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Home My WebLink About0146 WOODLAND AVENUE - Health l ,146 aVvodlarid Avenue . Hyannis A 270 315 ;' I � ice• Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments tt�d" GJr�o�PCa•��C �-v-e_ Prope4 Address Owner Owner's Name information is , / /i 1 ✓Y� /'/_6 required for /7 y/7/�/�/� every page. CityfTo n State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information MY INSPECTION DOES NOT IMPLY ANY WARRANTY OR GUARANTEE When filling out OF THE SEPTIC SYTEM AND ANY OF ITS COMPONANTS USEFUL LIFE. forms on the computer,use 1. Inspector: only the tab key to move your JEFFREY M. WALL cursor-do not Name of Inspector use the return key. WALL SEPTIC SERVICE Company Name rL P. 0. BOX 771 Company Address HARWICHPORT MA 02646 Cityrrown Slate Zip Code 508-432-4908 673 Telephone Number License Number B. Certification " I certify that I have personally inspected the sewage disposal system at this addressAa,d that the information reported below is true, accurate and complete as of the time of the inspd6i n. The in ectlon was performed based on my training and experience in the proper function and mainte ance of on site GO sewage disposal systems. I am a DEP approved system inspector pursuant to Sectl' n 15.3A—P?of rn Title 5 (310 CMR 15.000). The system: [Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 7he Si ure Date ystem 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 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 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. i5insp.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page t of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner O ner's Name -n/ !� �\ information is 1�1I— �J q_V 9 required for 1�I� every page. CityfT n State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) Syst 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: eRditieRally One or or more system components as described in the"Conditional Pass"section need to be laced or repaired.The system, upon completion of the replacement or repair, as approved by the and of Health,will pass. Answer yes, or not determined (Y, N, ND) in the❑for the following statements. If"not determined," ple explain. ❑ The septic tank is tal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, ibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspect) if the existing tank is replaced with a complying septic tank as approved by the Board of He h. *A metal septic tank will pass inspe 'on if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank I ess than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water leve ' the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven di 'bution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed 15insp.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w� 5 ®md ccc n a oij F T Property Address Owner Owner's Name information is required for n�� /6�y `1 15•_L/`/f q l /J � GCS €J 7 CJ every page. Cityrro n State Zip Code Date of Inspection B. Certification (cont.) distribution box is leveled or replaced ND Expla ❑ The system required pumpin ore than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(wl approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: Conditions exist which require further evaluation by the Board of Health in order to determine if th system is failing to protect public health, safety or the environment. 1. Sys will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)( that the system is not functioning in a manner which will protect public health, safety and th nvironment: ❑ Cesspool or p ' is within 50 feet of a surface water ❑ Cesspool or privy is in 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Boar f Health (and Public Water Supplier, if any) determines that the system is function in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil abs tion system (SAS)and the SAS is within 100 feet of a surface water supply or tributary a surface water supply. ❑ The system has a septic tank and SAS and the S is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is wl ' 50 feet of a private water supply well. t5insp.doc•03/08 Title 5 Official Inspection Form:Subsurface Sew a Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments H.(p k) d ( n a 1 l JlP io— ,s:�-xT Property Address Owner Owner's Name information is /l A,to f�\ r� required for cat. r�.C.J every page. Cityffc�,n State Zip Code Date of Inspection B. Certification (cont.) The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or re from a private water supply well". Method used etermine distance: '*This system passes if the we ater analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the pr nce of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other re 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 ❑ ar/ 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 ❑ IY4 Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/z day flow ❑ d 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. fi ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. t5insp.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner O ner's amel information is �a N required for 1�� every page. CityfT wn State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ �� Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ �,�I/} Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ � Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory., for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ❑✓ The system is a cesspool serving a facility with a design flow of 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. Systems, Te be eensideFed a large system the system must AQPXQa`��-- design flow of 10,000 gpd to 15,000 gpd. For larg stems,you must indicate either"yes"or"no"to each of the following, in addition to the questions in on D. Yes No ❑ ❑ the system I 'thin 400 feet of a surface drinking water supply ❑ ❑ the system is within 20 t of a tributary to a surface drinking water supply El ❑ the system is located in a nitroge ensitive area (Interim Wellhead Protection Area-IWPA)or a mapped Zone II o blic water supply well If you have answered "yes"to any question in Section E the system is sidered a significant threat, or answered "yes"in Section D above the large system has failed. The own r operator of any large system considered a significant threat under Section E or failed under Section D hall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5insp.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments (2 (OOC"-Cl ,C) Property Address Owner Owner's Name information is L I u' ry� 1, required for [T a o--n� ' 1 `14 6 f 5 every page. City/Towln State Zip Code Date of Inspection C. Checklist 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 ❑ ED/ Were any of the system components pumped out in the previous two weeks? ❑ [/ Has the system rec ved normal flows in the previous two week period? LatSTDcc(Ar,*1ce0 Se#0r a-oo $ ❑ 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? -: tJ c,[.uref n 6 ❑ Were all system components, e�1er6ing the SAS, located on site? L1Y ❑ 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? g ❑ 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: W21 ❑ Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] l5insp.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y (-P 1� � Ca na 3h) p L ropes erty Address m Pro U cx� Owner Ow er's Name , information is Na (`� G�J required for ,�L r� f6� � ) — every page. CityTo State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: CPg-e V l o"_5L y Z>nr�) Does residence have a garbage grinder? ❑ Yes P"'No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes g2/No Laundry system inspected? (1e 1ecTe.'e7=� ��SYS�"� ❑ Yes P'�No Seasonal use? l_i Yes ❑ No Water meter readings, if available last 2 ears usage (gpd)): Sy g G 9 ( Y 9 3'7/ 6c?7 7� � = El Yes �o Sump pump? moo Last date of occupancy: Date Type of blishment: Design flow(based 10 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/perso sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): t5insp.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments Proprerty Address Owner �t I Ow er's Name information is required for every page. Cityfto n State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Se-eT T/��k ��..►�Oeo�/i'1 -:100 f/ 0 3 oS o B Source of information: Was system pumped as part of the inspection? ❑ Yes LKNo If yes, volume pumped: gallons How was quantity pumped determined? �/� Reason for pumping: �� of7stem Type S : Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes 8 No t5insp.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Prop ETrty Address I Owner Owner's Namel information is required for every page. Cltya n State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron V4OVC ❑ other(explain): Distance from private water supply well or suction line: feet feet Comments (on condition of joints, venting, evidence of leakage, etc.): e--ycnT/'ICese.jT �oaF ,off Septic Tank (locate on site plan): e .3 Ou1—Ce �r— Depth below grade: feet Material of construction: ly/Concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: /O� ��%'/are S x y'G•¢as, �_Leu eL Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? � — — l5insp.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Rim Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments U)0ciJLa-r-,,A LET- Property Address I )1 r Owner � l -•� h�Il�l� Ow er's Nam - information is � � /1�j required for MIA Y1�t1� Imo_ _(Q� 5—�—6 / every page. City(f wn State Zip ode 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.): m �GlrHp 7-0 f164P So(.t o& erC� r . CtJP�i pare To lCc�/ ��S• . Z'Nce?— o..Tze.TtCV? e 577 <_e 9�e,6 &eyee. IS sate e Dep below grade: feet Material of nstruction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee o affle Distance from bottom of scum to bottom of outlet tee affle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or ffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): f inspection) (locate on site plan): Depth belo de: Material of construction: ❑ concrete ❑ metali�erglassEl polyethylene ❑ other(explain): 151nsp.doc•03108 Title 5 Official Inspection Four:Subsurfac ewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts qm Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address , Owner �- O er s Name information is required for r every page. Ci y/T q n State -Zip Code Date of Inspection D. System Information (cont.) Dimen ' ns: 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.): Attach copy of current pumping contract(required). Is copy attached? ❑-(es ❑ No Distribution Box (if present must be opened) (locate on site plan): �ieP/he�� ea•� Depth of liquid level above outlet invert �O 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.): 3vis Ge�,°L G✓i��i �N2 6c�TLei�tio S�L�c�' 'vim - Pumps in working or El Yes El No f' Alarms in working order: ❑ Yes ❑ No t5insp.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Yti t P u � P Owner O ner's Name information is required for f\' �✓ v I �`J I every page. City State Zip Code Date of Inspection D. System Information (cont.) +;d-appurtenances, etc.): Soil Absorption System (SAS) locate on site plan, excavation not required): /q1�x -ec.vw 6/za a-,e 7-0 OT-07-1-5� If SAS not located, explain why: Gt/ R r Set G✓,�•� �� 6 Type: a piLtX� S Errr�i�2 leaching pits number: oN 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ ihnovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): :110 I i S S/j•� (9 24ye.L , ^�O S• c (_ ?� L a J t C. o��/'d rj'Pf h 6 iS —a --. ti o .?_r o.v S•We 6t,�,411S , 15insp.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owners N me � information is l 0 a(a required for every page. Cityff n State Zip Code Date of Inspection D. System Information (cont.) rj site-plan): Numb nd configuration Depth—top of liq o inlet invert Depth of solids layer Depth of scum layer -- Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes, ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Di-ivysate-e+;-site-pl apt--- Materials onstruction: Dimensions Depth of solids Comments (note condition of soil, signs of by is failure, level of ponding, condition of vegetation, etc.): t5insp.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments fit )r)o d UcQ--,a UI)2- X Property Address n Ana Tl 4 Owner Owner's Name ��information is �(� nla-`c required for every page. dtlwn , State Zip Code Date of Inspection D. System Information (cont.) 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. 7n`') �aTe-a L7�lQGJ/n6 /S S2�Tc Ti9i�`C. I 3 i t5insp.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title .5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Wa P u t �v� c2(2C,,9A Owner 1�r's Nam information is 4 required for _2--�"()? every page. City/T n State Zip Code Date of Inspection D. System Information (cont.) Site Exam: U Check Slope [Surface water Check cellar 3/Shallow wells Estimated depth to high ground water: f� ,�y eJ67re/�. feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) [ Checked with local Board of Health-explain: �e S r L e 5 17Z ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: c / �°u-� Dom•. G-�. l5insp.doc•03/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 15 LOCATION SEWA E PERMIT NO. VILLAGE llIq 3 INSTALLER'S NAME i ADDRESS R U I L D E R OR OWNER co 09 / 1 h�DATE PERMIT ISSU D �. Y DAT E COMPLIANCE ISSUED 1: Ero 0 N --------------- ho N I�p Iv e'J �i No................_....... Fizic ...S...... THE COMMONWEALTH.OF MASSACHUSETTS• x7C BOAR® OF HEALTH Town Barnstable ...........................................OF.............I..".,.......... ......... pfira#ion for Dispogal Morks Tonstrurtiun Wrmit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: Lot #52 Woodland Ave . , Ext. Hyannis , I'fiA _________________ .......................................................... _.....----______.........._----••--•----•------•.........-•-•-•--••--•---•------•-..............__ Capricorn Rom'-`yA USt 765 Falmouth Raa�,N-Hyannis --------------------------......................._..... •------•----•--........... --...._.._..__._............-----............._..---•--•-•--•---.........................._--•••• W Steve Lebel In, Address a =---------------- ----------•--...,.... --------------------- --------- •-----•-•----......._....._.......•-----------------;-••--•--------- Installer• 4 Address Type of Building Size Lot............................Sq. feet aDwelling-No. of Bedrooms..riC w•- "" _Expansion Attic ( ) jarbage Grinder p, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q, Oth r fixtures 3_3,fl................ ...........:....... WDesign Flow_______________________________V6QD__gallons per pers�$el; day. Totq 41*flow__________..__._:...___•______________._5.glans. - W Septic Tank.—Liquid capacity......_..:._gallons LengtH................ Width................ Diameter---------------- Depth................ x Disposal Trencl --No_____________________ Widt�i�__________"_______ Total Length____-_6_e_________.Total leaching area_._. �6.......sq. ff. . Seepage Pit No..................... Diameter...................."Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) DosinjRi4�Qe Engineering 11-25-81 = Percolation Test Re It Performed by______________!_..-..______._____:_._.._ ,_.___....____..__....____ Date__._______..__ a 2 -no-ne----envo unt e�- � Test Pit No. J, A__-.._____minutes per inch Depth of Test PitI4/A............ Depth to ground water._N/A-------------- e Test Pit No. minutes per inch Depth of Test Pit____________________ Depth to ground water........................ 1"""""_____ * ................................--___________...................__----____•---•••--_..._. 0 Description of Soil......... 2 loam &""topsoil x ___.I"O_,_._.._Yits-d±UM-_-y'ali ow"-sand V _W _________1Q1_' -12-''-•----nre—d-:---whit-e•-"sand/tra.cus-..o_f---gravel/rev---W&te-r---at-- 1.2� _.__. ................... 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 TITI,- 5 of the State Sanitary Code— The undersigned fur er agrees not to place the system in operation until a Certificate of Complia issued1 the board of 1 . Signed re s. 7/5/8 • Date ApplicationApproved By................................................................................................... Date Application Disapproved for the following reasons:--"-""""""""""""""--""""""""""""""""""-"---""-""""--"-""---"""""""""""""""""""-..-___:_••__________________••-•- ..........................................................................................................""""-""""-"-""""-""""""-"--"""""""-"""""""----"--"--""-""""""•"-•--•-------___._________....__. Date PermitNo......................................................... Issued_....................................................... Date -` 5 � _ h No................_....... FEB.........: o.d„d THE COMMONWEALTH OF MASSACHUSETTS YX BOARD OF HEALTH Town Barns tabl e ...........................................OF..............................---.........................------......................_... Appliration for Disposal Works Toni �rnr�ion �erani� Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage';Disposal System at: Lot #52 Woodland Ave ., E.~ t. Hyannis , MA ��` ----------------- ..........................--•-----•-••-:...••--••--•---••--....... .......•--•-• ••-•••-•--------••--------- -------------............ ----......... Capricorn RLAftYA'�Mst 765 Falmouth Rdt18t,N°�:yannis ......................_._... --- ......._.:....... .............................. ••••••••------------....................................................... ......a............... W Steve Lebel ' Owner Address Installer Address UType of Building 3 Size Lot............:...............Sq. feet a Dwelling—No. of Bedroomsranch............................................Expansion Attic ( ) arbage Grinder ( ) aOther—Type of Building ......................:..... No. of persons............................ Showers ( ) — Cafeteria ( ) QOth r fixtures.-•-•------------------------------•-------------•--•---------------------------- Q W Design Flow....... ��.................. .0, __gallons per pers�gq day. Tot qiy,,flow.......................................... Vgns. W Septic Tank, capacity_.___...::gallons Length................ Width................ Diameter................ Depth..._......._.. x Disposal Trench—No. .................... Wid *--_---------------Total Length..............._.._ Total leaching area---- sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosin a _- tPeNdde Engineering 11-25-81 - Percolation Test Res It Performed by..............:.......................... T .. Date........................................ .� 1.2 ---•------- ' none encounte - Test Pit No. 1/A..__.._._minutes per inch Depth of Test Pi �.`A..._.._.__._ Depth to ground water.�I .............. e Lz, Test Pit No. ..............minutes per inch Depth of Test P0-4 i ._/___.__..__:_._.__ Depth to ground water........................ x •P Z _...1.�.,......lUle dDM-yellow s ai`&---------------------------------------•------------..------------------•---. -------- -• ...._. . - g-- ----- 0 Description of Soil 2 oam &. OpSOlY W -----------------=---------- lul----_---1-2-T------tiea.....wIM-6 sand/t_race-s---off- gravea:/my waur at 1.2 UNature 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 undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Fres. 7/5/ Signed. ....------.. ....... $•. Date ApplicationApproved By.................................................................................................. Date Application Disapproved for the following reasons--------------------------------------------------------•-----------------------•-----•--------------••------••- -----•---••----------•----•-------•----------------•---------------------•...•----------••-•-----------•----------------------------------------•------------------------------------------------.....•. Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town O F.......Barnstable .............................................................................. Trr#ifiratr of TompliFanrr THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed (X ) or Repaired ( ) b Steve Lebel Y ..---------•--•--•---------------•-•--•------•-••------.................--•---•-----•-----------•-----........---.......-•••._....••......--•••- Lot 5$ iloo Bland Ave. , Ext.nstaller H annis, MA at...................................................................................................................................................................................................... has been installed in accordance with the provisions of TITLE, 5-of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... datgl-------------'........................... THE ISSUANCE OF THIS CERTIFICATE IrL6PVE CONSTRUED A,A A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DA : ... 'L� Inspect r.. ✓ ----•------------------ --r -----.--------------------;.--------------•-•--------•---.--- THE COMMONWEALTH OF SSACHUSETTS BOARD OF HEALTH Town of Barnstable -. Yi ,y............. ...-- No..... .. ;;..<. FEE........................ Disposal Yorks Tonstrnr#ion rranit Steve Lebel j Permission is hereby granted.,1.. .............••-••--------------------•-------- to Construct ) �r?,v irdial r iVe Individual., et.w ge Disposal S_Ys em11is i`,Ik atNo.................1 ..--------.....--••------.......-----••--------..........._.......-•--•----.-•---------------y---------..----......------....---------------•----------................. , Street as shown o/thh.ea lication for Disposal Works Construction Permit No....P? '_� '6Dated...,_................................... ................„.......................---.._................................_................_......Board of Health DATE------ -•-------------------------------•-------------------- FORM 1255 HOBBS & WARREN. 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S�EPT/C TANK D/sT. • . t • • • • • • • t • • 4 WA SH£D S71�NE BOX • t • � 8• • � •� + .•�� - .� .• • t t 1FffECTIYL + � � y 3�E�- � �2 �: • '� + •• L�PTl�1• �• • �• W.4SXED .STd�YE :a.=• l S( x ?5 —3 73 :♦.•- t t • • • • •0 • ,O � •. • • . • • • • • • ► fps r OREG45T SE. 4GE - 7- e/+/-A ceTY 4 90 �A�/vim/ • ••� • • • • • • • • • s QP/7 OR EQU/V. //VYERT AT 8U/LD/NG ,� FT Arr. DNA". 1 /INET .S'tpTwC Ti4A/K. ¢3.B FT. /2 f? O/i4M. y f:�3FB 7>9AV ATlON> gw7.LET SEP?IG TANK 43,4 FT. r INLET D/STR/BNTION BOX `/3 4 I=Y SEC7"/O/V GF GROIJNO iY�TER Tit�K,E - - DV72ETD/ST7'iJBtJT/ON BL1X 43-ZFT- /NL.FT LEACNIA6 P/T FT_ " SEWAGE O/S~A L SYSTEM L EACI�/NG P/7 TABULAT/DN sssLE DES/6/Y CM/TER/A 01NAW510A0 8—gd-JWT- ✓ NL/I+lQER OF BEDu4'04/NS 3 _ G,nRatGEO/SPOSAL vNlr NONE SO//— LOG SO/L TE3T TOTAL ESTI/rfATEG FLOK/ 3 3 2 Gd44.10 ay SO/L. TEST Al $O/L 7ESr,*,Z XUMBER 444r I.-ACNIAI& P/Ts / FtEY 47 0 ¢ S/OFAxACHING PER PIT FT. f rE11�K �,.4TE OF SO/,� TEST 3� �jAcv 8/ �_j,3 RESULTS JVIT/VESSFD SY R OGTTOM L,G4C�,f/NG PER P/T $Q- �T. L0 A-Al- `AeRCOLAT/ON JIA7w.*/ L.Ess M'JV GN TOTAL LEACX/NG AR,=A Z 6 `�SQ. FT. PENCotATION RA7F RESERI�ELEACNlN6 AREA 2--40 Y-SQ_ FT. 3 ,- , 2p � Iz f OF s M��/uy/ 50!L 7 �- 3Zo_7 o Atsrs ��H M� s� sa►�✓v LD T S Z K/ovD Ex T -; yr ROBERT BRUCE -' w o ORSE c i �E 9 �lv°19��°'4 EL DREDEriE ElNGlJViS�RlJyiG CQ,/NG. �90 ISTEP6`2�c' CL. 3-r a 7t2 MAIN .S-r, /NYANN/9, MASS. TE O FSS/ONAI 4� I=i�•4�1/c e� D�tTE= 7/ G/8'0 Sl1R'�`� Q �/OCs/g0[lND. YYi4TfR E/yCOU/yTl�RtrO CL/ENT: - 1� GROUNy YV,4TER A7- EL.�Y. BZ /QJ-. dw&,L-T_Z-Of Z JOD /ND — l Y 1 , 1 T sf r � 0 y s� ec T S .. y - n , r q z S _ jNOFM4 -''' /5oaa sue. 3 r ? p? ALB / G'' �', 7c 1 / oo ••--JJCC ., QNo.10951 O } ss1ONAl�c 5 LEGEND EXISTING SPOT ELEVATION ONO CERTIFIED P L A T PLAN EXISTING. .CONTOUR ----- 0 ---- - \ L o Z. vt/v ��.,f �i v =FINISHED , SPOT ELEVATION ] U� ROBER,r ��, Ex7'. ..FINISHED.- CONTOUR 0 — 6RUCE � t�/�'.�! /yr ,s�.leS ELDRE i �► I N APPROVED " BOARD OF HEALTH �� DATE AGENT SCALE, Vr_ ¢D ' DATE , DRED16E ENGINEERING z _—_- CLIgNT.,�..,,...._, I CERTIFY THAT THE PROPOSED =1 EGISTERE RE013TERE0 JOl NO. 82.,..,! .5 BUILDING SHOWN ON THIS PLAN . CIVIL LAND CONFORMS EN(iMiNEER UR E DR.BY� '�{ A. NORMS TO THE zoNlNa LAws. - OF BARNSTABLE MASS''712 M A I N STREET CH. BY, s,�• -7 6 to "4 N.YA N N I S/ MAS 5. _� �7 ?' i say' a - SHEET,_.l ,OF. ... .. DATEREG. rl� L0 CAT 10N S E W A E PERMIT N0. VILLAGE zzc "/ —3 INSTALLER'S NAME A ADDRESS B U I L D E R OR OWNER DATE PERMIT ISS D DAT E COMPLIANCE ISSUEDy�� 1 l J rV(IV ` 1 A -- I