HomeMy WebLinkAbout0192 GARRISON LANE - Health �1_9215ARRISON LANE (OSTERVILLE)
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SULLIVAN ENGINEERINGINC.
7 PARKER ROADIP O BOX 659. ,
OSTERVILLE, MA 02655t
phone 508-428-3344 fax 508-428-9617 .
November 20,2012
Health Division
Town of Barnstable F
200 Main Street
Hyannis,MA 02601 -" -
RE: 192 Garrison Lane,Osterville `
To Whom It May Concern:
As a follow up to our meeting with your staff today,I would Pike to summarize our discussion with
regard to the above referenced property.
• The property is located within the Estuaries Overlay District only.
• The area of the lot is listed as 1.53 acres(66,647 square feet),which can support six(6)
bedrooms per above.
• The existing septic system consists of a 1,500 gallon tank,and two 1,000 gallon leach pits'
with two feet(2')of stone per permit#95-657 issued 3/24/95 (pre 95 Code)_'
• The existing septic system passed a septic inspection in October 2012.
• Calculations show that the existing leach pits have capacity for at least 1,098 gallons per day, '
which can support six(6)bedrooms plus a garbage grinder,and that the existing septic tank
similarly has capacity for six(6)bedrooms plus a garbage grinder pre the 78 Code. ,
The owners of the property are proposing to renovate and add onto the existing. The total number of
bedrooms as proposed would be six(6),plus a garbage grinder. After our discussion,it was decided that
present Health Division policy would allow the owner to go forward with the work with no change to the
existing septic system.
I trust this meets your present needs. If you have any questions or require any additional information,
please feel free to call.
Very truly yours,
Al
J O'Dea,P.E. 11
Sullivan Engineering Inc. y '
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Members of
American Society of Civil Engineers,Boston Society of Civil Engineers
♦ 1
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
192 Garrison Ln
Property Address
LaMantia
Owner's Name
zafa� c2 r�I MA 02478 10/4/12
City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.
A. General Information
1. Inspector:
Frank Nunes III
Name of Inspector
saa
Company Name
Box 841
Company Address
East Falmouth MA 02536
City/Town State Zip Code
508.272.6433
Telephone Number
B. Certification r
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 approve_d system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000).The system:
® Passes ❑ Conditionally Passes. El Fails
❑ Needs Further Evaluation by the Local Approving Authority
10/4/12
Inspe 's Sign a 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.
192 Garrison LnAoc•03108 Title 5 Official InspecffFo : bsurface Sewage Disposal System•Page 1 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
192 Garrison Ln
Property Address
LaMantia
Owner's Name
Barnstable MA 02478 10/4/12
City/Town State Zip Code Date of Inspection
.. r
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E f always complete all of Section D
A) System Passes:
® 'I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are
indicated below.
Comments:
Pumping suggested every 3 yrs to prolong the life of the system' F
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.
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:
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):
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❑ broken pipe(s) are replaced
❑ , obstruction is removed
192 Garrison LnAoc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15
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Commonwealth of Massachusetts
Title 5 Official Inspection Fora
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
192 Garrison.Ln
Property Address
LaMantia
Owner's Name
Barnstable MA 02478 10/4/12
City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ distribution box is leveled or replaced
ND Explain:
The system required pumping more than 4 times a year due to broken or obstructed i e s . The
❑ Y q P P 9 Y - PP O
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)•are replaced
El obstruction is removed
ND Explain:
n/a
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 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
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.
192 Garrison LnAoc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15
r
Commonwealth of Massachusetts
W Title 5 Official Inspection Forte
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 192 Garrison Ln
Property Address
LaMantia
Owner's Name
Barnstable MA 02478 ,..10/4/12
City/Town State 'Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.): }
❑. The system has aseptic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
• a.
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 than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
n/a
r,
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes"or"No"to each of the following for all inspections:
Yes No
❑ ® 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,
El ® Static.liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool'
❑ s ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than Y2 day flow
El ® 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 100 feet of a surface water supply or
tributary to a surface water supply.
192 Garrison LnAoc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
192 Garrison Ln
Property Address
LaMantia
Owner's Name
Barnstable MA 02478 10/4/12
City/Town State Zip Code Date of Inspection
B. Certification (cont.).
D) System Failure Criteria Applicable to All Systems (cont.):
Yes No
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ '® Any portion of a cesspool or privy is within 50 feet of a private water supply well.-
El ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,.for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and.chain of custody must be attached to this form.]
The system is a cesspool serving a facility with a design flow of 2000gpd-
❑ ® . 10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303,therefore the system fails. The
system owner should contact the Board of Health to determine,what will be
necessary to correct the failure.
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.
192 Garrison LnAoc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Foam
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 192 Garrison Ln
Property Address '
LaMantia
Owner's Name
Barnstable MA 02478 10/4/12
City/Town State Zip Code bate of Inspection
C. Checklist
Check if the following have been done. You must indicate "yes" or"no" as to each of the following:
Yes No
❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® 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?
El ®- 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, excluding 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:
E ® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteda related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
192 Garrison Ln..doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of.15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
GnM 192 Garrison Ln
Property Address
LaMantia
Owner's Name
Barnstable MA 02478 10/4/12
City/Town State Zip Code Date of Inspection
D. System Information
Residential Flow Conditions:
Number of bedrooms (design):. 5 Number of bedrooms (actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ® No
Seasonal use? r ® Yes ❑ No
Water meter readings, if available(last 2 years usage (gpd)):
Sump pump? ❑ Yes ® No
Last date of occupancy: Seasonal
Date
Commercial/Industrial Flow Conditions:
Type of Establishment: n/a
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
y .
x Water,meter readings, if available:
Last date of occupancy/use: Date
Other(describe): n/a
192 Garrison LnAoc•03/08 ' Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
w 192 Garrison Ln
Property Address
LaMantia
Owner's Name
Barnstable MA 02478 10/4/12
City/Town State Zip Code Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information: -No history given
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) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known) and source of information:
Original system from 1979 was excavated and moved to current location in 1995 per BOH file
Were sewage odors detected when arriving at the site? ❑ Yes ® No
192 Garrison LnAoc=03/08 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 8 of 15
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Commonwealth of Massachusetts
Title 5 Official Inspection Form tr
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
192 Garrison Ln -
Property Address
LaMantia
Owner's Name
Barnstable MA 02478 1 W4/12
City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
2'
Depth below grade: feet
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Material of.construction:
❑ cast iron ® 40 PVC ❑ other(explain):
>10'
Distance from private water supply well or suction line. feet
Comments (on condition of joints, venting, evidence of leakage,'etc,):
t
Septic Tank(locate on site plan);
1811
Depth below grade: feet
Material of construction:
Z concrete ❑ metal* ❑ fiberglass ❑ polyethylene ❑ other(explain)
Riser to.3" of grade at inlet cover
If tank is metal, list age:
years
Is age confirmed by a'Certificate of Compliance? (attach a'copy of certificate) ❑ Yes ❑ No
--------------------------------------------------------------------------------------------------------------------------
Dimensions: 1500g
311
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle >1
Scum thickness _ trace
>211
Distance from top of scum to top of.outlet tee or baffle
11
Distance from bottom of scum to bottom of outlet tee or baffle >2
How were dimensions determined? measured
192 Garrison Ln..doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15
F
ssachusetts Commonwealth of Ma -
z Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
192 Garrison Ln.
Property Address
LaMantia
Owner's Name
Barnstable MA 02478 10/4/12
City/Town State ' Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Pumping suggested every 3 yrs to prolong the life of the system
Grease Trap (locate on site plan):
Depth below grade: feet
Material of.construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
n/a a
Dimensions:
Scum thickness
t � _ •
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.):
n/a
Tight or Holding.Tank (tank must be pumped at time of inspection) •(locate on site plan)::
Depth below grade: '
Material of construction:
❑ concrete El metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
n/a
•
192 Garrison Ln..doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM 192 Garrison Ln `
Property Address
LaMantia
Owner's Name
Barnstable MA 02478 10/4/12
City/Town State Zip Code Date of Inspection
D. System Information (cant.)
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.): r
n/a
*Attach 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 level w/the bottom of the pipe
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 2' below grade an6 in average condition for its age
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: . ❑ Yes ❑ No
192 Garrison LnAoc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11'of 15
t
Commonwealth of Massachusetts
Title 5 Official Inspection Fora
_ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 192 Garrison Ln
Property Address
LaMantia
Owner's Name
Barnstable MA 02478 10/4/12
City/Town - State- Zip Code Date of Inspection"
D. System Information (cont.) 1
Comments (note condition of pump chamber, condition of pumps and appurtenances,.etc.):
n/a
Soil Absorption System (SAS) (locate on"site plan, excavation not required):
If SAS not located, explain Why:
t
Type:
® leaching pits number: 2
❑. leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system 4 -
Type/name of technology:
Comments (note"condition of soil, signs of hydraulic failure, level of ponding damp'soil, condition of
vegetation, etc.):
Leach pit"C"was excavated and is dry at this time, no distinguishable stain line, no evidence of
backup. Leach pit"D".was probed and surrounding soils are dry and compact.
192 Garrison LnAoc-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15
Commonwealth of Massachusetts.
W Title 5 Official Inspection Fore
Subsurface Sewage Disposal System,Form Not for Voluntary Assessments
,M 192 Garrison Ln
Property Address
LaMantia
Owner's Name
Barnstable MA 02478 10/4/12
City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Cesspools (cesspool.must be pumped as part of inspection) (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 ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan): J s
Materials of construction`
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
n/a
192 Garrison Ln..doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15
Commonwealth of Massachusetts l
Title 5 Official inspection Form,-
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments.
192 Garrison Ln
Property Address ,
LaMantia
Owner's Name
Barnstable MA' 02478 " 10/4/12
City/Town State Zip Code Date of Inspection .
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties
to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.
Locate where public water supply enters the building.
0 - L[
192 Garrison Ln..doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -.Not for Voluntary Assessments
M
192 Garrison Ln F
Property Address
LaMantia
owner's Name
Barnstable MA 02478 10/4/12
City/Town State Zip Code. Date of Inspection
D. System Information_(cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar _
❑ Shallow wells "
Estimated depth to high ground water: >12'
feet
Please indicate all methods used to determine the high ground water elevation:.
❑ Obtained from system design plans on record _
If checked, date of design plan reviewed: Date.
® Observed site (abutting property/observation hole within 150 feet of SAS) .
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database- explain: ,
You must describe how you established the high ground water elevation:
Per elevation to nearby surface water.
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192 Garrison LnAoc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15
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oFWE
' Town of Barnstable
9 LK Board of Health
039. ��� P.O. Box 534� Hyannis MA 02601
ED Mpl
Office: 508-862-4644 Susan G.Rask,R.S.
FAX: 508-790-6304 Ralph A.Murphy,M.D.
Sumner Kaufman,M.S.P.H.
To: LAMANTIA,CHARLES R&A Date Monday,March 05,2001
3 GOODWIN RD
LEXINGTON MA 02173
RE: Underground Tank at 192 GARRISON LANE (cjz-A c"ogle)
Map/Parcel 114005002
Tank NO: 01
Tag NO: 00000
The Town of Barnstable Public Health Division records indicate that your undergroud
or chemical storage tank is 23 years of age,and has not been tested as required under section 07:(5)of th
health regulation regarding fuel and chemical storage systems.
You are directed to have each tank and its piping tested within thirty(30)days of the receipt of this
notice. Results of the testing shall be filed with the Board of Health and the Fire Department.
You are reminded that you shall have the tank and its piping tested during the 10th,13th, 15th, 17th,
and 19th year after installation,and annually thereafter.
Failure to comply with this order may result in a fine of up to$300.00.Each day's failure to comply with
an order shall constitute a separate violation.
You may request a hearing if a written petition requesting same is received by the Board of Health
within ten(10) days after this order is served.
Per Order of the Board of Health
Thomas A.McKean, RS, CHO
Health Agent
Mar 19 01 11 : 68a LaMantia 617-663-9688 p. 1
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March 19, 2001
1 T 1 jr N T I N: Korin Soheible
Town ofBarn:stable Board of Health
From Charles UiMantia
'75i i_xa;�=usjXSZ
1 his 1+yX is reggaralng tn-e 1111a�rground tail-k at ICY l3UMSU11 L KIX, The,tarik Way
removed by the prior owner jm 19.94 before change of title to rite property.
Following are three pages:
• Yohr Ietter of March 5,2001
The hermit fnr the prior owner(Wells)to remove the tank
0 rorojnt Fnr the ud- by ShnrPline Tank S.-Mcc,v,rlated M.T h 24 1 q4Q indi-c-atinggy
a• LWb}a fl, b!Y t_a.L! ,♦ L. .5 _-- _v_ _:
k1Lg4 kLLe Lcz:^.l.Zhu•)i2S3�4Y44u and 4uuY LLVaY rar'yry no aG$11J•. -
i _._...._._;.Y This aesose es Hie SOW ton.
Yours truly, .
Charles Y LaMa"-t1a
1
F
Mar i8 ui ii : 58a LaMantia 617-863-5688% p. 2
Y
JJ 8 \ r! Own
ce A m.I s.� �A- .Y
_ O W n O BAI 11s Iable
/ LV{ll V liv ll Kll
p a/� P.O.Box 534,riyannis ivies loi i
Office: 508-862.4644 Susan i,.RasK,R.S.
A.7..rh; Mu hA!�
FAX: 508-T90-6304 .�w ., �•;.. A,.•. .
Sumner Kaufman,M.S.P.H.
To: LAMANTIA,CHARLES R&A Date Monday,March 0,200i
LEXING1ON NIA 02i7i
RE: underground Tank at 192 GARRISON LANE
MapiParcei 114005002
Tank NO: 01
Tag NO; 00000
The Town of Barnstable Public Health Division records indicate that-your undergroud
or chemical storage tank is 3.3 years-of age and has not been.tested as required under section 07:(S)of th
health regulation regarding fuel and ehemicai storage&ystemss.
You are directed to have each tank and its piping tested within thirty(30)days of the.receipt of this
notice. Results of the testing shall be filed with the Board of Health and the hire Department.
v_,.: - .i s/.�♦ A�i)Via: the)wnk and It.�.nin► o JP f it- rind!e l!?h�1 t!l 15 H H' t
i vu are re�minuc"`';i fat you shall I€ h. r r Cb.S-� U11H,rine,_t!_ t- � ;_ b _1-h,
and 19th year after i1nstwrrgI o%and annually there-after.-
u°lur:t---comply with this ardPr may 1__Olt in-a.fe"e of tip W'$3011.1.00.Each day tallure tq comply whit
all order-shAll con-stltate a separate violation. - -
You may request a hearing if a written petition requesting same is received by the Board of Health
within ten(10) days after this order is served.
Per Order of the Board of Health
Thomas A.McKean, RS C:HO
Heahk Agent
Mar 15 ui ii : 53a LaMantia , 617-863-9688 p. 3
MAR 24 `94 14:44 ALGER & SCHILLING PAGE 3
FORM F.P. 292
ONO 9190)
QS
11p. (bitntnupi#fit � f....-,
i6111 V f-NYII%i :ty
Division of Fire Prevedon and plat n
AMCATION i PERWo AND PERMIT FOR P MOVAL AND TRANSPORTATION TO WROM'LANK YAM
FD1D1 . 0190._._. Permit C Date_.. March ZtX, }0 94,
^sCe:^r:.11e
chy,Town orWoo C .�3 8 .i0
DIG sArz NUMBER
Fee VaidlS in.nn _ 941103455
WWI SCFI start date3/22/94
In accordance with the provipj.nnn 6f Chapter 1481 sea. 3RAt -)f.G,1• t
527 CHA 9.00 application la he 8noic
r;hy made bys iinc ionic 6Ervicc .....
street Addreoo CIE.- or Town!
1.t.... w 7 �w
P.Lg tature of app aL:lciya
For Permission to remove and transport, one underground storage tun'K. fromo
• i��.I3v 792 Garrison Lan#, Oatervi.)je
owner. street Address.
evil ni3. MA-40
Firm transporting waste: State L10.1--
Hazardous waste manifest j L.P.A. f MarlDR2103777—
Approved tank yard! Mid_ city scrap yard
Tank yard Addraast Westpdrt, MA
n''ne of.Adam gaai UL. t$nk - -- -
Soo #2 Fuel Oil
Tank capacitl: Substance.,last stored$
n�a ., , w �! Q1� Date-Ofv 4 1ri�»• April. T 0 94
Date of is&ue i r1arc1h. 24, 19 . enp ra : �' -T—=''
n�ti;r '7 itle of--0f-fica r ant-Ing F: 1tliL:: ��� /t J
3 y
hccP ORIGINAL ORIGINALL AS A ,1Ch11ut: ADD ISSUEDOUP��vATE n� PEReMIT 'W
Mar 15 Oi i1 : 55a LaMantia 617-863-5688 p. 4
M MiiR 24 `94 i4144 RLGER 8, SCHILLING PAGE 2
SHOREL_INF TANK SERVICE, INC..
wt rDCiiu LiccL
usterville, NIA 02655
508-4 Z8-5529
J�vs aye Tank Re-i7ivv'a �8fi�u+)�
Tyne: o,l ._
V Q t7.rWYrwMF�.IW�__.r
Owner;_ MR_n k,Wpk4s
n ui coa--- QR'h :SI: -i=5 0::h�;Y �..,- -----•--- - ------__--
M A%`_T- � t- 1 .
---------_. ... - - r�tei=v_LU�rt l-4Ft0"�►1---__ ..-----......_-_.--- - --_._--.....-..--
Tank '___--_..______________________.._�..��.______
M.►.+R.�_�_.�__--------__ ---- --- _------.�--- .ter..----►--�.
Date Remaved:_�.`���� `Rl.�S4K -- V Aa-Q -- _
Dig Sa fsa3_q�t
Tana Transported To: 381 Old Fzlmv-,nth qd. Unit 6
ITAMM rare l3ggrinatlnn�
Clnek 'i'unit flht }finntinr�• �ml: _. �•`h � n w lam `rh IT,ntc
i 111A I011A i,�r�v4y�auv��.__1��:.t,�..`:�1�.�,t?•4:1� x�stitk}�s f.�..�.,k��r_�.►:Tdtis:1,.__4XY.?G� �
�r l
Comments:__----_.._____________�-__� _-.-.--
_ --------
---------—.. --... ---___-_ _--- __-_.----__---_...w-------:
�___---------r--- -----=_=,_------
TOWN OF BARNSTABLE Of U/ol?j'
LOCATION SEWAGE #
VILLAGE /2, y� /�2 �
ASSESSORS MAP LOT
INSTALLER'S NAME & PHONE NO,Z)/Q.,e--
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type)?P (size)
NO. OF.BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER -P `z a /`jI-J It✓T( y
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
� � �a � k- r
-�
� ��"
i_-_ -- ---, �i � -^ - - - - _ - Ys
� � � �� ��
� ��
�'�,.r - --�_
..
�,, `�
� � - � �
. -, . � ��
�_ _, ��:�rhl�:r
L
ASSESSORS MAp No C
PARCEL NO•
No................-....... Fm$........3.0...............
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Appliratiou for Di-lipw3 al Wor1w C omitrurtion Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal
System at
192 GARRISON LANE OSTERVILLE
............................................................. .................................... --•-•-•----------------------------•--------------•--•-------•--•-•--•-•-------•--••------....----
Location-Address or Lot No.
....................CHAI2LE S...LAMAI`1 .I A...............SAME....... .............................................................•....................................
Owner Address
...............................ARCH...CONST..CO------.--------------•--------- HIANNT-S.................................................................................
Installer Address
Type of Building 4 Size Lot.............................Sq. feet
.., Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons__------------------------------ Showers ( ) — Cafeteria ( )
a' Other fixtures ------------------------------- - -
w Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacityl_5_0 Q-gallons Length________________ Width---------------- Diameter.--------------- Depth___-__--__--....
x Disposal Trench—No_ ____________________ Width-------------------- Total Length.------------------- Total leaching area....................sq. ft.
Seepage Pit No-------------2------- Diameter--------6---------- Depth below inlet-------6........... Total leaching area..................sq. ft.
Z Other Distribution box ( x) Dosing tank ( )
aPercolation Test Results Performed by-_------_-------- -•--•-•-------------------------•--•----•---•---••-- Date........................................
,.a Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water_-.___.-.-____-_-____.-.
L% Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water--.-__-...__--__--___--.
1:4 ----------------------------------------- ----------------------•--•-----•----------._......._•-----... ----------------------------...............
0 Description of Soil........................................................................................................................................................................
x
w
U Nature of Repairs or Alterations—Answer when applicable-----MQUE..._EX_I ST-I-NG---SSPTI-C--------------------------------
------S Y S T EM.--1.... O s t.--.vbox......C2.)....1_Q.Q.Q1p...2.f:_e e t---s-t;.on-e-------------------------------------------------------------••-------
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 is ed by oar health.
SignE -�.----- --- - -------- ------- ...... ....... .......... — ------V24/95:------
Dare
Application.Approved B _
_ Dace
Application Disapproved for the following reasons- ------------------ ---------------------------------------------------------------------------------------------------I---------
...... ............................................................. ..... ..................................... ............ ........................................
Permit No. ..... .: �' v`�. ..��.... Issued cif`_-��----C.f'-. -.....
Dale
No. - Fis........30...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
App iratiou for Diinpmiat lVarkii Towitrnrtinn ramit
Application is hereby made for a Permit to' Construct ( ) or Repair (X) an Individual Sewage Disposal
System at
192 GARRISON LANE OSTERVILLE
......................•------•-•--•--........----.........-•-------------------..._.....---------- ------•----------------------•----------•-----••-•-------••---•--•---...--••-•-••---••----•-••----
Location-Address or Lot No.
....................Ci A:RLES..L,A.MANT.IA,...............Sl M.E..----- -------------------------------•------•-----------•-•
Owner Address
W ARCH CONST.Ca.............................. HYANNIS
Installer Address
UType of Building 4 Size Lot............................Sq. feet
►� Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ..................... ...... No. of persons---------------------------- Showers ( ) — Cafeteria ( )
d Other fixtures --------------------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacityl-5-0-0.galIons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No---------- .2------- Diameter--------6---------- Depth below inlet------- ........... Total leaching area..................sq. ft.
Z Other Distribution box ( X) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................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........................
R�+ ----------------------------------------------------------------•---------------•-----------..............................................
--.------•---.-----
ODescription of Soil........................................................................................................................................................................
W .
U
W
-------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------•------------•--------------
U Nature of Repairs or Alterations—Answer when applicable------M4'_)VF..Sy LS TntrcFpTT-a____________________•_.•-•_____.
SYSTEM -1500..E Db® (?) -l_00:1 stAne .....
..........................••----•.....-•--
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 tth.e boar ..of.health.
Signed . -/_a-..... ..
-::... 3/24/95.
Dare
Application.Approved By .y.,r ...... ------------------------------ �F^'. ..`T-
Date
Application Disapproved for the following reafons: ...........................................................
... .................................................................... . ..................................................
Date,`._.
Permit No. -----.....-.✓ -r.... ...._�`� Issued � � � . �✓�"
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
0:11.Qltifirate of (ILIam fiance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
ARCHCONST.--CO.......... ............... .. .. --------- ------------------_._- ----------------------------------------- -------------------------------------------
by ---------------- - ....... - t�,taue
at .----------.1.9.2......SA.ItR.I.SDN....LA.N.E---------------------0S'TE.RVI LT.E.--------------------------..---------------------------------------------------------------
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. . i...Zv --.....�j� �7 dated'
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT`BE-CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE....... �P.. ....., .s., ------------- - ... Inspec or-....: F=' ---- ----- -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Mopma1 Workii Tunitrudinn "Vantit
Permissionis hereby granted.............. RCH---CONS .... Q...-•-------------------------•--------------.....---•------------------••----•--••-.----•
to Construct ) or Repair (X) an Individual Sewage Disposal System
at No...........1�2...GARRISON...LANE__-__-ASTER.V.1JT:F_......----....................�HARLES__LAMANTIA
Stree
as shown on the application for Disposal Works Construction Permit Nam..:"_1 �llated.����---.
------------------- ' '
Board of Health
DATE--------------------•---•---------`-'•-.._..-----------....---....----•--------....
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS
f
AsBuilt /) Page 1 of 1
TOWN OF BARNSTABLE
LOCATION SEWAGE #
VILLAGES i tE' L`r l AP ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type)13f' �asr •r'�%r �, (size) 3C {
NO. OF.BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER C/N -izle
DATE PERMIT ISSUED: 3/ j/ �%
DATE COMPLIANCE ISSUED: '°"' ��" 7 .
VARIANCE GRANTED: Yes No
I ,
u
I S"rr P
`
IV 6`�• +
http://issgl2/intranet/Propdata/prebuilt.aspx?mappar=l 14005002&seq=1 10/2/2012
No.-----79-nz Fm$.......$.5..0.0........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
......_........own--........O F........Barnstable--....................................................
Appliratiou for Uhipaii ai Works Tomitrurtiun frrutit
Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal
System at:
192 Garrison Ln..e...Osterville� •026. J..
- _.. ..... ...................•----......-•---•••..........------
Location-Address or Lot No.
Gregory Wells 192 Gison Ln:_.__.Ostervillea_ MA._._02655____
........ -----•---- . .............. --
Owner Address
a A & B Cesspool Service 128 Bishops Terraces Hyannis MA 02601
Installer Address
Type of Building Size Lot..... -. .--......Sq. feet
Dwelling—No. of Bedrooms..............5_._._._.__.____..____..__..Expansio Attic ( ) Garbage'Grinder ( )
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ------------------------------- -
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid'capacity............gallons Length................ Width_............. 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 ( )
Percolation Test Results Performed by........-................................................................. Date.................................-----
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water---__--._____--_--_--._.
(T Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------..................
M ----------------------------------••-----------------------•---.....--•-••----------.........--••-•..........................................................
0 Description of Soil........S -•--------••-•-------------------------------------••--•-----------------------------------•-•--•------------------•-•-------•------------------------
x
w
----------------------------------------------------------- ...........---
VNature of Repairs or Alterations—Answer when applicable........Installation_-of-_a__1-.500-.Septic-Tank,_-.
3 d sty taut o� bO � - ns _.a_.1;04Q__ al* pie-ca t..leach- pit..w_.th..eAxa...st.Qne.....----•---.........
Agreement:
The undersigned agrees to install the aforedescribed Individual.Sewage Disposal System in accordance with
the provisions of ii:L�. y g g p y
5 of the State Sanitary Code— The undersigned further agrees not to lace the system in
operation until a Certificate of Compliance has b' n issued by the boar of ItL_
Signe -- •--•- P - 10-6/79------•--
/ �ac.,ps Date
Application Approved By--•----.�--------•---•.... . ...... ..�Z----.. _...........-----•----- ---------••-11/26/79---------
Date
Application Disapproved for the following reasons:............................................................................................................
....-•--•-••---------•-------------------••-------•-------------•---------•--•-------------------•-•-
I Date
Permit No.......... 9'---------------------------------------- Issued.........11A6/79
Date
T FEE........ K�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..................__T own.... ....OF.........Baa-mt&b-e---------------------------------....------••--•--
Appliratiuu for Dhivoii al Vorkg C ontitrurtiou rruti#
Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal
System at:
...192..Gard.&on..Ln.r...astervi1. a,_MA..---026-•5- -----•--••--•------------------------•---------------------------------.--.----------..-.-.------• .
Location-Address or Lot No.
...>_ir"'1.y""�d•__JOL��.........._•___---------•----•------------------------------•-• _�7{-__►sC4A.7-iS�n. �4...o.�te ..a .4beLCT..'"FtL----O2645---
Owner Address
a A..&__B..Casspos>l Service.......................................... ----02602...
Installer Address
QType of Building Size Lot............................Sq. feet
U Dwelling No. of Bedrooms................ .Expansion Attic Garbage Grinder
pa,, Other—Type of Building ............................ No. of persons-------tY.................. Showers ( ) — Cafeteria ( )
QI Other fixtures ..................................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity------------gallons Length................ Width................ 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 ( )
aPercolation 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........................
------------------------------------------------•--•-----------....................••--••••--•-••---------------•----...........-••••---•••---•---..._......
ODescription of Soil.........Sari-............---------------------------------------•-----•-----------------------------------------•-----------------------------------.------------
x
---------------------•------------------------------------ ----------------------------•------------------------------------------------------------------------------------------------------------•---
U Nature of Repairs or Alterations—Answer when applicable_______-Installation..of_a..1, 0l1__SEgtiC-•'?'2tik�--
-Z-Aistribut-lon..tox....and--a--1r000..gal.--P -cast.•-.leach--Pi:t---w4th.-extra--stm-a..------....--•---.......
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal 'System in accordance with
21/'1''iT E
the provisions of[ 5 of the State Sanitary Code— The undersigned furtt:er agrees not to place the system in
operation until a Certificate of Compliance has bei6n issued by the board,of-health.
_�Yl
- -
Si n d.---�-----••--•--.G �• �- - a ....1,1�26�!.9--_..._
Date
Application Approved BY ---�`"�•-I Z�•7,f,,-'*
••......-----••--•--... ----------•-11/26�179-•--•---
Date
Application Disapproved for the following reasons-------------------- --•---------------------------------------------------------------------------
-•-•••-••-•••--•---•-•-••------•-•-•----•--••-•------••••-•---•--•••-----•••-•...............••----•-•-...--•---•-•-••--••--••--------••-----•---•-•-•-------•--•---------•-----••-------•-•••--.........
Date
Permit No.------...Z9m--------------------------•-----------• Issued-.........11/26/79...........................
Date
w>v
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF , HEALTH,,
........................Town.....,..oF...........F.a=gtalalga................................................
(Irdif iratr of TuutpliFaurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (x)
by...A-- __B Cesspool--Service,-_•128-B shoE -Teri'ice►_..?:- ?in115,__1`?A.....02601-----------775A.?------------
e - Installer
at__19.2..Garrison Ln.,.._Osteryille,--NIA-----02655_---'--Gregory--Wells-.....--.....•.................................
has been installed in accordance with the provisions of TI T LE j of The State Sanitary Code as described in the
application for Disposal Works Construction. Permit No.......79 -.-•-__----_- dated .._ _!1/?6/79._-----.
f
THE ISSUANCE OF THIS CERTIFICATE SHALL NOY� ;A CO RUED AS,# GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DAT I:........... ..................................................
..................................•--• Inspector_. .....................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........................'.f.'.oW.n........oF....,'BBsrnstable.......................................................
No..... FEE....$5.,00........
�iu�ruuaal Turku �uat��rur#iuu rruti�
Permission is hereby granted....A & B Cesspool_Service,_ 128 Bishops Terraee�.._HyApAis-t...MA... 02601
to Construct ( ) or Repair ( x) an Individual Sewage Disposal System
at No...lg2-Garrison Ln.a Osterville.e._MA �Z6 ........ G ° dells
Street / /
as shown on the application for Disposal Works Construction�mit No. ..79-..__.____ Dated..........11L26!79.............
. - ..........................................
DATE.............
�,/ /79 o Ith
.`,1T/
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
`n
ao
Fizs... .:'.-.
U V THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1�
Appliration for Disposal Works Tomtrurtinn Vamit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
....-•--•-.......................... ....................................... .........-------•-••--•---••-----------------------------------. ------------. -----
fI J oc tion--Address 4 :or
.�.�. •---•----•-----..•..................... ...1../.�...... G�..Y'v` ' I ��`'' !'�.!!.�_ v a
j _.._
t IS
Ownez J ....! s Y
►W-a .......t�.. je Installer
1 ................................ I V. ..........
P InstalIer Add ss
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms------ -_------_-------_-•-___-_-•Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Oth71.9
r fixtures _________________________
W Design Flow....... ......................__:,gallons per person per day. Total daily flow............................................gallons.
1:4 Septic Tank—Liquid capacity ...gallons Length................ Width................ Diameter---------------- Depth................
Disposal Trench—No. -------------------- Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------(------------ iameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box (` Dosing tank ( )
'-, Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water----------------_-----
4q Test Pit No. 2................minutes per inch. Depth of Test Pit.................... Depth to ground water.....................
P4 - -
- -- ------ ----
ODescription of Soil--------- --- l.6 --- ..._.. _.. ..f. ......--•---••-•-----------------------------------------------•-----------------------------------------
x
(� ---••--•-•---•---••--•------•-• ------
-------------------------------•-------------•-----------•------------••-•------•-•----•--•--•-------------•------------------•--•------------•----
W `_..... ,� c
•------. . j
UNatures o pairs or egations— nswer when applicable...
0
............................ ..... ...........................................................................................................................................
Agreement:
The undersigned agrees to, install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of i i _:;�. ;of the State Sanitary ode—The ndersi ed furt agrees not to place the system in
operation until a Certificate of Compliance has an sued by the f he
Signed --- ------------- •. --- ---------- .........................._ ------------------•--•-•--------
9 Date
Application Approved By.................. --__ ..
Date
Application Disapproved for the following reasons:-------•-------•----------------------------•-----------------•-------------•--•-••--••----••---------------•.
-----------------------------------------•--•---------------•--------------------•----.......------------•------•---•-----•-----•-•-----•-- ......................................................
Date
PermitNo....... ' ------------------. Issued.......................................................
Date
_t`
No. .. Fizz a ................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............ ...........................OF.........................................................
Appliration for Dispatial Works Cnuntrnrtion Vrrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
..... _ _ --------------•----.....-•-•---------- -----••-----------------------.�----------•--------------------------.-•-- ...
Lesat:on- A.ddress )� t or t No. /�} �p•�
C -----•--------------------------------------------• f rA'................�� -•--�-�-:.f.... ---- --Y U 1 '
W Owner Q / dressy/
...... ...... Q... 1 nh.k:l..•-•.............................. °� �-.....--�•.-� . = .f/_Gl V N°�C?tl .. _.
....
Installer Address
Q Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms-__-`....................................Expansion Attic ( ) Garbage Grinder ( }
04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Ot er fixtures ____________________________
W Design Flow.....A_Q......................,J J_gallons per person per day. Total daily flow............................................gallons.
1:4 Septic Tank—Liquid capacit/.,�-..---...gallons Length................ Width................ Diameter---------------- Depth................
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft.
�t Seepage Pit No------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water---------------------_..
f=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--------------------
----------
(� -
O Description of Soil.......Yh------- ----_------ ...!A.!n.. . ..........••---•---•----------•-•--•-......------ -•-........._...------•................................
- r
U ---•--- ------------------------------••--••---•---••--------------......-•----------------------------......---------------------------------------------------------------------••-......----------•--
W Q -
U Natu;e if�epairs or lterations �nys`wer when applicable.__.�__✓t___�______�.�._>�--------__-._....__!...:.........:.f�..._�/---.
V ---------------------
w 1......--•-----••-•--•---•�
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T iTLE 5 of the State Sanitary Code—The unders' nZturer agrees not to place the system in
operation until a Certificate of Compliance hV. enssued by the o d o
Signe ... . .-- ..........................
Application Approved BY -P"" - ate
-- -----------• --------------------.........
D
..................
Date
Application Disapproved for the following reasons:-----•--------••--------•--•-•------•-------•-•--------•-----------------------•---------------------......----
----•--•-------•-------•---------------------•--....------•-•----•--•-•-----••-------•.....---------•-•--•••---------•-------•----•-••-•--••---•-•-••••------------•---•-••-••-------•--••--•--•-•------
Date
PermitNo..... -- --------------_--.. Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
{ .........................................
C�lertifirate of ToutpliFanrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired`k�<)
-by ----- -•--- --------------•----------•--•--••---..............--•---......••-------••---•------....--•---•.
Innstallerstaller
has been installed in accordance with the provisions of TI T IE j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No---- ........ dated_-------------------------
....................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..................2...'. �.. _�_..... ............................. Inspector.---- -- --........--•-- .c'"'--=`-::: ...._........_........---•-----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
y OF ................ F nr ,.,_......
Disposal Workii Tongtra ion rrntit
Permission is hereby granted..........rt.'J'' ...................
to Construct ( ) or Repair )-an Individual Sewage Disposal System
at No............1_..:K. .... - == 'p!"^ ....L_ ..................0 1_r
........................................................................
Street L
as shown on the application for Disposal Works Construction Permit No 7:__ 7 Dated.................................:........
........... .. ......... .. .�Crrse^^�^..--•-- •-^---------^-------..__._....-----^
� � Board of Health
DATE...............................................................................
FORM 1255 HOSES & WARREN. INC., PUBLISHERS