HomeMy WebLinkAbout0135 WOODLAND AVENUE - Health N
135 WOODLAND AVENUE,HYANNIS
A= 269 262
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TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date (� Time: In Out
Owner�o p►�1L� _ W�l l.1 Tenant v AG,Af%-),T
Address f (D R>0)( `4-'Li Address 13-5 &'�, M A W SE
COT AA &
Compliance Remarks or
Regulation# Yes NO Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrical Facilities
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use /
12. Exits ✓
13. Installation and Maintenance of Structural J
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17. Temporary Housing
18. Driveway Width
19. Number of Tenants Observed
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Number of Bedrooms Number of Ve ' Ilowed (m )
Number of Persons Allowed (max)
Person(s) Interviewed �t�LQ- Inspec or
If Public Building such as Store or Hotel/Motel specify here
S 8
O
COMMONWEALTH OF MASSACHUSETTS �
EXECUTIVE OFFICE OF ENVIRONMENTAL AFF �
DEPARTMENT OF ENVIRONMENTAL PROTEC OCr tg 195
ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 , 8
XE
WILLIAM F.WELD S retar:
Governor
B. STRUHS
ARGEO PAUL CELLUCCI Commissioner
Lt. Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
fA" — 01(0 q c PART A
CERTIFICATION
Property Address q�S �" �` la+. V~ t ( �r''t�i5 Address of Owner. j�,,-,i,,
Date of Inspection: Y\ �� (If different)
Name of Inspector: VA i�r.tX 1^\�. L;
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name: T 1--
Mailing Address:
Telephone Number:
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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance
of on-site sewage disposal systems. The system:
Passes
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signatur
Date:
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the
buyer, if applicable, and the approving authority.
INSPECTION SUMMARY: Check A, B, C, or D:
A] SYSTEM PASSES:
"' I have not found any information which indicates'pat the system violates any of the failure criteria as defined in 310 CMR 15.303. Any
failure criteria not evaluated are indicated below. 11 n C1 (\
k `'
COMMENTS: Sy;7<w� Qr�SSt S �a�-+� C¢\I V-1 1, o'- l�4 FIX e- y_=��lrvc Di- ,n1 .c i ►,c.
E N u C_ ft , )01
B] SYSTEM CONDITIONALLY PASSES:
One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system,upon
completion of the replacement or repair, as approved by the Board of Health, will pass.
Indicate yes, no, or not determined (Y. N. or ND). Describe basis of determination in all instances. If"not determined", explain why not.
_ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection. or the
septic tank. whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure
is imminent. The system will pass`inspection if the existing septic tank is replaced with a conforming septic tank as approved
by the Board of Health.
(revised 04/25/97). Page 1 of 10
.:; •ti
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued) .
Property Address: /
Owner:
Date of Inspection:
B) SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or
due to a broken. settled or uneven distribution box. The system will pass yfispection if(with approval of the Board of Health).
Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass irispectic
if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
i
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health. safety and the environment. f
r
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETER IVIES THAT THE SYSTEM IS NOT FUNCTIONING I,ti A
• MANNER WH?CH WILL PROTECT THE PUBLIC HEr A;\'
I.TH AND SAFETY D THE EN'VIRONhIEN7:
Cesspool or privy is within 50 feet of a surface dater
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF ITEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIgNING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
i
i
The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply.
_ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil;absorption system and the SAS is less than 100 feet but 50 feet or more from a private
water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is
free from pollution from that faciliti and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppr
Method used to determine distanc ' (approximation not valid).
3) OTHER i
(revised 04/2SI" Page 2 of 10
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
r
Property Address: f
Owner:
Date of Inspection:
DI SYSTEM FAILS:
You must indicate either "Yes" or "No" as to each of the following:
I have determined that the system violates one or more of the following failure criteria asrdefined in 310 CMR 15.303. The basis for
this determination is identified below. The Board of Health should be contacted to deteKmine what will be necessary to correct the
failure.
i
Yes No
Backup of sewage into facility or system component due to an 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
- i
cesspool. i
_ Static liquid level in the distribution box above outlet invert dWe to an overloaded or clogged SAS or cesspool.
i
Liquid depth in cesspool is less than 6" below invert or avi table volume is less than 1/2 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 portio&,Idf the Soil Absorption System. cess ooI or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within feet of a surface water supply or tributary to a surface water supply.
. a
Any portion of a cesspool or privy is wit n a Zone I of a public well.
Any portion of a cesspool or privy is ithin 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet-but greater than 50 feet from a private water supply well with no
acceptable water quality analysis If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile orga tc compounds, ammonia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAILS:
You must indicate either "Yes" or "No" as each of the following:
The following criteria apply to I ge systems in addition to the criteria above:
The system serves a facility nh a design flow ofJ0,000 gpd or greater (Large System) and the system is a significant threat to public
health and safety and the a ironment because one or more of the following conditions exist:
Yes No
the system ' within 400 feet of a surface drinking water s4ly
— _ the syste is within 200 feet of a tributary to a surface drinking water supply
the sy cm is located in a nitrogen sensitive area (Interim Wellhead Protection Area -IWPA) or a trapped Zone U of a public
wate supply well)
The owner or operatoof any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 MR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 04/2S/47) Page 3 of 10
v
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: l31� UtXxxl4v.'A
Owner: KQ AQ-2 t Cc L
Date of Inspection:
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes No
_ Pumping information was provided by the owner, occupant, or Board of Health.
None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rate
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
As built plans have been obtained and examined. Note if they are not available with N/A.
X _ The facility or dwelling was inspected for signs of sewage back-up.
_ The system does not receive non-sanitary or industrial waste flow.
_ The site was inspected for signs of breakout.
_ All system components, excluding the Soil Absorption System, have been located on the site.
_ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles o:
tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scurif.'
The size and location of the Soil Absorption System on the site has been determined based on:
The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of St:t
Surface Disposal System.
Existing information. Ex. Plan at B.O.H.
_ Determined in the field (if any of the failure criteria related to Part C is.at issue, approximation of distance is unacceptable)
[15.302(3)(b)]
(revised 04/25/97) Page 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
` --'' SYSTEM INFORMATION
Property Address:
Owner: V'j�V, '+.K i
Date of Inspection:
l O FLOW CONDITIONS
RESIDENTIAL:
Design flow: D-0 ¢.p.d./bedroom for S.A.S.
Number of bedrooms:
Number of current residents: C�
Garbage grinder (yes or no): tJ
Laundry connected to system (yes or no):
Seasonal use (yes or no): tN
Water meter readings, if available.(last two (2) year usage (gpd): b
Sump Pump (yes or no): f--)
Last date of occupancy: �J*XCt+vJ-�-
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow:_gallons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)_
(Non-sanitary waste discharged to the Title 5 system: (yes or no)_
Water meter readings, if available:
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy:
GENERAL INTOR.M,&TION
PUMPING RECORDS and source of�infoyn)ati4
to L`l�cS U--j
System pumped as part of inspection: (yes or no)_L�0
If yes, volume pumped: Gallons
Reason for pumping:
TYPE OF SYSTEM
XSeptic tank/distribution box/soil absorption system ;
Single cesspool -
Overflow cesspool
Privy .
Shared system (yes or no) (if yes, attach previous inspection records, if ary)
I/A Technology etc. Copy of up to date contract? �/`'
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information: ty-A
Sewage odors detected when arriving at the site: (yes or no) 5
(revised 04/25197) Page 5 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: i 'S U`"c�g �
Owner:
Date of Inspection: j k;
BUELDING SEWER.-
(Locate on site plan) �b
Depth below grade:
Material of construction: _cast iron _40 PVC _other (explain)
Distance from private water supply well or suction line
Diameter
Comments: (condition of joints, venting, evidence of leakage, etc.)
SEPTIC TANK: c�
(locate on site plan)
Depth below grade: Co k
Material of construction: concrete _metal _Fiberglass _Polyethylene —other(explain)
If tank is metal. list ace_ Is age confirmed by Certificate of Compliance _(Yes/No)
Dimensions: 1600 Iy PA
Sludge depth: .4"
Distant: from top of sludge to bottom of outlet tee or baffle:
Scum thickness: I 'I X
Distance from top of scum to top of outlet tee or baffler_ n
Distance from bottom of scum to bottom of outlet tee or baffler_
How dimensions were determined: (MUKp i i 11A
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relatio,� t outlet invert structu l trite rity.
evidence of leaks , etc. l� c C ( ut
PEA
GREASE TRAP: �v
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain)
1
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle!
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity.
evidence of leakage, etc.)
(revised O4/25/97) Page 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: I�s
Owner: 1>A v-Z yC�c
Date of Inspection:
TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection)
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm level: Alarm in workine order _ Yes. _ No
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches. etc.)
)ISTRIBUTION BOX: Lf5
(locate on site plan)
Depth of liquid level above outlet invert: V
" Comments:
(note if level and distribution is equal, evidence of solids ca over, evidence of leakage into or out of box, etc.)
t>- to U -DL
PUMP CHAMBER:JLD
(locate on site plan)
Pumps in working order: (Yes or No)
Alarms in working order (Yes or No)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised oa/25/97) Page 7 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: L�S Ust.C,(
Owner: VCXti Z:yt-�C t
Date of Inspection: C�
SOIL ABSORPTION SYSTEM (SAS):-W S
(locate on site plan, if possible: excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number: tiwop
leaching chambers, number:_
leaching galleries, number:
leaching trenches. number,length:
leaching fields. number, dimensions:
overflow cesspool, number:
Alternative system:
Name of Technology:
Comments:
(note condition of soil. sips of hydraulic failure, level of pondingg, condition of vegetadon,.eic.)
of
z civv.IP tnj
CESSPOOLS:.L
jb
(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater:
inflow (cesspool must be pumped as part of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level 4ponding, condition of vegetation, etc.)
PRIVY:
(locate on site plan)
Materials of construction:' Dimensions:
Depth of solids:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(revised 04/25/97) Page 8 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner: f� Zt-Ic.�C,I
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
2
W
r t
b q 32l
(revised 0112S/97) Page 9 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection:
Depth to Groundwater{20 rFeet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observation of Site (Abutting property, observation hole, basement sump etc.) `
Determine it from local conditions
Check with local Board of health
Check FEMA Maps
Check pumping records
Check local excavators, installers
Use USGS Data
Describe in your own words how you established the High Groundwater Elevation. Must be completed)
G t1 ff
(4-1 01d�L �jtl;U2�� c„/�-11 5
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(revised 04125/97) Page 10 or 10
pp TOWN OF BARNSTABLE
LOCATION \3S Q000t AK)d m1 L SEWAGE #
VILLAGE ASSESSOR'S MAP& LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY ( ow 9 hr l
LEACHING FACILITY: (type) (size) \000
NO.OF BEDROOMS Z
BUILDER OR OWNER Q?1U G1-C.1
PERMTTDATE: S 1 I LI 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) I. Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by - sLC�
s�r�
w
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r =
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No.----.l.._�.-�..!�✓ Fps...,,, ._Uf....�'
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Appliration for Disposal Norio Tonstrnrtinn ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
--......- ............... ............... ..................................................
ocation-A ress
Owner Address
..........:? -. i�( � G •----.--- --••-•--• I-U....1 ...... �a-----
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms____. Garbage Grinder
( ).Ex ansion Attic
Other—T e of Building No. of persons............................ Showers — Cafeteria
Pa Other fixtures -----•--------------------------------------------
W Design Flow.........
._ _....................gallons per person per day. Total daily flow........33_.b..................gallons.
WSeptic Tank-- Liquid capacity-1 gallons Length..., ....... Width..... Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No...../------------- Diameter...,(-__`_----- Depth below inlet...,6v ......... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date.......................................
,--4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
04 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ----------------------------------------------------------
.....-----------------------------------------•-----------------------------
0 Description of Soil-----•-------------•--------•--•------------------------•-------------------------------------------------------------------------------------------------------------•-
x
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
U Nature of Repairs or A}te ations—Answer when applicable._x,1___ 1, _t(___-.�_.0
.......... .. ?! _ :I SZ....P1 ff.....c�.` ,.--:S�C�_G 1� ............................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by-the bo of hea
Signed ....----...�---------------- -- ....
. .......
.......................
------------... .------....I...----
Dace
Application Approved By ... ... '-Dmm
Application Disapproved for the following reasons- ------------------------------------ ----------------------------------------------- -------- - ------------------------------
--------- ---------------------------- -- - -- ------------------- ---- ---............---........................................................--------------------------------------- ---------------------------------------
Da........
PermitNo. 71--- .-- ----- ---- -------- -- Issued -----------------------------------------------------.....Date
i
TOWN OF BARNSTABLE
LO'C ATION�� uxja( (I �1. �_ SEWAGE #
VILLAGE di An 1 SESSOR'S MAP & LOT
INSTALLER'S NAME 6s PHONE N Ofiblat*
SEPTIC TANK CAPACITY v
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WAT
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
� .
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N...
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiou for Disposal Works Tonotrurtinn ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
---------- 1JX-d)4-L-Q\14N1_d,(-jp-----.po�i�e------------------ --------------14 a_ ,N-.t`I S...._. .....................................
-- - - ..........------.
Location-Address or
=... ..........�.;.........
Owner Address
t
s
Installer Ad ress
PQ U . Type of Building Size Lot............................Sq. feet
Dwelling_No. of Bedrooms..---may------------------------------------Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons............................ Showers — Cafeteria
QI - Other fixtures ------------------------------------•--•--......----.- ---
W Design Flow....... —......................gallons per person per day. Total daily flow--------- -------------------gallons.
WSeptic Tank-Liquid capacity l_OMgallons Length...C:....... Width,--.�zt, ___ Diameter________________ Depth................
x Disposal Trench—No..................... Width..................... Total Length.................... Total leaching area......_----_------sq. ft.
Seepage Pit No----/.............. Diameter._;t0_`_...__ Depth below inlet_._&�_.._.-:. Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
`-� Percolation Test Results Performed'by----•-----------------------------•----------------------•--•......_••-•_. Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water................ _.
Test Pit No.�2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ----•-----------------------------------•-••---.....•-•--•..........-----•-------------•-------.._...........----------......_..-----•-•--------••......---•-
0 Description of Soil...............................................................................•----•---------••--
x
c,
x ...........................................-------------•-•-------•------------•----------•------•----•------------•------•-•-...--------•----------•-•••---•-----•------------------------------------
U Nature of Repairs or Alterations—Answer when applicable_.�..y�-,_�.E..�_(.(____-.�.
60.- -Own = �^, '� d� f � LTG{
Agreement: I
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until.a Certificate of Compliance has been issued by the boa- d of heal h.
Signed .. .......... -----------------------=------
Dare
Application Approved By ................... ... - - --." ',' /
Date
Application Disapproved for the following reasons: -------------------------------------------------------------------------------------------------------------------------- ----
--------------------------------- ..........................................................................................................................................----------..---.--
q Dale
Permit No. ... .. / l- ........................ Issued ..----..---.----..------.
Date
f�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(9rdifirate of CUlIImVliance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System"constructed ( ) or Repaired (v,__)�
by.................. ... ..-- ,...5��,.{.�1... .....--. -fir,-.'.. ...Insraller........--...--.................--..-...................-------..............-...--'-'----..........-...--...-...........
at -------------------- `---------- 1 �1 �Y�-----------1� ... { ............
has been installed in accordance with the provisions of TITLE 5 Qf The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ......r.../_- .... 1 ....... dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. -
DATE........ ...- '4 �.. .......................... Inspect r ,. �0..�� �?/.�2�'�-� -----------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_ TOWN OF BARNSTABLE
/...._..�+.1.�� FEE. .........
Disposal Workii Tlanstrnr#ivan f ami#
Permission is hereby granted......f-IA.-p�--f,-d `A414)....- .(71 -�•-------------------------------------------------------•-------
to Construct ( ) or Repair (L an Individual Sewage Disposal System
at No.........�-1.......Gt//11a. ...�1 t I ....... �e 2.:
ee Str ( f
as shown on the application for Disposal Works Construction Permit No. _.fl_ Dated..........................................
•---------••---•- ------•------------------------------•-----•-•----
q• Oar .f Health
DATE................... ���-----------
FORM 36508 HOBBS 8 WARREN.INC..PUBLISHERS
7t. 2-
` CATION SEWAG PERMIT NO.
VI-LLAGE
Xt
I N S T A LL Rls NAME i ADDRESS
o S
y
0 UILD',IR OR OWNER
F C C
ri -07
DATE,, JPER IT ISSUED ® �
DAT° E COMPLIANCE A'SSUED
��
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11
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THE COMMONWEALTH.OF MASSACHUSETTS
BOAR® OF HEALTH
Town Barnstable
.............. ..........................OF............................._.........----------------•---_._......._....._..............
ApplirFation for Disposal Works Tontrnr#inn "ami#
Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal
System at:
Lot # 11, Woodland Ave. , Ext . Hyannis , MA
.............. -......-•- -............. ....._.............----••-•-•--•••-•-•-...-••----- .................---•-•---•-•-•••-•--.........-•--•---••----•---...---•--•-----•-............•----
Capricorn Re t'e'�rA� st 765 Falmouth Rolla I yannis
................................................................ .... .......
....
-_----•----•-••----------•...................
Steve L e b el owner Address
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms_3________________________________________Expansion Attic ( ) ;arbage Grinder ( )
Other—Type T e of Building ranch - No. of ersons____________________________ Showers — Cafeteria
a YP g --h P ) ( )
Q' Other fixtures ................................
•--•---------------------------------------------------------------
W Design Flow....... ..,___•-------- 000 gallons per pers�j Deer day. Toll�c 6y"flow____..........................._________ g&ns.
WSeptic Tank—Liquid capacit}'__.__.__:__gallons Lengt ________________ Width!............... Diameter................ Depth.______._____..
x Disposal Trench,—No_____________________ Wid�he...__....._._.___.. Total Length..... t----------.Total leaching area....�_66-________sq. ft.
Seepage Pit N --- -------------- Diameter.................... Depth below inlet.................... Total leaching area.........._.......sq. ft.
Z Other Distribution box ( . ) Dosing_ a
14 redde Engineering 11-25-81 =
Percolation Test Results Performed by................................ ____ Date___________,__._......._____..._.
2,p 1 none ehcounterd-
,-4 Test Pit No.1_TAminutes per inch Depth of Test Pi�v,_____________ Depth to ground water_NI e
Test Pit No. minutes per inch Depth of Test Pi ____________________ Depth to ground water........................
n+' ...........................................................
0 Description of Soil......... _Y....- 2' ` loam & topsoil.............. ------------•-------------------------------------•--•-----..._....
-------Niediuin yellow-"sand------------------------------------------------------------------------------
W ----------1-b-,---__ 12-,-----med:---rirTl te--saria��race's--pf_-_grawI/Tro...Wate_r—at__-1.2'
x -•--------•----------------------•------•-------._.. -._.-=
.---•----•----••--•••------• ------••-•---•----•-•-----•----•------•---------•-•--•--_._...--------•-----------.._.._---------.._...._.....----
U Nature of Repairs or Alterations—Answer when applicable.............................................................................._.................. .
Agreement:
The undersi d ees nstall h aforedescribed Individual Sewage Disposal System in accordance with
i
the provis'ons o T 5 of e St tary Coda— The undersigned ther agrees not to place the system in
oxeratioi nt' Cert too o e as b A iss# by e bo4,rd.o alth.
DaAe
Apion Approved By.......................... --•01--=--••-•------•------•--
Date
Application Disapproved for the following reasons:.........................................................................................................._........
...---•---•--•------•----•-•-•-•--•--------=---------••-.._...--------•--•-------•--------------------------•----...•--•:...-----••-------•-----...---•---•-----•----------r_:_—
Date
Permit No..... - �1 9•••---.....•--•••----•• Issued...............................................•\>-
S,
net':
k.
�;
No.... FEs..... ............_.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town Barnstable
..........................................O F.........................................----------...........•-----.._...........---•--••
Appliratiou for Uispoii al Vorkg Tomitrur#iuu Prrutit
b . Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal
System at:
Lot # 11n6^voodland Ave. . Ext. Hyannis , MA
................_.. -__............._... -- .........-----------------..........----•---------•---•--•-----------------------..............._.
Capricorn RJfflt)rATffzst 765 Falmouth RCMI&;N'iyannis
.............. --...............- .................................=................. ........------------••----------•----..........----...._..........-•---------.....:.............._.
W Steve Lebel Owner Address
a ..----•----•...............•--•--•-....._...---•--............•-•---......_.....................•. ...........-------------------------------------.........------------•-••--•--------
Installer Address
Q -Type of Building Size Lot----------------------------Sq. feet
Dwelling—No. of Bedrooms..........................................Expansion Attic ( ) arbage Grinder ( )
Other—Type of Building Y'anCh.............. No. of persons............................ Showers ) — Cafeteria ( )
04 Oth r fixtures ----------------------------------•---• .
WW Design Flow.......-•5--------------- gallons per pers gT day. Tot , } ' flow - ns.
WSeptic Tank, capacit} d _.gallons Lengt ._g.......... Width..�.v-..... Diameter................ Dept ................
x Disposal Trenci —No..................... Wid *_._..........___.. Total Length----- ........... Total leaching area.... sq. ft.
Seepage Pit No._-_-_-_-._...--- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
z Other Distribution box ( ) Dosin
gf4dde Engineering 11-25-81
Percolation Test Re It Performed by........................................ ._ Date....................___.._.___..___....
a b 1Z' ''""""" none encounte -
Test Pit No. A__._.._...minutes per inch Depth of Test PijT/A............. Depth to ground water. _fA_..._.._._.._.. g
Test Pit No. ................minutes per inch Depth of Test Pi .................... Depth to ground water-------.................
O Description of Soil......._0 — T t.._._foam �c yiNI o1T-
x 2 _---I 0- I�Ie ciiizm""yelZ-o w-"s axid------------------------------•-----•---------------------•---.-.._..-•--•----
W --------------------------------S-a-*...._...1Z- fined:...Wh1te.'sariditfffcee--of---grav�i/yTo...water-_-at---1.2'
UNature of Repairs or Alterations—Answer when applicable.__._..........................................................................
Agreement:
1 The undersi ,ed rees t instal t aforedescribed Individual Sewage Disposal System in accordance with
the provisions a IT = 5 of e St e anitary Code— The undersigned further agrees not to place the system in
r operation unt' a Cer 'ficate _ > e has been issued by the board of health.
-� Pres . 7/5/84
Slgned................. .._--•------................................. ..........................
Ap li ion Approved By--- '-- =' sue:. :` `' v .............4Z- .................
Date
Application Disapproved for the following reasons------------------------------•------•--------------------------------------------------------=---------..._..
........................................................-................................................................................................................................................
Date
PermitNo.----- ......................................... Issued......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS `
BOARD OF HEALTH
Town ...O F.......Barnstable
....................................... ..............................................................................
Trr#ifiratr of Tautpliaaaurr
THIS IS TO CERTIFY hat the I div'dual Sewage Disposal System constructed (X ) or Repaired ( )
Steve Leb.
by........................................................................ -----------------...---.............----------...................._..................-•-------
at------ --------- -- ---- -_--------••-•----- .
Lot ; 11 Woodland Ave_......
. , Ext Installer .Hyannls MA
.......... - --•----- ---•--- -------_----- --- ---.--
has been installed in accordance with the provisions of TITLE 5-of The State Sanitary Co as described in the
application for Disposal Works Construction Permit Nor�'4_"________ ___ .............. dated_ ...I-R-A- 14
_
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS RUE® AS A GU EE THAT THE
SYSTEM WILL FU CTIO SATISFACTORY.
i
DATE................... . ..2�Ea_. �... Inspector
..�
-- ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town OF Barnstable
.........................:.... .....................__.......................----.........
No..�-..---.. ..9 _ FEE........................
Disposal urku Tuuitr ion motif
Steve Lebel
Permission is hereby granted ------------ -----------
to Construct (,' ) R air ( n Individu S wage Disposal S stem
at No. Lot._r ... ._: �oodla :1-1ve . Xt. Hyannis-' --ir'�
-••-•---------•-•-•--•--.......---•--......---- ----•-•-••................
Street
as shown on the application for Disposal Works Construction Permit No..."'..._........ Dated..........................................
LY
...............................
------
/ ............................. Board of Health
DATE----------...7.'..1�2.-�--�--•-�-
FORM 1255 HOSES & WARREN. INC.. PUBLISHERS �'
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LEGEND , oN�
`IEXIISTIN® SPOT ELEVATION '0_4
EXISTING' ' CONTOUR - 0 � -- ` CERTIFIED PLOT PLAN
AHED . SPOT ELEVATION �] . LU �4 G✓owL�wr' ,�l vc, x7 '
DOTE ,The location of any existing underground sewerage, 'N
wells;, or ,othe.r utilities shown on this plaan- is .apprOX7
imate onl as determined from records and/or.Y SAJIJJ 1A.0 lAASS*
1 information,• The contractor is, responsible. for .the .,�4 /
verification of the existing locations in'-the field; $CALEs /'�—4D DATE /D/ /7../g`Y
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�►QRE®AGE ENGINEER
ING Ca IN
CLIENT 1 CERTIFY THAT THE PROPOSED
E413TERE REOISTEREO JOp N 01 BUILDING SHOWN ON THIS PLAN
CIVIL LAND CONFORMS TO THE ZONING .LAWS
DR BY�' .
ENGINEER - RV OF BARNSTABLE, i�ASS. -
712 MAIN STREET CH. BY /v /g
HYANN I S .MA$S. Z
SHEET. OF A E REG. , LAND. SURVEYOR
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