water in pit. No sign of over loading or solid carry over. No high stain line. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No 15ins,doc-rev.6116 Title 5 Official Inspection Form:Subsurface Savage Disposal system•Page 13 of 17 «.may .,Inl Ine inspector clan 5U6b349919 page 14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r` 132 Woodland AveE WoE Property Address Nancy Feroci Owner Owner's Name information is required for every Hyannis _ MA 02601 page. CityfTown - State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): - i tbins.dcc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 17 IIIC nIaPtlLLUF' Ilan page 15 E Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Y - 'r 132 Woodland Ave _ = Property Address Nancy Feroci - E Owner Owner's Name information is required for every Hyannis _MA _ 02601 7-11-16 page. cily/rown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately A-Iz �r � 3 - 3i� 3° tEJ A -3 - 3& 13 'q_ y- 31 0 t5ins.doc rev,6/16 Title 6 official Inspeclion Form:Subsurface Sewage Disposal System-Page 15 of 17 JIM me inspector Tian 5Ubb349919 page 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 132 Woodland Ave Pro perty party Address i' i Nancy Feroci Owner Owner's Name information Is required for every C1tHyannis MA 02601 7-1 1-16. page. ylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells rO Estimated depth t high ground water.- 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: 2-15-85 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain:. ❑ Checked with local excavators, installers-(attach documentation), ❑ Accessed USGS database-explain: - You must describe how you established the high ground water elevation: Disposal const- permit 2-15-85 12' no G W Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6r16 Title 5 drliclal Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 L j - 11- JIII1 IIIe utspecior Tian 5U2S5:349919 page 17 Commonwealth of Massachusetts T'itle� 5 Official Inspection Form R Subsurface Sewage Disposal System Form - Not for Voluntary Assessments . 132 Woodland Ave Property Address Nancy Feroci Owner Owner's Name information is required for every Hyannis MA 02601 7-11-16 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist r ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file s 15ins.doc- ev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 0117 No. 6 Fee �6r' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 9..� Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Nplifation for Mispo8al 6pstem Construction Permit Application for a Permit to Construct( ) Repair()� Upgrade( ) Abandon( ) ❑Complete System XIndividual Components Location Address or Lot No. 13;L i.,4JO0 4-AAJD A V Y Owner's Name,Address,and Tel.No. NA-40-Y FEQ0Ct Assessor's Map/Parcel P(01 1 A WO LAA)b A 1(6 14Y,4PAh5' Installer's Name,Address,and Tel.No. 5&-4;-?-g 2 7 7 Designer's Name,Address,and Tel.No. 5 O'®kcKcGW_iAf- Sr ASH 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) eC I'C4CG D"80K C I40(P6L i tic ID Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt igned Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. �� a Yt Date Issued . `tea 8 41 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: • PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE MASSACHUSETTS Yes 21pplitation for Disposal *pstem Construttlon Permit Application for a Permit to Construct( ) Repair ) Upgrade( ) Abandon( ) ❑Complete System V Individual Components Location Address or Lot No. 3;L WOOT'[.a x ) A i e Owner's Name,Address,and Tel.No. Assessor's Map/Parcel a(p G jl A W OLY � CAVZ AY6 H\1APAh.5 Installer's Name,Address,and Tel.No.50%-4-7s7-$$71 Designer's Name,Address,and Tel.No. CAoEwtaE 5hXrMPA-1S6% (.k4_ 1114 155 Cow,,we_0 ./A1- S 04 c t 114 Type of Building: g 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 i Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil s Nature atu a of Repairs or Alterations Answer when applicable) x P ( PP ) � PC...�4'� D 1CN0md-- 4ju6 FA_Uc4 S*?rtG V_ D-edc Date last inspected: y Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. igned Date Application Approved by Date 7 Application Disapproved by Date for the following reasons 2 Permit No. � �Q Date Issued --------------------------------------------------------------------------------------------------------------------------------------- ( THE COMMONWEALTH OF MASSACHUSETTS vy . BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(x) Upgraded( ) Abandoned( )by_CA Pc-w 1nF_ Ekj—rERl?0_i9cS u.C- II at- ��l noPiLA NA AVE t4 ykj o I s has been constructed in accordance -with the provisions of Title 5 and the for Disposal System Construction Permit Noce b �/O dated Installer CAK (b _ G f eXPK >�4LG Designer. N / I f #bedrooms A Approved design flow w�A gpd The issuance of this permit shall notlbe construed as a guarantee that the system will ct n lr�esigned. Date / Inspector - ---------------------------------------------------------------------------------------------------------- No. Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstrm Construction permit Permission is hereby granted to Construct( ) Repair()() Upgrade( ) Abandon( ) System located at 1 3A- 6p L,4)j +4 y/4r f l�m i S 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 b9,completed within three years of the date of this permit Date / � /�P Approved by AsBuilt Page 1 of 1 . � y ,,� �� LO SEWAGE PERMIT NO. YI INSTALLER'S NAME ADDRESS To HK J ��Se f �►� _ B U I L D E R OR OWNER T C ►�c DATE PE MIT ISSN'ED Z 15 S DATE COMPLIANCE ISSUED EMCr Ar 7 3 3 5 3l i 63 ee/ http://issgl2/intranet/propdata/prebuilt.aspx?mappar=269263&seq=1 7/11/2016 ' , Y TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION - � r � Date !;Xl Time: In Out r Owner Tenant ' Address Address Ikjf'� V I Compliance Remarks or Regulation# Yes O Recommendations 2. Kitchen Facilities AppmVem, 3. Bathroom Facilities Nk-A Cot;•C3.�1 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 8 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal $ —f S 5 17. Temporary Housing 18. Driveway Width `�v. t&) " 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) �---" Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here r TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION r Date Time: In Out 1 Owner Tenant C � — Address Address 9 3 Z— wov-� Complian a Remarks or Regulation# Yes O Recommendations 2. Kitchen Facilities 3. Bathroom Facilities Approved:..�o MCI n rA* 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing 18. Driveway Width A51 19. Number of Tenants Observed Do' PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) _ �-- Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here �� i - �•�► ,.� ..f��;/�.i f �per,�.._._.rr...�._.- _...�- MLD Cent: _ -1 TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date i o� Time: In Out MOvIVic" 1 � Owner W mjcC 4 f teoG 1 Tenant L iES f aao Address SIS lAaAL No7 ST• Address 3 Z. t^-,20A L, 1.0 AVE t_�co Ht sZ G�- l�� CS1 4�S NAN p6 w W 1 S, 1.Okx Compliance Remarks or Regulation# Yes ,,NO Recommendations / 2. Kitchen Facilities 1/ 3. Bathroom Facilities 4. Water Supply Zo 5. Hot Water Facilities (� 6. Heating Facilities 7. Lighting and Electrical Facilities LX 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal j` 7 1E tjp� 16. Sewage Disposal P t V-f, ;z 17. Temporary Housing K/ --. 18. Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; --�� 0o S� Lei Removal of Occupants; Demolition Number of Bedrooms ' N� 5„� �F Number of Vehicles Allowed (max) Number of Persons Allows max) .� 14>U SF Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here A. �: .1 TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date ` � 06 Time: In D. 1 o Out ZU Mav%uy % Owner N Ntv . —f zo G 1 Tenant C LES o �£ Address G/S` AG 1vu-7 ST Address 0V) LnN0 A,VI- IFx-j Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 20 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service (/ 11. Space and Use 12. Exits- � z { 13. Installation,and Maintenance of Structural Elements 14. Insects and Rddents 15. Garbage�and Rubbish Storage and Disposal 16. Sewage Disposal Pazt vt, L ' 17. Temporary Housing K/A-. 18_. Driveway Width 19. Number of Tenants Observed i PART II 37. Placarding of Condemned Dwelling; —�V Do SZ G0 Removal of Occupants; Demolition J Number of Bedrooms , S F Number of Vehicles Allowed (max) `7 Number of Persons Allowed. max) f. .`-Person(s) Interviewed - �� Inspector Z94 .'If Public Building such as Store or Hotel/Motel specify here f , 1 � � � � i R - - ., �� i � �� J T FORM30 Caw HOBBS&WARRENrn THE COMMONWEALTH OF MASSACHUSETTS ` BO. . D OF HE LTH CITY/TOWN i DEPARTMENT Hig o y 1 DRESS V�/^/a W_ �n GSM sv0y5o LEPHONE Address l3a WOW 10-30L� `�l�Occupa � ,rJ 'Pik✓ 4 SL1SAf� Floor ApartmQnt No. No. of Occup nts No.of Habitable Rooms No.Sleeping Rooms No. dwelling or rooming units_ No.Stories Name and address of owner Q V414�+-W Remarks Reg. Vio. YARD Out Bld s.: Fences: i Garbage and Rubbish - Containers: A Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 , Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Faciil. Sup.Ten,.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties.- Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin, Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS IN PECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALT nEU FI ." INSPECTOR TITLE - T-6-AV 1,3 j A.M. DATE TIME /I ` `�O P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human'habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in'this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. _ (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). - (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. s ��. v ©ass-- �� C 1 � � L�l o�f� _ 13Z �ao� l�� �� t �n� �- F`• i..� � � Parcel Detail Page 1 of 3 NO 0 FUT iW a, � �! ,r y .ace» 05 F, ILOc, ed Ire H>: Thursday,dzfy, i =€" u' arced Detail €%arcei Loo<uo Parcellnfo ....... ......... Parcel ID 269-263 DeveloLotS LOT 54 ,__..._.___............... Location 1132 WOODLAND AVENUE Pri Frontage�226 Sec Sec Road, ........_. _..._._ _ _......_ Frontage village I HYANNIS Fire District HYANNIS f _"".___-_"-.._---------------- . _.- -"".__-----------._.. £_._ _ .--------.._"...._ Sewer Acct I Road Index?1872 Atom w j ; M a Interactive � < Map '"',, E N Owner Info _.., m_.. ___ ....._ ._.._.. ___.... Owner:FEROCI, NANCY P Co-owner streets 45 WALNUT ST Street2 ......... .. ......... cityLEOMINSTER State MA zip 01453 Country US Land Info ._ ....... __.... Acres E0 32 Use S Fam MDL 01 zoning Nghbd i0106 ... ._ ......... _ ingle_____ _____._._ _ .w� _.... .._ _.__..__..__. Topography Level Road Paved Utilities?Public Water,Gas,Septic Location Construction Info Building I of -.- .--_ Year=1985 Roof Gable/Hip ExtWood Shingle Built Struct Wall Effect Roof .. ... _.. .._ AC _. w Area 1356 Cover`Asph/F GIs/Cmp Type None i�,.�, ,� -._. ............. .............. .......... . Style,Ranch Int Drywall - Bed�3 Bedrooms Wall Rooms Model Residen _ Int Vinyl/Asphalt Bath tial 2 Full _.._._ Floor Rooms _,.,.. ...,.. Heat , . 1 Total Crade',Average Hot Air 6 Rooms " _.... Type' �,,. .. I Rooms '— _.... __ ,�,�— http://issgl/Intranet/propdata/ParcelDetail.aspx?ID=19971 2/22/2007 Parcel Detail Page 2 of 3 Stories 1 Story Heat Gas Found- poured Conc Fuel ation Permit History ........ __... . . ......... .. ............. .......... Issue Date Purpose Permit# Amount Insp Date Comm 6/1/1985 B27962 $40,000 1/15/1986 12:00:00 AM HY 1 Visit History Date Who Purpose 5/20/2002 12:00:00 AM Paul Talbot Meas/Listed 9/15/1990 12:00:00 AM ML - Sales History Line Sale Dato Omer Book/Page Sale P 1 1/15/1988 FEROCI, NANCY P C103807 2 10/15/1985 FEROCI,ANTHONY V & NANCY P C103807 3 11/15/1982 FRANCO, NICHOLAS D TR C90060 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parc€ 1 2007 $135,600 $2,700 $0 $166,100 ; 2 2006 $124,200 $2,700 $0 $147,700 3 2005 $118,200 $2,700 $0 $133,800 4 2004 $96,000 $2,700 $0 $113,700 5 2003 $86,700 $2,700 $0 $40,700 6 2002 $86,700 $2,700 $0 $40,700 7 2001 $86,700 $2,700 $0 $40,700 8 2000 $67,800 $2,600 $0 $26,400 9 1999 $66,500 $2,600 $0 $26,400 10 1998 $66,500 $2,600 $0 $26,400 11 1997 $65,100 $0 $0 $26,400 12 1996 $65,100 $0 $0 $26,400 13 1995 $65,100 $0 $0 $26,400 14 1994 $64,000 $0 $0 $29,700 http://issql/intranct/propdata/PareelDetail.aspx?ID=19971 2/22/2007 Parcel Detail Page 3 of 3 , -15 1993 $64,000 $0 $0 $29,700 16 1992 $72,900 $0 $0 $33,000 17 1991 $78,100 $0 $0 $46,100 18 1990 $78,100 $0 $0 $46,100 19 1989 $86,000 $0 $0 $46,100 20 1988 $60,900 $0 $0 $19,900 21 1987 $60,900 $0 $0 $19,900 22 1986 $0 $0 $0 $16,900 Photos http://issgI/intranet/propdata/ParcelDetail.aspx?ID=19971 2/22/2007 . � r g W 9L 00 : W � . �Wma V)l CA ILL � S W �7 .• N N me W us w a- at s oc M s W Z Lai p oc sm O — Z = t J > O O � M � M � M �9. • 16 No. ....`� -T}1E COMMONWEALTH.OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable .. .......................................O F.......................................----...............--------•--..................... ApVftrafton for Bhipasal Workri Tonstrnr#inn Errant Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: „ot # 54 Woodland Ave . Ext. Hyannis , NIA ......... ...»u................. .. .........�........................ ..._...... ._...................... .. Capricorn Reaf`VyA`�rrtst 765 Falmouth Rcfad;NHyannis - ........ - - ........................................••-•--------••--•------..._...: ........---••-....................._...........-•••-•---...............------------.............-- W Steve L e b el Owner Address ........ ............................................... Installer� Address UType of Building Size Lot............. Sq. feet Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) 'Parbage Grinder ( ) s ok Other—Type of Building Y'anCh............... No. of persons............................ Showers ) — Cafeteria ( ) aOther fixtures -----•............................................................... pp .. Design Flow------5.5 00.. gallons p p 6 y [)'' 30 mil W _.;.............. Ilons per ers i er day. Tot 1� i flow.......................--....•........Dept ...... x Disposal Trench—No: .................... Wid ti------------------- Total Length...._ .t._____..__.Total leaching area.... sq. ft, Seepage Pit N4.................... Diameter.... ...........: Depth below inlet.................... Total leaching area..2.b�.......sq. ft. Z Other Distribution box ( ) Dosi tank ►-a ldredg)e Engineering 11-25-81 Percolation Test Results Performed by......................................... . .-. Date........................................ 0 T2 none encounte�- Test Pit No. 12._./`A_.:.._...minutes per inch Depth of Test Pity.rA_........... Depth to ground water ........... ... e (4 Test Pit No. !.............minutes per inch Depth of Test Pi ............ Depth.to ground water.../..._.........____. Ra' •---•-•-----------------------------•-------•-------------••..... ------------------------------------------ 0 Description of Soil.........0 ° -. 2' loam & to s o li . .x 2 - 10 Me ium ye ow san ---------------- -------------------------- --- V ------•-- I----•......... ........... ----------------------------•. 10 - i2 mei * w�ii e saric�� races oT--gravelAY6---WAti ..at---1'2 .----------•-... ••-••---------------••----•-•---- U Nature of Repairs or Alterations—Answer when applicable................................................. ........_......._.............. .. ••-•-•••----------•--------•--------•-•------•••......••..... Agreement: T undersigned agre to ' stall the aforedescribed Individual Sewage Disposal System in accordance with the o isioi o LL of State Sa ry Code—The undersigned fL her agrees not to place the system in OP ra on ntil a erti- t ompliance as n isr by e board o th. t/ Signed.._... .. -- Px�_5........ 5� ......... = ^ Da plication Approved By..... .. ---••-- --(a..L�'t......................................... ... •--.... ate Application Disapproved f o the following reasons: •-------------------------------------------------•-----------------------•---..:------•--•-...._.. ...............•-•--•------•-•----............--------------••----------•--••-•--•----.....--••----------'---•-----------------------------......------------------•-------------------------------...... Date PermitNo......................................................... Issued-....................................................... Date No.......... ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ...........................................OF.......................................................................................... Applirotion for Dispvii al Works Tonitrurtion amit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at Lot #54 Woodland Ave. , Ext. Hyannis , MA Capricorn R&&1tyAVMst 765 Falmouth R®r&dt,N°Hyannis ............................................ .......................................... ..............................................-•-•aares s. --•--•••........._............---...W Steve L ebel - owner .. a --•--•--. .......................... Installer Address Type of Building Size Lot............:...............Sq. feet aDwelling—No. of Bedrooms anch Expansion Attic ( ) arbage Grinder ( ) pa Other—Type of Building ............................. No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 04 Oth�r fixtures •-••••......--•------•--•- --•.. WDesign Flow----_.-----••---....._.-••••-- gallons per pers ii ppei6 day. Tot �1agi ,�low...........................--.._...:..:: 1pns. . R: Septic Tank_—Liquid capacity'_ -gallons Length_-....__..___. Width-----.._ p----------- Diameter....------------ De tlr................ Disposal Trencl —No..................... Wid __- Total Length . leaching area g Z6e...••-• q Seepage Pit No..................... Diameter..................... Depth below inlet.................... Total leaching area.......:_:-_._._..sq..ft. Z Other Distribution box ( ) Dosin a tP44dde Engineering 11-25-81 ;'" Percolation Test Res It Performed by_____________ .. _. �.___.....___...__..___._. Date......................................... a ,tb I.2 none encounte - ,-a Test Pit No. T/ minutes per inch Depth of Test Pi J/A___.__._____ Depth to ground water. /A-------------- ea Test Pit No. minutes per inch Depth of Test Pi ________ Depth to ground water.._.._......._.......... O Description of Soil_.._.....c_,._---_---2,-.----•- --to SO11.-------------------------------------------------------------•---._._..._.......-----•--- Z - -•i•0- Mimi •- e1I ow sand ------------------------------------ W --------- :... ------•-•-----------I D-.-••-_-•-12'-------me—0....WhIUS--sand/traces off'--gi%Ve l/Yio__-waltiy ... 't;---12 , x ....................................................................................:................................................................................................................. U Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: ;.. T undersigne agre to stall the aforedescribed Individual Sewage Disposal System in accordance with the o sioi of of State Sanitary Code—'The undersigned further agrees not to place the system in op at n ntil a rti• ompliance has been issued by the board of health. / / � Signed..............•-----•--------------.........................•--•--Pre S-...... ......Z...S/$�!:......... ' _ _ Date, VP Approved By... __ � =' r' j%a � '�c re ':Z,/ _- :.?:.----- D to Application Disapproved f o the following reasons:............................................................................................................... ....................•-•-----------------............-----------------------------._._........-------•-----•----•-•-------••--------•-----•--•-•----•----------•--•-------•----••---------•-•-.....-••-- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ...................OF..................................................................................... (Intif irate of Tontpliatta THIS IS TO CERTIFY That the I div dual Sewage Disposal System constructed (X ) or Repaired ( ) Steve Lee Lot ;#4 54 Woodland iWe . , E.t. Installer Hyannis, MA at-------------------------------•----•---•----_________-•-----•-•--•--------•----------------•----.----------------•-•-----------•----------------------------------------------------•--------------- has been installed in accordance with the provisions of TITLE 5-of The State Sanitary Code,.. escri esd,:i ,the application for Disposal Works Construction Permit No........... __ t='. .__. dated_________________ ____-.:'7 :_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM W14 FU TION SATISFACTORY. DATE.......7.. . _.. V -------------------------------------------- Inspector------------- --- --•-............... - u THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH --- Town OF Barnstable �--- C �v No.....`-�.........:.. FEE....... ::...... Disposal 10orkii C�onotrurtion firrutit Steve Lebel Permissionis hereby granted.............................................................................................................................................. to Construct (`^'- ,) R,, air n Individual Sewage Disposal System at No Tot '> �4'___"^ooclA .Lwe. , Ext. Hyannis, i+'�A Street as shown on the application for Disposal Works Construction-Permit.No..................... Dated.._.: ...il �-'.---_.-•__-___-__, � �� Board of Health DATE------ .............................. ......... FORM 12,, HOBBS & WARREN, INC.. PUBLISHERS �. r -=�..5 ._� i � 1 � i 1 � x *a t a } i .„ ..} 10 t � 3 y � $fir _ � �} 1/C, X•��' ��, *+' v i► �l�J' 5191 L TLGST`:t a I ' ; cl- a fo ID /QI i: 7 a , ,'�, '� �\^ • '/y/�^�� + 'LO/Y►c i y t{ 1 :716 We— If lU Q r.�/YU 7f/•. ,y�!}`i.l OF�yqS (f�,'' �9 . lQo. 366 4' •ST�� r LEGEND f stiarF, CERTIFIED PLOT PLAN :1EXISTING SPOT ELEVATION OxO -�.,r�;. EXA;STbNO CONTOUR — 0 --- � Lp y S, 'wo00L,4Na A-✓�, ,EX T . . w �FINISkED SPOT ELEVATION "` ` rx""�`�� ,.. cskucs_ H IS F. INISH:I,D. CONTOUR IN , 1/APPROVED BOARD. OF HEALTH su DATE AGENT SCALES°;/"=9'0 ' DATE Vr . .`DREDGE-ENGINIEERIMG CO. IN _ GLIENT. ,:.$ i 'CERTIFY THAT THE PROPOSED EG:LSTERE REGI$TBRED JOB NO. eZ___ I4 BUII.DINOs .SHOWN ON THIS PLAN ',CIVIL ` LAND CONFORMS' TO THE ZONING LAWS NEER DR:BY ALE MEN0 AS atR" Y ' " „T1' MAIN. STREET: 1'. 11, BY 001 ;= HYANNIS, MA9S , SHEET, :L:OF z. D TE ";. REG. LAND. 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Using Water-Level Range Zone and " Index Well ,Map locate ' site and determine: r A):Appropr i.ate index wet 1 . . . . . B) Water-level range zone' . . . r lr i STEP 3 Using monthly report"Current a ; Water Resources Conditions" - 1 determine current depth to 2,z.Z water level` for index well / ► mo yr Y STEP 4. Using Table of Water-level Adjustments for index. well jSTEP ;2A , current depth to water level for index well (STEP 3) , and water-level zone (STEP 2B) determine ) . tf water-level' adjustment " . . . . . . . . . . . . . . . . . . . .. STEP 5 Estinate depth to high water by subtracting the water- level adjustment (STEP �4) from measured depth to water s level at site (STEP 1) . . . . . .. . . . ..... . . . . . . . . . . . . . . . . . . . . . . . . . . . .. r IA