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0077 SIXTH AVENUE (HYANNIS) - Health (2)
77 SIXTH AVE., HYANNIS A= o i ti4 No. 4/ Fee J" THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUB& HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ` lication for �iopo�ar *pgtem Construction Permit Application fora Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. -7 7 S• 7791 77-67N ,1�1_ G20 L-/1/A ZA R I A t � Assessor's Map/Parcel �0 �� 7 -r�� V e t°i1/PS! ANN Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Gv� � Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow //0 gallons per day. Calculated daily flow 7 -7 O gallons. Plan Date t la Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil I� Nature of Repairs or Alterations(Answer whep applicable) �_S7 �&'w Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thi and o alth. Signed Date/,? Application Approved by Date Application Disapproved for the following reaso s e Permit No. Date Issued 4 r ^Y.Y ..,,r.�...."i-: No. a Z Fe Sp e THE IMMONWEALTH OF MASSACHUSETTS' Entered in computer: , Yes PUBLIC HEALTH DIVION -TOWN OF BARNSTABLE., MASSACHUSETTS T , ZippYication for 30igpogal *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components , ,., Location Address or Lot No. Owner's Name,Address and Tel.No. —7 7 5' 7 3'91 7 • ITN f1l� �T�o L-AIAZARIAA) Assessor's Map azcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Gv C " Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( Other Type of Building No. of Persons Showers( )-Cafeteria ( ) --- Other Fixtures Design Flow �� gallons per day. Calculated daily flow 7 7 0 gallons. Plan Date Number of sheets Revision Date Title Size-of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Iterations(Answer whe applicable) . d Date last inspected: ; Agreement: " The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thi ard o alth. q Signed Date Id Application Approved by r . w Date Application Disapproved for the following reasons Permit No. Date Issued j THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS i Certificate of Compliance J THIS IS TO Qi*TIFY,that the On-site Sewage Disposal System Constructed( )Repaired )upgraded( ) Abandoned( )by G Cld? C 0 at 77- G 7/d 4 tlP Aes' c o � has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date - I"9 Inspector 0 ,Asp No. 9 X~7 7Z---------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Oigpogal *pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair(,/.,Upgrade( )Abandon( ) System located at e Lt,1<",rJ ,LwdS- re/L and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this e. it. �' Date: /2- 9- 9 Approved by Q.w C�/I�_ 47 . - J 10/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only: CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) <J 1'e , hereby certify that the application for disposal works construction permit signed by me dated 13 concerning the property located at 7 = '�N,�Ue LIX � /,bNN�J(�/ meets all of the following criteria: • There are no wetlands located within 100 feet of the proposed leaching facility • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • If the proposed leaching facility will be located within 250 feet of any wetlands, the bottom of the proposed leaching facility will=be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) Z B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED : DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:Bert ICI i 1 k TOWN OF BARNSTABLE LOCATION 707_ T11 SEWAGE # ��� v VILLAGE ,n 414&AVW, r 9f A&Of r ASSESSOR'S MAP &LOTor INSTALLER'S NAME&PHONE NO.X ll 4&1' d. .t.91c., All no r3 d SEPTIC TANK CAPACITY DOS iJ — yr� LEACHING FACILITY: (type) (size) IC N NO.OF BEDROOMS_ BUILDER OR OWNER��D L+ �� A f%,s� N PERMPTDATE: I';� - `1 - q COMPLIANCE DATE: - Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by \A r Q V ASSESSORS MAP NO: PARCEL NO.: -1--3 W 1 :541- N THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... .................. OF__..................................................................................... firation. for Ntfi'00,941 Voirks (funstrurtion "amit V .AtrDiication is'� struct or Repair an Individual hereby made for a-fPermit to Con al Sewage Disposal u System at: h.. .Z ve- . AIM ........... ....... ............... ........ .......... ..............................47.................. . ................ Location-Ad ress or Lot No. ----------------------------------------- ................c2v ® .I:t'p...... ...LZ:. .... .......... . ............................ ..... .... Owner Address .... ...... ............... ..... ...... Installer. Address Type of Building Size Lot..:.........................Sq. feet U Dwellin No. of Bedrooms.............. .........................Ex pansion Attic Garbage Grinder ( g— Other—Type of Building ............................ No. of persons...._....................... Showers Cafeteria ( P4 Other fixtur ---------W. -------------------------------------------------------------------------------------------------------------------------------------------- Design Flow......... ......................gallons .... ...........gallons per person per day. Total daily flow..............:;.....Z..:4CD.......gallons. P4 Septic Tank—Liquid capakity............gallons Length................ Width..._.....__..._. Diameter___-__________-- Depth................ Disposal Trench—No. ---_------_------ Width........ .......... Total Length......_ # Total leaching area....................sq. ft. 'r---------- _Zzy— ____ Seepage Pit No---------/......... Diameter....../42...... Depth below inlet......V......... Total leaching area..................sq. f t. Z Other Distribution box ( ':); Dosing tank ( ) I Percolation Test Results Performed by___________________________________________________________.............. Date_..................................... Test Pit No. I................minutes per inch Depth of Test Pit..____.............. Depth to ground water..._........_........__.I Test Pit No. 2................minutes per inch Depth of Test Pit.................... .Depth to. ground water..._....._.........._... ------------------------------------------................................................................................................................. 0 Description of Soil....................................................................................................................................................................... ................................................ ............................................................................................ ........................................................ U .. . . .................... .................................................................................................................. -------------------------- Nature of ReVairs or Alterations—Answer Answer when applicable--------- U ..... ------------ z0a,.......... .............. ........ ................. Agreement: 10je)1"V'(� The undersigned agrees to install the aforedescribed Individual Sewage Disposal Systemin accordance with the provisions of'LNLE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ben issued by the board f healt jgned7_A, ........... ........ ............... ..... -49 S ate ApplicationApproved By......... ..................................... ........................................... ......... Date Application Disapproved for the following reasons:.............................................................................................................. ......................................................................................................................................................................................................... N % . Date PermitNo........... .......... I�sued..................Dom._....._.... -------------------- ----------------------- No -- - ......................... THE COMMONWEALTH OF MASSACHUSETTS ���---✓✓✓"'✓✓✓ e� BOARD OF HEALTH ....... ........:..... ................OF....................---...................------.......................................... Appliration for Dispasal Norks Tonotrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �7'.................. Location Location-A ress or Lot No. ............... ?c t^ct :...._. r. ?!`" . v i. .- .............................7.. =-�,a ------....-................._..... t Owner Address Installer Address 4 Type of Building ..•��r Size Lot............................Sq. feet V Dwelling—No. of Bedrooms..............r? .............._._..Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............... No. of ersons............................ Showers QI � - ----•---------------------------•-••----•----P--�- (---).— Cafeteria ( ) dOther fixt ----------------------•-------------------•---•-..---- ---------. W. Design Flow........._ T gallons per person per day. Total daily flow.......... .. .._ .......gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.......e----------- Total Length ----- -e--- Total Leaching area....................sq. ft. Seepage Pit No......../......... Diameter......1p...... Depth below inlet... ........ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1.4 Percolation Test Results Performed by.......................................................................... Date........................................ 04 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 .........................................•.......................................................................................... Descriptionof Soil...................................................................................-.................................................................................... x w 'mot U Nature of Re airs r Alterat>ons—Answer when applicable_......_.O .... .... �' •-----••---- ............ d1 :t 's-----•---------- '�(..C.©lt i-. .' ✓ v i yr,c/f/ Agreement: / � L- The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of TITL%. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance b h n issued by the board f healt . G � ,� Signed. ----• .................... .................... .......... --------. .--... ------ /��,� /Dal ApplicationApproved By.......... �-- •• ------••••••----------••-••---•....................••••••... ....--••• • . .. .... ` Date Application Disapproved for the following reasons-------------------------------------•----•---.....-----------...........----•--•---•.--- ......•---....._....„ --.........-•-------------------------•--------.........-----............-•----.....----........----•-•-----------•--•-•......0...-•-•••------•-......•-----------•-----------••------......---•--•----- PermitNo........... --.. Issued....................................................... °'sw.'.'�......-�-•.... . Date a� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ;"� t...0F.......� Gt,6!.l2e:.`:? '...4&............................ (Inrtifirtttr of Tontpliattrr THIS IS T �FY, at the Indiv> TT e Dispo� System constructed ( ) or Repaired .�-.. d� lg ,� r --:••-- - ...... at. ✓ ..................... ^................• � Insta has been installed in accordance with the provisions of TITLE 5 of T e t te. Sanitary Cod .s descr•b d 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 FUNC N S TISFACTORY. Inspector DATE..............•--••..........• pvb------------------------ P ..............-------•--................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H. EALTH y r _ v''OF........ r�...✓..lti.rah.: .. ..................................... No........................: F$$..... ... ........ Bill ork Ton f rr it Permission is hereby granted........... G ..'�:r'.._._.._. .r.✓` ---------•..... -. .f............................................... to Construct -�), or Repair (�n Individual Sewage Disposal System atNo. �� d ........................... Street a ¢ as shown on the application for Disposal Works Construction Permit No D�aatt`e ......... ... .�:.............. •--••-•------•------- _. ........................ .........„ \ Board of Health DATE....... ...7 <S _- ...._._ ......... ......... Y: FORM 1255 q. M. LKIN, INC., BOSTON -77 ]\ ......... .r.- '�-..�w•3.,x. ?`" ""`�,a ; .: , FE�......� ...-�-_'..... THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH _.... -....OF......... ... .: ....G.(. -.----------------------------------------- ----- Appliration -fur Di-qVugttl Works Tomitrurtivaa Vrruift Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: _ .!------------------------------------------•-•-•- ---••-•-•x�-..••...............•-•-••.....-......--- �____---- __•________ _____ Locatio -Address or Lot No. . ...-•--•.......-•--- ...........1•� -------- wner 9s.s=... pJ_:-f.A .9.0............. .............................. .................... 14.1..L_ p Y--........ ....... Installer Address UType of Buildi� Size Lot- ().,._ 1d/----------Sq. feet U Dwelling 4 No. of Bedrooms.-_--_ _.--. .--.Expansion Attic (NCO Garbage Grinder (/ (� aq Other—Type of Building .M_�=�------- No. of.persons_..--,!�.................. Showers ('4 — Cafeteria ( ) a Otl- xtures ------------•-•--•--••••------ W Design Flow... .................................•.gallons per person per rdday.-Total daily flow------Z_M..-.------_-.--..........gallons. WSeptic Tank A Liquid capacity .-gallons Length...-.. .._... Width. -....... Diameter................ Depth.__............. xDisposal Trench—No- -------------------- Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area.......-----------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) p/ "Oe /he, aPercolation Test Results Performed by.......................................................................... Date--------------------------------------- a Test Pit No. 1----------------minutes per inch Depth of Test Pit...-------------_ - Depth to ground water..._---.____.---.._.__-. rXq Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water......-----..-..-.---. - 9 ,•- ;: - - O Description of Soil.-----e ----- ---- F�-���--=�...--�...... �!c� ---Z"-�z�- �.��►� x U --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- W UNature of Repairs or Alterations—Answer when applicable..................................................................... .................. ....... ------------------------------------------------------------------------•---------------------------- -----------------------------------------------------------------------.-----..---------._...._... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article LI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of he lth. Siged----- .--------- ----------e*-•-----------------------�-.-�- ............- a................. ItA Application Approved By-•- ---"eadd 'I�1 •-----------•------------- Y............ -.- --------------------Date �� Date Applicat}'on sap roved or tl e f 110 ing reasos:---- -------------•----------------------------.....----------------------•-••----......•••--- Date zr-77 PermitNo......................................................... ` Issued......' --------- ............................... Dattee -77 + No.......... .......... Fay.............................. THE COMMONWEALTH OF MASSACHUSETTS R BOARD OF HEALTH ----OF..........I 6.4 tt,�' - ...... ................. Appliratiun -fur Uiipuiittl Eorks Tottfitrurtiun Perutit Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: PLocation Address or Lot No. t'..) S wner ss a :-•--•---..-- rv"5---•-------------------------- -----••--------......�jG�!�f ,'' r � f------. M Installer Address V Type of Building Size Lot) 0 •--- � Sq. feet i ----- Dwelling No. of Bedrooms........ ___•--------------------------Expansion Attic (No Garbage Grinder Other—Type of Building _ Arc a YP g �---•• •••••- -•--•-• No. of persons...___�____.............. Showers (�} — Cafeteria ( ) Q Oth rtures ---------------------------------- Design Flow............................gallons per person per da Total�y flow_---_-ZO_.�_j_---.__-_..._--------------gallons. W ��// r WSeptic "lank Liquid capacity __gallons Length______ ________ idth.r.... Diameter---------------- Depth.._.-_---------- x Disposal Trench—No_ ____________________ Width-------------------- Total Length.................... Total leaching area-_-__ --_-_.._--__-_sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area--__.-_._______.__sq. ft. z Other Distribution box ( ) Dosing tank ( ) O,- Percolation Test Results Performed by.---------................................................................ Date-- W ------------------------------------ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..._---._-_.--.._-.--._. 1:14 Test Pit No. 2................minutes per inch Depth of 'Pest Pit.................... Depth to ground water__._.-_-.--.---.____---- a � / �hc. ...... - D "erZ : 2- /2 Aifw uescr -- Description of Soil -- x ........ _--------- -- W x -----------------------------------------------------------------------•------------------------------------------------------------------ --------------------------------- ------------ ------------ 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 \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of he th. A roved B ' D PP Y---------- =i'4_1_1 l' - ! ------------- Application Application Disapproved for the following reasons:-------------�---_-------___------------------------_----------------_____----_----- Date-----------•-- -----------------------------------------------------------...................... - Date PermitNo......................................................... Issued-------- ................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT IOF........... .1.. .. .... .. . ........................... Trr#if irtt#r of 'T'outplinnrr i,,. THIS JS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by:. ---- --- ----- ----------- �. r ...............•• ......................... Insf Ile, ol r j 2ar at...."--a - 'r____-__ I___ ...... .................................. has been installed in accordance with,.the provisions of Ar4'' XI of The State S n Code as described in the application for Disposal Works Construction Permit No. _s F ?1s _-_ dated....•_.............................................. THE PP P ..: _ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------`A•-a? C'- .---- 77 Inspector._..- -� f �� THE COMMONWEALTH.OF MASSACHUSETTS t 1 BOARD OAF-t HEALTH a ........TZ�,,.�41,".........O F........... .r': i'w"-=•1.:.:�. "'u. G'M 4�u^!. .M.. t f No..._.. FEE �.v NnVwial urk,q Qlunstrur#iun Errant I Permission is hereby granted----------•------------------•-___..._.•... --•-......._... ._..------•-• . IF - -- --- --••----•- .•-_.. to Construct (� or Repair`- ) an Individualewage Disposal System f at NO..__Ax�` l--y '.� r '}° �r �f 6tZac ......f Streetf as shown on the application for Disposal Works Construction Pentt N6r----- Dated ........................ ru�.Y:•---- ---- ---------•---. (—•-- �-y Board of Health 7! DATE.-- .. ✓ / ---------------------------------•-•--_.... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS t Mr. John .T. Prorctor, In-v e°t.igator, was in concerning the George LaLazarian file, { When told by Peggy to put his request in writing he stated he had been with Town Counsel and'the Building Inspector and Town Counsel - had told him he could Took at the file. Peg called Town Counsel to confirm - was told by Mr. Smith that Mr. Proctor could look at' the file but bafore he got any copies of anything in the file, Mr. Smith wanted to look at the file and especially the things that Mr. Proctor wanted. As Mr. Kelly was out of the office, Peg instructed Mr. Proctor he would have to wait until Mr. Kelly' s return. Mr.. Proctor will be back Wednesday morning and stated he would like a copy of the Sewage Permit, the Engineer' s Sewage Plan, any other comments or requirements that the Board might have added to the. sewage permit when it was inspected. - or any complaints' about the system. ' i ( ,x• ar r .� s t r- a . t J` M t � - Kf'.i.4-. n,'..j� Fy t,,* •r a' , } `t..-.. , S v. 1 i 5 t• °�"r .' ' .::` R` i,.,r .w', a \ t tar y, n,*, •qf. - 4 '+ s (t :,i . v:rd 4 -" t x r• is r; V" ,,:. v - r., t ' z• t +.,•`:.\' r ,. 5 v �,_r r 'f .,,,a ''y.,Mr e.'1.�'»i a'.a +, p,,''�•r.'.r. +r.j r }• •,r.Sy., +r- 'it 3 F V "� { �y ra t t :7 r t, .se �: L. �i v� rw � ,,p, } % C } ! 'I- .A i� ,�Ri + ,1 , M1�A . x p}! d y +rb�-;l 'tF t` < ?1- 4 +1L < +. a J �G a r t < t. 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KnoErles''- Jr.W,�,'42, '' , "'r* ti ,-w rt " ( _?'Al I �v• ,, r �,:.( :-°i _4 r t*'�,. e _f r agQrr r Investigator i Lt ' f r a.'�,•'L z.t.�y i.• +� �Y.r Iy. % .1 A ��L +, 4.�+j��' Z } .w < -. - x • `F. b Y.V r�t, fl• y' sV !—,`.S 3�• M, v"� it �' i}�' Pub .z"c: Prateet�on�.B�reau _ �Y r y= r.� sr ^ram �. 4 �, ';; z r ,k� t Jk=+� ,h Department of ;they Attorney It-General �'" Y 1 1 , ra t Y r ; =r� 1 fi� � , , ,,, ^ ;K> r` Oney,,Ashburton, P/�y;pce'd f y.: -.�`"'�'}sfy��E _?{'� _f" z.M i*�„rit 1tV 5" `'' , .r •sue,. Ali' 1 •t >'_I t . �4?' BotS{.OngC�r i1 .11Q 1 I �-C;t S" \ v Sr..a�' a' k•{ {aJ i• w +< ?ay S..' t t ,, 'fit N te,.:�`r Zr<• >i �' fi. 1F- r 1 ♦ t� v .r' C ,.,t ^r•'„ n "A. 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(_) Harbormaster (_) Selectmen (_) Health (_) Tax Collector (_) Housing Auth . • (_) Town Counsel (_) Human Service (_) Veterans Serv . (_) Inspector ACTION ! ) (_) BY( DATE ) SIGNATURE : (—) YOUR INFO: ( R) INITIAL & RETURN (_) FILE '_ ) (_) READ & CIRCULATE ( ) REMARKS : f3 mshed 5tabre 3parit ®t Publi un Cape Cod since 1830 A community newspaper published every Thursday at 24 Pleasant St.,Hyannis,Mass.Tel.771-1427 1830 � 1982 � � � � � � � X �} i � �� � � � THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF THE ATTORNEY GENERAL JOHN W. MC CORMACK STATE OFFICE BUILDING - ONE ASHBURTON PLACE, BOSTON 02108 ° Sye ye RRANCIB X. BELLOTTI ATTORNEY GENERAL October 25 , 1982 Mr. John Kelly Health Department Town Offices Town of Barnstable P.O. Box 534 397 Main Street Hyannis, MA 02061 RE: #82-04-70551 Complaint of George LaLazarian Dear Mr. Kelly: This matter, which you indicated you had some knowledge of , involves allegations of improper septic system design for the complainant' s home at 462 Sixth Avenue, West Hyannisport, MA, built in 1977 . You agree that this would appear to fall within your department' s jurisdiction. Would you please provide this office with any information you may have pertaining to this complaint. Thank you for your anticipated cooperation. Very truly yours, Frederick M. Knowles, Jr. Manager Investigator Public Protection Bureau FMK/ah LAW OFFICE JAMES H. QUIRK, P.C. ATTORNEY AT LAW A ADDREss ALL MAII. TO: COR. RTE. 28 & POND ST. JAMES H. QUIRK P. O. Box 547 P. O. Box 547 JAmEs H. QUIRK. JR. SOUTH YARMOUTH. MA 02664 SOUTH YARMOUTH, MA 02664 (617) 398-6969 September 30, 1982 Board of Health Town of Barnstable' 367 Main Street Hyannis, Massachusetts 02601 Re: 462 Sixth Avenue, West Hyannisport Dear Sir:,, We would appreciate your providing this office with a c:op"y•,of the application for septic permit and, if available, `..a copy of the stamped building plan. The building permit indicates that it was issued to George Lalazarian of West Hyannisport to build a one-story frame dwelling single family duplex on January 24, 1977. The name of the contractor is James K. Smith and the occupancy permit No. 18914 was issued January 21 , 1982. Any assistance you may be able to give us will be very appreciated. ry truly yours c ;.; Ja es H. Quir r. JHQ/mre 0�y Np�� OF A[f g pp DATE October 8 1982 ❑ URGENT isV'a+itV }.s '.S:a#Ys a, i ❑ SOON AS POSSIBLE .�A, BOARD o EL H, FILE NO. ❑ NO REPLY NEEDED 3157 lob n Street P. 0. Box 53 ATTENTION TO SUBJECT Mr. James H. Quark, Jr. Attorney at Law ' Cor. Rte. 28 & Pond street :' P.O.Box 547 ' SOUTH YA,RMOUTH MA 02664 MESSAGE Dear Mr. Quirk " We- are enclosing a copy of the application for a Disposal. Works: Construction Permit, No. 77--8,1 and a copy of the stamped building plan as you requested in your letter of September 3:0, 1982. Where is a charge of $1.50 for these copies - please make your check payable to the Town of Barnstable. V Aours , SIGNED J n - REPLY. DATE OF REPLY 1 K i SIGNED 1 SENDER: DETACH THIS YELLOW COPY FOR YOUR FILE. MAIL WHITE AND PINK COPIES WITH CARBONS ATTACHED. No........... ................._ THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH . ..................OF............ .................................................. Appliratinn 'fnr Disjivsttl Hlorks Tonstrnrtinn rrntit Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: d I.ocatio •Addreaa or Lot No. 1--------------1-. - J Leo i� wner a if.c._I_ .!S.!F►1 ----------- �'�- ------------•---•-••---------- .................... .P��.a 5.,..._..-....-...- ......... ` ....... Installer Addreaa Size Lot.L0 ... ... S feet Q Type of Building/ 9 U Dwelling No. of Bedrooms._:.• Expansion Attic Qyd Garbage Grinder (/f Q ---------- pa, Other—Type of Building .h9 ....... No. of persons......4.................. Showers (may — Cafeteria ( ) a Otl xtures --------------------------- W Design Flow__. gallons per person per da Total daily flow..__..L� .............•..._..._._..gallons. WSeptic Tank Liquid capacity.��__C...gallons Length..... ........ Width................ Diameter................ Depth................ W Disposal Trench—No- -------------------- Width.................... Total Length.................... Total leaching arca....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet------_............. Total leaching aren..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) O/ f C 4 PercolationTest Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ tz Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ ............................ X - D Description of Soil._....11 �....... ......... ' ._. ..._V_.WY� -_�-_1 z.�. .� ^.. ..-- V .........................-.................................................................................................-............................................................................ W ---------------------------•--.....-----------------•--------...--------•--------------------------------------------------------•---------------•-----------------....---------._._._.......----------- UNature of Repairs or Alterations—Answer when applicable.............................................................................................. ------•---•------•------•----------••---.•---•--•--•.----•--•--•••----------------------------•----..._................_..........--------------------------•---....._•------•------...--•--•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of h lth. Sied..... - ------------ -----------d - - Date Application Approved By-_-.._. ' ''-L`� 7 - ---- .. �� - Date Applica 'on isap roved or t �110 •ng reasops:----------•------- --------------•---------------------------------------------•---•---------- - :- .. - • . � -------------- Date Permit No----------------------------------------------------- Issued_--- -., �t'-77 — --.�.. --------------------------•------------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF . HEALT . 1 TPrtt iYAtP 1tTf �Itmplinurt THI,1; S TD CER FY, That the Individual Sewage Disposal System'constructed or Repaired 0 - ----- -®-- has'been installed in accordance with the pro.nsio of A 3 of The State Sam Code as aescn�-an the application for Disposal Works Construction Permit No. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT RE CONSTRUED A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY,' DAI'I? _ — -- - -------•--______..� inspector - ----- THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD- OF HEALTH 'j.Wit.-rOF_. _ 01 - — J J.s aVlak n1 Waits (911ndrurtilu rrnn Permission is hereby granted- :_': to Cons �or Repa un`lndyiv�i ual epge Disposal.Systern -- -^ --+ I. Str as shown on the application Tor Disposal Works Construction t _.------ Dated— �"_ _'l' 7 1 DATE.......................��-�_.7 Boo 7....................—.....-•-•....... ,r6 of Heah6 FORM 1255 HOBBB 11 WARREN. INC.. PUBLISHERU LOCATION SEWAG PERMIT No. . , VILLAGE INSTALLER'S NAME & ADDRESS B UItDER OR OWNER S/-1 DATE PERMIT ISSUED f1Y PA-ti/1 DATE COMPLIANCE ISSUED /Sav C.yr: I c F_ y t�Ky i i r o I LAW OFFICE v JAMES H. QUIRK, P.C. ATTORNEY AT LAW ADDRESS ALL MAII. To, - CoR. RTE. 28 & POND ST. JAMES H. Qom$ P. O. Box 847 P. O. Box 547 JAMES $ QUnM- JR. SOUTH YARMOUTH. MA 02664 SOUTH YARMOuTH. MA 02664 (617) 898-6969 September 30, 1982 Board of Health Town of Barnstable 367- Main Street Hyannis, Massachusetts 02601 Re: 462 Sixth Avenue, West Hyannisport Dear Sir:We would appreciate your providing this office with a copy of the application for septic permit -and, if available, a copy of the stamped building plan. The building permit indicates that it was issued to George Lalazarian of West Hyannisport to build a one-story frame dwelling single family duplex on January 24, 1977. The name of the contractor is James K. Smith and the occupancy permit No. .18914 was issued January 21 , 1982. Any assistance you may be able to give us will be very appreciated. , ry truly yours Ja es H. Quir r. JHQ/mre 70',"JW C7 �n�eNSTABLE DATE , October 8� 1982 ❑.dROENr raa e� ®SOON AN)!OSNDLd , BOARD 02 tbzk1 • ZG !n Street F.�9.you 524 F7[E NA ®JYO/FFPLY NEED _;• HYIKMS.MASSACHUSETTS 02601 ATTENT/ON , TO SUBJECT Mr. James H. Quirk, %Tr. Attorney at Law Cor. Rte. 28 6 Pond Street P.O.Box 'S47 SOUTH YARMOUTH Mh 02664 ` MESSAGE - Dear Mr. Quirks He are enclosinga of the copy application fob a Dispossl Wotka Construction permit„ No. 77-8, and a copy of the stamped bnildiM Dian as you requested in your letter of September 30, 1982. _There is a charge of. $1.50 for these copies - Please make yogi check payable to the Town of Barnstable. • 0 at #,rulY ott�- • SIGNED J r-X. REPLY DATE OF REPLY Y SIGNED r 4� +r SENDER: DETACH THIS YELLOW COPY FOR YOUR FILE MAIL WHITE AND PINK COPIES WITH CARBONS A?TACHEDL 1 1 t . Assessor's ma,'I� and lof'number . .�: SEPTIC SYSTEM Sewage; Permit number ;....._}.......t........E.... .....,.. .....-..... LLED IN LIANCE JNSTA COMP V,�TH l R- TICLE 11. STATE • F TINE ro t; n R TOWN n TOWN O N' " TEA F ;BAR iff BUI'LDIHG INSPECTOR s� 0 w L1 00: C': Gi h C7 © • APPLICATION: FOR: PERMIT TO .:.... .v ..t. .. ... .. .. ..... TYPE OF CONSTRUCTION ...:.....f.... ... L/ . CY c� a I or • Z ....................19T.�. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......5.?... .................. v-.......................t�.y(.F ?�� .�.5.... Z...�........... ........ ProposedUse ....................................4....r. ............................................................................................................... ........... Zoning District .............. ................:........................Fire District ..... .. ............................................ Name of Owner 64-C1.4t .......... ...!^ k. fl9'1F-Address ................................................ ................................ i Name of Builder ` . I .�..'.-�....................................Address 01 �.�....!n t� • r l Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ...........JJ ...................................................Foundation L .... � '``......... .G �! ".................... < Exterior ........ ..........C.f....4..r- .....................Roofing ......... b. ............................ .... Floors (34.45 C7.IQ'.!...�•�....� ........................................Interior ..........................................................................�........ Heating (r .......... . 7 :[ ... t.!1........... ..Plumbing ............ .. .:�a!�il.L. . ................................. . r. Fireplace ..-........ .I. .......... .....................Approximate Cost ............?-5 v... I 22 Definitive Plan Approved by Planning Board -------__� 19 . Area I.J`sv f Diagram of Lot and Building with Dimensions - I Fee .......................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH ! fi 1 j t..p,,s.R,y Yc +Ks :=.Yta�°•t^ €b k "A , ,.. ..,. �..z.-.:;r:: *afi.' ., 8^ a n .. .•, �.:." {.ds„rz�r�e ,. Kf I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. '".. ..... ............................................ • A > o' • 3Y a X .. ......., -3 . 2 T f,T a Ki co Ai K. VWq-T OT " .0 M 0 0 1:4 00 16 co At H air t U FA m 09 0 to Vt 0 3 l: --: i ................................. ................. CIT Tiifl3q ifti I TClJ% A. 0 ....... .... .............. ....... ........ ....... ...... ................ ........ MPI T:)it q TI li 0:) 0 M 10 .0 .0 10 10 _j .................... ..... . ...... 44 ----'AtG- 751 �2 117- -5T .. Ht 4 nos, tc),mIllaini pnv�volio! 's of pnibionb fimi'4 o vol eeilq'o ydg-igH. ber-pinebmu s-HT q q -W ........ .. ........... ............ ......... ................. el ............................................................ ....................... ;.:.......................... ......... ................ ...... ........................... .............. 3nlz'IG gn' inoS biltaic) SIR.......................... ....../.. .............. ... .... Fy Isnwo to 5moL-1 .................................................................................... .............. ...... '§'_'!)U8 iO SMOM .......... zesibbA......... .............. .....................T .... . . �;:.........-��.... ci .i. ... ................................................ zze-ibbA........... ........................................ ............. ir iD i A io emc!,' ........... ........... . ......... nOltDbnuo�......... ................... ...... 2MOO9. 10 15d, ............... ........... ...................... ....... qlocn........ pniloog......................... .......... .......... ........................... . .................. ...................... ........................... . ............. ............... ....... ............. �JJl ......... ....... .......... ....................... pnidmulq.................. . ..... ... ............ nit�) i 7 . eaOlqqli3 ...........I ... . . .. Aw .. . ... -CA yd -be\,oiqqA nojq evilinilso -iA b-iooS pninnr)jq .........................I.............. . znOiansmiG Htiw pn:.bliu8 bno foJ do mojpo';i'_j ........................ ............ HTJA3H 90 GRA08 10 JAV05;lriA OT TDR81J2 % my A-1 7 fn TT- -svodo adt gnibiogsi aldounicE to nwoT edl to enollolup-39 bnD aSIUR eH, JID of of at-.-:a v.4q,,srf ............... .................'!.`.'<'0MCO f... .. - 9' 1 0 wj%a ;--- "%A, f ac z N J *A r x el 0 Zr S Q A e .a CA w a • 4 �" J i r .e /WI T/,/ N / OF F//1,(/SHOOG.eA off, p E Vr.vT /NES F/F.'OM /NF/L7;QA7//V8 COVAZ JAOO M/n/ir/.P� ,c•Miw r a-r�.,w '�Na/.o.. aa' Mv..i . --„—.,. _..,,._. '' . b'LE.AaAl � !O WAA1 Miv 1oi rce✓. ��; T�/T „y4 /fool ^'�� D,4 - /� D/A. Hn�! '•I`/coon " I O 0 WA S HE O _�. /.vvE,er SrOA/E GAL LON 'AlVEQT Ol /� ac/Ty �WA�'E,eT/cS`NT /NVE72T r e-07T:MI OF /NVEQT TEI-.;4 y'r'1!Y `-. .. ,, �T. SEr7T/G TA�✓/� �'O s A /(1 7 LOCH T/Q/t/ '7.- o•� �o' fro y' =ov..�,DAr �e�r c��h.fC�. � r4 •r �.�ACH _ems f7.:a. - .F��Nc� // c�J},-�.5 '. ��0/✓�✓ ZL„1 .5E.pr1c TAN. . h ,-S.r,Q/BUT/ON 80X O NF+O.c:'r'Ea CONC.2ET�� •.�� t 3000 Rs/ Miw .�Mc S iMi' Try'-/ + :,STEErC. 20000 .. /4 7-02y LA/vE- .a' caAic y .VZWE-WAY MOT TO 8E LOGATaD �;� karMUr:U p✓ ' �YST�M UN[.E35 A/- 20 17ENN/S , M.4 S$. DES/GA/ L-OAa/wG /S USr-D. Na::7443 H/ I C 2 7-i Fy TN.4 r rH Ex i.T/N -•�.:�.- 'T .OS Sy0 u..N A n!U CU.V/=�1z��1.S ��`�Okf��•�G ,1` �. tv .T N Tf•�/E FS C//L.J�/iV G S ET p�_L:..E; _,� ~L`►'..;�...is� I- PA 7S f/E.A I-7;V A C54E 17 i \ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS . DEPARTMENT OF ENVIRONMENTAL PROTECTION J TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM Is q1 PART A CERTIFICATION Property Address: 77 6th Avenue W. Hyannisport Owner's Name: Massie Lal azari an Owner's Address: Date of Inspection• yf _e Name of Inspector:(please print) Wi 11 i am E_ •Robinson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 Centerville, MA Telephone Number: (508) 775-8776 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15340 of Title 5(310 CMR 15.000). The system: asses Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: �r / �, Dute: /0 —/ 6 The system inspector shall submit a copy of this inspection report to the Approving Authority(Boar of Heart c DEP)within 30 days of completing this inspection.If the system is a shared system or has a design ow of 1 0 t:—' d or eater,the inspector and the system owner shall submit the.report to the appropriate re io office o�lie gP Br � P Y Pg � DEP.The original should be sent to the system owner and copics'.sent to the buyer,if applicable, 'the apprptng authority. W Notes and Comments N) ut _ ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 77 6th Avenue W. Hyannisport Owner: Massie alazarian Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Systt Passes: I have not found any information which indicates that an of the failure criteria described rbed in 310 CMR 15.303 or in 310 CUR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System onditionally Passes: One o more system components as described in the"Conditional Pass"section need to be replaced or repaired.The ;ystem,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,C D or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The se tic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,ezh its substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank s replaced with a complying septic tank as approved by the Board of Health. •A metal se 'c tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating t the tank is less than 20 years old is available. ND expla' servation of sewage backup or break out or high static water level in the distribution box due to-broken or obstru pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with ap al of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND a lain: The system required pumping more than 4 tunes a year due to broken or obstructed pipe(s).The system will pass in pection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is P=Ycd ND a plain: Page 3 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 77 6 th Avenue W. Hyannisport Owner: Massie Lalazarian - Date of Inspection:_/0—/ -o Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is fa ing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety.and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the ystem is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more fron5 a private water supply well•• Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for colifotm bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. (her: 3 Page 4 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 77 6 th Avenue W. Hyannisport Owner: Massie Lalazarian Date of lospection: U D. stem Failure Criteria applicable to all systems: You m st indicate'Yes"or"no"to each of the following for all inspections: Yes o - Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged AS or cesspool Static liquid level in the distribution box above.oudet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than'/:day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within I00.feet of a surface water supply or tributary to a surface water,supply. Any portion of.a cesspool or privy is within a Zone 1 of a.public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 f et from a private water supply well with no acceptable water quality analysis.(This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.( (Yes/No)The system fails. 1 have determined that one or more ofthe above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. Large Systems: o be considered a large system the system must serve a.facility with a design now of 10,000 gpd to 15,000 pd. ou must indicate either"yes"or"no"to each of the following: ( to following criteria.apply to large systems in addition to the criteria above) y s no _ the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well f you have answered"yes"to any question in Section E Lite system is ccrosidcred a significant threat,or answered 'yes"in Section D above the large system bas failed.The awns yr operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 77 6 th Avenue W. Hyannisport Owner: Massie Lalazar�n Date of Inspection: /&— C S Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No V Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? _ :' /Have large volumes of water been introduced to the system recently or as part of this inspection?. L/_ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _ Was the facility or dwelling inspected for signs of sewage back up? _ Was the site inspected for signs of break out? Were all system components,excluding the SAS,located on site? v _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ -L/- Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: . Yes no / Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CUR 15.302(3)(b)] 5 L: Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 77 6 th Avenue W. -Hvannisport Owner: Mas ie L Date of Inspection: /V FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design) Number of bedrooms(actual): DESIGN flow based on 310 CMR 5.203(for example: 110 gpd x#of bedrooms):/G,i u Number of current residents: Does residence have a garbage grinder(yes or no): 5 Is laundry on a separate sewage system yes or no):Ea [if yes separate inspection required] Laundry system inspected(yes or no)A6 Seasonal use:(yes or no):/i'S Water meter readings,if available(last 2 years usage(gpd)): 0 4/0 5 — 29 250 Sump pump(yes or no): 0 3 0 4 — 30,750 Last date of occupancy: COMMERCIALUSTRIAL Type of establis ent: Design flow(b ed on 310 CMR 15.203): gpd Basis of desi flow(seats/persons/sgft,etc.): Grease trap resent(yes or no): Industrial Xaste holding tank present(yes or no):= No 'n-san waste discharged to the Title 5 system(yes or no):_ Water eter readings,if available: Last ate of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: l I6 Was system pumped as part the inspection(yes or no):�v.v If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYP F SYSTEM eptic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval —Other(describe): Approximate age of all components,date installed(if known)and sourcq of information: Were sewage odors detected when arriving at the site(yes or no):4,'O 6 r•' Page 7 of I I OFFICIAL INSPECTION FOR AI—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION DORM PART C SYSTEM INFORMATION(continued) Properly Address: 77 6th Avenue W. Hyannisport Owner:Massie Lalazarian Date of Inspection:/rs /�G,� BUILDING SEWER(lo ate on site plan) Depdi below grade: Materials of cons tion:_cast iron _40 PVC_other(explain): Distance Gon]pr' -ate water supply well or suction lu]e: Commcnts(on ondition of jousts,venting,evidence of leakage,etc.): SEPTIC TANK: oocatc on site plan) Depth below grade: �_ Material of construction:_concrete_metal fiberglass_polyedrylene _othcr(cxplain) If tank is metal list age:— Is age conftrn]ed•by a Certificate of Compliance(),es or no):_(attach a copy of certificate) d Dimensions: Sludge depth: / 7___ •' r Distance Gom top of sludge to bottom of outlet Ice or bank: C Scum thickness: 0 Distance from top of stun]to top of outlet Ice or baffle: Distance from bottom of scum to bottom ofyytlet tee or baffle: l low Hcrc dimensions detcrn]incd: 71a w/< Commcnts(on pumping recuntnrendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 5' ,w 4 4 GREASE TRAP: (locate on site plan) Depth below gr c:_ Material of co traction:_concrete_metal_fiberglass_polyethylene__other (explain): Dimensions: Scum Iltic css: Distancc onl top of scum to top of outlet(cc or baMc: Distance on]bottom of scum to bottom of outlet Icc or baMe: Date of s1 pumping: Conun is(on pumping recontrnendations,u]Iel and oullct ice or baflle conditio:, structural integrity, liquid Ievcls as rcla cd to oullct invert;ct idcncc of leakage,etc.): 7 'age 8 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORhIATION(continued) Property Address: 77 6th Avenue W. Hyannisport Owner: Massie L lazarian Date or lospectlon:_ 16-1-6 TIGHT or ll WING TANK: (ludo must be pumped at time of inspection)(locate on site plan) Depth below ade; Material of c nstruclion:_concrete_metal_fiberglass��olyallylerte other(explain): Dimensions Capacity: gallons Design FI gallons/day Alarm pre cm(yes or no): Alarm le cl: Alann in working order(ycs or no):— Date of 1 t pumping: Comrncnts(condition of alann and float switchcs,ctc.): DISTRIBUTION BOX: ✓(if present must be opcncd)(locate on site plan) Depth of liquid level above outlet invert: Conunents(note if box is level and distribution to outlets equal,an)-evidence of solids carryover,any evidence of leakage into or out of box,etc): PUAIP CRAPIDE (locate on site plan) Pumps in workin order(yes or no): Alarms in work' g order(yes or no):_ Continents(n a condition of pump chamber,condition of pumps and appurtenances, etc.): Page 9 of I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 77 6 th. Avenue W. Hyannisport Owner: Massie Lalazarian Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (. (locate on site plan,excavation"not required) If SAS not located explain why: Type Ching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: - leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): v : lie G 1 42 CESSPO/oiquid (cesspool must be pumped as part of inspection)(locate on site plan) Number aration: Depth—td to inlet invert: Depth of r:Depth of :Dimensi000l: Materialsction: Indication of groundwater inflow(yes or no): , Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIV/sof (locate on site plan) Materionstruction: Dime sions: Dep of solids: Co ents(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 10 of I] , OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 77 6 th Avenue W. Hyannisport Owner: Massie Lalazarian Date of Inspection:/0 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. a � '�- 3 L) 10 I • Pad: 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 77 6 th Avenue W. Hyannisport Owner. Massie Lalazarian Date.of inspection:lG l-CS— SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how ou/established the hi ground water elevation:la5 , $ e a 11 SEVYAGE ERi,1T N0. 114STA l. LER'S SAME ADDRESS 0 O I I. 0 E R OR 0WN ER ATE 00MPLIAHCE ISS0r; 0 6x5�S�Nfo 1000 6A-L PR •GWST P t � II' fold C-AL F=1?e-cfg AT ��5�12�Burt uN wJ 3°of 1J"S&UNL �3ox !Ll 1 0� �X515Ti IN(� i i o00 6w L- Sc-fn-lcTA(v W 1 Vll TOWN OF BARNSTABLE LOCATIONS 3 SEWAGE # :NMLAGE Je—A�Wh ,* � �� ASSESSOR'S MAP &LOTS.- or r1STALLER'S NAME&PHONE NO. �• y.M► �. .tric, { "t[3" 4:'3 SEPTIC TANK CAPACITY .0,0 1 LEACHING FACILITY: (type) C-d-0®,��,Ci�i�,�`.v�S(size) 510'K /it NO.OF BEDROOMS BUILDER OR OWNER AV L+ 4�C6 A A PERMITDATE: COMPLIANCE DATE: 2 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by o ': IAL q ", CFO- Q4 042-e4n14� �� � LOfCAT10N � / SEWAG P RMIT NO. 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