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HomeMy WebLinkAbout0060 CLAMSHELL POINT LANE - Health � an� l�ell Point Lane COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a DEPARTMENT OF ENVIRONMENTAL PROTECTION F � O y0 ASSESSORS MAP NO; 00 PARCEL N0: TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:60 6&yl ak e i I thin I t AA c- Owner's Name: lyl i.k,a- i2 ivti c,(- Owner's Address: 6c', cwrn :ikz,it &,A l LA--� �'- -W. �- YVi 4 Date of Inspection: 6//;/o q Name of Inspector: (please print) Company Name: mw ajjl-LA Lvytetj Mailing Address: 10o go k- jr.&i Ply-me,4n rMA Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature e Date: o 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. Notes and Comments _ 5`X5i--4---WX PAS5,,-S A-1 I%Vk: G� i�5�•e�ti-tcln ****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. r Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 62 C-/qm ,-sko,j 1 Obit I L,q,i� C� 3+ �• Owner: )'j,he Ays,-e i- Date of Inspection: 6 jL /&-/ Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: `y, I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 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 leveled 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 11. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 60 C/Q,% -S kel J f_4.'LC Owner: ►,Iz �► S,l✓i� Date of Inspection ge, 4 s-/ate% C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ or Cesspool privy is within 50 feet of a surface water P P �'Y 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: wle _ The system has a septic tank and soil absorption system.,(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 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 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. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property hAddress: � �» r5li"l/ IA, 2 Cr fy AMA Owner: lr,k4- La s sj-k Date of Inspection: !�s/e y D. System Failure Criteria applicable.to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than'/2 day flow x Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. s< Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. x Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails.I have determined that one or more of the above 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:/V/A 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 drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 11.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 66 e—JAm sf`.li :P,. ZAIUC (!,4u -� M A Owner: jn,lz*- y2+3jkeA- Date of Inspection: e, bs-&'f Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No x _ Pumping information was provided by the owner,29 cupan or Board of Health Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? _ Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system components,excluding the SAS,located on site? _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of thebaffles 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: Yes no j _ Existing information.For example,a plan at the Board of Health. _ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable).[310 CMR 15.302(3)(b)] Page 6 of 11 J OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: b 7LI I G u, 'l• rri Owner: ft 6e p&5,y it Date of Inspection: 6/r 5-jvti FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): ' Number of bedrooms(actual): S DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 3 Number of current residents:4 Does residence have a garbage grinder(yes or no):,A-0 Is laundry on a separate sewage system(yes or no):.vo [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no):A Water meter readings,if available(last 2 years usage(gpd)):C�xiZ� Sump pump(yes or no): Last date of occupancy: rr COMMERCIAL/INDUSTRIAL W/ Type of establishment: Design flow(based on 310 CMR 15.203): 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 inspection(yes or no):_ If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM A 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 in talled(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 6c) 61r+M 5 UAk O?k4 y AAAL &-Av"� Y►1EF Owner: hit tz%e ,ynsitk Date of Inspection: 61,61-oy BUILDING SEWER(locate on site plan) Depth below grade: d ' Materials of construction:_cast iron gg�_40 PVC_other(explain): Distance from private water supply well or suction line: lit Comments(on condition of joints,venting,evidence of leakage,etc.): Catn t Leeti12 }v bye `iiocyk -410 /'iy,r12nc.z 0,� lea" /ie r� qRen e2-0-t, /,gft5 tP SEPTIC TANK:x(locate on site plan) r'G Depth below grade:10 h 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: l_To� 6.41 //,W 4a4d7 Sludge depth: q" Distance from top of sludge to bottom of outlet tee or baffle: 3 ` Scum thickness: 6 Distance from top of scum to top of outlet tee or baffle: g ` Distance from bottom of scum to bottom of outlet tee or baffle: 13 How were dimensions determined: j qP•� m,�,,g<<„�4 Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): fleco,'A ge d g(gl � ��r✓c�v-ail;�s��ul. ��4� .,/� �4f,v»e¢f t,/ GREASE TRAP: ocate 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 INSPECTION FORM PART C SYSTEM INFORMATION continued Property Address: lD C?Aln /,�//Para¢�An•� Owner: 7}'jr/z ,,0vE-,j:t,k Date of Inspection: G X i/a TIGHT or HOLDING TANK:Y(A-- (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:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: (0" Comments e is(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): r`s- ,"'66on Rox (W- 4 i .Na 'ticdyncA GA 1eAkA9Ay Ak-j 'a,kcd C*-,A,- csc�rj PUMP CHAMBER:-4(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.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: l6 i&n 5 L, ✓>oz rt f L4 uZ Owner: Oi,k•2 41S,cA Date of Inspection: ells-/o!i SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): iDyr.lene¢ R/TnAidy euu•t���r,,���2¢.41, -41A/ CESSPOOLS:*(cesspool.must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY.;-�locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: -5/Lg//✓�:, � Lra,t� m4 Owner: 017,1`e ►.45:c.� Date of Inspection: 6 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. l��c'c t5oo G�I Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ,,b c%m ,-51w i 1122,n4 /.,4a- do fu,# �nA Owner: YL r fz- 44-1:c$ Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: k 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 must describe how you established the high ground water elevation: U s G S L n�-m�+�a„ (z.�.o�e C�s� !�i• y,rn,S�c,:n Q,L cl��-�,� TADCO CONSULTANTS (TED DUMAS) " = 26 COMPASS LANE, DENNIS, MA 02638-2342 r` (508)385-2425 s 4Y July I,.1999' 4 - :• �-:. - ram.,: ,-; Barnstable Board of Health Main=Street t- , wti Hyannis,.Mk,.02601 Re: Lot 9 Clamshell`Point Road, Cotuit,MA ocatio n-and elevat enced:property, and found the l ' onof the A.S:.to- be°a S: s the.Pro ose ,� W I have ins ected the installation of a title 5„-system at the above refer p �� d P1an�by Sweetser;� K Engineering dated'May 6,'1.998, and.revised on.August.24,.September 1, and October 2, " g 1998. - r- fi My inspection.was'done on July 1, 1999 h R, r ----- Very truly yours; 4 Theodore A: TAD/mgd ti cc: Michael Pasic - y - �'z; U; N _31 0 0 0 ll, 1459 Z 466 730 087 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. t" Do not use for International Mail See reverse Ellen T. Carlson,Tr- - ETC Realty Trust_ 20 Spywood Road Sherborn, MA -01770-1218 4 .3 Z Certified Fee 1.3 .4 1 � a Special rd ive ee Restrict ed Delivery Fee rn Retum s ce`-AoQ1nj Q J C/ Whom,�Date Delivered ®d1 r Return Receipt howing to Whom, Q Date,&Addr s,' d�dre 0 TOTAL Postage 8 Feesy'` $ 7i•�� CO) Postmark or Date E O LL a Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the'return address leaving the receipt attached, and present the article at a post office service ) window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the QQ) return address of the article,date,detach,and retain the receipt,and mail the article. u7 3. If you want a return receipt,'write the certified mail number and your name and address M on a return receipt card,Fomi 3611,and attach it to the front of the article by means of the gummed ends if space permits.-Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q li 4. If you want delivery restricted to the addressee, or to an authorized agent of the O O II. addressee,endorse RESTRICTED DELIVERY on the front of the article. M 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. li 6. Save this receipt and present it if you make an inquiry. 102595-97-B-0145 a 1 h5-ro u; SENDER:" I also wish to receive the v ■Complete items 1 and/or 2 for additional services. f0110W1ng services(for an 0 ■Complete items 3,4a,and 4b. 0 ■Print your rdme and address on the reverse of this form so that we can return this extra fee): U) card to you. ■Attach this form to the front of the mailpiece.or on the back if space does not 1.❑ Addressee's Address •2 i permit. 2.El Restricted Delivery N � •Write"Return Receipt Requested"on the mailpiece below the article number. Y ■The Return Receipt will show to whom the article was delivered and the date postmaster for fee. delivered. Consult o y o 3.Article Addressed to: 4a.Article Number i p fie+ 350 68 °C d � a ! 4b.Service Type E Ellen T. Carlson Trustee ( 0 ❑ Registered El Certified ETC Realty Trust cI w t '�,ag ��,;,� [I Express Mail ❑ Insured � rn , V�ywood Road .,, y w i Return Receipt for Merchandise ❑ COD fr Sherborn, MA O1 �- �1' Date of Delivery o -� 0 cc 5. Received By: (Print Name) ddressee's Address(Only if requested x H 1�igB and fee is paid) w s 6.Sig ure (Addressee Agent) Spy I >. — I:i /( -" PS Form 38 1, December 1994 102595-98-13-0229 Domestic Return Receipt UNITED STATES POSTAL SERVICE First-class Mail Postage&Fees Paid LISPS Permit,,No.G-10 o Print your name, address, and ZIP Code in this box . a SWEETSER ENGINEERING F .Q. Box 713 South Dennis , MA 02660 �l t!!!i! FIi tilt !! Ei3i !liliiil??? !?.3i1lit !! �fi?il � Z 466 730 086 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Ronald H. Reif 50 Clamshell Point LaNe _ Cotuit, MA 02635-3429 Certified Fee 3 S Special Deliv Restrict D i rry Fee ,n c rn Retum, a iptShowingt Whom&D teD I' ` r� �0 n Return Recei NS ' to Whom, /� Q Date,&Addre_ee's Address (> QTOTAL Postage,&R*, M Postmark or Date ""s E 0 LL a i Stick postage stamps to article to cover First-Class postage,certified mall fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). L, 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the Q return address of the article,date,detach,and retain the receipt,and mail the article. N 3. If you want a return receipt;write the candied mail number and your name and address rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the rn gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery,restricted to the addressee, or to an authorized agent of the I addressee,endorse RESTRICTED DELIVERY on the front of the article. CO 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. li 6. Save this receipt and present it if you make an inquiry. 102595-97-8-0145 a ai SENDER: r;;: I also wish to receive the v ■Complete items 1 and/or 2 for additional services. f0110Win services for an 0 'a Complete items 3,4a.and 4b. g d ■Print your name and address on the reverse of this form so that we can return this extra fee): ai card to you. ■Attach this form to the front of the mailpiece.or on the back if space does not 1.❑ Addressee's Address •2 ■Write permit.ri e"Return Receipt Requested"on the mailpiece below the article number. 2.❑ Restricted Delivery a) a) ■The Return Receipt will show to whom the article was delivered and the date cn delivered. Consult postmaster for fee. a 0 3.Article Addressed to: 4a.Article Number ing�o . 4b.Service Type E Ronald H Reif 50 Clamshell Point Lane ❑ Registered Q�Certified cc Cotuit, MA 02635-3429 El Express Mail El insured c w '� ❑ Return Receipt for Merchandise ❑ COD 3 o f 7.Date of Delivery cc 5.Received By: (Print Name) 8.Addressee's Address(Only if requested s and fee is paid) co w t 6.Signature: dressee. Agent) j X y PS Form 3811,December 199 102595-98-B-0229 Domestic Return Receipt UNITED STATES POSTAL SERVICE First-Class Mail M4 O Q e&Fees Paid ' n1 C P eL �., .. ... ±n n o Print your•-narr�e, a idre s, and ZIF�Code in this box s Fm P.C. Box 713 South Dennis , PEA 02660 ���li?!?�!�!�`1i99f}?I19I1l119?1 Z 466 730 085 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. .Iln AA.a../Snn mvnrcnl Donald & Judith Houghton Trustee J A H 93 Trust + 989 Main Street - Sprinfield, MA 01103_-2139 rvaiayo T 3Z. Certified Fee Special Delivery Fee LO Restricted Delivery Fee Return Receipt Showing to Whom&Date Delivered � a Return Receipt Showing to Whom, ` T Q Date,&Addressee's Address C O TOTAL Postage&Fees $00 ZA M Postmark or Date ;1 y rn a I f i r Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selectetlloptional services(See front). 1. If you want this re_eipt postmarked,stick the gummed stub to the right of the return address Ieavin6 the receipt attiched, and present the article at a post office service y window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the Q return address of the article,date,detach,and retain the t,and mail the article.receipt, �- i p LO 3. If you want a return receipt,write the certified mail number and your name and address rn jon a return receipt card,Form 3811,and attach it to the front of the article by means of the l gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article Q RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the C addressee,endorse RESTRICTED DELIVERY on the front of the article. 00 CV) 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. �`6L 6. Save this receipt and present it if you make an inquiry. 102595-97-s-0145 � (4-L7..,1 d SENDER: I also wish to receive the a ;@ Complete items 1 and/or 2 for additional services. fOIIOWIng services(for an y r Complete items 3,4a,and 4b. 0 ■Print your name and address on the reverse of this form so that we can return this extra fee): y card to you. i ■Attach this form to the front of the mailpiece.or on the back it space does not 1.❑ Addressee's Address •2 y'). permit. 2.❑ Restricted Delivery N ■Write"Return Receipt Requested"on the mailpiece below the article number. ry t ■The Return Receipt will show to whom the article was delivered and the date delivered. Consult postmaster for fee. n o 3.Article Addressed to: �4a.Article Number E Donald & Judith Houghton Trustee 4b.Service Type 3 J A H 93 Trust + El Registered CMCertified 989 Main Street ❑ Express Mail El insured Springfield, MA 01103-2139 ❑ Return Receipt for Merchandise ❑ COD 7. Date of Delivery `� o pc 5.Received By: (Print Name) 8.Addr see's Address(Only if requested and fee is paid) w � 6.Signature d es e or t) 3 O X T N PS Form 3 11,D cember 1994 102595-98-e-022g'�P'Domestic Return Receipt UNITED STATES POSTAL SERVICE First-class Mail Postage&Fees Paid USPS Permit No.G-10 C Print your name, address, and ZIP Code in this box O I d I SWEETSER ENGINEERING P.O. Sox 713 ` South Dennis , MA 02660 I I I IIII111111u fill 11111111111ifillilll11111111 O444?p Z 466 730 084 US Postal Service Receipt for Certified Mail ' No Insurance Coverage Provided. Do not use for International Mail(See reverse) Richard Myers 262 Hilltop Road Coopersville, PA 18036-2814' Certified Fee ,3s Special Delivery Fee�� o s Resirict very Fee rn Retum Receipt�Sf6w'n to WhorQ&Date Deli . n Retum- eipt Showing to ,*, Q Date Ws$+'. s Add[ess�(�` TOTAL Postage&=Fees . CO Postmark or Date E o` u_ rn o_ Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service m window or hand it to your rural carrier(no extra charge). Lo m 2. If you do not want this receipt postmarked,"stick the gummed stub to the right of the Q) return address of the article,date,detach,and retain the receipt,and mail the article. u) 3. If you want a return receipt,write the certified mail number and your name and address °) rn on a return receipt card,Foie 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the G addressee,endorse RESTRICTED DELIVERY on the front of the article. o0 r� 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. i`o 6. Save this receipt and present it if you make an inquiry. 102595-97-s-0145 a (46-Cl,, a; SENDER: I also wish to receive the fl ■Complete items 1 and/or 2 for additional services. fOIIOWIng services(for an y ■Complete items 3,4a,and 4b. d ■Print ycn:-74?ame and address on the reverse of this form so that we can return this extra fee): U) card to you. a; ■Attach this form to the front of the mailpiece.or on the back if space does not 1.❑ Addressee's Address y permit. ■Write"Return Receipt Requested"on the mailpiece below the article number. 2.❑ Restricted Delivery fn m ■The Return Receipt will show to whom the article was delivered and the date delivered. Consult postmaster for fee. a o 3.Article Addressed to: 4a.Article Number a r(,C. 7--�O 48�}. °C d a 4b.Service Type Y c ,-Richard Myers 1 ❑ Registered 2 Certified fi 262 Hilltop Road I ❑ Express Mail ❑ Insured CO w Coopersville, FA 18036-2814 ❑ Return Rec ttarMerchandise El COD FA o 7. Dat D Jqu� o 5. Receiv By: rint Name) 8.Ad ress e's Address(Only if requested Y and fee is paid) w t 6. ig atur (A dr ssee rAgent) 'o X 2 PS Form 3811,December 1994 102595-98-e-0229 Domestic Return Receipt t r • - First-C ss Mail UNITED STATES POSTAL SERVICE Post`' FEes Paid:,.• 4 usPs� & ._ LV F-11-011"' )�',i I li 010 1. .1-fo •Print your name, address, and ZIP Co in th s-��6 • 18p3�- 4 i P.O. Box 713 South D@nnis , MA 02660 °r �o�TNero� TOWN OF BARNSTABLE ��Q ♦� OFFICE OF t 11ssa9TssL 3 BOARD OF HEALTH � MA6R p� 0o i639' `em 367 MAIN STREET 'Ep ypY 1r• HYANNIS, MASS.02601 November 16, 1998 Robin Wilcox Sweetser Engineering P.O. Box 713 South Dennis, MA 02660 RE: Lot 9 Clam Shell Point Road, Cotuit Dear Mr. Wilcox: You are granted a variance from 310 CMR 15.311 of the State Environmental Code on behalf of your client, Cape Vest Realty Trust,to construct an onsite sewage disposal system with it's reserve area only ten feet from the foundation wall at Lot 9 Clamshell Point Road, Cotuit, Massachusetts. The variance is granted with the following conditions: (1) The septic system plan shall be revised to show the location of the percolation test conducted. (2) The applicant shall submit a copy of a deed recording which restricts the dwelling to a maximum of three bedrooms. (3) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in strict accordance with the revised plans. Wilcox The variance is granted because it is unlikely that the reserve area would ever be used. In the event of a leaching facility failure, it is more likely that the primary area would be used for a future replacement soil absorption system. Sincerely yours, C . Chairperson Board of Health Town of Barnstable SGR/bcs Wilcox . .. . ., , , :".r_r., rlt:_,•u_. I I i Ut_t' I 5U>37�3U6;iU4 P . 01 b o�tw �. DINE • AIDUL HAft FEE 16 Town of Barnstable REC. BYf4� Board of Health 367 Main Street, Hyannis MA 02601 otnce: 308.790-6265 FAX: 509-790-6304 Susan O.Rask,R.S. Sumner K-I'nan,M.S.P.11. Ralph A.Murphy.M.D. .. Property Address: Lot 9 Clamshell Point Road Cotuit Assessor's Map and Parcel Number, �(/qy Size of Lot: 27,800+/— Wetlands Within 300 Ft. Yes Subdivision Name: Cotuit Coves No Business Name: Sweetser En ineerin APP .IC'ANT Name: CAPE VEST REALTY TRUST Na `�, me: Robin W. Wilcox Address: P.O. Box 321/W Hyannisport Sweetser Engineering Address: P.O. Box 713 South Dennis Phone: 978-459-8971 Phone: 508— 98— 22 FAX: FAX: VAR(AN� FROh ( R .C11 .,1TInN coal RaR.) g , 8�- (May attach If more space needed) in{mrlm Sathark Reserve area to be less than 20' from cellar wall, re oast Variace -t, 10 Check( (to be completed by oJJce stgljperson receiving variance request application) Four(d)copies of plan submitted(including septic system plans and/or restaurant floor plans) Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date M applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted (for grease trap variances only) Variance request application fee collected (no raa fa lifyvard nredlnulbn di raran.tll,pays trap rui.na ranwrl.train.o..�aAoy,a only l•ow,d. n,na o ruirns.ran�r..lr(run. nw erAwav onlyl,and."..Ca "Veit railed r.waa.dlrpoul"I'Mr(only it no e.p.roinn to Il14 Eu.ldinr propaod Variance request submitted at least IS days prior to meeting date VARIANCE APPROVED NOT APPROVED Susan G. Rask, R.S., Chairman REASON FOR DISAPPROVAL Sumner Kaufman, h1.S.P.H. Ralph A. Murphy, M.D. Q:/HP/VARIREQ I I - I I J III I T4' i I I I s i h I , � I^i i r ` q a ; E —, a:T £z L i -- L I i u� � I • I a I:Z I d I P I. 3$ o, �+ E r o .rr I ��� Dup.blSTna.0 .^� t• it q Cd I I I \ I L -lpp° i � I 1'N�T£ S7oa Fowl D.. fff��� �Fog R$p17uN C I I ia i I r . o _ o G, r Y I F � 1 C yJ a� i ► eu _ l. t I' O, Iv 6 0 1xy . • � A •L .fW. t11r IL•0• 1 w �• ' C I N _ N•� w 1• I b° d z pF r r rr• i • � L ' i/1♦ D u N !' � • � V r S • i3 3�/ ICa � �i i ' 4 1 . r js 1 ry w is 1 ��. h• i OP � � ���� I I ,I CL` .. �`1.� �i1. �yV�n 1 I - I o a. 71 I I I; 10 I— I id3 0.; b - I j 61 I - tua1E S7o P r,,,D.. aF, R�tl17UPJ I I i - I 'o. S ,-o , I. i r' 1 3 r o „c N 3 I IN 1 m I III f 61 i Y LF Y 6 �,• 71 o. 0 • I� r• r y I O • N{6 W � u P4 " F Q'I Lo_ r , r �I \ .n e { i N Z I � 1 No. 4:w. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Ye / ZppYfcation for Migpoar *p.5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( )—N Complete System El Individual Components Location Address or Lot No. I"V-r (AM Owner's Name Address and Tel. F Pia r/K(C o+-ec if. �i9Sic— Assessor'sMap/ParceL)D/ �� l9ff urban �Ai Installer's Name Addres ,and Tel.No. CP Designer's Name Address and Tel.No. W 16 P �b�e��� mi2 , 3y 3�i2Z Type of Building: u� Qe-mi S+ Dwelling No.of Bedrooms _ Lot Size_Zsq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 gallons per day. Calculated daily flow gallons. Plan Date 44o Number of sheets Revision Date Title V Size of Septic Tank Type of S.A.S. I Description of Soil $( U S_locs Nature of Repairs or Alterations(Answer when applicable) TQ,L'i C-00gh A C-15iJ AS P-9f' Sr^t Date last inspected: DESIGNING ENGINEER WRITING INSTALLATION AND CERTIFY IN STRICT Agreement: THE SYSTEM WAS INSTAIJ-E E TO PLAN. The undersigned agrees to ensure the construction and maintenance of the affix ��Sn-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 Certifi- cate of Compliance has been iss e by this Board of Health. L/ Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. ,711,1 Date Issued �� _g No. O # zx�T '! Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:,� t -P�UBLIC'HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS J ?. Vn 01pplfratior� for Digpoml *pdtf-ift-Con.5truction permit for a Permit to Construct( )Repair( )Upgrade('�;')Abandon Complete System ❑Individual Components Location Address or Lot No. T' # C,�A►1 Owner's Name,Address and Tel.N - 106 Z Assessor's Map/Parcel �n A� 1, JD. 7" — Installer's+Name,Address,and Tel.No. CJ Designer's Name,Address and Tel.No. rsQ�'�_. 5W{ eTSe Ex) r Type of Building: S6 07 Via-nni S t Dwelling No.of Bedrooms _ ____Lot Size sq.ft. Garbage Grinder( ) 1 Other Type of Building No. of Persons Showers( ) Cafeteria( ) -•- Other Fixtures - Design Flow _ gallons per day. Calculated daily flow gallons. Plan Date -- Number of sheets AL Revision Date Z rf _ Title V eSN (T\ 51 Size of Septic Tank �S"nU el 1 n Type of S.A.S. n t O in IQ11 Description of Soil s r Q l , Of) ray . _ f Nature of Repairs or Alterations(Answer when applicable) /ate We r ,AY-) , Date last inspected: Agreement: �. f r' 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 Certifi- cate of Compliance has been iss d by this Board of Health. ✓ F Signed, Date Application Approved by Date Application Disapproved for the following reasons Permit No. 9A' — Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-si e S a e Di osal>S: stem Constructed Re aired g p ( p ( )Upgraded( ) Abandoned( )by �, at _o l t�r �� �H dri� has begi constructed 'n accordance with the provisions of Title 5 and the for Disposal System Construction Permit Not. dated �1 Installer Designer / G The issuance f this ermit shall of be c©/nl!strued.as a u ntee that the s(ste�mwill,function a design Date '�f? J IJt�� j��r �Inspector r p C1 7 /�� �/� --------------------- No. Fee ��►�_ I THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Diopogar *pztem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at Z d `�` , y (1 .�1 -c,,✓z 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: 1 0 t'`I Approved by Town of Barnstable 7l5-- _ Department of Health,Safety,and Environmental Services �Im Public Health Division Date 30�j 367 Main Street,I lyannis MA 02601 � BARNBrAB[E. MASS. Date Scheduled �QL-J 1-1 I R9•7 Time I0'.3c) Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed By: LOCATION &`GI;NCRAL INFORMATION' Location Address t0T_ q . iF60 6-hMSNte1-4. Pr, LA• 7 ame —1ti t. Go o rr Mlt• Address 59 i l t)V EOLC[1 `Zo fi 5t5:NEst:;,A A/t.. 2ottl& Assessor's Map/Parcel: MAP (D 1'GL d Engineer's Name 13AXTEa_ le. ►h/E I�— NEW CONSTRUCTION x REPAIR Telephone N Land Use 'LEStVEWTI A L— Slopes(%) Cam?'•-/5- Surface Stones Distances from: Open Water Body 17_S R Possible Wet Area lei R Drinking Water Well R Drainage Way R Property Line R Other n SKETCH:(Street name,dimensions of lot,exact locations of lest holes&perc tests,locale wetlands in proximity to holes) �L_? - �© �"� id �►1iV1 / I �A. 1150 m� Q� Parent material(geologic) (7 t W N S e \1 Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face T— Estimated Seasonal High Groundwater Z'IPAC — ilk, FLLO MtJ,'>-770/J t3E7CERTVIYNATTIV F'Oy2 SEASONAL, HIGH '4�VATET TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment R. Index Well H Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ I PERCOLATION TI+ST Date Time, Observation Hole H Time at 9" Depth of Perc Time at 6" Start Pre-soak Time© J Time(9"-6") End Pre-soak SRTd'R✓rTx- Rate Min./Inch � �N 2M/A/, Site Suitability Assessment: Site Passed + Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Obse.;vation '-sole Data To Be Completed on Back--� Copy: Applicant DEEP OBSERVATION HOLE LOG Hole# Depth from Soil I lorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. o 9 - 27 ,g ;n Z 7 0 DEEP OBSERVATION HOLE LOG Holc # z Depth from Soil Iiorizon Soil Texture ( Soil Color I Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % O 3 y" E /'0y'Z o S4140 „ N 7 Z8-A) C �� sANo /� llEEP 0I3SERVA. ION HOU LOG note# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % i DEEP OBSERVATION HOLE LOG hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. 0 Flood Insurance Rate Man: / Above 500 year flood boundary No_ Yes ~ Within 500 year boundary No Yes Within 100 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? y�5 If not,what is the depth of naturally occurring pervious material? Certification I certify that on m� 1K. '(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 tramin expertise and experiehce,desciibe�d in 310 CMR 15.017. Signature C Date 17. 97 11 17i98 TUE 09:55 FAX 7818264450 KETHRd AND THOMAS 10003 To my knowledge at the time of the signing of this Deed, the Power of Attorney from Catherine A. Myers to me had not been altered, amended, terminated or revoked. For title, see the Deed recorded in Book 2834, Page 183 of the Barnstable County Registry of Deeds. EXECUTED this day of 1998. Richard L. Myers Catherine A. Myers by Richard L. Myers POA STATE OF PENNSYLVANIA COUNTY OF On this day of 1998, before me personally appeared Richard L. Myers and Catherine A. Myers by Richard L. Myer, POA and acknowledged that they executed the foregoing instrument for the purposes therein contained. Notary Public My Commission Expires: 11/17/98 TUE 09:55 FAX 7818264450 KETHRO AND THOMAS 10 002 QUITCLAIM DEED RICHARD L. MYERS and CATHERINE A. MYERS, of Coopersburg, PA for consideration paid of ONE HUNDRED SIXTY-FIVE THOUSAND and 00/100 ($165,000.00) grant to MICHAEL A. PASIC and JENNIFER S. BARTH, husband and wife, as tenants by the entirety of Cotuit, Massachusetts with Quitclaim Covenants, A certain parcel of land situated on the northwesterly side of Clamshell Point lane, Barnstable (Cotuit) , Barnstable County, Massachusetts, bounded and described as follows: Southeasterly: by Clamshell Point Lane, one hundred ten (110) feet; Southwesterly: by Lot 10, as shown on plan hereinafter mentioned, by two lines, measuring respectively, one hundred thirty-four (134+/-) feet, more or less, and thirty (30+/-) feet, more or less; Northwesterly by mean low water mark in Poponessett Bay; and Northeasterly by Lot 8, as shown on said plan, by two lines measuring respectively forty-four (44+/-) feet, more or less, and two hundred thirty-two (232+/-) feet, more or less. Being shown as Lot 9 on a plan of land entitled "Plan of Cotuit Coves - Section One - Owned by Chase Street Village, Inc. & Seymour Williams, Jr. in Cotuit, Barnstable" dated November 1955 by Newall B. Snow, Eng'r. recorded with Barnstable County Registry of Deeds in Plan Book 134, Page 41. The above described premises are conveyed subject to and with the benefit of all easements, rights and restrictions as found in a deed from Allan F. Crawford, at al. Trustees of Allan Crawford Realty Trust to us dated January 15, 1969 and recorded with Barnstable County Registry of Deeds in Book 1424, Page 415. This lot is conveyed subject to the restriction that it shall not be used for the construction of a single-family dwelling containing more than three bedrooms. TOWN OFBARRNSTABLEj / LOCATION iZAl/SEWAGE #/ 'VILLAGE. n Z6/2 ASSESSOR'S MAP&•LOT INSTALLER'S NAME&PHONE NO. tW11 -11W /D/�I5� 4� l� 1 SEPTIC TANK CAPACPTY/'T".�2D - X!ro 0,efla2. tv LEACHING FACILITY: (type) �/f//�/�/ �O�S (size) Y NO.OF BEDROOMS BUILDER OR OWNER ,G TERNIITOATE: .�!f�7 I COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility !1_ Feet Private Water Supply Well and Leaching Facility (If any wells exist . ' on site or within 200 feet of leaching facility) Feet Edge of Wedan&And Leaching Facility(If any wetlands exist within 300 feet df leaching facility) 4� Feet. Furnished by TOWN OF BAWNSTABLE LOCATION SEWAGE # tom, VILLAGE ASSESSOR'S MAP & LOT-- INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMPTDATE: 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) Fee: Burnished by 14-/ 0 ' 31 V3, TOWN OF BARNSTABLEAA C�'Q� 11 LOCATION ��.� .5 �d/��iZ�SEWAGE #/ o VILLAGE e7 7262 7 ASSESSOR'S MAP &•LOT INSTALLER'S NAME&PHONE NO. &ZJI-11L11110 ID/1V6 '110 y !� SEPTIC TANK CAPACITY/'T` Q tv LEACHING FACILITY: (type) (size) `Y NO.OF BEDROOMS_ © BUILDER OR OWNER PERMTTDATE: // 11'7 1 /q f 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 �I Wj2 �� /J3 ` 3713, y y;�EE . TOWN OF BARNSTABLE Q LOCATION�L'7 ��.1 /7— EWAGE #Z 6 Va LAGE � Co ZLl ASSESSOR'S MAP &-LOT INSTALLER'S NAME&PHONE NO. 6VIIIL11'1'" SEPTIC TANK CAPACITY//—.�2D /!5--'O O LEACHING FACILITY: (type) (size) y NO. OF BEDROOMS BUILDER OR OWNER G PERMUDATE: COMPLIANCE DATE: 11,Nqq s N 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) y' Feet Edge of Wetland and Leaching Facility(If any wetlands exist / within 300 feet of leaching facility) l/ Feet Furnished by 32 A - 6 ,6 / Z13 13- 3 J 3 Town of Barnstable I'# X`� 7(S Department of Health,Safety,and Environmental Services Public Health Division Date L J 367 Main Street,Ilyannis MA 02601 .yl enruverABLM >.usa rE039. Date Scheduled ��t� I"1, 1297 Time 10'.3n Fee Pd. (00 Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed By: LOCATION &':GI NERAL INFORMATION ' Location Address 6 j- 9 (s0 -4AM54Et-L A o • s Name /A �o 59111 o v EC LE-A Qn Go,ro i-r MIL. Address 13=N ss-P A !✓ram. 2pg1(o Assessor's Map/Parcel: MAP 6, Pu• d- Engineer's Name 'BA-XTE+L PYC-=- 1kt-- NEW CONSTRUCTION REPAIR Telephone# q)31 Land Use &iD&WTl A L-- Slopes(%) Surface Stones a Distances from: Open Water Body I'LC7 ft Possible Wet Area 115 ft Drinking Water Well I • Drainage Way ft Property Line P5 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 0 Parent material(geologic) 007-WA-M iq-AI v Depth to Bedrock @� Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face r— Estimated Seasonal High Groundwater %/1Vf_ ' A10 hVCVV /� Y3E7['E I�*VYINATIO FOB SEr SC: *E4Y, l[ I: '�x�A'TER T r E Method Used: Depth Observed standing in obs.hole in. Depth to soil mottles: in. Depth to weeping from side of obs.hole in. Groundwater Adjustment ft• Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level I'ER+COLATION TEST Date Time Observation Time at 9" Hole# Depth of Pere Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak SATd2✓7x— Rate Min./Inch �SS�+'►�6 l��/,t/ 2M/A� Site Suitability Assessment: Site Passed VZ Site Failed: Additional Testing Needed(YIN) Original: Pubic Health Division Observation Hole Data To Be Completed on Back—� Copy: Applicant - J , DEEP OBSERVATION:HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (Munsell) Mottling (Structure,Stones,Boulderes. o q --27 27 !2�" � S�No ivY 2 7/4 o DEEP OBSERVATION IIOLE LOG Hole# 2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) I (Munsell) Mottling I(Structure,Stones,Boulderes. % a 3" o I 3 9" g 12M� �A�tlo �o ✓L 1^�3 o e� 61e D DEEP<OI3SERVATION HOL1J'LOG` , $Ole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency, i DEEP OBSERVATION HOLE LOG'' Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % i i i i Flood Insurance Ra ap• Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 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? If not,what is the depth of naturally occurring pervious material? Certification , I certify that on mR 9 /44 (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 trainin expertise and experience described in 310 CMR 15.017. A Signature Date - >7- / 7 SOIL TEST TOP OF FOLVJDATION 20 FT. MINIMUM FROM CELLAR DATE OF SOIL TEST "�� ��� (9 ) 7 �� 10 FT MWIMUW FROM SLA1 OR CRAM SPACE SOIL TEST DONE Y rT R Yf ELEV. - 10 FT. MINIMUM CLEAN SAND .7A9,r2 s., a #_, WITNESSED BY '1 WiCKTE LOAM AND SEED OBSERVATION HOLE 1 ELEV.- OBSERVATION HOLE 2 ELEV _L. _o j COVERS 4' SCHEDULE 40 PVC PIPE PERCOLATION RATE "r-z- MIN./INCH PERCOLATION RATE L z_ MIN./INCH _ WN. PITCH 1/8- PER FT. r 2' LAYER OF \1/8' TO 1/2' DEPTH Ht�2IZ TEXTURE COLOR MOTT. OTHER DEPTH HORIZ TEXTURE COLOR MOTT. OTHER WASHED STONE I VENT 4' CAST IRON PIPE 1 REQUIRED PITCH 1/4�PER FT. \ Z 1 CU. FT. OF _ (OR EQJAL MINIMUM - -----_ f CONCRETE L o,9,*,, y W C �►.., �a Flow LINE 3 1 a 1_� S��b yQ r/ 3 9 2r • to 2p. ���irL y �� ELEv. - --T -i Q , LEVEL • • F Y,2 Q�D G/� Ev. - 3 2., to ELEV. - �-Z f iELEV. - ''` J aEV. - s• SU t_E EV. - DISTRIBUTION v. _ "11rol '"' r°x 1° Q C� OUTLET 4 HIGH CAP1CIT`f_iNN LATDRSnTH z7 'Z� 5� 2��� Z�'120 f,q.�72 X 7/g u to BOX 5 rvNt t INCH S (TEETO BE PLACED ON FIR BASE) TO BE WATER TESTED �,; K TRENCH FORMA11oN s •� " 5 24 �� 5OO GALLON IF MORE THAN ONE OUTLET `�"� ; �_N/ P too WATER ENCOUNTERED AT �6 ELEV. • Z� ' 3 J)O WATER ENCOUNTERED AT rzo ELEV. - 2SP 29 N S SEPTIC TANK (TO BE PLACED ON F{RM BASE) SOIL ABSORP T DN ZONE 3/4- TO 1 1/2- SYSTEM (SAS) INDEX WASHED STONE ADJUST _ LEGEND: DESIGN CALCULATIONS USGS PROBABLE WATER TABLE ELEV. - GAR EXISTING SPOT ELEVATION OOxO B OF BEDROOMS SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ( / / ) ELEV. - EXISTING CONTouR ----oo----- GARBAARGG E DISPOSAL UNIT _ice NOT TC SCALE BOTTOM OF TEST HOL4 ELEV. - FINAL SPOT ELEVATION TOTAL ESTIMATED FLOW 7 FINAL CONT ( 110 GAL./BR./DAY X -' BR.) � GAL/DAY OUR SOIL TEST LOCATION REQUIRED SEPTIC TANK CAPACITY (a.1aS�_ GAL UTILITY POLE -0- ACTUAL SIZE OF SEPTIC TANK GAL y TDWN WATER B SIN W � SOL CLASSIFICATION GAS LINE DESIGN PERCOLATION RATE S_5 M1N./IN. : EFFLUENT LOADING RATE GAL/DAY/SF, I / CLEAN OUT LEACHING AREA SQ FT. CESSPOOL C:.P. 0 ( 1 -1x,&) t( �b'xzx �o-iZ� 3 ' 5` LEACHING CAPACITY.(AREA X RATE) GAL./DAY ,7 j� 4 / 1 RESERVE LEACHING CAPACITY -1 GAL/DAY I/ / NOTES: lWORKMANSHIP AND MA ALS SHALL FORM TO D.E.P. I / �I Ti0 / ,y/ /� / TITLE 5 AND THE TOW `�N OF 4n 1"Ns RULES AND o REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHI10. ALL DISTURBED AREAS ARE TO BE REVEGETATED. SHED GRADE. 3 �ypp�� �i OF THE iTARY SYSTEM SHALL BE CAPABLE OF 11. GUTTERS, DOWNSPOUTS AND DRYWELLS ARE REQUIRED. WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WTHIN 12. A HAYBALE WORKLIMIT IS TO BE MAINTAINED UN71L ALL WORK IS I'lNiSNED. 10 FT OF DRIVES OR PARIONG AREAS. H-20 LOADING SHALL BE 13. VARIANCES TO TITLE 5 AND BARNST.ABLE RULES AND REGULATIONS: SHALL TO TO B A. RESERVE AREA LESS THAN ?0' FROM FOUNDATION WALL. USED UNDER OR W"IH01 10 FT. OF DRIVES OR PARKING ARREAS 4. ANY UASOWYTAM .UNITE USED RING COVERS BADE a. NO G�ETERMWATION HAS BEEN MADE AS TO COMPLIANCE WITH } .... a �r �'_,�,•�- •• /` DOM oA ZONING REGULAT04S. OU R / APPUC:ANT IS TO �� �" �. ''� . r/M* / ,,r• "J t .' 74f s 't Jut r+ iiC}i N�Mliiyio ifa r R kr*srRom' k' nib 't'". •y" ,,� / '� 6. OC ARE T1)aMATE ONLY, CAATICIN CONTRACTOR/ / S CALL ONG-SAFE' AT1-MO- 344-7233TLEAST 7tHOU I /'/ j �"_,�-��✓ '�.- ! / �' / �/ / / PRIOR TO COMMENCING WORK ON SITE 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS 00, 'Poo - 1/ - .-- f. / ,,,i �, SITE CONDITIONS PRIOR TO COMMENMIG WORK ON SITE, ANY VARIATION I ,f / /' / ✓ _ �'_ r' 4- IS TO BE BROUGHT TO THE ATWION OF THE DESIGN ENGWEEA / PARCE1.�IS IN FLOOD ZONE ��3 9. LOT IS SHOWN ON ASSESSOR MAP �` AS PARCEL // 7 90n S �n / t , H,t ��' APPROVED: BOARD OF HEALTH W oaf 04, DATE AGENT 3_ — �� PROPOSED SEPTIC DESIGN / FO ✓ lie / ! - , ® PROJECT LOCATION 2Jl � .V,()/ \ ` «r•tS�/F2� C..4 Tv .T- , . • SWEETSER ENGINEERING (211 __ ' / �c^.nyrrcc s 235 GREAT WESTURN ROAD r,,a'` -----__ T 508— P. 0. BOX 713 398-3922 SOUTH DENNIS, MASS. 02660 r � � ~- Ga v� DATE SCALE of , 4 � /✓J,�y DUM REVISED �� y �r JOB NO. —0 0 0. r� - 33 /Z S / s tI R�a ! REVISED / T C ( j6 V12) ITP I`, LOCATION MAP 9 �� SHEET i f 0 1 49N3 SMIEE'TSER ENURING Tf�- T-7120 FT. MINIMUM FROMCELLAR SOIL _TOP OF FOA110N - DATE OF SOIL TEST -.��„ (� ELEV. U 10 FT. MINIMUM 10 FT. MWWU WM FROM SLAB OR CRA SPACE SOIL TEST DONE BY r rra CLEAN SAND /1 WITNESSED BY �iRNsT5 Ze P,6r=�� CCOVERS ONCRETE 4" SCHEDULE 40 PVC PIPE LOAM AND SEED OBSERVATION HOLE ELEV.- `� ' OBSERVATION HOLE 2 ELEv. ,� 7- MIN. PITCH 1/A" PER FT. PERCOLATION RATE �Z MIN./INCH PERCOLATION RATE '� 7._ MIN./INCH r 1 LA I'ER OF DEPTH j HORIZ TEXTURE COLOR MOTT. OTHER DEPTH HORIZ 1, TEXTURE COLOR MOT?. OTHER �r WASHED STONE 2 i 4' CAST IRON PIPE — - VENT REQUIRED �'"J I ✓-� :� (OR EQUAL) MINIMUM PITCH 1/4 PER FT. , ? 1 Cu. l OF CONCRETE q i L O.9rti Y ro L o�+••, r ro FLOW UNE S I J 1 ANCHOR 3- / yQ / { 3 ELEV. 10, --T". 3 3 • r L�,p,z�r f o G O r-+ y l0 _ ° . , rn t r„ :v. • q ELEV. ` '�) GAS El.EV. 8 8• LELEV. 0" ELEV. S,q,J f2 BAt.E DISTRIBUTION �{ HIGH CAPACITY INFILTRATORS + T}i , :; ^II�Div,�� ID 1 MrD/per r0 OUTLET BOX 4' STONE IN ANTrr ' 2?-�i� C XR7/� IZg-I� G s� X� 7� 1 INCHES (TO BE PLACED ON FOM oASE) TO BE WATER TESTED 10 X38 X to TRENCH FORMATION 3 5 19 IN IF MORE THAN ONE OUTLET f 26 Zr 3 �1r, WATER ENCOUNTERED AT /ZO El 2SD 24 15 0 0 GALLON , • ,,,�, �1 A 1 WATER ENCOUNTERED AT �_ ELEV, _ 29 1N (TO of PLACED ON FIRM aASE) SOIL ABSORPTION e 34 s SEPTIC TANK �'1 — 3/4" TO 1 1/2• INDEX WASHED STOKE SYSTEM (SAS) ADJUST --- _ _ LEGEND: DESIGN CALCULATIONS USGS PROBABLE WATER TA&I ELEV. = EXSTING SPOT ELEVATION OOx0 NUMBER OF BEDROOMS SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ( / ; ELEV. - EXISTING CONTOUR ----00---- GARBAGE DISPOSAL UNIT _NO_ NOT TO SCALE BOT''OM OF TEST ROLL ELEV. - - FINAL SPOT ELEVATION TOTAL ESTIMATED FLOW FINAL CONTOUR ( 110 GAL 1191R./0AY X BR_) GAL/DAY � SOIL TEST LOCATION REQUIRED SEPTIC TANK CAPACITY GAL UTILITY POLE ACTUAL SIZE OF SEPTIC TANK fit_ GAT... TOWN WATER SOIL CLASSIFICATION CATCH BASIN (/` DESIGN PERCOLATION RATE 5 MIl/IN. 1 : EFFLUENT LOADING RATE. /6u.0.74 GAL/DAY,/S.F. CLEAN OUT LEACHING SO. FT CESSPOOL C P. 0LEACHING �TY� AREA X RATE) 3! f GAL...t l RESERVE LEACHING CAPACITY GAL/DAY NOTES: / 1 ALL WORKMANSHIP AND MA ALS SHALL CgNFORM TO D.E.P TITLE 5 AND THE TOWN OF 09 A S S rAs` RULES AND i REGULATIONS FOR THE SUBSURFACE. DISPOSAL OF SEWAGE 2. ALL COVERS TO SANITARY UNITS SHALT. BE BROUGHT TO 10. ALL DISTURBED AREAS ARE TO BE REVFGETATED. WITHIN 6' OF FINISHED GRADE.. 3. ALL COMPONENTS OF THE SANITARY' SYSTEM SHALL BE CAPABLE OF 11. GUTTERS. DOWNSPOUTS AND DRWVELLS ARE REQUIRED. WITHSTANDING H-10 LOADING UNLESS THEY ARE JNDER OR WITHIN /16 / // / 12. A HAYBALE WORKLIMIT IS TO BE MAINTAINED UNTIL ALL WORK IS FINISHED. 10 FT OF DRIVES OR PARKING ART-AS, H-20 ;OAD(NG SHALL aE 13. VARIANCES TO TITLE 5 AND BARNSTA13LE RULES AND REG'u'_ATONS: USED UNDER OR WITHIN ,0 FT OF DRIVES OR PARKING AREAS / A. RESERVE AREA LESS THAN 20' FROM FOUNDATION WALL 4. ANY MASONARY Ull USED TO INJNG COVERS T GRADE SHALL or ME TERMINATION INPt ACE. DE�i0 HAS BEEN MADE AS TO COMPLIANCE MA?}� I lop, e*T" ':"CH bf' IA" R M APPROPRIATE AU7WOR1?" JTfIJITIES S1M ARE APPWVM IE ONLY, EXCAVAr4N CONTRACTOR / i �/� --'� �- -� / IS TO CALL 'LTG-SAFE° AT dtls-344-7233 AT LEAST 72 HOURS { PRIOR TO COUM. NaNG WORK ON SITE. 7 CONTRACTOR IS TO vERIIF� GRAA)LS AND ELEVATIONS AS WELL AS ► / / / / �- i i 1 '''� / SITE CONDITIONS PRIOR TO COMMENCLN(; WORK ON SITE. ANY VARIATION IS TO BE BROUGHT TO T}RE ATTENTION OF THE DESIGN DJOR EFR / 'MMEl�ATEL.Y /� y / / / d PARCEL IS IN FLOOD ZONE /'� So . / G. LOT IS SHOWN ON ASSESSOl UAP __. � AS PARCEL 101, OF 00 .� 441 APPROVED: BOARD OF HEALTH At DATE AGENT — p e, J PROPOSED SEPTIC DESIGN �- % % r✓ _ FOR y- :` � _ - - � � I f?fir" !/`<:�--r- ;�• - . __ .� , .�--r PROJECT LOCATION � 4 � � � oT 9 �. L� }' S iPEETSER ENGINEERING CLA•IW V n 235 GREAT WESTERN ROAD 508— P. 0. 80X 713 SOUTH DENNIS, MASS. 398-3922 02660 I `N 14 of M ;� co�e l DATE r la SCALE DUM REVISED JOB NO. r {NG vP A� S� tER� REVISED ' C L r,AP',o LOCATION MAP 9l/� � � SHEET OF 01998 SWEETSER ENGINEERING