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Home My WebLink About0819 MAIN STREET (COTUIT) - Health 819 Main Street, Cotuit A= 035-064 a I i (� TOWN OF BARNSTABLE j LOCATION 1 1 MA19 SEWAGE# 204 ` VILLAGE CG.O_rU J I ASSESSOR'S MAP&PARCEL 35 CA INSTALLER'S NAME&PHONE NO. A N&C�Z C-00 ST'RO CTI A SEPTIC TANK CAPACITY _L OCArC 10: f�� LEACHING FACILITY.(ty_p/e) ` �1/( (size) NO.OF BEDROOMS r OWNER A L 1 3 PERMIT DATE:.c R 114. COMPLIANCE DATE: 5 / 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 facili Feet FURNISHED BY 1. (� �. .� ins► Onj v N d •g� - 2v s � O n�5t -;ANbJ No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2ppliCatlon for Misposal �p8 'n' Construction Vertu Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) ❑Complete System ividual Components Location Address or Lot No. M/'t1Al Sr, Owner's Name,Address,and Tel.No.Assessor's Map/Parcel 64TV is bJ qI 1q /'AAI#1 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Irbri CjA 2 'PA4r�rL("fF �V rvt 141 �'�G4 S P6 Type of Building: qbC v�I ' E /d� v `�0 �a>< -�Z°! An .W%GkA/+ 025-6,3 Dwelling No.of Bedrooms ' Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design floyz provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank P W Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He Si Date h3 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued C l ' = Fee � NO.. "r THE COMMONVVIE6ALTH`OF MASSACHUSETTS Entered in computer: Yes -, PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS :. 9pphration for disposal 6pstem Coustru lion Permit Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) ❑Complete System ividual Components Location Address or Lot No./ M&1N I Owner's Name,Address,and Tel.No. A. Assessor's Map/Parcel �TU►� 35 " �ji ' t�f r 1,�, (,j IS b✓r` Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. .Agf2 eA'-46 6NST�(� � LAS St,rVt �4� ��"�/�.�� Type of Building: 40 C V-1I 1 111 u" YD (�o 7( 1 G Z Dwelling No.of Bedrooms Lot Size �� sq.ft. Garbage'Grinder( ) ' Other . Type of Building No.of Persons Showers( )'Cafeteria( ) ' Other Fixtures Design Flow(min.required) gpd Design flow Drovided gpd Plan Date ? rld Number of sheets Revision Date Title Size of Septic Tank 1 Sb U Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) t A k �S�o 0 a ti j�t,AJ h C 1�h' - ))N •r Date last inspected: Agreement•. x The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He Si Date /3 S Application Approved by Date 9 ZI yr Application Disapproved by Date for the following reasons Permit No. �� Date Issued (J l r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS / r�cX Certificate of Compliance �P.. THIS IS TO CE(�RTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by R 2 at a r has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. tl I I / dated Installer Designer r/ #bedrooms Approved des�tgnfio)w T D gpd The issuance of is pe it shall not be construed as a guarantee that the system w' 1ll on-as designed. Date ( Inspector V\.�, y -4 ------------------------------ -------------- -------------- ------------------------- ----------------- No. Cl '�� Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade Abandon( ) System located.at 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:Con tructio must be completed within three years of the date of this pe Date (� ��[� Approved by / TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ��f!�/r l ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1.5 0 0 LEACHING FACILITY: (type)T/v I ` (size) 7 A G 0 NO. OF BEDROOMS BUILDER OR OWNER W14 PERMITDATE: 9—�� y COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 aching facility) Feet Furnished by G 4y y �_ �. 0� < ! ^ No. Fee�s�•�_�� THE COMMONWEA H OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2ppfication for 33iopoal braem Construction Permit Application is hereby made for a Permit to Construct( )or Repair( +ean On-site Sewage Disposal System at: Location Address or Lot No. Owner's r's Name,Address and/Tel. o. /� ��/l� Jam, 7✓ Assessor's Map/Parcel � ✓ �4/y Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7`pGo7t`1 G®d1�f7"�tGy`i®�l 7/- Type of Building: Dwelling No.of Bedrooms Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3#e gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alter tions(Answer when applicable / �d -7/ fQ44 — X r iU f W i0 Date last inspected: Agreement:' The undersigned agrees to ensure the construction and maintenance of the afore'described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue b %;;=E /, Signed Date fl� Application Approved by eg rq Date ►" �' Application Disapproved for the following reasons Permit No. 19,Pam L�� Date Issued "F" /6 ¢ 2 7 �V Fee kzq t '~ r THE COMMONWEAL H OF MASSACHUSETTS j PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 01pprication for Mi000l *pgtem Con!6tructiou Permit Application is hereby made for a Permit to Construct( )or Repair( ✓)an On-site Sewage Disposal System at: qq . Location Address or Lot No. �y l 9 ��l y� Owner's Name,,Address and Tel.No. ��! Assessor's Map/Parcel GDu� ' �4/7 gN� Zd�'3 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. gD/'fe/o It 7/- 1 Type of Building: I Dwelling No.of Bedrooms Garbage Grinder(,lam Other Type of Buildina No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ///' gallons per day. Calculated daily-flow yCj gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable.) r`Or5 w i7-- 5 mnfe Date last inspected: ' Agreement: .a The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance,has�been issue Y`b hi az of Health:- • , t. r � Gr�/ Date Signed Application Approved by _ r Date ", Application,Disapproved for the following reasons ' is { Permit,No. 9 J!6 1 Date Issued �"' / L " - THE COMMONWEALTH OF MASSACHUSETTS i BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Dispos System installed( )or repaired/replaced(V )on by InstallerG'l at 9/c/ Melln 5/-17 CO 7-4(/ has been con ted in accordance with the provisions of Title 5 and the for Disposal System Construc�Permit No datedstru ! Date 91 Inspector THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS- TEM WILL FUNCTION SATISFACTORY. No.— —------------------- — JS �I6y Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLES MASSACHUSETTS ZigoOal *pgtem Cottgtruction Permit Permission is hereby grante �4/ dl.� / D/�'��/°l�G %�"'/1 ✓IG'. to construct( )repair( k,15an On-site Sewage System located at No.# C 07V 7-- l_..., street and as described in the above Application for Disposal System Construction Permit. No. Date I The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within three years of the date below. / Approved Date: Aby Board of Health s f, In N 19 r•+� ' 0 I a ; I- CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) ' certify that the a lication for disposal works hereby ce Q i f�"� e��l®�/ Y Y PP construction permit signed by me dated concerning the property located at f y�llP/'��s,7 �6cr� meets all of the following criteria: /Irlicreiv' hin 3�o f f the fir sed sc is system /rIncre arc no wetlands ill _ cci o proposed PI , five?I `vithin ISO fee? of theproposed septic stem arc no private s sY � rvc r und«•ater table is Ia feet or?niter beioiv the.bottom of the levching facility �lcobsc dg o _ _ . T�iere is no increase in Ilow and/or c1hin¢e In use proposed There are no variances`rcquesfed or needed.' SIGNED : DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER iAtlach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submittedl. t'f_.. YyR�i',�r.-.�''y.., v:i,_�+i1�.:� f�:+-� .�rqf'G,�+�.•,.. tl::..�. 'fi.....-._._ r� ! ., a.�f.f+�.��7^a... i�' n:.' - �?- ,C�i_.:..�3+^��.'w:.�. '.h�".•.� - y: I - IQ,� . - V f _ ' Commonwealth of MOSSOChusettS. Executive Office of Environmental Affairs 'l. a rtment ®f �99 • �nvlranmental Protection vp 4 , Wl WM F. Weld oo.�rnu. Tnidf Cox. Arg"Paul Colluccl n- s.c riary u oo`emo, David S. Strube . - fbrt+n+lp{oerr . SUP-SURFACE SEWAGE DISPOSAL SYSTEM IN4I'bf'TION �RMASSESSORSMAPNO: _..�..� PART A PARCQ 14O:—_ CERTIFICATION .Property Address Dale of Ins Address of Owner. 2$r�7E" Odz/IJUIi1,C1. ✓tIi 0! Peotlon (s i (If different) c� � ( fo Name of InsP�tor~�o (?j �_cJ;�.q-,-.� b � 1. , •�`� Company Name,Address and Telephone Number. American Home & t nvironmentel Inc. 7 ► ",ga5k 0-.( p ' 35 Winter Street ao"-1 C_OPF11CATION STATEMENT Hyannis vn A U8U8chu6ettb 02601 I Certify that I have personally inspected the sewage disposal system at this address and that the iaf ormabon reported and complete as of the time of inspection. The inspection was performed based on training and experience in the Proper f unctio bed is ctio san and maintenance of on-site sewage disposal eystems. The system: _ Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspsotoi's Signature: ��_ .t��_�_ Data fe The System Inspector shell submit a copy of this on �P�. report to the Approving Authority thirty(SO) of WPection. If the system is a shard system or has a �s 0006 this rspoet to the appropriate rogwral ofike of the Departmentliar.of nmen 1pd or coon.greater,the inspector and!I»system owner shall submtit tlss of Environmental Protection. The original should be sent to the system owner and Copies sent to the buyer,if applicable and the approving authority, INSPECTION SUMMARY: Check A.B,C,or D: A) SYSTEM PASSES: I have not found any information which indicates that the eyatesa violates any of the failure criteria as defined in 310 CMH 1b 90.4. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: , One or more system oomponents need to be replaced or repaired. The system, upon completion of the inspecdoz rsplaos®ent or rePe3r,Passes Indicate yea, ao,or not determined(Y, N,or.ND). Describe basis of determination in all instances. If"not determined^, The septic tank is metal,cracked struct explain why not)orally unsound, shows substantial infiltration or exSltration,.or tank failure is imminent. The system Kill Pass inspection if the existing septic tank is replaced with a Donforming septic tank as appro by the Board of Health. (revised 11/03/95) 1 One Wbow Stroat • Boston,MOssachusetts 02106 . FAX(617)SWI049 a TNaphoea(617)2924500 `r � �� irinhd a+ttcyded 14pr SU BSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Addreew 81 Owner. 1�1tc'i� NOflrrA 5f}ILS�iJC'(� 1h.��_irJ •k-4� }�►'a `1 Nf3 '?>��rf /W (ytaVt`Or1 H[W Date of Inspection: -7 B)SYSTEM CONDITIONALLY PASSES (continued) — Sewage backup or breakout or high static water level obaerved in the distribution t is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will iu as inspection if(with approval of the Board of ° Health): I bmken pipes) are replaced { obstruction is removed distribution box is levelled or replaced i - -- The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed I C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: �� I --�=— `onditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL,PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONME". — Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. _) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPIdER,IF.APPROPRIATE) DETER2i1I M THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND. SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and a within 100 feet to a surface water supply or�tssy a surface water supply. — The system has a septic tank and soil absorption system and is within a Zone I of a public water sup*well. — The system has a septic tank and soil absorption system and is within 50 feet of a private water$appd wdL — The system has a septic tank and soil absorption system and is lees than 100 feet but 50 feet or mor from a private water supply well,unlaes a well water anabrais for ooWbrm bacteria and volatile organic oompouads iinditxtas that the wan is g" from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or leas than 6 ppm. g) OTHERThe system has 2 cesspools.The first has approximately 60"of fluid but has not been used in the last 8 months. Both pools are Clogged with roots. The second is empty and-dry but clogged fluid f{ratttrr_ir*„sham (revised 11/03/95) Z tl SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART A r�yy CERTIFICATION (oonUnued) Property Address: q(41 W{dCo, Owner. Date of inspection ,,DI SYSTEM FAILS: I have determined that the system violate,one or tnon• of the fol1ow•ir'9 failure criteria u defined in 310 C" 15-303. The basis for this detormination is identified below The Board of i oa-Ith should be contacted to determine what will be naceanary to correct the failure. — l3ackup of sewagr into facility or et-etem component de:c to von overloaded or clogged SAS or oesspool. — Discharge or ponding of efnuent to the surface of the ground or surface waters due to an overloaded or carpool. clogged SAS or Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is leas than 6"below invert or available volume is Is"than 1/2 day lbw.. — Required Pumping more than 4 times in the last year NOT due to clogged Number of times pumped or obstructed pipe(,)• — Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater al vation. — Any portion of a Cesspool or privy is within.100 feet of a surface water supply or tributary to a surface water — Any portion of a Cesspool or privy is within a Zone I of a public well. — Any pin of a cesspool or privy is within 60 feet of a private water supply well. — Any Portion of a cesspool or privy is Is"than 100 feet but greater than 60 feet from a no a00eptable water quality analysis. If the well has been analyzed to be aooeptnble,attach P eoP9 wall water ivatewater ateg well with analysis£o r ColifCrm bacteria, volatile organic compounds,ammonia nitrogen and nitrate nitrogen. ED LARGE SYSTEM FAILS: The fOlbwing criteria apply to)age 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 mignificant health midsafety and the environment because one or more of the folio threat to pob�c wing conditions ezist: — 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 it supply in a nitrogen sensitive area(Interim Wellhead Protection Area(IRtpA)or a mapped Zone 13 of a -starpublic The owner or operate of aqy such system shall bring the system mad facility requirements of 314 CMR 5.00 and 6.00. Please consult the lo regional office of the De complumes with the ground watertreatment program IOW Department for further information. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Addredw I�N l c.tt Owner. N• �d�1S — ��TRd uT— Date of Inspection: '.;hack if the following hwve been done. —L-1�umping information was requested of the owner, occupant, and Board of Health. _None of the system components have been pumped for at least two weeks and the system has been receiving normal(Law rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _As built plans have been obtained and examined. Note if they are not available with N/A. facility or dwelling was inspected for signs of sewage back-up. I'he system does not receive non-anitary or industrial waste Clow . The site was inspected for signs of breakout. system components,excluding the Soil Absorption System, have been located on the site. he septic tank manholes we. uncovered,opeaed,and the interior of the septic tank was inspected for condition of bafies or tees,material of construction,dimensions,depth of liquid,depth of shulge,depth of scum. e/!'he sae and location of the Soil Absorption System on the site has been determined based on existing information or appaaximated by non-intrusive methods. kl�taciliv owner(and oocupanta,if different from owner)were provided with information on the proper maiatensnoe of Bub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Addressl�(Owner. Date Date of Inspection: •�'=Ri+�9YDENTIwt� cr- FLOW CONDITIONS ->:Design flow: CDt? onr Number of bedrooma:_2 , Number of current meidentA: Garbage grtnda..r(pen or no):_t � Laundry tvnnect.ed to vct.r-m (y,.v or no): ` (yam or no'): Rater meter readiryp, i, available: 30 Z 3 L&A date of occupancy: COMM rwr,/INDUSTRIAI„ Type of establishment: Iesip flow: Inns/day Grease trap present: (yea or no)_ Industrial Waste Holding Tank present: (yea or no)_ Non-46nitary pasta discharged to the Title 5 system: (yes or no)_ Water meter readings,if available: Last date of occupancy: OTHER;(Describe) , Last date of oocupju, r GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as Pan of won: (Yes or no AJ If yes,Wilms Pumped:_1!Q) gallons Reason for pumping: ►-;i N TYPE OF SYSTEM Septic tankldistnbution bos/aoil absorption system single cesspool Overflow owspool Privy hared system(has or no) (if yea attach previous jnspection records, if any; Other(eaplain) 0- A.-(J APPROXIMATE AGE of all components,date installed(if known)and source of information: Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/95) 6 r± ',e, z, q, '!,{ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 6'( \ Va i I, 0 1 Owner. t:}ram e-, A). Date of Inspection: q —o( � O` szmt (locate on site plan) tf Depth below grade: r C-) Material of construction: �ncmt� —metal-_FRP —otherimplair+) Dimensions: — Sludge depth:__ Distance from top of sludge to bottom of outlet tee or baffle:-- 4 Scum ct,;� Gi Distance from top of scum to tap of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: �s �r SF ��` �� rT`A T?)CS1i21w� b F G�✓rl E Comments: (recommendation for pumping,condition of inlet and outlet tees of baffles,depth of liquid level in relation to outlet Revert,structural integrhy, evidence of etc.) w. GRFASE TRAP:_ (locate on site plan) Depth below grade: Material of Win:_concrete _FRP other(explain) Dimensions: Scum thfclmass: DuUmos f vmt top of sum to of outlet tee or baffle: Distance from bottom of to bottom of outlet tee or baffle: Comments: (recommendation for Ping,condition of inlet and outlet tees or baffles depth of liquid level in relation to outlet invert,structural hdogfto evidence of leakage, ) (revised 11/03/95) g rt t � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Addreea A`'( AA6yt -T- Owner. �'� 'C C`� �•�.{3`/j:lS�A1V�� Date of Inspection: ;TIGHT'OR HOLDINd ANK (kxc®tre on site plan) Npth below grade: Material of conatru(lion:_concrete ^—}'R}' --(rtlierlexpieuiF Dimensions: Capacity: twn s Design flow: s/day Alarm level: Comments: (condition of inlet tee, 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 1fodfids carryover,eevidenice of leakage into or out of ben,etc.) PUMP CAMBER: (locate an rite plan) r Pumps in working order:(ges or no) i Comments: (note condition of pump clamber, condition of purr and eppurtenances, etc. (revised 11/03/95) 7 x : t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM i PART C r A8 SYSTEM INFORMATION(continued) 'a PrOPerty Address: ,q( Nv ,v- S7'. c6L9'7— Owner. E- date of Inspection: ; SOIL ABSORPTION SYSTEM (SAS): (Ift*to,oa:stte,; ) per-u p�1�1e:excavation not required, but mny be spproximAted br non•intru®ive methoda) If not detr e rtnirnt+d.to be present, arzpWn: leeching pitA, number: Z— leacbiatg chambers, number: "Ching 8lIerift, number:._.-- i leaching trOnches, number,length: 1>wldzkg fields, number,dimensions7 ovwtow cesspool, number: nts: (note condition of soil,signs of bydrauhc failure,level of n f W 1'1'N po dnng, condition of vegetatio 1,etc.) POOLS:yam` on site plan) and Z:!uration: (m -skA�ti `-Y2— ` r Q p�-7h tpth-top of lignid to talet invert: " r " "h of solids Igyer: rpth of scum layer: t.)t1rle— wnions of cesspool: `t aerials of cow: of groundwater: /JQ infiaw(auspool must be pumped as part of inspection) v � (sate coffin of soil,signs of hydraulic faihu+e,Ievel ofponding. condition of vegetation ateJ IVY: i ate on site ) Oaf of solids: Dimenabons. , b:( n of snail,erne of hydraulic failure level of ponding,condition of vegetation,etc.) . i ised 11/03/95) g r 'j f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 'Property Address: (�'( Ka%V, Owner. Date of Inspection: SKETCH OF SEWAGE, DlSP0)sAL'd4'STERf: include e.i„o to st lwfsst tu; 1,4,mrLfi tent. rs•frrene" landr:uirkn or iwnchmark t lo`a;e all welin a-it. in 1lh�' f# F r �l DEPTH TO GROUNDWATER Depth .r. to VmMwat.,_L�--feet of d0@ermination or aPPrc:imation: Ld revised 11/03/95) 9 'A__ ! - COTUI'T` NOTE: SEPTIC INFORMATION SHOWN PER TIE CARD LOW R�L PARK � Q<v4,1 LOCUS PORTION OF SCHOOL ST. COTUIT HOUSE AND f �� BULKHEAD BAY N TO BE co REMOVED z' PARCEL ID: Q 35/67 CoLo Lo _ _ _ -- — ETw EDGE LOCUS MAP - — AKA NICKERSON DRIVE fi �l — — — — 12' RIGHT OF `WAY (� _ 150.00 —UPOLE— -LOCUS INFORMATION BY EDGE OF WAY 123�2� _ N85'12'1:0 — — -"' _ —— — PLAN REF: 576/65 _ 3 ( Y _ - / �— TITLE REF: 10819/249 OHW N HEDGE j (f� PARCEL ID: +MAP 35 PAR. 64 W w N�1 ZONING: "Rr" SETBACKS: 30'=15'-15' N 'UPOLE I O F- SALT WATER ESTUARY PROTECTION WIND EXPOSURE "B" + FLOOD ZONE: "C" PARCEL ID: p 0 COMMUNITY PANEL: 250001-0018=D DATED:07/02/92 o .... 4819 z �'35/64 J ;; EXIST. HOUSE L, AREA=8,980t S.F. r*i 56.7 r�� ., , , . o. v NEW SUGGESTED I N ADDI '' "' OHW I 3 POLE CERTIFIED PLOT PLAN TION ��. , . . ' O �J FULL FND. POSITION OF THE SEPTIC `" ON CONC. 35.0 (FOR -ADDITION,) TANK 'AND DISTRIBUTION 10 15.2'sLAg�n PIERS N ,y 81`9 MAIN STREET CD BOX 4N. DE P SCREENED N ~ ' rn C O TU I T, M A. _ 00 14.0'— —13 7' v, PREPARED FOR PARCEL ID: N — _ _ _ -s__ — Ss•o, N i PETER G. S A L I S B U R Y 35/62 �- °cri -- _.— _ A.S. s�, 12/06/13 REVISED: 06/03/14 00 N81 5 FENCE �- — — °n OfAl t 129 L _ DRIVEWAY _ N, 4SSgo f 4.5' END OF FOUNDATION 70 TO BE 4' FROST WALL " _ �o�� ED HARD y�0 W%SLAB ON GRADE STON y PARCEL ID: 35/63 o.2 8 � AL LAND E. A. S. SURVEY, INC. GRAPHIC SCALE 141 ROUTE 6A SALT POND BUILDING zo 0 10 20 '40 '80 P.O. BOX 1729 SANDWICH, MA. 02563 ( IN FEET ) BUS:(508)888-3619 CELL:(508)527-3600 1 inch = 20 -- f �- — SHEET 1 OF 1 J 16,12A, PROJECT TITLE ~n 4 J tL :ilbQc Ml lc-� .. ........ - LL .1 & i � F if r r -. 1\-A Y x$ -- �' y ! I , At PREPARED FOR •:mot. f , ._._...--a..._ .®._.,.._ ` - _ 07 f - FLtral Cons" , Z S#eve L) vd � u _ "The F=kem ii820 Main Street .wr'r-ontr��ca.� e i SCALD, F s [SATE a! DESIGN DRAWN JO13 NO. h Existing Stair Ex. Closet z� _ New _ _ _ New _ Existing Bedroo �- Closet Closet i Existing Bedroom Existing .�' Mall New Hall s� j - New undry New Bedroom �3 823 10 =T' Existing . � Bathroom Li v t,.e - i i � z _ e ace