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0243 EISENHOWER DRIVE - Health
243 Eisenhower Drive Cotuit P A 038 016 i I it TOWN OF BARNSTABLE LOCATION 12�, SEWAGE# 4,61�, -t�l'7 VILLAGE -i��,U ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. C S eg'-7 7 P- 9'1 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) ZF7i tc2_JN._ (size) gg,6 X Six f NO.OF BEDROOMS OWNER -?I PIL, �-9-o L Z PERMIT DATE: f —oS —P COMPLIANCE DATE: Separation Distance Between the: 0 Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility Of 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) N s4— Feet FURNISHED BY 3-7 O r - >d G'st- b 1 No ' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 21pplitation for Disposal 6pstem Construction VrrmIt Application for a Permit to Construct( ) Repair(V Upgrade( ) Abandon( ) ❑Complete System WIndividual Components Location Address or Lot No. 5/3 /$F✓fl hx�lec-��. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel $ .` �v cQ,k4-;iL, A4 4 p>C.3 - 9 19 Installer's Name,Address,and Tel.No. •C( _31 <„ Designer's Name,Address,and Tel.No. �s4ol ClO�is��vc�or�2rr.- yS vsfvy 4-N '7�Il)av`d-k 5O.N Type of Building: q Dwelling No.of Bedrooms Lot Size ��G�� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) r' Other Fixtures Design Flow(min.required) k1 yU gpd Design flow provided V 7 U gpd Plain Date Is",I Number of sheets Revision Date Title � R� o Size of Septic Tank �y` ,'�� /56 ¢pg Type of S.A.S. /o?01 ° /S)Clod Description of Soils-up_ "0' Nature of Repairs or Alterations(Answer when applicable) ��p/ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Co n to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date e /k Application Approved by Date Application Disapproved by Date for the following reasons Permit No. e�991 S L� 1-7 Date Issued /15 1A .." a � ,. Fee THE COMMONWEALTH OFjMASSACHUSETTS Entered in computer: - PUBLIC HEALTH DIVISION - TOWN OF BA S ABLE, MASSACHUSETTS Yes 2pplicatlon for Disposal 6pBtem Construction 3permit Application for a'Permit to Construct( ) Repair(V Upgrade( ) Abandon( ) ❑Complete System A(ndividual Components s Location Address or Lot No. P(/3 11 (��(,t)�1-�(', Owner's Name,Address,and Tel.No. l Assessor's Map/Parcel 3� /� Sol? Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. t3o1 -� OY�SfirCsG.t IOY?�=ram• rj/StJ+l�'f I�� �.70W"f/_J-N 2 ')g AJvrJ.4. Sir. 3r� r�c�o�' l s�c�.�s 1/Y►�115 rill �� i i A GaCob Sy -ln/-7Sox Type of Building: q Dwelling No.of Bedrooms 1 Lot Size 3�Uy5 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures (/ Design Flow(min.required) y yU gpd Design flow provided V 7 U gpd Plin Date Number of sheets Revision Date R' Title S 1�c 4- &_o�-tli Size of Septic Tank ex;4i nr, /SC.k:) Type of S.A.S. /o?Ozi!`4 y yp 1-1-d �S X66 Description of Soilp_ Nature of Repairs or Alterations(Answer when applicable) 6L/- ^4 4n- Z S�IY J E Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Co an no to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed - Date f/v/2 b A-s— Application Approved by Date Application Disapproved by Date for the following reasons Permit No. (:991_ c) 1-7 Date Issued 3 -------------------------------------------------------------------------------------------------- ------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Se/wage Disposal system Constructed( ) Repaired(A� Upgraded( ) Abandoned( )by &r�to , .c. Co r S1lUc-T/O/7 . 1;�c has been constructed in accordance at 0 ei'Sen hO�j212 with the provisions of Title 5 and the for Disposal System Construction Permit Nolc 15 - '// 7 dated Installer&r L�I e>-6&� Ct,nSfrLrj/of-i.Sr-, ' Designer UU #bedrooms 7 Approved design flow gpd i The issuance of this permit shall 4t be con trued as a guarantee that the systei will 'on desi . ed. Date { Inspecto`` No. d G" l —/7 Fee /6c" THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS DispoBaY 6pstem Construction 3permit Permission is hereby granted to Construct( ) Repair(e Upgrade( ) Abandon( ) System located at GY Y 9 QAAOUVA �U J--(� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be comp eted within three years of the date of this per it. Date 3J)S Approved by DEC-30-2015 00:45 From: To:15087906304 Pa9e:1/1 'down of Ug rnstibk e9101.0 ory S&"kes Richard V.Scait,Interim Director z > public Aesilth Division ram° ThonnaS.M?.Keatt,Director. 200&Iaip Street,.Hyaenas,MA 02601 office: 5Q-$O2-4b44 1 ax: 508-790-6304 T.gstaller 8i Desi er CertifkAtton Form Date: - Sewage Permit# -Jr!b,c'-' :r 7 Assessor's lV�aparcel Resigner• 132.Ls•b- - kj.gp- Installer: 13�::iT;Ie •�+gf— Address•. - ,-e Address: p'e Gi3,6 7. 'V I.- i Vt/l'e 1ff11`R c_. �2.G 5f Qn I t 23 �a.t I3a.�Ee. I g+ i was issued a permit to40ma.4 iristalier t septic system at, 2y d• i- based on,a design*wn by . (addre55) � :F,3 e:;it i►J dated 1 I K�i q!l a designer) r soil a.b xo�te14:d.+ L certify th the- sit tht-44 sttai.refgtgOed c.was installed ssib's#antially according to _ .... -- design,'. . tdo out (if required vwas.inspected.and the S soils were found satisfactory.. I terrify that;the septic system referenced.above was:instalk-4 with.major Chad&g--- greatet,than 10' latcrial reloeation of'the SAS or any vertical teldcatioa of any.conipobent 'Of the Sept c.systei a)but:ia accordance:with State&Local Regulations. P..lan;:revigion or certified as-built,by. designer to follow...Strip taut(if'icquiied)Was'inspected and the sails were-found satisfactory. I cettify that thec systft referenced above Was constructed iu,co liapGe with the terms `ofthe 11A apptoval.lett'ers(if applicable) r Q STEPHEN rigtallet's gK� re) �: ,wsisoN _ (Designer'sigaature). (Affix Dies .ere) PLEASE REIM, TO BARNSTABLE TUBLIC HEALTH:riIVi l= CE1tT1F1CA lE OF' COMPL ANCE WILL NOT BE ISSUED UN'Y'IL BOTH''fHiS FORM AND. AS- BUILT CARD'.ARE.RECEIVED.By• :BARNSTAKI. PUBLIC HEALTH DIVISION. THANK OU: Q:1Se}1ticlbesigs+er Ccrdficayon FbrM Rev 8-14-13.doc z a l 5— i a No. COMMONWEALTH Of MASSACHUSETTS Board of Health, czcns ta,b(Q , MA. =o� APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT . Application for a Permit to Construct(V Repair( ) Upgrade( ) Abandon( ) - Complete System ❑Indivi9dural Components Location �S Owner's Names rL� Map/Parcel# 2t ctl tiYr Address an i E M (ya < C'4-, r� I�.'t, wri Lot# J Telephone# Sc s 1? 3 2I -4 5 f3 Z�<<. Installer's Name Designer's Name , i2 K),l L. Address Address La t Z Y11 %`1' cjs-IirV d 2105E Telephone# Telephone# 4n_i l 3! Type of Building Lot Size .Q' 5 sq.ft. Dwelling-No.of Bedrooms JAL Garbage grinder (4 Other-Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow (min.required) 411c!�- gpd Calculated design flow 44-0 Design flow provided 44-0 gpd Plan: Date It 01 w Number of sheets Revision Date Titles Description of Soil(s) R! use r4r-- +0 rii-a i( l cs54 "ya, -[ Z Soil Evaluator Form No. h `(?- Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further a ees to not lace the system in o eration until C,e�rf' icate of Compliance has been issued by the Board of Health. Signed No. 79 .� FEE COMMONWEALTH OF',- l[AACHUSETTS Board of Health, /f c'--e"j±�``& , MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) O'Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ( ) at Z 'Y has been installed in accordance with the provisions of 31100 CMR 15.00 (Title 5) and he approved design plans/as-built plans relating to application No. q� 7 t dated z -�b/ `��". Approved Design Flow (gpd) Installer Designer: Inspector. l Date: Sc-- The issuance of this permit shall not be construed as a guarantee that the system will function as 4signed. No. 9 O / FEE /Uy' COMMONWEALTH Of MASSACHUSETTS Board of Health, �� CC ,MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( �epair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at 2 y 3 r,J--� k4-Y— '` �� j �`" as described in the application for Disposal System Construction Permit No. 9�- �� dated Z Provided: Construction shall be completed within/three years of the date of M permit. All loc nditions must X met. P / r Form 1255 Rev.5/96 A.M.Sulkln Co.Boston,MA Date Board of Health G' Town of Barnstable P 4 Department if Health,Safety,and Environmental Services Public Health Division Date �} 367 Main Street,Hyannis MA 02601 BAnNBTABIA • : . ° ►asy .� r`�' Time lO:u'�t stN t Fee Pd. rFp�► • Daate Scheduled 1��GIa"WlWaf"'t.:; Soil Suitability Assessment for Sewage Disposal Performed By: `A-e-pWi v A U�i MC wvti j al= Witnessed By: 3-crr Location Address Owner's Name G116t,* 'fL.Aj XCW1,Sna• CAM,itvtt Address Vn1i• Mll•� Co 59ufr% Cmo.-). Wahu,k. ,vnr+.. G 1940 Assessor's Map/Parcel: ^fP .96 Pe/ /4 Engineer's Name � N14 A,,=tW-. NEW CONSTRUCTION t/- REPAIR Telephone N q Z P--q 13 I Land Use Slopes(%) Surface Stones -70net Distances from: Open Water Body Zeal R Possible Wet Area I.5,1.7 ft Drinking Water Well ft Drainage Way Il Property Lino R Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands In proximity to holes) 4 x ` I' �W Sf �1 Q jg 1 \� � -� ,gyp ,'• � r---�„_ IV p I e;� Parent mnlerial(geologic) 610Csal QVAA 4 Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater A /A 5. Method Used: _ Depth Observed standing in obs,hole:. In. Depth to soil motllesi in. Depth to weeping from side of obs.hole: ip. Groundwater Adjustment n• " Index Well N_ _,_ •Reading Date: Index Well level. ; _ Adj.factor Adj.Groundwater Level Rumd.. I Observation II I tole H Time at 9" Depth of Pere 101. Time at 6" Start Pre-soak Time Qa 16;31 Time(9"-6") End Pre-soak I Q:4?a v 5c6! Z4-3a.18u�n�' RateMin./Inch ILllf 9`k16rt ? wit" loci,, Site Suitability Assessment: Site Passed l/� Site Failed: Additional Testing Needed(Y/N) nlveprvatlnn i-Inte nnta To Be Comnleted on Back � I . ..................................:.... Depth from SoiI i I o r I z o n Soil Texture Soil Color ', Soil Other: Surface(in.) (USDA) (Munsell) ( Mottling (Structure,Stones,Doulderes. Consisloncy. to I f e ' (6 �� S' r,Jy /a VIZ c nuQ� & - ZZ" .13 � �;�� 1bYi2C" 6 j j I I :....:..... 1 :.. .. ..ILL.. . .! ....................,.Hole::#.:<: :<:>::>:<::>:::;•:;•<:: >:::.;:.;:<.>;»:. :.:;;: Depth from Soil Hotizon,. Soil Texture So11 Color Soil Other . Surface(In.) " (USDA (Munsell) Mottling (Structure,Stones,Doulderes. 41 C 4 9 516 <:<:>:<>;;:>::: :<: Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling .(Structure,Stones,Doulderes. Consistency*a I j i I II fio Soil Texture Soil Color Solt . Other; Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Doulderes. 0 Depth rom Soil 1-lor z n o Gravel) j I . I I � , i i Mood Insurance Rate Man: Above 500 year flood boundary No Yes ✓ i .Within 500 year boundary No ✓" Yes i Within 100 year flood boundary No v Yes it 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? jves If not,what is the depth of naturally occurring pervious material? - Certification I certify that on 9 fs (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and•experietice described in 310 CMR 15.017. jj . Signature Date // 7 ff' Dis PERC TcSi DATA : P-192914 12. 3.9is sz6N DATA W/Garba3c Gri�dcr E Dc►ily Fteiu '4 x l td 9PdJ�,� _. -. s — A�'Su;L S./, n 3 - qP•Sundy toaM 6"— ro Y2 S I Io YR 6�t Selo3ie Tank 46 Y. I' s sea Q,sz»d 4n2m USE 1SOO rsALloNt TA1JiC�2 Co„, r4m4cat� �� �a 92 616 ?,5Y2S/L ZS= LIEkCH1UG SYSTEM DE3ZGN Applicaftori Area R%virt-0 440 GPD = a,74 GPD/sF SF 9C�xsp- A"Itcaha+ Area pesi3ri Sicdawall Arsa (I-J-- la Howcj " ZSo, Rcc ;t Cie*VV".. AMAt 5 x �00� _ DO S!= AID tdq.4r,- TO-owl Arca Ioc�SF . No Wa4rr •Pei-ceu: iaa R.fc 4 5 n m f iweii Gi.►ss ? moils r. A Fr,--40,b _ 38,i )SO& r TOOK -- A l � f T . 13e16rn of TPda Devti�Lo PEp Pkto Ft t� SITE 5EPTrG PLAN . LOCATION : ISENHDtJGrP2 �12!✓�� coi C r Sri`p��ty SCALE: A., NefGal DATE ALL'IN a PLAN REFERS WW Rrvcs�-,� /2�%/9./�ti� o. 0218 /11$5lSSOAS MAP: PARCEL: /b A PPUCANT BARTER NYE. INC. LAt�. S�tveYoRS • Ciuit_ En�weaRs Os-reRV ILLS i MASSAc-HUSETTS 0 c-+s froM boildin,%s skovttof Met be usc.( tb csf,ltb l l s L. fv.�o �.ic3.Pcr !J ?ob No c4 1 °? ;G �� \\_.. _, \'•tom 0.8 � � •x 33.� � � �• � Spit � 9 E�c�°� 41.4 BENCHMARK ° TOP OF SPING'_E I25.6 27.3 x 39.2 ► �, I �= �' #200 = 45.5-' 100' JURISDICTION 42.242.6/ 7 x .e3. �h x 40.9 28.2. 39.3 � i b 39.6 31.5 9 I f "�. / °'moo \w C7 PO cd t r. .263 o t� X 40.E 1. _ / # 4D. cu a 90 w o I 7 / 39. 31,.7 30.4 ' ( s 40.5 3 .9 <� c i 4' 38.7 28.0 w 1 7 /.3 25;7 11 x 37. 38.3,/ I \ 30.0 j x 39.4 I I ' x32.8 II x 35.7 ` x 9 �!37.6 125.0' F i 35.8 1 r Y I. 32.0 / IJ 1 T, cT I. 157 5 , 23.0 0 9 33.3 34.9 4 28.4 -- 04 Town of Barnstable P.4 � Z� Department of Health,Safety,and Environmental Services �„te, Public Health.Division Date 367 Main Street,Hyannis MA 02601 O � Time 10'ZnAW7 Fee Pd. °"' Tfn►nr�" Date Scheduled Soil Suitability Assessment for Sewage Disposal Performed By: krnlnn� A rive IREEE Witnessed By: NE :.....:..: :.:.... .:.....: .. .: .:. .: & RA ,tN>�4?1VA Location Address Owner's Name Gj(�, a� rG W1rTne,. .2�4 3 �>9eu.�v+er ��e C&M}V tt Address Unttr 011 Co 5VIrt, CM4rk No.j c w- ►'AA. O MOO Assessor's Map/Parcel: X,pp aeJ1 ire/ /(o Engineer's Name T 1,IVY Vr 32�. NEW CONSTRUCTION V"* REPAIR Telephone N 4Z96-113 f Land Use Slopes(%)" Surface Stones K70r/e Distances from: Open Water Body 066t R Possible Wet Area 11 Drinking Water Well It Drainage Way fl Property Line R Other It SKETCH: (street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) �\\ ` `1 IVY N �\ Parent material(geologic) Ghazal QUAAWti Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater ::: <<:::::;::»> ,•. :, N.>T' It:. ASOIAL; TT:'4?VATATL :<:;::.;:.<>:<:<>::::::>::>::<::; « ::::::..<.::;::.:«.;b�T)JTt1VrINAIO.::.:::,.:Q►::.:............ ::.......:.. Method Used: Depth Observed standing in obs.hole:. in. Depth to soil mottles: in. Adjustment R• Depth to weeping from side of obs.hole: � in. Groundwater Ad.� Index Well N _._ •Reading Date:_.__ Index Well level.._;___ Adl.factor Ad}.Groundwater Level .........::... ..:.;:::. :. ,: :;: `r.>::.:::::.:.::.::Daf6... :.:..... .;;Li,(tt4........ Observation I Iola N ' Time at 9" Depth of Perc Co Time at 6" Start Pre-soak Time Q 10:3'7 Time(9"-6") End Pre-soak ZA-3a.11aon Rate Min./inch wun loci, Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Orieinalt Public Health Division Observation Hole Data To Be Completed on Back j rr o� •�rOXIOU Depth from Soil Horizon Soil Textur8 Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,noulderes. 3 ��� /� S YJ /a yr: V, ............................ ...... ............ . . .. ....... ��P 1< 4< .: ::pB ER.V,ATIQN:.:I�.Q:L�:.:L..�.��.;:.:< Depth from Soil Horizon Soil Texture Soil Color Soii Other Surfatie(in.) ` (USDA) (Munsell) Mottling (Structure,Stones,Doulderes. ° _ravel)_ /o 1?r2 6// �oo'`�ire 7,5'?9 516 �es '�l�o.r, C aeJeu�n.Saac{ /0 Y,-" I ' .0140 ; >:; nle :. Depth from Soil Horizon Soil Texture Soil Color Soil Other . Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,©oulderes. % 1. :::::::::::::::::,:.:::::::::::::.,:::::.:::::::.:::;:,...::...........................................:............ '. is {:. :i3:l.:;i; :i. .:: iii;i;i;ji}iy% ':: > . :: ;.:; A �P.: BS�R TIONIOL�.;LO�G.. ::.:.. :. :.:iii�Ia1e::#.;.'?:::>:;: .......:::::::.::.::.:::::::::. Depth from Soil Horizon Soil Texture Soii Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes. % Flood Insurance Rate Man: Above 500 year flood boundary No Yes ✓ Within 500 year boundary No ✓ Yes Within 100 year flood boundary No f/ 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 9 f'S _(date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310.CMR 15.017. Signature. Date J/ 7 ff AAF1 ®3 � PARCEI ® I LOT r- DATE 6 4,22/0 4 PROPERTY ADDRESS 243 Ei-enhowe2 Derive R-' IVED n c0 "` DEC 2 3 2004 (�a�� 02635 E TOWN Of- BAiqNSTABLE HE;,LTH DEPT. On the above date, the4eptic system at the address above was Inspected. This system consists of the following: 1. 1-2000 gaiion zept.ic tank.- 2•. 1- Dizta igut.ion Sox. 3., I-Leaching aicea 201X40' Based on inspection, I certify the following conditions: 7h.iz .is a 7.itie Five Septic Syztem, The 6ept.ic hyhtem .ih .in paopea woak.ing o2dea at the /zee.6ent time. Leaching �ieid .iz dzy. SIGNATURE Name: Robert A. Paolini Company: Joseph P. Macomber & Son Inc . Address: P. O. Box 66 Centerville, Mass 02632 Phone: 508-775-3338 or 508-775-6412 F JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachfieids Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775.6412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OPFIGE'OF ENVIRGNMENTAL AFFAIRS DEPARTMENT OFNyIRQN]VI'ENTA3�pRpTCTIUN Y A TITLE 5 OFFICIAL INSPECTION FORM—.l-()T.F ' NT-ARSYSTEM F'ORMMENTS SUBSURFACE SEWAGE DISPOSAL PART•A CERTIFICATION PropertyAddress243 ejzgnhowe.¢ DaIva o .. Owner's Name:,� e2 / ¢u. Owner's Address: S a m e Date of Inspection: 1111,1r2a0 4 Natde of Inspector: (please print)i..0 ge2t- /?ao e. n;c Company Name: , I Nacom —SAn Mailing.Address: Cen z4v c e, abb. OZ63�2 Telephone Number: 5 0 8—7 7 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system,at this address and that the-information reported time of the inspection.The inspection-was performed based on my below is true;accurate and complete as of the training and experience in-the proper fimetion and maintenance of on-site sewage disposal systems.I am a DEP approved system inspector pursuant wS ction.15:340.of'Fitle 5(316 CMR 15:000). The system: Passes -Conditionally Passes Needs Further Evaluation.by the Local Approving Authority F 'ls Dater 4VIL Inspectors Sign.atirre: The system inspector shall submit a•copy of this inspection report to the.Approving Authority(Board of Health or 10,000 DEP)within 30 days of completing this inspection.If the system.is.a.shared syAtettt or has a design flow ce of gpd or greeter, the inspector and the system'owner.shall submit the report to the appropriate regional office of the DEP.The original should be sent to system 0-?Mu and copies sent to the buyer,if�ppiieabie,and the approving authority. Notes and Comments ****This'report only describes conditions at the time of inspectibtr 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. F/isi�nnn Daze I Page 2 of 11 _ OFFICIAL INSPCCTION FORM—.NOT F.OR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART A CERTIFICATION (continued) Property Address:243 .E.izeahowea DItiye Cotu.it Na Owner: C 4P 11O,rr�� Date of.Inspection: 23 Inspection Summary: Chick AillAD or.E./ALWsAY'S:bcomplete-all of Section D A. System Passes: NO 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: Septic .6uhtem .ih .in 121tope2 w62k"inp 6.,zde2 at the /z/L•e-�ent t.ime. B. System Conditionally Passes: No One or more system components.as described in the"Conditional�Pass"1section-need to be replaced:o.r 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. No '.The septic tank is metal;and.aver0 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-tenk.es-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: NO. 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 brokeii,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 orieplaced ND explain: NO 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 pipes)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL U TW-ECTION FORM-NOT VOR VADL-UNTA.RY ASSESSMENTS SUB> tTRFAtCE SEWA�CE IIISROSA-L SYSTEM INSPECTION.�'OR- M PART:A . . CER.TITICAMON'(aontinued)• : Property Address-2 4 3 U z e ah o o ait Nd Owner6i.99e2.t l au e Date of Inspection: C. Further Evaluation-is Required by the Board of Health: No Conditions.exist whichxequirefurther..eualuation-by.theBoard,ofHealthd.n•order.:toAdtemiineifthesystem is failing to protect public,health,.safety or the environment. O(h) 1. System will pass unless Board•of'Health determinestin accordance with 310.CMR 15:303 I that the a-manner�vhiclh�w9l•protect public health,safety aff0 tbe:.envirohment: system is not functioning i#'. NA Cesspool or privy is within,50 feet of asurface water NA Cesspool or privy is within 50L 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),dgtermines:that the system is functioning in a mariner,that protects thepttblic health,safety and environment: NO The system has a septic tank and soil absorption system.(SA•S).:and the SAS is within 100 feetofa surface water supply or.-tributary to a surface water.supply. NO The system-has-aseptic lank and SAS and the;SAS is--w-ithin a Zone 1 of a-public waterfsupply. NO - The system has a septic tank and.$AS:andthe SAS is u�ithin:.50 feet of a private water.supply well. NO The system has a septic tank and SAS and the7SAS is less than 100 feet.but 50 feet or-snore from a private water supply well".Method used to determine distance v -6ua 2 *'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•INSP.ECTION FORM NOT TOR VOLUNTARY ASSESSMENTS' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A . CERTIFICATION(continued) Property Address: 243 C.i.6enhowea Dzive Cotu.it Ma Owner ii9e2t l aule. ' Date of Inspection: 1 D. System Failure Criteria applicable to all systems:. You must indicate."yes".or"no"to.eacb ofthe:followi9&for all:inspections: Yes No — . x Backup.of,sewagedilto-fachity.:or system component.due!to overloade&or clogged SAS..or.cesspool X Discharge:or ponding of effluent to thm surface of the:;gound or..suxface:waters due to:anoverloaded or clogged SAS or cesspool X Static liquid level in the distribution box above.outlet invert due to an overloaded or clogged SAS or cesspool _ X hiquid depth in-cesspool is less than.6"below invert or available volume is less than 1A day flow Required pumping more,than-4 times in the last year NOT due to clogged or obstructed pipe(s).Number X of times pumped ' Any portion of.the SAS,cesspool or privy is below high ground water elevation. _ _T my,portion of cesspool or privy is within 100 feet of a surface water supply.or tributary to a surface X water supply. _ Any portion:ofa cesspool orprivy is within a:ZoneJ ofa:public.well.. _ X 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 5Q.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 ludicates:tbat the well is.free from pollut;oAfrom:that.facility and:thq presence of In 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€orb.] .NO .(Yes/Na)The system falls.I have determined that one ormore,of:the:4bove.failure.criteria exist as described in 310 CMR 15.303,therefore the.syster-1hils.The system owner.should contact the Board of Health-to determine what will be necessary to correct the failure. E. Large Systems: to by considered a large system the:system must.serve.a>facility,with a design flow of 1.O;OOA gpd to 15jQ00. 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 ' _ X the system is within 400 feet of a surface drinking water supply — X the system.is within 200 feet of a tributary to a surface drinking water supply X . the:system is located In a nitrogen sensitive area Qnterim 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 15.304,The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS 9ttUSURFACE-SEWAGE DISPOSAL'SYSTEM INStPEC`FI.ON FORM PART CHECKLIST Property Address:243 Eizenhowe2 DlLive Coiail- Na Owner: Date of Inspections Check if the following have been dpne You trust indicate"yes"or"no"as to each.of theoilowing: Yes No ' 1 Pumping information was provided by the Owner,occupant,or Board-of Health X Were any of the system components pumped out in the previous two Weeks? X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as-part of this inspection? X Were as built plans of-he system'obtained and examined?(If they were not available'h a is N/A) X Was the facility.or-dwelling inspected for signs of sewage back up? X Was the site inspected for signs of break out? X • _ Were all system components,, cluding the SAS;located on site.? X _ Were the septic tank manholes uncovered;opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? X _ 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 Ex g no istin information:For example,,a plan at the Board of.Health. _ X Determined in the field(if any of the failure criteria related to Part C is at issue approxitnetion.-d distant is unacceptable)[310 CMR 15.302(3)(b)] 5 Page 6 of 11 e OFFICIAL..ANSPECTIOUNT--ORW_NOT FOR VOL UNTA:RY ASSESS11 NT.S SUBSUIMACE-S 'AGE DISPOSAL-,SYSTUP,M JNSPEM40! 9'FORM PART.-C. SYSTEM-WORMATION Property Address: E.�,seahwoea D4irie . Cotuit Na OwnerJiigea.t l au Date of Inspection: fit t? '.' FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 5.- Number of bedrooms,(actual): 4 DESIGN•tlow-based& 1a C1VTR 15.205':(fbr exainple:.1I0 god z#'bfbedrodih 4 LX 110'=4 4 0�q D Number of current residents:.:3 I7oestesidence have a garbage grinder(yes br no): N ee Is laundry on a separate sewage.sysiem.(yes or.no):n 0 [if y..es separate inspection required) Laundry system inspected(yes or no): n o Seasonaluse!(yesorno)kAO, 03=76, 000 gae2on�s 'G. ��. l7. _208. 2Z Water meter readings,if available(last 2 years usage(gpd)):0 4=7 6, 0 0 Ogg i o n z G. %. D. _-1-208i.,22 Sump Pum (yes or no): n o Last date 5 occupancy: R a e h e n t COMMERCIA1.0bUSTRIAL Type of estab ::•j.,•. t: N{� Design flgw �'` on310 CMR.15.203):• apd- Basis.of dM'i" ow(seats/.persons/sgft,etc.): N{1 Grease trap•'present(yes or no):N R Industrial waste holding tank present.(yes or no): NA Non-sanitary waste discharged to the Title 5 system•(yes or no):NA Water-meter readings,if available: NA Last-date of occupancy/use: . N A OTTER(describe):. e4; GENERAL INFQRMATION Pumping Records Source of information: .4127102 pumR 7 ma.in.t Was system pumped as part of the inspection(yes or no): n o If yes,volume pumped:_gallons--How was quantity,pumped determined? Reason for pumping: ma in.t TYPE OF SYSTEM JI v Septic tank,distribution box,soil absorption system _Single cesspool Overflow co spool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative-technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a.copy•of the DEP.approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: 5 (denn.t euitt in 1999 Were sewage odors detected when arriving at.the site(yes or no):rz o 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:243 (S.ieenhowea Da.ive Cotu.it l7a Owner.,qi-e9e2t Paul Date of Inspection: J'7-12 1 U 4 BUILDING SEWER(locate on site plan) Depth below grade: 10 Materials of construction:_cast iron X 40 PVC othe expp1,am): Distance from private water supply-wel�—or suction line: ��f f Comments(on condition of joints,venting,evidence of leakage,etc.): Ate .io.int3 ate .t.igh.t No z ignz o9f .leakage. SEPTIC TANK: y e locate on site plan) 2000 g a.e-e o n tank Depth below grade: 15" Material of construction: X concrete_metal_fiberglass_polyethylene _other(explain) >f tank is•metal list age:_ Is age confirmed by a Certificate of C certificateompliance(yes or no):—(attach a copy of Dimensions: 12'L 9 6' 6" !J X 6'11 Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 9" Scum thickness: t 2 a c e Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or b�3" How were dimensions determined; m e a z u a e d Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of le age,etc); / umI2 ,tank annua.P.Cy ga/z age dais/2ozai .i.3 /22ezent.- 7eez ate .in 12iace No atgnz o ea ge Tank .cz a . GREASE TRAP: N0(locate on site plan) Depth below grade: -NA Material of construction:_concrete_metal____fiberglass_polyethylene_other (explain): NA Dimensions: NA Scum thickness; N A Distance from top of scum to top of outlet tee or baffle,: ..N A Distance from bottom of scum to bottom of outlet tee or-baffle: N A Date of last pumping: NA Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Gaeaze taaN .iz not /2ae sent,, TMA C Tnannntin«T7n«... ic/1 cmnnn 7 i Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS :O&W—HPACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C• SYSTEM INFORMATION(continued) Property Address:243 E izenhowe2 Dz ive o u.c a. owner.•C1���e2 / au Date of Inspection: 7771,12,310 4 x TIGHT or HOLDING TAM{: NO (tank must be pumped at time of inspection)(locate on site plan) Depth below grade:NA Material of construction: concrete metAl fiberglass___polyethylene other(explain): NR Dimensions: NA Capacity: _,gallons Design Flow: gallons/day Alarm present(yes or no): NA Alarm level: . NA Alarm•in working.order(yes or no): Date of last pumping: N,4 Comments(condition of alarm and float•switches,etc.): 7aht oa hodiinq tankz ate not. aaezen.t. DISTRIBUTION BOX:Jeh (if present must bs opebod)(locate on site plan) Depth of liquid level above outlet invert:0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of I*age into or put of box;{etc.): 13ox 4-6zeveP.•Nx ha.3 -eatelta.65 No evidence o� boeids cazayove2. . A!A .c.i J n 4 � �P 6S�b Fb•E�'+B 6lb 61+�d EL6 dr� bLp �rA Y.r PUMP CHAMBER: NO (locate on sife.plan) Pumps in working order(yes or no):NA Alarms in working order(yes or no):VT- ' Comments(note condition of pump.chamber,condition of pumps and appurtenances,ett;.): Pump ehaaPna .iz not aae.3en ., I 8 . J f Page 9 of 11 OFFICIAL INSPECTION FORM—'NOT FOR VOLUNTARY ASSESSMENTS --• SUD9URFACE-SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued). PropertyAddress;?43 U.6enhowelz Dlz.ive Owners Gil&eatC�Zlziit 11a Date of Inspection: - ''/'ZZ0 4 N SOIL ABSORPTION SYSTEM(SAS): .(locate on site plan,excavation not-required) If SAS not located explain why: See page 10. Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: X leaching fields,number,dimensions: 20 X 4 0' 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.): --�. Lome .to medium .sand • No z ignz oZydizaue.ic Za.iiu�ze " So.i.&j ate daU Veae.ta.t.ion L6 nolzmaP CESSPOOLS: NO (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: NA Depth—top of liquid to inlet invert: Depth of solids layer: NA Depth of scum layer: NA Dimensions of cesspool: Materials of construction: IVA Indication of groundwater inflow(yes or no): NA Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): —Ce.6zaoo�13 aae not aaazen.t PRIVY: NO (locate on site plan) Materials of construction: NA Dimensions: NA Depth of solids: NA " �' �► " 1. Comments(note condition of soil,signs of hydraulic failure,level of'ponding,condition of vegetation,etc.): P/L iv y ih not P ze sent , Page l4_of YI OFFICtIAL INSPECTION FQxM= .OT FOR•'VOLUNT-AR3Y:ASSESSMENTS GE•:II ?.QSAL'SYSTEM.INSPEC�TIDN:FORM SIISI�RFA:CE'SEih'A PART C, SYSTEM INFORMATI.ON(icontinved)'" Property Address243 Ejhenhowe2 Chive Cotu� Na Owner: Gine-a au Date of Inspection�'Ll-.2.3a1/04". KETCH OF SEWAGE-DISPOSAL SYSTEM Pravide a sketch of the sewage disposal system including ties to at Ieast two permanent reference landmarks or benchmarks.Locate all.wells within 100 feet.Locate where public water supply enters.the building. ?o('CAN 3 , -Dr a s � 10 f Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS -"` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:243 e.ijenhowen D2.i.ve OwnerJi,ege21t 1 au Date of Inspection: m 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: Obtained from system design plans on record-If checked,date of design plan Mviewed: Observed site(abutting property/observation hole within 15o feet of.SAS) Checked with local Board of Health-explain: Checked:with local excavators,installers-(attach ocumentation) rS Accessed USGS database=explain:,h, sa 11k �—. You must describe how you established the high ground water elevation: used,Gaherty & Miller model 12/16/94 rsrntlnd water Mlavai-Jnnc used•USGS observation w 1 used• 'Technical bull —QL— . wa ere eva ions. Leaching Pit "eet Groundwater: Feet Btlow Bottom of Pit High Groundwater Adjustment 1.8 ft ger 1&invptejMethod Therefore,the.vertical•separation distance betwt:en the bottom of the leaching pit and the adjusted groundwater table is 1 � feet: • tt lip, >•Rr Atti..-R.TOf•Tr lrlrTalR:Rrslrfa'-:*ITtssrrsTlr:-.Tt'+•nasrtmrrtrnn rrrRL•i/rse•errlefllTA 'PORN OF [ ARIVS74PLE 130ARD OF IIEALTII SUBSU11FACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D CERTIFICATION ren/s•eee*'+rr+rP*rr:+rmn:••:rrr•Tr•-.r.•.•.� •-r:•t-r•:'::.-n+:s-•rrn,zrm•rttn rnre.-:re+rm•+m'*.-n�+-rumr.+A arnwer"•�s:av9lr�re+°^�"^°T� . -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 243 .ihenhowea Da.ive U. ASSESSORS MAP , DI,OK AND PARCEL # 038-016 ` OWNER' s NAME G.i.igea.t p2a' PART D CERTIFICATION /loge?p�ao-ein_i".'. 1 NAME OF INSPECTOR - ---- COMPANY NAME Joseph P ' Macomber COMPANY ADDRESS Box 66 Centervillp., mA n?63? Street Town or City state ZIP COMPANY TELEPHONE t 508 775 - 3338 FAX 508,) 790 - 1578 CERTIFICATION STATEMENT I certify that I have personally +inspected the sewage disposal system at 0r this address and that t}i.e information reported is true , accurate., and omplete as of the time of * inspection . The inspection was performed and any ecom►nendations regarding upgrade , maintenance , and repair are consistent with my 't'rainin_g and experience in the proper function and maintenance of on- site sewage disposal systems - . I Check one; XXXX System PASSED The inspection which I have conducted has not found any information which indicates that. the system fails to adequately protect public health or the. enviropment as defined in 310 CMR. 16 . 303 ; Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this. form . System FAILED* The inspection which I have coil t�cted has found that the system fails tc • Protect the jaublic health and the environment in accordance with Title 6 , 310 CMR 15 . 303 , and as specifically noted on PAR ( ,FAILURE CRITERIA of this ins ction form. Inspector Signature Date ga O( ne copy of this certi. ficatio'n must -be provided 'to the OWNER, the BUYER where applicable ) and tha• DOARD OF HEALTJI. * If the inspection FAILED, thv owner or operator shall upgrade ' the eyetem. within o'ne year of the date of the in.spection., unless al:low,ed or requi..red otherwise as provided in 3.;10 eM.R 16 . 3-06 , pa rtd .doc .3 . . . - 4 Y : r ., k Ta G ft a ,� ,, E .'' S : • �ti,� to = d S I. I. { b +,'y -, _.:.>, :: .11' t \: S: ; a`: ir 1 b k :<.`f st.''.Y t l 1. t. ._. - .:- .: . A ;..`...,_ 5, , ,. ,%:' S ':,,f -u,. ..W S tM. '`I'F. 2 1: 1 L: :ah .ti:;•g;, •,.. -!,: -:.,; Y:.,;. 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'.i. f F I FY l - , f k:'. ,f. .::•.. !of },•7 a i E s t• :,. ,.. ., .. ,.,>y: n ,a .: 1'.p Ik ,1,C, F.".., j,�, vt& t h E .,y. A r,' ,-.t :: .-, t 1.:.. n .. .'d f 51,.:, .c 1. c. SON ,.L -::.l,v.. x' �4` i ',i �+ Tk }.'k.r tt '.Y.a 1 s't Y? 7 .. M1 '., : r ..: -: ,..:.:_:: r v ,e, -1,. ,.. ::: �'. 2 J '.:y t� ,SOME s,.Y +...{;F `.3 t .rMwww I" fC' 1l .a + `i 1 P d f� x 11::: ,l '... 9 .,,�,_' .� ,.;, : � "t,lllii r - ..-... .,. ... . '.::. ., . Y TOWN OF BARNSTABLE LOCATION 5 5,,p , 4 !j t,.,r- -p11-474SEWAGE # c-76 VILLAGE co-T—y t ASSESSOR'S MAP & LOTnj r INSTALLER'S NAME & PHONE NO 04 1yl t s SEPTIC TANK CAPACITY Z i DGo %- 64-4 LEACHING FACILITY:(type) r5 x 60 (size) )�X NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER �I�c Btik -OR OWNER 01'14i,.PY V �1 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes ooD 7 No. . /*� ._ FEE /cm r r I Board of Health, Rar sfae b o , MA. � APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct(* Repair( ) Upgrade( ) Abandon( Complete System LJIndividuaj Components H 3 Location tSC Owner's Name Gil pep Map/Parcel# 3& ulr� ( Address UV,11.0'11 (( c uir� �' � &Ll-to, MA Lot# Telephone# '50R.) 3 2 _q S g Z 2�S 6flL�t" Installer's NameOA Designer's Name Mq e mac: Address Address f3(Z m e o 5 j-, Os cru i d(t MA O?dv.5� Telephone# Telephone# 4ZT_5151 Type of Building Lot Size 34,04 sq.ft. Dwelling-No.of Bedrooms Garbage grinder (WI, Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) 44c� gpd Calculated design flow 1-1-40 Design flow provided 0 -A CO gpd Plan: Date !����'� Number of sheets Tt,,Pz� Revision Date I?-(14J I V' Title ;ji-r Description of Soil(s) Rd er se b!) ate Sh to Z e r Z� Soil Evaluator Form No. P- cf ZCtg- Name of Soil Evaluator SA,Wits"I Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further a ees to no lace the system in o eration Cer' icate of Compliance has been issued by the Board of Health. Signed ow e cro No. S. ;e' ;� ., 8, FEE -COMMONWEALTH OF MASSACHUSETTS Board of Health, parns4w 61a MA. Z1(�+ APPLICATION FOP, DISPOSAL. SYSTEM[ CONSTRUCTION PERMIT Application for a Permit to Construct(lX Repair( Upgrade( Abandon( L)(Complete System ❑Individual.Components Location �tSch � Owner's Name Map/Parcel# m qua ( 0_ Address Uvi�>i•w�1 S vIrc Ct, "hc_k. mri Lot# $ Telephone# C5O8J 43 ZV _45e 2 installer's Name%I - VA M, 65Designer's Name �i 4 Q4 L- 'Bic. Address Address ¢' S(Z mash 5t��.Oskruil(c MA 62r-Ss ` Telephone#-•`- Telephone# 4?..B'_t131 Type of Building Lot Size 34,0 4 5 sq.ft. Dwelling-No.of Bedrooms Four- > �' Garbage grinder Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) 4410 gpd Calculated design flow 440 Design flow provided 440 gpd Plan: Date 111,301181 Number of sheets 7WIM Revision Date 1 Z It+(I r Title S,� 'P14v� Description of Soil(s) gi cx se •i , so,1 1 cx.o , S".k 2_ Z Soil Evaluator Form No. P- rY7- -4 Name of Soil Evaluator 5,14, &X/Sc*j Date of Evaluation-, 1 3 • J' DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further a ees to not o lace the system in operation Ce ' kate of Compliance has been issued by the Board of Health. Signed t , t � t s No. ? i FEE COMMONWEALTH Of,MASR`ACHUSETTS Board of Health, (`"'3" `� MA. _ CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) Cromplete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ( ) by: has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and theapproved design plans/as-built plans relating to application No. �� 7 dated Z " b ' Approved Design Flow !�6 6 (gpd) Installer Designer: Inspector: 1Z< /)Date: �el_ 9 J d The issuance of this permit shall not be construed as a guarantee that the system will function as designed. 9 7-� /�� ......_ No. FEE v V, Board of Health, ©a—107JV"& , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( lj<epair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at 2 y 3 r !i as described in the application for Disposal System Construction Permit No. 9, � dated 12-11 -f Y.' Provided: Construction shall be completed wi in three years of the date of t permit. All loc co ditions must be met. 0 Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date Board of Health Y �SI6 N DATAPER C TeS T DATA : P-9i 2 9 4 12. 3•q g -r-pu2 sk-llc Farm l-A _L Bcjwora, a 9— �c��6arba�c Grindcr 3 _ E 3, _ E �QA Sunk L o2n Suhd Loam �yQ Daily Flow '4 x ila 9Pd/�e,.�, '�'��� ?0 YR S�l Ap' 6 - Io 42 6 1 Sc mfte--rank = 146 x Zom7 : Sec — 13 llldt to."M 18 13,Sava taz.*s USE ISoo GAL.om -Mmw-�2 CO, fe,4YY�[t 2Z- 1 Zr= Appllcafion Arca Rcivirt-0 Peac 440 GPp: e174 GPD/ = S�iS SF qm5p A"hcibha+ Arca 10 YR. 714 /0 V,p -SA 5.ldawall Arcs (M-- n- llowcd f' ZSO' RcC Re flvm Ar•ca I S x �O = �00 S!= To4al Arca = llOo SF No uJQz4,- Iz0 - ��-• �28,2 Pcreslsfia.l R•fe 5 w+r1/Iwcs, Glss ? S.�Is 4Pcr�' PJG�i3p Z" PC2s41r%c WashctQ S}one y SCCT1 O h/ A- A FG=4o,b V,i !: l ��zff r��co 37,2 . qst 3�6 ISoe 37.5 1. �\3�o Mn 371Seem A ;7,$ TAWc — �i, 5tc•,2e Brsc 13e Owno} TP Z Z$.2 � Devito Peep Pile ft tE SITE SEPTZG PLAN ���.✓��do LOCATION = TSEN/40ul4r02 GG7u O i ST . ', r-: SCALE. As Nay-`d DATE : /2 . o. yr AiL"N ,` PORN REFERE NGE' Rcv[scr� /2 j/'g o."+ .2'° ! g55L55ORS fnAP: 36 PARGEL: /b \ JO:UiS APPUCAWT: .G,lbe.—C y-C n i r BAXTER NYE, IIJG. LAmb. SuhweYoRS • Civ%L- 97wz.IlJE6RS OSrCRVILLE, MAStACHuaETTS O 3a'1's fflwi buildwS S sko%)tJ not bo use-4 tC cs� o 111s1, r�o lInca. �'oh No : a13i � SHEET 2. c, �•. T That 71r)c i?roposcc( l�wcllinc, �howw 1lcrcon Complz6s W.+1, S,dclinc Anc( r�2 25.0 27.3 Sc.Ho&ck Rc uircvnir✓-fs c� the Town o f Bar`nsfable A�of Ts Not ►,oca+r-•c0 27.6 EAGLE • C.B. l.J lthl «.� A spla l Flcod 1-Iz,zArd ZcC n POND n ` ; y FND G Imo' J C, \ cC L C0 )24.3 �V Qrossion2l �2•.c! Survc�G.- i. iC \ � O ! 1 x32 5 O O 24.5 1 c� o 126.7 40.4 X S)3,54 4 H LOCUS MAP S'CALE 1 25,000 40.8 ASSESSORS X 33. 25.1 ` `, SPlrt r 9� MAP •38 ' PARCEL' 16 _ � `rt � � �''c�° 41.4 BENCHMARK ZONES ° - ° TOP OF SPIND'_E / c, ,^ _ AP ° 273 R 39.2 RF �,� MINIMUMS II 0 BU , ,���a� ° 42.242.fi,' 42.7 AREA = 43,560 S.F. ` 100� JURISDICTION x 40.9 P / S`�` c \ , FRONTAGE = 150' , X 33. 'r o FRONT SETBACK = 30' � SIDE SETBACKS = 15' II 282 39.3 `~ bv \ REAR SETBACK = 15' II 29.3 * 39.6 ' �a'wn W BUILDING HEIGHT = 30' %b 1 31.5 THIS LOT IS NOT LOCATED _a W,THIN THE FLOOD PLAIN. 25.8 - % a _ �3' x 4a'¢ -�� % , x 4� _ 1 293 o t� 90 39. ` I o % � LEGEND ' ! ` aQ) - ` I 31.7 , s 40.5 3 ANY WU)RK I..JITHIN I00 F -r-T Sr- THE EDGE OF ` '- - o C _ - 7H-'f A -At DoNED C'OG REOultZES kPPROVAL. I � , z 30.4 � �• � � �'. _7. SER ^ 3 .9 . / - 4 � EX, - r; H iL,F=rvT 13-Y THa TOWN 01° jOT t ►1sTpC3�G GCIJS�RVATi0ti1 _` . Comn1%5S1oN I �3 ^.8 - 4N �7 d x 39 I TF ^c 38.7 L X 28.0 x 37. 130.0 I - X 39.4 I 1 32.8 I t X 9 �, �/3 7.6 COP- 125.0 1 x 29.7 r" ,l s' 35.8 22.7 25.3 r 32 SITE PLAN OF LAND (D 1 r, �5 ,5 -- X o3, 49p�,J 33.3 34.9 I N o � � � BOG _ I � o o < TOP OF BOG = 23.00' 230 I o 5�5 X 34.5 I x (COTUIT) rn a 28.4 j I X 33.1 BARNSTABLE , MASS. x 29.5 Fc,R , 33.5 GILBERT PAUL X 11 \ 25.8 x 305. �. 23.0 N >� , LE 28.0 t �� 4 R_j DEC . IA lye 8 \ o I x 30.6 1133.4 22.5 ti \ EAXTEP & NY'E INC 'EuISTEP'ED LANL t ` CIVIL ENGINEEDS ESTEPVILLE, Mr;SS. � V XTcR \ k %o 240Q 26.9 26.7 CERTIFICATE REFERENCE.' LOT 55 L.C. PLAN 36CO8C; PHILIP BURLEIGH, JR. CTF. 79152; OWNED ci IN That 7h� p I �ho�. I-lercon Comp�ys ln� +l� Ti'*- S�de.linc Aila( l�rb osccS Dwc ��� r�2 25.0 2;76 Sc�back f�cc�vircv+�cr�+s o� fh� Jowv, of Barnstable Av,,f T5 Not coca+-c.c0 �F C.B. LZ,fhwn R Spc¢ial Food 1-L-ukrJ Zcntz . EAGLE FIND POND L )24.3 QojcS5fon2� La+'d 5Vrvc�Or X 32.5 `J 60 V 24.5 c,, o �O 12 6.7 40.4 I X LOCUS MA P SCALE I 25,000 40.8 X ASSESSORS 4\ � � - Split r a ° 25.1 MAP 38 PARCEL 16 �' x \\ ` �� ��\ 41.4 BENCHMARK ZONES ° TOP OF SPIND;_E / o, AP o Ii 27 3 f 39.2 --� \ ` , ` `D #200 = 45.54 i. R F �25.6 ` ' �` D 40 o MINIMUMS II 0 BUFFEF3 42.242.c� 42.7 AREA = 43,560 S.F. 100` JURISDICTION P v l �` r� FRONTAGE = 150' x FRONT SETBACK 30' I ( 13 4 � SIDE SETBACKS 15' d I 28'2 39.3 REAP, SETBACK 15' 29.3 39.6 ib', ^ W BUILDING HEIGHT = 30' Al THIS LOT IS NOT LOCATED n ^ 25.8 3 b 13 X 40.E f�r 1h THl ! THE FLOOD PLAIN. z 9a 283j o t� I ° 39. LEGEND 31..7WY C P TrIE E�6E OF rod ' /c' X VA TER SER VICE ANY w��zK w1THIN iao r Gar I . ( - T1iL RchNDO►J6D ii OG REOUIRec- A-PPROVAL- (� , z LZ30.4 -, c EXISTING H fDR,�NT 2Y THE TOWN 01= 1Z, ARt► s �C3Lc (�C►.1S�f2vR �oN I 8 T �� � -rr'� � ��Q � �a �_E_�RI� S��NPV!'-t Comnl�55ioN 18 - � \ I i h o�,Sc¢ CF 41 f `s l .7 26.3" 125.7% 28 0 1` X 37. `L / O SOD / I 1 30.0 i X 39.4 /( X 32.8 o X .9 1� 37.6 / X 35.7 3 25.0, 6.9 ix29 7 - '� 36.8 22.7 35.8 X 25.3 I r 32.0 SITE PLAN OF LAND �n BOG I o owl 49n�i 33.3 1 34.9 IN X y 2.0 �5 o n TOP OF BOG 23.00' I o S X 34.5 X (COTUIT) a r 28.4 X 33.1 BARNSTABLE MASS. I F0P\ ._- 33.5 X X 29.5 25.8 � GILBERT PAUL ll �23.0 x 30.5 ` � � , ' � � E 25.7 SCALE: � " _ >n DATE, NOS". 3J,I°9/2 28.�, 33.4 RAJ DEC . I A 19 9 8 X 30.6 0 y, 22 s \ 33.4 -_ BAXTER & NYE INC. / (r ''.JI , .. REGISTERED LAND SURVEYORS �•J��t�� c, STEP CIVIL ENGINEERS "tea 4k�,aFn •- ❑STERVILLE, MASS. s" aAXTER 26.9 n 981`6 26.7 CERTIFICATE REFERENCE: LOT 55 L.C. FLAN 36E08C, PHILIP BURLEIGH, SIR. CTF. 79152; OWNER