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HomeMy WebLinkAbout0176 COTUIT BAY DRIVE - Health 176 COTUIT BAY DR., COTUIT A= 016 0119 4 a i �* yE Cotuit Fire Department pT Uj Fire, Rescue & Emergency Services G COM / 64 High St. - P.O. Box 1632 1926 '�� Cotuit, NIA 02635 S . ��'•RE Paul A. Frazier Phone (508) 428-2210 Chief of Department FAX (508) 428-0202 TO: Tom McKean, Director of Public Health Town of Barnstable, Board of Health P.O. Box 534 Hyannis, MA. 02601 FROM: Chief Frazier, Cotuit Fire Department SUBJECT: Tank Removals, et al DATE: December 23, 1998 The following tanks have been removed/abandoned since my letter dated September 15, 1998. If you should have any questions or need additional information, please feel free to call. Thank you. NAME ADDRESS DATE NOTES Johnson 209 Ralyn Rd. 10/30/98 1000 gal. tank removed, Cotuit, MA. 02635 no contamination or odor present. Moore 33 Putnam Ave. 11/08/98 500 gal. tank removed, Cotuit, MA. 02635 no contamination or odor present. Brown 123 School St. 11/12/98 500 gal. tank removed, Cotuit, MA 02635 no contamination or odor present. Pappalardo Cotuit Bay Dr. 11/24/98 500 gal. tank removed, Cotuit, MA 02635 no contamination or odor -- ---� _ present. Mikutwizz 59 Point Isabella 12/15/98 1000 gal. tank removed, Cotuit, MA 02635 no contamination or odor present. BORTOLOTTI CONSTRUCTION INC. DRAINAGE LAND DEVELOPMENT SEPTIC SYSTEMS ` September 19, 2005 ' Town of Barnstable Board of Health 200 Main Street Hvannis,M.A 0.2601: Telephone: 508-862-4639 RE: .176 Cotuit Bay Drive- Cotuit,MA ' Bethany & Luther White `-? z Health Inspector: Upon further inspection of the Above referenced location,there is a minimum of 2' of stone surrounding the'leaching facility. I hope this information is what you were looking for and answers your questions with,regards to our certified.inspection 'performed ori.July M, 2005. c r If you have any further questions with regards to this matter,.please feel free to contact my office at 508-771-9399. ; Sincer .y . Bert J.•Bortolotti \. resident- Bortolotti Construction, Inc: _r7 �=R` z( ,? s S. s v :+✓ l `A.`a. . ,i. '! ' v t -Y,..j:y. A i { A �t .... } ;�. Y ,�4...t ti i��+•.�1,i�', SrD.i �; I"` � {r.,, \( 'C.(',( 2..• s� a t' P.O_ BOX 704 • MARS,TONS MILLS,AASSACHUSETTS 02648•'M8) 771-9399 • FAX(508)'428-9399 1E I -BOUDREAU'& Bfie:O;UDREAU;LLP 396 NORTH STREET, . . ; „ IIYANN.IS,•MAS'SACHUSETTSE02601 ; M __Telephone (508),7754-085 Telefax (SU8)i7NW722 Philip Michael Boudreau Mark H. Boudreau - - - .. .. September 29,-2005 Thomas McKeon, Health Inspector '- Town of Barnstable 200 Main Street Hyannis, MA 02601s• _ ' RE: 176 Cotuit Bay: ay Drive,Cotuit i Dear Mr. McKeon: ' As per our,conversation yesterday'afTown Hall, I represent Luther and Bethany White, owners of real-estate located at.176 Cotuit Bay Drive.in Cotuit. .Theproperty has recently been inspected relative to final Building-Department:, sign-offs. , During an inspection by the Board of Health a question arose as to an office located-over a garage that appears to.fit the technical definition of a bedroom. = - The property has the benefit of a,.four-bedroom- (almost 5)'septic system. ,This "office" could be construed as a fifth bedroom. In lieu of a Deed Restriction, we agreed that I could write this letter for your file specifically acknowledging that the property is just a 4-bedroom home. To the extent that the office or any other room were to be used as a bedroom;legally the system would need to be expanded after approval for same were obtained. This letter.shall further indicate that the property lias been advertised for sale as a '-bedroom home. I have enclosed a copy of the broker's advertisemenf indicating such. ` The property is under agreement and-the Purchase and Sale agreement drafted by me "includes a provision taken directly from the Offer that the property is a 4-bedroom home.. If you needrany additional'information, please contact me. -; T 'Sincerely, Y 5 Mark H.Boudreau MHB Sotheby's International Realty ,. - Page 1 of 1 Sothebyls INTERNATIONAL REs - *y Lis T iNGs _ Fabulous Redo -176 Cotuit Bay Drive, Cotuit. Price Bedrooms' Baths Half Baths Style $995,000_ 4 5 -0 Cape �' *, MLS #20502991 This is a spectacularly renovated and beautifully appointed spacious Cape loaded with extras. r ,. vyx*, T ', Features include maple floors,three fireplaces, a fifth * bedroom or office,and a beautifully finished basement its own bath.The fabulous master suite is on the first flc and includes a dressing room and a bathroom with heat( �•; "� , marble floors and sauna.All this,plus deeded rights to beach and dock on North Bay, four tennis courts, and walking paths are included! • •. � ¢ � " 1 II III y "' ,.. , NPITI w t - s Osterville, MA ` ' Sotheb Hyannis,`MA y's 508-428-9115 or 800-851-9115 E-mail 508-775-0900 or 800-775-9'INTERNATIONAL REALTY http://ww,w.cottonre.coin/listings/PropertyLi sting.asp?Id=8313 9/28/2005 TbwN, OF BARNSTABLE LOCATION `._._ v _ .�. _ SEWAGE # VILLAGE !-�' ASSESSOR'S MAP & LOT �p S NAME&PHONE Nei �I,�D�,�l�� '/a P /3�► 7�� 'l al SEPTIC TANK CAPACITY ilgl% %A, TQ/It.Q.. LEACHING FACILITY: (type) (size) 000 NO.OF BEDROOMS R BUILDER OR 0W`NE9Q3L&",sP PERMTTDATE: 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 It° f� b r qq L a'cf �� TOWN OF BARNSTABLE_ LOCATION 76o (1`7(-t, i4— wf / SEWAGE # OS(C VILLAGE l..t lit ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY C— 1 cn-kc LEACHING FACILITY: (type) 1UA--,(-p ` (size) NO. OF BEDROOMS BUILDER O 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 i Edge of Wetland and Leaching Facility (If any wetlands exist within',300 feet'of leaching facility) - -- - - _ Feet Furnished by + `� 7 t v. .. �4' _ _/- � ^ j./ t Y Y � . ' /q/.. ._ '� / .. ��' � .. O , � 1 i I } , f � i ' 3 t -_' 3q -- ,. -\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM 1 PART A E CERTIFICATION z, Property Address: `r —� � �P/L�i Owner's Nam Owner's Address: ,� G Date of Inspection. Name of Inspect • (please oprint �� 9 VCJ �j Company Nam Mailing Address. Telephone Number-6ar, s ro CERTIFICATION STATEMENTCD ; ] I certify that I have personally inspected the sewage disposal system at this address and that the i`�formatiort reposed below is true,accurate and complete as','of the time of the inspection. The inspection was performed based,on mys`)" trainin-and experience in the proper function and maintenance of on site sewage.disposal syste' I . I am a DF,P approved"system inspector.pursuant to Section 15.340 of Title 5(310 CMR 15.000). The sysiem:- i Passes Conditionally Passes Needs Further Evaluation by the.Local Approving Authority ails Inspector's Signature: L, - Date: ' /U� The system inspector shall submit a co"y of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing thiK'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 w _, ****This report only describes conditions at the time of inspection and under the conditions of use at that 4 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 6/15/20.00 ! page I Page 2 of l 1 . tiJ OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continueyy) Property Address: Owner: Date of Inspection. `(�> Inspection Summary: Check A,B,C,D or E./ALWAYS complete all of Section D A. S stem Passes: J I have not found an information,which indicates that an of the'failure criteria described in310 CMR. Y y 15.30,3 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 ex filtratiori 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. l 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. S};tem 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: 2 Y Y. i Paee 3 of I 1 i; iF OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: / A Owne j . rr Date of Inspection: 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. L: System rwill.pass,unless,Boa rd of Health determines in accordance with 310 CMR'.15.303(i)(b)that the system'is not functioning in a'manner which will protect public health,safety and the environment: _ Cesspool or privy is withiii 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 mannei 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 surface water supply or tributary to a surface water supply. j' _ The system has a septic talk,and SAS and the SAS is within.a Zone 1 of a public water supply. t.. r. . 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 tae k and SAS and the SAS is less then 100 feet but 50 feet or more from a private water supply well". Ivl;.thod 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 r 3 �E r �y v Page 4 of I 1 ' OFFICIAL INSPECTION FORM—.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: / &6 ;; Y Owner: Date of Inspection: Mgt Q()0S_ D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No/ �✓ Backup.of sewage into facility or system component due to overloaded:or clogged.SAS or cesspool Discharge or ponding of effluent to the surface of the ground dr surface waters due to an.overloaded or clogCr ged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or / cesspool ' Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow J Required pumping more than 4 times in the last year NOT duc:to clogged or obstructed pipe(s).Number / of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface-,water supply or tributary to a surface y water supply. Any portion of a cesspool or privy is within a Zone 1 of a:publc well. _ Any portion of a cesspool or privy is within 50 feet of a.private water supply well. Any portion of.a cesspool or privy is less than 100.feet but greater than.50 feet.from a private water supply well with no acceptable water quality analysis. [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.presen.ce..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.] t� (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. Thek 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 drinking' ater supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—I WPA)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 operatgr of any large system considered a . significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR. 15:304.The system owner should contact the appropriate regional office of the Department. 4 r C Page 5 of 1 1 k OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM` PART B CHECKLIST s Property Address: Owne Z y4l , r ;a, ` 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,o_Board of Health V Were any of the system cork�ponents pumped out in the previous two weeks? /— �i t� Has the system received nonal flows in the previous two week period ? Have large volumes of water been introduced to the system re ently of as part of this inspection ? Were as built plans of the s, stem obtained and examined? (If they were not available note as N/A) v — Was the facility or dwelling inspected for signs of sewage back up V — a Was the site inspected for sr'Qns of breakout? 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 liquil;..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 oil Absorption System (SAS) on the site has been determined based on: Yes no 'Existing information. For example,'a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] i f;• r ; .r� y� I x 5 Page 6 of I I ,t. OFFICIAL INSPECTION FORM—NOT FOR VOL8,7NTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM!INSPECTION FORM PART C ' SYSTEM INFORMATIO?q Property Address: 1CdGU.h.44 Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL, Number of bedrooms(.design): � Number of bedrooms(actual): DESIGN flow a g o based on 310 CMR 15.20� for example: 11.0 d x#of bedrooms): 7 ( P �P ) Number of current residents: — Does residence have,a garbage grinder(yes or no): A/C Is laundry on a separate sewage system (yes,or no);/V .[if yes separate inspection required] Laundrysystem inspected e . r o no . Y P (Y ) Seasonal use: (yes or no): U Water meter readings, if a ilable last 2 ears usage d ��✓Jl Yy� ( Y � (,-P ))� Sump pump (yes or no): Last date of occupancy: COMMERCIAL/INDUS.TRIA }( d Type of establishment: Design.flow(based on 310 CMR 15.203): gpd r Basis of design flow(seats/persons/sgfr;etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Tit-e 5 system(yes or no):._ Water meter readings, if available: e Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records , Source of information: • L Was system pumped as part oft e inspection(yes or no): d If yes, volume pumped: gallons--How was quantity pumped deterralined? Reason for pumping: TYPE OF SYSTEM Septic tank, distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared,system (yes or no)(if yes, attach previous inspection records, i 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 V Other(describe):. G Approximate age of all components,date installed(if known) and source of information: Were sewage odors detected when arriving at the site(yes or no): I 6 a Page 7 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM:INFORMATION(continued) Property Address: V Owner: . 7' Date of Inspection: .L BUILDING SEWER(locate on site pl' n) Depth below grade: t Materials of construction:_cast iron 40 PVC other(explain): Distance from private water supply well or suction line: i- Comments(on condition of joints, venting,evidence of leakage, etc.): SEPTIC TANK: (locate on site plan) Depth below grade: 40 Material of construction: . concrete metal_fiberg __ polyethylene polyethylene —other(explain)- .! If tank is metal list age;_ Is age confirmed by a Certificate of Compliance (yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: J Scum thickness: o Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee.or baffle: How were dimensions determined: Comments(on pumping recomme ations, nlet and outlet tee or baffle condition, structural integrity, liquid levels- as related to outlet invert,evidence of lerakage tc o/ GREASE TRAP: (locate on site pl6n) « Depth below grade: Material of construction: concrete_, metal_fiberglass_polyethylene_other (explain): a Dimensions: f 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.): 4 •E I 7 Page 8 of 11 :t OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued). Property Address: aft ' Owner Date of Inspection: 1 t TIGHT.or HOLDING TANK: (tank must be pumped at time of in�pection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass__pol ethylene 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.): o ened DISTRIBUTION BOX: (if present must be p )(locate on sitep�-lan) Depth of liquid level above outlet inver: Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.):. PUMP CHAMBER: (locate on site plan). Pumps in working order(yes or no): Alarms in working order(.yes or no): j Comments(note condition of pump chamber,condition of pumps and aprurtenances, etc.): I 4: 'i 8 f Page 9 of l 1 ' ,i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 'A Ilia V� �� Owner: Date of Inspection: ; SOIL ABSORPTION SYSTEM (SAS).: (locate on site plan,excavation not required) If SAS not located explain why: E 4 Type leaching pits,number: leaching chambers,number: leaching galleries, number: leachintr trenches, number, length: leaching fields,number, dimensions: overflow cesspool,number: :a _ innovative/alternative system Type/name of technology: Comments(note condition of soil, sig "s of hydraulic failure, level of ponding, damp soil, condition of vegetation, t r ` �C 'rAll CESSPOOLS(cesspool must bd:pumped as part of inspection)(loyate on site plan) v ' Number and confieuration: 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 O (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.): 4 ;p t{i ;P .1 'i Pa-e 10 of 11 s OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ,y Property Address: Owne Date of Inspection: ,] ' 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 NO feet.Locate where public.water supply enters the building. 1 to° UI C_- �k . i , mad) a k ,1 10 Page 1 l of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM' PART C. SYSTEM INFORMATION(continued) Property Address: r c ' Owner: Date of Inspection: SITE EXAM Slope Surface water {` Check cellar Shallow wells Estimated depth to ground water �' �F feet+ v; Please indicate(check) all methods used to determine the high around water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site (abutting property;ipbservation 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: l `t f G r - ty, . s ll r Permit Number: Daie: Completed by: _ HIGH 0UND•WAT'ER LEVEL COMPUTATION Site Location: (f®� ,'+ - � �, -- )/ . � Lot No, 11 Address: Contractor: ® 1 I'A- S . Address:_ 7 Notes: + 57 STEP i Measure depth to water table to:nearest 1/10 / ............... .............. .Date month/day /year STEP 2 Using Water-Level Range Zone and Index Well Map Ix- e�t _ site and determine: i CCU n�� Approc riate ind _.rti,.rl.:..-.....-. BJWater-levei range -c-rre`.........................................:......... - tc?,: STEP 3 Using monthly report''`:urrent W'ater Resour I . ` - ces.,Cond=ions" determine curre.nt.depth to water level for index is-1..-• ........:............. �7�® i +7 ✓�` t; STEP 4 UsingTable of IN "' Water- ereF Adjustments for index well STEP 7 I e c� ( �,; current depth to water level for index,vv it (STEP 3), and.water-level zone (S.Ti E:2B) L d >. I Y etermme water-level o =P.8 ment ........................................ �. STEP 5 Estimate depth to high I by.subtractin the vv - 9 aEar iG> h_ L level adjustment(STEP 1; r; from measured depth to vfatertit I' level at site (STEP g : r o Roble 11--Reproducible computaiion iorru. s 15 I I . SENT BY: SOP.TOLOTTI CONST; 5084289399; SEP-19-05 17A 4; PAGE 1!1 i `4 B®RTOLOTTI CONSTRUCTION INC. � I)gAINA(,F LAND OMLOPMENT SLPTIC SYS rF..MS i September 19 2005 I i '1'awtt of Barnstable 113oard of Health .200 1NIain Street Hyannis,MA 02601 .Telephone: 508-8624639 i RE: 176 C.ntuit Bay Drive-Cotuit,MA Bethany& Luther White 'Health inspector: Upon further inspection pection of the above referenced location tloerejis a minimum of 2' of stone surrounding the leaching faciHty. I hope this infor latiO4 is what you ±were looking for and answers your questions with regards to our certified inspection performed on July 25,2005. I If you have any further questions with regards to this ma er,please feel free to contact my office at 508-771-9399. sincer y f ert J. Bort�lotti resident I I Bortolotti Con1truction,Inc. i i i i r I P-l"). BOX 704 •MARSTC)INS MILLS,MASSACH(IS[I I S 02641 + (.SUHI 77*1.9.0 o FAX($ft 428-939�) i t � I I CO1IlXION WEALTH.OF TMASSACH i;SET l S EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET,BOSTON MA 02108 (617)292-5500 . TRUDY CORE Secretary ARGEO PAUL CELLUCCI . DAVID B.STRUMS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ®-rU I T PART A CERTIFICATION Property Address: 7b COTV Y DR, Name of Owner Ia DO (j 1 Address of Owner: Date of Inspection: ,a-00 . Name of Inspector:( ease Print)EQWO-0 C, I I am a DEP approved system in�sspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: G- �y IJ R. 15(US i!t--C U Mailing Address: aC woo-o live 02S-6 Telephone Number: 9Rg 6 Q3 CERTIFICATION STATEMENT. - - I certify that I have personally.inspected the sewage disposal system at this address.and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in-the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signatur �,. . Date: -a -00 The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection. If the system is.a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original.should be sent to the system owner and copies sent.to the buyer,if applicable, and the approving authority. NOTES AND COMMENTS pop 64G114f l . ..; revised, 9/2/98 Page Iof11 -- i�Printed on Recyded Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: ► 6 Ce?.u�7 /3�' D Owner: PAPA Date of Inspection: INSPECTION SUMMARY: Check B, C, or D: A. SYSTEM PASSES:. I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. 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. Indicate yes, no, or not determined(Y,N,or.ND). Describe basis of determination in all instances. If"not determined",explain why not. _ The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within-twenty(20)years prior to the date of the.inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health: - Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if Iwith approval of the Board of Health): . broken pipe(s)are replaced obstruction is removed. revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Add►ess:/7 CoTVit Owner: PAPACAPi Date of Inspection. 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 r Public health, safety and the environment. g protect the 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 11)(b IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SA )THAT THE SYSTEM FETy AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surtace 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)DETER FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT.)DTEMINES MINES THAT THE SYSTEM IS _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water tributary to a surface water supply. supply The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. or PPY The system has a septic tank and soil absorption system and the SAS is PPY within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a . .Private water supply well,unless a well water analysis for coliform bacteria and volatile organi c compounds indicates that the. well is free from pollution from that facility and the presence of ammonia nitrogee nitrogen is equal to a l than 5 ppm. Method used to determine distance n and nitrat (approximation not valid). s 3) OTHER revised 9 /2/98 Page 3 of I I.' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Icarrtinoed) Property Address: 1 b (c?f o(T Owner: PAPACARao Date of Inspection: _C D. SYSTEM FAILS: You must indicate either"Yes" or"No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine.what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.. Discharge or ponding of effluent to the surface of the ground or surface waters due.to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 day flow. _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR.15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4orii r - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property address:f 6 C 07`U�7 G�fy ©F, Owner: PAPAf..IVIDD Date of Inspections Check if the following have been done:You must indicate either"Yes"or "No" as to each of the following:. Yes No Pumping information was provided by the owner,occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving irormal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. A's built plans have been obtained and examined. Note if they are not available with NIA. The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. _ All system components, have been located on the site, The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum: The size and location of the Soil Absorption System on the site has been determined based on: Existing information.For example,'Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [15.302(3)(b)1 The facility owner(and occupants,if different from owner) were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Pages of11 E SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 6 C67v/r (�q ��� Owner: NP14L DO Date of Inspection:R_O�}_V�t CO FLOW CONDITIONS RESIDENTIAL Design flow: g.p.d./bedroom. Number of bedrooms(design): 3 Number of bedrooms(actual):3 Total DESIGN flow `33i> Number of current residents: Garbage grinder(yes or&: Laundry(separate system) (yes or(P:La; If yes,separate inspection required Laundry system inspected (yes or no) Seasonal use(yes or no):— Water meter readings,if available(last two year's usage(gpd): Sump Pump(Yes or(q: AID Last date of occupancy: zLLL1xV,-V63 COM MERCIALIIN DUSTR IAL: Type of establishment: Design flow: apd ( Based on 15.203) ". Basis of design flow Grease trap present: (yes or no)_ Industrial Waste Holding Tank present:(yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)— Water meter readings,'if available:. Last date of occupancy: OTHER:(Describe) Last date"of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part.of inspection: (yes or r�¢'° If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribn{ivrrbox/soil absorption system Single cesspool Overflow cesspool - Shared system(yes or no) Of yes,"attach previous inspection records,if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed(if known)and source of information: /'ip?jeo o�C7�30 L.r S Sewage odors detected when arriving at the site: (yes o1a revised, , i 9/2/•98 Page 6of11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION(continued) Property Address: l-(o CC7`U i T 8AI Y DO, Owner: Date of Inspection: BUILDING SEWER: (Locate on site plan) I Depth below grade:_ Material of construction:_cast iron_40 PVC_other(explain) Distance from private water supply well or suction line Diameter Comments:(condition of joints,venting, evidence of leakage,etc.) SEPTIC TANK:, (locate on site plan) Depth below grade:.1?5"lUC'gS Material of construction:1concrete metal_Fiberglass Polyethylene_other(explain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: V C . t �i(0 S r Sludge depth: 1 I tDC14 Distance from top of sludge to bottom of outlet tee or baffle:3©Ow045_, Scum thickness: Distance from top of scum to top of outlet tee or baffle: INCNS Distance from bottom of scum to bottom of outlet tee or baffle:y�a4tq.S How dimensions were determined: E 01 e#SL1ZG Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) 7-A/UK iS iyU (tCRY GOcD CC,,1V j7y0/C)/ L/MCF SoC•lD.S PCASTi f—EC= o v'-.FT GREASE TRAP: (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: (recommendation for pumping,condition of inlet and outlet tees or.baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) revised 9/2/98 Page 7of11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM INFORMATION(corrtirrrred) Property Address:176 C0rvi T SAY OR, Owner: P RPACF�l��C3 Date of Inspection: Q-a-Oa TIGHT OR HOLDING TANK: (Tank must be pumped prior to;or 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 Alarm level: Alarm in working order:Yes No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: (locate on site plan) Depth.of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into 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.) -revi - I s'ed .9�2�98 : page 8or11 i a SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(eorffinueO Property address: JIG CCTV 1 r eA y Gam, Owner: P�PC�R�o Date of Inspection: SOIL ABSORPTION SYSTEM(SAS) (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Type d/�lCr leaching pits, number: leaching chambers,number:_ leaching galleries,number- leaching trenches,number,length: leaching fields, number,dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure;level of ponding, dam soil,condition of vegetation, etc.). 501 �s pPv f Gk�X14 P/7`i5 (_r TzIA/U �lAL� F)(C,: CESSPOOLS _ (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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plant Materials of construction: Dimensions: Depth of solids: Comments: .(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.) revised 9/2/9e Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION(continued) Property Address: 17 6 C07ZaT Owner: P6+PE�( M Date of Inspection: _'1,00 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) .1/U o 1 3q revised 9/2/98 Page 10of11 r• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(eonmr+edl Property Address: 176 60)7v(r 60 Y 2D, Owner: Pi3PcA�ae Date of kupection:q ) NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to GroundwaterJO Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property, observation hole,basement sump etc.) Determined from local conditions Checked with local Board of,health Checked FEMA Maps Checked pumping records Checked local excavators,'installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) MM9 ce e /7V revised 9/2/98' Page 11or11 a Fns................ .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............OF........� . ..... ...:............. .................... I'7 ( Appi rFation -fur Uiipuiittg Workii Towitrurtinaa Vanift Application is hereby'made for a Permit to Construct (kf or Repair ( ) an Individual ,Sewage Disposal System,at: K. �o o �.• .'�` .•-5-_.•-•-:......-•- --••-•-•................................•-•-•---••--•-----............--------.-........._.------ Loc ion• ress or Lot No, w 5�Owner Address --• - a. -y------------ Installer =�' Address d Type of Building Size Lot.,...Q.. o4 21........Sq. feet U Dwelling—No. of Bedrooms...:.-` ---------------------------- .....Expansion Attic ( ) Garbage Grinder (/) Ga, Other—Type of Building ............................ No. of persons_:.._ --. ---------- Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------- - - W Design Flow..........`—.........................gallons per person per day. Total daily flow._...-., 0.0--.------------------...gallons. WSeptic Tank—Liquid capacity®p--gallons Length._®------- Width.. -....... Diameter................ Depth---------------- x Disposal Trench—No................... v idth__._....-_-------- Total Length.................... Total leaching area...........-..------sq. ft. Seepage Pit No I90'�. .. iameter------------------- Depth below inlet_._-_.___-..�.tn...._ Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) - aj_ "9. C,'fi�©rc�. //-Z X`7 G Percolation Test Results Performed bY--------- -----------------------------------------------_------------.- Date.-----------------------------------.... aTest Pit No. I................minutes per inch Depth of Test Pit_.....------------ Depth to ground water-----------............. ti Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ --------------r----------------_"fr..---•--_----....�.....------ --•- •---.-..-7----•--•---�---- •-•-•---••-• -- - �`�Y - - ------ --...---- O Description of Soil--------`�.... .�as� �... ....- ^.1. -.. ------------- x ------------------------- ------------------------------------- ----------- ---------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable............................_.-..-..........-..-...._..-............----- ------------_------.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is sued by t b rd of health. 2ate7 7 Application A f�__til -------------------------- �.... ----- ---------------- PP Approved B Y -G �- Date Application Disapproved for the following reasons:--------------------------------------------------------------------------..................................... .....................-----------------------------------------------------------------------------••--•..-------------------------------------------------•----------------------------....--_••-••---- Date PermitNo.—,.................................................... Issued.-----.....------------------------------------...-•---• Date 7. No............. ......... ................. ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF .HEALTH ........OF... .. :` ...r..v'jr?+ d f�� 1,�-- Application is hereby`made for'a Permit to Construct (, or Repair ( ) an Individual!:Sewage Disposal System at: r Air ,f `' fs f < r._ ..:'. +s U . ---•-••--, ............................................. ------------------ .................................................................................... --- Z, Location•Address or Lot No. 4. = .:.........................••......._........ ��Owner a ddress . ' e. .�/"—t .................................................. ' �`f f' ,�" r w � ;.Installer �. Address Type g r .r,.<5........Sq. feet of Building Size Lot..'_: _.:._:....L:. Dwelling—No. of Bedrooms..........:............... -_....._..Expansion Attic ( ) Garbage Grinder ( ) aOther Other.—Type of Building ............................ No. of persons_......` _.......... Showers ( ) — Cafeteria fixtures -----------•--------•--------------------------------......----------------------------------------•---•---------•--•--------------.------------------ W Design Flow___.___..: ...` .._.•___________________gallons per person per day. Total daily flow-_---_-_ t'_�.-_..........._.__.._._gallons. P; Septic T lIlk—Liquid capaci Length_'_° ....... Widtll_._z'....-.__.. Diameter----- ---------- Depth..____.___._... Disposal Trench—N617 _ ..... idth.................... Total Length---_----.-._:___---- Total leaching area....................sq. ft. Seepage Pit No..=�!}:` s' Diameter________--__-_-_-- Depth below inlet.................... Total leaching area------------------sq. ft. Z Other Distribution box- ( ) Dosing tank ( ) wt l'. �..I ?>fc 3 l#' ' jy` 6 '-� Pet'colation Test Results Performed by---------------------- ................................................... Date:-----------------------------------.--- a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit._.................. Depth to ground water.._---.--------.--._.... fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O r Description of Soil -LA.__a . ;, {' {' , i a ` �* t ' f�. .. .---..r....z.---•`. ........ ......r:. -.),A-- --•--=�-.. ._..at.. --- .-.-. - •-----� ..----- tar /U ..................................'._..._______._....._..........._..___.__._....._.................__.__...............__._______...._..----•--__-___--__-_---------_-__-__._-- _--_--.------___-._... W U Nature of Repairs or Alterations—Answer when applicable......................................................................:......................... ..................................... ------:-----------......------••------•-------••-----•--•--•--------------------------------------------------------------------------------- ----------------- Agreement The undersigned.agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in .. operation until a Certificate of Compliance has been issued by the­board of health. 0_ 7 Signed - .......................... -- -- . -- •-------------- . e° t / te Application Approved By-- ---. ----- xik. c . p Date ' Application Disapproved for the following reasons---------------••-...-•-•••------.._.-•---------••-•-•----------•--•..._..•----------•................------•-•-- ................•-•------------••--•-------••---•--......--•-------......--•----•--•-----.................................-----------------------------------------------------=----•----------------- Date PermitNo......................................................... Issued....................... ...... i Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............f..2F:.. ri..........OF........... `w <' i.e" c.�...°? .............. IvErdifirtttr of f1.111mviiaurr THIS IS TOkCFRTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) ,. by u'u ---------------•---•---•------•---------- --•----=•-=-•------- ----•-• = :�----•-------- �I at.. �+ T✓ Q� � -=.....�¢talle G6��:._.e �'•---—--- r!.................................... has been ustalled in accordance with.the provisions of Arti e I of Ti e'State Sanitary Code as described in the application for Disposal Works Construction Permit No..'.._ry�.._' ____________________ dated._../_.-_- -1 ` -7 7 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......� ..------.3.........1�1�-.............. Inspector.. .... . -- ------------•-------•••-•------••-•................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTO .I.A/Y.N .........O F.......... ... " I Vr — No.............•1-........ FEE........................ %spoliM Permission is�hereby granted------------------ =------------ ---- =---•---•------------------------------ to Constr ct/( 9�r Reir ) n I dividual SAwa e p al Syjm at treet as shown on the application for Disposal Works Construction �itN.e,7c.-_ Dated__--__ ---_2_L DATE....._.�.�--Z�---7-7=--------------------------------------- Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS v j 86-o .O -41 _ + N I� � � — 26 •—►I D � � L O T /00 �kf+•36, 5SO 5. ft r ZZo.oO • o� 4 8 � ` Zp 00 N ,-24 4 9.• A y D R. or c oru / hereby certify that the PL O T PL AN Foundation is located as shown L o r /o0 and conforms to the Zoning By Laws of the Town of } y: CQTU/T BAY SHORES Bornstab/e. /4 c �r� IN 0 BOMAN143N ' COTUI T, BARNSTABLE , MASS. Pao. ZE' Scale / = 40' Dec.20, 1976 i GRETE M. BO HANNON, R L.S. West Bridgewater Mass., 02379.. i- LOCATION : _ _ - y _n ERMIT M-0. _- C �/ILL h GE •. — -- — --- ----- ---- -- - _ BUILDER_5- -Q &"F--�-_-ADD.R.ESS_ DIaTE -P_ERM1T - - D.AT.E -COMPLI &&ICE ISSUED ; _ __ _ _ _ _ � o iv �� ��� e 9 i 2XI0'S.@�'OL' • _ — I '�;::Wit/,r(p ------------- � 9!9 1 ScF.Vt�u� 4 \` _....o. -�� o W n Q / • I 3�DPOPW ll 1O'I �_ � 4� JIL�—JU 0 y \ e0 p:c t e-FtYW� ValN / \ to � 20 vp Rae @ � .• .. o Q �h145.EL o° \ —\ i .T Y.7G�l. �lbr' 7/� SiJ�9.. � / �`• � T+t ?�`_:. \ \. .WA :Ac 6... �� = 17K_. VN-Pat... o_.►.�...P_ldt�, / / _31 �+ F\ ti. /, an 6:EQ:S AGES?.._ moo, \ . II IIears �axa'ao� 11 NEV(i sG�EN EP.POP-�Hcii :d FUfI� �✓E C'�cl t6 P.016 \ o NLC.C'GoeeL. NLG�6P69:fZ • - - - u /gip°../ O- I m F., IY I - -. � I E i Rom¢ /jam kBovE�I ��N .Fes.. I Pff I hMo.A A I FADS. 6�ns t ca e. I ((ter L�urgf .>tme) ¢SL. lu.UaLL s�--� �, voLY vG rt�2 I p :Fiore 5L0( y'. 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I _ �iQl�lx 2 ���c��st� �'_�STo��-d,eFA::. .8��.�'.� s, _ 44 !2 ft>tW�rn_ �v¢Wall;*`fs . .. . _ Cfi �f :�I �/1S`��o --- �� TZ�TJ _. ��.._.< - r o r��GIIOIJ: — — — — MULCH / PLANn G ARE at 7' PRIVATE WAY ) 263.41 — -- — — 5� SHELL BENCH MARK - TOP OF -.N CONC. BND EL. 35.8 LP QRIVF f _ T 30.5'' SHED o . s� an O O �OJ -- - - o co I SMELL DRIVE p 29 a�� 22oD p0o - LOT 100 30 -'36.551t SF w yy na� ''07-042 SLOANE: 0.8t AC. Ot,� SCALE ,.: = 20' 4/2/07 I �° I f _ C 17-9 yr r n'-t sre• 1 try are• L0 M DOWN O Lf) O - O O �d L m 1 TaN�dl pU O BAlFDR00M � - - - - - CONVERT STORAGE ROOM 10 .t m on p BEDROOM. i - MICE SPICE/PLAY ROOM Z N o .. S�A BEDROOM 5 yT, Q M c= 0 ;t q M•- a m T BEDROOMZJ BATHROOM �T 5+ ScNTLaEY ./e O , BARROOM LIBRARY M N Second Floor Alterations LEI Q 0 � o t5• 19' U FCTF --F ' I � d CD O MASTER q�OW DD DBt00M - 0 GARAGE - s DO"ROOM in O O - - j - - - Ei + � DOUBLE FlRFPIACE �- '. _ MIRI ROOM - DOW Scale: +S r Date: 09-16— MASTEROS BEDROOM - - - PORCH FOYER R CONSERVATORY . LMNG ROOM UP 18'_P - 11•_7'1/2' - O . . PORCH WIds � - �, 1 04 LLI � r CIO v 33 } o m� . I • L - 86 N'-6• Z O O Q x p f m a-U 10- 1 i 1 (? BATHROOM GARAGE � GAME ROOM � _ '�� - .;f FURNACE ROOM - S + ( OP—) _ W\ �/ 11') s � nN - HOME THEATER - .CHIMNEY N X : WO S+ +% ( .� (ems e.) i " 'n O CAME eooM WU /I •L Wv m 7-3 - - •� Basement Alterations 1 Scale: g-_1•_0- f Date: 09-16-05 - a g s 0- - q i