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HomeMy WebLinkAbout0008 NORTH PRECINCT ROAD - Health 8 NORTH PRECINCT RD., CENTERVILLE A = N UPC 12534 No.2 53 QR HASTINGS, MN 0 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: Fill in please: APPLICANT'S YOUR NAME/S: Ly i�_ L-At =eP/dZ BUSINESS YOUR HOME ADDRESS: U2--z:;) CJrg O ' TELEPHONE # ;II,i e-telephone NumberD Cr -` -- NAME-OF-CORPORATION:`' VI lA--- — NAME OF NEW BUSINESS TYPE OF BUSINESS O < fgTHIS A HOME OCCUPATION? YES NO y L� �'�- `\ ADDRESS OF BUSINESS 1 MAP/PARCEL NUMBER U [Assessing] 2 cn — OZ = O iVhen starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of tarnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth ~ d. & Main Street to make sure you have the appropriate ermits and licenses-re required to legally o i hl� i.O000PATION YP q 9 Y pffa w °1. BUILDING COMMISSIONER'S OFFICE RULES AND REGULATIONS. FAILURE TO a. CC > COMPLY MAY RESULT IN FINES. 2 p Q This individual has been in rm d any permi q rements that pertain to this type f business. ® �z - � Autho d Sig JCLCOMME TS: x 0 2. BOARD OF HEALTH C This individual ha b' n informed oft rmit r quirements that pertain to this type of business. Au horized Signature** COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: t IUWU Ul .DUfUSLUUle . F THE Tp� Regulatory Services o Richard V. Scab,Director RAENsTAB . : Building Division MAss Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 wwrv.town.barnstable.ma us' Office: 508-862-403 8 Fax: 508-790-6230 Approved: • Fee: � t Permit#: f 1 HOME OCCUPATION REGISTRATION Date: Name: Phone Address: _ Name of Business: �_1 G Type of Business: Gt72it-G f U Map/Lot:t � s U INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor,no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall.be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located . within that dwelling unit.' . • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,.glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,m excess of normal household quantities. • Any need for parking generated by such-use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. . • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Cnstomary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and n6t to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwellinLy unit. ]y the undersigoe ve read d agre e . e resin ions for my home occupation I am registering, PA I Applicant: Date:_6911)7 Z6�� Homeoc.doc Rev.06 116 �\ ��� �"'", Y �� t - 3 a .. ` •~ .+%�' � w/ No. 2-o® 5 — 1611 Fee r / 00 .� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MA S ACHUSETTS Yes application for Mi 5al *pgtem Con5tructioi permit Application for a Permit to Construct O Repair Upgrade O Abandon O ❑Complete,System ❑Individual Components Locatioon�Address or L t No. h Owner's Name,Address,and Tel.No. 5-4-73 7 3 �3 Assessor esso's M p/Parclii 14�L T r2� 3s 4 F L. F U Z 0TT Installer's amjAt� ncy�TeJ.No. (,1_ 7 7 7 Designer's Name,Address and Tel.No. 1 �JY V !� / 8 00(LTti t912EC l/VC-T Type of Building: �i e2 / Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 7 �2 11:�P7// T#41 'k 7V /ygi,,. 1%%)s E DES r fz.o y s17 7-4^1 —w ,N dIZ5,c-, PGS-rdyc Q V2 F Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by G S F• Date Application Disapproved by: Date for the following reasons Permit No. 2_,0 o b — l q1 Date Issued S" /3 ?_0O's THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance t THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( � Upgraded ( ) Abandoned( )by 9C-o L EU R at k�,j e)g:x SA_ 1 jAe—I �� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 0®8 t dated S' 3^ 66. Installer 70 Designers �►p`LLtic„ #bedrooms 3 Approved design flow 3 C3 gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. Zv O 5 1 1 t Fee f 010 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS wig pour *pgtemc Congtruction Permit Permission is hereby granted to Construct ( ) Repair (✓) Upgrade ( ) Abandon ( ) System located at 5 N O eg-TN Pgo.G C?k 7gz-vi r— and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed.within three years of the date of this permit. Date Approved by ---.r.V...-v..hr u �-s;;r.({�...,-•gyi�:.:�%+.rl.a_ �—.���.y.yi¢-�_,_..... ^-.o..t""."z „-.- , ,�`�.»._... .]-•-r.�_ ..;,-'j. �_. ,..-..- .. ... �. ..r - No. 200 o,.. �. y ' Fee.4/ 0 Q tTHE COMMONWEALTH OF`MASSACHUSETTS 1 Entered in computer: N -PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rulication for 7) Upgrade gar pgtemc �Cottgtructton Permit Application for a Permit to Construct O Repair ( ) Abandon O ❑Complete.System ❑Individual Components -Location Address or Lot No. 2 Owner's Name,Address,and Tel.No. S0 p—73 7` �' �3 AsAlcry ses 's M p/Parcel p 1 mil T 1I Za .560 7--r Installer's Designer's i ner's Name,Address and Tel.No. 'EOM I L SOS- 3 - 7 1 �� ry -No (1719 P12ee "Ve—7 Type of Building: fi 1L Cryh ►� Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder (� ) ° Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Y Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil y Nature of Repairs or Alterations(Answer when applicable) &az 7- PT/2 T—d Vk V /Vg4„- w 14w5F. IDES T2oy67D A `1 F/2 g E, i X/571,V6 T-rgn/l r' " IU9-W hPC- o,All V 191- 0 5 E S%'dy Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed / Date ' Application Approved by �j/ G S 4!�. Date s' —/:3 — Z 6 O 5 v Application Disapproved by: �/ Date. r• for the following reasons Permit No. 2_0 O f> Date Issued .r^ /,3 ?_00 g ;._ - - --- ------------------------------------------ - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS -- 4 Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (� Upgraded ( ) Abandoned( )by 9CD,-C �„p. (, V_U O at f> N A ?-Z N !� ra G"T 'd has been constructed in accordance with the Vprovisions of Title 5 and the for Disposal System Construction Permit No. Z pp i dated Installer 70 6�., WC Designer 20" ('A O 1 LL&L� #bedrooms 3 Approved design flow '� C.) gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector --------------------------------------- No. Zoo 8— 1ctk Fee lDO , THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 1=igpo!9ar,,*p!5temc Construction Permit Permission is hereby granted to Construct ( ) Repair (✓) Upgrade ( ) Abandon ( ) System located at S /V O!1-TN Pgg_c n.,G7- mod• Cfti'7jFtZ-v1 P14, and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date Approved by Commonwealth of Massachusetts Executive Office of Environmental Affairs REc, Department of MAR 2 8 1997 D Environmental Protection TOWN OFBARNSTAK HEALTH DEPT W011arn F.Weld 'g Trudy N Goranor Argeo Paul Celluccl U.Govemor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A - 8 AT Rd CERTIFICATION Roberta Mulcahy Property Address: Centerville Address of Owner. Date of Inspection: (If different) Name of Inspector. W.E. Robinson SR Company Name,Address and Telephone Number. ( 5 0 8 )7 7 5-8 7 7 6 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site disposal systems. The system: _ Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspectoe's Signature: 4i' a 1 y Date: 3—t;P-V ' The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A,B, C,or D: AJ SYST,EM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal, cracked,structurally unsound, shows substantial infiltration or enfltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-UN 40 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 8 N. Precinct Rd Centerville Owner. Roberta Mulcahy Date of Inspection: B)SYSTEM CONDITIONALLY PASSES(continued) _ Sewage backup or breakout or high static water level observed in the distribution boat is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. The system will peas inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution boat is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C) THER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 9) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 8 N. Precinct Rd Centerville Owner. Roberta Mulcahy Date of Inspection: 3-�Lce—%, D) SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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 I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. El GE SYSTEM FAILS: i The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public ealth and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The o r or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirem nts of 314 CMR 6.00 and 6.00. Please consult the local regional office of the Department for further information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST 8 N. Precinct Rd YO Centervile Property Aid Roberta Mulcahy Date of Inspection: 3-d2 t/—,9 1 Check if the following have been done: Pumping information was requested of the owner,occupant,and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. 1//As built plans have been obtained and examined. Note if they are not available with N/A. V The facility or dwelling was inspected for signs of sewage back-up. Lthe system does not receive non-sanitary or industrial waste flow 4he site was inspected for signs of breakout. /All system components, excluding the Soil Absorption System, have been located on the site. fhe septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction, dimensions, depth of liquid,depth of sludge, depth of scum. /!'he size and location of the Soil Absorption System on the site has been determined based on existing information or TT77 approximated by non-intrusive methods. 41_�facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub. Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 8 N. Precinct Rd Centerville Owner. Roberta Mulcahy Date of Inspection: FLOW CONDITIONS RESIDENTIAL.- Design flow: `/Y 4) gallons Number of bedrooms: 3 Number of current residents: Garbage grinder(yes or no): © _ Laundry connected to system(yes or no): � Seasonal use(yes or no):Ae fj Water meter readings,if available: 1995 51 ,000 gals 50,000 gals Last date of occupancy: v�+�[—ol COMMERCIALANDUSTRIAI.: Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)— Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS apd source of information: System pumped as part of inspection: (yes or no)_ If yes,volume pumped: Gallons Reason for pumping: TYPE 9F 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) Other(explain) APPROXIMATE AGE of all components, date installed(if known)and source of information: A j l?c at Sewage odors detected when arriving at the site: (yes or no) f� (revised 11/03/95) b SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 8 N. Precinct Rd Centerville P''Operty Address: Roberta Mulcahy Owner. Date of Inspection: SEPTIC TANK (locate on site plan) Depth below grade: g 1 Material of construction:L1W/=rete metal_FRP_other(e:plain) /b n W/S Dimensions: 4k Sludge depth: J °r w Distance from top of sludge to bottom of outlet tee or baine:3 y Scum thickness: (. r . Distance from top of scum to top of outlet tee or baffle: 9- Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) /�� M- l� L L cn j 7 Svc 1r� .4lec .� G E TRAP. (loca on site plan) Depth low grade: Mate ' of construction:—concrete.—metal_FRP_other(e:plain) Dime ions: Scum Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comm to: (reco endation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, avid ce of leakage,etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 8 N. Precinct Rd Centerville Owner. Roberta Mulcahy Date of Inspection: 3 -;L TIGHT OR HOLDING TANK_ (locate site plan) Depth be grade: Material o construction:_concrete_metal_FRP_other(explain) ' Dimensie Gunmenac' ¢allons Design w: ¢allons/day level.• Comments (condition f inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX:L (locate on site plan) Depth of liquid level above outlet invert:® �J 6 Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP CHAMBER:_ (locate n site plan) Pum in working order:(yes or no) Comme ts: (note tion of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 8 N. Precinct Rd Centerville Owner. Roberta Mulcahy Date of Inspection: `�- 4 '7 SOIL ABSORPTION SYSTEM(SAS):_ (locate on site plan,if poswble;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits, number:—L— leaching chambers, number:_ leaching galleries,number: leaching trenches, number,length: leaching fields, number,dimensions: overflow cesspool,number: Comments: (note conction of soil,signs of hydrae failure, level of ponding, condition of veggtatipn,etcJ b e C POOLS: (loca on site plan) N and configuration: Depth- p of liquid to inlet invert: Depth solids layer- Depth scum layer: D' no of cesspool: Mate ' of construction: n of groundwater: inflow(cesspool must be pumped as part of inspection) Comments: note oondition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) PRIVY- (locate on 'te plan) Materials construction: Dimensions: Depth of so Comments: ( condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) (revised 11/03/95) 8 v .a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 8 N Precinct Rd Centerville Property Address Roberta Mulcahy Owner. Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' ,/JAG c� DEPTH TO GROUNDWATER Depth to groundwater g o feet method of determination or approximation: 6 N � (revised 11/03/95) 9 i V f CO'.%SJSO\`WEALTH OF MASSACHUSETTS �- _ C EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION. 'gam 0\E %INTER STREET. BOSTOT NiA 0210F i617, 292-550o TRUDYCOME Secretan ARGEO PAUL CELLUCCI DAVID B. STRI, HS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION j Property Address: 8 No . Pr:e c ii1ot ld%- Name of Owner Mulcahy Ce ne rev11 e r MA Address of Owner: Date of Inspection: Name of Inspector:(Please Print)Wm. E . Robinson Sr. I am a DEP approved systerq inspector rsuant to Section 15.340 of Trde 5(310 CMR 15.000) Coml_yName: Wm. E . Robinson eptic Service Mailing Address: PO BOX 089, Centerville , MA Telephone Number: �8 (� CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-sizPasses a disposal systems. The system: Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails OF Inspector's Signature: L Nate: The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (301 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to tfte system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS ,t 9 � RfrrwEO �r J u N 1 8 1999 �. TOWN OFBMNSTABLE HEALTHOEn revised 9/2/98 Page Iorlt N �0 ✓retied on Recycled Paper SUBSURFACE SEWAGE DISPOSAL.,SYSTEM INSPECTION FORM PART A CERTIFICATION.(continued) IropertyAddress: 8 No : Precinct Rd.. , Centerville , MA Owner: Mulcahy Date of Inspection: INSPECTION SUMMARY: Check A, B, C, or D: A. 7SY PASSES: _ V I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. S STEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicatc yes, no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board-of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipels). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed r revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Prop"Address:8 No . Precinct Rd. , Centerville 0wnef: Mulcahy Date of Inspection: /_'e;_ P ,C� C., FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. - 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 8 No . Precinct Rd.. , Centerville Owner: Mulcah q Date of Inspection: D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: f have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this etermination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes N Backup of sewage into facility-or system component due to an overloaded orclogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. RGE SYSTEM FAILS: You m t indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes o the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The own r or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of he Department for further information. revised 9/2/98 Page 4ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART B. CHECKLIST Trop"Address: 8 NO . Precinct Rd.. , Centerville , MA� Owner: Mulcahy Date of Inspection: G_ly• Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and•the system has been-receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with NIA. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. Y _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. / The size and location of the Soil Absorption System on the site has been determined based on: V _ Existing information. For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)1 _ The facility owner (and occupants,if differeni from owner) were provided with information on the propertnaintenaac"f Subsurface Disposal Systems. revised 9/2/98 Page 5ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION 'ropertyAddress: 8 No . Precinct Rd.. , Centerville , MA owner: PMulcahy Date of Inspection: 4(1•—5i FLOW CONDITIONS RESIDENTIAL: Design flow: g.p.d./bedroom. Number of bedrooms(design): Number of bedrooms (actualAl— Total DESIGN flow® Number of current residents Garbage grinder(yes or no): B Laundry(separate system) (yes or no)Lo&O If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no):A 49 1998 156,000 gal. Water meter readings, if available (last two year's usage (gpd): Sump Pump(yes or no):A- ® 1 136, 000gal. Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type o establishment: Design Ow: 9Pd ( Based on 15.203) Basis o design flow Grease rap present: (yes or no)_ Industri I Waste Holding Tank present: (yes or no)_ Non•sa itary waste discharged to the Title 5 system: lyes or no)_ Water eter readings, if available: Last to of occupancy: OTHE :(Describe) Last of occupancy: GENERAL INFORMATION PUMPING RECORDS d rce of'nfor ation: � -0-O. v� System pumped as part of inspection: (yes or no)_ If yes, volume pumped: gallons Reason for pumping: TYPE SYSTEM Septic tank/distribution box/soil absorption system cesspool Single 9 Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records,if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known) and source of information: 9--a ,--•3 Sewage odors detected when arriving at the site: (yes or no)�i U revised 9/2/96 Page 6of11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'rop"Address: 8 No . Precinct Rd.. , Centerville , MA , Owner: Mulcahy Date of Inspection: G —g 17 BU LDING SEWER: (Loc to on site plan) Depth below grade:_ Mated I of construction:_cast iron_40 PVC_other(explain) Distan a from private water supply well or suction line Diam er Cc ants: (condition of joints, venting, evidence of leakage,-etc.) SEPTIC TANK:_ (locate on site plan) Depth below grade: Material of construction: - concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal, list age_ Is.age confirmed by Certificate of Compliance_ (Yes/No) Dimensions: Sludge depth: ��' ► Distance from top of sludge to bottom of outlet tee or baffler Scum thickness:_ t Distance from top of scum to top of outlet tee or baffler ► i Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined:4 'omments: (recommendation for pumping, condition of inlet and outlets or ba as, depth o�li i level in relationto outlet Evert, structural integrity, evidence of leakage, etc.) / b A �a JteGs J0, GREASE TRAP: (locate on site plan) Depth elow grade:_ Materi of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimen ions: Scum hickness: Dista ce from top of scum to top of outlet tee or baffle: Dista ce from bottom of scum to bottom of outlet tee or baffle: Dat of last pumping: Co ments: (rec mmendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evid nce of leakage, etc.) revised 9/2/98 Page 7or11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION(continued) ,-rop"Address: 8 NO . Precinct Rd. , Centerville , MA Owner: Mulcahy Date of Inspection: TI HT OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (loc a on site plan) Depth below grade:_ Materi I of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dime sions: Cap city: gallons De gn flow: gallons/day A rm present Ala m level: Alarm in working order: Yes_ No_ Dat of previous pumping: Co ments: (co dition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX- (locate on site plan) Depth of liquid level above outlet invert: Comments: Inote if level and distribution is 1, evidence of solids carryover, evidence of leakage into or out of box, etc.) - PUMP C MBER:_ (locate o site plan) Pumps in orking order: (Yes or No) Alarms i working order(Yes or No) Commen s: (note co dition of pump chamber, condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8of11 III SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'rop"Address: No . Precinct,,'Rd. , C .nterville , 1vA. Owner: Mulcahy Date of Inspection:6_g 9 t SOIL ABSORPTION SYSTEM(SAS):_ (locate on site plan, if possible; excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits;number:—I—q leaching chambers,number:_ leaching galleries, number:_ leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number:_ Alternative system: Name of Technology: Comments: (note ion of soil, signs of hyd ulic failure, Igvel of pondin , damp soil, conditio f vegetation, etc.) _ )f V CES OOLS:_ (locate insite plan) Number d configuration: Depth-top of liquid to inlet invert: Depth of olids layer: )epth of cum layer: , Dimensio s of cesspool: 4 Materials f construction: Indication of groundwater: flow (cesspool must be pumped as part of inspection) Comme s: (note c ndition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) j on site plan) s of construction: Dimensions: f solids: nts: ndition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revised 9/2/98 Page 9ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'rop"Address: 8 No . Precinct Rd.. , Centerville , MA, lwner: MUlc ahy Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate-all wells within 10.0' (Locate where public water supply comes into house) I J �'0 Y woe l revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) rap"Address: 8 No . Precinct Rd. , Centerville., MA Owner: Mulcahy Date of Inspection: NRCS Report name Soil Type_ Typical depth to groundwater USGS. Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record cl' Observed Site(Abutting property, observation hole, basement sump etc.) t Determined from local conditions Checked with local Board of health Checked FEMA Maps _Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) revised 9/2/98 Page Ilof11 '1 STOW OF BARNSTABLE / LOCATION U �� t'�L 7� EWAGE # `�/��f— a`�_ VIklLAG4101 /4 i ' ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO�bO-i �c�{)�J(CUU(, 77�-O*At SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) &X Ov t, NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER (' DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED � � VARIANCE GRANTED: Yes No �� .. G 0 3 ��i�o U Se t c ��� � ���a �T cu�.�� s'TvK ��� ,, � � ►'" .. i =�_ No..•...7/= � Fss.... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Applira#ion for Dhipoii al Workii Tatuitrurtiun Frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( i Individual Sewage Disposal System at: ---........... N 12.T '....�r. zs� ;e v.�......... .................. ��'e'-�Ti�o!tv� ! ............................... Lo ation-Address Lot No. ...............1 d`�..- J '`-E.�.....---•_.... ----......------------.••--- ............................................... " Ow Addres a G.�aP -�—a L-------------- �r� 1_.. .� -----U ---------------------------- Installer Address � feet Type of Building Size Lot............................S q. V Dwellin No. of Bedrooms...................... .__-.Ex Expansion Attic g— -----•--- p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -------------------------------------------•----------------------------•••.-----------........---- W Design Flow_- .........................gallons per person per day. Total daily flow........_3':X z...................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------I------------- Diameter-__-. Depth below inlet.... ._......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by.......................................................................... Date........................................ 1 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water...................... :- fZ4 Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........................ 9 ••••------••------------•-•••--•---•---•----•-•------••--...•.......................•-------•--•---•..................................... ------------ ODescription of Soil...............................................................................x w x •-•------•--•---•••--.....--••-••-•------•--••-•-••••-•--•-•--••--------•------••-•-•---•--••-•----•-------•-•••-----------•-------•-------•--------•--•-----------•......---•-••---•-...7----------- U Nature of Repairs or Alterations—Answer when applicable------A_0.a_._---_ ..... ---._•__--_-.__. lht -.........1)1 �........ �/..el -�------.. . --••----••--....-•----•-•-•••-•••--•-••..................... 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 b th board health. Y p P -------------------- Signe .. -. Date .r° a. Application Approved By ----�.....�.,td,�w,.�-- .-------. -77 -3_ o..t_ -/ ........................................................ ' V Date Application Disapproved for the following reasons- ...........................................------------------------------------------------------------------------------------------- --------------------- ---- --- - ------------ --- ---------- ---------- --- --------------------------------------- -- -- --- ------------------------- - - ------------ ------------------- ------------------ Permit No. --------- 1 - �.Z G....:....................... Issued ........................................................Date Date � � C No....Z�= Finc...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Bispnottl Works Tonstrnrtiun i1jermit Application is hereby made for a Permit to Construct ( ) or Repair ( �-)=an Individual Sewage Disposal System at: /a..................... .- .....- - .... ................................ - Location-VAddress .or Lot No. ................ ---- = - ) I............ate' �"---•---------•--- ---------------------=�=?p=' . ------.....---•--........................... /n� Own _ ` Address w ............ '- Y/ t f t/{�) Y l 1. . t. / _./.-�_(k Z Installer Address UType of Building Size Lot_________________________...Sq. feet .-t Dwelling—No. of Bedrooms-_-�3............. :........:-___---_Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No., persons............................ Showers R� YP g ---------------------------- .. P ( ) — Cafeteria ( ) Otherfixtures --------------- --------------------------\`----'---------------------------------------------------------------------•--•------------------------ 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------1............ Diameter.....J-D.__.... Depth below inlet._..6n_.___..__. Total leaching area........,.........sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1.4 Percolation Test Results Performed by........................... ---------------------------------------------- Date........................................ a a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 9 ------------------------------------------------------------------------------------------------------------------------------------------------------------- ODescription of Soil-------------------------------•-----.-.---------------------------------------- x c.� --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable------11_Ax?------- ?'� ! ��: _-7...... !'_. - .............. r .a f�•r-�"-------------1---- ------- ' ' ¢_- r__rk 1 Agreement: J ` 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 o.health. f + n_ �i� . { j,._...._..._..._._ -- `�....�,_...•_ --........�--Date g. Application Approved By -----------------U -- -----t - .mot� --, ------ ............ > Application Disapproved for''the following reasons: ------------------------------------------------------------------------------------- Dare Permit No. -------- ---- -_ ------- -------------- Issued ----------------------------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Oler#if nde of Cfomylinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by - - -1 '�?_----- ----Z!5 "t-C�....--...-------------------------------------------------------------------------------------------------------- ---------------'-- Installer at f n T 1=" .................. --------�� � 0- ?`` has been installed in accordance with the provisions of TITLE 5 o�,The State Environmental Code as described in the application for Disposal Works Construction Permit No- ---------- ------- dated --------------.---............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------- ' -------------------------------------------------------- Inspector ---- ------ -..:.=----------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ��No... �2b TOWN OF BARNSTABLE Fes �---...------ -1isposnl Radii ThItts#rnr#inn jJrrmft Permission is hereby granted-----------.-------------C_ _ .F__� _u_ __.:e>'r"e`��� �. to Construct ( ) or Repair ( )"an Individual Sewage Disposal System at No--------------------------------- - - t'V(aYLT!-f _ '/ _a--e ``'� G 'ot..'r` ------------------------------------------------- street as shown on the application for Disposal Works Construction Permit No--- �� Dated.......................................... ---------------------------------- ------------------------------------------------- -------------------------------- Board of health DATE----------------- ��----�� FORM 36508 HOBBS Q WARREN,INC.,PUBLISHERS No.. �, FE. ......:.0................. THE�COMMONWEALTH OF'MASS;CHUSETTS AF If U A& OF... . ... .................................................... Appliration -for Dhipoott1 orko Tonitrurtion Vaniit Application is h eby made for a Per it Construct (/�or Repair ( ) an Individual Sewage Disposal System at: F �egea'ozlg ------------------------- a n• dres or Lot No. wner Address W .............. --•---_.._... •----•---••--------•-• . .................................•---_._____.••--•---------___••---- Installer ! Address UType of Building Size Lot_._.__ _07 ____Sq. feet Dwelling—No. of Bedrooms..........._�___________________________Expansion Attic ( ) Garbage Grinder ( ) PL4 Other—Type of Building ............................ No. of persons..__________________________ Showers ( ) — Cafeteria ( ) Q' Other fixtur s --------------------------------- W Design Flow_______________ __________________________gal ions per pet son per day. Total daily flow.._....__._., �1 ______.__.__._._gallons. WSeptic Tank—Liquid cap ----gallons Length________________ Width.........------- Diameter................ Depth._-._____._....- x Disposal Trench—No_ ........._________ idth_.___.__... _ Total Lengt _______ -------- Total leaching area...79 2--_.sq. ft. Seepage Pit No _ � �t� rSm Total leaching area Seepage {t. Z Other Distril: ion box ( / Dosing tank ( ) •l® — j Percolation Test Results Performed by-------------- ........................................................... Date........................................ 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------------------------ ------------------------------------------------------------------------------ j O Description of Soil----------------- - ............... ._---• ••------•-•--------•••-- - --------- •_'---- --- U -------------------•-------•------------•---- --- . .._---• �.. 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 NI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has cAn issued by the boar f healt . �} Signed....... --------------- --`---� Date ApplicationApproved By.................................................................................................. Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- •--._...---•-•----•_____________________•---•••--..._..-----------------•-•-••---•-------------------------------------------------------------------------------------------------------------------- 2ePermit No-----------------------•-------•••-•-.................. Issu d No.._......31-l.... F>�E ........©................ THE�COOMAO�NWDEALTHCOF�ASS/AC SETTS /�� �z Alipfiration -for Dispotiaf Workii Cnonuitrnrtion Prrntit Application is hereby made for a Per it to-lConstruct�(�-' )J or Repair ( ) an Individual Sewage Disposal System at: _.i� ���� � ��'` , �/G�� E'�G�l� � • -/ Locati�n. ress �t f 9 or Lot No. caner /� Address W 1 F r - ............... :.... ""r, ... `.............. .. .�.�.._. ....•.........................--.------------.---............._.. Installer Address UType of Building Size Lot......./.2----�._.Sq. feet ., Dwelling—No. of Bedrooms------------ ----------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building -_------------------------ No.,of persons--------------------------- Showers ( ) — Cafeteria ( ) dOther fixture ... ----------------------•-•-•---•---------•----.......................---•-•. ...... WDesign Flow_______________>.. _._______........gallons per person per day. Total daily flow-_--____•-__-_ -�---_-.-.--_---gallons. WSeptic Tank—Liquid capa�Lty--__gallons Length---------------- Width-__.--.._-_-- Diameter................ Depth..-._-_-_-_--- x Disposal Trench—No. .....//_..________.�J �tdth______________f:.___ Totalength ._._..- ___ Total leaching area.. -�h -_.sq. ft. Seepage Pit Now?_ > let�e -E'r----_- /�F1fl�'b.�1€xnl 64 ......... Total leaching area------------------sq. ft. Z Other Distribution box 4 Dosing tank ( ) IV— Percolation Test Results Performed by---------------- ---------------- ...................................... Date-_--.-------------------------------.... a , 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------------------------ --------------------------------------------------------------------------------------- -- (� a - j . JO Description of Soil------------ -----• - -------------------- .......- •-------- ------- ---- --------------------------------------------- -------- --<--,F•----- - 44- W j` - x •--• .... .� O_..._--- . V Nature of Repairs or Alterations—Answer when applicable..---------------------------------------------------------------------------------------------. -----•----------------------------•-•---•---------------------------•--------------••--------------------------•-----------------------------•---------•----------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article 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 y the board of health., Signed. / r -------------------------------------- ------- - --------- Date ApplicationApproved By----- --•---•-----------•----•-------------------•-•-•--.....--------------------•--•---•---•--•-. ---------------------------------------- Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------•--•-• ----•----•-------------••-•-••--•••---••••---•---------------•-•------------------•-•--••------•---------•----------- ---------------------------------------------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS .v . BOARD. OF HE_A/ TH ............OF.... /C�.-fib '7Yc ............................ Q.,rrtifiratr of f�ontpfiatta THIS IS TO CERT&Y r-Tlj st th/Indt i';fial. sewageAal em t ed orepairedby-------•----•-------- -------•-- Ins aller� k ' � J -�'`�,..� .�- at----•-------------•--•---- ------------ ----- ----- ------------------------------------------- has been installed in accordance with the provisions of Ar 't XI of The State Sanitary Code Code as described in the PP P application for Disposal Works Construction Permit No.-:( 3 . �: dated7."7...`_........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................. ------..... Inspector------------------------------------------------------------------- ................ THE COMMONWEALTH OF MASSACHUSETTS _ BOAR D--O'F HEALT1 YA: �y �. ... No.......... f FEE........................ ihVplial or ,g Q15notrnrtiou r ! �—fit;- Permission is hereby granted------ - .•............... ' `... _ to Construct ( ��'or R air ( an Individual,Sewage Dispoml/System r✓ atNo......--•-........ -- �.--.......................................................�. 1 C--_------ / 1� ••. Street _ as shown on the application for Disposal Works Construction Per o.____ ___. ated...��'� .�7�............. Board of Healthy DATE------. -------------- ----- ---- ----- -----------------------------------• FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS O , a '3� .rat-C.==>.E'n, o�•� ,� Y % 1 7 /3y�oca fe- y � /n0 0 ��9G. Ef'T/C TANS x ---�/) G '�DEP T,y� o,E'�'CAS T G�=d7C'f� .4 $` •, GOT .2 f'�_o4 ./ e3oo ac zt3/a ./SST �✓iTH P, /eL � '�-/�'�Es®Y GE',CT/FY TNFaT THE BCJ/LDi�t/6� f �t� -SAVA PVA.1 O.t./ Tf-//S .oL/4 ti/ IS G O C A TE La O,t/ TAIE e. .@PIJM �� SP,/O w�/ �-/���0/V �A.V L� THF�T i T i ��{ 2 co,vF o e.✓1 7o Ts,/E' --o,cv/,t/G ��1N OF Mq i1/.WE'�/ CO.t/ST�G/GTE D. �p ARNNE I. (VA-LA fn �A y. tos✓/� ��� �n9ineerir� Ll 4215,34$ tf 4A?A./D 5UeV6Yo25 /v ,t �ii l_O AT1ON Wi,CxE PER IT UO. VILLAGE . _ - - - - - - - - - TALLER S-kl�tJlE --$ t_DEF2 5 - E - -ADDRESS - - - - -- --Dl►TE-P-ERM1T 155UED r -� �6�, �a� 0 �� 1t��" 1 r. zs v U zra' to-v � txv yy 3.0 x'd T.6 17.7 tT-T 6'-T <'.O' Td — Q N D T A V) O CD O - 5 E v- ABOVE O ABOVE OABDNE A6 - p � D E1 D U)LQcc N its 1 C C (— �aa0o n A5 D I x D - w Lp Tn (n 0 'MIGHT i OUGHT i D DECK a b- A4 b M D L J SUNROOM G (VAULTED CEIIB.G) LLBfg1E A6 b h C UNEOFFLOORABOVE- - - ro __ J SINx 1 DW ---� SINK 8'd b BENCHYV N - T" 1 i HOOKS KITCHEN RANGE PANTRY/ T. - Tx6V I CAMPY O MUDROOMO B- ti I LAYOUT WIOWNER) OVJ ON. y DINING D ALL P 16 b m A A4 GAIK I I I �M6� RV STORAGE GARAGE SO'OPENING Ft (DAB 4 �4 L\1 (T GANG.ST T IVL BEAM SLOPETTOYYARDS MULTI LVL BEAM �- DOOR) b BATH ^ - a b w c T` iCL6e j LIVING OFFICE HALL W 1s-s• I .z-r r-z T 6'd1- T-S E N PT.6 x 6 POSTS WI' ]N xBCASING BV xTPO.H.DOORWI TRANSOM WI x T0'O.H DOOR WI TRANSOM I E' z t x 6646E UP APRON B b A4 D /+ A6 AS 4-4 ON R-612 3-V 3'-O- 5'.P TA Sif co w t0'DIA PEPMACAST r . ' 1T-0' 6'-P GOLUhW 1TQ F-1 •It--\1 aAa Z 17u za•.D' � F-1 FIRST FLOOR PLAN FIRST FLOOR = 1288 S.F. SECOND FLOOR= 1696 S.F. GARAGE = 576 S.F. 1 0S SMOKE DETECTOR E—H WINDOW SCHEDULE ©CARBON MONOXIDE DETECTOR G--1 O FY'PE MANUFACTURER'S UNIT ROUGH OPENING REMARKS A ANDERSEN45-4246-20 7'-101/2"xC-10314" DOUBLEHUNG BAY NOTES: B " TW 2446 T-6 1!8"x 4'-9 1/4" DOUBLEHUNG 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS 11.)ALL SHEETS OF PLYWOOD WALL SHEATHING TO BE INSTALLED VERTICALLY C C 335 6'-0 3/8"x T-5 3!8" CASEMENT &DIMENSIONS IN THE FIELD 11.)THE NAILING SCHEDULE ON SHEET Al TO Q FOLLOWED WITH NO EXCEPTIONS. U) D TW 2646 2'-B 1/8'x 4'-9 1/4" DOUBLEHUNG 2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS, DEVIATION FROM THIS SCHEDULE WILL REQUIRE ADDITIONAL METAL HOLD DOWNS&STRAPS E TWf 2615 2'-8 1/8"x V-7 7/8" DOUBLEHUNG TRANSOM DETAILS,&FINISHES IN THE FIELD WITH OWNER 12.)SEE DETAILS ON THE PLOT TING DEVELOPED BY BARTER&NYE SURVEYOR'S&ENGINEERS FOR ALL " DETAILS ON THE EXISTING PROPERTY F VELUX VS 304 2'-6 1!2"x T-2 1/2" SKYLIGHT VENTING 3.) ROUGH OPENING HEAD HEIGHT OF WINDOWS AT 13.)FOLLOW ALL MANUFACTURER'S SPECIFICATIONS FOR INSTALLATION OF ALL SIMPSON COMPONENTS SCALE G ANDERSEN A 251 2'-4 7/8"x 2'-0 5/8" AWNING FIRST FLOOR TO BE 6'-10"ABOVE SUBFLOOR H TW 24310 2'-6 1!8"x 4'-1 1/4` DOUBLEHUNG 4.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MA °,ACHUSETTS /4R — t—ON A 21 2'-0 5/9"x 2'-0 5/9' AWNING STATE BUILDING CODE K C 245 4'-0 1/2"x 4'-5 3/8" CASEMENT(TEMPERED) 5.) PROVIDE UTILITY INSTALLATIONS FROM STREET TO NEW HOUSE DATE VIA UNDERGROUND CONNECTIONS TO COMPLY W/A'.L LOCAL CODES 1.CONTRACTOR TO VERIFY ALL WINDOWS WITH OWNER AND ROUGH OPENINGS 6.) ALL CONCRETE USED FOR FOUNDATION WALLS,FOOTINGS&SLABS 3/11/2008 WITH WINDOW MANUFACTURER PRIOR TO ORDERING OF WINDOWS TO BE 300D PSI 2.ANDERSEN 400 SERIES WINDOWS WHITE PERMANENT EXTERIOR GRILLES 7.) THIS HOUSE MEETS ALL REQUIREMENTS OF THE MASSACHUSETTS 110 MPH CLEAR VIEW SCREENS - CHECKLIST EXCEPT ON THE SUNROOM GABLE WALL WHICH WILL THE DESIGNERSHALL BE NOTIFIED IF ANY DWG. N.O. ERRORS A NGSSPRIO TO FOUND ON REQUIRE ADDITIONAL STRAPS + CONSTRUCTION,DRAWINGS PRIOR To START a W L BE RESPONSIBLE THEFO BUILDING CONTRACTOR 6.) THIS PROPERTY IS RATED EXPOSURE"B"AND THE HOUSE HAS AN ASPECT RATIO OF 1.75 W THESElu BE REsooNSIeLE FOR THE wrNFi+T Al BOMMEN DRAWINGSOUT NCONSTRUCTION E DESIGNED TO THE MASSACHUSETTS 110 MPH WFCM CHECKLIST coAtMEHGEs WiTHom NDtBYWGTHE l/(—{//�\\Nu\� DESIGNER OF ANY ERRORS OR OMISSIONS. THESE F THE OWNER NOTED ARE OTHERE FOR USETHE OF USE f THESE DRAWIENG6REONRE EWRRT"` ' CONSENT OF THE DESIGNER UNDER THE ARCHITECTURAL COPYRIGHT PROTECTION ACT OF 1!1?O COR-XMW A5 U ENT,RIDGE VEM C) Q N N CERTAIMEED HATTERAS O C T 2, HIGH WIND ASPHALT ROOF CD 7 Wd M Gp v]WN— co IYP.AZEK,x e FASCw a W^C 1 x 6 FRIEZE BOARD6 TOP OF PLATE O mV �o�CQ El TYP,AZEK 1,E RARE BOARDS Ty P,MEK ta< WI tx3DRIP BOARD TRIM AT VWJDOWS ❑ a a DDORS TYP.HAR WPIM'K SIDING LJIAT FROM ONLY.VERIFY (-� tZ COLOR WIOWNERS 2e�— Lj TYP.AZEK1a5N a8 t, I� CORNERBOPJtDS U SECOND FLOON 6UBFLOOR TOP OF PLATE P.T.6a 6P061SWl F 1a7/1xBCA61NG ElEIDE] 10 4� WI1atDBA6 b DEJL DODO FIRST ElEIDL �DO� FIRST FLOOR 6UBFLOOR 0 oa DODO 1 V DM PERMAC ST VERIFY O.M.DOOR STYLE,MFit.aOETMS IN THE FIELD W/OYlNERS FRONT ELEVATION 60LUh4J tz-v zaa W D A5 H C C A5 A5 W za 6" (SHED DORMER) E-H 3'-11• t2.1' T-t t• IFX 6-6 D'-3 6.7 t E I�I-� g A AB I D Q J Fi B K TEMPERED WINDOW BEAT -,,, G � 0^J 3 x 6 WMRLPOOL �. AS (10 I1� TUB F ': I HO& —PLUMBING WALL H PLUMBING WALL ti g•.6 I ' Z-fP 6-it• t7'/P E- STEP D BEDROOM#2 B OWNT SHELVES W.I.C. ! BATH O• W A 4 I I ..„ A a a.w sx66 I LIN. eFOLD i— I CLOS. I `, O R b e I m - W D V L I — W T6x66 j n O'� 10 6HELVE6 7� FF---F—,,t� ROOT BELOW-- u.,.: O-> F+ .5.. IPULL-DOWN � ' •tlV25a6H --, o a STAIR S rv0 � I F b MASTER ❑N. HALL I I. �w I a BATH vB. - n C _- © L zsx66`C r ,. L_ J LOS.I - MULTI LW BEAM(FLUSM -..., ,.. ,.....,. .✓. ,.--. —__ _D1L ItLILLYL -{ - �T, MASTER BEDROOM © r� El O a rn------ THEATER W ]'6a6 ROOM U) BEDROOM#1 B f I W.I.C. SCALE A B B DATE B B B B B E F As 3/11/2008 D A6 A5 6S D 6-6 V V V. NO. i (SHED DORMER)'- _ (6//�/�'/s� iZ.R N'4 .. 1/. SECOND FLOOR PLAN ALWAYS DIG. SAFE PRIOR TO CONSTRUCTION--UTILITY LOCATIONS SHOWN INCOMPLETE. 00 M t\ . C� r N - m N/F _ TOWN OF BARNSTABLB 9 FILL HOLE HER[ IF NEIGHBOR/YOU 53.1 49.0 49,1 � 5 3.4 X3 '- 5 50.0 BENCH MARK--TOP OF SPIKE SET 47,6 DOWN. 1.7= 50.83 TOWN G►Sf -. - 45.4 —LOT co2 46 44.5 2021 : ±S.F. 4 . w r- 4�, x 53,3 � f •., ,83 �, t�. J .6 415 a 41, \ o4 8.6p.. \ i 0 47 c11 .44 42.2 ` 52`i k Jy�� C�opvS���M �$ 42 50.0 L gE ` 2.2 \ 7 7" 482 (0 6 \\ 47,E i 43.6 46 a. „ l 7, � x Qos mod.- , v s 45.1 P�� Q a 4 7,3 6 = CONSTRUCT GENTLE S�0:p 35 45Ar O,o OQ ,� r4 .49 x SWALE TO GUIDE > O-p , X \ SURFACE WATER 'pp AROUND HOUSE \ p, 47x0 -p� ,Lq' x ��x 46.6 TO FRONT YARD �y �ZFO 47 a\ x47,3 m r N/F �� /4 ,9 DASILVA 48J9 ti 44.3 � a x \\5,0 f 0, 1 48,85 10 4I2 cN PROPOSED CURB .CUT i i x 44 45. i i 45.97 i i �44 THIS PLAN IS A VALID CO AN ORIGINAL RED STAMP A ED 4 ,36 - N OF&t,18 L s � \ GE14D o �i�Ssil 45.09 4E " CADILLAC " C ® 43,40 # 1060 a 1 �C ,µ W EXISTING WATER LINE -' �G�STER�G t� G EXISTING GAS LINE S'4NITAR�Pa I'01x x 9.5 x 47.3 EXISTING & PROPOSED.ELEVATIONS ('X' MARKS POINT) BENCH MARK--TOP N.W. CORNER t , i EXISTING CONTOUR CONC. BOUND=45.09 TOWN GIST ` PROPOSED CONTOUR ®; EXISTING DRAINAGE CATCH BASIN g x - FENCE (NOT ALL SHOWN) w HEALTH AGENT APPROV) REV. 3/10/08--RELOCATE HOUSE & DRIVEWAY i t _JOB NO. B-08-01 Race Ln. I NOTES LAFLEUR.dwg . 1. LOCUS IS A.M. 148, PARCEL 120. r 2. ELEVATIONS SHOWN ARE APPROXIMATE TOWN GIS f0.5' a' 3. LOCUS IS .IN FLOOD ZONE -C ON -FIRM...DATED AUGUST 19, 1985. 4. ALL PIPES TO BE 4" SCH 40, AND PITCHED AT 1/4 PER FOOT. (UNLESS NOTED) 5. ALL CONSTRUCTION TO MEET TITLE 5 ;AND LOCAL REGULATIONS. Gsa��G tea: ,y o NOT TO Q`0c � F36� SCALE GREE LOCATION MAP CONNECT NEW HOUSE SEWER TO EXISTING I 48.5 Invert 46.15 SEPTIC SYSTEM Top Foundation �f OG. Proposed Proposed b N/F YONS w T S=J/8"/ft+ . r----------i Existing �-I Invert 45.76 j 1000 Gal. j Existing Septic Tank I CONSTRUCT GENTLE S,WALE TO "GUIDE SURFACE. WATER AROUND HOUSE TO FRONT YARD INSP PTIQU HEALTH AGENT WILL PROBABLY REQUIRE '� R.J. CADILLAC- TO INSPECT NEW SEWER LINE. INSTALLER TO ASK HEALTH AGENT. 49.3/ -4,9.3 SITE PLAN FOR ONLY IF IT BEARS SIGNATURE. SCOTT R . & LYNELLE /�L. LAFLEUR LOT 21 8 NORTH PERCINCT ROAD, CENTERVILLE, MA. cy ` FEBRU ARY 14, 2008 SCALE: 1 =20' ADILLAC `36779 >sumjl RONALD J. CADILLAC, PLS, RS, P.C. PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN P.O. BOX 258 WEST YARMOUTH, MA 02673 , L DATE (508) 77.5-9700 PAGE 1 OF 1 02008 BY R.J. CADILLAC { 3