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0038 OLD TOWN ROAD - Health
3W A Town Road Hyannis , I i en a r TOWN OF BARNSTABLE LOCATION ow �d��-+% ✓� SEWAGE# 40 4 VILLAGE A/# ASSESSOR'S MAP&PARCEL,�- 4 7 -G .I*,STALLERS NAME&PHONE NO.` dJi SEPTIC TANK CAPACITY )5'6v LEACHING FACILITY:(type) (size) ' NO.OF BEDROOMS �s OWNER `/PERMIT DATE: `/ Z COMPLIANCE DATE:;r,�-<'-/" Separation Distance Between the: Mx-;imum Adjusted Groundwater ble to the Bottom of Leaching Facility Feet Private Water Supply Well and Le ching Facility(If any wells exist on site or within 200 feet of l ching facility) Feet _ Edge of Wetland and Leachin acility(If any wetlands exist within 300 feet of leachin facility) Feet FURNISHED BY ti ICA a 'M . � Y f G� 4 r � r LD No. Fee tZ* �qT/E COMMONWEALTH OF MASSACHUSETTS Entered in co puOer,: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9pplitation for disposal *pstrm (Construction Permit Application for a Permit to Construct( ) Repair�4 Upgrade( ) Abandon( ) ❑Complete System individual Components Location Address or Lot No. .3160 T, .n Owner's Name,Address,and Tel.No. �f7 ®�jll� PJ c Le U'Tc✓z.�� /L� �c� Assessor's Map/ParcelAGs Installer's Name,Address,and Tel.No. It 77-T$T) Designer's Name,Address,and Tel.No. C4rz.j J c--krPrz, %sue��.�.L. f s Type of Building: Dwelling No.of Bedrooms Lot Size %2`i���� 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) �p�14<-C ^4-isj C.i S 1✓ — fr� Tsai' 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 his Board of Health. �j ig ed Date / Z Application Approved by Date4t- -Application Disapproved by Date for the following reasons r Permit No. V Date Issued t ar No. Fee T E COMMONWEALTH OF MASSACHUSETTS Entered in compu er: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYitation for Disposal *pstrm Construction i3ermit Application for a Permit to Construct( ) Repair( 'Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No-316 o LA T .n ''Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel2(p"'j �(os ��lYr CLEtJ7"C,2io /2-�'c-c-i Installer's Name,Address,and Tel.No. '-1 7'7-98 71 Designer's Name,Address,and Tel.No. C/A f P��✓ �.�vt t/Pr. �S /j-S Type of Building: , Dwelling No.of Bedrooms Lot Size y E ono sq.ft. Garbage Grinder( ) 's Other Type of Building No.of Person§ Showers( ) Cafeteria( ) .a Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date s, Title Size of Septic Tank.'a Type of S.A.S. Description of Soil ( t Nature of Repairs or Alterations(Answer when applicable) L i`K45 vim+ y<� Date last inspected: Agreemiinjnt: ,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 this Board of Health. _ '++t Mied Date r I �y f, Application Approved by Date 171 Application Disapproved by Date for the following;reasons „ t Permit No. r Date Issued ------------ ---------------------------------- - - - -- - --- - - --` - - - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by L!NOX,W.,4 L L L at 3 p O La Tc��.Sy1 2A v4 c�.-r has been cons. cte 'n ac IdIt ce with the provisions of Title 5 and the for Dis osal System Construction Permit No. ed Installer C D v 1 < <� Designer n #bedrooms Approved design flow - gpd The issuance of this it shal of bd construed as a guarantee that the system w' nc io a-sA,esi %f ed. ® {' Date / Inspector k.0 `7 ,ry Vy� ------------------�n4�� -------- - -- ---- --- ----------------------------------- - - - �5? No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH-DIVISION-BARNSTABLE,MASSACHUSETTS _.7. Disposal *pstem Construction permit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) e System located at 3� (,)kA and as described in the above Application for Disposal System Construction Permit; The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special condition's. Provided:Construct o must b/C)) ompeted within three years of the date of this permit. Date Approved by 1 0 - - Town of]Barnstable P# 1 .21 y oar Department of Regulatory Services DAM _ Public Health Division NAM" Date 1639. �� 200 Main Street,Hyannis MA 02601 EO MIa�' Date Scheduled (/ Time l_�_YL—/ Fee Pd. v Soil Suitability Assessment for Sewage Disposal Performed By: O RV1D CDUG H NpW(Z LSE Witnessed By: �)00rtL0 O ESM AAA IS LOCATION& GENERAL INFORMATION, j Location Address g (� /d a,,L1 �� Owner's Name �� 1 f ._ C C uR t Address l v n 5 HyAnN� S a Assessor's Map/Parcel: p Engineer's Name of / n I CBaa606t•✓y, NEW CONSTRUCTION REPAIR v Telephone# V 3(9 D - RE Ii�E T% t_ _ _ S Land Use' N Slopes(% 0 Surface Stones W 0 N C ~ Distances from: Open Water Body I Dy + ft Possible Wet Area 1 D D t ft Drinking Water Well I�� ft Drainage Way + ft+ Property Line 1 0 t ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands�n proximity to holes) 1Q I ® I r I ® I I 1 e I I I IGROUNDWATER ADJUSTMENT I I - EXISTING GROUNDWATER I ER LEVEL I BASED ON TOWN OF BARNSTABLE E I GIS DEPARTMENT RECORDS. INDICATED GW 11.00 INDEX WELL M1W-29 I I ZONE C READING DATE MARCH. 2008 I , READING 7.7 ADJUSTMENT 2.7 ADJUSTED GW 13.7 h p� I - Parent material(geologic) l/I Depth to Bedrock 0 K(e Depth to Groundwater. Standing Water in Hole: `" Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE -Method Used: SEE .A D V E Depth Observed standing in obs.hole: In, Depth to soil mottles: in. Depth to weeping from side of obs.hole: in, Groundwater Adjustment f[. Index Well# - Reading Date: Index Well level Adj.factor- Add.Groundwater level PERCOLATION TEST Date � Tline to R M Observation . Hole# Time at%" Depth of Pere �2'h � Time at 6" Statt Pre-soak Time @ Time(9"-611) End Pre-soak 1 0: 10 Rate Minllach 2,,lP Site Suitability Assessment: Site Passed V Site Failed: Additional Testing Needed(YIN) - ,v 1 Original: Public Health Division • , ; Observation Hole Data To'Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEPTICU'ERCFORM.DOC S O I L TEST L O G DATE OF TEST: APRIL . 2008 APPROVED SOIL EVALUATOR: DAVID• D D. COUGHANOWR. n461 ' WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. PERC NUMBER: 12157 T E S T PIT ._ 1 NO GROUNDWATER ENCOUNTERED PARENT MATERIAL: PROGLACIAL OUTWASH PERC AT 62 to - 2 MIN/INCH IN C SOILS ELEVATION+ DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER 38.10 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 0-3 0 WOOD-LOAM 10 YR 2/2 NONE FRIABLE - _3-4. E _ LOAMY SAND 10 YR 4/2 NONE FRIABLE A _ _ i 4-9 LOAMY SAND 10 YR 4/4 . NONE FRIABLE 34.93 t9-36 w B LOAMY SAND 10 YR 5/6 NONE LOOSE J-2-7.10 38-132 ` C MEDUIM SAND 10 YR 6/4 NONE LOOSE T E S TP I T 2 NO GROUNDWATER ENCOUNTERED PARENT MATERIAL: PROGLAC_ IAL OUT WASH WASH J 2 MIN/INCH IN C SOILS � ELEVATION' , DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER 36.20 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 0-4 D WOOD LOAM 10 YR /__ _ 2 2 NONE FRIABLE _ __ _ IABLE 4-6 E LOAMY SAND 10 YR 4/2 NONE FRIABLE 6-12 -A LOAMY SAND s 10 YR 4/4 NONE FRIABLE 34.87 12-40- B - LOAMY-SAND 10 YR 5/6 NONE LOOSE 25.03 40-158 C MEDUIM SAND _. 10 YR 6/4 1 NONE LOOSE DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistengy.%Gravel) • I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency. .Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes _ Within 500 year boundary No=' Yes ' Within too year flood boundary No '! Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious.material exist in all areas observed throughout the area proposed for the soil absorption system? 1 If not,what is the depth of naturally occurring pervious material? Certification I certify that on IJ o y (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,ex ertise=andperience described in 10 CMR 15.017. TH OF,ye9 g Ps Signature 404 Date p �� AID o D. " COUGHANOWR '�/C E N SE�p6 Q:\SEPTi0PERCFORM.DOC E V A L V P' Fe't THE'COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es ZippYication for 33igogal *pgtem Construction Permit Application for a Permit to Construct( ) Repair( i Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot N ner's N A d e,Address,and Tel.No. O Ld i ovtx,�, 1� . �n�s `'` I I c�� 1 q Assessor'sMap/Parcel �) vs, 5 t ��et���-F t Lece,,�\Y, •4ex-, Installer's Name ddress,and Tel.No. ,� i �� Designer's Name,Address Tel.No.`w� 3w`®�� r1 Type of Building: (/ Dwelling No.of Bedrooms Lot Size 20 p 03 Y sq.ft. Garbage Grinder A Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures f Design Flow(min.required) 336 gpd Design flow provided 3.3o -/ gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 11aa ^^ nn � � Nature of Repairs or Alterations(Answer when a licable)—Lo 5TLtlC�[_Cun ��► -KE- S -- S NS°� 40 &In_s ©r E-1co 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 ro Date Application Approved by r _ Date "► Application Disapproved by: Date for the following reasons Permit No. A D® — 16 V Date Issued L�-1 -0 Now 16 Fee'Y " . THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ei/ks 01pprication for ;Dtoogal *raemc Cow5tructton jaermtt. Application for a Permit to Construct O Repair( Upgrade(_) Abandon O Complete System ❑Individual Components Location Address or Lot No. Owner's Na"_ e,Address,and Tel:No. c.�. t Assessor's Map/Parcel CO r' !s( P)eocsDi)l• -SA- , �Y-\s ./_ l,,,ct,�A. Installer's Name Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: v A ' Dwelling No.of Bedrooms Lot Size U ; 03. 6 sq.ft. Garbage Grinder (!v Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 3,3C). L / 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 applica�ble)J (JC- C)5+ZU . cL,ne�' . )�'j `1�� 5 ��1C,. i SKIS ` pbx�S 0r y=- 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 o H Ith. Signed ► Date t''' " '_ O Application Approved by L..✓'1 Date �y " 0 Application Disapproved by: Date for the following reasons v • t Permit No: 00 — 6 Date Issued L/—j 1-0 { THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Zlcu Certificate of Compliance THIS IS TO CERTIFY,that the�Ojn--site Sewage Disposal System Constructed ( ) 'Repaired OO Upgraded ( ) Abandoned( )by K) 1zdE n,'l �r Sk. C. atJa D 1A1_7&, -1'\ ( U CL,+\r�(j �-, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 0200 X' Ibo dated Ll-t. OO Instal ler Designer #bedrooms —3 Approved design flow 3 - L gpd The issuance of thi a/rmit/shall not be construed as a guarantee that the system will unction as desigtil ks Date �7// 9 Inspector 1 � -____________________ No. a006 - 166 Fee" 100. � THE COMMONWEALTH OF MASSACHUSETTS- PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS =ig;pogal *pgtem Cott!gtructiotl hermit Permission is hereby granted to Construct ( ) Repair (X ) 'Upgrade ( ) Abandon ( ) System located at � —Tc� � L{Qll� .J v and as described in the above Application for Disposal System Construction Permaaprecognizes 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 thi Date Z'd 0 i Approved by `/ Town of Barnstable .� ' .3.0 Regulatory Services Thomas F. Geiler,Director BAR'1SUBM 9 MASS. Public Health Division 16.19• Thomas McKean,Director 200 Main Street,Hyannis,NIA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form { Date: - S' ` Sewage Permit# © L' d Assessor's Map\Parcelo�R (per �J r'� Installer:—�►erl Designer: \ Address: LA���1ax\q Address: kC) q V On �� y.6 �� UbI c�✓` was issued a permit to install a (date) (installer) septic system at 3 ©�67TC_14 1 �!5 ase on a design drawn by (address) � 4 _ Cc>-- 1 .2CJV" dates i / (designer) ' I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component -of the septic system)but in accordance with State &Local Regulations. =Plain revision or certified as built by designer to follow. eg0p t H I0F4q���� o\•• L i C ,.yG Sq- n= (installer's Signature) L 0 t7 S ;e m • C. # 14 Ease S, IjjSA (De( er' Sigma e) (Affix Desiggner's Stamp Here) PLEASE RETURN TO BARN_ STABLE PUBLIC HEALTH DIVISION. CERTMCATE OF CONTLLANCE WILL NOT.BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CART? ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOL, x Q:Health/SepticlDesigner Certification Form 3-26-04.doc j OMPLETE THIS SECTION T SENDER: C COMPLE,H THIS SECTION ON DELIVERY ■ Complete itams 1,2,and 3.Also complete A Sjgn to �— Mirn 4 if Restricted Delivery is desired. Agent ■ Print your name and address on the reverse X Addressee so that we can return the card to you. B. Received by(Printed Name) Cr DIN of ellivery ■ Attach this card to the back of the mailpiece, or on the front if.space permits. D. Is delivery address different from Item 17 ❑Y 1. Article Addressed to: If YES,enter delivery address below: ht'No 1 411 Lt)ak&t-s-' 3. Service Type ®certified Mail ❑Express Mail ❑Registered ®Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee)_ -� Cl Yes 2. Article Number III t'' i i215 0° 0 b 0 2 103, F 6 6 811 (Transfer from service/abed '7 0 0 6 .PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 :..... .UNITED STATES.POSTA " �1/(Y'7 ..ti� z F C'lassVa• „#t} .� _ ._ 2:..�i a._i . � Jt% y"'�S.s�jV rn.. • Sender: Please print your name, address, and ZIP+4 in this box • 4 Town of Barnstable F cbr' Health Division 200 Main Street Hyannis,NIA 02601 e_C)CAL '�€ �ieia�i�i��ee��iiie►t��►1`►►11I :st.l� P�p'p THE Tp�y Town of Barnstable Barnstable AHmh; gR , CIW Regulatory Services Department m'c� k.�HAVSTAHLE, nAS� Public Health Division q 200 Main Street Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO February 4, 2008 Prudential Lenmar Realty Paul Mendes 949 Worcester Street Natick, MA 01760 ORDER TO-COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 38 Old Town Road, Hyannis MA was inspected on January 14, 2008, by Mark Polselli, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system NEEDS FURTHER EVALUATION under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: Solids hanging from top of tees in septic tank shows signs of backup. SAS needs to be opened and system water tested. After further evaluation by the Town of Barnstable Health Department, it has been determinedthat you are ordered to re-inspect and test the septic system within Sixty (60) days of the date you receive this notification to ensure the system is functioning properly. Failure to re-inspect and test the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOA OF HEALTH c ean, R.S CHO Agent of the Board of Health, Clrp�c►���a rn��� -tooe a�sv 000a 403IS Q:\SEPTIC\Letters Septic Inspection Failures\38 Old Town Road.doc COMi�IONW-EALTx OF IVLASSACrrusETTS EXECUTIVE OFFICE OF ENVIRON1�lEN-TAL AFFAIRS DEPART ENT OF F1VR0 G _- 14E1`�TAI,�ROTCTTORI s Wk �'rM Syev � G � _ o6 � � LAI . ITLE 5 OFFICIAL I�TSPE -140T FOU VOI1U�'TAR�'ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM FORM PART A 2 n CERTIFICATION a#&, �c L �-en 4-r Property Address: ✓ 9 C�1- 0tvpl Ad wi Oa63� 1� / Owner's Name: sue, �G�C`2[� 7L'>c Z- Owner's Address. 3z? 4G �00�6 Gem lir -), Date of Inspection: Name of Inspector lease print) Gt✓ %o l�Pi�ii Company Name. �& ® — —L G Mailing Address: O 'A'jL /� (�e ��c(��Sf o h ark en W 2t6Y� Telephone Number:(, t CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information regorted�.'.' below is true,accurate and complete as of the time of the inspection.The inspection was performed based on training and experience in the proper function and maintenance of on site sew-age disposal systems-A am a Duf approved system inspector pursuant to Section 15.340 of Title 310 CMR 15.000 . ne syst3ik Passes __,C-o-n-ditionally Passes Needs Further Evaluation by the Local Approving Authtty Fails Inspector's Signature: al�l /" Date: 0 —/`j- of The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10.000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. So y Ads Notes and Comments Sid V a.7-� /0R c4.1 k1< too"s-e dtus lr�e�, e��� �ilifl r=/o�✓� -¢ems Sdrrr� �rvyre. C✓or- !n/�s Coh�Nc�e� �f Sr / L✓i'fG, �c. - ���+��' ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 Page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPEC TON FORM PART A CERTIFICATION(continued) Property Address: 26 0/,/ eN Owner: Date of Inspection: — — Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: /V-I have not found any information which indicates that any of the failure criteria described in 310 C R 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 be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,'N ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is Ieveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 39 0/c/ %O w0 /?i Owner: Date of Inspection: O C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CAM 15.303(l)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone i of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance *This system passes if the well water analysis,performed at a DEP certified laboratory,for cohform 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. 3. Other: f� 2SS/loa i Page 4 of I i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT'S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM PART A CERTIFICATION(continued) Property Address: 2- 0 /Owe► e KV.- C Ool Z6 - Owner: C--1 SSA Date of Inspection: /a- y—O D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for ali inspections: Yes No _ ! ckup 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 gged SAS or cesspool Static liquid level in the distribution box above outlet invert due to as overloaded or clogged SAS or spoal _ _ uid depth in cesspool is less than 6"below invert or available vohrme is less than 1/2day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number primes pumped (/_ Aa 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 er supply. jmy portion of a cesspool or privy is within a Zone 1 of a public well. ty 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. [This system passes if the wen 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.] �Q (Yes/No)The system fails.1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinldng water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310('_MR 15.304. 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 FoR-m PART B CHECKLIST Property Address: ®�cJ 7, t-17 P✓v�Ile Odb�� Owner: �C.ssr y� Date of Inspection: Check if the following have been done.You must indicate`yes"or"no"as to each of the following: Yes No/� (/Pumping information was provided by the owner,occupant,or Board of Health V- Were any of the system components pumped out in the previous two weeks? tl Has the system received normal flows in the previous two week period? Nave large volumes of water been introduced to the system recently or as part of this inspection? r/ Were as built plans of the system obtained and examined?(If they were not available note as NT/A) Was the facility or dwelling inspected for signs of sewage back up? r� Was the site inspected for signs of break out? v_ Were all system components,excluding the SAS,located on site? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the/baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Ye no Existing information.For example,a plan at the Board of Health. Determined in the field if an of the failure criteria related ( y r 1 ted to Part C is at issue approximation of distance is unacceptable) [310 CIVM 15.302.(3)(b)] Page 6 of 1 I OFFICIAL. INSPECTION FORM—NOT FOR VOLUNTARY ASSESSIMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM wSPEcTjON FORM PART C SYSTEM INFORMATION Property Address: told 7-®t-m Owner: Crsr Date of Inspection: — 4f— O FLOW CONDITIONS RESIDENTIAL, Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): 00 Is laundry on a separate sewage system(yes or no): [if yes separate inspection required] r Laundry system inspected(yes or no): 6V /lo Seasonal use: (yes or no): !� Water meter readings,if available(Iast 2 years usage(gpd)): Sump pump(yes or no): 4/0Last date of occupancy: COIi MERCLAL/1NDUSTRIAL Type of establishment: Design flow(based on 310 CAR 15203): gpd Basis of design flow(seats/persons/sgft,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: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping'Records Source of information: Was system pumped as part of the inspec n(yes or no):— If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: OF SYSTEM _Septic tank distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 61 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 SYSTFM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Q/P/ vino PC Owner: Date of Inspection: /—N — g BUILDING SEWTR(locate on site plan) Depth below grade: � Materials of construction:_ ast iron �-40 PVC_other(explain):_ Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:v(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 a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: //o an Sludge depth: C2 6 4". Distance from top of sludge to ludgeto bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottgm oj outlet tee or baffle: � How were dimensions determined: /ter o Q C- Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as r later to outlet invert,evidence o eakage etc.): ,52 1 c j1�h�/ VI2e s �� /t�-o AM {H 60mt 7 �0�� /��� /�1 OOG �'"' "O�l� GREASE T'RAP:/►/ (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL, INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM I NSPECTTON FORM PART C SYSTEM INFORMATION(continued) Property Address: 0/c/ /ot,, �2 Owner: Date of Inspection: TIGHT or HOLDING TANK:IV (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass___polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition 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(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage to or out of box, etc.): ��;� PUMP CHAMBER: & (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): T:tl f. G T____ Page 9 of 11 OFFICIAL INSPECTION FORM—MOT FOR VOLT TNTARY ASSESSMENTS SUBSURFACE SEWAGW DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 3q O/Cj- Tpc✓v► )2,=-j Owner: ��sf. y _ Date of Inspection: 7—-A{—O'v SOIL,ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain_why: Type leachin its number: leaching � � leaching chambers,number: leaching galleries,number: J T ph 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 f / Y► i//T7^G�pb-s l/�O r �oC �fi� C /"g 4e"e f� CESSPOOLS: /L(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert:_ Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY:Zlocate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION>r-+O M PART C SYSTEM INFORMATION(continued) Property Address: ®�c= cwi,7 Ad 45 Owner: Cs� Date of Inspection / � y--®'f 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_ 1 14 i ' r �� S co►��- _l be �- Fi 1/6 �ess�00) �Wlo7� 7,�f — 11�'04 f� b7tJ �l - aLf I Page 11 of 11 OFFICIAL, INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property W P �3 Address: O Y� PJ w�S Owner: Date of Inspection: SITE EXANI Slope 3 Surface water XIV Check cellar 47-`� Shallow wells /tv i Estimated depth to ground water/.s 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 local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You mu) descri e how y u e blished the high ground ater elevation: e �� ems, CARMEN E. S A Y (508)-548-0796 ENVIRONMENTAL SERVICES,INC. P.O.Box 627,East Falmouth,MA 02536 December 13, 2002 RE: Certification of Title V Septic System Installation: Residential Property—38 Old Town Road, Centerville, MA Dear Sir or Madam: On December 11, 2002, Roger Roberts, Inc. was issued a permit to install a Title V Septic System at 38 Old Town Road, Centerville, MA, based on a design drawn by Shay Environmental Services, dated, December 10, 2002. XX I Certify That The Septic System Referenced Was Installed Substantially According to the Plan I Certify That the Referenced Above Septic System Was Installed With Changes but in Accordance With State and Local Regulations, Revisions or As-Built Plans/Sketch will Follow. The Septic System Was Not Installed Per State and Local Regulations and Corrective Action is Required. If you have any questions, please do not hesitate to call the undersigned at(508)-548-0796. Sincerely, CARmENE SHAY ENVIRONMENTAL SERVICES,INC. I�A OF o` CARMEPv o E. `-' SHAY s 'I F31 Carmen E. Shay, R.S., C.S. G .iiER President S4N1rA R\��� Health Complaints 26-May-04 Time: 8:45:00 AM Date: 5/4/2004 Complaint Number: 17407 Referred To: DAVID STANTON Taken BY: DAVID STANTON Complaint Type: CHAPTER it HOUSING Article X Detail: ILLEGAL OPERATIONS Business Name: Number: 38 Street: OLD TOWN Village: HYANNIS Assessors Map_Parcel: Complaint Description: A T M TI TRENCH COH VE PVC SHED INTO A' D (POTENTIALLY ILLEGAL SEPTIC CONNECTION) Acti ons Taken/Results: DS WENT TO SAID LOCATION WITH _ BUILDING INSPECTOR DAVE MATTOS. IT APPEARS AS THOUGH THEY ARE IN THE PROCESS OF CONVERTING A"SHED" INTO A DWELLING. THE ORIGINAL SHED WAS A 15'X 15"'SHED". THE SHED AS A NEW EXTENSION THAT MAKES IT A 15'X 27' "SHED" THIS"SHED"IS ONLY ON CONCRETE BLOCKS. THERE IS A TRECH WITH PVC PIPE LEADING FROM THE SHED TO THE SEPTIC TANK,WHICH IS NOT PERMITTED. THERE IS A LOT OF RUBBISH IN THE YARD AS WELL. AN ORDER LETTER WILL BE MAILED. DS WENT TO SAID LOCATION ON 5/25/04 AT 10:00 AM. TWO CONTRACTORS WERE PRESENT THAT WERE GOING TO WORK ON THE ROOF BECAUSE IT WAS LEAKING AND WANTED TO KNOW IF THEY NEEDED A BUILDING PERMIT. DS TOLD THEM TO 1 I - --a ME OF OFFENDER !'� _..,a_.�,.-.,.,�,..... ....-.....,.. ... _ m (1 -9 A0 Health Complaints 26-May-04 CHECK WITH THE BUILDING DEPT. DS ISSUED A TICKET BUT THEN VOIDED IT OUT, AS HE CALLED TM TO FIND OUT HOW ,.: TO FIX THE PROBLEM. TM CALLED PAT 771-7864) HIM BACK AND LEFT HIM A MESSAGE TO REMOVE THE ENTIRE PIPE, AS IT IS ILLEGAL. DS WENT TO REINSPECT ON 5/26/04. THE PVC HAS BEEN REMOVED. NO FURTHER ACTION REQUIRED AT THIS TIME BY THE HEALTH DIVISION. Investigation Date: 5/4/2004 Investigation Time: 9:30:00 AM 2 I Town of Barnstable , Op 1HE tp� Regulatory Services BARNSTABLE ; Thomas F. Geiler, Director 9�A b 9. r Public Health Division rFD MA'S A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. e Health Complaints 26-May-04 Time: 8:45:00 AM Date: 5/4/2004 Complaint Number: 17407 Referred To: DAVID STANTON Taken By: DAVID STANTON Complaint Type: CHAPTER II HOUSING Article X Detail: ILLEGAL OPERATIONS Business Name: ` Number: 38 Street: OLD TOWN Village: HYANNIS Assessors Map_Parcel: Complaint Description: ATTEMPTING TO CONVERT A SHED INTO A DWELLING. TRENCH WIT PVC (POTENTIALLY ILLEGAL SEPTIC CONNECTION) Actions Taken/Results: DS WENT TO SAID LOCATION WITH BUILDING INSPECTOR DAVE MATTOS. IT APPEARS AS THOUGH THEY ARE IN THE PROCESS OF CONVERTING A"SHED" INTO A DWELLING. THE ORIGINAL SHED WAS A 15'X 15' "SHED". THE SHED AS A NEW EXTENSION THAT MAKES IT A 15'X 27' "SHED" THIS"SHED" IS ONLY ON CONCRETE BLOCKS. THERE IS A TRECH WITH PVC PIPE LEADING FROM THE "SHED"TO THE SEPTIC TANK, WHICH IS NOT PERMITTED. THERE IS A LOT OF RUBBISH IN THE YARD AS WELL. AN ORDER LETTER WILL BE MAILED. DS WENT TO SAID LOCATION ON 5/25/04 AT 10:00 AM. TWO CONTRACTORS WERE PRESENT THAT WERE GOING TO WORK ON THE ROOF BECAUSE IT WAS LEAKING AND WANTED TO KNOW IF THEY NEEDED A BUILDING PERMIT. DS TOLD THEM TO I i Health Complaints 26-May-04 CHECK WITH THE BUILDING DEPT. DS ISSUED A TICKET, BUT THEN VOIDED IT OUT, AS HE CALLED TM TO FIND OUT HOW TO FIX THE PROBLEM. TM CALLED (PAT 771-7864) HIM BACK AND LEFT HIM A MESSAGE TO REMOVE THE ENTIRE PIPE, AS IT IS ILLEGAL. DS WENT TO 7 REINSPECT ON 5/26/04. THE PVC HAS 7 BEEN REMOVED. NO FURTHER ACTION REQUIRED AT THIS TIME BY THE HEALTH DIVISION. 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L r a. ., �. a ,. uu ,w.^..;:Pas ,. � r :., y�• -. z, A _ r Y•_ .4 k � � C 4 a r Pa y- i 1 4 A t � � d ty 3arnstable Assessing Search Results Page 1 of k dome: Departments: Assessors Division: Property Assessment Search Results 38 OLD TO WIN R"OAD"I >' R 3wner: CASSIDY, PATRICK L Property Sketch Legend Map/Parcel/Parcel Extension 267 /065/ Mailing Address CASSIDY, PATRICK L l 15 IRVING ST yi yrr/ W HYANNISPORT, MA. 02672 E' f lr t004 Assessed Values: Appraised Value Assessed Value - 3uilding Value: $62,000 $62,000 -xtra Features: $0 $0 Outbuildings: $ 1,300 $ 1,300 Land Value: $ 114,300 $ 114,300 Interactive Property Map: ap requires Plug in: lCt� t) ' Totals:$ 177,600 $ 177,600 1 have visited the maps before ' First time users Show Me The Mao Click Here April 2001 photos available Sales History: Dwner: Sale Date Book/Page: Sale Price: ELDRIDGE,JUNE E 5/9/1962 1156/293 $0 3ASSIDY, PATRICK L 12/23/2002 16130/145 $ 175,000 2004 Tax Information: Tax Rates: (per$1000 of valuation) Town Tax $ 1,173.94 Town Fire District Rates Other Rates 6.61 Barnstable 2.01 Land Bank 3%of Town Tax Hyannis FD Tax $360.53 C.O.M.M. 1.10 Cotuit 1.52 Land Bank Tax $35.22 Hyannis 2.03 West Barnstable 1.36 Total: $ 1,569.69 Due to rounding differences these values may vary Land and Building Information ittp://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/Assess03/display... 5/4/200, 3arnstable Assessing Search Results Page 2 of Land 'vim Building Lot Size(Acres) 0.46 Year Built 1920 Appraised Value $ 114,300 Living Area 1255 Assessed Value $ 114,300 Replacement Cost$99,988 Depreciation 38 Building Value 62,000 Construction Details Style Ranch Interior Floors CarpetHardwood Model Residential Interior Walls Drywall Grade Average Minus Heat Fuel Oil Stories 1 Story Heat Type Hot Water Exterior Walls Wood Shingle AC Type None Roof Structure Gable/Hip Bedrooms 3 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 2 Bathrooms Total Rooms 6 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value SHED Shed 225 $1,300 $ 1,300 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area (Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) ittp://www.town.bamstable.ma.us/tobO2/Depts/AdministrativeServices/Finance/Assessing/Assess03/display... 5/4/200, i •ir� �'r..` .fit. 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', T�d r 4, i�.#- "i � � x�.1w' 'rtt At a �7t - e w f 6f � �a jf, 1�, t . . 1: �I t 5 �, 4 ` NAME OF OFFENDER _ P BAR 66783 TOWN OF ADDRESS OF OFFENDER BARNSTABLE CITY,STATE,ZIP CODE q n 114E/phi 11 G V/MB REGISTRATION NUMBER OFF SE E� �9 RAHN'SI'AHLK., 0 Cnw f /� LLi MASS. ,639, `m O prFD MPy 6, 0,l c I ` 1° Z z TIME AND DATE OF WO ATI OCATION OF V OLATI N W NOTICE OF r A. . P.M.)ON 0 !t)�q�, Q THREBY OF EN FOR 1 N EN RCING D PT. BADGE NO. rw VIOLATION cr o OF TOWN ACKUJI NOWLEDG RECEIPT F CITATION X t�, Q Unable to obtain si natu of offen r. .�� ORDINANCE E NONCRIMI AL FI E FOR THIS OFFENSE IS S Date mailed S w OR YOU HAVE THE FOLLOWING AL RN TIVES WITH REGARD TO ISPOSITION OF HIS MATjER.EIT R OPT �)Q,�i OP,TI (� ILL OPERATE AS A FINAL CL DISPOSITION WITH NO RESULTING CRIMINAL RECORD. (�/ V'VJ W REGULATION (1)You may elect to pay the above fine,either by appearing in pe on between 8:30 A.M.and 4:00 P.M.,Monday through Friday,le I holidays cepted, < before:The Barnstable Clerk,230 South Street,Hyannis,MA 02601,or by mailing a check,money order or not to Barnstable Jerk,P. x 2 3 J Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. LLJ (2)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request t ST T C T E T,FIRST. BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,Attn:21D N imlTat' afings an enclose a C py of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature I- NAME OF OFFENDER Ito \ Aw `(�Y r a . - A 11(1„6o 1.n It 4 1CP.«« BAR .TOWN OF t ;ADDRESS OF OFFENDER , /` t BARNSTABLE.' CITY,STATE,ZIP CODE . p ` lit ME tph- - 1MV/MB REGISTRATION NUMBER Yeti Y OFFE E IIAN\Sl'AHI.i:. f\ (� (� y� 1() 1/} LLj y ,IAss. g U 'C—M R 1,<.© V \ Q t 7�9! �, /•Pq�1!j d tEDMA+s, CD i. f S APd i'1 �Q � �! 111 I !U Se L 5 4M t > TIME AND DATE-0F�V,IOLATIO LOCATION OF VI LATI W NOTICE OF lo'o A.� P.M.)ON �. tpinitt k� ����I SIGN U� OF ENFOR XE ENF CING DEPT. -�'' BADGE NO. N VIOLATION � �'L.J -s- � r' oA . o OF TOWN �✓ rt r°/t ilJ+ Nr w I HEREBY ACKNOWLEDGNRECEIPT I F CITATION X R t a Unable to obtain si ,,natur of offend r. V //,t,UE? � ORDINANCE E NONCRIMINAL FINE FOR THIS OFFENSE IS $ V�/ Date mailed S 2s 0` � LU J OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF'HIS MATTER.E�€�i OPTIIfN], 0�,OP I0 (2� t ILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD. j/t G�1� U +t�� Y!t/c N REGULATION (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays e�`cepted, w before:The Barnstable Clerk,230 South Street,)Hyannis,MA 02601;or by mailing a check,money order or pas l.lgt Barnstab e l�,P t6o Q Hyannis,MA 02601,WITHIN TWENTY-ONE 21 DAYS OF THE DATE OF THIS NOTICE. )) ��}} `'( C (2)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request 19,01STPDT COURT ErAR`ME1;IT,FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,Attn:21D No rimmal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature NAME OF OFFENDER t'r't`r °['r c rC 1 r! G+� ��� A.,• ��p.,� BAR MMM TOWN OF ADDRESS OF OFFENDER v }} BARNSTABLE CITY,STATE,ZIP CODE q tHE�p� •D� ' K,) J �`f. � {1�../-i\d f t /�p • f. 1 f`egi(/ CL lIASS. R .e�fD6 79• {[!1( LU CD M �\nP C 04 Illy �rVCys y . J Z TIME AND DATE WVIOLATI { ! \ LOCATION OF VIOLATION LU NOTICE OF IA. . P.M.)ON �' ,`f}� , /c/ T0wn SIGN TU�fi-OF ENFOR 16.BER N i ENRORCING DEPT. -^' / BADGE N0. W VIOLATION w; 4,j- �I +' Ihl W OF TOWN 1 , ✓(���� lN1 '"' Q I HEREBY ACKNOWLEDG RECEIPT a F CITATION X �l 1' J ~ ORDINANCE Unable to obtain si natu f offend r. THE NONCRIMINAL FINE FOR THIS OFFENSE IS S`�(�'Ub Date mailed S :ESL D W OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGAR�TO SPOSITION OF THIS MATTER.Ell OPT ON�y)0�pP,T.IOh�(WILL OPERATE AS A FINAL U" DISPOSITION WITH NO RESULTING CRIMINAL RECORD. 1 V tn' s �flU { � REGULATION (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Mogday through Friday,legal holidays eItcepted, LU before:The Barnstable Clerk,230 South Street,Hyannis,MA 02601,or by mailing a check,money order or posTTa of to Barns Ue Clerk,P-0 7ox 2g3Q, Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. `1 /— (2)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request o D1ST,RIICT COU TIDEP-ARTMENT,FIRST, BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,Attn:21D N imirial Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature 'ME OF OFFENDER I fi,� ff TOWN OF ` ;ADDRESS OF OFFENDER y¢ i Y ypr y o a a BARNSTABLE - . CITY,STATE,ZIP CODE' 1 ' Q '� VIMB REGISTRATION NUMBER tHf 0. I T" $, a 0 F FENSE �N fd I FY J� � /y F R' W o l.i c 11ASS ,1 d X r . ... 'lw#{� L W . .6}q,a 0 ' f Mr. �q O I n h m y n "arEO MA j , td W W K w ► r r�ah ��E + _. r3 � :ILra .7.ct$ F > x o x c TIME AND DATE,_OFVIOLATI - .-ti LOCATION OF VIO AT�IoN„�,,, w A. ./.P.M. ON. 20.1. yy/ ltrT13 ,1 I G?/ >p� J W a w = NOTICE'OF ta:o�. ) 5"I r ' f Q h o H SIGN OF'ENFOR 6.R E RCING�p PT. �` f BADGE NO. w a .nJ f ECD C2 o OFTOWN I HEREBY ACKNOWLEDG RECEIPT F CITATION X � � +`°f' _ t � iI 6 �° a q Q ORDINANCE �+�? Unable to obtain si natu e f of r. I 5 w o W THE NONCRIMINAL FINE FOR THIS OFFENSE IS $ '. _ <Z t y b' w i m n ` Date mailed i ! W OR YOU HAVE THE FOLLOWING ALA RNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITW A OPTION 1')ORnOP,yTI 1N(27 WILL OPERATE AS A FINAL CL n i z i . 7l t,"t LU I o m o n DISPOSITION WITH NO RESULTING CRIMINAL RECORD. i' REGULATION (1)You may elect to pay the above fine;either 6y appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, LU before:The Barnstable-Clerk,230 South Street,Hyannis,MA 02601,or by mailing a check,money order or postal, of o Barnstable Clerk,P.Ot Box 24430; Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. N} 1 ' a 2 If you desire to contest this matter in a noncriminal proceeding,you may do sob making written request e uest.lo-451STRIOT COURT�DEPARTMENT,FIRST. I l Y P 9 Y Y Y 9 q x x BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET;BARNSTABLE,MA 02630.At in:21D Non riminal Hearings and,enclose a copy of this e y e +: citation for a hearing. r.. (3)If you fail to pay the above offense or td request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined.at the hearing r I ¢ o =o i to be due,criminal com taint may be issued against you.. n x m x n !)w N W v E I HEREBY ELECT the first option above confess to the offense charged,and enclose payment in the amount of$ Signature z m na TO OFFENDER: Failure to obey this notice within 21 days after the date of violation may result in a Scamp I criminal complaint being issued. DO NOT Here MAIL CASH. Post Office will not deliver without stamp I I i j oz j MAIL TO: I j BARNSTABLE CLERK j j P.O. BOX 2430 I HYANNIS, ILIA 02601-2430 I • I I I i I F1ME ra,, Town of Barnstable Regulatory Services ♦ {#j M BAMSfABLE, 9 MASS. Thomas F. Geiler,Director �p i6;q. 10 rE039 1% Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 5, 2004 Patrick L. Cassidy 15 Irving Street Centerville, MA 02632 NOTICE OF VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE, THE TOWN OF BARNSTABLE BOARD OF HEALTH REGULATIONS, NUISANCE CONTROL REGULATION NO. 1, The property owned by you located at 38 Old Town Road, Hyannis, was inspected on May 4, 2004 by David Stanton RS, Health Inspector for the Town of Barnstable, because of a complaint. The following violation of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage was observed: 310 CMR 15.020: Disposal Construction Permits: A trench was observed with PVC pipe leading from the "shed" to the septic tank. There is no permit on file with the Town of Barnstable Health Division to conduct this work. The following violation of the Town of Barnstable Board of Health Regulations, Nuisance Control Regulation No. 1 was observed: Nuisance Control Regulation No. 1, Part VII, Section 1.00: A large pile of Rubbish is accumulating on the property. You are directed to correct the violations listed above within ten (10) days of your receipt of this notice, by removing the PVC piping that is illegally connected to your septic system, and by removing the rubbish from your property. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance could result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. QAorder letters\38 old town rd.doc . w w PER ORDER OF TH BOARD OF HEALTH Thomas A. McKean,S Director of Public Health Town of Barnstable I r No. V FEE �O 0 10 � COMMONWFALT14 ®F MASSAC14US ETTS Board of Health, , MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) -XComplete System ❑Individual Components Location ;0 Owner's Name Map/Parcel# Aj Address Lot# #3� D Telephone# 4. Installer's Name p - ; Designer's Name Address Address Telephone# -(Q 5��� Telephone# ISA8_0_+ S Type of Building 1�Q,n}�O�� Lot Size-I_cL�. sq.ft. Dwelling-No.of Bedrooms Qg Garbage grinder (44 Other-Type of Building De�,aC�yx No.of persons ?J Showers ( Cafeteria (V( Other Fixtures I.-PA-iy,"t'c&l ks� yysr-, Design Flow (min.required) L gpd Calculated design flow 3250 Design flow provided 334•y8 gpd Plan: Date . O 13 Number of sheets f Revision Date u Title .�`- Description of Soil(s) Soil Evaluator Form No. m `a. Name of Soil EvahiatorC Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS 4�6 9*, Ar"a 7 CXrS . The unders' ed agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agr s to n t to place a tem in ration until a Certificate of omp'ace has bee sued b�y the Board of Health. U NSIGNING ENGINEER MUST SUPERVISE Signed Date Z— THE AND CERTIFY IN WRITING E SYSTEM WAS INSTALLED IN STRICT Inspections ACCORDANCE TO PLAN No. 700.. � /� � # �Yl FEE 50, 00 L Board of Health, c^.c c Sac G Y��2 MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) RepairX Upgrade( ) Abandon( ) -XComplete System ❑Individual Components Location ,� T6 2 Owner's Name f" Map/Parcel# S Af,` Address Q ` Lot# { �� l� Telephone# < Installer's Name 5-4�C <_ v`CQ Designer's Named Address Address Telephone# 5D - (C) - C \ Telephone# 511t8-cj�-g(p ® gS to Type;of Building 4`7 1C1.0', t C,x Lot Size -1 _ �o t" sq.ft. Dwelling-No.of Bedrooms mc),C"'p? (3) .Garbage grinder (t4 p, Other-Type of Building - D2kC.r`SPA �J` �` No.of persons _Showers ( KCafeteria (yY Other Fixtures �-1. x��t ll -t^cSaZ1�ti 6-2C1 Design Flow (min.required) ")?pc) gpd Calculated design flow a-1.)o Design flow provided r �Jy gpd Plan: Date \\, )� Number of sheets_ t Revision \Date Title �C^�JOQ - �d�t�c ��11�� �%��CK�c�� 1 i111 tt Description ofSoil(s) � � G'� CeC' r\ '-7�Z` �P � t1<'.("hpr Soil Evaluator Form No. Name of Soil Evaluatorta-2N4F=tA Date of Evaluation 1 DESCRIPTION OF REPAIRS OR ALTERATIONS �c The unders'gned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agr es to bt to place a stem m* 'eration until a Certificate of omp ce7has been issued by the Board of Health. Signed Date 1 -Inspections t / No. U FEE 50, 00 I! Board of Health, MA. CERTIFICATE Of COMPLIANCE Description of Work: ❑Individual Component(s) Complete System The signed hereby certify that Sewage Disposal System; Constructed ( ),Repaired (1�Upgraded ( ),Abandoned n ( ) by: der iff V) L T at j�1 1 �—'`' U ✓t has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) at I Id the approved design plans/as-built plans relating to application No\ 00 'S7K , da ed/ Q-//_Oc�-^ . Approved Design Flow 330 (gpd) Installer Designer: Inspector: "tom, ^�>•Date: r a y The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No.1Zodc< 57g FEE COMMONWEALTH Of MASSAC14USL14,1iVG j (r_� II '' INSrALLATIO ENGINEER'MUST Board of Health,. �5�a 6 / Sy _ N AND CCRTIFy IN^^„ ��Sr`:9 WAS INSTALLED IN DISPOSAL SYSTEM CONSTRUCTION Pl�llffcE TD PLAN. Permission is hereby granted to; Construct( ) Repair((/ Upgrade( ) Abandon( ) an individual se agedisposal system at 3 3 0 Lp TOW M RQ AD C L TL-U I I J( E as described in the application for Disposal System Construction Permit No.R 0 `57 dated Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Form 1255 Rev,5/96 A.M.Sulkin Co.Boston,MA Date /c2-/ _.uc�- Board of Health D cJ/ s n/ TOWN ARNSTABLE Me LOCATION �/ SEWAGE # 429- 20 VILLAGE ASSESS �` & LOT INSTALLER NAME&PHONE N ////�� { SEPTIC TANK CAPACITY !,6 `il 1 T,A`" UW r 7 LEACHING FACILrrY: (type) '�i-Lai�-i L- (size) NO.OF BEDROOMS BUILDER OR OWNER 2 � PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted.Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet o(leaching facility) Feet Furnished by I _ i s / FORM 11 — SOIL EVALUATOR FORIN Page 1 of No.: Date: 12/9/02 COMMONWEALTH OF MASSACHUSETTS Barnstable , Massachusetts Performed By: Carmen E. Shay Date: 12/9/02 Witnessed By: Waiver Location Address or#38 Old Town Road Owners Name: Estate of June Eldridge Centerville,MA Address and #38 Old Town Road, Centerville Lot# (Map—267,Parcel 065) Telephone Number: New Construction : X Repair : OFFICE REVIEW: Published Soil Survey Available: No ❑ Yes ❑ Year Published: Publication Scale: Soil Map Unit: Drainage Class: Soil Limitations: Surficial Geologic Report Available: No❑ Yes❑ I Year Published: Publication Scale: Geologic Material: (Map Unit): Landform: Glacial Outwash Flood Insurance Rate Map: Above 500 Year Flood Boundary: No ❑ Yes X❑ Within 500 Year Flood Boundary: No F 7x Yes ❑ Within 100 Year Flood Boundary: No a Yes ❑ Wetland Area: None National Wetland Inventory Map (map Unit): Wetlands Conservancy Program Map (map unit): Current Water Resource Conditions (USGS): Month Range: Above Normal ❑ Normal 1E Below Normal ❑ Other References Reviewed: USGS Topographic Map DEP APPROVED FORM 12/7/95 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No.: #38 Old Town Road, Centerville, MA On -Site Review Deep Hole Number: #1 Date: 12/9/02 Time: 10:00 AM Weather: Sunny, Cool Location (identify on site plan): Refer to Sketch Landform: Outwash Plane Position on Landscape (sketch on back): Refer to Sketch Distances From: Open Water Body N/A feet Drainage Way N/A feet Possible Wet Area N/A feet Property Line 25' feet Drinking Water Well N/A feet Other DEEP OBSERVATION HOLE LOG Depth From Soil Soil Soil Soil Other Surface Horizon Texture Color Mottling Structure, Stones, (inches) (USDA) (Munsel) Boulders, Consistency, % Gravel 0" - 8" AP Sandy 5 YR 5/32 None <5% Gravel, Friable Loam Friable 8" - 25" BW Sandy 7.5 Y/R None <5% Gravel, Friable Loam 6/6 Friable 25" - 156" C' Medium 10 YR 8/4 None Medium Sand, 15% Sand gravel, Loose Parent Material (Geologic): Glacial Outwash Depth to Bedrock:None encountered Depth to Groundwater: Standing Water in the Hole: None Weeping From Face: None Estimated Seasonal High Water Table 156" Assumed — No groundwater Observed DEP APPROVED FORM 12/7/95 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No.: #38 Old Town Road, Centerville, MA Determination of Seasonal High Water Table Method Used: ❑ Depth observed standing in Observation Hole: N/A inches ❑ Depth weeping from side of Observation Hole: 156 inches (assumed) ❑ Depth to Soil Mottles: None inches ❑ Groundwater Adjustment: None feet Index Well Number: Reading Date: Index Well Level: Adjustment Factor: Adjusted Groundwater Level: N/A DEPTH OF NATURALLY OCCURING PERVIOUS MATERIAL: Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system: Yes CERTIFICATION: I Certify That on September 17, 2000, (date), I have passed the soil evaluators examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature: Date: FORM 12 - PERCOLATION TEST Location Address or Lot No.: #38 Old Town Road COMMONWEALTH OF MASSACHUSETTS Centerville , Massachusetts Percolation Test Date: 12/9/02 Time: 10:30 AM Observation Hole #: #1 Depth of Perc 30" — 48" Start Pre-soak 10:28 AM End Pre-soak 10:36 AM Time at 12" Would Not Hold 24 Gallon Presoak Time at 9 Time at 6" Time (9-6") Rate Min./inch < 2MP1 * Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Performed By: Carmen E. Shay Witnessed By: Waiver Comments: Would Not Hold 24 Gallon Presoak - <2 MPI Site Passed X Site Failed DEP APPROVED FORM 12/7/95 Serp- 20-01 13 : 52 BARNSTABLE HEALTH DEPT 5087906304 t . vL 52s/ol ' 1\OTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. i PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM l hereby certify chat the engineered pian signed by me iia,.ec G1.N.O�N Da concerning the property located at �1d Own :RoPo meets all of the • This failed system is connected to a residential dwelling only. There are no .omrntr:.ial or business uses associated with the dwelling. • The soil is ciass:ced as.CLASS 1 and the percolation race is less than or equal to Ti.nuces per Inch. The applicant may use historical data to conclude (his fact or may _or:ducc ore!imi. ar;- tests at the site without a health agent present. • There :s no increase in now and/or change in use proposed • There are no vanances requested or needed. • The- bottom of the proposed leaching facility will not be located less than fourteen fee; aoove the maximum adjusted goundwater table elevation. fAdjust 'he nunc!water cable using the Erimp(or method when applicable) Please complete the following: a i Trip ,Dl Grounc? Surface E':zvation (using GIS information) _ _- 1 c g; &W Elevatior, adJuscroenc for high G.W..- ',,?.. = -�. — S:GVED DATE: voTI 3asec snort the move ir.formation, s repair permit wil! be issued for 5edr^oms add�w)nat bedrooms are authorized to t`te future witout en,tneerec :ept.c system plans. �-_nn:c Au �u cc.im9 i 5 Permit Number: Date: Completed by: l � ; HIGH GROUNDWATER LEVEL COMPUTATION I i Site Location: M�&nn Lot No. Owner: �'��� 17NAC,5� 'a. Address: Contractor: �Sjj7 J4ddress i Notes: STEP 1 Measure depth to water table tonearest 1/10 h. .............................................................................. Date month/daylyeai l i STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OA Appropriate index well.................................................... Msvl OB Water level range zone..................................................... STEP 3 Using monthly report "Current j Water Resources Conditions" determine current depth to , s r� water level for index well ........................... ;? rrfoAtA/y@af � STEP 4 Using Table of Water-level Adjustments - for index well (STEP 2A),current depth i to water level for index well (STEP 3), and water level zone (STEP 2B) determine water-level adjustment .......................................................................................... STEP 5 Estimate depth to high water by subtracting the water• i level adjustment (STEP 4) from measured depth to water levelat site (STEP 1) ............................................................................................................. t I i i i i i Cape Cod Commission: USGS Well Data-November 2002 Page 1 of 2 United States Geological Survey Observation Wells As a service to Cape officials, engineers and other interested parties, the Cape Cod Commission publishes monthly groundwater data gathered by its Water Resources Office. The water level measurements shown below are taken monthly from United States Geological Survey (USGS) observation wells and compiled during the last week of each month. They are published as soon as possible thereafter. Listed below are nine out of the 61 wells measured across Cape Cod by the Commission's Water Resources Office. These nine are employed as index wells to be used with Technical Bulletin 92-001 to predict high groundwater levels. For your convenience, we've also provided links to USGS national and state data. See the last column in the table and the footnotes below. For further information, please contact Hydrologist Gabrielle Belfit at the Commission offices (508-362- 3828). November 2002 USGS Site Water Record Record Departure from Number*'-*'-'-' � Location Well No. Level* High* Low* Average** (links to t. SGS Monthly Overall national water-level database) Barnstable 230 25.6 20.5 26.6 -1.1 -1.9 413956070164301 Barnstable 24W 27.4 20.5 28.6 -2.2 F7-2.9414154070165001 Brewster BMW 21 13.4*** 6.9 13.6 -2.6 -3.2 414518070020301 Chatham CGW138 25.4 20.9 26.6 -0.8 -1.4 414100070011101 Mashpee MIW 29 9.2 5.6 10.0 0.0 -0.6 413525070291904 Sandwich SD 2 47.8 45.9 48.2 -0.2 -0.5 414418070241601 Sandwich 2I53 54.6 45.8 55.1 -3.8 F7-4.5414124070265901 Truro TSW 89 12.1 10.2 13.0 0.1 -0.1 420206070045901 Wellfleet WNW 12.2 7.3 12.8 -1.1 -1.7 415353069585401 http://www.capecodcommission.org/wells.htm 12/11/2002 T �F7BLE LOCATION OSEWAGE # VILLAGE 444 ASSESS & LOT G,✓ rti-�_ INSTALLERS NAME&PHONE NO. j SEPTIC TANK CAPACITY (size) LEACHING FACILITY: (type)NO.OF BEDROOMS r., BUILDER OR OWNER PERMTTDATE: d 11 d�- COMPLIANCE DATE: ) 1� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facilit)�(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by I fig , �� 0 � . TOWN OF ARNSTABLE LOCATION ; 0I I o SEWAGE # VILLAGE� ASSESSO W & LOT o -OK INSTALLER'S NAME&PHONE NO. r- SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Livti i (size) NO.OF BEDROOMS J BUILDER OR OWNER PERMTTDATE: 11 d?- COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ,S b 7 a CARMEN E. SHAY (508)-548-0796 ENVIRONMENTAL.SERVICES,INC. P.O.Box 627,East Falmouth,MA 02536 December 13, 2002 RE: Certification of Title V Septic System Installation: Residential Property—38 Old Town Road, Centerville,MA Dear Sir or Madam: On December 11, 2002, Roger Roberts, Inc. was issued a permit to install a Title V Septic System at 38 Old Town Road, Centerville, MA, based on a design drawn by Shay Environmental Services, dated, December 10, 2002. XX I Certify That The Septic System Referenced Was Installed Substantially According to the Plan I Certify That the Referenced Above Septic System Was Installed With Changes but in Accordance With State and Local Regulations, Revisions or As-Built Plans/Sketch will Follow. The Septic System Was Not Installed Per State and Local Regulations and Corrective Action is Required. If you have any questions, please do not hesitate to call the undersigned at (508)-548-0796. Sincerely, CARMEN E. SHA Y ENVIRONMENTAL SERVICES,INC. OF c o� CARMEN m O E• SHAY cn 181 Carmen E. Shay, R.S., C.S. President s4NiTA I ALL PIPE SPECIFIED ARE ATIONS FLOW PROFILE EXPRESSEDLINV DECIMAL FEET NOT FEET NDT INCHES.TIONS ENT TOP OF F 3 FOUNDATION OUNDATION RAISE COVERS TO WITHIN SIX INCHES OF FINAL GRADE PPE EL = ONE INSPECTION RISER FOR LEACHING GALLERY TO WITHIN 3 INCHES OF FINAL GRADE AS INSPECTION PORT. 36.15 D-BOX OX X ALL PIPE TO BE MAX SCHEDULE 40 PVC /3" DROP H-20 AND TO PITCH AT T— VFLOW- LINE I I i i 33.15 in/Ft1/8 FF 10 14 H-20 48" GAS�� PRECAST BAFFLE DRYWELL L32.6 6 in LEACBOTTHING OF STONE32.25 LEACHING GALLERY EXISTING BASE 32.85 6 in STONE BASE 32.42 GALLERY 1500 GALLON00 32.15 (END VIEW) 30.15 5.00 Ft + SEPTIC TANK SEE DETAIL ON REVERSE EXISTING 14 Ft el 5 f t 12.5 Ft PIPE INVERTS AT EXISTING 11 bl 12 Ft 11P SEPTIC TANK = 33.20 ADJUSTED SEASONAL = 13.70 HIGH GROUNDWATER mz mx x�m y� C) �r- mz z n O rnrn cim o�irn oa n rn \ I �m o� �or- Z� �m mn`rri 00 0 �rnm 1 �rn mo 0 rnzn � z � ° m m � � / y�.00 4 i00 y cm-o W m 1 _P> y � o M% 3 \ vX �� \ � ycoo p * r" m r sli�s� N o��-' m n \ / oaddvl c c N m \ co W W m Z ` lN011��a3�1 N115IX3 �1 Z \ Q gip^ o Moyh m m rt y X �NIN�v3 o m X Z /a z T \ m o eZ \ // v� o0 a�� w A— o �w Pt) � ��, / m sll s m \ � /// 6t < N 6£t 3 m rm mm-<r- m �> aD mJ � = Z m OGl z Z om zo z Q) =czi ® (D f TI ® �"�n -4 � > P-9m�tA rn L 3rn co ra N F rn 0 i O 1 Dcil rn o r 0 D I C morn CD ry �X o m =oMro co CP �� m r o m ZN ? Y Z r O W m Z <0 rn (� ., O = zZ r xo�Z Z? Wmo m co> m C N.) rn Z o �mzr`lm Z Oy] 3 >rnN. m — �� r\j ❑ -0 a OA�Om O M 2N�-0 z XO� 0)) Z� ;u � ZO UIgOp;] m Om lm3 < �O o -m �m r m;3;O7p 00� MZ 0 V08 NM01 0 10 Z m I o"m A G) n CZ -+ r � Nz IOHmz O m �m � �omcil O moA�m �on or .� T m m3 c, n In z pj m 0 cv�)yo I- LTl m` R 0 STRAmmporn TWA Y 0;00:KM n Z i r DATE OF TEST: APRIL 7. 2008APROVED I I I A S 0 I L T E S T L_ O G WITNESSED) BYVALUATOR: DONADAVIDLDD DESMAR ISO HEALTH DEPT. 0 � S I G N .'C A L- C / \ T I O N S PERC NUMBER: 12157 DESIGN F-LOW: 3 BEDROOMS X 110 GPD = 330 GPD NO GROUNDWATER ENCOUNTERED SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS TEST PIT 1 PARENT MATERIAL: PROGLACIAL OUTWASH INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) PERC AT 62 in - 2 MIN/INCH IN C SOILS ELEVATION DISTRIBUTION BOX: USE 3 OUTLET D-BOX. DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOIL ABSORBTION SYSTEM: A 24 Ft x 12.5 Ft x 2 Ft LEACHING GALLERY CAN LEACH (INCHES) HORIZON TEXTURE (MUNSELU MOTTLING 3B.10 Abot. = ( 24 x 12.5 ) = 300 sF 0-3 O WOOD LOAM 10 YR 2/2 NONE FRIABLE Asdw = ( 24 + 24 + 12.5 + 12.5 ) x 2 = 146 sF Atot = 446 sF 3-4 E LOAMY SAND 10 YR 4/2 NONE FRIABLE Vt 0.74 x 446 = 330.04 GPD 4-9 A LOAMY SAND 10 YR 4/4 NONE FRIABLE USE A 24 Ft x 12.5 Ft x 2 Ft GALLERY. Vt = 330.04 GPD > 330 GPD REQUIRED 34.93 9-38 B LOAMY SAND 10 YR 5/6 NONE LOOSE 27.10 38-132 I C MEDUIM SAND 10 YR 6/4 1 NONE ILOOSE.. NO GROUNDWATER ENCOUNTERED L EA CHID)G GA L L ER Y TEST PIT 2 PARENT MATERIAL: PROGLACIAL OUTWASH USE SHOREY PRECAST 500 GALLON NOT TO 2 MIN/INCH IN C SOILS. LEACHING DRYWELL (H-20 LOADING) SCALE 1500 GALLON SEPTIC TANK ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER DIMENSIONS AND DETAIL NOT TO (INCHES) HORIZON TEXTURE (MUNSELU MOTTLING CONSTRUCTION DETAIL USE SHOREY ST-1500-H-10 SCALE 38.20 DRYWELL UNIT STONE 0-4 O WOOD LOAM 10 YR 2/2 NONE FRIABLE 4-6 E LOAMY SAND 10 YR 4/2 NONE FRIABLE 2 4,0 Ft 1 In 6-12 A LOAMY SAND 10 YR 4/4 NONE FRIABLE CC)4 TfiPEF? 34.87 12-40 B LOAMY SAND 10 YR 5/6 NONE LOOSE .j Ln 40-158 C MEDUIM SAND 10 YR 6/4 NONE LOOSE N IE__01� 4`` !N of t'25.035 - 21 O 8 i n GROUNDWATER ADJUSTMENT 3.5 FLL 8.5 Ft 8.5 Ft .5 Ft EXISTING GROUNDWATER LEVEL 2 4.0 Ft BASED ON TOWN OF BARNSTABLE GIS DEPARTMENT RECORDS. INDICATED GW 11.00 500 GALLON DRYWELL INDEX WELL M 1 W-29 DIMENSIONS AND DETAIL ZONE C INLET CENTER OUTLET READING DATE MARCH. 2006 USE H-20 LMT END COVER END READING 7.7 INSTALL ONE INSPECTION az; ADJUSTMENT 2.7 RISER TO WITHIN THREE 3 IN DROP4 .....: ADJUSTED GW 13.7 INCHES OF FINAL GRADE Ar, FLOW LINE AND INDICATE LOCATION FROM — ON AS-BUILT PLAN BUILDING '- 10 14 TO, 1n D-BOX 48 to LIQUID GAS NOTES o 36 LEVEL BAFFLE L7p �0 oo��oo moo p0000 In 1) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING"WORK. oa00000000o D00 2) EXISTING PLASTIC SEPTIC TANK TO BE PUMPED AND REMOVED. REPLACE WITH 00000Q 1500 GALLON CONCRETE TANK AS DEPICTED ON PLAN. 102 60 CROSS SECTION VIEW 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS 1� OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND. UTILITIES CROSS SECTION VIEW BEFORE EXCAVATING FOR SYSTEM. � _. SEWAGE DISPOSAL SYSTEM PLAN 5) EXISTING CESSPOOL TO BE PUMPED. COLLAPSED. AND FILLED. '� 2 in PEASTONE 2 in PEASTONE 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND 'DUST IN PLACE. o o -TO SERVE EXISTING DWELLING 7) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF, LOW FLOW FIXTURES 28 3/4,n TO 24 in 3/4,,, TO 26 AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC ;TANK.. in -112in`R""E` 01Pr" 1-112 i,GRAVEL i^ ELEUTERIO & ROSE MARIE RICCI 8) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT 38 OLD TOWN ROAD HYANNIS. MA PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. 46 in 58 in 46 in 150in EEO-TECH ENVIRONMENTAL 9) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE' TO GRADE ON A LEVEL STABLE BASE THAT HAS BEEN MECHANICALLY-' COM-.PACT-ED •AND ON TO-WHICH INSTALLER MAY SUBSTITUTE AN APPROVED GEOTEXTILE 43 TRIANGLE CIRCLE SANDWICH MA 02563 SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING. FABRIC IN PLACE OF THE 2 in. PEASTONE LAYER SPECIFIED. ' E : : ETE 26651 APRIL 14, 2008 2/2 p SECTION A A_: V 2000' 4/- ALL�OUUT PIPES FWW THE, w in. frorn *NOTE: ALL PIPES ARE TO BE 4*-SCHEDUtE 40 P.V.C� PROFILE VIEW OF ADDITION,�TO LBACHM: -SYSTEM msv*uTm sox sNAu.K, [house to septic tank Comm SET LEVEL FOR AT LEAST 2 FT� Tr COV6 Existing' Foundation Septic t*rtk covers must be 3* of 1/8" - 1/2' Waithed Poostone f %ithio 6 in� of finished rode /4' to 1 1/2 wosf� Crushed Stoni Erode ow Septic Tank 98.50 Or*&over 0-Dox 1111,06 ----Orode over W -".50 3 5'OUTLET 2" Sr KNOO<MTS T L 12* INLET T I . IR.- 71 00" 0.02 3 HOLE H-10 DIST. DOX moknum co�,w top of SAS- Elev. -96�50 10* EXIST. rXity. PIPE CA 1 500 GAL. X S- 0.0110'per foot SCH. 40 Tt-,�/ TIC TANK 3z. rffecti�e th 4' FRON EXIST. FOUNDATION LAJ C14 H-10 6 Uras PLAN 'SECTION CRQS�-SECTIQN to I' VOW 'UNDER CHMURS CONCRETE FULLv, of 3 SITE 3K Z 6 in.of 3/4* 1 1/2' 11 to 3 H OLE H-10 DISTRIBUTION: BOX CRAIGVILLE BEACH SYSTEM PROFILE campocte, ton 0) 0) RDA > Not to Scale C 7F• ) 0 Effecii,ve Length. NOT TO SCALE 4', SOIL��ABSORPTION 'SYSTEM (SAS) LOCUS MAP 6 Ift.of 3/4'-1 1/2' CULTEC MODEL '125 (H-20 LOADING)/ SHOREY PRECASTE 0 �20 40� 50 compacted stone Effectiv*,wwh GENERAL" NOTES (OR EOUIVALENT)Not to'Scale M 1. Contractor is responsible for Digsafe notification ....... NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18- /EFFECTIVE HEIGHT 15 12- and protect* n of oil underground 'utilities and pipes. to u IL------M 2. The �septic tank and Aistribution box -shall be set level on 6' of 3/4"-1 1/2" stone. 3. Bockf ill should be clean Sand or.grovel with no SCALE: 1 20 stones over,,137 in size. ACCESS MAINIMUS 4. This system, is subject,,to inspection during installation to _9* by Carmen E.1- Shay Environmentol Services, Inc, C 0 with Title V of the Mossochusetts state code, the approved plan L 5. The introct6r,shall instoll this system.,in accordance and Local Re ulotions. Ilotior 6. If, during insto n the -contractor encounters any soil conditions or Site conditions that ore different INLET owu Til 7 from those:sh,shown wn I on he:-sot tog or in our L design THE ACCESS COVERS FOR THE SEPTIC TANK, DISTRIBUTION BOX AND LEACHING COMPONENT installation must halt & immediate notification be SHALL BE RAISED TO WITHIN 6' OF made to Carmen E. Shay Environmental Services, Inc. Ix FINISHED GRADE. vehicle or heavy machinery shall drive over the 7. No STEEL, REINFORCED PRECAST CONCRETE, INSTALL TUF;-TITE GAS BAFFLES OR EGUALS septic system unless noted as H-20 septic components. ON ALL OUTLET TEE ENDS PLAN VIEW 8. Instoll Tuf-Tite gas boffles or equols on Of, outlet L tee ends. 3-24*FtEmOvAkt CovMS- 9, All Distribution Lines be -4" diameter Schedule 40 NSF PVC pipes. 1 OL. All solid piping, tees'& fittings shall be 4" diameter 4* Schedule 40 NSF PVC pipes with water tight,joints. N 85d 440 20" E I J.L Municipal 'Water is Connected to The Residence and Abutting INLE T ro J7F!!t7EJ:LAM, *"t to-outiet- - 6. " f"T 102 1 to min.T-1 L;ii;_1dWVi1t_ 11:1t 17 INL OUTLET .;T Properties Within 150 Feet. N 86d 26' 30" E ow .D.M Liquid depth 36.85 THE PROPERTY LINES ARE APPROXIMATE AND COMPILED FROM THE -SURVEY PLAN GENERATED BY JOHNP. DOYLE OF W. FALMOUTH, MA ENTITLED " SITE PLAN FOR,ESTATE OF UNE ELDRIDGE, 38 OLD TOWN ROAD, BARNSTABLE, MA," DATED SEPT. 14, 2002 CROSS SECTION END-SECTIONAND IS NOT.INTENDED TO BE A SURVEY PLOT PLAN CV) IT SHOULD BE USED FOR NO PURPOSE,OTHER THAN THE SEPTIC SYSTEM,INSTALLATION, TYPICAL 1500 GALLON H- 10 'SEPTIC 'TANK O EXISTING CESSPOOLT TO BE PUMPED FILLED IN PLACE PARCEL # 65 NO T I TO,SCALE -re Feet 6 MAY REPLACE WITH 1500 GA_LLO N L POLYETHYLENE SEPTIC TANK) 19,762.Squa 12' NOTE: ANY STRIPPED-OUT SOIL-CONTAINING LEACHATE FROM GEORGE OBRIEN & COMPANY (H- 10) FROM THEr EXISTING LEACH PIT TO BE DISPOSED lo* OF AS PER BOARD OF HEALTH SPECIFICATIONS, EXISTING SHED -esian Calculations LEGEND NEW D-8Ox Number of Bedrooms: 3 Equivalent to 330 Gal./Doy, (330 Gal./Doy per Title V) Garbage Grinder-, No 20 DENOTES PROPOSED Leaching (,opocity Proposed 330 Gal./Doy Minimum (Min. Per Title V) F10_4_7'1� _\9 8 Septic Tank 3 x 330 Gal./Doy - 660 USE 1,500 GAL. Septic Tank. SPOT GRADE SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch N -100 Bottom i Area: 0.74 gal/sq. ft. x 360 sq. ft. 266.4 gallons X 104.46 DENOTES EXISTING Sidewoll Area: 0.74 gal./sq- ft. x 92 sq. ft. 68.08 gallons SPOT GRADE N Providing: 334.48 gallons Use: (5), CULTEC MODEL 135 UNITS, HAVING A 1' EFFECTIVE DEPTH, PL PROPERTY LINE EXISTING TO BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, AND 3' OF WASHED STONE M- 3 BEDROOM 198 ON THE ENDS. NO STONE UNDER. F96P PROPOSED CONTOUR ot If HOUSE 0 - - - - - -97 EXISTING CONTOUR It 0 #38 0 PERCOLATION TEST DEEP TEST HOLE & NEW 15 901. 1 POLYETHYLENE Septic To I nk Date of Percolotir)n Test: SEPT, 11, 2002 PERCOLATION TEST LOCATION Test Performed By, John Doyle Results Witnessed By: E. Waiver (Barnstable B.O.H 1 6 FOOT STOCKADE FENCE EXCAVATOR, Brett Field Percolation Rate: Less Than .2 MPI Z DECK Failed Cesspool Test Hole P LOT P LAN No. 1 OF PROPOSED SEPTIC SYSTEM UPGRADE DEPTH SCILS ELEV. 0 100.00! PREPARED FOR GRAVEL Loorny -To Old Town Road DRIVEWAY 16.77' Sand ESTATE OF J U N E E L D R I D G E 49.96' 5 yp 5/3 AT N 86d 15' 41 E 0'-8' A, 99.25 0 Existing Fence Existing F&" N 85d 44' 20 E Loamy #3 8 LD TOWN ROAD Sand 75 Ylt CENTERVILLE, MA 8'- 25" tIV 98.00 PROJECT BENCH MARK Mediurn Son d PREPARED BY: TOP OF FOUNDATION 10 YF 8/4 87-00 Ir -;,7 ELEV. 100.00 (Assumed) 156 CARAIEW E. SHAY C Ni A ENVIRONMENTAL SERVICES, INC. Perc #1 118 P.O. BOX 627, Depth to Perc: 30" to 48" Q Perc Rote- Less Tho 2 MPI EAST FALMOUTH, MA 02536 Groundwater Not Observed TEL/FAX .508-548-0796 No Observed ESHWT ston ET OUTLET 0 S 0 7. L EXIS 10 Soo GAL -T:J P_n TANK' 01 Sat" _P.ctod stone t 4*I to ki W., ADJUSTED H20 Elev. = None 1"=20 DRAWN BY: CES DATE: DEC. 9, 2002 PROJECT#SD367 FiLENAME: SD367PP.DWG SHEET 1 OF 1