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HomeMy WebLinkAbout0000 LOUISBURG SQUARE - HYANNIS CONDOS LOUISBURG SQUARE- Center Village ti ft. ,y ,o —ad .o� F ' Town of Barnstable k n was ♦y4 Y•: Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Sumner Kaufman,MSPH Paul J.Canniff,D.M.D. January 25, 2006 Mr. Jim Cutis Huntingest Group 40 Industry Road Marstons Mills,MA l E C rt r �/r Iage�Co d {x�n irdin x��. .Dear Mr. Curtis, el, � You are granted conditional approval to continue to utilize the existing septic system connected to the above-referenced building as is, without any innovative/alternative nitrogen reduction components, until such time the Town of Barnstable has an administrative consent order (A.C.O.) procedure and agreement in place. The recently installed septic system meets the State Environmental Code, Title 5. If you should have any questions, please contact our Health Agent, Mr. Thomas McKean at the Public Health Division Office at 862-4644. Sincerely, ay Miller, M.D. Chairman ' o� DATE.• / o au+rte'rAer.s, t�.k 'F 13 AVIRS CF'�+�'LE FEE-- = � t[rt sv� � HASIL g, l lEDMA'1A�0 �Od 3 31 REC. BY� s� 240 'Town of Barnstable,, C < HED. DATE. l3 63 Bird of Health 200 Main Street, Hyannis MA 02601 0 Office: 508-862-4644 Susan G.Rask,R.S. FAX 508-790-6304 Sumner Kaufman,M.S.P.H. Wayne A.Miller,M.D. VARIANCE REQUEST FORM LOCATION 6 Captain Cook Lane, Building 1, Units 6,8,10,12,14,16 Property Address: .d P. . Assessor's Map anar_ 274-14 5 Acres. cel Number: Size of Lot: Wetlands Within 300 Ft. Yes Business Name: No }C Subdivision Name: enter 1 age on ominlums APPLICANT'S NAME: James F. Curtis Phone S08-428-1112 Did the owner of the property authorize you to represent him or her? Yes X _ No PROPERTY OWNER'S NAME CONTACT PERSON Name: Center Village Condo Trust Name: Huntingest Group - Jim Curtis Address: Captain Cook Drv, Hyannis Address: 40 Industry Rd. , Marstons Mills Phone: 508-428-1112 508-428-1112 02648 Phone: _ VARIANCE FROM REGULATION(ust Reg.) REASON FOR VARIANCE(May attach if more space needed) XTTI' (3) SEE ATTACHED NATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System ,! (to be completed by office styperson receiving variance request application) Four(4)copies of the completed variance request form r Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Tide V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only],outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date { VARIANCE APPROVED Susan 0.Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Wayne A.Miller,M.D. Q:\HEALTH\Application Forma\VARIREQ.DOC i I December 2005 0 CENTER VILLAGE CONDOMINIUMS - Building 1, Units 6, 8. 10, 12, 14, 16 VARIANCE REQUEST Subject system failed per "Certification Report" dated 12-5-03. A variance was granted shortly thereafter with the provision that the pit be inspected regularly and not present a health hazard. In September a new system was installed per Title 5 regulations but does not conform to BOH Article XIII (3) as it does not contain an "I/A nitrogen reduction" component. We are seeking a variance to put the installation of the I/A component on hold until the installation of sewer (per information garnered at sewer meeting held November 29th) said variance not to exceed three (3) years. C 0. o 2 t < w w ua )> z � . w r Town of Barnstable 9 Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA 02601 Office: 508-8624644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO October 31, 2005 Mr. Mark Ells, Superintendent Department of Public Works School Administration Building 4th Floor 230 South Street Hyannis MA 02601 t RE�C�e tee illa ����n�lamTm>�m��Capfam Gool�Lane Dear Mr. Ells: The Town of Barnstable Public Health Division requests the Town of Barnstable Department of Public Works to provide a sewer line to Centervillage Condominiums, which is located near Route 132 (off of Strawberry Hill Road) and is presently in the preliminary design for the Lake Wequaquet sewering project. These condominiums are located within a designated area of concern and within a nitrogen sensitive area. In addition, one of the nine existing septic systems there was recently found to be in failure, which was a potential environmental and public health hazard. An emergency repair permit was recently issued by this Office. The owners of the condominiums are currently researching the cost of shared innovative/alternative nitrogen reduction system to install there in the near future. However, the engineer for the project has already informed me that a shared UA system for this site would be economically unfeasible. The Public Health Division is committed to providing any assistance you may need to accomplish this objective. You may telephone me at 862-4644. Sincerely yours, 1'Y1'1 T o . McKean, RS., CHO Director of Public Health i OFIKE TOE DATE: -'IIO,e FEE: * MMOrABLE, NAB& �ArFG,19. p�0� REC. BY Town of BarnstabletCHED. DATE: Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-8624644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Wayne A.Miller,M.D. VARIANCE REQUEST FORM LOCATION Property Address: 6 Captain Cook Lane, Building 1, Units 6,8,10,12,14,16 _ _ 5 Assessor's Map and Map 274-14 Parcel Number: Size of Lot: Acres Wetlands Within 300 Ft. Yes Business Name: No X Subdivision Name: Center Village Cond initur-�i4 APPLICANT'S NAME: John MacEachern Phone 508-771-9' 9 Did the owner of the property authorize you to represent him or her? Yes PROPERTY OWNER'S NAME CONTACT PERSON ti Name: Center Village Condo Trust Name: John MacEachern •• D� Address: Captain Cook Lane, Hyannis Address:71 Captain CooR Lane OD rn Phone: 508-771-8889 (428-1112) Phone: 508-771-8889 VARIANCE FROM REGULATION(list Reg.) REASON FOR VARIANCE(May attach if more space needed) Title 5 See Attached NATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System ,1 Checklist(to be completed by office staff-person receiving variance request application) _ Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only],outside dining variance renewals[same owner/lessee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) _ Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Wayne A.Miller,M.D. Q:\HEALTH\Application Forms\VARIREQ.DOC April 2004 CENTER VILLAGE CONDOMINIUMS - Building 1, Units 6, 8, 10, 12, 14, 16 VARIANCE REQUEST Subject system failed per Certification Report dated 12-5-03. The report stated that it had failed due to "Liquid depth in pit is less than 6"below invert or available volume is less than 112 day flow". It further stated that "Leaching is one 10'deep 1,500 gallon precast pit. Pit is 5"below grade with steel cover at grade water in pit 55"from cover, stain line at 30". Avail- able volume in pit is less than 112 day flow. Leaching not working, failed." This, however, is not an "emergency situation". . There is no water bubbling,out of the pit (nor has this type of condition every existed). No health hazard appears to be present. The other systems in the complex appear to be in good condition with certifications through 2006-SEE ATTACHED REPORT. Center Village did have a new system engineered (plan attached) and the cost of installation will be approximately$30,000. Center Village is located on Old Strawberry Hill Road and the projected Wequaquet sewer line is scheduled to run directly in front of this condominium and it is expected that the condominium will have to hook onto the sewer. We are seeking a variance to put the repair of the system "on hold"until we can hook up to the proposed sewer system particuarly as the "hook up"will cost the owners in the vicinity of $200,000 in addition to the "betterment liens". April 2005 We are seeking an extension to the variance which was granted a year ago. During the past year the pit has been monitored as requested by the BOH. There have been no "overflows" during the year due to any malfunction of the system. } the r N�k e _ _ y MONTHLY INSPECTION REPORT To: RE: Town of Barnstable - Board of Health Center Village - Failed Septic System P.O. Box 534, Hyannis, MA 02601 Bldg 1 - Units 6 thru 16, 6 Captain Cook Ln ATT: Mr. Thomas McKean % Huntingest Group 40 Industry Rd., Marstons Mills, MA 02648 DATE REMARKS GALS 5-14-04 Initial inspection. Pumped tank and leaching pit completely to start 5,600 monthly inspections. Tank had been pumped in Nov, 03 - 2,200 gals. (Jy C11-eckt) I-eAc 1rnJc �i7 aV) AYN 1;W 6'F ajg1, b r Ver, �m r W43 (dW,1 Adr-1 mwv -a3-dy UV) - - fru�s. end //� -rhty a� h��„y reP ,rid, PLIM l�� dry, e Y y A&K Septic Systems 565 Carriage Shop Rd. c East Falmouth, MA 02536 (508) 540-6706 BY Akn A&K Pumping and Inspections _ Involc _ Division of Kerrigan&Axon,Inc 565 Carriage Shop Road Date Invoice# East Falmouth,MA 02536 1a29/Zoo3 60 508-540-6706 Bill To Job Location Huntingest Management Center Village 40Industry Drive Bldg 1 and 3 Marston Mills,MA 02648 Terms Due Date Service Date Net 15 11/13/2003 10/29/2003 Description Rate Amount Title V Inspection-2 inspection plus Barnstable county fee for Bldg 3(dt, not file 350.00 350.00 � r rj� r f -r1 c Thank you for your business!A 1.5%charge will be added to all invoices over 30 days. Total $350.00 �_ _ _ __ _ _ � :,� �: ? � 1 h =�♦ i t � s ss �' �;�� �� �� �� 4 �c; �; ) ��� �. � N ,hevppf 411, � � f �; � V � �n, ��'+ w tt1[[(� F�ii� 4cJ .�.. �� 'My, 7'"� J AA 1. 1 C� � ,� ®^ V •' ,,;�, •� , BORTOLOTTI CONSTRUCTION, INC. Y s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address Prop l L/` 0-1 S y0 Date of Inspec p ar el Owner � Ma�.?y -- a' CHECK PART A — CHECKLIST CHECK IF THE FOLLOWING HAVE BEEN DONE: LIMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF HEALTH. • ONE OF THE SYSTEM COMPONENTS HAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND THE SYSTEM HAS BEEN RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE COLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO /THE SYSTEM RECENTLY OR AS PART OF THIS INSPECTION. v AS-BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED. NOTE IF THEY ARE NOT AVAILABLE WITH N/A. THE FACILITYOR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK-UP. 4----THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT, ALL SYSTEM COMPONENTS,EXCLUDING THE SAS,HAVE BEEN LOCATED ON THE SITE. 4--THE SEPTIC TANK MANHOLES WERE UNCOVERED,OPENED,AND THE INTERIOR OF THE SEPTIC TANK WAS INSPECTED FOR CONDITION OF BAFFLES OR TEES,MATERIAL OF CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID DEPTH OF SLUDGE, DEPTH OF SCUM. THE SIZE AND LOCATION OF THE SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR APPROXIMATED BY NON-INTRUSIVE METHODS. THE FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SSDS. PART B — SYSTEM INFORMATION RESIDENTIAL FLOW CONDITIONS � No of Bedrooms - _- No of Current Residents — —Garbage Grinder \ Laundry Connected to System w U� Seasonal Use NON RESIDENTIAL: --------- — - Calculated flow) WATER METER READINGS,IF AVAILABLE: --- ------ --- -------- -----_---- ------- Pumping Records and Source of Information: -- GALLONS SYSTEM PUMPED AS PART OF INSPECTION? 6 IF YES,VOLUME PUMPED = GALS FReason for Pumping: OF S TEM: - ---- I Septic tank/distribution box/soil absorption system Single Cesspool Overflow Cesspool Privy Shared system (if yes, attach previous inspection records, if an Other'(explain) Approximate age of all components. Date Installed,if known. Source of Information. SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE? i t. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) SEPTIC TANK: Depth below gr e: e j Dimensionsi Material of construction: _j,.-Cdrt6rete Metal FRP Other} Sludge Depth /i Distance from top of sludge to gpttom of outlet tee or baffle Scum Thickness 4 Distance from Top of Scum to top of outlet tee or baffle 3 Distance from bottom of Scum to bottom of outlet tee or baffle C men !�O 17 ---7" i t 4,borlz Oro An • DISTRIBUTION BOX: /` i' DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT Comments: Uv QYV A PUMP CHAMBERWO orkin order? _ Comments: SOIL ABSORPTION SYSTEM SASIF NOT PRESENT,EXPLAIN: TYPE: OOv // —�'G /pf mments, /000 �- a/ �2_ a s �C)090 . CESSPOOLS:, 41&4 Number and configuration Depth-top of liquid to inlet invert Depth of solids layer I Depth of scum layer Dimension of cesspool Materials of construction Indication of groundwater inflow(cesspool must be pumped) Comments: PRIVY: Materials of construction Dimensions Depth of solids Comments: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES,LANDMARKS OR BENCHMARKS. LOCATE ALL WELLS WITHIN 100' T� CD O - 9 DEPTH TO.GROUNDWATER: DEPTH TO GROUNDWATER METHOD OF DETERMINATION OR APPROXIMATION: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C — FAILURE CRITERIA (Indicate Y—yes N—no ND—not determined.Describe basis of determination.If"not determined",explain why not.) Backup of Sewage into Facility? Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the districution box above outlet invert? Liquid depth in cesspool, 6"below invert or available volume, 1/2 day flow? Required pumping 4 times or more in the last year? Number of times pumped Septic tank is metal?cracked?structurally unsound?substantial infiltration?substantial exfiltration? tank failure imminent? Is any portion of the SAS,cesspool or privy, below the high groundwater elevation? Within 50 feet of a surface water? Al/ Within 100 feet of a surface water supply or tributary to a surface water supply? /X Within a Zone I of a public well? Within 50 feet of a private water supply well? Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools&privies only, not the SAS)? Al Less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,amonia nitrogen and nitrate nitrogen. PART.D — CERTIFICATION INSPECTOR: ROBERT J. BORTOLOTTI ADDRESS: 765 WAKEBY ROAD, MARSTONS MILLS COMPANY: BORTOLOTTI CONSTRUCTION INC. MA 02648 (508)771-9399 CERTIFICATION STATEMENT I CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION REPORTED IS TRUE,.A000RATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED AND ANY RECOMMENDATION REGARDING UPGRADE,MAINTENANCE AND REPAIR ARE CONSISTENT WITH MYTRAINING AND EXPERIENCE IN THE PROPER FUNCTION AND MAINTENANCE OF ON-SITE SEWAGE DISPOSAL SYSTEMS. CHECK ONE: V 1 HAVE NOT FO UND ANY INFORMATION WHICH INDICATES THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC HEALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15.303. ANY FAILURE CRITERIA NOT EVALUATED ARE AS STATED.IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. I HAVE DETERMINED THAT THE SYSTEM FAILS TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN 310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. INSPECTOR'S SIGNATURE: DATE: ORIGINAL-TO SYSTEM;OWNER,COPIES:BUYER(if applicable),APPROVING AUTHORITY ,r t BORTOLOTTI CONSTRUCTION, INC. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address Prop Dads of Inspec} Map Oarcel Owner PART A — CHECKLIST CHECK IF THE FOLLOWING HAVE BEEN DONE: PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF HEALTH. NONE OF THE SYSTEM COMPONENTS HAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND THE SYSTEM HAS BEEN RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE COLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO THE SYSTEM RECENTLY OR AS PART OF THIS INSPECTION. AS—BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED. NOTE IF THEY ARE NOT AVAILABLE WITH N/A. THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK—UP. SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. _,_,ALL SYSTEM COMPONENTS,EXCLUDING THE SAS,HAVE BEEN LOCATED ON THE SITE. THE SEPTIC TANK MANHOLES WERE UNCOVERED,OPENED,AND THE INTERIOR OF THE SEPTIC TANK WAS INSPECTED FOR CONDITION OF BAFFLES OR TEES,MATERIAL OF CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID,DEPTH OF SLUDGE, DEPTH OF SCUM. THE SIZE AND LOCATION OF THE SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR APPROXIMATED BY NON—INTRUSIVE METHODS. v THE FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SSDS. PART B — SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL 7J No of Bedrooms No oflCurrrent Residents /vim Garbage Grinder Ye5 Laundry Connected to System /I/0 Seasonal Use NON RESIDENTIAL: Calculated flow WATER METER READINGS,IF AVAILABLE: GALLONS Pumping Records and Sour"of Information: SYSTEM PUMPED AS PART OF INSPECTION?A10 IF YES,VOLUME PUMPED = GALS Reason for Pumping: TYPE OF STEM: Septic tank/distribution box/soil absorption system Single Cesspool Overflow Cesspool Privy Shared system ('If yes,attach previous inspection records, if any) Other(explain) Apprwdmate age of an components. Date installed,M known. Source of information. SEWAGE ODORS DETECTED WHEN AP RMNG AT THE SITE? a, ;• A s` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION (Continued) SEPTIC A Depth below grade: Dimensions: Material of construction:' ncrete. Metal FRP Other} Sludge Depth f /� Distance from top of�sludoe to bottom of outlet tee or baffle Scum Thickness Z! r) Distance from Top of Scum to top of outlet tee or baffle D�/,Br1"ee Distance from bottom of Scum to bottom of outlet tee or baffle Comments:. DISTRIBUTION B X: G /%7 DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT Comments: PUMP CHAMBER: Pumps in working order? Comments: SOIL ABSORPTION SYSTEM SAS IF NOT PRESENT,EXPLAIN: TYPE: o AUS om a ants: dy.b4927 e o ibis Gy CESSPOOLS: Number and configuration Depth—top of liquid to inlet Invert Depth of solids layer Depth of scum layer Dimension of cesspool Materials of construction Indication of groundwater Inflow(cesspool must be pumped) Comments: PRIVY: 41,0 Materials of construction Dimensions Depth of solids Comments: h �� a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B=USTEM INFORMATION (Continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES,LANDMARKS OR BENCHMARKS. LOCATE ALL WELLS WITHIN 100' 1071 0 0 DEPTH TO GROUNDWATER: DEPTH TO GROUNDWATER METHOD OF DETERMINATION OR APPROXIMATION: s r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. Y , PART C — FAILURE CRITERIA Ondlcate Y-yes N—no ND—not determined.Describe basis of determination.If"not determined".explain why not) M Backup of Sewage into Facility? Discharge or ponding of effluent to the surface of the ground or surface waters? /V Static liquid level in the districution box above outlet invert? Liquid depth in cesspool, 6"below invert or available volume, 1/2 day flow? Required pumping 4 times or more in the last year? Number of times pumped Al Septic tank is metal?cracked?structurally unsound?substantial infiltration?substantial exfiftration? tank failure'imminent? Al Is any portion.of the SAS,cesspool or privy,below the high groundwater.elevation? Within 50 feet of a surface water? /L Within 100 feet of a surface water,supply or tributary to a surface water supply? Within a Zone I of a public well? Within 50 feet of a private water supply well? Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools&privies only, not the SAS)? Al Less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,amonia nitrogen and nitrate nitrogen. PART D — CERTIFICATION INSPECTOR: ROBERT J. BORTOLOTTI ADDRESS: 765 WAKEBY ROAD,MARSTONS MILLS COMPANY: BORTOLOTTI CONSTRUCTION INC. MA 02648 (508)771-9399 CERTIFICATION STATEMENT I CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION REPORTED IS TRUE,ACCURATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED AND ANY RECOMMENDATION REGARDING UPGRADE,MAINTENANCE AND REPAIR ARE CONSISTENT WITH MY TRAINING AND EXPERIENCE IN THE PROPER FUNCTION AND MAINTENANCE OF ON—SITE SEWAGE DISPOSAL SYSTEMS. CHECK ONE I HAVE NOT FOUND ANY INFORMATION WHICH INDICATES W I AT S THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC HEALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15.303. ANY FAILURE CRITERIA NOT EVALUATED ARE AS STATED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. I HAVE DETERMINED THAT THE SYSTEM FAILS TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN 310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. INSPECTOR'S SIGNATURE: Jr DATE ORIGINAL TO SYSTEM OWNER,COPIES:BUYER(d applicable),APPROVING AUTHORITY BORTOLOTTI CONSTRUCTION,iNC. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address Prop Cep t}' t Coy 07N!I7 v 5 - U h 1 r #,5 y0 y Z Z/ G/ u•�ti� ,may` ��oU � usf� �o� �Q�sro�,s �./.l� x4. Date of Inspec} Map / arcel Own PART A — CHECKLIST CH ECC IF THE FOLLOWING HAVE BEEN DONE: 7V PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF HEALTH. NONE OF THE SYSTEM COMPONENTS HAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND THE SYSTE RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE COLUMES OF WATER HAVE NOT BE I CfDUCED INTO, /THE SYSTEM RECENTLY OR AS PART OF THIS INSPECTION. C AS-BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED. NOTE IF THEY ARE NOT AVAILABLE WIT THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK-UP. aD jut ' THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. r� l 199- Q ALL SYSTEM COMPONENTS,EXCLUDING THE SAS,HAVE BEEN LOCATED ON THE SITE. to THE SEPTIC TANK MANHOLES WERE UNCOVERED,OPENED,AND THE INTERIOR OF THE SEPTIC TANK FOR CONDITION OF BAFFLES OR TEES,MATERIAL OF CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID,D 00 L DEPTH OF SCUM. /THE SIZE AND LOCATION OF THE SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR /APPROXIMATED BY NON-INTRUSIVE METHODS. THE FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SSDS. PART B — SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL 1 Z No of Bedrooms /f No of Current Residents �Q. Garbage Grinder J`T Laundry Connected to System /f' Seasonal Use NON RESIDENTIAL: Calculated flow WATER METER READINGS,IF AVAILABLE: GALLONS Pumping Records apnd Source of Information: / LfN7 Ol lL 9$� 4'S T Q T ✓'� cp/l' �`� 5 sal SYSTEM PUMPED AS PART OF INSPECTION? IF YES,VOLUME PUMPED = GALS Reason for Pumping: TYPE OF S TEM: Septic tank/distribution box/soil absorption system Single Cesspool Overflow Cesspool Privy Shared system (if yes, attach previous inspection records, if any) Other(explain) Approximate age of all components. Date installed,if known. Source of information. new ir' in /Y5 SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE? Itle I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) SEPTIC TANK: Depth below grade: 3 / Dimensions: X5- x //.6 i Material of construction: Concrete Metal FRP Other} Sludge Depth / iI Distance from top of sl df�to bottom of outlet tee or baffle Scum Thickness O Distance from Top of Scum to top of outlet tee or baffle O - Distance from bottom of Scum to bottom of outlet tee or baffle Comments: �4hk Uhl DISTRIBUTION BOX: DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT Comments: ,/J Q / Q O v` e 7` /,eW L!'el e Cll�'15�`j'%/G jG%O/o PUMP CHAMBER: Z Pumps in working order? Comments: SOIL ABSORPTION SYSTEM SAS IF NOT PRESENT,EXPLAIN: TYPE: //` 7g57177 Comments: ,Ba S�1 CESSPOOLS: /(J Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimension of cesspool Materials of construction Indication of groundwater inflow(cesspool must be pumped) Comments: PRIVY: Materials of consVOction Dimensions Depth of solids Comments: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES, LANDMARKS OR BENCHMARKS. LOCATE ALL WELLS WITHIN 1Go' 1 0 36 DEPTH TO GROUNDWATER: DEPTH TO GROUNDWATER METHOD OF DETERMINATION OR APPROXIMATION: r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C — FAILURE CRITERIA (Indicate Y-yes IN-no ND-not determined.Describe basis of determination.If"not determined",explain why not.) Backup of Sewage into Facility? Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the districution box above outlet invert? Liquid depth in cesspool, 6"below invert or available volume, 1/2 day flow? V Required pumping 4 times or more in the last year? Number of times pumped N Septic tank is metal?cracked?structurally unsound?substantial infiltration?substantial exfiftration? F ,,— tank failure imminent? A/ Is any portion of the SAS,cesspool or privy, below the high groundwater elevation? j w Within 50 feet of a surface water? ✓�/ Within 100 feet of a surface Water supply or tributary to a surface water supply? Within a Zone I of a public well? Within 50 feet of a private water supply well? i Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools&privies only, not the SAS)? Less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water j quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for j coliform bacteria,volatile organic compounds,amonia nitrogen and nitrate nitrogen. i i PART D — CERTIFICATION II INSPECTOR: ROBERT J. BORTOLOTTI ADDRE SS:. 765 WAKEBY ROAD, MARSTONS MILLS li COMPANY: BORTOLOTTI CONSTRUCTION INC. MA 02648 (508) 771-9399 1 i CERTIFICATION STATEMENT I CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION REPORTED IS TRUE,ACCURATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED AND ANY RECOMMENDATION REGARDING UPGRADE,MAINTENANCE AND REPAIR ARE CONSISTENT WITH MY TRAINING AND EXPERIENCE IN THE PROPER FUNCTION AND MAINTENANCE OF ON-SITE SEWAGE DISPOSAL SYSTEMS. CHECK ONE: v I HAVE NOT FOUND ANY IN FORMATION WHICH INDICATES THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC HEALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15.303. ANY FAILURE CRITERIA NOT EVALUATED AREAS STATED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. I HAVE DETERMINED THAT THE SYSTEM FAILS TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN 310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. INSPECTOR'S SIGNATURE: DATE: i ORIGINAL TO SYSTEM OWNER,COPIES:BUYER(if applicable),APPROVING AUTHORITY r a � { > 1 TOWN OF BARNSTABLE THE TO OFFICE OF o B,Ba9TABL = BOARD OF HEALTH 90� 1AZIL g 9 397 MAIN STREET HYANNIS, MASS. 02601 June 14 1974 Mr. John Sasso 11 Howes Avenue Hyannis, Massachusetts Dear Mr. Sasso: I have received letters from Mr. Roland Dusseault, Regional Sanitary Engineer, Southeastern Health Region and Mr. Manuel R. Salgado, P. E. J. stating that the septic systems of Buildings No. 1 and 31 Phase II, of Center Village Condominiums, are installed as per plans. Your name is on the permits as installer; however, the construction permit has not been taken out nor ' Certificate of Compliance issued by this office. Please contact us on this matter as soon as possible. Yours very truly, -A Lk a<," Paul C. Murray Health Inspector PCM/mm cc: Mr. Roland Dusseault Mr: Manuel R. Salgado TOWN OF BARNSTABLE �NIS ` BOARD'OF HEALTH Z JUN'4 397 MAIN STREET HYANNIS, MASS. 02601 �,�T�.DNF� f' 1974 ) °" SENDER r` O 2 6�\ P— B•i 1 IYY 1 1:1 "�, t Mr. Jahn Sasso � 11 owes Avenue / xY NNaS WISSACHUSETTS 026O1 Cl Moved, left no address_ tD No such number ❑ Move". not.forWBrdabl5 Addressee unknoWn� f i olr -' - . b -� -4 C � tf ,( `ti t'^s x�• n. a ,� :t�r t� � :c 1 a r, .� c .l•„.' Y � �.lry r Y� . (r K � r , 9 i�t i N LL }.'�:{ tt ::Y � ���� • � a'! � Ti" Y CC _n• ry 'f �,r � �. � - x - G, in it ,,4 # 'q �' , i� -t .a: ».y,z 't ; '• +- ,^e t r.°, �r e. rP?. 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A ry {r s r1� -_ r P r. F P & t 1 1 to r .•.. a C n r , r. 4 ..� qr } •r ♦,b.g.°*, C'M?.'�:L ,� 9 � "�. � •�. : .rtd 1� w ( r•' yx. `,v � -. { ;§; -` , 4 t 4 "^. � ��{ r. ' n• � }� �r� ire{�° 4 - b i N ,r .. y '� �4 ,.,.f. d t � r 7 t • x • We ,r 0` f .44�[..t '�'' Y .A'• -r ,. r r r,w a t *. n st 4 R.'•- rn r y �. + �. •, ''+ Nli t d a -+' :. �r - yi ;fir 4p. •M F ,r J `., �y J x r�. t x ,y t • i �.t y s.,w f h F :1A � s r ; x} x#v' �: J•'x r., pM I rMi.' 4 lr'iaj r .r`4.:�f J T"'M:' 'Mr - 1 _T t4.. ,�, � ,< Y , wIt.`1 - s. n s�• , } + r. • r .! 4 .. } •,ry t 3 w e 1'4 ✓'�'. Y r r t,�cr. ��ti _ - r• .K r`, -. t rc • ra •t- •.1 .f4 L` y f `r' S .n +; ','j 's.� ,/ - ,i •ry+. _ it.F rl r. 5 rti..w ,C' ..�.-�.r�. a •. st •' ,.,C s.. •}, Tr i .�.i,: scr.w' > - ',.• ya. .xs-.. w s,. _ r ,�++"'t64.rl.,r ~ 3 y ..{ L_ ram. �_ i t Clearview Drive Somerset, Mass . May 1, 1974 Mr. Paul Murray Town of Barnstable Board of Health Town Hall Hyannis, Mass . Re : Center Village Condominiums Barnstable, Mass. Dear Mr. Murray: In reference to the on-site. sewege disposal system at the above location, I have found that the system has been constructed in accordance with Dwg. No. SP-3 and SP-4 as previously approved by your office. Reg. Profession Engine r f cc: Mr. Julius Doliner jy 3 / 9 > I DIVISION OF ENVIRONMENTAL HEALTH D2/// TEL: (617) 727-2690 June 11, 1974 Board of Health RE: BARNSTABLE--Subsurface Sewage Disposal Town Hall for 60 Two Bedroom Town House Hyannis, Massachusetts . Condominum, Old Strawberry Hill Road Hyannis, Massachusetts Gentlemen: An engineer from the Division of Environmental Health has examined the sewage disposal works installed at the above-named location and finds that they have been installed in accordance with the plans approved by this Department in a communication dated September 7, 1972. Very truly yours, For the Director Roland A. Dusseault, P.E. Ljg onal Sanitary Engineer Southeastern Health Region Lakeville Hospital Lakeville, Massachusetts 02346 D/Ejm/GM cc: Barnstable County Health Department Barnstable County Court House Barnstable, Massachusetts Manuel R. Salgado Jr., P.E. Clearview Drive Somerset, Massachusetts J \ �- R a � �1 � �. �. � .� �o �, �� t � � � `� "® �'� �� ` �. ',, ,� � �� �\ � � `� � ,� ,: ,� ��,` ,� � + d f F ^ � SENDER: to • Complete-items 1 and/or 2 for additional services. I also wish to receive the • Complete items 3,and 4a&b. following Services (for an extra ` • Print your name and address on the reverse of this form so that we can fee): N return this card to you. N • Attach this form to the front of the mailpiece,or on the back if space 1. ❑ Addressee's Address N does not permit. r, • Write"Return Receipt Requested"on the mailpiece below the article number. G t _ 2. El Delivery • The Return Receipt will show to whom the article was delivered and the date d c delivered. Consult postmaster for fee. Cr 3. Article Ad essed to: r[ 4a. Articlg N mber Y° ✓// 4b. Service Type 0 a /��/ El Registered El Insured .v" �' .- �J ® Certified El COD 5 W !� ❑ Express Mail ❑ Return Receipt for c Merchandise °a 7. Date of Delivery o T 5. Sig t e (Add 8. Addressee's Address (Only if requested w and fee is paid) H r LUature Age Tit) 0 PS Form 3811, December 1991 *U.S.GPO:1993-352.714 DOMESTIC RETURN RECEIPT N - _4_:. I UNITED STATES POSTAL SERVICE I I Official Business PENALTY FOR PRIVATE USE TO AVOID PAYMENT l OF POSTAGE,$300 El Print your name, address and ZIP Code here Health Department C gown of Bamstable P.C..Box 534 gyannL%Massachusetts 026M � 1 P 411 221 S34 RECEIPT FOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL " (See everSe) N ff � ent o v N W r an m Ae a ,State and ZIP Code c� y a Postage S Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt showing to whom and Date Delivered �n o00i Return Receipt showing to whom, Date,and Address of Delivery d j TOTAL Postage and Fees 0 Postmark or Date O L to a I STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, i CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES.(see front) 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier. (no extra charge) 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address of the article,date,detach and retain the receipt,and mail the article. 3. If you want a return receipt,write the certified mail number and your name and address on a return I receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space per- mits.Otherwise,affix to back of article. Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee,endorse RESTRICTED DELIVERY on the front of the article. I 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return ' receipt is requested,check the applicable blocks in item t of Form 3811. 6. Save this receipt and present it if you make inquiry. *u.s.G.Po.1e8s-234.553 Town of Barnstable � Department of Health, Safety, and Environmental Services eARNSfASM Z Health Division ' �� �� 367 Main Street, Hyannis MA 02601 A Office: 508-790-6265 Thomas A. McKean FAX: 508-775-3344 Director of Public Health May 26, 1995 TO: Huntingest Group 40 Industry Road Marstons Mills, MA 02648 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at Building #6 Center Village Condominiums, 42-50 Captain Cook Lane, Centerville was inspected on May 4, 1995 by Robert Bortolotti a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to.the following: . Liquid level was above the inlet in the distribution box. You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health ASSESSOPS%fiAP NO: —e- PARCEL NO: [Installer letter] TO: n 67rod (Date) (6 MA- ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 4), a (P �" was v inspected on /4?g y i 9 by Ia,IF,' a Massachusetts licensed septic inspector. L� The inspection of your septic system showed that your system has failed under the Cyr guidelines of 1995 TITLE 5 (310 CMR 15.00) due to th llowing- —L, u, eves love. You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable i 1 IA ASSMSORS MAP NO: ��N� , �q � ���RTOLOTTI CONSTRUCTION, INC. 249-035 s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 11 A Address Prop CENTER VILLAGE CONDOMINIUMS — UNIT #'S} 40,42,44,46,48,50 BLDG #6 Captain Cook Lane, Centerville, MA %Huntingest Group,40 Industry Road, Marstons Mills, MA 02648 508.428-1112 1�95 Date of Inspec} Owner ---a� PART A — CHECKLIST CHECK IF THE FOLLOWING HAVE BEEN DONE: le " PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF HEALTH. 8 ✓ NONE OF THE SYSTEM COMPONENTS HAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND THE SYSTEM HAS BEEN RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE COLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO THE SYSTEM RECENTLY OR AS PART OF THIS INSPECTION. AS-BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED. NOTE IF THEY ARE NOT AVAILABLE WITH N/A. / ✓/THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK-UP. ✓/THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. ALL SYSTEM COMPONENTS,EXCLUDING THE SAS,HAVE BEEN LOCATED ON THE SITE. THE SEPTIC TANK MANHOLES WERE UNCOVERED,OPENED,AND THE INTERIOR OF THE SEPTIC TANK WAS INSPECTED FOR CONDITION OF BAFFLES OR TEES,MATERIAL OF CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID,DEPTH OF SLUDGE, DEPTH OF SCUM. VTHE SIZE AND LOCATION OF THE SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR /APPROXIMATED BY NON-INTRUSIVE METHODS. ✓ THE FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SSDS. PART B — SYSTEM INFORMATION _—RESIDENTIAL FLOW CONDITIONS -- ---------------...-..... _._......-..------------ -- - 12 No of Bedrooms 18 No of Current Residents NO -.-Garbage Grinder YES Laundry Connected to System NO Seasonal Use WATER METER READINGS,IF AVAILABLE: GALLONS Pumping Records and Source of Information: SYSTEM PUMPED AS PART OF INSPECTION?1149 IF YES,VOLUME PUMPED = _ GALS Reason for Pumping: TYPE OF SYSTEM: _Septic tank/distribution box/soil absorption system Single Cesspool Overflow Cesspool Privy x Shared system (if yes, attach previous inspection records, if any) Other(explain) Approximate age of all components. Date installed,if known. Source of information. SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE? SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FURM PART B — SYSTEM INFORMATION (Continued) SEPTIC TANK: Depth below grade: Dimensions: Material of construction: Concrete Metal FRP Other} 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 i Distance from bottom of Scum to bottom of outlet tee or baffle �gr� —om---ments:- ----— --- - . .------ --- C _DISTRIBUTION BOX: ��--- ------- -- ------------------ ------------------ ___Y DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT Comments: PUMP CHAMBER: �/9 Pumps in working order? Comments: SOIL ABSORPTION SYSTEM (SAS): t �s IF NOT PRESENT,EXPLAIN: / TYPE: Comments: CESSPOOLS: !I/ Number and config_ura_tion Depth—top of liquid to inlet invert �Depth of solids layer Depth of curn!aver. Dimension of cesspool _ _ _ Materials of construction Indication of groundwater inflow(cesspool must be pumped) Comments: Materials of construction Dimensions Depth of solids Comments: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -- PART B — SYSTEM INFORMATION (Continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES,LANDMARKS OR BENCHMARKS. LOCATE ALL WELLS WITHIN 100' r-k Z;414j(46 , �Z kk DEPTH TO GROUNDWATER: DEPTH TO GROUNDWATER METHOD OF DETERMINATION OR APPROXIMATION: oevl • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C — FAILURE CRITERIA (Indicate Y-yes N-no ND-not determined.Describe basis of determination.If"not determined",explain why not.) Backup of Sewage into Facility? Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the distribution box above outlet invert? Liquid depth in cesspool, 6"below invert or available volume, 1/2 day flow? /V.-- Required pumping 4 times or more in the last year? Number of times pumped _ Septic tank is metal?cracked?structurally unsound?substantial infiltration? substantial exfiltration? tank failure imminent? Is an portion of the SAS cesspool or privy, below the high groundwater elevation? —�...- Y p p p � Y� 9 Within 50 feet of a surface water? Within 100 feet of a surface water supply or tributary to a surface water supply? Within a Zone I of a public well? Within 50 feet of a private water supply well? Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools&privies only, not the SAS)? Less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,amonia nitrogen and nitrate nitrogen. PART D — CERTIFICATION INSPECTOR: ROBERT J. BORTOLOTTI ADDRESS: 765 WAKEBY ROAD, MARSTONS MILLS COMPANY: BORTOLOTTI CONSTRUCTION INC. MA 02648 (508) 428-1112 CERTIFICATION STATEMENT I CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION REPORTED IS TRUE,ACCURATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED AND ANY RECOMMENDATION REGARDING UPGRADE,MAINTENANCE AND REPAIR ARE CONSISTENT WITH MY TRAINING AND EXPERIENCE IN THE PROPER FUNCTION AND MAINTENANCE OF ON-SITE SEWAGE DISPOSAL SYSTEMS. CHECK ONE: I HAVE NOT FOUND ANY INFORMATION WHICH INDICATES THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC ALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15.303. ANY FAILURE CRITERIA NOT EVALUATED ARE AS STATED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. - 1 HAVE DETERMINED THAT THE SYSTEM FAILS TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN 310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. INSPECTOR'S SIGNATURE: DATE: ORIGINAL TO SYSTEM OWNER,COPIES:BUYER(if applicable),APPROVING AUTHORITY m BORTOLOTTI CONSTRUCTION, INC. 249-035 y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address Prop CENTER VILLAGE CONDOMINIUMS — UNIT #'S}6,8,10,12,14,16 BLDG #1 --- ---__--Captain Cook Cook Lane, CePAerviIIe;MA Y4aJ)/,r % Huntingest Group,40 Industry Road, Marstons Mills, MA 02648 508.428-1112 Date of Inspec) Owner --------------- ---- — ---- --- PART A — CHECKLIST CHECK IF THE FOLLOWING HAVE BEEN DONE: PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF HEALTH. NONE OF THE SYSTEM COMPONENTS HAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND THE SYSTEM HAS BEEN RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE COLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO THE SYSTEM RECENTLY OR AS PART OF THIS INSPECTION. V/ AS—BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED. NOTE IF THEY ARE NOT AVAILABLE WITH N/A. Vi THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK—UP. THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. ALL SYSTEM COMPONENTS,EXCLUDING THE SAS,HAVE BEEN LOCATED ON THE SITE. THE SEPTIC TANK MANHOLES WERE UNCOVERED,OPENED,AND THE INTERIOR OF THE SEPTIC TANK WAS INSPECTED FOR CONDITION OF BAFFLES OR TEES,MATERIAL OF CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID,DEPTH OF SLUDGE, DEPTH OF SCUM. --, THE SIZE AND LOCATION OF THE SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR APPROXIMATED BY NON—INTRUSIVE METHODS. THE FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SSDS. PART B — SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL 12 No of Bedrooms 16 No of Current Residents NO Garbage Grinder YES Laundry Connected to System NO —Seasonal Use WATER METER READINGS,IF AVAILABLE: __ GALLONS Pumping Records and Source of Information SYSTEM PUMPED AS PART OF INSPECTION? IF YES,VOLUME PUMPED = GALS Reason for Pumping: TYPE OF SYSTEM: --------..___------.--- --._ X Septic tank/distribution box/soil absorption system Single'Cesspool Overflow Cesspool Privy x Shared system (if yes, attach previous inspection records, if any) Other(explain) Approximate age of all components. Date installed,if known. Source of information. SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE? SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FURM PART B — SYSTEM INFORMATION (Continued) SEPTIC TANK:, _____ Depth below grade: Dimensions: Material of construction: Concrete Metal FRP Other} Sludge Depth Distance from to/9f sludge to bottom of outlet tee or baffle _3 -- 37 Scum Thicknes i` Distance fro 4�of Scum to top of outlet tee or baffle Distance from bottom of Scum to bottom of outlet tee or baffle C -- omments: DISTRIBUTION BOX_:_ e-3 DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT Comments: / a J PUMP CRAMBER: Pumps in Working order? Comments: SOIL ABSORPTION SYSTEM (SAS): IF NOT PRESENT,EXPLAIN: TYPE: /' l0 1 e�J- "w leec /J' Comments: L y g 0 --- Q v �Qlllc� 7" 7��rit�P 01� Tif j0� art CESSPOOLS: _ Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimension of cesspool Materials of construction Indication of groundwater inflow(cesspool must be pumped) Comments: -------------- Materials of construction Dimensions Depth of solids Comments: L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM �4 PART B — SYSTEM INFORMATION (Continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES, LANDMARKS OR BENCHMARKS. LOCATE ALL WELLS WITHIN 100` �5 81 10112-, ly) rb, z f I�Nf JllZa � � w 1'ur 5lzz N 10 6� Wit-CRn :�a c -� ci�- �,,c. xj •rn� o� c e,tom y �a,� DEPTH TO GROUNDWATER: 7-b DEPTH TO GROUNDWATER METHOD OF DETERMINATION OR APPROXIMATION: �+ ---�' l�JC I vn r c0� J���M !,(.�J. ,ae r© T SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C — FAILURE CRITERIA , ll (Indicate Y-yes N-no ND-not determined.Describe basis of determination.If"not determined",explain why not.) /v Backup of Sewage into Facility? Discharge or ponding of effluent to the surface of the ground or surface waters? l" Static liquid level in the districution box above outlet invert? Liquid depth in cesspool, 6"below invert or available volume, 1/2 day flow? Required pumping 4 times or more in the last year? Number of times pumped L" Septic tank is metal?cracked?structurally unsound?substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS,cesspool or privy, below the high groundwater elevation? —� Within 50 feet of a surface water? /!//� Within 100 feet of a surface water supply or tributary to a surface water supply? Within a Zone I of a public well? Within 50 feet of a private water supply well? _( Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools&privies only, not the SAS)? v Less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds,amonia nitrogen and nitrate nitrogen. PART D — CERTIFICATION INSPECTOR: ROBERT J. BORTOLOTTI ADDRESS: 765 WAKEBY ROAD, MARSTONS MILLS COMPANY: BORTOLOTTI CONSTRUCTION INC. MA 02648 (508) 428-1112 CERTIFICATION STATEMENT I CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION REPORTED IS TRUE,ACCURATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED AND ANY RECOMMENDATION REGARDING UPGRADE,MAINTENANCE AND REPAIR ARE CONSISTENT WITH MY TRAINING AND EXPERIENCE IN THE PROPER FUNCTION AND MAINTENANCE OF ON-SITE SEWAGE DISPOSAL SYSTEMS. CHECK ONE: /1, HAVE NOT FOUND ANY INFORMATION WHICH INDICATES THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC HEALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15.303. ANY FAILURE CRITERIA NOT EVALUATED ARE AS . STATED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. _ I HAVE DETERMINED THAT THE SYSTEM FAILS TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN 310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. L R'S SIGNATURE: TO SYSTEM OWNER,COPIES:BUYER(if applicable),APPROVING AUTHORITY -- � , , ��� � � o ti � _- '� rn �� � _ � � � i� c� '�%� f — f/ BORTOLOTTI CONSTRUCTION, INC. 249 035 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address Prop CENTER VILLAGE CONDOMINIUMS — UNIT#'S} 18,20,22,24,26,28 BLDG #3 Captain Cook Lane, Centerville, MAC % Huntin est Group,40 Industry Road, Marstons ills,M 2648 508.428-1112 Date of Inspec} S"1411�s. Owner PART A — CHECKLIST CHECK IF THE FOLLOWING HAVE BEEN DONE:V PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF HEALTH. NONE OF THE SYSTEM COMPONENTS HAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND THE SYSTEM HAS BEEN RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE COLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO THE SYSTEM RECENTLY OR AS PART OF THIS INSPECTION. v/AS-BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED. NOTE IF THEY ARE NOT AVAILABLE WITH N/A. 1/' HE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK-UP. THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. ALL SYSTEM COMPONENTS,EXCLUDING THE SAS,HAVE BEEN LOCATED ON THE SITE. THE SEPTIC TANK MANHOLES WERE UNCOVERED,OPENED,AND THE INTERIOR OF THE SEPTIC TANK WAS INSPECTED FOR CONDITION OF BAFFLES OR TEES,MATERIAL OF CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID,DEPTH OF SLUDGE, DEPTH OF SCUM. V/_ THE SIZE AND LOCATION OF THE SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR APPROXIMATED BY NON-INTRUSIVE METHODS. THE FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SSDS. PART B — SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL ----- - - - - ----- -- --- 12 No of Bedrooms 22 No of Current Residents NO Garbage Grinder _--YES _—Laundry Connected to System NO Seasonal Use WATER METER READINGS,IF AVAILABLE: GALLONS Pumping Records and Source of Information: SYSTEM PUMPED AS PART OF INSPECTION?X/0 IF YES,VOLUME PUMPED = . GALS Reason for Pumping: --- --- - - -- -- -- -- -- TYPE OF SYSTEM: Septic tank/distribution box/soil absorption system Single Cesspool Overflow Cesspool Privy x Shared system (if yes, attach previous inspection records, if any) Other (explain) Approximate age of all components. Date installed,if known. Source of information. --------- — ---- __- SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE? l_ ' f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIUN t-UHM - PART B — SYSTEM INFORMATION (Continued) SEPTIC TANK: _ _ Depth below grade: Dimensions: r/ s/_ xs�,.xGG Material of construction: X Concrete Metal FRP Other} 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 Fyn Comments:-- — DISTRIBUTION DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT Comments: PUMP CHAMBER: /t/.� —[Pumps in working order? Comments: SOIL ABSORPTION SYSTEM SAS : IF NOT PRESENT,EXPLAIN: TYPE: Z ` IO �0 x Comments: CESSPOOLS: Nsl Number and configuration Depth-top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimension of cesspool Materials of construction Indication of groundwater inflow(cesspool must be pumped) Comments: ------ ------- — PRIVY:---- Materials of construction Dimensions Depth of solids Comments: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM • PART B — SYSTEM INFORMATION (Continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES, LANDMARKS OR BENCHMARKS. LOCATE ALL WELLS WITHIN 100' BLS& z /1,6 x s' x /7' - I f DEPTH TO GROUNDWATER: DEPTH TO GROUNDWATER METHOD OF DETERMINATION OR APPROXIMATION: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C — FAILURE CRITERIA / (Indicate Y-yes N-no ND-not determined.Describe basis of determination.If"not determined",explain why not.) Backup of Sewage into Facility? /V Discharge or ponding of effluent to the surface of the ground or surface waters? /v Static liquid level in the districution box above outlet invert? Liquid depth in cesspool, 6"below invert or available volume, 1/2 day flow? _y Required pumping 4 times or more in the last year? Number of times pumped ------- Septic tank is metal?cracked?structurally unsound?substantial infiltration?substantial exfiltration? tank failure imminent? /y Is any portion of the SAS,cesspool or privy, below the high groundwater elevation? Within 50'feet of a surface water? Within 100 feet of a surface water supply or tributary to a surface water supply? A Within a Zone I of a public well? /v Within 50 feet of a private water supply well? Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools&privies only, not the SAS)? Less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,amonia nitrogen and nitrate nitrogen. PART D — CERTIFICATION INSPECTOR: ROBERT J. BORTOLOTTI ADDRESS: 765 WAKEBY ROAD, MARSTONS MILLS COMPANY: BORTOLOTTI CONSTRUCTION INC. MA02648 (508) 428-1112 CERTIFICATION STATEMENT I CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION REPORTED IS TRUE,ACCURATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED AND ANY RECOMMENDATION REGARDING UPGRADE,MAINTENANCE AND REPAIR ARE CONSISTENT WITH MY TRAINING AND EXPERIENCE IN THE PROPER FUNCTION AND MAINTENANCE OF ON-SITE SEWAGE DISPOSAL SYSTEMS. CHECK O I HAVE NOT FOUND ANY INFORMATION WHICH INDICATES THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC HEALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15.303. ANY FAILURE CRITERIA NOT EVALUATED ARE AS STATED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. _ I HAVE DETERMINED THAT THE SYSTEM FAILS TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN 310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. INSPECTOR'S SIGNATURE: 2/� DATE: ORIGINAL TO SYSTEM OWNER,COPIES:BUYER(if applicable),APPROVING AUTHORITY °' I r Alk DIVISION OF f ENVIRONMENTAL HEALTH - -„ - • , Sapte First granite Beaty. 1CQr, apt oaa M,' �V,--Sdrsrfecfe gew e b spoaal . • $ Boylston $ire;at for Proposed 60 Two De om Tom :Koase n Hill Ssac3huetts b 3-67' Crnc La ums. , fold utrh V '4 l Rod, t Gentlemen he tm 3t'o 1�` p�� -.ea � �.��, �espa to y request, ? a ro�r1ewei� s reset set of p in two s*eta f tw Jurst -ot which li tit.1.0; t. W-e flat Smlta y- '$ewer Pyste T -6/W12 Town House 0otx omjA1 , S,. s$. Dravu by T.L. Chostnixt Hill, nus e 021, cOv104s pubs 'se dsposal3 11110r tam 84SeP-t- 0l°to w - .°awroved office In a letter Uted Fobruwy 1912. At thit time tba., owners were U.44 MCMAney Assom ates The revi set 'plar,w now propow to dispose of 12.,900,.warns p c AY of she From the.404eGt Projeo # s ' t Z •o . .o rl s s µ I— gynt four hul k #2a;`�� A, 5 and, w 1 as h dispose ,. it 13 �. per. off" s �� fit � t� bedroo�z U by m� 0 �E �,000 precast ren 'c ' ed,.zoncrteank. atxtlet nerc#.e dst�rlt~uttaxs box, and one se4meo PI: Pro�►'i l �gt�re �ee� of ays��e lea i area, eons per . of sexago,m eight two be4rom units by meal of a 21500 plIca re0ast re nxdreed goneve septic tank, a .five oatlet concrete 4istaribcstioA box, mod. two sesp�ge.p$ta proytdir% s€�t 'e t of avn e area. The D vition ofR v nmental " .tk hereby appro ves thepleas subJsct' tQ' all�r ` p: the prcv1s .on,s and ooAditions,-as stated' the letter or appram. •datied rebrtz y 41 McKinney A ' oclates. en the s ;e m dspcss : sys"mo bavb been eontrced, Pr 10 r to, haz . thls office and tic'Barnstable Beard o Realth must he notified so that a fl,pld. c *=UsUoh cagy be made. r « ty.•t - i �XwI � - �• ., „ a a« .,, `. ' e. �F�3 is ♦. p R ears c zait tCsfr . ie 'nor-thb sewage dIs '8y8'E;E3 S c Vi g r ;y • cext3.cite bf Cxx*lienc U 164wd by the.m le..ot%bRoar. Of I eol . n fazed 3� +pit Z stud a v Gape ` the, pl y a capy' oaf wh c r . y" 1 St i ii on �7C.F. L1t�ed' �'QI� «�p trt����oSl y•� �$el�e M F�".� i' a r ]/y yy �.�y�y�} p�y�p�a iG�Ry N4•i.F•F. w{Mf.Q,' - f `t a aE _$`•t +y ryy . .: ,{, t�� ° 4_.. t � •• iec- nrp 1 .,,r y' .d• w »x.t•.. �t•, •� x: .y i S °- J t ♦,,.. �y✓. a A+ ` i Anderson` f i 'f F�S'"' x • +y F Mx' e nal 31$, X' " .VI ti Sc+b :30utheastmm'Realth Regio .L a.'K .4 r 1 _ _• �; is LJLLLSovilleX6r .G'It `3 a s ;•y ` «I. kqanrds r' • e-Barnstable ,,ypry `,F.C, Heath Department ,�,3• • _ « ;� ,r , .R�«. .i J•- at. .t r .. ouaV �.*^G�N,�E?•y7 oie r&%A " 'M'4• Wiait]. £ •� ♦r J l?�CFf�`, '4G•RI+��.�.-3�9,t3a"3.�4v�4�t��G 4't�. i n I•'�g� i`J[ , > t. �;x f � r j. �-• .'e t..• 71 Ik a` `' r _ 'p'•y6. � , a k •4 •; � '' C '� - * ��� y °tna .t. , ; • 1 e ,�� �� R.i jh �^ S ^ F• i � •! n c..x.�, jai � .o a , � . d' +•r' ,r , .` .+e ; �. .. .. } * r.*ems u, t .� ht4 `'` i •t` T � .` _ •a ,.F}4 � � �.R•. �� `�'f ,k°, �r.F t. g' a s r• t`� �, _. ,. .. � r. •i; „� `!:�, s �4' t �,�t �, r ,� 9•.,$•� �. �'. a .�`a r'-. ,a „ ,C. ,� • r r - c �oFtHET�,,� Town of Barnstable B„MLE STAB . = Board of Health 9q, 39. ,�� 200 Main Street Hyannis, MA 02601 Office: 508-8624644 Susan G.Rask,R.S. FAX: 508-790-6304 Wayne Miller,M.D. Sumner Kaufman M.S.P.H. April 24, 2004 Ms. Jane Curtis The Huntingest Group p.c. 40 Industry Road Marstons Mills, MA 02648-0340 RE: fCehter Milk ie..:Cbnd:bmi�nioms/:Rciqu6st forV.ari.8inco Dear Ms. Curtis, Your request for a variance from the Board of Health provision which requires qualified swimmers to wear orange colored hats or orange colored visors with the words "POOL STAFF" in 15 millimeter (5/8 inch) black colored lettering on the front of the hats at the Center Village Condominiums outdoor swimming pool, Captain Cook Lane, Centerville, was not granted. It is our understanding that once the padlock is unlocked at the pool gate, all residents (and visitors) of the condominium complex have easy access into the pool area, whether they are certified or not. There is no strict method in-place for limiting or restricting certain persons, particularly those who are not CPR certified "qualified swimmers" from entering the pool area at the present time. The Board requires the orange pool staff attire so that health inspection staff will be able to easily identify 'who is the certified "qualified swimmer" supervising the pool whenever it is open to the residents and visitors there. Variances may only be granted when, in the opinion of the Board of Health, the applicant has demonstrated that (a) enforcement of the particular provision would be manifestly unjust and (b) the same degree of protection could be achieved without strictly adherence to a particular provision or regulation. You were not present during the meeting of the Board of Health. Therefore, you n did not demonstrate manifest injustice and you did not provide information relative to how you would provide the same degree of protection to the swimmers *re Therefore your request for a variance was not granted. er M.D. VarianceDenial I ` DATE: HAENBUISIA g PER: NAM as9• M1d REC. BY Town of Barnstabletc HED. DATE: Board of Health -� 4 C) 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 2 t FAX 509-790-6304 Susa o.R9 R.S. Sumner KauS mk M.S.P,H, Z Wftjj A,11W,M.D. VARIANCE REQUEST FORM N v - w LOCATION Property Address: (D Assessor's Map and Parcel Number: Si .e of Lot: Wetlands Within 300 Ft. Yes Business Name: J No Subdivision Name: APPLICANT'S NAME: Phone Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON Name: Name: Address: Address: Phone: — tea :fzlf -!2l Phone: VARIANCE FROM REGULATION(list Reg.) REASON FORAl V1MCE(May attach if more space needed) NATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System ❑ (to be completed by office sh{f-person receiving variance request appltcation) Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans of restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to mating date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected (no fee'for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only],outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Swan 0.Rask,1LS.,Chairman NOT APPROVED Sumner Kauflnen,M.S.P.H. REASON FOR DISAPPROVAL Wayne A.Miller,M.D. Q:\HEALTH\Application Forme\VARIREQ.DOC THE COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE Fee: Board of Health $75.00 Permit To Operate A Swimming Pool In accordance with the provisions of Chapter 111,Section 127A of the General Laws,and Regulations established by the Massachusetts Deparment of Public Health(105 CMR 435.00)permit is hereby issued to CENTER VILLAGE CONDOMINIUM TRUST corporation or individual for the operation of OUTDOOR POOL (Public,Semi-Public,or Special Purpose Pool) at 10 CAPT COOK LANE, CENTERVILLE MA. address Method of water treatment is chlorine-automatically fed Bathing load not to exceed 19 bathers. QUALIFIED SWIMMER MUST BE AT POOL SITE ALL TIMES POOL IS OPEN. JANE CURTIS 508-428- 1112 Wayne Miller, M.D., Chairman Board This permit is valid until December 31, 2006 Sumner Kaufman, M.S.P.H. of Paul J. Canniff, D.M.D. Health r POST CONSPICUOUSLY By Thomas A. McKean, RS, CHO, Health Agent r .� ENVIROTECHI ABORATORIES,INC `. 1fIA C'ERT.NO.:M M 063 8Jan Sebastian Dr., Unit#12 {� Sandwich, MA 02563 908(888-6460) 1-800-339-6460 A UG 2 3 2004 FAX(.508)888-6446 NEALTFj RNSTABLE POOL ANALYSIS REPORT �EPj. Client: Oceanside Pools PO Box 610 So. Orleans, MA 02662 Sample Location: Center Village Barnstable MA Sample Type: Outdoor Pool Time Sampled: N/A Date Received. 8/10/04 Collected by: Oceanside Pools Lab/D#: 0408279 Results of Analysis: Parameters Method Recommended Limit Results Coliform1100 ml @ 35 C for 24 hrs. 9222 B 2 0 Pseudomonas Aeruginosa/100 ml @ 35 C for 48 hrs. : 9217 B - 1 Heterotrophic Plate Count/ml @ 35 C for 48 hrs. 9215 B 200 Background Bacteria/100 ml @ 35 C for 24 hrs. 9222 B 200 YES POOL WATER IS SUITABLE FOR SWIMMING FOR PARAMETERS TESTED. TNTC too numerous to count <= less than > = greater than Date r y nald J. Sa ri Laboratory Director ENT71ROTECHLABORATORIES,INC. AIA CERT.NO.:M-MA 00 8Jan Sebastian Dr., Unit##12 Sandwich, MA 02563 508(888-6460) 1-800 339-6460 FAX(508)888-6446 POOL ANALYSIS REPORT Client: Oceanside Pools PO Box 610 So. Orleans, MA 02662 Sample Location: Center Village Barnstable MA Sample Type: Outdoor Pool Time Sampled. N/A Date Received: 07/14/2004 Collected by. Oceanside Pools Lab ID#. 0407352 Results of Analysis: Parameters Method Recommended Limit Results Coliform/100 ml @ 35 C for 24 hrs. 9222 B 2 0 Pseudomonas Aeruginosa/100 ml @ 35 C for 48 hrs. 9217 B 1 Heterotrophic Plate Count/ml @ 35 C for 48 hrs. 9215 B 200 Background Bacteria/100 ml @ 35 C for 24 hrs. 9222 B 200 r: YES POOL WATER 1S SUITABLE FOR SWIMMING FOR PARAMETERS TESTED. -TNTC=too numerous to count < = less than > = greater than Date Ronald J. aari Labor t Director .' EArVIROTECHLABORATORIES,INC. MA CERT.NO.:Af-Ul 06; 8Jan Sebastian Dr., Unit#12 RECEIVED l Sandwich, ALL 02563 508(888-6460) 1-800 339-6460 J U N 16 2004 FAX(508)888-6446 TOWN OF BARNSTABLE POOL ANALYSIS REPORT HEALTH DEPT. Client: Oceanside Pools PO Box 610 So. Orleans, MA 02662 Sample Location: Center Village Barnstable, MA Sample Type: Outdoor Pool Time Sampled: N/A Date Received: 6/9/04 CoNected by: Oceanside Pools Lab ID#: 0406244 Results of Analysis: Parameters Method Recommended Limit Results Coliform/100 ml @ 35 C for 24 hrs. 9222 B 2 0 Pseudomonas Aeruginosa/100 ml @ 35 C for 48 hrs. 9217 B 1 Heterotrophic Plate Count/ml @ 35 C for 48 hrs. 9215 B 200 < 1 Background Bacteria/100 ml @ 35 C for 24 hrs. 9222 B 200 YES POOL WATER IS SUITABLE FOR SWIMMING FOR PARAMETERS TESTED. TNTC=too numerous to count < = less than > =greater than Date W4ald J. S Laboratory irector i a a THE COMMONWEALTH OF MASSACHUSETTS > TOWN OF BARNSTABLE >` Board of Health Fee: $75.00 Permit To Operate A Swimming Pool In accordance with the provisions of Chapter 111,Section 127A of the General Laws,and Regulations established by the Massachusetts Deparment of Public Health(105 CMR 435.00)permit is hereby issued to ROGER DALAND,TRUSTEE/DBA CENTER VILLAGE CONDOMINIUM TRUST rc corporation or individual for the operation of OUTDOOR POOL (Public,Semi-Public,or Special Purpose Pool) at 10 CAPT.COOK LANE, CENTERVILLE, MA address Method of water treatment is chlorine-automatically fed Bathing load not to exceed 19 bathers. QUALIFIED SWIMMER/LIFEGUARD MUST BE AT POOL SITE ALL TIMES POOL IS OPEN. Susan G. Rask, R. S.,Chairman Board This permit is valid until December 31, 2003 Ralph A. Murphy, M.D. of Sumner Kaufman, M.S.P.H. Health POST CONSPICUOUSLY ByGa� Thomas A. McKean, RS, CHO, Health Agent ENVIR07ECHLABORATORIES, INC. MA CERT.NO.:M-MA 063 8Jan Sebastian Dr., Unit#12 . Sanduich, MA 02563 508(888-6460) 1-800-339-6460 FAX(508)888-6446 POOL ANALYSIS REPORT Client: Oceanside Pools PO Box 610 So. Orleans, MA 02662 Sample Location: Center VillD BarnstableSample Type: Outdoor Po Time Sampled: ° - C-Apt. 1� l Date Received: 08/13/2003 Collected by. Oceanside Pools Lab ID#: 0308277 Results of Analysis: Parameters Method Recommended Limit Results Coliform/100 ml @ 35 C for 24 hrs. 9222 B 2 0 Pseudomonas Aeruginosa/100 ml @ 35 C for 48 hrs. 9217 B 1 Heterotrophic Plate Count/ml @ 35 C for 48 hrs. 9215 B 200 Background Bacteria/100 ml @ 35 C for 24 hrs. 9222 B 200 YES POOL WATER IS SUITABLE FOR SWIMMING FOR PARAMETERS TESTED. TNTC =too numerous to count C �� ® < = less than 3 > = greater than �, 1 ZOO 1 , A1JG Date443 WN OF pEP-r• y n SD i To HEp�SH L oratory rector I r FREIVE® ENVIROTECHLABORATORIES,INC. MA CERT. NO.:M-MA 063 Z0038Jan Sebastian Dr., Unit#12Sandnich, MA 02563 ARNSTABLE508(888-6460) 1-800-339-6460H DEpTFAX(508)888-6446 POOL ANALYSIS REPORT Client: Oceanside Pools JUZ PO Box 610 2 4 ?003 So. Orleans, MA 02662 Sample Location: Center Village Barnstable, MA Sample Type: Outdoor Pool Time Sampled: N/A Date Received: 7/11/03 Collected by. Oceanside Pools Lab ID#. 0307276 Results of Analysis: Parameters Method Recommended Limit Results Coliform/100 ml @ 35 C for 24 hrs. 9222 B 2 0 Pseudomonas Aeruginosaf100 ml @ 35 C for 48 hrs. 9217 B 1 Heterotrophic Plate Count/ml @ 35 C for 48 hrs. 9215 B 200 Background Bacteriaf100 ml @ 35 C for 24 hrs. 9222 B 200 YES POOL WATER IS SUITABLE FOR SWIMMING FOR PARAMETERS TESTED. TNTC =too numerous to count < = less than > = greater than Dat I n onald J. S a " Laborato Di ector THE COMMONWEALTH OF MASSACHUSETTS 1 TOWN OF BARNSTABLE JUN 16 2003 SWIMMING POOL INSPECTION REPORT TYPE OF POOL: PUEA❑ SEMI-PUBLI SPECIAL PURPOSE❑ POOL VOLUME:" GAL. MAX.BATHER LOAD NAME OF POOL ADDRESS OWNER ADDRESS Re,gula.i n 105CMR435.000 effective date:2/20/98 The items marked below with an"X"indicate the violated provisions. Items marked with a check are satisfactory. 03Bathhouse and sanitary facilities adequate lighting.ventilation:sanitary condition.Adequate enclosure around pool.Gate self-latching 4 ft.above ground. 04. Sewage disposal `/05 Location,structural stability,finish Water circulation&filtration systems.Filter effluent flow meter reading�gpm.#of turnovers if 06 Suitable automatic equipment for disinfection of pool water. N06 CO2 equipment for pH control CO2 cylinders anchored Inaccessible to public Adequate ventilation. 336, vd Ag!!f'68 Inlets&Outlets-hilets located to produce uniform circulation.Over rim fill spout 6"above max.water level.Properly shielded&located. _V'O8 Main drain suction outlets covered w/suitable protective covers/grates.Cannot be removed w/o use of tools.Open area does not provide entrapment of fingers,toes, /etc...At least one antivortex drain provided 08 Each system outlet protected against user entrapment by antivortex cover or by other means.Minimum of 2 suction outlets provided for each pump,properly located and plumbed. 4✓ 08 `Suction outlet covers in place,unbroken and secure and cannot be removed except w/use of toolL Close pool immediately if outlet covers missing,broken,loose or can be removed w/o tools until repairs are made. /VtA8 Special purpose pool&wading pools equipped with emergency shut-off pump switch.Accessible and prominently marked. Cross-connections.Potable water supplied through air gap. V, 1�0 Skimming Facilities.50%of recirculation drawn from surface of pool. V12 Line with floats separates non-swimmer area from deeper water. �2 Water depth markings on deck and walls.Properly spaced.Boundary line on pool floor and walls.Step edges marked with contrasting color. 13 Walkways&Decks 4 ft.wide.Safe condition. 4 Ladders,steps-one per 75 feet.Not less than 2 ladders. /AP/-/�15 Diving equipment in safe condition. ._je'*'7l 7 Pool supervision provided. CPO w/proper training:On staff or on contract,Documentation provided. 11 1 Permit issued Adequate maintenance and testing records.Records initialed by person making tests. /1 I62 Health Regs.Signs posted Warning signs for special purpose pools. _A/23 .Lifeguard ❑ Qual.Swimmer!9 If lifeguard:proper credentials,proper suits and garments wom.Whistle&bullhom provided. Qual.Swimmer:CPR trained, BOH approved.Limit bather load to 19 V 24 Safety Equipment.Ring buoys and rescue hook provided. Rescue tube and backboard w/straps at pools attended by lifeguard. Y24 25 First aid equipment provided. First aid kit complete. V25 Emergency Communication system at the pool and in working order.Emergency copimumca ion device in unlocked area and available at all times to staff and the public.Operating instructions and emergency numbers posted. P _26 Waste&backwash water disposal properly discharged. No direct connection to sewer system.Separation tank provided for diatomaceous earth filter backwash water. 29 Chemical Standards. Frequency of Testing:_7 POOL SIDE READINGS IN PARTS PER MILLION- m Bromine 1 2.0-6.0 Total chlorine Alkalinity 60-150 110 Free chlorine g-7.8 C anuric Acid 30-50,max 100 Comb.chlorine Water rem • 78-84,s a<104 H -f 300 Water testing equipment.DPD kit provided for chlorine&bromine.Unbreakable thermometer for special purpose pools.No test strips _V 31&32 Water Clarity:Can see 6"black disk at bottom of pool.Water clarity maintained.Filtration operating continuously. 2 Special purpose pool drained&cleaned every 14 days minimum 33 Thermostatic control provided for each SPP.Thermostatic control only accessible to the pool operator. N4 POOL MUST BE CLOSED UNTIL IT MEETS 105 CMR 435.29 THROUGH 435.31.If the pool is closed by a Health inspector or other agent ofthe B.O.H., the pool shall remain closed until the Health Inspector re-opens pool in writing. COMMENTS: SIGNED: SI ED:PERATOR oard of Health/Health Dep resentativ�DA�TE � T No..... Fic$...2................._ . U� THE COMMONWEALTH OF MASSACHUSETTS BOAR QF HEALT y�� (:e� .- o (�.__...........OF..... . > Appliration for Bigpasal Workii Qlanstrurtivrt Vantit Application is hereby made for a Permit to Construct (010fl or Repair ( ) an Individual Sewage Disposal System at: ...4�bb....5��?i 4?$3 +RJ?y 4iu.4......:'2��0 HYAAA)is. - 8uK-61„16 # - eP_wrcat -�akLW1bk._ `...--.... ....................•---..........._......------------.....------------........ Location.. -Address or Lot No. ?.t�E.....I� !-T..7................................... '. �.....BoyLS: si..=......$Ytaa!gvk!PP_-..._. Owner A dre s W TOsASSo• 11 HAw%12�s 1 i�Yu�aw�S- Installer Address Q Type of Building Size Lot.............................Sq. feet U Dwelling—No. of Bedrooms..... ..................................Expansion Attic ( ) Garbage Grinder ( • ) Other—T e of Building ............. No. of persons............................ Showers — Cafeteria dOther fixtures rr------------------------•----------------------.---------------------------..---•---------•----------------------------------- W Design Flow........�C�............................gallons per person pier day. Total daily�ow-___-_:�a00_.......___.....__....__. �11014s. WSeptic Tank—Liquid capacity_a®gallons Length.�!._'Al..___ Width_ __'G_.___ Diameter..._.'-_..__.__. Depth. :6...... x Disposal Trench—No. .................... Width ....... Total Length.___.....r._.....u. Total leaching area....................sq. ft. Seepage Pit No----- ............... Diameter------�__.. _..__ Depth below inlet.._ .7.9...... Total leaching area..6�.........sq, ft. Z Other Distribution box ( ) Dosing tank ( ) `_' Percolation Test Result Performed b S J..sty ... �R��b aDate...........................---•••------ Y = •-•---•- t i� Test Pit No. 1.3. :.....minutes per inch Depth of Test Pit...!P- Depth to ground water----PQY f--_.. Test Pit No. 2.'� .......minutes per inch Depth of Test Pit..... Depth to ground water........................ g----------rr--------------------------------------------------•----------------------------------------.----.-.---------------------------------------•---- O Description of soil......Q__. 36--•_-_-•--l.OAV_%._._.r..51tA-SOIL - ....--------36"_ by ?I �Uoi=!- °� - 20it CL AaI..._._�o 0 SAujil- W ------------------------------------q6 ` -- --- 10 V- . Nature of Repairs or Alterations—Answer when applicable........................................................................ ..JQ(.�....... UG •---•-------------------•---...---••------------------ --------------------------------......--------------------..._...__...----------------------------------------------- .. Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation`until aCertificate of Compliance has be n issued by the board of health. Signed-- ---- ••--- •--•-- -•-.-•-••••.....: ................................I6. T, Date ApplicationApproved By............................. ......................................•--•-••-•-.............•--•- Date Application Disapproved for the following reasons----------------------•---------------------------------------------------------•----------------•-•-----._._.._. .................•...........................................................................................---•-----_....------------------------------------------------------•-----......---••..:._.. Date PermitNo......................................................... Issued........................................................ Date 41 No........................ Fmc -Z............... hw THE COMMONWEALTH Or MASSACHUSETTS BOARD ............. OF.................. ........... ......................... lar Big pusal 1911rks Tonstrurtivit Vantit Application is hereby made for a Permit to Construct (V4'or Repair an Individual Sewage Disposal System it: ...QW)� ............ C 6 v�l"Z,#2 U k L'�vu,t,-- . ................................................................................................. Location-Address or Lot No. .......... ......`ice ...... f.I..Z...... ................................... &.S ...... ....5A......... Owner Address !1,5w...................................... 14 utE. (_j y 14 to 0S ............... ........ ................................................................................ Installer Address U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms... ...............................Expansion Attic Garbage Grinder P-4 Other 7--Type of,Building ............................. No. of.persons_.__*::.1.......... -------- Showers Cafeteria P4 Other fixtures ........1PP.Q.n.................................................................................................................................. Design Flow....... :: --gallons per person per day. Total daily flow.........I. Aco W ..:........................gallons --------------- Width_ JV_ Q . ................................iFills. 1:4 Septic Tank—Liquid capacity,2.0.00-gallons Length.(!"-.9_--'_. Widthk...,6...... Diameter............. Depth__... ------ :V. Disposal Trench—No...................... Width...._........._.... Total Length........I........ .- Total leaching area....................sq. f t. Seepage Pit No.__!-_______..._..-- Diameter.--- ----------- Depth below inlet..4................ Total leaching area.-4!121........sq. ft. Other Distribution box ( ) Dosing tank ( Percolation Test Results 6-16CO 6Q1 V,I Pei-formed bv-------- ............ ................................ Date........................................ Test Pit No. 11A.......hiinutesperin'ch Depth of Test Pit.tWnb....... Depth to ground water._W_". _t �q Test Pit No.. 2................minutes per inch Depth of Test Pit................... Depth to ground water______._........_._.___. ..........?------------- ..................................................................................................................... 0 Description of Soil--- ..........tx_iA.�n.....jt---- ................................................................................................ .............................. ..... ... ..............................................I......... ---------------------------------------------------------------------------- �11- ------------------------------------ ........C1 ------ .................................................................... 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 Article X1 of the State Sanitary.Code—The undersigned further agrees not to place the system in operation until a Certificate of.Compliance has been-issued b the board of health.: Z 13 Signed -k-411 . ................................................ t4 Date ApplicationApproved By...-----............. ---------- .......................................................... .................... ................ Date Application Disapproved for the following reasons::.............................I........ ...............m........................................................... ................................................................................... ----------------------------------------------------------------- .................................................. Date Permit No....................................... ................... Issued. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i......... ......OF.. ...... .......... a' 0.WV a:urr �... IS S TO CrTIFY,That the Individual Sewa'ge Disposal System constructeI:14:��Tor Repaired p.,, - by... .. ----------------------------------................................................................................................. initaller, t -ie�provisiotis of Article I of The State Sanitar s been install- 'in accordance with r_ r has JtV as e c ib rt' S r; d i I�Ze application for lisposal Works Construction Permit No------_----il-`-�F----------­-- dated-. .................... r ..A THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS AR NTEE THAT THE SYSTEM WILL FUNCTION, SATISFACTORY. Z.A4 ............................. DATE.............. ................................... Inspectoi..........P. ....... .................... THE COMMONWEALTH-.OF MASSACHUSETTS BOARD OF HEALTH 44�.. . . OF.... ............ ..... No.l--,Y,f............ FEE a................... 41, X. Permission !,,s,%hereby granted.11, . ......... .. ... .... . . ............................................................. 1 1 to u or Repair e,..Wisp s Cons/ _�'a� individual �e D' al.,Systetm at No _. ...._ . treet as shown on the application for Disposal Works Construction Xrmit,No...... Dated ... ... .y 7 -i ...................... 0 DATE............ . ........7,,)........................... ............ ,, a FORM 125 HOEBS & WARREN. INC.. PUBLISHERS No.....5 = Fmic............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................OF..............................------ ---------------------------------------------- Applira#iun for 19iipsal nrkfi Tlinstrurtion Urruiff Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: , t` 5 , ..0A 0--- = -`�-Q''t!^!5 .-- -�- -- ..�..S.E�.an. _Y'_.. .1-1-�----- Loc ti Address or Lot No. K r� C)OCAM.,` P.�.. � L ...�r u_�. .. F3'S S� C�e� .l._��.... .f:---- Owner Address Installer Address QType of Building Size Lot............................Sq. feet U g— _Expansion Attic (iw Garbage Grinder (iAo)Ac Dwelling No. of Bedrooms_....1' ................................ 1-1 P4 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a'' Other fixtures ..... —---------------------------------------------------•-•-----................................................-------_--------- d Design Flow............. ...._..._........_..._gallons per person .er day. Total daily flow.......... _�_ -------__--____-___ allons. WSeptic Tank—Liquid capacityZt VCkallons LengthiV-0'`__. Width -_(A..-_ Diameter________________ Deptli_(�i�-o__--. x Disposal Trench—No. .................... Vl Width.................... Total Length.................... Total leaching area--------------------sq. ft. 3 Seepage Pit No..---______________ Diameter-_- Depth below inlet..q..='Q_o...._ Total leaching area__.�'__d_1-----sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by- 1 .� _`v... Q�✓�:x_ ;_l �._........ Date---)_0_--V 2_-..t Test Pit No. 1................minutes per inch Depth of Test Pit........l __.... Depth to ground water__-_ �, Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water------------------------ -----------------------------------------------------------------..................................----------------------------------..................... 0 Description of Soil--.(�"-�._"3. ��.t c��xs _. t��.. .__._. 1' ` x '' E� x ------------------i-&_i- -t---tc ��---�c�r.�tt--�'r�.��� �` � �r�.a.c. �r W l � U Nature of Repairs or Alterations—Answer when applicable.__:in., __________________________________________________________________________ -----------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual, Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ben isstWd by the board of"-iea�lth. igned..-----.. ----------------- .. ------------------------------------- ................................Date ApplicationApproved By----- =----------------- ------------------------------------------------------. ----------.1, 3.iq--------------- Date Application Disapproved for e f ollowing r sons--------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------.................-............................................................................................................... Date Permit No. rP,1... Issued f --'3-a 7 .z� ----------------------------- Date No.............=---..--=---- FIuE.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... .. ...............O F.........................................------- , ppliration for Uiopooaf Workii Tonotrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: A fJ 1 Lod tron Address .15 or It No.^- aY ` FYL3°'= i �°aGilt �7 La �.3 � t ' � = S- =....tC- - -��-�--`.��. Owner 1 Address AS ---------------------•---------- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.__A:Z.................................Expansion Attic (ny -e - Garbage Grinder (Ilot)=e 04 Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) QI Other fixtures ._..s .. ----------------- ---•-••--•-- W Design Flow_____________S.Q...................... per person er day. Total daily flow....._....L � ._______-__--_------gallons. WSeptic Tank—Liquid capacitV4P4!0gallons LengthtZ.-O..... Width.G}-._�..."__ Diameter---------------- Depth__S__'o��_. x Disposal Trench—No..................... Width.................... Total Length.......4.____..... Total leaching area--------------------sq. ft. 3 Seepage Pit No..................... Diameter._4_-.L-.... Depth below-inlet_.q'1..•`t0_..__.. Total leaching area--a-0-1.....sq. ft. Z Other Distribution box ( , ) Dosing tank ( ) aPercolation Test Results Performed by.�_lnu I_= __. ! �_ ___�_ .+ : �___.._____. Date.. 10.'--� "_�-•-•----.__. Test Pit No. 1................minutes per inch Depth of Test Pit--------1_4._...... Depth to ground water___ _ ? . -.. fsI Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_--_-_--_---.---___-. - Oa •............... ......................................................`....__..._---_-_........_..-.__._____�+-...--_........11-------.-•-------•------ Description of Soil-- C..... V ---------------------------------`ter"-=t ream, : 00�5 �' ?t� ? `' = 4� -----?a... v ?' es,�,. k' ! :�---- i' kl .t?c z `'' ' �"'--------------- ---------------------- W -----------•---- 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n iss ed by the boa d of health. ..J1 s� D Application Approved By-----•••;;Z ✓.-. . `•- -a . Date -� -- 1 Date Application Disapproved for the following redsons:-•--••-----•----------•---- ................................................-------•------••-----•-•---•------- Date PermitNo.------...6 f-------------------------------------- Issued.------.. ............................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH • ..............`.. ..fi ace ,_ .......................... AT wirtif irate of Toutphanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (''( ) or Repaired ( ) ------------------------------------------------ r Installer f at-••'-' •' t✓ r r t i t 1�- ra�,l •/' f^ ----------------------------------- has been insfalled in accordance with the provisions of;%A1rticle,XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit NO....._ t_.f_ ________ dated.__-_L . - ___. - n ''__ ----------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. y NR DATE =�'......-----'• ... --------------------------•-------- , Inspector--------------------------------------------------------------...-----------........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.......- .............. FEE........................ �i��I�,��t! oxko C�on�trnrtion prntit Permission,is hereby granted '�'A==---------------- -`--- ---�i '�- ---- '_1_.. --- --------------- -- to Construct ( ` ) or Repair ( ) an Individual Sewage Disposal System , Street t t as shown on the application for Disposal Works Construction Permit No----------%.. '__ ____.�<)___-- Dated_______________ ::.:. `/. a �1 y1�3oard of Health DATE- — �_ ._... / - ..-- ............................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - ��0...:.---- Fimim.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .............. ..._.... i .--....OF.......................................-----------------•-......---------------------- Applira#ion for Dispwiat Worho T.ontrnrtinn Putuit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: rlocation-Address or Lot No. ....... _..--.... 6-66 .? Owner ` i Address ..................................... :i..... jO.A... Installer Address QType of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms------- __ ..............................Expansion Attic (i%r)v►e_ Garbage Grinder (inu�•t_ .1 aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) PaOther fixtures ----Aso_ +-e..--•-------------------------•-----•----------•---------- --•---------------•---•----------------------------------------------- d W Design Flow........5.0.............................gallons per person per day. Total daily flow.......LZ.!050....................gallons. WSeptic Tank—Liquid capacity2600gallons Lengthi21-0.1___ Widtha'__(0 `___ Diameter---------------- Deptli_f"q_".. x Disposal Trench=No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter_6-_'�__-____ Depth below inlet... Total leaching area-_C__0�----sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results PerformedI ...I-_J,.Nr,........ Date..`�.Q_-'_�_�-"_71.1--- ... Test Pit No. 1----------------minutes per inch Depth of Test Pit---13............. Depth to ground water-_- 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water___________________-.-._ 19 •-•-.....-•-----------------•--•------•--•-•---•-•-•------------••••-......•------•------•---------.......................................................... 0 Description of Soil... ------�3(Di1...4& ., --- -------------------------------- V ...................................&-0-•----_t-ea-----['�a_Z........�3 .t��� �Yfa�4�X.J �—��° ---- ------F-�bt'` W V 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 Article XI of the State Sanitary de— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been P by the board llof health. Signed !'L�C �. ................................ ---••-• --•---------- Date H`/ Application Approved By-----ie --- - ------- ----•--- ----------1,- 3d 1-----------------------•--•------• Date Application Disapproved forollowing asons:--•-••---------••---------------------•-•--------•---••--•-••--------------------•---•••--..Da---------••----- --•-••-••-•-••••-•------•----------•--------•--•.-•---•---------•----•---••------•-••------••--•----------------•----------............--••--•-------------••--•----------------••------------••-------- Date PermitNo......"-,o.................................... Issued........................................................ Date ........... Fizz.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' ..........................................OF..................................... Applirratioaa for Disposal Works Toni struriion Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: j .....................�� La invtiJ _ m......._ .__ 5 'u`-�°s-�......................iCi ocation Address _ or Lot No Owner ^yy W j1(i_ _. � 1n•�'- � Address ..... 7.f'ss.QW�----------------- �. a''-u.---•-- Installer Address UType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms------- .............................Expansion Attic Garbage Grinder Other a —Type of Building ............................ No. of persons.._._--___-_...._........... Showers ( ) — Cafeteria ( ) Otherfixtures ...!- - = ..........----------------------------• ---•--•-• ---------------------------------------------------------•-•••-------------- Design Flow........SjP............................. per person per day. Total daily flow....... -s ___-_--___----..._--gallons. Septic Tank—Liquid capacity2_ s?; .gallons Lengthg�'_:� _ _S'a_.. Widths+`�.��._. Diameter............. _ Depth . '4..��.. W Disposal Trench—No..................... Width-------------------- Total Length-------------------- Total leaching area---_.._-_._....-.._-Sq. ft. x Seepage Pit No-------------------_ Diameter&__.(fe-------- Depth below inlet..-...L�iS... Total leaching area.Co.00.....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0-4 Percolation Test Results Performed b .-Ckco:_S. c_.-. ' -ci. ' :_: ..... ........ Date-.1.Q-._Z_. 1.4 Test Pit No. 1................minutes per inch Depth of Test Pit_.i-4_......_.._-_ Depth to ground water.:k-_s _"C_' -. (14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..-..-_..__-.---_----- a' ------------------------------------------ -••--•-•---•-------•••----•-•-•-----------------•---••.......................................................... -•--•-•-•-••-----•-•-•---•-•--•'......-------•-••••---- O Description of Soil--- ' 4-t-� - i.........v C r 4 P = O+ w ` `'�� - 64 ____f'- •-s �p ie R t __. ...-_l>_.'z.___-•__ +_s ' ___ t_�c-�• l _____I_.- -_ ._.._ :-._i_"a_i�_.__ ..czC x_S .--_s '.d. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable.-.--_'pi_chin- _.._--:....•---------------------------_..----------_.-..__.._..-. ------------------------------------------------------------------------------------------------------------=-----------------=------------------------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary ode—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beer issu d by the board of heath. Signed--- ---= t A i• Date Application Approved'By_..___-- •'--------=-===------ --- -- f� f ----------------------------------------------------- ---------------------------------------- Date Application Disapproved for the following reasons---------------•--...---•-----•---•----------------------------•-••...-----------•-- ---•--------.....-•----•-•- --------------------------------•--•---••----------•-••-----•--••••••••-----_•--- Date Permit No....... ... , ..................................... Issued......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. . .. v .... x .� >.. ....,;f,.. . ....... ........... . .................................. • Q-11rrtif irate of (1911amplitaaarr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( �') or Repaired ( ) F Insta_lleX"_. i7 i`s�+�! •. .r�' ' ..,1 ^^ -- !�! 1.ff{- Cf J�'''' .�:. fi iCr / at .......................... .. ..... ....... . ................... has been mstaa9ed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM wiLL FUNCTION SATISFACTORY. DATE.------ / ----- -• ----------- ........................................... Inspector..........-.......................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....'..... No... -- FEE........................ orki C�.ontraartion Permit Permission is hereby granted._... a._ __.__._._.` f- _1 -------•-- to Construct C"t' ) or Repair ( ) an Indiv>dual Sewage Dts�osal System > -= `✓� ''�f at No ;. - .'- c - as shown on the application for Disposal Works Constructioo Dated Street n Permit No.=�-_: _._.._--_. ��'-' �:,-;---•-.- �. --�....... Y. h ..,! ._ �.';:`�i^'�„I: "; --•---------------•----•-- -----•--•--------'•-•-----�------••----'--^--••---•--- �/ �J - ���y Board of ealtli DATE =1 >... ✓ -------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - - No.....J Y;r.__._ Fxx............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ........... ....._.._...................OF......................................................................................... Alip ira$iun for Disposal Works Tiattstrurtion Putnit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Locat' Addr s � or Lot No. Owner Add ------------------------------- $ _ea.v�ress 1.,---a-- Wiz_ Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms-----M.................................Expansion Attic (KO)e. Garbage Grinder (v%6)e,4e_ 04 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ........ra.o_m�__._._.___. _ W Design Flow--------- _9.........................gallons per person per day. Total daily flow.............. ..__.........gallons. W Septic Tank—Liquid capacity_2LX10gallons Length!Z!n.�"_ Width " 1 T-76 �--fo.__-- Diameter---------------- De nth_ _ _-... x Disposal Trench—No_____________________ Width_._____4.__...._.__ Total Length.................... Total leaching area_---____-_-__--_-__-sq. ft. Seepage Pit No..................... Diameter__ ..... Depth below inlet__ __-0...... Total leaching area__&_fP:d.____sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by..... :I���r_Le`a___ u�.�__{__1_ Ge.____ Date....LO_~z7l_^1_1_------ Test Pit No. 1__A..........minutes per inch Depth of Test Pit....l�{=-_ ;�____ Depth to ground water--_11Ezve __.. f3. Test Pit No. 2__A..........minutes per inch Depth of Test Pit----f_0+4!... Depth to ground - ------ --------------------------------------------•------- ---------------- ---•--•---------------____-----• ---------------------------------- ._ I--3� ----- ��t �tDescription of SoiLO_ _��... . . 1�o. � , . __ . -- - ---_ V W ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- V Nature of Repairs or Alterations—Answer when applicable.__-_-A_o_%n-,_0—_______________________________________________________________________ -----------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article,XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bn is ued by the board health. Signed.... . - ------•-------------- J -..................°------------------- ------------------------------ Date Application Approved BY -------------------- --- --------•------------------------------------------------- ---------------- Date.3�_-.1.. Application Disapproved for lie following reasons-----------------•------•---•-•---•--------•--•--•---------------•-•-----------------------._._.----------------- -------------------------------------------------------------------------------------------•----------------------------------------------------------------------------- ............................. Date PermitNo.---.5--S 1_.---'._......-•-------------------- Issued........................................................ Date } i!.,y�•FiF FEx.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...-.....OF............................ .-------------- - Appliratiun for J%mu at 19orkii Tonstrnrtion prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual.Sewage Disposal System at ....9`'�---A...... -----6.. --*LJ-------C e'11r t LJ1--UA l.' -.__... ocation-Addfr. ss .. or Lot No. .._..._._ —ice ` _�5 ! i---f� •----3..C.jp Owner Address a !'a-Y--+_4��r ._.� ..G_�S°r. �3. . .............................. _ .e...2 _�' _fS`.:?!?L?ir $ �M G---n................. Installer Address UType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms----_ __________ _____________________Expansion Attic (h o),4L Garbage Grinder P4 Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) QE Other fixtures .......n.sa_)n.-.e------------------------------- W Design Flow.........��.-rQ__..........................gallons per person per day. Total daily flow.............. -------------gallons. WSeptic Tank—Liquid capacity2OD0-gallons Length.-11x0.°_- Width(,-.-(o i'-- Diameter---------------- Depth_S__'_-U e' x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area-----------.--------sq. ft. Seepage Pit No_____________________ Diameter__G._�`_�...... Depth below inlet..�l-_.- Total leaching area_&Z -_1-.__.sq. ft. Z Other Distribution box ( ) Dosing tank ( K ) a Percolation Test Results Performed by.... j_'k1c _____ Date....1.0.-.`Z-__)__-'I_l_--_-- Test Pit No. 1_ -----------minutes per inch Depth of. Test Pit----1.9.1 ._---- Depth to ground water------------------------ LTA Test Pit No. 2_A..........minutes per inch Depth of Test Pit...in_F4-:___ Depth to ground water_-------------------- W •---------4-----•---------------•---------•-----•-«-------•••--•-•�i--------------•8a-•-------•••........................... . ....---------F;-----•---•----- E: D Description of Soil. = _ ._�ra-• ' � ^ _e ------ q, , 5 � ) -_ _�ec;_ .. W UNature of Repairs or Alterations—Answer when applicable.----_-v_avk.le_�-----------------------------------------___-----_-_-___-__------... ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b en i ued by the board 9f ! health. - Signed--- .._ - � ' A- Date Application Approved BY F-f r = Date Application Disapproved for the following reasons:--------------•---•---•-•-- ----•-------------•--••--•--•-•-•-•--•---------------------------------- - -----------••--••--•--•---•-...---•--••---•--•...•--------•-----••-••-•----•-----•--------------------------•-------•••-•••---•--••----••-•-----•-----•----•-----------------------------------•-••-••-- + Date Permit No......... ......_ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.............. ............................................ (11rrtif iratr of (91amphatt e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (1 ). or Repaired ( ) n Installer /f at......... ,.��y =........ � iiG�/ ;= J`° -`' . d� f�r_ `'f has been instal ed in accordance with the provisions 6f Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No:-..-._j�__.._�,�___________...... dated........................................._...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY. DATE........=/'� - `�_.o ----- Inspector = THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No......._-' -' . FEE........................ ��•k� C�rrn��rnr#i�n prnti� Permission is hereby granted-- --- ------------------------------------------------------------------------------ to Construct 6 ) or Repair ( . ) an Individual Sewage Disposal System at No f`f0' /. .>ld: T�.f"� t�f �' `<r ' == x = =:- ---- ----------------------------------------------------- Street as shown on the application for Disposal Works.Construction Permit No.-- ...... Dated_.---. __ _ _`- .............. lBo rd of Healt DATE - )e.:' � -------------------------------------=--- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS - No..... ...... Fps.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..._................ .. ---- ..OF................................_...:.............-----.... Appliration for Uiipasal 19orko Tomitrurtion Vantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Lo at -Address , or Lot No. w. nn l + i .�x .(artaxLea... _ � _ Owner Address. ----------------------------------- -.V. .Z.0_A....-T.cj VV.%4-cJ1X..-j--M4,-P................ Installer Address Q Type of Building Size Lot----------------------------Sq. feet U - Dwelling—No. of Bedrooms------it'Z ..............................Expansion Attic Garbage Grinder (v,Ova e Other—Type of Building __________________•..._--_-- No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures a�_v,�..__... ----•----------------•----..---- -- Q -----------------------------------------------------•-••-••••-•-••-•--•--- Design Flow.......�.(-">...........................gallons per person per day. Total daily flow............ ---_____-.----...gallons. WSeptic Tank—Liquid capacityZ gallons Length.��o__ ..... Width_Q:7 -- Diameter---------------- Depth1-� '�"_. x Disposal Trench—No..................... Width.................... Total Length.-_--_______----__.- Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter... Depth below inletAV-_t2.°.... Total leaching area__Co_f?_I-----sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by. �c_14__ r,c3Er._ H4-"____._.____ Date--_1�2-_ _�_-_Z_�________-. Test Pit No. 1______ _______minutes per inch Depth of Test Pit...... Q;__... Depth to ground water.... 1:T, Test Pit No. 2.- .......minutes per inch Depth of Test Pit.11l.-.6'?... Depth to ground water.._.'an��..�r_. Q+' ----------------------1---------------------------------------------------------•----------------------------------------------------------------------------- O Description of Soil____0-' :10..�f 9�_. ....1�s �r•... .._ r_ x a -------------------- w -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable......ywc-�______________________________________________________________________ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article aI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be iss ed by the board oA health. Signed = ( - ------------------ ------------------ --/----...................... Date Application Approved By......... ------- -- .........-............................................ .. ---------------------------------------- Date Application Disapproved for the following r sons------------------------------------•----------------------------------•----------------------------------------- --------••------------•-•---••••--•--------------------------------------------------------------------- ---------------------------------------------------------------------------- Date Permit No...., 1.-r`� ; -------------------- Issued.---- ................... Date ...,.� r fir, .._7...__. Flmx:............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............... - ..................OF......................................................................................... Appliration for 43hip al Works Tomitrurtion Pumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal 71ts t o 6ev rj Hai1 R8 e IS A 4 c� `� C e, A.r e, U 1 4 t- --- -•---- -----------••------=------- ....... - I- � scat 6- is �P to S l 6 C� �"�(�' 4 s, or Lot No. .F Owner Address ............................................................•---••--••••---••••-••••....••-••-•••. -••----•-•-•----•--••••--•-- -----•---- jg Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms------M______________________________Expansion Attic Garbage Grinder pi Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 0.i Other fixtures ______Y d?&._______________ W Design Flow------- -° ___________________________gallons per person per day. Total daily flow._.__.__.__._ ®-�___.__-__.__...gallons. W Septic Tank—Liquid capacity S .='.gallons Length.�_'0' __ Width_ '-___R9--_ 1 ®cr ' Diameter___..__._.._.__ De?th__�T_'___ x Disposal Trench—No_ ____________________ Width.................... Total Length-------------------- Total leaching-area--------------------sq. ft. Seepage Pit No..................... Diameter..C,I ___ Depth below inlet_.11t'P....... Total leaching area_.( a0___-_sq. ft. y Z Other Distribution box ( ) Dosin tanks( ) Percolation Test Results Performed by. u:�'_� __`��' o: __�. +^ ______________ Date__t_ _v_ _ -_ _ ___.___.. r Test Pit No. 1__'�_-3______minutes per inch Depth of Test Pit------1_ _Qt..... Depth to ground water-__nuoLn_±;;, -_--. V-4 Test Pit No. 2__t_''______minutes per inch Depth of Test Pigs_.=_&_______ Depth to ground water-_.inu� -----------•----------------•-----•---•-------•------•-•-------------•----- ---•-•-------- -----•-----•----•-------------•-•---------•-•--•-••-•---•-_----- i. ', ' 6 1 3�il�P.✓ Lair _._.. g! 4tr W V ti Description of Soil '' ------- --•--- `1`/ y +�"-G-- ch^� ----------------1-- - U CO+4 W ----------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable.--__k± °'` __ _______________________________.__----_.-_--_-.----.__-_-.-_-.___-____. ---------------------------------•---------------------•--------•--•--•-•------------•-----•--•-------•---•----------••----•-•--•--••-•----•-------•••-•------••-------.._..--•---........... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary.Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be n is ued by the board health. / Signed. t___ Application Approved B ' ��'�%�"" Date PP PP y-------•--" Date ---•---------------- --------------- Application Disapproved for the following reasons:----•-----------•--------------•----------•----•-•-----•-•---------------------------------------•------------- --•----•--------•---------•-.._..••---•-----•----••---------••••••-•••••--•...........................................•••----------------•-•-•-----•-•---------------------------••_-_-•--•---••-•••••- Date 01< Permit No.---,J=! Issued._._•_'.`:_ ........................................ ------------••-...... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD. OF HEALTH tAT urfifiratr of Tompliaurr THIS IS TO CERTIFY, That t,le Individual Sewage Disposal System constructed ) or Repaired ( ) e"-� i'r • t, .. - 6 ,e of e)U,,� .r (� J T 'it"vv �?/' ' +` 1 � � 7", ° r. U�f '.ty�' l e;= ` ... max✓ 1'r a• r. at ---------------------------------- --------------------------------------------; •==---•---••------••-•---.-.-•-••- has been installed in accordance.with the provisions of Article XI of The State Sanit�ry Code as deseribed in the application for Disposal Works Construction Permit No.____: �__= --:_`_____________________ dated'. -.._ -------•.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........... .............................................................. Inspector.................................................................................... -THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �,. _.........OF Jr 7 / No...... ........ FEE........................ Bi-nVasal Works Tjon,61rurtion Vanfit Permission is hereby granted__., ,C-/___-:._ �4& 'x Ule' -- •---•-•----- ---•-• •••-•--...--•••-----• -••----•--•---------------•.....•-----•-----•---•-•-•----•-•••-----•--•=:----- to Construct ("i ) or Repair ( ) an Individual Sewage Disposal System at No. _ tfl_ = f Street M as shown on the application for Disposal Works Construction Permit No._,.'_.`__``_.____ Dated_._.Z ------ _ - - y B d of Health DATE ff". -- - FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS r2 wo CAPE 1'IWY• o �ouTE _r U ZZ Wc-Qd,c.gd eT LAkES �? 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Mass. ���artm��,` 1 Division of Env;ronmen'� : �.�:1 I�vu�th � 0 �� Z u 4 z0i1 i �l � rD � TA LEC1C- � rD �� L-- tJC- i2 ,� L MOT a S zc�N ; rr,ilhir`1 55 L_ IN7rTr_ r? r� - 2. � 2 ,Acr2r5 _J J o_oo_ Ex►sT'4ci Cor1TO"- 1. TrA15 SIT r- 2LAt-A pt2>rpAr2L- r> Fr2om it For2MATrorl 30 t�v�lcLLriJf� �1t�ItTS rr2opo5C-r� - 2 5Tot2Y vJoor� � Mnho>Jr2Y �7 o.00 Ftt�i,$ A Gor 7 oUrZ Tkket• F-2o sdavt�( 13�( : caovJe LL � TA`(Loa soap 8 ;Y�` �4" 7- tea T� s o 2 oo M - BIG s.F. o.00 FrtA�45A r-LcJATto� 89 WiUovJ 5-. YAr2MoLiTI-Ir2or2T > t�tAh� G TYPC IIr3" - TWO ►3ent200M TovJrJr-AOUa c - 1, 224 5 • F• hATcr2 oc' br"3e'a t'� �~r9'72 _ 1co T' 1CS "&' - TV40 1 c- oaooM t1�P Jtll_rS - 1, 224 "s• F U -Z 1 -s- 5�,.1tT�►2�( scvJetz W r - 0- SToam r2az\ttA 2. 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