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1089 MAIN STREET (COTUIT) - Health
1089 -Mai n,Street (Cotuit) C.t�l�t F A 034 '011 I x; M: i� 1 f COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS Y d DEPARTMENT OF ENVIRONMENTAL PROTECTION A ly -C P_ y EIVED Vy� Z FEB 2 3 2005 OF TITLE 5 T°�NH 4LTBH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION I r -ARCEI, ' Property Address: 1089 Main St OT ""'`` ^ Cotuit(Barnstable),MA Owner's Name: Lori Bailey-Gates Owner's Address: 1089 Main St Cotuit,MA Date of Inspection: February 16,2005 Name of Inspector: Gary J and/or Jane E Rabesa Company Name: Rabesa Subsurface, Inc dba Warren Cesspool Service Mailing Address: PO Box 2302 Teaticket,MA 02536-2302 Telephone Number: 508-540-7143 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1.am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: V Passes. Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature Date: February 18,2005 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments: Title V system in good condition with no failure criteria. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page l I ~ Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1089 Main St Cotuit(Barnstable),MA Owner: Lori Bailey-Gates Date of Inspection: February 16,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: YES X 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: NO One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Warren Cesspool Service 508-540-7143 i Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1089 Main St Cotuit(Barnstable),MA Owner: Lori Bailey-Gates Date of Inspection: February 16,2005 C. Further Evaluation is Required by the Board of Health: NO Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Warren Cesspool Service 508-540-7143 T41. c ❑,..„,pit VlAnn 3 Page 4 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1089 Main St Cotuit(Barnstable),MA Owner: Lori Bailey-Gates Date of Inspection: February 16,2005 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool —X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded 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_ Liquid depth in cesspool is less than 6"below invert or available volume is less than''/z day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a 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 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forma NO (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: N/A To be considered a large system the system must serve a facility with a design flow of 10,000 god to 15,000 gad. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—I WPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Warren Cesspool Service 508-540-7143 T41. c P,,,..,,An cMnnn 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1089 Main St Cotuit(Barnstable),MA Owner: Lori Bailey-Gates Date of Inspection: February 16,2005 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No x — Pumping information was provided by the owner,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 the system obtained and examined?(If they were not available note as 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,including 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 no x_ — Existing 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 approximation of dis tance is unacceptable)[310 CMR 15.302(3)(b)]. Warren Cesspool Service 508-540-7143 I Page 6 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1089 Main St Cotuit(Barnstable),MA Owner: Lori Bailey-Gates Date of Inspection: February 16,2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): three Number of bedrooms(actual):two DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 gpd Number of current residents:one Does residence have a garbage grinder(yes or no): no Is laundry on a separate sewage system(yes or no): no [if yes separate inspection required] Laundry system inspected(yes or no): n/a Seasonal use:(yes or no): no Water meter readings,if available(last 2 years usage(gpd)):2003 averaged 96 gpd,2004 averaged 60 gpd Sump pump(yes or no): no Last date of occupancy: occupied. COMMERCIAL/INDUSTRIAL: N/A Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:(owner)tank pumped October 2004. Was system pumped as part of the inspection(yes or no): no If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM x Septic tank,distribution box,soil absorption system Single cesspool _—Overflow cesspool Privy _no_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: 1997 permit for septic_ tank and trench. Leach pit previously installed. Were sewage odors detected when arriving at the site(yes or no): no Warren Cesspool Service 508-540-7143 Page 7 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1089 Main St Cotuit(Barnstable),MA Owner: Lori Bailey-Gates Date of Inspection: February 16,2005 BUILDING SEWER: (locate on site plan) Depth below grade:24" Materials of construction: x cast iron x 40 PVC other(explain): Distance from private water supply well or suction line: town water line. Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: X(locate on site plan) Depth below grade: 19"(outlet cover raised to 7"below grade) Material of construction: x concrete_metal fiberglass_polyethylene_ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: standard 1500 gallon septic tank Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: none 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: onsite Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.):The tank has no apparent failure criteria. The DEP recommends pumping every three years depending on use. The tank was not pumped at the time of inspection. It should be pumped again in October of 2007. GREASE TRAP: NO(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Warren Cesspool Service 508-540-7143 •r;*10 c 1 #;.,., G..— 4/1 ci,)Ann 7 I Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1089 Main St Cotuit(Barnstable),MA Owner: Lori Bailey-Gates Date of Inspection:February 16,2005 TIGHT or HOLDING TANK: NO(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: YES(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Uncovered,there were no failure signs. The cover is 35" below grade and should be raised for future access. PUMP CHAMBER: NO(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.): Warren Cesspool Service 508-540-7143 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1089 Main St Cotuit(Barnstable),MA Owner: Lori Bailey-Gates Date of Inspection: February 16,2005 SOIL ABSORPTION SYSTEM(SAS): YES (locate on site plan,excavation not required) If SAS not located explain why: Type x leaching pits,number: one leaching chambers,number: leaching galleries,number: x leaching trenches,number, length:one: 30' long leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): The 3' deep by 6'wide precast leach pit(with 30"of stone verified)had 28"available below the outlet pipe. Staining no higher than 8" from the bottom. The cover is 6"below grade over 30" risers. The leaching trench was viewed by remote camera. It looked good. By installer's"as-built",it is 30' long. Four feet of stone was verified onsite. CESSPOOLS: NO(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert:_ Depth of solids layer:_ Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): no Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: NO(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.): Warren Cesspool Service 508-540-7143 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 108q Main St Cotuit(Barnstable),MA Owner: Lori Bailey-Gates Date of Inspection: February 16,2005 SKETCH OF SEWAGE DISPOSAL SYSTEM NOT TO SCALE Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 3 I `Jn( � �. S Pt lc, TANK- . � ea- 143- 91' 6-3- 3 IV L EAGI� P 1-r A q— o LEAGA TIEF0,16+4 © 5 5- 135- Warren Cesspool Service 508-540-7143 T;.io c t--+;— ❑,.r.,,All ci1nnn 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1089 Main St Cotuit(Barnstable),MA Owner: Lori Bailey-Gates Date of Inspection: February 16,2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water is greater than 13 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: x Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: health agent Checked with local excavators, installers-(attach documentation)Engineer's certification Accessed USGS database-explain:town topography maps,USGS survey mans You must describe how you established the high ground water elevation: From onsite transit readings,the bottom of the leach pit is 40"above the road surface. Across the street is another 10' lower. �3 0 Warren Cesspool Service 508-540-7143 o PPos i r SINE TOWN OF BARNSTABLE { LOCATION ': o3q I' otIn SEWAGE # VILLAGE BTU CT ASSESSOR'S MAP_& LOT INSTALLER'S NAME PHONE NO. W I�LTE� N• J.xw IS �'IZS' y( SEPTIC TANK CAPACITY �CJ LEACHING FACILITY:(type) r,( f`, 00,4,0 / s*) NO. OF BEDROOMS PRIVATE WELL OR BLIC WATE BUILDER OR OWNER S. LA00le �• �I DATE PERMIT ISSUED: DATE ISSUED:COMPLIANCE E C OZ P VARIANCE GRANTED: Yes No i �0. SUBJECT TO APPROVAL OF BARNSTABL•E CONSERVATION COMMISSION TOWN OF BARNSTABLE LOCATION �3-f ►e 1�I1r1 �� SEWAGE # VILLAGE C�To [T'. �' ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. Li48-a403 SEPTIC TANK CAPACITY c�a LEACHING FACILITY:(type) r4,`5/"4(" �OOP NO. OF BEDROOMS-PRIVATE WELL OR UE C WATE BUILDER OR OWNER _I° I j, U C. DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No X J v('�V v, �,ti �/ i No....l -. .._.7 Fx$.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABL.E Appliration for MiViiiial Wor1w C omitrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: -: or Lot No. ...�_j`...' -- - '•--•---• ---- ------•--_-•� ............................. er Address a •• -- ••• •-•---•--•---------••-----••-----•- -------------- ----:5-r--•-••. •-•---•---••......----•--••--------•---•--- Installer Address UType of Building Size Lot............................Sq. feet .� Dwelling—No. of Bedrooms_ -------------------------------------_-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ............................... . . W Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity-_____-.--_gallons Length---------------- Width---------------- Diameter................ Depth................ x Disposal Trench—No_ ___________________• Width--------------------- Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by------------------- ...................................................... Date........................................ a ,.� Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ P+ ••••------•..............•---------•---=--------------------------------------------•--•••-•----•-----------------------------------------.-... --------- 0 Description of Soil........................................................................................................................................................................ x U --•--•..._..-••----•--••......-- W -------------------------------------------------------------------------------------------••-•-•• j -....-- U Nature of Rep - - - - ---------- airs or Alterations—Answer when applicable._.__. �` �?___________ __ _____________ _ ----/----- ---------*......*-------- -------------------------------------------------------------- ------------------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance a iss d b th and of health. Signed .... .... .............. ...--- --... .... - Application.Approved By ........ - -s.�. =� - , 3 -------------------------------------- Dare Application Disapproved for the following reasons: ...................................................................................................................................... ...................................................................... ..............................------.................................................................................... -................ ----------------- Date Permit No. ----------Cis--------- .. ..7-------- ---------- Issued '�. - ..-�5�------------------- Dare p 4 No---- = 7 FEs ...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Y" Appliration for Mirp i3al WorkB Tomitrnrtinn Urrmit Application is hereby made for a Permit to Construct ( ) or Repair (` a�"n Individual Sewage Disposal System at: � 0 f t _10� M1� �Lation or Lot No. t O�n i Address R , Iiistaller Address UType of Building Size Lot............................Sq. feet ..� Dwelling—No. of Bedrooms ...................._-__-____.--.--._Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------. Showers ( ) — Cafeteria ( ) a4Other fixtures ---------------------------------- --------------------------------------------- ------ -------------•-----••-••••-•••-•--•---••-------•--•---------- W Design Flow--------------------------------------------gallons per person per day. Total daily flow-.--__---__.-_______------------------------gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width---------------- Diameter................ Depth................ x Disposal Trench—No. ....................41 dth___---.---._-_____-_ Total Length__-__-_-___--_--__- Total leaching area------------_.......sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (� ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit_-_-----_--_--_..___ Depth to ground water........................ Gi,, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ a -----------•------------------•----------------•------------------------------------......----------......................................................... 0 Description of Soil........................................................................................................................................................................ �C _ - V W -------------------------- ----------------------------------------------------------------------------------fi r --------- ......................... ' == U Nature of Repairs or Alterations—Answer when applicable-_.-:.. ::_ f%............ �.•--------.... v %?` ! .___..._.. -------••-•---•--_. ---------------------------------------------------------------------------•---..- -...- ------......= -.... --••-K-----------------•--------••----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has.,been issued by the board of health. r• „ Signed ------- 1` Dace� ' ` 1 (i'`/✓ f' �-' q Application,Approved BA. ;4 J -� .�-c-� .. .-.�.. ... ......------ ........ a r Application Disapproved for the following reasons: .... ...............................................------------................----------------------------------------------- ............................................._.......... ...................... .. .. ... ....__.---------_----- ------- --------------- -------------------- ------------------------------------- Dace Permit No`./.......... 'i_: ...:-... -7--------- - ... ,..,, Issued .. ........_ � 5 ---------------------- Dare t i ._�._.__._.,,,-4'-`_"�_.._._,...._�,_>�o.a,.-.,�,....._,.._.�_—,�.ao�n�,c���..��-�_a�._,�®�e�-m�_,:.�:_,o� � �•..._.�.=ems_—.�:-��o��a...���._>� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (11Elrtiftrate of N"Llomplin Tre i THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired - --- --- - ..... ns�a er f -- ------------- � , � has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. -------- S:_ .. -._ f..�....- dated .------ ------- .-..l.`�............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...... - ........�-�'- ---~G`---�- ------- ------------------------------ Inspector ---------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH () 0 TOWN OF BARNSTABLE �o FEEJ.----.-............. �i��rn�n1_, nrk���rrtt_�#ri�rtilan �rrmit Permission is hereby granted_...< �� ` "` ` .................. to Construct ( ) or Repair O an Individual Sewage Disposal, System atNo......mr s - ! ., � �s ,s' � ------------------------.................................. 1 7 t f F . ------------ Street G�}} {{�� as shown on the application for Disposal Works Construction Permit No.-j-�:-�..fl_7 Dated...... . ..-_...�._.'��........ ................................ Board of Health DATES --••-•-----••••--- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE U0CATION� 19 ;v 5r SEWAGE �,!LLAGECQ& ASSESSOR'S MAP 6z LOT INSTALLER'S NAME 6z PHONE NO.UMI/ 1,C CV;y vV2 F a'Y0 3 SEPTIC TANK CAPACITY /s ✓1 L f �1 LEACHING FACILITY:(type) 0o - ad- p- 1" (size) u� C NO. OF BEDROOMS PRIVATE WELL OR UBLIC A BUILDER OR OWNER P e obt, DATE PERMIT ISSUED: / O Q DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes ._ No G^� IJ 4 rN ASSESSORS MAP NO: 'q _ No.�D PARCEL NO: /� ............. - __. F� �..................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Allp irFation for 14sp.as al Works Tvtw rnrfuan ami# Application is hereby made for a Permit to Construct ( ) or Repair ( 64-1fi- Individual Sewage Disposal System at --�U.. — •---... /0L 1. ................... - ----•-•----•------- G7 t .......................................... Ad ss or Lot No. 4 . ._ .C� ............ ..--• ..... -td ---•--_--•-- ---•......_.. �. ...... .......... • ........... Owner `1_&°�----------v{•% �- �.. t' r. ............ Installer Address Type of Building Size Lot............................Sq. feet ., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria fl, Other fixtures -•---•--•--------••----------------------`----•-• . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No-------------------_ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft, Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by........................................................................... Date........................................ Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water................_...... . (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--__-_-___.________.___. a ------•---•-----••----------------•-•-------------------------------------------•------...--•--•----.......... --------•-----------------------------------•-- 0 - Description of Soil........................................................................................................................................................................ V ---------------------•---------------------------- •--••---------------- ••--- ---- W -----------------------•••-----------------------------•••-------------------•-•---•------------------•--- --------------- ----------- - U Nature of Rep irs or Alterati ns—fAnswe�when ap li ble__ �?�___...____ 2Jk`z_ ---- ©o g P 5 Agree Ent:T e undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian %eEd/�kjQe board.o ealth.ned : ... 1yLl�--.... ------------.------ --------------------------Application Approved By ..---"f -- ------...�- -- ------------------------- "` te` Application Disapproved for the following reasons: ............................... - - - - ---------------------------------------------=--- ---------------------------------..--....----..---------------......--- ----------- --------- - _� Date PermitNo. ��------- ---�------------- --------------- Issued ------.....l. ..1-�. -------D------ --- - Date No. D----- � �r Fps ..... THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Cnnnstrnrtion 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair ( 6)-ilg Individual Sewage Disposal System at: / 20..._ V -------- -------- - ---------- Ad s or Lot No. ......... .!_. .......................... .......�....... .__ f` (/!........ ....................................... Installer Address Q Type of Building Size Lot-----------------------------Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aa Other—T e of Building No. of persons............................ Showers YP g -------------•-------------• P ( ) — Cafeteria ( ) Otherfixtures ---------------------------------------------------------------•--------------------------------•--------•--------.._ ------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter------------------ Depth..... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.................... ft. -Seepage Pit No..................... Diameter.................... Depth below inlet.................... Tof_al leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ,Percolation Test Results Performed by.......................................................................... Date........................................ Te�st Pith No 1?ff_ /'��.____._.VA' minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2........._..__minutes per inch Depth of Test Pit.................... Depth to ground water.....---_--_:_-.._____- { x j ................................................ ----..... =- O Description of Soil-----.....--•------------------ •---•-•--•-••••-•-••-•••---•------•--------•--=------------------- ------ =...............................................' UW ---•-----------------------------------t•-----------------..------------------------....----•----•------------ --••--- ...........----....--- Nature of Repa'rs or Alterati ns—Answer hen ap li ble...,/ _____-a-�!�............................ .2). .... ....... �� � ---------.6-------- t -4 -------- , f' Agreefe t: Tundersigned agrees to instal`l the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the StateXhvi'Fonmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian - � d board of ealth. rz -, � -- • .d � O y °�5 ApplicationApproved By ------------- ----------h'�............ .�....------ --- ------------..........................."... - -------- -----------------I...........Dace Application Disapproved for the following reasons: - — -- ................... .. . .........................................................I. ................................................ --- ---- --- ----------- ...........- Da ! V ../V t e Permit No. ------------------------------�`�-.;�:� �� !,/' Issued �-------..1 �.���.__- ..............---- -- Dare THE COMMONWEALTH OF-MASSACHUSETTS BOARD,OF�HEALTH TOWN,OF,,BARNSTABLE CgPrtifi.0 tPmod% . C'yII FIi� nve - T�/x T EI�TIFY, T' the n vidual Sewage Disposal System constructed ( ) or Repaired ( , / � •" / by .......... 11� ^ -----------...... .-- =-.....__._........-----.......................--n'---- ............................. at _........._--....------..._...----_--------------------------------------- at — .. .... ................0, '... '.{ ....................lost e — has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ......170......f�./... dated __... .......... ` THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARArdEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.5 DATE....� ......... - � l l ...---------------- �.�. -................................................... Inspector ............ -----------------------...---...................................................... Nk"! THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH \� No. .� TOWN OF BARNSTABLE 4 ® FE�:l -' Disposal arr Tuntr "r Permission is hereby granted................ to Construct ( ) or,.Repair (4_ff an-Individual S a isposal System atNo....------ ----•----..._r. -••-------------------------•-------. ---------------=---------- /'' / '( Street as shown on the application for Disposal Works Construction Permit No..`3n...I..8_.�Dated..... ���U-•._--•--_----• 1 ---------�1L Board of Health DATE......................•-�-----•---a--.�'a--•................ FORM 38E08 HOBBS 6 WARREN,INC..PUBLISHERS Mh P VIC z x� SHo r over h R0O l : o Ro L x/ e0o tN�, �tT1+ 1 cal OI S howtR Q � • � QN,` STALL. l N ; M THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) . A DATA .r 7,a ''I r"�r �T t{!; � rl�"..• t..r, J.i a -ti�r5't''3%'q`�-'�,t` .N '��f - . AN. 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REALTY TRUST O� NCROACHMENT r •o a t�v N5944'51W _ o 258.27' SHED '� so ao Y 'it 17.8 ^ �4.3' 12.3' t W o N/F STING o WING VILLAGE 3 J. 2,�' 2.4' AREA 31,200 S. F.t a __ _ _4_8.3'-------------- g REALTY TRUST 1 1/2 STORY -- r,,; ': EXISTING 6 WOOD FRAME ROOF LINE i� _o n I CERTIFY THAT THE BUILDINGS ARE ;o ,t 2 STORx.iN SHELL c w'ELUNc a d LOCATED IN FLOOD PLAIN ZONE C m N wooD FRAM N oRlvEwaY "' ; Z o AS SHOWN ON FLOOD INSURANCE RATE MAP N �.1; GARXGE v, COMMUNITY PANEL NO. 250001 0018 D 24.3' 9.21 AND THAT FLOOD PLAIN ZONEC IS NOT A SPECIAL FLOOD HAZARD AREA. PAVED DRIVEWAY o q a jOS 252.91' S 59*50`16' E osr DATE R 'ISTERED PROFESSIONAL SB'WRH, ) N/F - DAL FOUND so VVITH LAND SURVEYOR D^H:.FOUND ROBERT C. MALLORS, JR & ELIZABETH UND MELLORS rn r` o CERTIFY THAT THE BUILDINGS ARE ±' LOCATED ON THE LOT AS SHOWN. 9 d OS ;} DATE kEGPTERED PROFESSIONAL LAND SURVEYOR LOT COVER AGE'"NOTES cB 147H r' D.H. FOUND EXISTING PROPOSED MAXIMUM ALLOWABLE N TI E BY STRUCTURES 15.2% NO CHANGE 20% Unless and until such time as the original (red) stomp of the responsible Professional Engineer, or Professional Lend Surveyor BY STRUCTURES .'s 32.0% NO CHANGE 40% appears on this plan: PAVING/PARK NG.+'; (A) no person or persons. Including any municipal or other public officials, may rely upon the information contained herein: and (B) this plan remains the property of Holmes dr McGrath, Inc. DATE DESCRIPTION jDrawn hecked R n E V -I�-S PLAN 1 O N S SHOWING PROPOSED D OLLIN UNIT0VER EXISTING GARAGE #1089 MAIN STREET PREPARED FOR LAURIE BAILEY—GATES IN COTUIT BARN STABLE, MA SCALE: 1"=20' DATE: AUG. 30.2005 +. NOTES holmes and mc�grath, inc. civil engineers and Ion surveyors 1. HOUSE NUMBER: 1089 GRAPHIC SCALE 9 ?:• 362 gifford street 508 548-3564(PHO"O 2. ASSESSOR'S NUMBER 034-011 20 10 O 20 - /:- s0 falmouth ma. 02540 508 548-9672 3. ZONING DISTRICT: RF 4. FLOOD HAZARD ZONES: C DRAWN: SGL CHECKED: II' F1wr JOB NO: 205209 DWG. NO: 86-2-22 S ET 1 OF 2 1 inch 20 ft. 7� l+ N� O P ME ------------ -------- 12 -1 1 1 LIVING i I - lo , N l l NE 1 , 1 ; 1 BEDROOM , BATH i 7'-3" s` I CL I. 1 Or 9" o NOTICE - unless and until such time as the Original,(red) stamp of the responsible Professional Engineer, or Professional Land Surveyor appears on this plan: :.. (A) no person or persons, including any municipal or other public officlols, may rely upon the information contolned herein; and (3) this.plan remains the property of Holmes & mcGroth. Inn SECOND FLOOR BUILDING DETAIL DATE DESCRIPTION Drawn eCked SCALE 1/4"-1' R E V I S 1 0 N''S FLOOR PLAN SHOWING PROPOSED DWELLING UNIT OVER EXISTING GARAGE #1089 MAIN STREET PREPARED FOR c' LAURIE BAILEY—GATES IN COTUIT BARNSTAB MA GRAPHIC SCALE SCALE: 1/4"=1' DATE: AUG. 30, 2005 NOTES 4 2 0 4 ,2 holmes and me rath inc. civil engineers and land surveyors t o EILEa �, 1. HOUSE NUMBER: 1089 <!. Ta--r..n _ 2. ASSESSOR'S NUMBER: 034-011 ( in >� ) fal gifford street 508 548-3554(P►#oHE) t taaH s 4 tt Falmouth ma. 02540 508 548-9672.(Fr`,r*�`" 3. ZONING DISTRICT: RF DRAWN: SGL CHECKED: 4. FLOOD HAZARD ZONES: C B\BAILEY—GATES\205209\205 209 WS.DWG JOB NO: 205209 DWG. NO: 86-2=22 EET 2 of 2 --