HomeMy WebLinkAbout1800 IYANNOUGH ROAD - Health 1800 Iyannough Rd.
Hyannis
A = 254-016
3
TOWN OF BARNSTABLE
LOCATION �, � vc k4W SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT . (7
INSTALLER'S NAME fa PHONE NO. vc� a L -,;'t�o,� �./� Cam. 91:3
SEPTIC TANK CAPACITY � �. �� .� lSoe ���Q rP4S� fi✓�,D
LEACHING FACILITY:(type) (size)
NO. OF.BEDROOMS PRIVATE WELL OR PUBLIC WATER
OR OWNER
DATE PERMIT ISSUED: ��
DATE COMPLIANCE,ISSUED:
VARIANCE GRANTED: Yes No j
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TOWN OF BARNSTABLE
i,,G.A"10N IC1 LZ ��e,vc � �g�,�,Pr%uEWAGE # J�- /
VILLAGE ASSESSOR'S MAP & LOT _ (�
INSTALLER'S NAME & PHONE NO. e4�i
SEPTIC TANK CAPACITY � . e;c•�� •� �`�oe �/prPSS� ✓�.1J'
LEACHING FACILITY:(type) (size)
NO. OF-,BEDROOMS PRIVATE WELL OR PUBLIC WATER
OR OWNER
DATE PERMIT ISSUED: 30
DATE COMPLIANCE ISSUED: `3 i
VARIANCE GRANTED: Yes Now%
'hi W
Q _ O GIN
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N
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r
s •� ASSESSORS MAP NO: 2
PARCEL NO: Co
No.... ........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Appliration for Diopooal Ourk.6 Tomitrur#ion ramit
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System a .
......................f.5%j-................... ..-
Locij7 Address G (� or Lot No.
Owner Address
W
Installer Address
UType of Building Size Lot----- ............ eta
., Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons--..---.---.-_--._-_-_.----- Showers ( ) — Cafeteria ( )
C� 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. I----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water_.--_-.---_-___-_-_-.---
(14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water_...................... '
--•-----------------------------------------------------------------------------•--••--..........---.........................................................
0 Description of Soil........................................................................................................................................................................
------------=-- ---------------------------------------------------------------------------•------------------r�--�--,-,- ------------------------------- --------- ...
U Nature of Repairs or Alterations—Answer when�ap�licable...__.--f- Jam!-fit"_.._.._ . 5._. ______to................
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 board ot health.
Signed ,,. .. .....:. ....... ......... ---
,_ Date
------
Application.Approved B �y
4//��" / Date
Application Disapproved for the following reasons: --_------------------- ---------------------------------------------------------------------
----------------------------------------------------------------------------------- ------ -----------------------
Dg
Permit No. �--�: 7..................................... Issued ..............-
Daze
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Ter#tftratr of TomplinurE
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by ..... ...._..... . .......... .. ..... ......................------------------------------ ---- -----------....-
Insrallrr
at .... . .1f—........ ------ ----------- ---------- ------------------------
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. -9-17 ..__..---- dated ..----- -- --.--_:-
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.. .................. .. .......................... ---............. --------- Inspector ---- _-----------...._...--------- -- -----------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Q n TOWN OF BARNSTABLE d
No.l.... r FEE.
�t��nstt1 nr�� �un�#Milan �rruttt
Permissionis hereby granted---------------------------------•-----•--•-----.............................................................................................
to Construct ( ) or Repair ( an Individual Sewage Disposal System
atNo...... U•k4 ------: --------------------------------------------------------- ------------------------
Street Cj_�
as shown on the application for Disposal Works Construction Permit No------------------- Dated....--:�-....30 .
`�- -�
Board of Health
DATE. ........................
FORM 38309 1 9"S Ei WARREN.-INC.._EUBLIS"ERS }
i
F
�.^
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No. - _ _ F>ms.......���..............
THE COMMONWEALTH OF MASSACHUS TTS--
60AR® OF HEALTF
TOWN OF BARNSTABLE
Appliration f ur lli�vngttl Mirk.6 Tomitrnrtilan ramit
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at yyy
d
.....................................................�2--•••• a' d. -
-------- -------
LocaGo'}-:\ddress I / or Lot No.
:..�— b 1 ` t- --r--J.
---- ----- f X' -. ... °e - ------------------------
W Owner � ddress
t / .....................................................
Installer
v Address
U. Type of Building Size Lot---- --•••---
�-, Dwelling— No. of Bedrooms--------------------------------------____.Expansion Attic ( ) Garbage Grinder ( )
aOther
—Type of Building ____________________________ No. of persons-________.__-.._-.-__--_._._ Showers ( ) — Cafeteria ( )
Otherfixtures ---- ---------------------------------------------------------
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. I................mmutes per inch Depth of Test Pit-------------------- Depth to ground water_._._..________-•-----_-
' fit Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
1:4 ---------------•-• ---------•--------------•-----.......-•-•--......_....-•-•---•--•---•---••-------------•-•-------•--......--•••--•-••-••-•-•--•......•...
0 Description of Soil.........................................................................................................................................................................
x
U .....................................••••••...--••••-••-•-•-••---•--•---•--•----••-•--•••--••••••---•-•----•---------------------•••-----••-•----•--•--••-•---••.............••--••--•--•---•••-•-••-•--
W
x -- -------V•-------------1--- --------•----------------------
Nature of Repairs or Alterations—Answer when applicable--. ...__ c'n.�_ -_______ _�_!,_ _____ _ -� 1.1 �_.............._.
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 board of health.
Signed.- = --------- -------------- .� -----.--------------- -- - - _:.-..-Dace
Application Approved By ..................... - f-- ^ s 0
------------._.................._.-----------...-........------ ...... --.....Dace----------.------
Application Disapproved for the following reasons- -------------------------------------------------.-.------------------------------------------------..._..-..-----------
........................................ .-.----------------------------------------------------------------------------------------------------------------------------------------------------
n n e
Permit No. --.-.-7.-�--- --7��---..-..-_------------- Issued _ -.-..-...3 0 —
.... ----------
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
C ertifiratr of Compiianre s
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
g P Y ( )
by ------------------- __._.- .....................................................
hsianec
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. -�1� �..�r'-.�.. 3.._....... dated .-----3_.-_3 --.- e
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-------------------------------------_.-..--.-..-._..---------__ ---------- ------ Inspector .----------------------...----------._..._._._._--------------- --------..--------
TOWN OF BARNSTABLE
LOCATIONEWAGE
VILLAGE 1401 Qn +� ASSESSOR'S MAP & LOT . v
INSTALLER'S NAME & PHONE NO. - 1 e"ri l-'rac,/
SEPTIC TANK CAPACITY ���. ��� lSoe +�QrPsSf-
i
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS .lam PRIVATE WELL OR PUBLIC WATER
OR OWNER
DATE PERMIT ISSUED: Q -
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
-5
c3 Ve�S 5U�
sue`` �� �►✓
A re to
J
V_ y
TOWN OF BARNST,ABLE
SE'rVACiF �
�r
t !'✓ ✓
ASSESSOR'S MAP & 1
1NSTAL.L.E€{'S N A14E P:tOi•T NO �SyY!�CL::'l c(P L .T
3�
SEPTIC TANK CAPACITY _.__..._.1�� o�ai/ r P l , '
j:
LEACNWG FACILM' ::(v }
NO. OF BEDR00.mS 4''.__-.
Opt C`VNFtt
PF2341 DATE:---.�_�_____-i�1�LL'•�t�E 1DA1'E .�_ _ ._______..r_._
Scpamtion Distance Betwetn the _
MLvX Tium A<Ijuited Ctrit::1�iwat'.c TiNt uid Bono it (,f l-cacrans F%:,Liv
Pmate water Supply Wtu a,7.:..,r_ LIng Factor( JJ any w0s east
on site or witfun 200 fnec of leactung facility)
Edge of Wetland and i c&chmg'Fwil:ty (It an-, wetlands east
i within 300 feet of lextung facitira) Feet
iFurnished
fie/A
k v / IPA/ Ovt
I
ATt .
,e C -jv
TbWN OF BARNSTABLE
'LOCATION �� /3�- SEWAGE # 7` 3 ®o
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY �QQU
LEACHING FACILITY:(type)
NO. OF BEDROOMS_�_PRIVATE WELL OR PUBLIC WATER
,aWtE) OR OWNER C':0 Go 0/t
DATE PERMIT ISSUED: / 7
DATE .COMPLIANCE ISSUED: /n ° 2 !:4- �l
VARIANCE GRANTED: Yes No
f
I
-L.
Y_
1 �
THE OMAO N F rsO0RDF 6EALTH AV
OF.._.... .. .. ..........................
, ppliration -for R-opmi al lVarkii Tilaaitrurtioaa Vrrtuft
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
s
.AT•---•-•-- --------------------------------------------------------•-- -�-
L ion- ddr s or Lot No
ow ` l Address
...... '_ �� y -- -----------------------•---•--•--• -----•------•--•-•----------------"--------
Installer6 Address i
Q Type of Building Size Lot----------------------------Sq. feet
Dwelling—No. of Bedrooms............
Expansion Attic ( ) Garbage Grinder ( )
pi Other—Type of Building'CLA __7.__-_-__ No- of Expansion Attic
Showers ( ) — Cafeteria ( )
Q' Other fixture
Q ;�--------------------------------•--------- �•_
W Design Flow..... �._ ..................gallons per persoa-fir day. Total daily flow........../._S�_®_S�_......._.._.gallons.
WSeptic Tank-t-Liquid capacity.74 gallons Length---------------- Width_............... Diameter_---...-----_-_ Depth.._.------------
x Disposal Trench—No-
No_ ____________________ Width-------------------- Total Length.................... Total leaching area sq. It.
---fed -
3 Seepage Pit No..-.I.............. Diameter-------------------- Depth below inlet_______ ___..__.____ Total 1 aching aY--'4 stl. It.
Other Distribution box Dosin to}� --
Z Percolation Test Results Performed b .- 11i _�__ �............................ Date,, _�---/_f'_-7_
Test Pit No. 1----------------minutes per inch Depth of Test Pit._. ................ Depth to ground water..-.--__.--_. ---._-___.
ri Test Pit No. 2----------------minutes per inch Depth of Test Pit_--___-_____________ Depth to ground water------------------------
----------------------------- _.._..-•• -•---••-•••---•---------------
x
• -n �= S� --1--.. ............
D ription of oi . .a....... .7.... .....
U --- -----------------
-------------------------------------------------/-
U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------
----------------------
------------------------ ----•-----------------------------------••-•----•-•----------•------------------------------------------------------------------------------------------
Agreement: ,
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance witli
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
igned...... ........ -•=---- ------ .................. --------------------------------
Date
Application Approved By----'"---- ---- •. Y 1 --�r'� �' r--
Date
Application Disapproved for the following reasons:.................•-•----•-------_----_---- _-__-__----• --------_-----_-_..b
......__._�
---------------••-------•-------------------- .--`--0 -7
�. pate ��
Permit No......................................................... Issued....................... -``
•----•----•--•---•-•--
Date
t�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF...... '�` .............
ApplirFation -fur M,gpr ii a1 Works Toustratrtion Permit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
---=--------------------------•---•-----•-------------...------------------------....•------•----- --------•--•--••------•----=•-••-•-•-•-•-•••••-----•-----------•------•-•-•-•---•••-.....-----•--
Location.Address or Lost No.
....................... e t+,O h�as ' .... "�ls'«... � - '
--o
Wa Own r Address
Installer Address
Q Type of Building Size Lot.................... .Sq. feet
U Dwelling—No. of Bedrooms------------
________ __ ________Expansion Attic ( ) Garbage Grinder ( )U
Other—Type of Building t:..x-- No. of ersons____________________________ Showers —
a g ------- p ( ) Cafeteria ( )
QOther fixtures-----------------------•-•-----------•-----•---•-------- -------------------------------------•-----•-•--•----•----------•-----•-----•-------•-------
W Design Flow..... t.._%to .. ..................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 tre t;_ -..sq. ft.
Z Other Distribution box ( ) Dosing tank ( ram
a Percolation Test Results Performed by.- ► .
-------- --•---- 'lyre
` J
Test Pit No. 1_____,__________minutes per inch Depth of Test Pit.... ............ Depth to ground water-..r-----_--_-:----.--.
(.4 Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to' ground water................____----
-----------------------------
Description of Soil---6"- "°' -- 5 '1k awg="r ' - ---------------------------------------------
x
U
W
x -----------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable---------------------------•-_-_--.----_----_-__-__-••.------__:--.--.-..---.__-___-_-.-__---_
.--•------=-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of healt .
ligned ^1
.---' �, �
I Date
Application Approved By... `" w� ;-+ -s Af t ------------- ......... ...
rDate
Application Disapproved for the following reasons:............................. --•-•-•-- •-•---------........•
-•••••••-••••-•-••--....•--••---••-----------------------------••----••...---•---•--•--•••-••-•--•---•---•••---•-----........._..-------•-......-•------------ ••--•--• ................................
Date
Permit No...........
- Issued
Date
THE COMMONWEALTH OF MASSACHUSETTS / T�
BOARD OF HEALTH , iz � ��
OF........ .. .f', �'�s. '•r�G..... ,�.-'....... ...
F �7
(erttf cite of f�nmpittaure Yea��/''
T , ISMS TO CERTIFY; That the Ind- du ;Sewage sposal System constructed (�) or Repaired ( )
'by ... z �., ..,_. r
�:. ? Install
at_...-^": - --"-°'tom-'-�_-- --•--� • -�°-- •�-'--•------�a f�---'----- - -;;�? --'•'.�='"`-t�-�t�.�. -c-°^�------------......................................
has bee installed in accordance with the provisions of :Article XI of The State Sanitary Code as described in the
dated 2..,:✓. ..��-application for Disposal Works Construction Permit No............:.: ::. _.. �-••..
THEASSUAN.CE OF THIS CERTIFICATE SHALL NOT BE CONSTR ED AS A GUAR NTEE THAT THE
SYSTEM WILL,FUNCTION SATISFACTORY.
DATE -_ ' �' ----------------7...._. Inspector ---
THE COMMONWEALTH OF MASSACHUSETTS —�
OF HEALTH y r�
Al14
...........f '' r
No .�� ......... t
FEE........................
Bi p,agal( orkii To,iftitritrti a t1wMit
Permission is hereby granted.... Y` _ ^I�'"-` ---- --. A-- L----•----••------••-------
to�Construc,t/(� ) or Repair (i ) P"pf Individual Sewage Disposal S
�� .►
atNo 2wr - ✓ . � ' `- s� ............... ....... ...........• ---'-......-•----------.....----------------•-•.
Street '
n PermrtVNo.-.:____- `5 --". D ated _ _ '._..........................
as shown on the application for Disposal Works Constructio _.__.
— . .....
gg Board of Health'.
DATE---�!^......... .........;7.��_.........................................
RM I255 HOBBS,& WARREN. INC �PUBLFSH,ER3 +.;:-./
`PPLICATION FOR SITE PLAIJ16VIEW FOR OFFICE USE ONLY
• DATE' RECEIVED
ACTION DUE BY
LOCATION '
.eqa I Description,, of•Deeds Book 6851 Page 298
'lanninq Board Subdivision Number: N/A
.ssessor' s Map and Parcel Number: Map 254 Parcel
roper.ty Address: TYannijap'Road. Hyannis;'-Ma. 02601
OWNER- OF PROPERTY APPLICANT
lame r1uh Realt7Trust Name: Same as Owner
Adres : Address:
Attn: Fordie H. Pits Jr., Trustee
'hone: 162-2�06 Phone:
ame GINEPa AGEBill, Nye Name Jos ph Keller n Trusteapplicant )
tddress:812 Main Stredt T' Address r FFnnrr 19�j�e. H. Pitts, Jr., Trustee
Osterville, MA 02655 c/o Iyanough Hlil U01Z Course
'hone: 428-9131 Phone: 362-2006
STORAGE TANK-(S) none known at clubhou JLI9•JES ZONING CLASSIFICATION(S)
KISTINO PROPOSED Setirer • District: RF '
Number: 0 Hunberr 0 Public ' no Flood Hazard: no
sizal' 0 Size: ' 0 Privata�s .Froundwater Overlay: GF
Above. Ground:•_p-• ' Above- Grounds 0 ' Pipe Distniot:Bar�nstable 125 acres
Underground;^ 0 Undergrounds Waters LOT AREA: M;zXAg•
Contents: 0 Contents: 0 Publi•o Yes '
r Arivate: NUMBER OF BUILDINGS
"Fire Froteotion: Yes . Existing:
PARKING 'PS RACES ggRB �ETS •- Proposed: 0 '
equiredsnot cleermktjilgs 2 ,. lectr,tcal;... Demolition: 0
rovided. '163 Propo.sedt_ 0 • ' Arial: X
n .Sjtos 163 To Close: 0 Undergrounds•••, TOTAL FLOOR AREA (in 9q.ft.
of Sites— 0 Total: 2 Gass Residentials 18m
Natural: x Officer 800 I�
JN_HTORJCAG DIS3RICT;( gg}_ (no) X Propane: -no , Medical Officer N/A
* Commercial: 9000 s.f. total gc
IN_AJtEA ,OP_ CRI?JCAL ENVIROSMENTAL (specify use) clubhouse, prc
C��NCEFN(E G.E..A:�s ���3��X (n0)X' rAataurant, Locker• room,
_ Wholesale no
F Fc) WI�N l00' OF•WETLAND RESOURCE AREA: no
ugR)_ (no)X Institutional,_
TOWN OF BARNSTABLE Industrial:
SITE PLAN REVI7W
* conference room, maintenance t
MAY 1
`-r,0 BE REVIEWED BY^lABU1LDING, comhzSSLONER: •
.Zoning District
RF -
Old King's Highway .District NO or
NO
Listed tri' National .-and/or. State "Register of Historic Places
Perimeter. set 'backs:' Front •''100!
Side 15'
• Rear . E. '15' ,
Lot Coverage 8700•'s.f. Or * 0.100
Type of Use (zoning) golf course
Flood P2ain Zone C
Elevation 60'' to' 80' N.G.V09:.
Number 'Of Floors.. 3
Floor Arear ,lst. 4500•
•9nd • 451SO .ti:,.• ..,
Other.. (speclfV) • 4rd•- .800 s-f•• office -meeting room
Narking Requirements: Required • not defined
Provided 163
Handicapped Spaces, 5
Are there, accessory .buildings•?'- yes;.
Acaessory•••Buildings FI.00r Area 'Agiintenance'building - 3600 s.f•.
dwelling 1800 s.f. .
PLEASE PROVIDE A BRIEF,. NARRATIVE DESCRIPTION OF YOUR PROPOSED PROJECT.
An addition of 30'x 381.is requested-This will enlarge the dining room to seat 150
people within view of each other. There is existing seating for 150 at banquets, but
it is scattered.. This will increasb the•seating •capaoity by 24 seats, all on the deck.
parking lot will be expanded 53 -spaces. There will'be•a new free standing sign to
* replace the old sign'. The sign will'. x - (5r 65 s.f. The top of-tite sign wi be 9'
1 assert ..tHat I have completed (or gaused to be completed) , this page , the
Site Plan -Revi-ew Application and the checklist on the back of the
application and that, to the best of my kVeent�rance
e information
submitted here is true.. . . .. . � '
• s (date)
* above the ground. There is a new fence proposed with a height of 361 .
4�AM`ER & NYE, IN CO.
Professional Land Surveyors and Civil Engineers
812 Main Street •Osterville, Massachusetts 02655 Tel. (508) 428-9131
FAX(508) 428-3750
WILLIAM C.NYE, P.L.S. - President PETER SULLIVAN, P.E. -Vice President-Engineering
RICHARD A.BAXTER, P.L.S.-Vice President
May 10 , 1995
Mr . Ralph Crossen
Building Commissioner
Town Hall
Main Street
Hyannis , Ma 02601
Re: Iyanough Hills Golf Course
Rte 132 Hyannis
Dear Mr . Crossen :
Enclosed are seven copies of the Site Plan Sheet 1 & 2
including drainage calculations . Seven copies of the
Architectural Plans Sheets 1 & 2 . Seven copies of the Site Plan
Review Application and seven copies of a letter to Mr . Crossen
dated May 10 , 1995 concerning parking requirements .
If you need more copies or information please feel free to
call me.
Very truly yours ,
r Ny
S.
Pres
P.C. Joseph Keller
Ronald Silvia
WCN :slg
MEMBERS OF
CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS/AMERICAN CONGRESS ON SURVEYING AND MAPPING
MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS
I
r,
*BAXTER & NYE, INC.
Professional Land Surveyors and Civil Engineers
812 Main Street •Osterville, Massachusetts 02655 Tel. (508) 428-9131
FAX (508) 428-3750
WILLIAM C.NYE,P.L.S.-President PETER SULLIVAN, P.E.-Vice President-Engineering
RICHARD A.BAXTER, P.L.S.-Vice President
May 10, 1995
Mr . Ralph M. Crossen
Building Commissioner
Town Hall
Main Street
Hyannis , Ma 02601
Re: Iyanough Hills Golf Course -- Parking Requirements
Rte 132 Barnstable
Dear Mr . Crossen :
Iyanough Hills Golf Course has engaged Baxter & Nye Inc .
to examine their existing parking situation with an eye toward
obtaining site plan review approval to add a 30 'x 38 ' addition
to the diningroom.
The reason for the addition is so that 144 people playing
in a tournament can be seated in one room for a meal . They are
now feeding 150 people by utilizing the present diningroom, bar
and deck area . The deck seating for banquets will be eliminated
if the addition is approved . The bar/lounge area would be used
by other than those at the banquet . There would be 24 seats
maintained on the deck to be used in good weather for cocktails .
Based on the above there will be no increase in parking
requirements due to the addition . We are however informed by
the club that the present lot is not adequate for the maximum
use.
Iyanough Hills Golf Course is a privately owned facility
open to the public on both a member basis and a daily fee
basis . There are about 75 members . Reserved tee times are
available. The only time the course is closed to a member or
public play is when a tournament is scheduled . The members are
informed in advance.
An interview has been held with Mr . Joseph Keller,
Partner, Fordie H . Pitts , Jr . , Managing Partner and Allison
Jones, Food & Beverage Manager . The following information was
obtained .
MEMBERS OF
CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS/AMERICAN CONGRESS ON SURVEYING AND MAPPING
MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS
f
Maximum parking is required when a tournament is held at
the course with a "shot gun start" . That is , all golfers start
at the same time, eight on each of the 18 holes . These same
participants would return for a banquet in the evening . The
course would be closed to other players at this time. However ,
at the end of play in the tournament the course would open to
the public. This would occur at about 3 : 00 p.m. In addition
there are tees for 40 golfers at the driving range.
There is a bar and lounge area with 50 seats used by the
golfers for lunch or drinks during or after play. There is now
seating for about 150 persons by utilizing the present banquet
hall , bar & lounge area and deck. Twenty-four seats would be
retained on the deck. There is an apartment in the clubhouse.
The apartment is now being used as an office and meeting room.
I was also told that when a tournament is scheduled the help at
the course will park at the maintenance area where there is
generally unlimited parking .
The following is my analysis of the parking required to
accommodate the maximum use.
144 golfers (tournament) ( 18x8 @ two per car = 72 spaces .
50 lounge & bar seats @ one space/3 seats = 17 spaces .
Deck seating - 24 seats @ one space/3 seats = 8 spaces .
Driving range - 1 per 2 tees = 20 .
Players on course after tournament 9 holes x 8 players/
hole divided by 2 players/car = 36 .
Apartment/Office = 1 .
Total required spaces = 154
Total existing spaces = 110
Additional required = 44
Our plans show we can 53 spaces for a total of 163 .
There are an additional 24 seats proposed on the deck.
Hopefully this will meet your approval and site plan
approval can be obtained, assuming all other requirements are
addressed .
Feel free to call if you have any questions or wish to
meet to review this matter .
Very truly yours ,
6 r Nye
i y . L.S.
President
WCN :slg
a
METER % �T l3 Z �-� P�►-� 1�tS
i SULLIY'AR
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McKean Thomas
From: McKean Thomas
To: Ritchie Carol-Ann
Subject: lyanough Hills Golf Course/SP#51-95
Date: Friday, May 12, 1995 5:19PM
I am in receipt of the above referenced site plan review application dated May 12, 1995 and offer the following
comments:
This is an expansion of use of the facility served by the septic system. Therefore, a DEP certified onsite sewage
disposal system inspector must be hired by the applicant to inspect the septic system as required by Title 5,the
State Environmental Code.
- A professional engineer or registered sanitarian must calculate the proposed usage and determine if the
existing three 16'X 12' leaching pits can accomodate the overall flow. The applicant proposes to add 840
gallons per day by adding 24 seats on the outdoor deck. The existing septic system was designed in 1974 to
accomodate only 32 dining room seats, 28 lounge seats, and 125 golf rounds per day totalling 4805 gallons per
day. It appears an additional leaching pit.is needed.
-The existing grease trap is only 1,000 gallons size which is designed to accomodate a maximum of 66 seats.
This proposal appears to exceed that maximum number. Therefore, a larger grease trap is required.
-Will meals be transported by food personnel to patrons on the outdoor deck?
Page 1
Ap7ril 2 y 197
Tibbetts Vigineering Corporation HE; BAP SALE--Subsurface Sewage Disposal
620 Belleville l e Avenue ` , evi ans tootagh H.l i elf Course .
New Bedford, l sachusetts 027?+ � �2s�ute �32� Jab �� 94 R ,
Oentlerien Ia
The Depattment of Public Health, in response to your request, has hevi one
of its engineers reviev a reviled pleat gilled
ANDUGH HnLS GOLF GORSE = HYA=, MASS
SWAGE DIStOM SYSTEM
TIEBET S ampm o Co v,,
New Bedford, : %ssuhusett
` M. ICY: t.H. S=Z; AS NOTED
R. zt.s. ' VATS SEPT• 30 197
A previous plan-of subsurface sewage diopos41 was approved by this office in
r a letter dated October 18, 1974.
The rOv�.sed "plan differs from the origihal only U. the relocation of the J ''
sewage disposal: system. components. die disposal area will. rein n the same
4 basic location;
Tie Division of Environmental ,Health hereby approves the reprised plan
" subject to allthe provisions and Condit .or at, stated in original letter of
PP 'ova3. dated Qctober 18 . '74.
Enclosed herewith are stamfaed approved eQ a.ss of tYre�rev.sed plan, a copy y;
of which must be kept on the site and be.4sed,for construction puxposes,
Very trul"V ysours,
For the Director.
Fred ,. DeFeo, P.E.
Regional sanitary Engineer
Southeastern Health Region
Lakeville Hoop ta7.
Lakeville, Massachusetts 026
De/Edwf RIB
ec: 15 stable' Board, of Health
.397.140411 st cot
I �i aa4huset$s 02,601 :
( `
etc:' One . en) .- I
BarnNtable Ounty Health pepartment
Ba^nstabie, ISsachusett
t' ,
07/2911997 08:30 15089310 RUST'tfSINC PAGE 01
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TOWN OF BARNSTABL
BUILDING PERMIT
,__v,PARtEL ID 254 016 GEOBASE ID 16588
;.ADDRESS 1800 IYANNOUGH ROAD/ROUTE PHONE
Barnstable ZIP -
LOT BLOCK ., LOT SIZE
IDBA DEVELOPMENT DISTRIt BA—
' PERMIT 23281 DESCRIPTION RENOVATE SNACK BAR AREA
; PERMIT TYPE BREMODC TITLE COMMERCIAL ALT/CONV
CONTRACTORS: S I LV I A, RONALD J. Department of Health, Safety
ARCHITECTS: and Erfvironmental Services
J
;TOTAL FEES: $183-00 '
BOND 1HE
CONSTRUCTION COSTS $30,000.00
�T
437 NONRES./NONHSKP ADD/CONV 1 PRIVATE P
MAS&
OWNER OCHS, PAUL F TRS ET A.LS 039.
, ADDRESS IYANOUGH HILLS GOLF CLUB ED
ROUTE 132 BUIL D I ON
HYANNIS MA
i B
i DATE ISSUED 05/22/1997 EXPIRATION DATE
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN-
,CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR
ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS
PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF FOUR CALL INSPECTIONS REQUIRED
FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE
1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR
2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU
(READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH-
3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS.
4.FINAL INSPECTION BEFORE OCCUPANCY.
a
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
1 1
2 2 2
3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT
2 BOARD OF HEALTH
OTHER: SITE PLAN REVIEW APPROVAL
WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS
THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY
VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA-
TION. NOTED ABOVE. TION.
HM ] 11 H E A L T H M A S T E R ] HELP [ ]
R E C O R D ] ACTION C]
For Parcel Number 2541 0161 ] ] Rental Property(Y/N) [ ]
Owner Name OCHS, PAUL F TRS ET ALS ] Zone of Contrib (Y/N) [ ]
Location 1800 IYANNOUGH RD/RT132 ] Contaminant Rel (Y/N) [ ]
Business Name [ ] Area Number
Contact Person [ ] Phone [000] [ ]
Fuel Storage Tank Permit [ ] Card on File [ ]
Perc Test Well Septic
File/Permit No. [ ] [ ] [95-923 ]
Issuance Date [ ] [0330951
Completion Date [ l [ ]
Last Communications [ ] (MMDDYY)
Comments [UPGRADE TITLE V ]
Cancel [ ]
NEXT SCREEN [HM ] ACTION [ ]
PARCEL NBR [ ] [ ] [ ] TANK NBR [ ] ]
r
1ya�®�gG► ��`Is
8 8- C � JAW
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cn
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s
' TOWN OF BA.RNSTABLE
LOCAT10I4 t� �e / ® ` SEWAGE 0
VnIAGE Q '��'------�.-----W ASSESSOR'S MAP & LOT--
INSTALLER'S NAN M PHONE N®. .. __. 1 c . .
SEPTIC TANK CAPACITY -
k
i,EAC3iIA1G FACILITY; (type)
NO.OF BEDROOMS -
OR OWNER
pERMITDATL: _-- -__ __COMPL1A.NCE DATE: —
Sepmdon Distance Between the:
A(atimum Adjusted Groundwater Table and Bottom of Leaching Facility
Ptriv,te Water Supply Well and I.c&;lting Facility (If any wolls exist Feet
on site or within 200 feet of leaching facility)
Edge of Wedand and Leaching Facility(if any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
P�
All
tibbEttS EnginEErng Corp.
620 BELLEVILLE AVENUE
NEW BEDFORD,MASSACHUSETTS 02745
TELEPHONE (617)996-5633.
STAFF MEMBERS
Robert L.Sundblad
FRED E.TIBBETTS,JR.,President Richard L.Silviera April 21, 1975 ,
Henry C.Govoni
Fred E.Tibbetts.111,Ph.D. Job No. 3289
Robert C.Verkade C
State No. SE74-294
Barnstable Board of Health
397 Main Street
Hyannis, Massachusetts 02601
Attention: Mr. Paul Murray
Gentlemen:
Tibbetts Engineering Corp. has performed inspections of the sewage
disposal system for Mr. Allan Jones at the Iyanough Hills Golf Club,
Route 132, Hyannis, Massachusetts. The system was built in accordance
with the revised set of plans which were approved by the State Depart- M
ment of Public Health on April 2, 1975. The following certification
statement is in accordance with the requirements of the Massachusetts
Department of Public Health.
Certification Statement
I, Robert L. Sundblad, Massachusetts Registered Professional Engineer
No. 23761 hereby certify that the constructed sewage works at the .
Iyanough Hills Golf Club were inspected by Tibbetts Engineering' Corp.
and that they have been constructed according to the approved plans
and Article -XI of the State Sanitary Code.
qoejrtdA-L. P.E.
cc: Fred L. DeFeo, P.E.
Southeastern Health Region
Lakeville Hospital
Lakeville, Massachusetts 02346
CONSULTING ENGINEERS C,IVFL ENVIRONMENTAL/
SANITARY / STRUCTURAL ,1 TESTING `
t
p t,J y y'$it;y r
60041:�,sllingtoi St...
Bcs.nn, fti ss. 11
Oct-Ober 183; 197
Tibbetts Snginedring 0orp4ration • ; i E 41S 3E&a5ubsurface Sete DIsposal
62O Bed1c:vt a A� uc � u 'Dills Golf Coarse, �o�xte 132,
' New EedfardL, Marssachetts: 021,45 Hy0wis.7 Job #SE74-294, '
Geatlemen '
r
` Die Depert ent of Pub-lie Teeth,, in response to your request, has had one
of its etglneert 'e. ne this soli at the above-noted 0it e and has reviewed 4,
plan titledi,
IYA14Dfi3GH H)TM aOL' COME - HI YA1S:s,MASS.
t bbetto engineering torp.
Nev Bedfordi, M ssgchusett
` lR• JJ�Jp:��q:T .M.wSTte •. , d d�i.1 e: Wd,'s�"i. 0 9 c1..9 l 4
.:
ex,a 'ta oz s canducte i at the• `mb jest site can Septerber 23, 1974-�.n the
a far sposal indicate that the natural soil , beneath proposed xf w -
the c igint load. and pub oll, consists, of fine. said to coarse sand and ' ravel below
` which has a percolation rate of Less than two minutes per inch. (Ground grater -as
not enc€=tered-down. to elevation, 02,8 feet«)
Me plan p ohao s-°to dispose of , C S' ga ms per. '• a e'f'rom the
subject project by means of a J: POO gallon eoncrete grease traps. a 7,50 gal-16n
concrete .septic taaa ,4 a, tribution boy, and three reepoz
e pits Wit II a total
available leaches ewof 2,41 s f6ot.rr
Die Div sion of Environmental liealtha I�ereby approves the plan with the
foUbvingproviaioos.4.
h An unsuitable materx beneath
a. the invert elevat ans of pits shzall.
be removed and rep�.aced nth clean co se material. treaty-five feet in
�. all'directions (except to •L•I e case of pit s ere excavation should
be as close to the fou n.datie t. s safety p x its},
4
x
r
\L
t<.;r!
Al.]. pipes and `fittings from the building fto five f eet out of the septic
tank shall, be cast iron or schedule, 40 PVC..
3: h outlet' tee-i°n the 'grease trap oha l extend`to within twelve inches'
of :the bottom of the-trap. i
4. Construction. shall be ins strict accordance v.th thee approved plan and
article XI of the State Sanitary Code and no. further changes mill be
Made ire the approved plan.'without' the prsor' wTitten approval of thus,
Department
5. A• Disposal.- Works.Connstructlon Pe=it must be obtained from the
Barnstable Board of Health prior to the g t ax t of any c-.onstruction,
6 Written certification that the disposal f'aOil.itles' 'have been constructed
in-4ccordance with the apprcvedplan and Articel ' of the State Sanitary
Cade roust be submitted to.the tarnstable Board o- Health idth a copy to
this office by ys i �e?ngineering co q r prier_:to the systeia being bacj�filledc
r Nothing in this px�_pvision is intended to iterereth the right of the.
Board of Health to inspect the disposal fagil.ities at :an time, during,
COnstrtCtifl22. '
The,build ng shalil.fnoc be c�ceu ied r�t31 `a Certi.fidate offf"CorspliaAce is
:issued by the Barnstable Boatd•of Health.
Enclosed heretrsth are stamped approved copies cif :the plan,; a copy of which
-must be kept 6 the- di•te and be used for'lconstruction purposes.
t Very truly yours,,,_ . :. .
' For tli6 Director
Roland A llia..s s e•aul Et g. P.E. -
Regienzel. Sanitary Rigi nee:r
°'. Southeastern Health Region
r
Lakeville Hoaptal ,
y . Lakeville, Massachusetts * 02346
Df Bdqf RFF R,
cc Barnstable`Board 4f bowl th 1
.397• Main .Street
Hyannis, Massachusetts 026o
One Flan
Barnstable`County Health- Department "
County Court Douse
Barnstable, 124ssachusetts
'N6vember•E4. 1986
bir: Joseph Daivuz
Building Commissioner _
Town Hall 7
3671.1taiti,Street
Hyginnis�.Ua 02601
Dear.•Mt. DaLuzaJ i
pa' .Octotier 3d, 1986,(, ah`' inspectlon of the , lyanough -Mille Golf Course '
wait tebstnoe building was c6n4i cted, by Nancy 'Leitner, ,Health. Inspector for.-
the Town.of 13atnstable., At:thlp tlrr} `it was discoveiii that footings.were being.,
poured without'a foundation_permit on the Golf Course property, for an-existing
offlce;,.building .which .wa$.'moved from'.Route 132,. Hyannis prior to October-_.--'-.,
-30, 19$0.
The' Building :Department eras notified and Nancy Leitner was fold that' was'. '
the ,building was to be.used,gnly a's storage. Please-be advised that this strucryure ;
hae;not been'approved for>ang use by the Board of Health.
This building is located• in a critical Zone of.Conttibution to nearby pu ic,bupply
wens: :-No .use should.be permitted until an. Bnginecred Sewage Disposal.Plan'.''
has been•approve, by ,the.Board`gf. Flealth for this relocated'structure,tend the
Golf Course,Maintenance;Building:,
Very truly yours,
John M*,Ke11y
Director of Public Health
TO.WR OF.BARNSTABLB
cc `$electmen t ;
PRAC7/C E AVT T/NG
- GREEIV� • - -
w E L _-- L EA C H
175
_ 50
GREA'SE
Ba2� - CLUB HOUSES o a o o
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SEPT/C
_ TAN K
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SFr - , s:r, The numberous ;violations tpou refer;;,,to R n ..your 1btter•,were �,, r 41 v `;'
` , +
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®"SE,XB£R:• Caaa�lete'ifamsl 2,'and'3
{i ld gems address in ke•`RETURN 70"
reverIC6
a.
1. The:followirig service+is rerijested(check one.)
X Sl ys>w to whom and date delivered............r�.
J1Yow to whom,date.and address of delivery,...,_.._4
El REMUCTl )DELIVERY
Show to w•hgm and date delivered......,......_.._.-d
fl RESTRICTED D£LPd URY.
:Show to whom,date,and address of delivery.$_
(CONSULT POST9gfa:4T'lR FOR FEES)
Z ART'ICLE.ADDFREMED TO: —
Mr: Allan Jones
Iyanough Hills Golf Club
i Rte. 132 , Hyannis,Ma.02601
'& ARTICLE DESGRtPTIQM: IJ —
REGISTERED NO. CERTMED NO. INSURED NO.
� 0523323
41 (Always obtain signature of adc nee or agent)
u>
m
1 have received the article descr.?ied above.
EfGk1lATURE ❑Addressee uthm
r
4
D!A'E
40.
s. ADDRESS(C®MaI t.opiy i
a
m 6. UM"LE TO DELIVER E£CAU-19: :,.lr . K'S
O INITIALS
P.
Y{GPO:1979-300-459
r
UNITED STATES POSTAL SE�RVICrEr
OFFICIAL BUSINESS IV.j
PENAL FOR PnIVATE"
SENDER INSTRUCTIONS " r'' " USE TO AVOID PAYMENT.
e�, - �, OF;PO5'rAGE.$390 ,.
Print your name,address,and ZIP Code in the space below-
• Complete items f,Z and 3 on the reVersa m
• Attach to front of article if space parmilK
` otherwise affbc to back of article.
f • Endorse article"Tatum Receipt Requested"
adjacent to number.
RETURN
TO
BOARD OF HEALTH
TOWN ?f TABLE
P.O•Box 534
(Street or P.O.Baac)
' HYANNI S MA 02601. 0534
r
CSty,State,and ZIP Code
FTHE T0� TOWN OF BARNSTABLE •
ft `*
OFFICE OF i
> mum BOARD OF HEALTH
ppa, 1639.
•Fp MAR k� 367 MAIN STREET
HYANNIS, MASS. 02601
i
1 April 16, 1982
Mr. Allan Jones
Iyanough Hills Golf Club
Route 132
Hyannis, Ma.
NOTICE TO CONNECT BUILDINGS ON THE IYANOUGH HILLS GOLF COURSE TO
PUBLIC .WATER
You are directed to connect all buildings on the Iyanough Hills
Golf Course, Route 132 , Barnstable, Massachusetts, to the 'Barn-
stable public water system by June 11 1982.
On April 2 , 19751 subsurface sewage plans were approved 'by the
Department of Environmental Quality Engineering for the Iyanough
Hills Golf Course. The approved plans showed a public water
service.
We recently discovered that .instead of utilizing public water, you
installed a private well approximately 175 feet from the septic
leaching facilities. The installed well is in a different location
than shown for the public water connection on your plan. This was
a violation of Regulation 2. 3, of Article XI, Minimum Requirements
for the Disposal of Sanitary Sewage in Unsewered Areas. Article XI
is now known as Title 5, of the State Environmental Code.
A recent inspection also revealed numerous violations of the Town
by-law relating to the storage of hazardous and toxic materials.
You have also failed to comply with the Federal Safe Drinking Water
Act and the Massachusetts Safe Drinking Water regulations.
You must furnish the Board of Health a complete chemical and bacterio-
logical report of your drinking water within seven (7 ) days of re-
ceipt of this order.
. You may request a hearing before the Board-of Health- if written
petition requesting same is received within seven (7) days after
receipt of--- this-order-
_:
y
Mr. Allan Jones
Iyanough Hills Golf Club
Page 2
April 16, 1982
Non-compliance could result in a fine of up to $500. Each day' s
failure to comply with an order. shall constitute a separate vio-
lation.
PER ORDER OF THE BOARD OF HEALTH
J n M. Kelly
irector of Public Health
JMK/mm
cc: Department Environmental Quality Engineering
Mr. Thomas Mullen - Barnstable Fire District Water Dept.
1
i
f
TOWN OF BARNSTABLE
SITE PLAN REVIEW
b�
OD E� EO
DATE: May 12, 1995 R�CN
MAY 1 2 199
TO: Tom McKean
WxM 4.
FROM: Carol Ann Ritchie, Site Plan Review Coordinator ,'
RE: Site Plan Review # 51-95 '"
Iyanough Hills Golf Course
1800 Iyanough Road, Hyannis.
Map/Parcel: 254/016.
Proposal: Remodel/enlarge dining room, increase
seating by twenty-four, increase parking by fifty-
three spaces, free standing sign.
Please submit this form, with any comments or additional requirements you may have
regarding the above referenced application, to the Building Commissioner's office by
May 23, 1995.
I have the following/attached comments/requirements regarding this application for
Site Plan Review .
I do not have any comments/requirements regarding this application for Site Plan
Review at this time.
(Signature)
dra51metM
S ^l
vD (94Lt J3 cf-z 5�� s
�� q
McKean Thomas
From: McKean Thomas
To: Ritchie Carol-Ann
Subject: lyanough Hills Golf Course/SP#51-95
Date: Friday, May 12, 1995 5:19PM
am in receipt of the above referenced site plan review application dated May 12, 1995 and offer the following
comments:
-This is an expansion of use of the facility served by the septic system. Therefore, a DEP certified onsite sewage
disposal system inspector must be hired by the applicant to inspect the septic system as required by Title 5, the .
State Environmental Code.
- A professional engineer.or registered sanitarian must calculate the proposed usage and determine if the
existing three 16'X 12' leaching pits can accomodate the overall flow. The applicant proposes to add 840
gallons per day by adding 24 seats on the outdoor deck. The existing septic system was designed in 1974 to
accomodate only 32 dining room seats, 28 lounge seats, and 125 golf rounds per day totalling 4805 gallons per
day. It appears an additional leaching pit is needed.
-The existing grease trap is only 1,000 gallons size which is designed to accomodate a maximum of 66 seats.
This proposal appears to exceed that maximum number. Therefore, a larger grease trap is required.
Will meals be transported by food personnel to patrons on the outdoor deck?
*«.....*.,..,t, .**». ,
- Page 1
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R0� SHEET 1 OF 2 \ `• �O' • \
IYANNOUGH HILLS DEED REFERENCE: BOOK 6851 PAGE 298, & BOOK 6562 PAGE 215 69.0 \` C•p
oG GOLF s' \ GOLF COURSE
COURSE OWNER: IYANOUGH HILLS REALTY TRUST \ ` �» .a 4� 9 F< A St`oC.o
�2 N ADDRESS: ROUTE 132 HYANNIS, MA. 02601 \ gSF,yS7j
` LOCUS o �c tic ,e
CO. PHONE NUMBER: IYANOUGH HILLS GOLF CLUB 362-2606 & 362-4551. \�\ 4.0 ° �, ST r'2 t," "/,, A,
OZ. \ d' p 9
p F x 94. 9 \ Q �ooR oR c�q F'�' p cgRT
gSFMFN NO WETLANDS LOCATED ON OR NEAR SITE. x 99.2 , \ x' Qd 4C� FCF`�F�� Four S
z ic-3.3 O o
ti x 1.7 $? g po 85.8
?• >'
yG' 81.3 \ `� 65.3 65.2
E� SHALLOW / 6�, -x
BPONDE y POND d C 6 �` ,i 65.2
--- 9 2 6 Q \ \
SCALE 1 `1 25,000 3.2 0/'�� \» x. •a\ sF 68.9 /
ASSESSORS \ \ '� 80 \ 085.3 79
MAP 254 PARCEL 16 �o W� a, x 6, 81.4 °G�. \ / ONE RG
o� c,W \ sQ i EPTIC SYSTEM z
ZONE .6 x 81.2 ®89.2 -- --- RF
G.P. 2 �. �`'- °/� 4.9 $ .6 x ® E
Q G� 81.1 89.7 ZON
RESIDENCE F y °
a .6 \ � _..,. off• � 88.8 \
x�6.\ }k $5.8
MINIMUMS � 2 �' • cr \ y
AREA = 43,560 S.F. '�� o \ 1 • 89,9BE
FRONTAG = 150' 7 95.8 HMA = 9 .9 �- �N o 70 ®69.2 ✓�
/ $4.2
FRONT SETBACK = 30' z 2. / 79.7 . x�
(100 ALONG RS. 28 & 132)
2 n 80:Q ,,• 080.3 o' . P 69.2 t�,��
o ; / GRASS 'f / 3 r ' ®87.5 QP�%
I
SIDE SETBACKS = 15' x $1.3
REAR SETBACK = 15' �Q o v \ ISLAND /� 6etas of / •$ \ GAO
£ = '� / C• �I #314 72• ,TELEPHONE
1
BUILDING HEIGHT = 30 n g 2.5 x 79.1i \ 79.5 78.2 / x
(OR 2.5 STORKS IF LESS) WOODED AREA 92.3 _ /
7 79� N 80.1 / 74.
°U
x 79.6 W 79.5 r 75.
2.1 -
RESIDEFCE G 68.1
v►
x 7A,2 a 78. Q 74.8 ELECTRICAL
MINIIii S
AREA = 6 000 S.F. SITE PLAN , O E LAND 66/ -r9.9 ��� / c ROL B
FRONTAGE•:. = 20' r, Q
79.
WIDTH ' 200' 1 N 86 \ -
82,1 y ^_:' ; BITUMINOUS CONCRETE y 79,3
78.7 �
FRONT SETBACK = 30 (HYANNIS) /84.8 � DA--4 79.7 �-- --
:�a \ GOLF COURSE
(100' ALONG RTS. 28 & 132) '� 8 \
BARNSTABLE M----
2
SIDE SETBAG�KS = 15' ASS. bL - >< 8 4
REAR SETBACK = 15' \
FOR � •4.0 � i@.2
\\ \ \
BUILDING HEIGHT = 30' �080.4 \
o �
(OR 2.5 STORIES IF LESS) , \ '-� y 4,3
79.4 / I w \ \''
78.8 I _ -
- .T ALS TRUSTEES \ � x�80.4 0.0 � ; ---- --
EXISTING PARKING - 110 SPACES FO R D I E H. P I TTS J R.
x �i.`S� 78.3 o z
X 0.0 = EXISTING GRADE I
IYANOUGH HILLS GOLF CLUB o � - e� .�-- .. - � �$9.2
0.0 = PROPOSED GRADE
gQ a o
SCALE: 1 - 20 DA ,E: MAY 2,1995 .- MCA aASIN
fZL=fir t ti ►cj \x 78.5 o / \ \
PROPOSED TREENYEINC,90.6
BAXTER & NY_ I C, ,4 .2
PR x 72.7 \ 77.5
ORT DUMPSTERS `� \
REGTSTEREI) LAND �,URVEYORS � \ - .� / .\ \
CIVIL ENGT��,;=ERS
76.3 / 1.3 \
ence ,-
i -
N r, ( o
ARK1
M \ 8
u� � 1 v 1LL.�. d. sASS, o
/ \ eC WOODED AREA
EXISTING SPACES ELIMINATED = 3 TEL. # 428-sI31
� �o x 70.8
TOTAL SPACES = 163 x9P'
6' X_ 8' LEACH PIT
r PARKING SPACES REQUIRED FOR THE HANDICAPED - 4' OF STONE 93.5
TOTAL SPACES REQUIRED - 3% OF 163 - 5 SPACES x 63.6 ,
TOTAL. SPACES PRO1/IDED - 5 SPACES CP \ � 7-7
77. \ x . \
x 7 7
76.1
x 8.2 \ 9
CERTIFY THAT THE PROPOSED ADDITION CONFORMS "' Q!',j x 7 . \
TO THE SET BACK AND SIDELINE REQUIREMENTS OF ���jH'oFdss� / x 82.a X 8' LEACH PIT gQ 80. #�31.2
THE TOWN OF 'BARNSTABLE AND IS NOT LOCATED IN 4' OF NE
\ 94.0
+� WILLIAM � a� SULLIVAN x �,� --�c 78.0
THE FLOOD PLANE. c,,
E8o
N Y 29733 \ 76.5PENCHMARK
DATE: R.L.S.�:� �^� �,� ��. a�,y a'� f x 81.4 ; \ \ X.\�%
. ..�+31,4 .9
x 703 �O
v \
x 78.4
�•�•,� .,, \ \�
78.5 \ 78.1 / / / 94.
AREA x 8$ \ \ / AREA L�LE RED OR OW R LI S
a` NEW SPACES 20 sa.0
0 .0 \ x 74.5 \ ( \ / / \ x 94.3
x64.8 \\ \
G 73.7
�� REA 2
\ / 79.8 g _
\ NEW
.3 SPACES 6 x
1 2• SP CES ELIMINA ED
XISTI G PO L WITH H. LIGHT,;
EW PACES = 33 C
x
) \ x 74.1
• x 71.3 x 63 6 \ eQ DA-2 0 ►.. r
O 3183.7
x c,
8$.5 X. \ \ " x 88.
x • 6 x 0.7 \ ath
89.Y 71.1 \ \ X EXIS G SP CE ELIMINATE jI p
67.3 / �• •� `� 9.8 x4.9
O . \ x 69.z / 1 \ x 73.
x 71.1
Q� \ EMOVE • OLD R8 do \ \� g P� 9.2 84---a .. 89.7 .
• y�
�6� 1 G•` \- - x 64. ONSTRUCT N 18* BERM \ \ \ oP� j ad.1.
• • � TO CONTAi WAFER. , ' �
/ - --.
X °c \ _ • .
QQ�•� --- �" (`'fit,✓ \ gQ°G� \ ` - -- -
76.7
x 89.0 x 65.2 . spaces �o \
\ DA- 7o.a '\ �\ \
EASEME . T \a o \ 0 628 69.7 \ / -- - - x 0.4 a a�
23,525 sq.ft. '�►`j \
TOWN BARNSTABI.6 0.54 acres o
.3� 02 sAv�es x 62.3 0 \" 'S x 7 .1 \ \ \ gQ° '� 0+00 X _ 0 17
S c PLAN HEV17W S�, C3 \
9, T 130" ITUMINOUS SPHALT 82.3 \
/ \ i +-- 1+0 B1TUM OUS SPHA T
€ aces 5 \ \ 78.1, 76.4 DA-1+50
1
� �' x 79.7 \ 1
RI 6 ti
�. �; ;p �=108.30• MAT R-'LINE Tct� t�A�N x 6z. 6 ' _ � � '. � 72.2 \ - ��\
L' !! R-9867.00' -S�- - - \ \ x Pi i:M_',� ----
#121 s 8 66, o \ 72.0 73.4 \ ,gyp cv r
• a \ T ,CURB !.9 , � � �� � �
1 6g9.5 ASP 1. 3.8 G 9
577 CA AMIX 6' LEACH PIT 6 ,
•
,, e I / .0 69.G .\ .2 x 70.��W\4' OF ONE i2.6 \ • /\,-
6 x.8 x 3" OF NEW 72.77/1 !// /Pn 7n \ /EME _
.. _ 71.8 `�V MENT R�2_a 2.0 x I .. ..
9'-0" SHEET 2 Or2,
RAILS TO BE MORTICED THRU POSTS
-
IN 7
(HYANNIS) X '
f
I W
POSTS 6X6 P.T. A
BARNSTABLE MASS. (AD ;; I CFORit
0
FORDIE H. PITTS JR. ET ALS TRUSTEES
0
T�4
PUBUIC
IYANOUGH HILLS GOLF CLUB cop*EK 40 AIC.,
SCALE: AS NOTED DATE: MAY 2,1995 J
REV: 5-11-95
U D1y0Ss-WVW 'G, R&NGiE
BAXTER & NYE INC,
REGISTERED LAND SURVEYORS
CIVIL ENGINEERS R Vj k \_1 C) lukro, 11 p1t 9 L A -S
OSTERVILLE, MASS,
OF N' or
WILUAMM
C.
N Y suwvAn yFENCE DETAIL
Mo. 1933 No.29733
NO SCALE i t PROPOSED SIGN
%
O*A 3 /41 1-0
ALL CATCH BASINS & LEACH PITS
TO BE CONSTRUCTED AS PER
TOWN OF BARNSTABLE DEPT. OF
PUBLIC WORKS STANDARDS & SPECIFICATIONS
ALL PIPES TO BE 10" ALUMINUM OR PLASTIC
ALL CATCH BASINS TO HAVE HEAVY DUTY
FRAMES & GRATES BRICKED TO GRADE.
6 2'
EXISTING GROUND
EXISTING
18" BITUMINOUS CONC. BERM
2 1 3" BITUMINOUS COINCRETE PAVEMENT V6" HIGH WHERE REQUIRED
SEE PLAN.
S
4M ED
6"LOAM _2%_ 8" PROCESSED GRAVEL 3
LOAM & SEED
---FROST FREE MATERIAL ��<EXISTING GROUND
L--lo8.30, PROPOSED PARKING' LOT
TYPICAL SECTION A -A
L=603.60#
O.
SCALE: 1 10'
C
r
MATCH
LINE
SEE S�HEET I
�a�' Q �P / ;,z. �,' X 60.9 SIDELINE OF ROUTE 132
K, 4
X 3.
. . . . . . . . . . . . . . . .
019 x 61.2
x 71.2 X 80
x 2.
722
72.3 0
x 60.2 00 x .
x �7.5 6o
x 71.5 s 72.4 x �7.2 00-_
X 08.9 66.6
X x 67.6
59
x 71.0 64.9
:3
• 714
x 57.0
x 69.7
x 59.3 55.1
68.6 63.4
�, / __-- `/� IPROPOSED NEW SIG & I ND .(LANDSCAPED)
__\ _7Z PROPOSED FEN
x 67.1
x 67.0 2.
63 \ �'`_.
. . ........ 7�4
card rail FENCE 62.5 X
x 69.3 Q� 01.7 6 63.\10
PROPOSED FENCE
------- 65.3 X x 51.7 Z3
x 67. 0
3.2- �_ ---_
64.7 .3 berm 85.2 tel. box X &
7 x 64,5 150/ 9
Oveme *-4M8
--age 0 P 3.8 .6 9 83. 63 62.3
939/
ZD
63.1
65.2 63-663.3
5-
OF
64.7 65.1 _iK.4
"4 63.5
6/3.9
n 48 65.6 edge m 1952 UGH 63.3
ward rail 63.8 of P`3ve nt 63.6 STATE LAyo 63.7::
V_ U T ROAD
77'- ---m 64.9 X 64.3 VARIA13LE WIDT
v
84.9
tel. box 63.5 63.6 64.0 63.3
63.3 granit curb 635
O -side-walk 63.7
64.0
PLAN OF ENTRANCE
SCALE: 1 209
aoc-lo
;-
i
' i
I
_.I
d
<, •:
?,
':;
,�
,: ..
4 �"
' - !:: - _ _
Acr e 5 7 4
RAP,
�/V,' 0 ''7vh&&- 0 C 0 Undisturbed
84
: — r �7 I ov t I
REASE . .. .. .
77
510 y ��, ev
;ka
10 to
x C.
4aav 4T . cn, 6j - Can
1-fo x Ito. 5
f4c-A\tp, tArr, Q,caa r-1,
oz 1, x I I C, — -!,
/,T5
. 1 1/2.11
Ito
M;
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D
L -T
x C. C5.
_rf"e A, c--, - eii. 411 _,_
NOTE. PRIOR TO 136NSTHUCI-�()N, COYNIIRW_�710FI
MUST VERIFY candlor exisfinn
COM144k.?ns or for an-
y
-;r ii.,IorJ,s nol brozmf-d
aftentinn of tlie d;�:30rtlr,,
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PRO J�:-C7
L N (D
N E VV PEES 1 D f-- N C F
NO
Silvia & Silvia SCAB F-
L✓-, A T E
Associates, Inc.
V A
1) VV N PY -T��
CUSTOM BUILDEPS , DESIGNERS
C L
610 Main St reel. CoTq.7RA,- OR
Centerville, MA02632
Otom.1C. 110,ij ALL Di MENS I ON AND
CC)N T, 0 N 'DN
7 J,
+
7
-7 k 70'-
T7- W 71 ''S
71Z �T F-
F
T
F
to 7
�Tk 76..1.11
(z-) *,g
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MATCR EXt:�TiNG- FINI.S4
4-
;W4,LL
H07E Ulj "__7 �- I T-4) ALkN „ONES � ASSOC
.0
NEW E N C P' DV,/G
NO
/—\7 4
SHvia & Sid-ia DATE_
SCA LE 114 -1 `0 REV
3-744"
Associatm Inc.
CUSTOM OUILDERS - DESfGNERS DWN By
619 main Street -CONTRACTOR SHALL VF-PIF'Y
Centerville. MA 02637 775ol"2
R*fmw 1. pw"
ftoo"m ALLDIMENSION AND
CONDITION ON SITE
br�n� ncy
kA kP 2 574 1. o-r lire
1zs• jac•, ,rPF's . -
x r- \
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p6 <<- C\
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use
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12 PLAe C
450: rATTAC 1-I-14-- PLA-W S 1
c vv�
w
OF
W ILLIAM
NYY L)E ��
No. 193 �. r
t:*�
P (,- A, �J
!4 Y /-\ Q �-,) I `:2, �A A S 4J
Ij-2t11
o --
1680B Iyannough Road/Route 132
Barnstable -
A = 254 - 016
I
I
i
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
c
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 1680B Route 132 a1A 19 9
Hyannis
Owner's Name: Hyannis Golf Course, Superintendents Residence
Owner's Address:
Date of Inspection: 3/26/2007
Name of Inspector: (please print) Patrick T. Sullivan
Company Name: Ready Rooter
Mailing Address: P.O.Box 371
Sandwich,MA 02563
Telephone Number: (508)888-6055
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector pursuant to Section 15.340 of tle 5(310 CMR 15.000). The System:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Authority,,
Fails
Inspector's Signature: Date:'
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health'or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design�flow of 10;000 ..=
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,andi the approving
ca
authority. r—
Notes and Comments
****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.
a
{ I
Page 2 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1680B Route 132
Hyannis
Owner: Hyannis Golf Course, Superintendents Residence
Date of Inspection: 3/26/2007
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. Sy em Passes:
0 I have not found an information which indicates
y es that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to b. eplaced or
repaired.The system,upon completion of the replacement or repair,as approved by the Bo of Health,will pass.
Answer yes,no or not determined (Y,N,ND)in the for the following stat ents.If"not determined"please
explain.
The septic tank is metal and over 20 years old*or the septic t (whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank fail a is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as appro d by the Board of Health.
*A metal septic tank will pass inspection if it is structurally und,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is avai e.
ND explain:
Observation of sewage backup o reak out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broke ,settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:/
he systemrequired pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
s inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1680B Route 132
Hyannis
Owner: Hyannis Golf Course, Superintendents Residence
Date of Inspection: 3/26/2007
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to detern a 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 R 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,s ety 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 JP blic Water Supplier,if any)determines that the
system is functioning in a manner that protects the p lic health,safety and environment:
_The system has a septic tank and soil abs rption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surrface water supply.
The system has a septic tank ancj /A S and the SAS is within a Zone 1 of a public water supply.
_The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply wk11". Method used to determine distance
"This system p ses if the well water analysis,performed at a DEP certified laboratory,for coliform
bacteria and volati organic compounds indicates that the well is free from pollution from that facility and
the presence of#nmonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteri are triggered.A copy of the analysis must be attached to this form.
f
3. Other:
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1680B Route 132
Hyannis
Owner: Hyannis Golf Course, Superintendents Residence
Date of Inspection: 3/26/2007
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
L Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
(� Static liquid level in the distribution box above outlet invert due to and overloaded or clogged SAS or
cesspool
Liquid depth in cesspool is less than 6"below invert or available volume is less than %2 day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
Any portion of the SAS,cesspool or privy is below high ground water elevation.
jjQ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
Any portion of a cesspool or privy is within a Zone 1 of a public well.
_ Any portion of a cesspool or privy is 50 feet of a private water supply well.-
ALQ 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 coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
(Yes/No)The system fails. I have determined that one or more of the above 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 ign flow of 10,000 gpd to 15,000
gpd•
You must indicate either"yes"or"no"to each of the followin
(The following criteria apply to large systems in addition a criteria above)
yes no
the system is within 400 feet of a dace drinking water supply
the system is within 200 et of a tributary to a surface drinking water supply
the system is to ed in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone II of ublic water supply well
If you have wered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in ction D above the large system has failed.The owner or operator of any large system considered a
sign, cant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
.304.The system owner should contact the appropriate regional office of the Department.
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 1680B Route 132'
Hyannis
Owner: Hyannis Golf Course, Superintendents Residence
Date of Inspection: 3/26/2007
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
140 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?
1 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 than owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes No
_ Existing information. For example,a plan at the Board of Health.
Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.302(3)(b)]
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 1680B Route 132
Hyannis
Owner: Hyannis Golf Course, Superintendents Residence
Date of Inspection: 3/26/2007
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): Number Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
Number of current residents: 0
Does residence have a garbage grinder(yes or no):
Is laundry on a separate sewage system(yes or no):_J�Q[if yes separate inspection required]
Laundry system inspected(yes or no):
Seasonal use:(yes or no): S a
Water meter readings, if available(last 2 years usage(gpd)):d5 o/.. 7
Sump Pump(yes or no):
Last date of occupancy: Tr,Y
COMMERCIALANDUSTRIAL
Type of establishment: ,C
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/s . c.):
Grease trap present(yes or no -
Industrial waste holdi present(yes or no):_
Non-sanitary w ischarged to the Title 5 system(yes or no):_
Water in eadings, if available:
L ate of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as part of the inspection(yes or no):
If yes,volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
Septic tank,distribution box,soil absorption system
_Single cesspool
_Overflow cesspool
_Privy
_Shared system(yes or no)(if yes,attach previous inspection records, if any)
_Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
_Tight tank _Attach a copy of the DEP approval
_Other(describe): '
Approximate ge f all c ��ponents,date installed(if known)and source of information-
Were
Were sewage odors detected when arriving at the site(yes or no):
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 1680B Route 132
Hyannis
Owner: _Hyannis Golf Course, Superintendents Residence
Date of Inspection: 3/26/2007
BUILDING SEWER(locate on site plan) ;
Depth below grade:
Materials of construction:_cast iron�40 PVC_other(explain):
Distance from private water supply well or suction line: 14f,
Comments(on condition of joints,venting,evidence of leakage,etc.):1 ( C
SEPTIC TANK:_(locate on site plan)
Depth below grade: gn,
Material of construction: concrete_metal_fiberglass_polyethylene
_other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions:
Sludge depth: in
Distance from the top of sludge to bottom of outlet tee or baffle: \A0
Scum thickness: &I
Distance from top of scum to top of outlet tee or baffle: jt-''
Distance from bottom of scum to bottom of outlet tee or baffle: 6
How were dimensions determined: TZde d g."'V,-C i"o
Comments(on pumping recommendatio s, inlet and outlet to or baffle condition,structural integrity,li uid levels
as related to outlet inverb evidence of le age,etc;
GREASE TRAP:_(locate on site plan)
Depth below grade:
Material of construction:_concrete_metal_fiberglas �)olyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top o tlet tee or baffle:
Distance from bottom of scu bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pum ' g recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to out invert,evidence of leakage,etc.):
Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1680B Route 132
Hyannis
Owner: Hyannis Golf Course, Superintendents Residence
Date of Inspection: 3/26/2007
TIGHT or HOLDING TANK: (tank must be pumped at tim spection)(locate on site plan)
Depth below grade:
Material of construction:_concrete met _fiberglass_polyethylene_other(explain):
Dimensions:
Capacity: allons
Design Flow: allons/day
Alarm present(yes or ):
Alarm level: Alarm in working order(yes or no):
Date of last p ping:
Comment condition of alarm and float switches,etc.):
DISTRIBUTION BOX: (if present must ened)(locate on site plan)
Depth of liquid level above outlet ' ert:
Comments(not if box is le and distribution to outlets equal,any evidence of solids.carryover,any evidence of
leakage into or out o x,etc.):
PUMP CHA >order
(loc�onilan)
Pumps in work nop.
Alarms in wor or no):
Comments(no pump chamber,condition of pumps and appurtenances,etc.):
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1680B Route 132
Hyannis
Owner: Hyannis Golf Course, Superintendents Residence
Date of Inspection: 3/26/2007 /
SOIL ABSORPTION SYSTEM(SAS): �O (locate on site plan,excavation not required)
If SAS not located explain why:
T leaching pits,number:
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.): I
/
L�eaj-�, /i
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate a plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of constructio
Indication of grop&1al er inflow(yes or no):
Comments condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(n condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 1680B Route 132
Hyannis
Owner: Hyannis Golf Course, Superintendents Residence
Date of Inspection: 3/26/2007
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.
At q 6�
zs
. : 336
J
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 1680B Route 132
Hyannis
Owner: Hyannis Golf Course, Superintendents Residence
Date of Inspection: 3/26/2007
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to groundwater 'v feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record—If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with the local Board of Health-explain:
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain: /l', s� h ��=(�5�,5.(�(1✓
You must scr'be how you established the high ground water elevation:
/
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�1800 IyannoughRoad/Route 132
A = 253- 016
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
i DEPARTMENT OF ENVIRONMENTAL PROTECTION
Y'
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM y , D/6
PART A
CERTIFICATION
Property Address: 1800 Route 132
Hyannis
Owner's Name: Hyannis Golf Course
Owner's Address:
Date of Inspection: 3/26/2007 .
Name of Inspector: (please print) Patrick T. Sullivan
Company Name: Ready Rooter i
Mailing Address: P.O.Box 371
Sandwich,MA 02563
Telephone Number: (508)888-6055
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System:
V/of Passes
Conditionally Passes
Needs Further Evaluation by the Local Authority
Fails
Inspector's Signature: Date:
i 4
e:
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-,1.0,000,'
gpd or greater,the inspector and the system owner shall submit the report to the appropriate.re peal office of the y
DEP.The original should be sent to the system owner and copies sent to the buyer, if applicabk;7and the approving
authority.
Notes and Comments '
****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.
L
Page 2 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued) .
Property Address: 1800 Route 132
Hyannis
Owner: Hyannis Golf Course }
Date of Inspection: 3/26/2007
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
_ZI have not found any information which indicates that any of the failure criteria described in 3101CMR
15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section nee o be replaced or
repaired.The system,upon completion of the replacement or repair,as approved by the oard of Health,will pass.
l
Answer yes,no or not determined (Y,N,ND)in the for the following st ments. If"not determined"please
explain.
The septic tank is metal and over 20 years old*or the septic (whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank fail a is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as appro d by the Board of Health. -
*A metal septic tank will pass inspection if it is structurally und,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is availa e.
ND explain: k
e
Observation of sewage backup or eak out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken, ttled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The stem required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
pass ins ection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
- t
ND explain: i
r
Page 3 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1800 Route 132
Hyannis
Owner: Hyannis Golf Course
Date of Inspection: 3/26/2007
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by t - oard of Health in order to determine if the system
is failing to protect public health,safety or the envt'r�Cxunent.
1. System will pass unless Board.of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning-th a manner which will protect public health,safety and the environment:
_Cess or privy is within 50 feet of a surface water
sspool 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)deOrnfines that the
system is functioning in a manner that protects the public health,safety and enviro ent:
_The system has a septic tank and soil absorption system(SAS)and AS 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 i�,w"a Zone 1 of a public water supply.
_The system has a septic tank and SAS and e SAS is within 50 feet of a private water supply well.
_The system has a septic tank and-SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well**.Metliod used to determine distance
**This system passes'i the well water analysis,performed at a DEP certified laboratory,for coliform
bacteria and volatile.organic compounds indicates that the well is free from pollution from that facility and
the presence o monia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria arine triggered.A copy of the analysis must be attached to this form.
f,-
3. Other:
t
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1800 Route 132
Hyannis
Owner: Hyannis Golf Course
Date of Inspection: 3/26/2007 t
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
k Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
. Static liquid level in the distribution box above outlet invert due to and overloaded or clogged SAS or
cesspool
Liquid depth in cesspool is less than 6"below invert or available volume is less than''/z day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
Any portion of the SAS,cesspool or privy is below high ground water elevation.
Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
_ ! Any portion of a cesspool or privy is within a Zone 1 of a public well.
_ Any portion of a cesspool or privy is 50 feet of a private water supply well.
'to 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 coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this/ form.]
�
iv� k
tr (Yes/No)The system fails. I have determined that one or more of the above 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.
r
E. Large Systems:
To be considered a large system the system must serve a facility with a d or'fl w of 10,000 gpd to 15,000
gpd•
You must indicate either"yes"or"no"to each of the followin
(The following criteria apply to large systems in additio a criteria above)
yes no j
the system is within 400 feet o surface drinking water supply
the system is withi 0 feet of a tributary to a surface drinking water supply
the syste • located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone of a public water supply well
If yo ve answered"yes"to any question in Section E the system is considered a significant threat,or answered
` '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 3101CMR
15.304.The system owner should contact the appropriate regional office of the Department.
i
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Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B k
CHECKLIST
Property Address: 1800 Route 132
Hyannis
Owner: Hyannis Golf Course
Date of Inspection: 3/26/2007
i
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
4 Were any of the system components pumped out in the previous two weeks?
Has the system received normal flows in the previous two week period?
Have large volumes of water been introduced to the system recently or as part of this inspection?
Were as built plans of the system obtained and examined?(If they were not available note as N/A)
_ Was the facility or dwelling inspected for signs of sewage back up?
Was the site inspected for signs of break out?
Were all system components,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?
i
Was the facility owner(and occupants if different than owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based,on:
Yes No
_ Existing information.For example,a plan at the Board of Health.
Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.302(3)(b)]
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Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 1800 Route 132
Hyannis
Owner: Hyannis Golf Course
Date of Inspection: 3/26/2007
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): Number of b ms(actual):
DESIGN flow based on 310 CMR 15.203 (f ample: 110 gpd x#of bedrooms):
Number of current residents:
Does residence have a garbage ' er(yes or no):_
Is laundry on a separate s ge system(yes or no):_[if yes separate inspection required]
Laundry system ins ed(yes or no):
Seasonal use: or no):_
Water me readings,if available(last 2 years usage(gpd)):
S ump(yes or no).
t date of occupancy:
COMMERCIAL/INDUST/R� IAL i
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sq.ft.etc.):
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: o -!,- q&6p
Last date of occupancy/use: -f-j,"
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as part of the inspection(yes or no):_)8 + �,
If yes,volume pumped: gallons--How was quantity pumped determined? :
Reason for pumping:
TYPE OF SYSTEM
v[Septic tank,distribution box, soil absorption system
_Single cesspool
_Overflow cesspool
_Privy
_Shared system(yes or no)(if yes,attach previous inspection records,if any)
_Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight tank _Attach a copy of the DEP approval
_Other(describe): -
Approximate age of all components,date installed(if known)and source of in f rmation:
Were sewage odors detected when arriving at the site(yes or no):
r
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 1800 Route 132
Hyannis
Owner: Hyannis Golf Course
Date of Inspection: 3/26/2007
BUILDING SEWER(locate on site plan)
Depth below grade: -g
Materials of construction: cast iron40 PVC other(explain): -
Distance from private water supply well or suction line: 4
Comments(on on of•oin condi its,vengtj,evid/%ce of le e,etc.):
�• �I��CYS� � / �4,. �
SEPTIC TANK:/(Iocate on site plan)
Depth below grade: c�e,)",
Material of construction: oncrete .metal_fiberglass_polyethylene
_other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions: '[#X
Sludge depth: i"
Distance from the top of sludge to bottom of outlet tee or baffle:
Scum thickness: ,S'"
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of o tlet tee or baffle:
How were dimensions determined: SjLii
Comments(on pumping recommendati6ns, inlet and outlet ted or baffle condition,structural integrity,liquid levels
as related to outlet invert,evi ence of eaka e,etc.)- .
h g
GREASE TRAP:Zlocate on site plan)
an •
Depth below grade:AL
Material of construction:2oncrete metal_fiberglass_polyethylene . other
(explain):
Dimensions:
Scum thickness: ,
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle: _
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of eakagee c.): �„
Page 8 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1800 Route 132
Hyannis
Owner: Hyannis Golf Course
Date of Inspection: 3/26/2007
TIGHT or HOLDING TANK: (tank must be pumped at time o c�on)(locate on site plan)
Depth below grade:
Material of construction: concrete metal erglass polyethylene_other(explain):
Dimensions:
Capacity: ons
Design Flow: allons/day
Alarm present(yes or n
Alarm level: Alarm in working order(yes or no):
Date of last p ing:
Comment ondition of alarm and float switches,etc.):
DISTRIBUTION BOX: (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments(not if box is level and distributi n to outlets equal,any evidence of solids carryover,any evidence of
leakage' to or out of bo etc.):
PUMP CHAMBER: (locate on site
Pumps in working order no):
Alarms in working r(yes or no):
Comments(n condition of pump chamber,condition of pumps and appurtenances,etc.).
Page 9 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1800 Route 132
Hyannis
Owner: Hyannis Golf Course
Date of Inspection: 3/26/2007
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
T
leaching pits,number:
leaching chambers,number:
leaching galleries,number:
leaching trenches,number, length:
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.): j
CESSPOOLS: (cesspool must be pumped as part of' wfion)(locate on site plan)
Number and configuration:
Depth—top of liquid to inlet inve
Depth of solids layer:
Depth of scum layer:
Dimensions of c ool:
Materials of nstruction:
Indicatio f groundwater inflow(yes or no):
Co nts(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: (locate on site
Materials of constru ' n:
Dimensions:
Depth of so '
Comm (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):.
Page 10 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1800 Route 132
Hyannis
Owner: Hyannis Golf Course
Date of Inspection: 3/26/2007
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.
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Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1800 Route 132
Hyannis
Owner: Hyannis Golf Course .
Date of Inspection: 3/26/2007
SITE EXAM
Slope
Surface water
✓Check cellar
Shallow wells
Estimated depth to ground water Meet
Please indicate(check)all methods used to determine the high ground water elevation:
✓ Obtained from system design plans on record—If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with the local Board of Health-explain:
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:Ica ahr l?�(4. V
You must de ribe how you tablished t e high gro nd wa er elevation:
SS�
' f 7z • ! �.. C i� Cre
�uS TOWN OF BARNSTABLE
SEWAGE #
LOCATIONS+.�
VILLAGE ASSESSOR'S MAP LOT-;
INSTALLER'S NAME Si PHONE NO. Y�
SEPTIC TANK CAPACITY t WV Q
LEACHING FACILITY:(type)2 -� (size) t, (coo
NO. OF BEDROOMS b PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: Cp (p
DATE COMPLIANCE ISSUED: / ---x ' 9's,
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
'r
,�pplirttttnit for Bi,�Vntittl Workii Tnwitriarttnn Prrmtt
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
---------------------------------------------------------------------------
Location-Address or Lot No.
t.5.... c ----------•- .. ._......
er 2 Address
WW1 -•••.-...... -.-• -- . ---••---- -•-.-..-•..............•--.....
Installer Address
d Type of Building Size Lot.............-..............Sq. feet
Dwelling— No. of Bedrooms........15-^-----------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
dOther 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........................
ri, Test Pit No. 2............----minutes per inch Depth of Test Pit.................... Depth to ground water........................
W ............................................................................................................................................................O Description of Soil-------------------------------------------------------------------------------------- ---------•-••-------•-•---------------------------------------------•----...-----
W
V -----------------------------------------•----------------•-----------------------------------------------------------•----------------•---------------------------------....-••---••-----•----•--••---
W
-------------------------------------------------------------------------------------------------------------- ----•- ------------------------------------------- -------------•--------
U Nature of Repairs or Alterations—Answer when applicable.-A,G&.e-------- if�cs�Fetc �qy .... ..•.-......._.-
•--%------------------------------•-••-••-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Envir ent o —The undersigned further agrees not to place the
system in operation until a Certificate of Comp en -ss >b
y the board of health.
Signe . ..... ------- ... .......................................
Application Approved By ..--...... .......... .... .- ..-.�
--- - .... ..
s
Dare
Application Disapproved for the following reasons- ------------- ---- --- ------------- ----------------------------------------------------------------------------------------
..................... . ............................. . - ... -- - - .....-.................-........................-.....-.....- - . ....... .-..... ...................-
Permit No. .-. *�..' •�'���`�--.-... Issued ....-4; . ......Date
Date
. _Via.
No.. ...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.L' TOWN OF BARNSTABLE
,� '� t�
_ ��ltrtt�t�an for �t��l ,ittl Wnrk,s Tomitrnrtinn Urrmtt
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
...a...... ................................. -••—......---••-•.......................... .... ..................••-•--•--••-•--••----•-.
Location-Address or Lot No.
CrW 16 Address
O vn 6
... �-?�................. I --------------------------------------......--------------------------------...•........----------
Installer Address
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' 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......................................
I
W I�
Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water...............`..... .
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 ----------------------------•---•-•••------------------•--••--------------•----•--••-•-•-•--•-•••.---•.........-•-••-••.......• -------------
.....
0 Description of Soil............................................................................................................................................••......-----•-•-•-•-••-•---
x
V .------------------------•-•----------------••-----------------------------••------------.....---------------------------------------------.............................................................
W
---------------------------------------------------------------------------------------------------------------------- ...
----------------------------------------------------•-•.------•-•----•.•--•--
U Nature of Repairs or Alterations—Answer when applicable.
_ _ CI!._._�? ...�T�!ns.+. r�
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Envir �nmenta ode—The undersigned further agrees not to place the
system in operation until a Certificate of Comp�Ta-e.(9Fa been J ssu - by the board of health.
Sign e :--- - -- --
W -........ - .[. .....
Application Approved By 2,!t!t ... --- G '.............................................................. ...
/��
.. ------.
Application Disapproved for th!fllowig reasoni .............'........_..--"�a. ' e
........................................... �............................................. . .................................... -- . --'--- --- ...... .........----
Permit No. �`�.. �°- ✓��-� Issued ..... `... iz / ,
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
C'Ier#tft.cate of CnompItonre
THIS IS TO CE TIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by - �-f' ...[.. .....................................-------....--..._.......-----------------------------------------------------------------...----......_...-...--........_._..-..-----------------------
1wak,
at
/G G /��{,rvr K-�.-.5.- r.0(3 _........
--..t.?ern t_T�t,Jt'------------------------------------------------------- ---
has been installed in accordance with the provisions of TITI.E_5 of The State Environmental Code as escrT0 in
the application for Disposal Works Corstruction Permit No. ----- dated .-._t..t..'.._.........�..... ._._ -...-
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACT
DATE...... .:....... 7............... ------------ --------- Inspec,or^ -
y2 i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No.•--.......`A...... FEE.................
11iiiVniial Vorhg Tamitradwi tt Pgrutit
Permission is hereby granted. rJ-��'- "�� '�tl :: ! ..........................................................
to Construct ( ) or ,ReePair ( an Ind! j4ual Sewage Disposal System
at No......Z 4� -!( %2'_ l _....4!'------ ---------
Street
as shown on the applicatio for Disposal Works Construction P�rra't o.�'_ ,:�5l-���Dated�!��1._'.__.��"'_....i
'�I?. ----------------
Bo
J ard�of Health r �,
DATE.. 1._.... j•-...�
V
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS
• - • si�/�T 7 G�-,z S/�/E�Ts
L. . .��./S. . ...
TOP OF FOUNDATION
CONCRETE COVER
CONCRETE COVERS
444-
' ,'�e 4"CAST IRON
n rrfsT�
•; OR SCHEDULE 482 MAX. 12"MAX.-
P.V.C.. PIPE 4 SCHEDULE 40 P.V.C.(ONLY)
� PITCH 1/4"PER.FT. PIPE - MIN. LEACH
PITCH I/4"PER.FT. PIT
PRECAST
o' INVERT e Q LEACHING
EL.sL.•.7/... INVERT INVERT n . " PIT OR
e'. SEPTIC TANK �-C DIST. -�y w q•, EQUIV.
, e INVERT NVER BOX • > + 0: ,,
e; EL. �� 79..
Ioaa.. .. GAL. IELs3� . INVERT G wwll 0 �:i: 3/4"TO II
e 29 EL. 7a. LL w� �, �;� WASHED
Eat.m.Zo
STONE
• , ZZ�--•�+-WDIA.
u •. . DIA
N �E
PROF1 LE OF GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM
NO SCALE
SOIL LOG _ WITNESSED BY
DATE TIME. A!r 4 JG-7Z2S/ wNr�/�NG BOARD OF HEALTH
TEST HOLE I TEST HOLE 2 ENGINEER 7
ELEV. . .�r 60. . . ELEV. .� Zo• . . . . . ..
DESIGN .DATA •
svB-seic. s�Cj SviL
NUMBER OF BEDROOMS • .
TOTAL ESTIMATED FLOW . .43�,C? . GALLONS/DAY
•S,Zo BOTTOM LEACHING AREA i.�3.9• . , SO.FT../PIT/i27.7 G.P.D,
SIDE` LEACHING AREA . . ���3: �1 SQ,FT,/ PIT 3o7•y G. D
Cogns e Ce,q�2sF_' ' � P •
GARBAGE DISPOSAL . !yO `!E.(50% AREA INCREASE)
W/7V µ/ry
/BUGS 12nCiG5 TOTAL LEACHING AREA :307. .,8 SQ.FT
�� PERCOLATION RATE MIN/INCH
/ a" L�.4s�o x �z_44 Zo
LEACHING AREA PER PERCOLATION RATE 435,E SQ.FT.�c,pp
WP -WATER ENCOUNTERED
NUMBER OF, LEACHING PITS . OrVET IN1771
APPROVED . .. . . . . . . . . . BOARD OF HEALTH fvv�z F6zT GI S7T>Ne.- OW 444-
DATE y
AGENT OR.,INSPECTOR
01
-�'/9T/avGI�1 �LLS �O!-,L Lo SLs o� E yoJ SO
Las A
D L HA
Z t�CELLEY H �,
No. 26100 a� 1STFP��
PETITIONER S�Py��, C. NEB 77e. ��N�lIANOg
s�1T cam:.Z
e11—EOP OF FOUNDATION
s CONCRETE COVER
CONCRETE COVERS
4,44' e 4"CAST IRON 2MT` .
OR SCHEDULE48 12"MAX. •
P.V.C. PIPE 4"SCHEDULE 40 PVC (ONLY) '7f
PITCH 1/4"PER.FT. PIPE - MIN. LEACH
PITCH 1/4"PER.FT. PIT
PRECAST
INVERT M a LEACHING
EL•s�..7/.. INVERT INVERT w �:; PIT OR
o'. SEPTIC TANK C DIST. j EQUIV.El... . Z . EL... ?. >_
INVERT /¢oo BOX ►=f-++I 0: ''
e; EL. s'� 19..
GAL. s INVERT
? =. INVERT w wl p: :.�: 3/4"To I I&
e Z9. EL r- 7Q. W WASHED
4,B.Zo STONE
ZZ WDIA. 1v.1c
DIA
14
PROFILE OF . GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM
NO SCALE
SOI L LOG WITNESSED " BY : ,
DATE f41��` TSB,. TIME. �0.� 4.1 ./G7Z��/ wN�/iwGu BOARD OF HEALTH
TEST HOLE 1 TEST HOLE 2 ENGINEER
ELEV. .. Lo . . ELEV. .r •?9. . -
woop[d", ti1/oa/>Lcs
-�+BSeIG s�Q so, , DESIGN '; DATA
SsFr�o Sao NUMBER OF BEDROOMS 3
AMCH C TOTAL ESTIMATED FLOW . .3 �? . ,., GALLONS/DAY 71 / BOTTOM LEACHING AREA q
�Z.S,Zo �'y'3•/: . S0.FT.`/PIT/it7.7 G.P.D.
SIDE LEACHING AREA . : �J�3' �1 . . SQ.FT./ PIT 3o7,g G. D
Cogizs� - Ceq�s.F - . � R
SAID S'�`JO GARBAGE DISPOSAL : NOwE (50% AREA INCREASE)'
l�eS /Zac1G5 TOTAL LEACHING AREA 307•,8 SQ.FT
EL 44:zv PERCOLATION RATE ?;� u 7PeZF MIN/INCH'Y
LEACHING AREA PER PERCOLATION RATE .. . . -.. SQ.FT.�c,OO
,No •WATER ENCOUNTERED
NUMBER OF LEACHING PITS
APPROVED . . . . . . . . BOARD OF HEALTH faviz FCTGF S�rv�: O� ,4u S/�
DATE . . .
AGENT OR INSPECTOR
j 5 It OF
OF Mqs goo ;+r
ED you s NAo
g LL
Z tRELLEY H
No. 26100 0 IST�p�`�
ass�fCISTERE� s�rrrt�a�►�
PETITIONER ��py C: ON j 7k. ��M�l LPMO
-I"TOgN OF BARNSTABLE
LOCATION SEWAGE # `f `��•�
PILLAGE � �%�= ASSESSOR'S MAP Q LOT, l�
INSTALLER'S NAME & PHONE NO.(A-
SEPTIC TANK CAPACITY `1000
LEACHING FACILITY:(type) = (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDEi OR OWNER s
DATE PERMIT ISSUED:
�4
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No j
13
A
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r
No... .... 4_0 Finc
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
ppliration for UinVn!3ttl Workii Tnnitrnr#inn ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: {�
....� Q. ---------- --�'-- ��� ----•-----------------•-----------------------------'•---.....-....----•---------------------•--
.. --- -------------------
ctie4:wi-i\ drys ,^ or Lot No.
-------- - - -�r ;'s
--
Owner
IListal erddress
Type of Building Size Lot............................Sq. feet
Dwelling— No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Pk Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' 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........................
G%t Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
P+ •--•-•••-•-•--------•--•--•-••-•--••----•-----------------•---•••-•---••••----..............................................................................
0 Description of Soil........................................................................................................................................................................
x
U ..............................................•--------------••-••--•---•-•----•••-•-•---•-••--•-•-•--•--•------•--••••-----•-••-----••-•------•-•--••---••----•---•••---•.....••-•"-------••••-------.
w _..•-•----••----------•------------•----••--•-••._...--•••----------•-----------•----------------------•----- -�. �f
U N ur e airs r Al raPo —Answer when applicable.__. ... .........__ ....`........................
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 Com ianc s been sue the board of health.
Signed _. ..� �..
e ®® Dat
Application Approved By ..... . . ... .... .... @-----. .. l
ce
Application Disapproved for the following reaso s -------------------------------------------------------------------------------------------------------------------------------
........................ . ... ................................ . ........................ --- ------- -----------....................I...
.................
' to
Permit No. �� .... . Issued ........... ..... .. ...
f
r
O� (49
No. ,._...... - --• Fi$
..... ......................
C THE COMMONWEALTH OF MASSACHUSETTS
` BOARD OF HEALTH
TOWN OF BARNSTABLE
ttttlirtttinn for Di,ipwiMi Vork,i C omitrnrtiun Vantit
Application is hereby made for a Permit to Coristruct ( ) or Repair ( ) an Individual Sewage Disposal
System,a� Q'icr
r ..�� �
L"eat-ion e\ dress or Lot No.
Owner A
-
ddre�s
............................ 6P__ ......CY) -- ......\.. U�......_-� t
Installer Address
UType of Building 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 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........................
fs, Test Pit No. 2................minutes per inch Depth of Test Pit__-__________.______ Depth to ground water........................
-----------------------------------•-----------------------•----------------------...-------.._..---.........................................................
0 Description of Soil-------------------------------------------------------------------------------------- ---------------------------------------------------------••--------...._••_•-----
U •--•--•--•-•----•-•-----•------•--•----•---•- --------•---------•--------------------••••---------•-----•-•------------•---•-----•----------------•....................................................
--------- -+ ------i----------------------------------------------------------- .........
'� =
- ----- - - ---------- ---
U Nature o Repairs or Altera o —Answer when applicable____________________ .__�-J:� ._.._._._._.____._____...
---...------ •-
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 Comp-lia e `Qas beenlissued'by the board of health.
Signed ---- --• '----
- Z
Application Approved By r1 �/l ✓_-.: = i... t' �.le�'A. ............ .....�/�.... �
Application Disapproved for the following rearon��----------------------------------------------------------------------------------------------------------- -----------------------
...... .............................. �-f.1 .-�-° 6'._�..... ------------ ----------- -/.......
.............................. ...
jre
Permit No. r . r�-------------------- Issued ,./.� (7i�}/��--------
A , te
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Complianee
THIS1,IS ,0 CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by ..... `' .. � � ..,<-�,.. t----'-''� -.-- .---.. ... --- ......... ...... --- ---- -------.. .. .----
p ,p _ Imc Ilrr
at ....... r`t-- .�. `�y - ......_------- t 11Lif�!- i3---- ------------------------------------- ----------------------------
t Environmental Code as described in
hhe applicationl for lDispr°alaWorks tConstuc on Perm TITLE 5` f4 e St �f� dated ......._......_.........._.....-.._........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUEA AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISF TORY.
DATE....._..../`:""' .; .' -� �------------.-------------------------- Inspector ----- ....... ... -- r
----------------------------- -------------------------------
------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No.....1................... FEE.---.Q...
19ispnstt1 n-r--bi -Tunitrudion. rrntit
Permission is hereby granted ' :\� .........
to Con�ruc (t�) or R�� ( ) an Individual-�Sexrage ,Disposal System
--rryy----- -- vc..�
Street -�,,,./
as shown on the application for Disposal Works Construction Permit NO.-.._._____... _G�/Dated :_..
(fJ Board o Health d/
DATE............. �f,!`f ,, ;1 f------- -------------------- \
U
FORM 36508 HOBBS R WARREN,INC..PUBLISHERS
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TOWN OF BARNSTABLE - UNDERGRUUND FUEL AND CHEMICAL STORAGE REGISTRATION
MAP NO. � PARCEL NO. TAG NO.�
ADDRESS OF TANK: 1100 O VILLAGE: 1 -pt6te
MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : I �' j G2G G�
OWNER NAME: HONE: �Q
ol
INSTALLATION DATE: a BY : G,n�`�' �1�� �,��
// s
INSTALLER ADDRESS: co a0lf ERT .NO.
_ t r
*TANK LOCATION: ABOVE BELOW 4gAlle (;!a,iinjb
(DClOPPxmu TANK LOCATION WITH AiOPaCT TO >u SLDINO)
CAPAC I TY500 TYPE OF TANK wit=Scf AGE - . FUEL/CHEMICAL r'Ce J
TESTING CERTIFICATION [ ] PASS , C ] FAIL DATE
LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND ' '
ZONE/OF CONTRIBUTION. C ] YES [ A NO DATE TO BE REMOVED
FIRE DEPT. PERMIT . ISSUED Cx] YES [ ] NO DATE
CONSERVATION C ] CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. C 13 p'® ] DATE kl 7A) �I
PLEASE PROVIDE A SKETCH SHOWING THE TAN.K. LOCATION ON THE BACK OF THIS CARD
.'. Srs'ts.-,z.,eassc.:;"r.3":'"'r�P"', 'w'RA'*9�+} •[ +!"t
TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
MAP NO. a5y PARCEL NO. 0/6 TAG NO. A36001
ADDRESS OF TANK: /d OO •-�•-�141VOy /Q� VILLAGE: 23/ kA—)
fvumb�r tr��! a /
MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : �60 E!4-414l® /G ?'""'0 U�
OWNER NAME: gy,4AIMS 6t4,,F 6j16 '-o-)A HONE: ��g No f3L
INSTALLATION DATE: S cat BY: 6001C Al ;fJf6AJN 50L.-U7-/0
INSTALLER ADDRESS: t0 L: 0 1 ER UAI �alICKRT.NO. I (2 rb
r
*TANK LOCATION: ABOVE BELOW 6otP—, G/ZouA-0
(Damon Z as TANK LOCAT Z ON W Z YI:4 ACOPaCT TO OU 2"D 2 NO)
CAPAC I TY_ OUQL,TYPE OF TANK _7P►G5E_L AGE / 'v°RS. FUEL"/CHEMICAL _b f E5
TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE
4
LEAK DETECTION [ ] CHECK IFN/A TYPE/BRAND bMryf �. r p of Lu 5
s
ZONE OF CONTRIBUTION [ ] YES [ ] NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED [A] YES [ ] NO DATE
CONSERVATION [ ] CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. [ 13 fo ] DATE �10
PLEASE PROVIDE A �SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
�1
91
so 0
c 60,
,._� x�.tw4�W"�►-*vf�'t"'yY-.+^'ri" 'lia:r',ls:...: ..--...,.._....e- ... ,-r;'vt.. _. �w.,, .--..,,:T..r.�;�x r �� ��.w. .,.ai.:o-:ro , _.
TOWN OF BARN STABLE - UNDERGRUUND FUEL AND CHEMICAL STORAGE REGISTRATION
MAP NO. PARCEL NO. TAG NO.
ADDRESS OF TANK: „. VILLAGE.:
Numb! ` {! ram• -
MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : 9" i �ZGo�
OWNER NAME: L r PHONE: �/
INSTALLATION DATE: f ° BY: .�117-41 -
INSTALLER ADDRESS:G °J CERT.NO.
r !
14
*TANK LOCATION: ABO E� BELOW L
(DClCP7I C�T�ANIC OCAT I ON W Z T►-1 IRGOP�CT TO !U Z LD I N0)
CAPACIT 0� TYPE OF TANK aa,S AGES. FUEL/CHEMICAL
TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE
LEAK DETECTION [ 7 CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION [ ] YES [ ] NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED [ ] YES [ ] NO DATE
CONSERVATION [ ] .CHECK I_F N/A DATE
BOARD OF HEALTH TAG NO. [ 3 J DATE 2 4
# PLEASE. PROVIDE A SKETCH SHOWING .THE TANK LOCATION ON THE BACK OF THIS CARD
Ms:rr.et� R ' +ndlN►ti'°"'. e^4 } `+.y,'Y"* •kF 114—i''+V—_
TOWN OF BARNSTABLE — UNDERGRUUND FUEL AND CHEMICAL STORAGE REGISTRATION
MAP NO. '� PARCEL NO. ��� TAG NO.
ADDRESS OF TANK: f Sao y,4 l✓✓NUJ
Number •trwft' „� G� J p�
MAILING ADDRESS- ( IF DIFFERENT FR�.OM� ABOVE) : l��0 . �,/,ya I �`` , �)r` 6
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OWNER NAME: f'AUAAAIM� al-F CLUO� f�wsiJ or P`'�R J�! HONE: f`", '� - �'� �
INSTALLATION DATE: C� A r BY: 60 R6' AA0; VC4eC6 &0��i• �,9�.;
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INSTALLER ADDRESS: �+2o �� �—ky4wu d wdc) 046114CERT.NO. cy -r
*TANK LOCATION: ABOVE) BELOW
(Damcm I aC TANK LOCATION WITH PfGOPQCT TO mU I LD I NO)
CAPAC I TY-t�0C6 , TYPE OF TANK lT =- AGE IU) YES. FUEL/CHEMICAL �T'ft
TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE
LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND MtMC( .» i P; ? Ltt,3
ZONE OF CONTRIBUTION [ ] YES [ ] NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED [ ] YES [ ] NO DATE �� .7107
CONSERVATION [ ] CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. [ / ] DATE
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ,ONJNE BACK OF THIS CARD
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