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HomeMy WebLinkAbout0144 WOODLAND AVENUE - Health 144 Woodland Avenue Hyannis P A = 270 316 e I U 1TOWN OF BARNSTABLE LOCATION y I GyUbC 1�� �VC . SEWAGE # eVII.L'AGE ASSESSOR'S MAP & LOT 970 IG INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY CVO LEACHING FACILITY: (type) A—r (size) NO. OF BEDROOMS C BUILDER OR OWNER C�n � PERMITDATE: L COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leac ng facility)_ Feet Fumished by,�Z�_r0e u., ' J w 00 00 w c� � p a _ 1 TOW`N\OF BIARNSTABLE LOCATION SEWAGE# C-3 VILLAGE ASSESSOR'S MAP&PARCEL 7 O 1 to INSTALLER'S NAME&PHONE NO. S CCU�(F '�-'rGJNK- S bX a I SEPTIC TANK CAPACITY Q X( 1000 Q G\L LEACHING FACILITY: (type) a (size) �C NO.OF BEDROOMS IA ' OWNER- PERMIT DATE: f p f(o COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table,to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY C C .? .� Jko c� No. V C! �✓ / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppfication for -Disposal 6pstem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. 1 (( W 6 Q `C,,A CiV Q, Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Addre s, d Tel.No Designer's Name,Address,and Tel.No. 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 A erations(Answer when applicable) o< W y 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 Health. Signed ��--� Date �s O Application Approved by Date o Application Disapproved by Date for the following reasons Permit No. ,;fv UP — 16 3 Date Issued t ,s No. Fee' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: � PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for Disposal 6pstem Construction 3permit Application for a Permit to Construct Repair( ) Upgrade( Abandon( Complete System Individual Components Location Address or Lot No. L`(( W G p(�`� GUQ. Owner's Name,Address,and Tel.No. Assessors Map/Parcel Installer's Nam,Addre s and Tel.No J Designer's Name,Address,and Tel.No. Type of Building: \ Dwelling No.of Bedrooms N { Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �j gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title k, Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations Answer when applicable) P ( 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 Health. _ II`I Signed o Date f IQ> h,1 Application Approved by f Date 0 Application Disapproved by Date for the following reasons Permit No.aO f Le 16 3 Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS C3�x v Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system,Constructed( ) Repaired-t(/) Upgraded( ) Abandoned( )by v at d has been constructed in accordance - - r i with the provisions of Title 5;and the for Disposal System onstruction Permit No.j U p ��� dated o Installer ((� `��-(�� Designer #bedrooms Pr Approved desig -fl w I� gpd The issuance of thi pe` it shall not be construed as a guarantee that the system will ctio P a design Date (� I i Inspector r� ��N 12 A ------------------------------------------------------------------------------------------------------------------------------------ No. of V — K 3 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS ID Disposal *pstem Construction permit / Permission is hereby granted to Construct( ) Repair(\./r Upgrade( ) Abandon( ) System located at 6\!\(� l� 1{�� t- «A C,A 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 be completed within three years of the date of this permit. Date Co e/tp Approved by ►�t.C � , an AsBuilt Page 1 of 2 U TOWN OF BARNSTABLE LOCATION y 1 W��I�� �V SEWAGE# VILLAGE 14VAJ 1S ASSESSOR'S MAP&'LOT A 3i6 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) I'+T (size) NO.OF BEDROOMS a- BUILDER OR OWNER C�1t1,1 t 1Q PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leadd ng facility) Feet Furnished by�^ T it„ A QI SALk �J 1 a O 3 A IS a as sa 3 3°1 33 y y . http://issgl2/intranet/propdata/prebuilt.aspx?mappar=270316&seq=1 5/10/2016 e S1Z®1�� COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 144 Woodland Avenue Hyannis, MA-02601 Owner's Name: Estate ofHelen Christie Owner's Address: Date of Inspection: May 2. 2005 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford ' Mailing Address: P.O.Box 49 a Osterville.MA 02655-0049 ' Telephone Number: (508)862-9400 Cn -n CERTIFICATION STATEMENT - r; ;r I certify that I have personally inspected the sewage disposal system at this address and that the iif& ation rqorted,M' below is true,accurate and complete as of the time of the inspection. The inspection was perform based orrmy U' training and experience in the proper function and maintenance of on site sewage disposal systems. I am a V-5P UD approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The syste .N ✓ rn Passes Conditionally Passes Needs Fu er Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: May 4, 2005 4 The system inspector shall submL copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DER The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving. authority. Notes and Comments i ****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. Title 5 Inspection Form 6/15/2000 page 1 t Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 144 Woodland Avenue Hyannis, MA Owner: Estate ofHelen Christie Date of Inspection: May 2, 2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if. (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 144 Woodland Avenue Hyannis, MA Owner: Estate of Helen Christie Date of Inspection: May 2, 2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and.SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for 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,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 144 Woodland Avenue Hyannis. MA Owner: Estate of Helen Christie Date of Inspection: May 2. 2005 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for 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,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)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 System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. 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) Yes No the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 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. A 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 144 Woodland Avenue Hyannis, MA Owner: Estate of Helen Christie Date of Inspection: ME 2, 2005 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _ ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS,located on site? _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ _ 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: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. j 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 144 Woodland Avenue Hyannis:MA Owner: Estate of Helen Christie Date of Inspection: Ma 2. 2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Number of current residents: 0 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): epd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source.of information: Unavailable Was system pumped as part of the inspection(yes or no): 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) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed on 5116185-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 144 Woodland Avenue Hyannis, MA Owner: Estate of Helen Christie Date of Inspection: May 2. 2005 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 20" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 Qal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 4" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: _ MeasurinQ stick .Connnents(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Cement tees were present. The liquid level was even with the outlet invert There did not appear to be any signs of leakage Recommend pumping. GREASE TRAP: None (locate on site plan) Depth below grade: , Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 144 Woodland Avenue Hyannis. MA Owner: Estate of Helen Christie Date of Inspection: May 2. 2005 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarn level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was level. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Continents(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 144 Woodland Avenue Hyannis, MA Owner: Estate of Helen Christie Date of Inspection: May 2. 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: I leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: 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.): The leach nit had P ofliauid on the bottom The scum line was approximately at the sane level There did not appear to be any, signs offailure. CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 a Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 144 Woodland Avenue Hyannis. MA Owner: Estate of Helen Christie Date of Inspection: May 2. 2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. A (3 L k Q A � _Q a 0 a� aq a 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 144 Woodland Avenue Hvannis, MA Owner: Estate of Helen Christie Date of Inspection: Me 2, 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps, the maps were showing approximately 25 +/-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,written or implied, relating to the system,the inspection and/or this report. 11 ' I_ ccIL 00 v �o � 0 W W. _ ® V� N WNo W W � W g \� 3� _� Z o- _ 4 J N \ a. aC O cc x Z � � J W O O W J AL V "t O t � � goy,� W Sig i ��a f' �� �� �� z �� / >' i/ � c. t �`���' ,:. No..... _"-9_6 .y= F�s..a.....J............... '2 7 0 TWE—CC fI MONWEALTH OF MASSACHUSETTS 01 ' 1 3 /� BOARD OF HEALTH J` ................OF..Barnstau.e-....................................................... Appliration for DiSposal Works Tomitrnrtion Vamit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: ........ ret_.#_5.3 •.W_oodland--• ye.,1,.,Ext. Ryan is .VA. •Location-Address or Lot No. ...... agrieo Re It r st-•------------------------- -7b5....Falmouth.-Raad•►...14annis..................... O er Address a S t ve= 1Jeei ----•-......... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...3.......................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ra-nCh.............. No. of persons............................ Showers (2 ) — Cafeteria ( ) Q' Other fixtures .................................. Design Flow......... .......gallons per person per day. Total daily flow.........339..........................gallons. WSeptic Tank—Liquid,capacity000.gallons Length$_1.611------ Width4!.1.V.. Diameter---------------- Depth-V-8`.._-- x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No.3____•_-..__---__-• Diameter...... .!.......... Depth below inlet.....W.......... Total leaching area...2.6,......sq. ft. Other Distribution box ( ) Dosing tank ( ) Z Percolation Test Results Performed by....E1-- r.Oge...Enging&ry ............ Date....L1_-2.5=B1--------------- Test Pit No. 1__� ©..._..minutes per inch Depth of Test Pit.._12!......_.. Depth to ground waterylo-n{a---ene punt e - (i, Test Pit No. 2Pd/fl minutes per inch Depth of Test Pit.N/A........... Depth to ground water...N_A._,_......... e -- - Q+' ----------------------------------------------------------- •---•--•--------------------...----------.------------------------ .------------------------------- ODescription of Soil.......... I. 2-1---------loam...&---toplsC 1•----------------------------------•-----•----- ..... = - }{3 l l�tec 1 use y 110 s a �i -------------------------------------------+-------- -'------- �, x 10 }2- mec�-.----wY��-t�--=sand/t-r-aces---af---gr-ausl:Aa--water-.-at_ 12' U Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The un rs' ed further agrees not to place the system in operation until a Certificate of Compliance h en i "ued y the of health. Si Pres' 9�25�84-- ---------------------- -- ---- --- ------- ---- - -- D ' ApplicationApproved By.................... ---- --'--� . •---•--------•------------------ ...... .......................... Date Application Disapproved for the following reasons- ----------------------------•---•--•----------------------•----------------••-----------_---------------- Date PermitNo......................................................... Issued....................................................... Date 1 gcl- No........ ........................•- 11 ThE COMMONWEALTH OF MASSACHUSETTS — � �� BOARD OF HEALTH Town Barnstable ------------ --- ------------------------OF.......................................---------------••---.........................-----. Applira#inn for Disposal Works Tonstrur#inn jJrrmit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal SysLott. . Hyannis , 111A .� -woodland r ve....,...��:t.'•--...................... - .... ..... ••. .......................... ............................................................ Capricorn Rd_ff3tlrsjATrUSt 765 Falmouth RdaldtI'Hyannis ...... - --- ................................................... ..........--...................................................................................... W -- Steve Lebel Owner Address a ................................................................................................... ...•-•----••-•••••-••-•.....................•-•••••....._.....--•-•••---••-•••----••--••-•-•---•-- Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.3.._-......I_..•.......................Expansion Attic ( ) arbage Grinder ( ) Other—Type of Building ranC...........::..... No. of persons................._........... Showers ( ) — Cafeteria ( ) f�I Oftr, fixtures -----------------------•-----.................-••-•-.-•----------. ------...---•------------•--- W Design,..Flow...... = 1�5� gallons per per 4 egF day. Tot �d�i�y��flow------------•----------------•--- • �ons. y` 1 u W Septic Tnk—Liquid capacit ._._.__._=_.gallons Lengt ................ Widt __.__.........._ Diameter------------_... Deptl...__....__..... x Disposal Trenc —No..................... Wid ,--------.----------Total Length..... Total.leaching area.... sq. ft. 6 2-6-6- Seepage Pit No..................... Diameter.._.......`.._.._. Depth below inlet........•....•...... Total leaching area..................sq.. ft. Z Other Distribution box ( ) Dosi -t 0­4le(dg)e Engineering 11-25-81 Percolation Test Re It Performed by______________,-_..___..........__---•.- Date___.._.._........._.........._......__.. a 12••---•••--••--- one encounteK- ,� Test Pit No. minutes per inch Depth of Test Pi ....... Depth to ground wate ___ ________________ e /A I /A----- NIA - --- 44 Test Pit 1v ................minutes per inch Depth of Test Pi .................... Depth to ground water........................ Kj T — _ ... .---_....". .p O Description of Soil........�.+_.-----•-�--,-•---.1 o3m 8c �fro-S O 11................•--•---.......---•--•-•---.._._....---••-----•-•-----•-•---••-•--•-•---- x _ 1tI Niedum...yeTT.................ii •...................... ----------------------- ---------- -0-r.........1-z,------mec2: wYi te...saridJ` races of graver/rio water a ..12 I --------------••-----••------------------•---------------------------`-----•--......•----- -----•---••------------•----------------••-----•---....--------•••-----------••-----••-•••-•--•••......--- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT11 5 of the State Sanitary Code—'.The -ndd-reigned further agrees not to place the system in operation until a Certificate of Compliance-has be r issu d by =booard of health. �.> 2 84� ---SI ned-•--•-•-- ....---- -- • /!/l�� ..'r_e..o 9� 5� Da Application Approved B J. __ ._ '.___ '. PP PP y......--•---•. --•-•......•••---••--•-••-•--•--•-....._..• ...................... Date Application Disapproved for the following re ns:----•-•-----••..-•--•......•---•--••-••---•-•-•--••......-••-------------- --•-:--•---•--................. .....:-•...............................•-------------------------•---•--.....-•-----•--•---•----•--....-----••••-••-------------------------------------------------------- ----------------------• --- 'G Date PermitNo......................................................... Issued_........................................................ Date >. THE COMMONWEALTH*OF MASSACHUSETTS BOARD OF HEALTH ..:....Town...................OF......Barns tabl e Trrtifirate of f ompliFatirr • THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed (X ) or Repaired ( ) by �teve_ .Lebel .... --.... at_..._..Lot � �� Woodland rive . , Ex�n�taller Hyannis, NIA ...............---- has been installed in accordance with the provisions o TLE �-Sf,,Xhe State Sanitary Code as described in the application for Disposal Works Construction Permit 1 o................+......._............._.......\1 dated_............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIO SATISFACTORY. f � > DATE...... r ...... .. ....................................... Inspector........ ..... °t ................................. ,h i y , THE COMMONWEALTH OF MASSA USET/ > l BOARD OF HEALTH f� 1 "r1'7S Town Barnstable ---' No......................... E ........................ Disposal Works Tnnstr inn umit Permission is hereby granted................Steve Lebel to Construct on Repair an Individual Sewage Disposal S S2�1r11S I at No...L of > 5 vu orrclarc 2 ..... ti i........_.- Streey 1_.._1r� �! P ) g P 9 _--.---. as shown on the application for Disposal Works Construction Perini No................... Dated......................................... /� Board of Health DATE................................................................................. FORM 1255 A. M. SULKIN, INC., BOSTON r r r P �Q`J _ o� ti '67 IV ' G 00 a, p l p o 2 a ` G) �/3 zvn/c— /. ,I% �.G z Gj pel- 0��y(H F M,�s f �; o, o O 'A. r o ORSE y v' No.10951 40 GIST 9o�Fs&IONI���ab\ LEGEND CERTIFIED PLOT PLAN EXISTING SPOT ELEVATION OA0 °EXOSTING CONTOUR --- ® �`�-:'f- vt/UO n��s.vi� Cx A✓E . T Z_o-1- 5 .FIND-SHED SPOT ELEVATION , ` FINISHED- '..CONTOUR 0 IN .R ` 'APPROVED BOARD OF HEALTH _:'U '� � 1��� �'.1���..� •�� i DATE AGENT SCALE DATE a� 4 ' `{r DREDGE �ENGINEERINO CO. IIV� CI,IENT�2A 1 CERTIFY THAT THE PROPOSED EGI3TERE REGISTERED JOB N0, r�"Z /4'S BUILDING SHOWN ON THIS PLAN _1 CIVIL LAND , ,� ,� CONFORMS TO THE ZONING LAWS }2ir ENGINEER RV Y R DR.BYt OF BARNSTABLE , MA MAIN STREET . CH. By' �w HYANN I S, MA$S. SHEET / OF L DATE 717 REG. 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S4ECT/0N OF GROUND �g7ER T. E • OtJ7�.[`TAl�gI,�YT/O/V�X 3 `�ZfT- ,. !/Vd rLE6d[!!/hAG sir 3 SE AGa=- /5~AL .SY.STWd�!! •+CALF : %4' _ =o DjAiENs!ov A 3 '/rT. D�ES/6N CRITERIA a_ �r -� •fYllMOER Ofl�ELMOOMS �_ - �I�IEJJVS/®N C►�_FT_��"� SOIL. LOG . TOTA1. FI-0AV 33 o GA4.1,0AY SOIL TEST#/ $o/L 7�ST,*,2 S0/L 7°'&�T NUMBER ax- LEACNIAIa P/73 / �`ELe`Y. 3 7 t �`-e—LEY. /&- OA rL OF SO/L 3 E,�T S/GE LEACHING GER P/T /S/ S¢ -7 ` sorronr L�c�rivG o�R Pir l/3 ass / R'�R CGl AT10N /�.4TE�/ /yll►PS/ AdC/'il TOTAL I-A5 CK/NG AREA -2- 6 4 SO fT. 3-z."3 S a IZWleC0L_ 47/0N RArJF 2 �� �'IIAI f INCN .QESERYE L EACi'//N6,4REA a 54. F T. Z a y s SAIL OF t.. rA 4,1 Pca oSRUCEELDrZE G i oMORSE s No.1095I OVC Clvp �� 7/Z MAIN ST. NYANN/5 MASs. ONA. IVGGJTOU/YD YY�TER 4TNC01/V7-44 CAIEKTt F AWC-0 D. 7-0 Q GROUNIo W,47,ER di7' ZL_& . Z JQ� ,MD_ 8 Z / f f F -�� 17 a r P' V 2 x IV `v Vp \ \ ^. 7` S� T 7-0 nAc ' r L g� /p�L�c� v S �. OF H (H. M4 v o �✓i ' A. a ORSE v, .o RFe10951�4��Q I GIS?E �FFSSIO.NA\.�a6 LEGEND EXISTING SPOT .ELEVATION Ox0 ,tr CERTIFIED PLOT' PLAN IEXOSTIN® CONTOUR _—_ ® Z-.o-r- 5 6 Wvv />LA A✓ . 5x7- FINISHED" SPOT ELEVATION ,y"Al s ,FINIS ED. CONTOUR 0 IN :�►1PPROVE.D BOARD OF HEALTH \ r, F •vU� a 1 �.A -` 4a y "' p.ATE AGENT SCALEt %o DATE , Ll 14 D REDGE ENO INEER/NG C� l!V �2 R.✓c_v. , CLIENT.' I CERTIFY THAT THE PROPOSED t 01ST.ERIE REGISTERED JOB NO. �'? /4S BUILDING SHOWN ON THIS . PLAN hs CIVlI: LAND CONFORMS TO THE ZONING LAWS ENGINEER RV Y DR.BY eq -1�?' OF BARNSTABLE , MA� a ,k' Tt2 MAIN STREET CH. BYE ; '�; 3 2C; f HYANN 1 $, MABS. / �, ' " SHEET DATE REG. LAND SURVEYOR i 41 Q ,A 14 46 LN lb se • a.•: 14 • •'o �6 O'0 o fa 14 V 1 1 AT •a " ; • • •� 4 o • M �► �� q ! Q V . l 44 14 14 ♦� J ��I V INyr r u StTTS t � N WO. O y;` 1 �I] l NN C � i fir'x• `�• _' i r �' ,� � O. 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