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HomeMy WebLinkAbout0146 STEVENS STREET - Health 146 STEVENS S ,,U NNIS A0005` ' f' l TOWN OF BARNSTABLE LOCATION `' �6 G y� :r T SEWAGE# q VII L GE �T T ASSESSOR'S MAP&LOT3 G G 0 0" 14IER'S NAME&PHONE NO. dltl C 0 SEPTIC TANK CAPACITY e— //L/ S/a c l&A✓ LEACHING FACILITY:(type) '(size) NO.OF BEDROOMS - BUILDER OR OWNER ,J 'If Alec T- /0Iz i LL f A PERMIT DATE: Cftff 6E DATE: 7 -)O A O C 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 M 4� v w 9 t TOWN OF BARNSTABLE LOCATIONIV6 SEWAGE # 8- 72- VILLAGE ASSESSOR'S MAP 6z LOT 309-0406� INSTALLER'S NAME PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY LEACHING FACILITY:(type)r�) /�i --N 1 J 1 (size) I �A l NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNERe,F'rle r DATE PERMIT ISSUED: ij- 7.7 - DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ✓►. I10 1 r Q 4^4 "No. C90g' �"l Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for �Digpogal *pgtem Co ruction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( El-Complete System ❑Individual Comp e ` Location Address or Lot No./v,,- �lP~ Owner's Name,Address,and Tel.No. ✓ D Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title i Size of Septic Tan Type of S.A.S. Description of Soil �r41JU 2 h,i Int - Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boa f Health. Signed Date Application Approved by Date Application Disapproved by: Date for the following reasons oe Permit No. 0 0 Date Issued a ^ , 5 . ./._, .'.��n' .,.•Y�v�n*nr.V..y,... -.+ , .r1,.�.-.7'•"' --._1, .,,. �. ..,�..:'.r:1..,...''..^,M�:.�...ev'r.�rT,�'Z'.- ..,�..,.,,+-ti,-:J.,4„�:..-.�...� �'E "' "1 No. 6�0 Fee /v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for ;Di5poga1 *pgtem 7E:1Complete 10fructton Permit Application for a Permit to Construct O Repair O Upgrade O Abandon( System ❑Individual Components 4? {i <, Location Address or Lot No./yG S W'e, �4/1rl�s' Owner's Name,Address;and Tel.No. Assessor's Map/Parcel f Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. t i Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow min.required) d Design flow provided g ( 9 ) gpd g P gpd Plan Date Number of sheets Revision Date Title w` Size of Septic Tank Type of S.A.S. i Description of Soil O� d v i Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boa f Health. Signed Date Application Approved by j`3- Date Application Disapproved by: Date for the following reasons Permit No. 0 Date Issued a " 15 O i ————————————————————=————————————- -———————-- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance s THIS IS TO CERTIFY,that the On-site Sewage Dis osal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by ) at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. a 00 OK� dated Installer Designer #bedrooms I V Approved design flow gpd --� The issuance of this ermit s all e construed as a guarantee that the system wAun as designed. 0 Date In > � No. aOC��' �`�� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS I 1=igool Q�p$tem Congtruction Permit Permission is hereby granted to Construc ( ) Repair ( ) Upgra e ( � ) Abandon ( ) System located at I Lic, _ and as described in the above Application for Disposal System Construction Permit.The applicant recogni s his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction Fst be completed within three years of the date of this it. I Date — I '6 Approved by a 3 . . `. ® Complete items 1,2,.and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. Q2f©Agent a Print your name and address on the reverse X `,�`%0 A ressee so that we can return the card to you. B. Received by(PHAd Nam C. Datf D ivery ® Attach this card to the back of the mailpiece, \ 11 or on the front if space permits. i I 1. Article Addressed to: D. Is delivery address different from ite'V ❑�No If YES,enter delivery address beloAac ❑ �/J 0 ' " Ox 3. Service Type a��; S � O�bO ®.Certified Mail ❑Express Mail 1 ❑Registered KI Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number �- '7006 0810 0000 3524 8523 (Transfer from service IabeQ I PS Form 3811,February 2004 Domestic Return Receipt 102595-02 M-1540 11 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 I ( Sender. Please print your name, address,-and ZIP+4 in this box• I I I I I 0Town of Barnstable 3 Health Division I 200 Main Street Hyannis,MA 02601 I I I I vV ) No. ee J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for lkgool 6pgtem Con0truction Permit Application for a Permit to Construct O Repair O Upgrade O Abandon EK.Complete System [:]Individual Components L cation Address or Lot No. I4LD SrEviU S Si Owner's Name,Address,and Tel.No. �30�1�05� Assessor'sMap/Parcel HIUNIS I aJIA beadbI Installer's Name,Address,and Tel.No. N I W W 7J Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures . Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1 CnQ►1_ REM0 PtL. Qi� SlE?fl C_ 1 h NVI 2f LEACN►ON SYS0EAA Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar ealth. Si Date Application Approved b Date Application Disapproved by: Date for the following reasons Permit No. 0 �j Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned by HlGrHWAY DE , M-314 Or &W:54 LE at H 6 5 ILVLM Sr HMANN IS MA NWQ1 has been constructed accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �� dated AA4110 Installer Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. `-' .�� ��� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 1wi.5paal �&pgtem Congtruction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon (x ) System located at KA 1 HL0 S1rEVENS' S . Hlf ,NSS , Mps �2L,u1 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction rVustAe��compl ted within three years of the date o is e t Date / CJ��� Approved y d --,.,r... �....+•yr r.R�•\.�a.,;d;,,•s.w't.+Gt^+'".�.^,A rt .,d" 1, r f'- No. 5�. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes '! lzappYication for aigogar &pgtem Congtruction Permit ! Application for a Permit to Construct( Repair( ) Upgrade( ) Abandon W ©.Complete System ❑Individual Components )' L cation Address or Lot No:'14L0 Sfr_,V6_1hI S S114 Owner's Name,Address,and Tel.No. nGn05 Assessor's Ma /Parcel rlyll' `IV LS A o2(0O1 p _ I J 1 Installer's Name,Address,and Tel.No. H I9c H IA1A"1 D1✓J_� Designer's Name,Address and Tel.No. I Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date -�, Title Size of Septic Tank Type of S.A.S. it Description of Soil i Nature of Repairs or Alterations(Answer when applicable) 1 N-1 AI— RIF MON AL (X SEF-11 C_ 7 h N,t I_EACN1tJf� SYSTF� Date last inspected: - r Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Bo94%mealth. Signed"" J' Date Application Approved by Date r Application Disapproved by: Date for the following reasons t Permit No. Date Issued ZoO ———————————————————————————————————————————- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned()()by tllGHr )AY beK jbWtq Or ' &RNS—MLE at I y LP S►`l_V L1�� �'. I- R t4 w I S M A n2w l])' has been constructed in accordance ,/ with the provisions of Title 5 and the for Disposal System Construction Permit No. 0�— dated d W v 9 Installer Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector -------------------------------------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS lid oml *patent con$truction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ()4 ) System located at OA I yLP c rr\_j=_.NS �i f I�I�Rf`ItsIS , Mrs oZt�c�� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty 0 to comply with Title S and the following local provisions or special conditions. . Provided: Construction mus be compl ted within three years of the date oftfiis pe t Date : f y Approved ty 4' a r. �oFIMET � Town of Barnstable Regulatory Services Department QARNb'TAQLE, ' " 9. 639• Public Health Division Qp i ♦� prF°MAC A, 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO March 5, 2007 RE: Certificate of Registration for 146 Stevens Street, Hyannis To Whom It May Concern: Please be aware that the dwelling located at 146 Stevens Street, Hyannis had an inspection of the State Sanitary Code 105 CMR 410.000 on February 28, 2007 by Town of Barnstable Health Inspector Timothy O'Connell. At the time of inspection, there were no violations of the state sanitary code; therefore a Certificate of Registration was issued for the property. Should you have any questions regarding this inspection, please do not hesitate to call the Town of Barnstable Health Department. Respectfully, 14 artie Barr tt Division Assistant CIA 31A Please be aware that the dwelling located at 146 Stevens Street,Hyannis had an inspection of the State Sanitary,Code 105 CMR 410.000 on February 28,2007 by Town of Barnstable Health inspector Timothy O'Connell, At the time of inspection, there were no violations of the state sanitary code; therefore a Certificate of Registration was issued for the property. Should you have any questions regarding this inspection,please do not hesitate to call the Town of Barnstable Health Department. Respectfully, � ltie Barr tt Division Assistant 31A NOI193NNOO 33IWISOd3 ON (b-3 d3MSNd ON (E-3 J,SnH (2-3 -1Id3 3NI-I d0 do 9NdH (Z-3 Wdd3 dO3 NOSd3d ---------------------------------------------------------------------------------------------------- T/T 'd NO PEVZSZZ80STS Xi J,dOW3W E9E ----- ---------------------------------------------------------------------------------------------- 35IJd i-inS3d (dnozdq) SS3dQQd NOI ldO 3QOW 3-1 I3 Hi-lb3H d0 QddOH 3-1Hd1SNdUS Ill ( Wd92:ZT Z002-S -ddW ) 1dOd3d i-inS3d NOIld9INf1WW09 S ,d I r- l-P,) Certified Mail#7006 0810 0000 3524 8523 Y�oFIKE rawti Town of Barnstable 0 7 Regulatory Services -- ' + BARNS-TABLE, g MASS. Thomas F. Geiler, Director i639• arFD MAC' Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 February 22, 2007 Charles Hodge c/o Bemice Phillips P.O. Box 653 Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000,.STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 146 Stevens Street, Hyannis was inspected on February 21, 2007 by Timothy O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.351 - Owner's Installation and Maintenance Responsibilities. Open electrical outlet grounds observed throughout house. 105 CMR 410.482 —Smoke Detectors. Inoperable smoke detectors. The following violation(s) of the Town of Barnstable Code were observed: 1§ 70-10- Smoke Detectors and Carbon Monoxide Alarms. Inoperable carbon monoxide detector. QAOrder letters\Housing violations\Rental ordinance\146 Stevens Street.doc You are directed to correct the violations listed above within twenty-four (24) hours of your receipt of this notice by replacing batteries in smoke detectors and carbon monoxide alarms. You are ordered to correct the violations listed above within thirty (30) days of your receipt of this letter by repairing all open electrical grounds. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF TH BOARD OF HEALTH T omas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Timothy O'Connell, Health Inspector QAOrder letters\Housing violations\Rental ordinance\146 Stevens Street.doc ' Certified Mail#0000 0000 0000 0000 0000 Town of Barnstable �nEty�rsr�.scA 4: ,.. Regulatory Services � 9 Thomas F. Geller, Director A Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Char 1'e5 400l GO date d e — 0 �I city,state,zip NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II —MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at /`7�Y 5-e& A)6 N avuu vas inspected onc;2 /�y / 6—) (Address) (date) , Health Inspector for the Town n (Inspector's name) of Barnstable, _ y (Reason for inspection) The following violation(s) of the State Sanitary Code were observed: State code violation number-violation descri tion 105 CMR 410. - C{c i 105 CMR 410.3al_ GfrfDi'''') )d5 ®h�y��G�Gtg,e ked� - ��'� 0 414-b PA �Idtu , 105 CMR 410. - 105 CMR 410. Q:\Order letters\Housing violations\Rental ordinance\template.doc 105 ICMR 410. The following violation(s) of the Town of Barnstable Code were observed: Town code violation number-violation descri lion l §170- §170-_- You are directed to correct the violations listed above within i' days. 02hr5 of your receipt of this notice by % l (wPrt ) #> AV A)% hyS _ bug Y /lam You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: (Name,tenant,owner,Fire Dept.,Building Dept....) Cc: (Health inspector's name) (Generic codes located at QAOrder letters\Housing violations\Rental Ordinance\GENERIC CODES.DOC) QAOrder letters\I-ousing violations\Rental ordinance\template.doc FORM30 II�W HOBBS&WARREN'" THE COMMONWEALTH OF MASSACHUSETTS C_� BOARD OF H LTH CITY/TOW W I DEPARTMENT A 'o AD Est p'1 ram, TELEPHONE Address _Occupant_. Floor _Apartment No.__i'y _.__.No. of Occupants No. of Habitable Rooms No.Sleeping Rooms--- No. dwelling or rooming units No.Sto es Name and address of owner �y — P0 4 f�tY1 t tb Remarks Reg. Vio. YARD Out Bld s.: Fences: '';L° 01 Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress: and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: '5 +-Id. Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing, Grnd.: C'Sv— Ljll) AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den —Living Room , a-- Bedroom 1 1 Bedroom 2 ?111 �- Bedroom 3 ),,p C Cl Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove a Bathing,Toilet Facil,_. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPOR S SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJUR INSPECTOR TITLE DATE ' Q TIME fo A.M. THE NEXT SCHEDULED REINSPECTION � V P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shali be deemed conditions which may endanger or impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 41C.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilitieE required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the elease of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. I � ��ec��o �� � � l��S���_e nS S�s�.�.SC 1 _ . COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form 305' Not for Voluntary Assessments e�M S e�OW c.o Subsurface Sewage Disposal System Form Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 1. Property Information: MAP 309— PARC 005 146 STEVENS STREET — HYANNIS, MA 02601 Property Address BELBODA, LORETTA Owner's Name 146 STEVENS STREET Owner's Address HYANNIS MA 02601 City/Town State Zip Code J U LY 20, 2006 Date 2. Inspector: JAMES D. SEARS t` Name of Inspector A & B CANCO Company Name 350 MAION STREET Company Address WEST YARMOUTH MA 02673 City/Town State Zip Code 508-775-2800 Telephone Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 16.000). The System: ® Passes ® Conditionally Passes ❑ Fails F—JAeeds Further Evaluation=theLocalpproving Authority pector's Signature: Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 COMMONWEALTH OF MASSACHUSETTS w Title 5 Official Inspection Form d Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. Certification (cont.) 146 STEVENS STREET Owner's Address WEST YARMOUTH MA 02673 City/Town State Zip Code BELBODA, LORETTA Owner's Name JULY 20. 2006 Date of inspection Inspection Summary: Check A, B, C, D or E!always complete all of Section D A) System Passes: l ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: N/A ® One or more system components as described in the"Conditional Pass"section need to be replaced or Repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND)in the ® for the following statements. If"not determined," please explain. ® The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of compliance indicating that the tank is less than 20 years old is available. ND Explain: Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Fora Not for Voluntary Assessments 11M SJOy`o Subsurface Sewage Disposal System Form B. Certification (cont.) 146 STEVENS STREET Owner's Address WEST YARMOUTH MA 02673 City/Town State Zip Code BELBODA, LORETTA Owner's Name J U LY 20, 2006 Date of inspection B) System Conditionally Passes (cont.): N/A ® Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ® broken pipe(s)are replaced ® obstruction is removed ® distribution box is leveled or replaced ND Explain: ® The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ® broken pipe(s)are replaced ® obstruction is removed ND Explain:. C) Further Evaluation is Required by the Board of Health: N/A ® Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1) (b)that the system is not functioning in a manner which will protect public health,safety and 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 COMMONWEALTH OF MASSACHUSETTS 19 Title 5 Official Inspection Form -,l�M SJOW`eW Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 146 STEVENS STREET Owner's Address WEST YARMOUTH MA 02673 City/Town State Zip Code BELBODA, LORETTA Owner's Name J U LY 20, 2006 Date of inspection C) Further evaluation is required by the Board of Health (cont.): N/A 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ® The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ® The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ® The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ® The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"" Method used to determine distance: "This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less that 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 COMMONWEALTH OF MASSACHUSETTS Title 5 Official Inspection Form Y Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 146 STEVENS STREET Owner's Address WEST YARMOUTH MA 02673 City/Town State Zip Code BELBODA, LORETTA Owner's Name J U LY 20, 2006 Date of inspection D) System Failure Criteria Applicable to All Systems: N/A You must indicate"Yes" or"No"to each of the following for all inspections: Yes No 0 Backup of sewage into facility or system component due to overloaded or clogged SAS® . or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® Liquid depth in leaching is less than 6" below invert or available volume is less than '/2 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 surface water elevation. ® N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. ® N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well. ® NIA Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.) YES. No 7 The system is a cesspool serving a facility with a design flow of 2000 gpd— 10,000 gpd. Yes No ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 COMMONWEALTH OF MASSACHUSETTS w Title 5 Official Inspection Form d Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 146 STEVENS STREET Property Address WEST YARMOUTH MA 02673 City/Town State Zip Code BELBODA, LORETTA Owner's Name J U LY 20, 2006 Date of inspection N/A E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No the system is within 400 feet of a surface drinking water supply ® ❑ the system is within 200 feet of a tributary to a surface drinking water supply ® ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area- IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 COMMONWEALTH OF MASSACHUSETTS w Title 5 Official Inspection Form d Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. Checklist 146 STEVENS STREET Property Address WEST YARMOUTH MA 02673 City/Town State Zip Code BELBODA, LORETTA Owner's Name J U LY 20, 2006 Date of inspection Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ® Pumping information was provided by the owner, occupant, or Board of Health ® Were any of the system components pumped out in the previous two weeks? ® Has the system received normal flows in the previous two week period? ® ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ® Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ® Was the facility or dwelling inspected for signs of sewage back up? ® Was the site inspected for signs of break out? ® ® Were all system components, including the SAS, located on site? ® ® Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction dimensions, depth of liquid, depth of sludge and depth of scum? ® ® Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ® Existing information. For example, a plan at the Board of Health. ® ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)]. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 COMMONWEALTH OF MASSACHUSETTS N w Title 5 Official Inspection Form o Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information 146 STEVENS STREET Property Address WEST YARMOUTH MA 02673 City/Town State Zip Code BELBODA, LORETTA Owner's Name J U LY 20, 2006 Date of inspection Residential Flow Conditions: ) Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: 4 Does residence have a garbage grinder? ® Yes ® No Is laundry on a separate sewage system?[if yes separate inspection is required] ® Yes ® No Laundry system inspected? R Yes ® No Seasonal use? ® Yes ® No Water meter readings, if available(last 2 years usage(gpd)): N/A Sump pump? ® Yes ® No Last date of occupancy: PRESENT Commercial/Industrial Flow Conditions: N/A Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.) Grease trap present? ® Yes ® No Industrial waste holding tank present? ® Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ® Yes ® No Water meter readings if available.- Last date of occupancy/use: Date Other(describe): Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 COMMONWEALTH OF MASSACHUSETTS n w Title 5 Official Inspection Form r e` Not for Voluntary Assessments G'1N yVP�� Subsurface Sewage Disposal System Form D. System Information (cont.) 146 STEVENS STREET Property Address WEST YARMOUTH MA 02673 City/Town State Zip Code BELBODA, LORETTA Owner's Name J U LY 20, 2006 Date of inspection General Information Pumping Records: Source of Information: NA—NOTE: MAINT. PUMP AFTER INSPECTION. Was system pumped as part of the inspection? ® Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ® Single cesspool. ® Overflow cesspool ® Privy ® Shared system(yes or no)(if yes, attach previous inspection records, if any) ® Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) ® Tight tank. Attach a copy of the DEP approval. ® Other(describe): Approximate age of all components, date installed(if known)and source of information: 1998 PERMIT#98-262 Were sewage odors detected when arriving at the site? ® Yes ® No Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 COMMONWEALTH OF MASSACHUSETTS r w Title 5 Official Inspection Fora d Not for Voluntary Assessments Subsurface Sewage Disposal System Form P Y D. System Information (cont.) 146 STEVENS STREET Property Address HYANNIS MA 02601 City/Town State Zip Code BELBODA, LORETTA Owner's Name J U LY 20, 2006 Date of inspection Building Sewer(locate on site plan): ✓ Depth below grade: 1 feet Material of construction: ® cast iron 13 40 PVC ® other(explain) Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): i Septic Tank(locate on site plan): ✓ Depth below grade: 20" feet Material of construction: ® concrete ® metal ❑ fiberglass ® polyethylene other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ® Yes ® No ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Dimensions: 1500-GALLON PRE CAST Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 26" Scum Thickness 3" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? ASBUIT&PROB Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 COMMONWEALTH OF MASSACHUSETTS W Title 5 Official Inspection Form c Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 146 STEVENS STREET Property Address WEST YARMOUTH MA 02673 City/Town State Zip Code BELBODA, LORETTA Owner's Name JULY 20, 2006 Date of inspection Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK & COVERS AT 20" INLET TEE - OUTLET TEE. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. Grease Trap (locate on site plan): N/A Depth below grade: feet Material of construction: ® concrete ® metal ® fiberglass ® polyethylene ® other(explain) Dimensions: Scum Thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): N/A Depth below grade: Material of construction: ® concrete ® metal ® fiberglass ® polyethylene ® other(explain) Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page I of 16 COMMONWEALTH OF MASSACHUSETTS r w Title 5 Official Inspection Form Not for Voluntary Assessments =y0 Subsurface Sewage Disposal System Form D. System Information (cont.) 146 STEVENS STREET Property Address p Y HYANNIS MA 02601 City/Town State Zip Code BELBODA, LORETTA Owner's Name J U LY 20, 2006 Date of inspection Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ® No Alarm Level: Alarm in working order: ® Yes No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach a copy of current pumping contract(required). Is copy attached? ® Yes No Distribution Box (if present must be opened) (locate on site plan): ✓ Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-BOX IS 16" X 16" —Z BELOW GRADE, CLEAN & SOLID. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. Pump Chamber(locate on site plan): N/A Pumps in working order: ® Yes ® No Alarms in working order: ® Yes ® No Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 COMMONWEALTH OF MASSACHUSETTS W Title 5 Official Inspection Form d Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 146 STEVENS STREET Property Address HYAN N I S MA 02601 City/Town State Zip Code P BELBODA, LORETTA Owner's Name JULY 20, 2006 Date of inspection Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: ® leaching chambers number: 3 ® 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.)- LEACHING IS THREE (3) MAXIMIZER WITH 4' STONE AT 32", WET. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 COMMONWEALTH OF MASSACHUSETTS w Title 5 Official Inspection Form r Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 146 STEVENS STREET Property Address HYANNIS MA 02601 City/Town State Zip Code BELBODA, LORETTA Owner's Name J U LY 20, 2006 Date of inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): N/A Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ® Yes ® No Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Privy (locate on site plan): N/A Materials of construction.- Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 COMMONWEALTH OF MASSACHUSETTS u W Title 5 Official inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 146 STEVENS STREET Property Address HYAN N IS MA 02601 City/Town State Zip Code BELBODA, LORETTA Owner's Name JULY 20, 2006 Date of inspection 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. ,; �3 l - J f o f e t5insp.dcc •03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal Systeri n a q e ?5.C"f 1 COMMONWEALTH OF MASSACHUSETTS R w Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 146 STEVENS STREET Property Address •+ HYAN N I S MA 02601 City/Town State Zip Code BELBODA, LORETTA Owner's Name J U LY 20, 2006 Date of inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to NO ground water: 10' Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health—explain: ® Checked with local excavators, installers—(attach documentation) ® Accessed USGS database—explain: i You must describe how you established the high ground water elevation: TEST HOLE AT 10' NO WATER. TEST HOLE 4' BELOW LEACHING. BOTTOM OF LEACHING AT 6'. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 TOWN OF.BARNSTABLE LOCATIONL7Ca /US�% SEWAGE Z ` VILLAGB ASSESSOR'S MAP & LOTT ' INSTALLER'S NAME 6s PHONE NO. A & B CANCO 77 -626d , .. - SEPTIC TANK CAPACITY /PU (j/� LEACHING FACILITY:(type)L3 f )( I 7r n S (size) U 'h l ( � w/y To►. c NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILb$R:OR OWNERc�Pr1 DATE:-PERMIT ISSUED: DATE COMPLIANCE ISSUED• VARIANCE GRANTED:. Yes No �. • ,6 : r ti No. � � � Fee � � ... THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Rpplicatiou for Migonl bpgtem Construction Vermit Application for a Permit to Construct( )Repair( 1116pgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. IV& e L ( Owner's Name,Address and Tel.No. • Assessor's Map/Pazcel �• 30� - OaS 7o GJ%nfcr ,54. Installer's Name,Addres""S rGANCO J Designer's Name,Address and Tel.No. 350 Main Street N1/¢ W. Yarmouth, MA 02673 Type of Building: Dwelling No.of Bedrooms r1J Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ,3 3 d gallons per day. Calculated daily flow (o S gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /S-D D Type of S.A.S. M191-)l iM�•?e,J Description of Soil L;mye_z Nature of Repairs or Alterations(Answer when applicable) 1 O-)J 4 r �- /S-6 D 5g.4/. S-ga/iC ZY-0 :o L D - Ah.9 .3- rYJ yka --n i zrr )c ec ck 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 this Board of Health. Signed —Date Application Approved by Date�-22 Application Disapproved for th'Y following reasons Permit No. a Date Issued � No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS application for Otgozar 6potem Construction Permit Application for a Pernnt.to Construct( )Repair(.✓f Upgrade( )Abandon( ) ❑Complete System ❑Individual Components j Location Address or Lot No. �� .� L�'��� Owner's Name,Address and Tel.No. _2 7 j— 6 Sa 7 Assessor's Map/Parcel U9 -. OCAS 7o W ,i1er ,S4. /,t X . Installer's Name,Address,*i .1130-CANCi0 Designer's Name,Address and Tel.No. 350 Main Street N�/4 W. Yarmouth, MA 02673 Type of Building: ' Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ? U gallons per day: Calculated daily flow tJ"" gallons. Plan Date Number of sheets Revision Date Title _ j Size of Septic Tank IS O U Type of S.A.S. /yzi-jx irYi c II Description of Soil 5�q /'A✓e ;I Nature of Repairs or Alterations(Answ r when applicable) I jU U jw�• SC�/��%C 7.4Nk 1 /_ . �� 6)e . Date last inspected: 1 w; Agreement: The undersigned agr�eso�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 this Board o /Health. Signed # J/ ( u Date Application Approved by ` . .....-.=.� c Date !:It-17,cl Sl Application Disapproved for the following reasons s s Permit No. 2a Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (✓S Upgraded ( ) Abandoned( )by e_1Y/j11_0 at I'/6 JfPUP�IJ �f. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.T1 —in$ dated Installer Designer 2 G A, The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date a q Inspector '"-\ F 9 No. c/�Al- ' ---------------------------- JFee t� 2102 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS t Migpogal 6potem Construction Permit s r Permission is hereby granted to Construct( )Repair(✓Upgrade( )Abandon( ) System located at I Y4 If le- S¢, /�/f/ . 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. g Provided:Construction must be completed within three years of the date of this permit. ' Date: 41 _ 0 Approved by a i { 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) hereby certify that the application for disposal works construction permit signed by me dated q-d7, FF , concerning the property located at I y6 Styychs S- -. 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 U91 be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: pp (� A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) 38, I B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED J tl - 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]. qhe alth folder:cert 3 M J SEPTIC -SYSTEM DESIGN l AL DZD S te . G AL/DAY/DZD M a .. c�L D SjPTIC TANK: . . GALI DAY a z DAYS GAL USE GALLON SKPT'IC TANK (EXISTING) IF.ACHING AREA-. USE S INFILTRATORS (M=A�XI I ZER CHAMBERS WITH C Off' STONE ALL AMUND (W x if z Z DEEP) SIDE AREA: sO + 11 z a z = 164 SJ' (.74) GAL/DAY BOrTo .• _ SP 04) _ GAL DAY ON- CAPACJTY _ GAL/DAY