Loading...
HomeMy WebLinkAbout0245 POPONESSETT ROAD - Health 245 Poponeasett Road Cotuit P A 019 172001 i 1f�I� I' Il� Y 1 �i 41 1 l J s 1 f v An b`/yr�11L\ca\ Commonwealth of Massachusetts 619 Title 5 official Inspection Form , Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'f 245 Pop onessett Road , Property Address Marie Mathurin Owner Owner's Name - information is required for every COtUIt Ma. 02635 02/24/2016xin page. Cityrrown State Zip Code Date of Inspe n Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael T Bisienere use the return key. Name of Inspector Cape Septic Inspections r� Company Name 624 Old Barnstable Road Company Address Mashpee Ma. 02649 Cityrrown State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority cf � — 02/24/2016 Inspector's Signature Date 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. ****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. �o �s t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 245 Poponessett Road Property Address Marie Mathurin Owner Owner's Name information is required for every Cotuit Ma. 02635 02/24/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: This home has a H-10 1500 gallon septic tank a H-10 D-Box and a pre-cast leaching pit it also has a leaching trench . B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)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. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of.17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 245 Poponessett Road Property Address Marie Mathurin Owner Owner's Name information is re uired for every COtUit Ma. 02635 02/24/2016 page. Cityrrown state Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or,replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y . ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N . ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 245 Poponessett Road Property Address Marie Mathurin Owner Owner's Name information is required for every Cotuit Ma. 02635 02/24/2016 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 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 106 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 fecal coliform bacteria indicates absent 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: D) System Failure Criteria Applicable•to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts _ . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M •'y 245 Poponessett Road Property Address Marie Mathurin Owner Owner's Name information is required for every COtUIt Ma. 02635 02/24/2016 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® 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: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 245 Poponessett Road Property Address Marie Mathurin Owner Owner's Name information is re uired for every COtUIt Ma. 02635 02/24/2016 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of.liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): i t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 245 Poponessett Road Property Address Marie Mathurin Owner Owner's Name information is required for every COtUIt Ma. 02635 02/24/2016 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection El ® No information in this report.) �I Laundry system inspected? ❑ Yes ❑ No 1 i Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: in 2015 13,000 gallons were used and in 2014 36,000 gallons were used Sump pump? ❑ Yes ® No Last date of occupancy: Fall 2015 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if,available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 245 Poponessett Road Property Address Marie Mathurin Owner Owner's Name information is re uired for every COtUIt Ma. 02635 02/24/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 245 Poponessett Road Property Address Marie Mathurin Owner Owner's Name information is required for every COtUit Ma. 02635 02/24/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 22"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 17"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: Years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: standard 1500 gallon Sludge depth: 3" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Ell Title 5 official Inspection Form "s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,••' 245 Poponessett Road Property Address Marie Mathurin Owner Owner's Name information is required for every COtUIt Ma. 02635 02/24/2016 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle apx:35" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle apx. 5" ' Distance from bottom of scum to bottom of outlet tee or baffle apx. 12" How were dimensions determined? sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I would recommend the new owner put the tank on a maint. plan with a local septic pumping co. based on the future use of the home.The Barnstable Health Dept. has a list of local pumping co.Both the inlet cover and the discharge cover are raised I Grease Trap(locate on site plan):, Depth below grade: feet ' 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: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form subsurface Sewage Disp osal System Form - g p Not t for VoluntaryAssessments essments .•' 245 Poponessett Road Property Address Marie Mathurin Owner Owner's Name information is Cotuit required for every Ma. 02635 02/24/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate'on site plan): Depth below grade: Material of construction: i ❑ concrete ❑ metal ❑ fiberglass El polyethylene El other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): rt Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts ;. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w y 245 Poponessett Road Property Address Marie Mathurin Owner Owner's Name information is required for every COtUIt Ma. 02635 02/24/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): I Depth of liquid level above outlet invert 0il 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.): At the time of the inspection there no signs of solids carryover or evidence of hydraulic failure Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): f 1 *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M ,•' 245 Poponessett Road Property Address Marie Mathurin Owner Owner's Name information is Cotuit required for every Ma. 02635 02/24/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: One ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: one apx. 44 x 11 ❑ 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.): Both the leaching trench and the leachin pit were dry at the time of the inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth-top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 245 Poponessett Road Property Address Marie Mathurin Owner Owner's Name information is required for every Cotuit Ma. 02635 02/24/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) ` Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 245 Poponessett Road Property Address Marie Mathurin Owner Owner's Name information is required for every COtUIt Ma. 02635 02/24/2016 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately GJ 9'� "G + O o ` 3 ' 50 �- 0J ter' A I 5' A-5. N U = 413 r jy � 3 L t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 I ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 245. Poponessett Road Property Address Marie Mathurin Owner Owner's Name information is required for every COtUIt Ma. 02635 02/24/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 15 plus feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record! If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I,augered a hole in the dry leaching pit to show five plus feet of seperation Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,.•'' 245 Poponessett Road Property Address Marie Mathurin Owner Owner's Name information is required for every COtUIt Ma. 02635 02/24/2016 page. City/Town State Zip Code Date of inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked i ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file (� o'I-i jm of Lec,-c-k.^J5bOT-Toyn or -17 V i j)jj_5 j e.e;T V t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 245 POPONESSETT RD Property Address MARIE MATHURINE �� (9 y Owner Owner's Name information is required for COTUIT MA 02635 3/11/08 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. t filling Whea filling out A. General Information When forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A. BROWN cursor-do not Name of Inspector use the return key. D.A. BROWN ^ Company Name P.O. BOX 145 Company Address CENTERVILLE MA . 02632 City/Town State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance-of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15 340 of Title 5(310 CMR 15.000).The system: ® Passes' ❑ Conditionally Passes ❑ F a i s ry G� c-n is ❑ Needs Further Evaluation by the Local Approving Authority ' "- -z if 1711) ' r- 3/11/08 CD r-1 Inspector's ' nature Date 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. ****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 V Inspection Form.doc•08108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 t s � Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 245 POPONESSETT RD Property Address MARIE MATHURINE Owner Owner's Name information is required for COTUIT MA 02635 3/11/08 `every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) . Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ' 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: SYSTEM AND OVER FLOW PIT MEET DESIGN FLOW FOR FIVE BEDROOMS B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as ' approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if,a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: i ❑ 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 Title V Inspection Forrn.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 245 POPONESSETT RD Property Address MARIE MATHURINE Owner Owners Name information is COTUIT required for MA 02635 '3/11/08 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cost.) a B) System Conditionally Passes (cont.): ❑ 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): 0 broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further.Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a mannerwhich 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. El The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Title V Inspection Forrn.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 245 POPONESSETT RD Property Address MARIE MATHURINE Owner Owner's Name information is COTUIT required for MA 02635 3/11/08 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 indicates absent 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: D) System Failure Criteria Applicable to All Systems: You must indicate",Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due'to overloaded or ' clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ' ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Title V Inspection Form.doc•08106 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Fora. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 245 POPONESSETT RD Property Address MARIE MATHURINE Owner owner's Name information is COTUIT re uired for MA 02635 3/11/08 every page. Citylrown State Zip Code Date of Inspection B. Certification cont. D) System Failure Criteria Applicable to-All Systems(cont.): Yes No ❑ ® Any portion of a cesspool or privy is.within a Zone 1 of a public well. ' ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd 10,000gpd. ❑ ® 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: To be considered a large system the system must serve a facility with a' design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D.shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the.appropriate regional office of the Department. Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 245 POPONESSETT RD Property Address MARIE MATHURINE Owner owner's Name information is COTUIT required for MA 02635 3/11/08 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ❑ Has the system received normal flows in the previous two week period? 0. ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank . inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing.information. For example, a plan at the Board of Health. ® F, 'Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] Title V Inspection Form.doc•08/O6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Fora - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "( 245 POPONESSETT RD Property Address - MARIE MATHURINE Owner Owner's Name information is COTUIT required for MA 02635 3/11/08 every page. City/Town - State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): . ' S Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for.example: 110 gpd x#of bedrooms): 550 Number of current residents: - 2 Does residence have a garbage grinder? ❑ Yes Z No Is laundry on a_separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): 06-38/07-68 Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd)- Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No . Water meter readings, if available: Last date of occupancy/use: pate Other(describe): . Title V Inspection Form.doc•06f06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 245 POPONESSETT RD Property Address MARIE MATHURINE - Owner Owner's Name inormation is COTUIT requiredfor MA 02635 3/11/08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: ' Source of information: OWNER PUMPED 2005 Was system pumped as part of the inspection? ❑ Yes-® No If yes, volume pumped: ' gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, 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 ACCORDING TO PERMIT#97-614 Were sewage odors detected when arriving at the site? ❑ Yes ® No Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurface Sew age age Disposal System Form Not for Voluntary Assessments 245 POPONESSETT RD Property Address MARIE MATHURINE Owner Owner's Name information is COTUIT required for MA. -02635 3/11/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): - Depth below grade: feet Material of construction: ❑ cast iron ❑`40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass-- ❑ polyethylene ❑ other(explain) 1500 GALLON If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No ------------------- --------------------- ---- ------------------------ ----------------------------------------- Dimensions: 10.5 X 5.8 Sludge depth: 611 Distance from top of sludge to bottom of outlet tee or baffle 2711 Scum thickness TRACE 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? WODDEN POLE Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 245 POPONESSETT RD Property Address MARIE MATHURINE - Owner Owner;Name information is COTUIT required for MA 02635 3/11/08 every page. City/Town State Zip Code Date of Inspection D. System information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): RECOMMENDED PUMPING TO OWNER BECAUSE IT HAS BEEN THREE YRS SINCE PUMPED Grease Trap(locate on site plan): Depth below grade: feet 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: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene . ❑other(explain): Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 't 245 POPONESSETT RD Property Address MARIE MATHURINE Owner Owner's Name information is COTUIT required for MA 02635 3/11/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (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 leakage into or out of.box, etc.): SLIGHT SCUM LAYER IN b-BOX Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Tide V Inspection Forrn.doe 08/06 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form , , Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 245 POPONESSETT RD Property Address MARIE MATHURINE Owner Owner's Name information is COTUIT rey uired for MA 02635 3/11/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.), Comments (note condition of pump chamber;condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required):. If SAS not located, explain why: OPENED 1 MAXIMIZER IT WAS DRY AT THIS TIME, OVER FLOW PIT DRY STAIN LINE AT 4 FT Type: ® leaching pits number: 2-1 INSPECTED ® leaching chambers number: 4. ❑ leaching galleries number: ❑ leaching trenches number, length:, ` ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): NO SIGNS OF HYDRAULIC FAILURE Title V Inspection Form.doc•08/06 ` Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 245 POPONESSETT RD Property Address MARIE MATHURINE Owner Owner's Name inormation is COTUIT requiredfor MA 02635 3/11/08 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration . Depth—top of liquid to inlet invert _ Depth of solids layer " Depth of scum layer Dimensions of cesspool ' Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure;level of ponding, condition of vegetation, etc.): , Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Title V Inspection Form.doc•08/06 Title 5 Official c al Inspection form:Subsurface Sewage D'Pe g Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form" Subsurface Sewage Disposal System Form- Not for Voluntary Assessments '^ 245 POPONESSETT RD Property Address , MARIE MATHURINE Owner Owner's Name information is required for COTUIT MA' 02635 3111/08 every page. City/Town State. Zip Code Date of Inspection D. System Information (cont.) A Sketch Of Sewage Disposal System: Provide a sketch of the sewage"disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. cxc ~ IV y, A'� k _ e0 Pt Title V Inspection For m.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 A , A ' • • , , Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 'l 245 POPONESSETT RD Property Address MARIE MATHURINE ' Owner Owner's Name information is COTUIT required for MA 02635 3/11108 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑ Check Slope _ ❑ Surface water ' ❑ Check cellar ❑ Shallow wells Estimated depth to ground water: 25++ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-'(attach documentation) _ ❑ Accessed USGS database-explain: ' You must describe how you established the high ground water elevation: OFF PREVIOUS ACCEPTED TITLE FIVE REPORT DATEDMAY 20 2005 PAT OCONNELL Tide V Inspection Fotm.doc•O&W Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 WE Town of Barnstable yip ti� Regulatory Services B,R,,S,,,B Thomas F. Geiler,Director A,E019. Public Health Division Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-8624644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Bamstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. i i ��tNE The Town of Barnstable BARNSfABLE. "A 1639. Growth Management Department `0� 367 Main Street,3rd Floor Hyannis, MA 02601 Tel:508-862-4678 Fax:508-862-4782 February 4,2008 John C.Klinm,Town Manager Janet Joakim,Town Council President Barnstable Town Hall 367 Main Street Hyannis,MA 02601 Re: Marie and Jean Luc Mathurin, 245 Poponessett Road, Cotuit; one-bedroom accessory unit This letter is to inform you that the Accessory Affordable Apartment (Amnesty) Program has received a request for a project eligibility letter under the Community Development Block Grant (CDBG) Fund and under Article II of Chapter Nine of the Code of the Town of Barnstable and the criteria for the Local Chapter 40B Program. This office is reviewing the request. If the Town has any comments on the project, please forward them to me so that they can be addressed in the site approval letter. This letter gives you official notice of our receipt of the above application(s). We will issue a decision as to the acceptability of the sites and the consistency of this development within the guidelines of CDBG. Sincerely, Elizabeth Dillen Special Projects Coordinator Growth Management Department cc: Building Division Health Division V Message Page 1 of 2 McKean, Thomas From: McKean, Thomas Sent: Tuesday, March 18, 2008 8:38 AM To: Dillen, Elizabeth Subject: RE: 245 Poponessett Road, Cotuit This application is: Approved for 5 Bedrooms -----Original Message----- From: Dillen, Elizabeth Sent: Monday, March 17, 2008 4:48 PM To: McKean,Thomas Subject: RE: 245 Poponessett Road, Cotuit Hi Tom - I'll send over a copy-what's your fax#? Beth Ditten Spectat Projects Coordinator Growth Management Department Town.of BarnstaPAe. 367 Main Street,t-ivannis MA TeL 508.862,4683 Fax 508.862,4782 -----Original Message----- From: McKean, Thomas Sent: Monday, March 17, 2008 4:47 PM To: Dillen, Elizabeth Subject: FW: 245 Poponessett Road, Cotuit FYI -----Original Message----- From: Barrett, Caitlin Sent: Monday, March 17, 2008 4:31 PM To: McKean, Thomas Subject: RE: 245 Poponessett Road, Cotuit do not recall seeing this one come in, however when i do see it i will bring it to you ASAP. -----Original Message----- From: McKean, Thomas Sent: Monday, March 17, 2008 4:22 PM To: Barrett, Caitlin Subject: FW: 245 Poponessett Road, Cotuit Caitie, 6/23/2008 Message Page 2 of 2 If we received this report, may I see it -when you get a chance? -----Original Message----- From: Dillen, Elizabeth Sent: Wednesday, March 12, 2008 3:34 PM To: McKean, Thomas Cc: Stanton, David Subject: 245 Poponessett Road, Cotuit Hi Tom -Marie Mathurin of 245 Poponessett Road, Cotuit left a message saying that Doug Brown dropped off a septic inspection report to the Health Division yesterday. If you can now approve five bedrooms at this property, please fax over her septic application at your earliest convenience so that I can get a site approval from the Town Manager. Thanks, Beth Beth.t?itten Speciat Projects Coordinator Growth Management Department Town of Barnstabte 367 Main Street,Hyannis Mn Tel 508.862.4-683 Fax 508,862.4-782 I 6/23/2008 L'w. McKean, Thomas From: McKean, Thomas Sent: Tuesday, February 12, 2008 8:29 AM To: Dillen, Elizabeth Cc: Miorandi, Donna Subject: RE: 245 Poponessett Road, Cotuit Good Mo_ning, After reviewing the file and discussing the contents with other health inspectors, we don't know whether or not the septic system has sufficient capacity for five bedrooms. Please inform the applicant that she or he needs to hire an engineer or a qualified inspector to make a determination of whether or not the system has sufficient capacity. HISTORY The original septic system was constructed in 1978 with a capacity for five bedrooms. That system apparently failed in 1997 . It was then replaced with four infiltrators. The disposal works construction permit was for four bedrooms and the subsequent septic inspection reports were for four bedrooms. WHAT WOULD BE REQUIRED? Six or more infiltrators would be required for five bedrooms. This system does not consists of six or more infiltrators. Please inform the applicant that she -or he needs to hire an engineer or qualified inspector to make a determination of whether or not the system has sufficient capacity. Sincerely, Thomas McKean -----Original Message----- From: Dillen, Elizabeth Sent: Monday, February 11, 2008 12:54 PM To: McKean, Thomas Subject: RE: 245 Poponessett Road, Cotuit Not sure - she described her as having short blond hair, if that helps! Beth Dillen Special Projects Coordinator Growth Management Department Town of Barnstable 367 Main Street, Hyannis MA Tel 508 .862.4683 Fax 508. 862.4782 -----Original Message-- -- From: McKean, Thomas Sent: Monday, February 11, 2008 12:48 PM To: Dillen, Elizabeth Subject: Re: 245 Poponessett Road, Cotuit I 'll look into it. Was it Donna or Meredith? ----- Original Message ----- From: Dillen, Elizabeth To: McKean, Thomas 1 ti b Sent: Mon Feb 11 12:37:34 2008 Subject: 245 Poponessett Road, Cotuit Hi Tom - I received your response to the accessory apartment septic questionnaire for 245 Poponessett Road, Cotuit. I relayed it to the owner, who explained to me that before applying to the Program, she had met with a very helpful female inspector in your office who had checked the property file and verified that her septic was okay for five bedrooms. She was told that if she wanted to add a sixth bedroom, she would need to hire a septic engineer. Is there any way we can get this discrepancy clarified? Thanks for any help you can provide, Beth Beth Dillen Special Projects Coordinator Growth Management Department Town of Barnstable 367 Main Street, Hyannis MA Tel 508.862.4683 Fax 508.862.4782 2 Town of Barnstable Health Inspector Office Hours do Regulatory Services 8:30—9:30 * Thomas F.Geiler,Director 1:00—2:00 * E BARNSfABL , 9� 039. � Public Health Division A�F p 39�a Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT — SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: C��S Address: & Map�(�'_Parcel 0 Name: M Q I e M Q I/ f'I yl Phone #: 2a. How many bedrooms exist at your property now? 2b. Are you planning to add any bedrooms? r1 If yes, how many? 2c. How many bedrooms total are proposed at this property(including the amnesty unit)? (� 2d. Please include a copy of the floor plans for the entire property- showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or O If the dwelling is connected to public sewer,skip questions#4 through#9 below. 4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? 5. Is the dwelling connected to an ONSITE ELL or to PUBLIC WATER? 6. Is a disposal works construction permit on file? YES or NO 6a. If yes,how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES or NO 8. Is there an engineered septic system plan on file at the Health Division? YES or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO ------------------------------------------------------------------------------------------------------------------- � FOR OFFICE USE ONLY �,-7 The Public Health Division has no objection to Al bedrooms at this roperty. Special Conditions: _ ,� 5A��. �k �-i5� 6 �o -- Signed; - Date: 2 Q;/health/w+ les amn�es tyVpE�n�. w,s1�a, 4' `�e� �°Y`' fi�C inS i�eo� Ptuta �aYe ` ,, �0 �``re- � Q��G � �gC4"o ayeiCe -a . �e n btsL J— W0,4 .have --6o ;As e.60, ei Message Page 1 of 1 McKean, Thomas From: McKean, Thomas Sent: Monday, February 25, 2008 9:38 AM To: Dillen, Elizabeth Subject: RE: 67 Marston Ave, Hyannisport and 245 Poponessett Rd, Cotuit 245 Popponesset- Please see e-mail from me dated February 12, 2008 indicating the system is undersized. No additional information received since then. a 67 Marstons Ave- Received a three bedroom deed restriction by FAX and an copy of an e-mail from Joe Gianesin indicating he hired an engineer and an excavator, Ron's Excavating. He also submitted a copy of a bill from Ron's Excavating (requiring 10% down). We do not have an engineer's certification.indicating the work was completed properly -see my e-mail regarding this dated February 15, 2008. No engineer's certification received since then. -----Original Message----- From: Dillen, Elizabeth Sent: Friday, February 22, 2008 4:40 PM To: McKean, Thomas Subject: 67 Marston Ave, Hyannisport and 245 Poponessett Rd, Cotuit Hi Tom - I am wondering whether there have been any developments with either the Gianesin (67 Marston Ave, Hyannisport) or Mathurin (245 Poponessett Rd, Cotuit) septic applications for the Accessory Apartment Program?They were both supposed to provide information to your office. Beth NUen ' Specica.t Projects C:oorfUncaor Growth Management Department . Iown of Sarnstc4_, 367 MaInStreet,Hgunnis MA Y `r l..et 508.862.4 683 Fax 508.862.E 782 - F . 2/25/2008 y Commonwealth of Massachusetts Time 5 Official Inspection FormE. _ F , a Subsurface Sewage Disposal System Form�Not Voluntary }+� for V luntary Assessments 245 POPONESSETT RD Property Address —____-- MARIE MATHLIRINE frJormatiort is Name Frform �...__...__ required for COTUIT MA 02535 3/11108 ell ypage- CWTown State Zip Code Bate of has ,Up Inspection results must be submitted on this form. Inspection forms repay not be alile ed in e;ir�_� way. Vlrltdn Fillirig out A. General Information forms on the oomputer.use 1. Inspector: only,the fah key c vor Move your c�rrr�r-do not DOUGLAS A. BROWN use the return Name of Inspectnr _� ,•. _.- hey. D.A, BROWN Comfy Name ym�n11, P.O. BOX 145 CompanyAddresr CENTERVILLE MA 02632 City/Town state 21p code _- 50®-420-4534 S 14297 Telephone Number Lioerwe Number B. Certification 1 certify that I have personally inspected the sewage disposal system at this address and tha'-the ' information reported below is true, accurate and complete as of the time of the inspection.The insp etl'.ir;rt was performed based on my training and experience in the proper function and maintenance of arl Mte sewage disposal systems_ I am a DEP approved system inspector pursuant to Section 15n�-,1A3O 4;;rff Title 6 (2110 CUIR 15.000).The system: ® Passes ; ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority `� 3/1110 3 nepec a Signature Date ---The systerp inspector shall submit a copy of this inspection report to the Approving Authority (Eloard of Health or DEP)within 30 days of completing this inspection. If the system is a shared.5ysten7 01 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall subrri t the report to the appropriate regional office of the DEP. The original should be sent to the system mur er. and copies sent to the buyer, if applicable, and the approving authority. "•"'This report only describes conditions at the time of inspection and under the conditions o°jtseW. at that Umeo This inspection does not address how the system will perform in thefi.rtlim luiljtle,j° the same or dif-lerent conditions of use. Ms V IPapW=Farmdoc-cwB Tleb50tfielullnspeet;onFor,n;SubauRocoSswageDi:posal3yat�,rq.�•1e935 - Z 'd LL9 'ON Wd6v: 80 7 y Commonwealth of Massachusetts y� Title 5 Official (inspection Form _ Subsurface Sewage Disposal System Forma Not for Voluntary,Assessments 245 POPONESSETT RD Property Address MARIE MATHURINE Owner Owneez Name -= lryformation is ro requiredfor COTUIT MA 02635 3f11108 c^rr=r!PSS'=• CitylTown State Zip Code ®ate of Irspecton �. Certification (cunt.) Inspection Summary; Check A,B,C,D or E/always complete all of Section ® . A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria desahl:nd in 310 CMR 15.303 or in 310 CMR 15.304 exist Any failure criteria not evaluated are; indicated below. Comments: SYSTEM AND OVER FLOW PIT MEET DESIGN FLOW FOR FIVE BEDROOMS B) System Conditionally Passes: One or more system components as described in the"Conditional Pass'section reed to blil replaced or repaired. The system, upon completion of the replacement or repair; as apprMle': iag� the Board of Health,will pass. Answer yes, no or not determined (Y, N, NO) in the 0 for the follo%ing statements_ If'riot determined,' please explain_ ® The septic tank is metal and over 20 years oi®r or the septic tank(whether rmetal or nrafi)ji:9 i structurally unsound, exhibits substantial infiltration or exIlltration or tank failure is imminenit. 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 tankVvill 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, N0 Explain- [] Observation of sewage backup or break out or high static water level in the distribution bo;x due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution bo)e,;;ystEs:m=' ill pass inspection if(with approval of Board of Health): �] broken pipe(s) are replaced obstruction is removed 7'ge\'�p�FnFerm.tiec•OB�B • 77N.S QRiakolJnapetsion Prm,SuCauReoe Savra�®®pose!Sq,!rMrni-Ee(�e 2cf i;a i Commonwealth of Massachuse tts l Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments lip 245 POPONESSETT RD Property Addresscqyner MARIE MATNURINE informaliarlls Owner's Name information COTUI quired for yao" MA 02635 � 3111108� every pale. CithylTcwm State Zip Code Date of Insp®eior, B. Certification (cost.) r : B) System Conditionally Passes(cunt.); ' Q distribution box is leveled or replaced ` i ND Explain: ❑ The system required pumping more than 4 times'a year due to broken or obstructed WP' (;;;) 1-�, ;` system will pass inspection if(with approval of the Board of Health): ® broken pipe(s) are replaced ® obstruction is removed ND Explain: C) Further Evaluation -- •• - -•__. . is Required by the Board of Health: r Conditions exist which require further evaluation by the Board of Heart in order to deterrilinIe ail' the system is failing to protect public health, safety or the environment, c. 1. System will pass unless Board of Health determines in accordance with 3111 C,IAR t 16,303(9)(b)that the system is not functioning in a manner which will protect public he ltth, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feel of a bordering vegetated wetland or a salt mersh 2. System will fall unless the Board of Health(and public Water Supplier,of any) determines that the system is functioning in a manner that protects the public health, salety and environment: ® The system has a septic tank and soil absorption system (SAS) and the SAIS 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 wi supply. thin a done 1 of �a a �, b,lic,a,;�;;r ❑ The syrstem has a septic tank and SAS and the SAS is within 50 feet of a private wci$P.'. supply well_ 'F1ps I Crhsi�1e;9 Form,doe•08y0S T1dc 5 OR1eiW 1nspaMW Fogs,Svbsurfsu S�Bge Dhpop�l S3^i mm•. �3 u '1! 4ti 'd LO 'ON A016�1 :8 8007 Commonwealth of IVFassachusetLs Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 245 POPONESSETT RD Property AddressOvvi MARIE MATHURINE infor mad�an i$r Owner's Name r�for mqui►ed for COTUIT NIA 02635 3/11lOS every page. cay/rovmn State 71p Code ®aw of EL Certification (cunt.) C) Further Evaluation is Required by the ®Gard of Health (cant.): The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or t more from a private water supply well*@. i Method used to determine distance: This system passes if the well water analysis,performed at a DEP certified laboratory, for coll0iriI bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is; equal i.0'tpr- less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis tnlas#'b;P attached to this form. 3. Other: i D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"NO"to each of the fallowing for all inspections, } Yes No ® Backup of sewage into Facility or system component due to overloadE.A or 3 clogged SAS or cesspoo) ; ® ® Discharge or ponding of effluent to the surface of the ground or sufaia a vvahC rs due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to air)overJr.:a.:�e d or clogged SAS or cesspool ® Liquid depth in cesspool is less than 6"below invert or available volurns i!a Ir ss. than Y2 day flow E ® Required pumping more than 4 times in the last year MOT due to clogged alp obstructed pipe(s). Number of times pumped: ® 9 Any portion of the SAS, cesspool or privy is below high ground watfar.f=1'a%rratiaari. ij Z Any portion of cesspool or privy is within 100 feet of a surface water supply.or tributary to a surface water supply. i111®\rin:p�lonForta.doe-odpg TWQ 5 official ftpadcn,Fmrn:SUbduf m Senago 0lapagalS3r•IBM <95 t ' F commonwealth of massachusetts - Title 5 Official Inspection Form e e Subsurface Sewage Disposal System Form_ Not for Voluntary Assessments #. 245 POPONESSETT RD Property Address MARIE MATHl1RIWE —��---- --- o•`wn Owners Namo infomna�ipn Is required for COTt11T MA 02635_ -� evefY Page. i Uown C State Zip Code ®ate ofjns<aectfon Bo Certification (cons.) - d) System Failure Criteria Applicable to All Systems;cont,)- Yes No y E Any portion of a cesspool or privy is within a Zone 9 of a public well., Any portion of a cesspool or privy is within 50 feet of a private wEitei.supial f well. ® Any portion of a cesspool or privy is less than 100 feet but greater than from a private water supply well with no aexeptable water quality�tnraiysi:;_ t °irousa system passes if the well water analysis,performed at a®Eli o�ae$ifia: laboratory,for fecal coliform bacberia indicates absent and the 1pres,ixitu� of ammonia nitrogen and nitrate nitrogen Is equal to or less thann 5 provided that no other failure criteria are triggered.A,copy of the ainalyisis and chain of custody must be attached to this form] , ® The system is a cesspool serving a facility with a design flow of 20(X)9pd'•-: } 10,000gpd. ® The system fails. I have determined that one or more of the above Ieihre. criteria exist as described in 310 CMR 15.303, therefore the system fails, T 1e system ovvner should contact the Board of health to determine what,Mll be necessary to oorrect the failure. E) Large Systems: To be considered a large system the system must,serve a'Facilit `design flow of 10,000 gpd to 15,000 gpde y yuitlh ; For large systems, you must indicate either"yes"or"no" to each of the following, ire.addition to th€* questions in Section D. 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 watar:s,lpply . the system is located in a nitrogen sensitive area(Interim Wellheacl Pj.c)tetr,ti Area—JWPA)or a mapped Zone If of a public water supply well zn ' If you have answered"yes"to an � y question in Section E the system is considered a signifiaint thrha.it'., , or answered "yes" in Section D above the large system has failed. The owner or operator of any I arid=„, system considered a significant threat under Section E or trailed under Section 0 shall upgra,cie tf,, # system in accordance with 310 CMR 15.304. The system owner should contact the appropr[3te regional office of the Department TP to V Imp�loq Fetm doe•D9lob' TWe S Wtiaf Inapectpa Folro:subsudse plgpaeq!S)Flh m-Riga s or1; t 59 'd LL9 'ON Wdos :� 800Z i Commonwealth of Massachusetts - This 5 Official Inspection Form ti,a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments _ 245 POPONESSETT RD Proper y Address MARIE MATHURINE Darner Ownw%Name informabon Is C07UIT requked for NIA 02635 3111108 every pzse. city/rown State T Code` Date of ins ectian C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the Micrrvilig: Yes No !` El Pumping information was provided by the owner, occupant, or Board of H::,altl� ® Were any of the system components pumped out in the previous tvw ��e€'i�;``• ® Has the system received normal flows in the previous two week perioija . i ® Have large volumes'of water been introduced to the system recently tar as.pan ol, this inspection? ® ® Were as built plans of the system obtained and examined? (If they we;ra na;)t available note as NIA) t ` Was the facility or dwelling inspected for signs of sewage batik up? ® Was the site inspected for signs of break out? £` ® ® Were all system components, excluding the SAS, located on site? f Were the septic tank manholes uncovered, opened, and the interior`of the tc�ial< Inspected for the condition of the baffles or tees, material of constructilDn, dimensions, depth of liquid, depth of sludge and depth of scum? + Was the facility owner(and occupants if different from owner)prov!ded witl-j ` information on the proper maintenance of subsurface sewage disposal systerrds'A The size and location of the Soil Absorption System(SAS)on the site haclx been determined based on: ® Q Existing information. For example, a plan at the Board of Health.' + ® Determined in the field(if any of the failure criteria related to Part C is ajt is:sur approximation of distance is unacceptable) [310 CMR 15.302(5)] . i• . . E I Tide s omcrer Inspswon FvrM_subsufiace Heraga 040M SysteM•Faas V of'15 ;L 'd LL9 'ON Ados : E 20 'l_l Commonwealth of Massachusetts Title 5 Official Inspection Form 6 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 246 POPONESSETT RD Property Address MARIE MATHURINE OwRler Owner's Name —_ inrounaVon is CO7UIT regLdred for MA 02635 3111/08 ovary page, Citylrown Slate Zip Code 00be of inapecliora D. System Information Residential Flow Conditions: Number of bedrooms(design): b Number of bedrooms (actual): DESIGN flow based on 310 CMR 15_203 (for example'. 110 gpd x 4 of bedrooms): Number of current residents: 2 Does residence have a garbage grinder? Yes No ' Is laundry on a separate sewage system?[if yes separate inspection requftd) Yes "�;( =lNo' Laundry system inspected? � 'Yes No Seasonal ease? Water meter readings, if available (last2 years usage(gpd)): �6a3�ffl;� i1 Sump pump? 1�es Na Last date of occupancy: _ Date , CommercialAndustrial Flow Conditions: Type of Establishment: _-- -- Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/personslsq.ft., etc_); Grease trap present? s 1®] tJcu Industrial waste holding tank present? Yes fro Plan-sanitary waste discharged to the Title 5 system? Y'es Water meter readings, if available: Last dale of occupancyluse; Other(describe}: r 11N�Er y an�otmdoe•09Fp6 I'ma S cfffrw wsp=o on Fcwrn;S4bsueaee sa r.Wago Dispes�l.yFa��Pam 7�'.+ ,8 d LL9 'ON WdOS 800Z 'Lil ''SEAT-. /,_ /C e / y / 7� - / - � S Ttir_4VS4EI MUST BE ' Assessor's offioe (1st floor): �.... .:..��.,,. . 1ARSTAL.L.ED1N COMP Assessor's map and lot number Q �o and of Health (3rd floor): . J' WITH�E _` ewage Permit number ..�.l�'P�?"!'S.�. `-f••.••••••• ENVIFRONME U t Engineering Department (3rd floor): a �( ULA 0 T6}9• \00 House number . `O•" O APPLICATIONS PROCESSED 8:30-9:30 A.M. and. 1:00-2.00 P.M. only, TOWN OF BARNSTABLE - BUILDING INSPECTOR APPLICATION ,FOR PERMIT TO ................. .........,............................................................................................ TYPEOF CONSTRUCTION ............ . ..:.......... ............................. .........................................................../........ ............ ........... .. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........> ` 7....... . . .. ........................................................... Proposed Use �J T. .............................. ................................................................................................... Zoning District ....................Fire District C� Name of Owner Y .....Address ... .` ? �i ?�s7�Sr; Z7` ................ Name of Builder ,1 �- 21. �c!�....5! 2� . '.f".�. ......Address ........... Nameof Architect ..............................................•....................Address .............................................:..:.................................... t Number of Rooms .-.. � ...................... ..................Foundation ...�ri�lz c� ..��1�'!'f.......,............................... ' ` Exlerior ......,,.........�:. .......... ::............................Roofing . ............. ..................................... Floors ...........Interior �............................................... .............:..... :.....'............................................ �. / <�L 4/ ...Plumbing HeatingA.../2 ........................................................... Fireplace .......................................................................:..........Approximate Cost ........�.?5 .........-.-........ ....... ................I........ ci4 Definitive Plan Approved by Planning Board ----_----------------_----------19-------- . Area .. .. . . fit .. oa Diagram of Lot and Building with Dimensions Fee" ..............5_0=7:�............ SUBJECT TO APPROVAL OF BOARD-OF HEALTH 11 , ' cCa/ APPLICATION PREREQUISITE TEXT In 1984 TM signed off on building permit for 5 bedrooms . Office counts as 5 th but the door on study must come off and put in 5ft cased opening. TOWN OF BARNSTABLE `I � LOCr3.TI;?lti Zg5�oParQ%fi VJ SEWAGE # SPA?,by� VILLAGE- 0,010` ASSESSOR'S MAP & LOV 37 42 0 0 111R'S NAME&PHONE N0 '��� S 717IC TANK CAPACITY 15-00 LEACHING FACILITY: (type) Z + 7 t" ii 5 (size) Nb.OF BEDROOMS BUILDER OR 111,:!"e— YnCA'A U-f;r(- PERMITDATE: CQNff4!bVTqt"E DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 1 ter. ck ;i Zb Zo 413 50 TOWN OF BARNST,A�JBL 6, G ,�,OCATIJIY SEWAGE # 1 ® S Vf ` VII.LAGE �T[ i ASSESSOR'S MAP & LOT l INSTALLER'S NAME&PHONE NO. 9 CO 4f),24 G ECZ*7 IF SEPTIC TANK CAPACITY e` . '�? LEACHING FACILITY: (type) NC.OF BEDROOMS la(s BUILDER OR OWNER.1AA 6111 5'andetfs 04 PERMITDATE: D _ " COMPLIANCE DATE:J,14f 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 leaching facility) Feet Furnished by i ,�1}f� .Y9 ,y � � �'` �i. �, c� �� � � � �� ��� '�' � � � � � �'� S � �� � �igt1� �l ��P�ts "w ��ZNo. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYicatfon for ]h5pogar 6�11' 9;t Construction Permit Application for a Permit to Construct( )Repair( )Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /' /� }f� Owner's Name,Address and Tel.No. Assessor's Map/Parcel_�/C�� V � Installer's Name ddress,and e. o. Design 's Name,Address and Tel.No. �/� �e 1-C G — d Type o Building: Dwelling No.of Bedrooms Lot Siz sq.ft. Garbage Grinder Other 'Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil re of Re irs 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 Certifi- cate of Compliance has been issue o Signed Date Application Approved by Date 9 Application Disapproved for the following reasons Permit No. Date Issued No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes ZippYication for Miopooar *pot Conotruction Permit Application for a Permit to Construct( )Repair( )Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ��, Owner's Name,Address and Tel.No. i Assessor's Map/Parcel �-S' We©n r SS C �9 Installer's NNam Address,and e. o. Design Vs Name,Address and Tel.No. G — O j .✓� - Type o Building:Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil re of Re airs or Alterations(Answer when applicable)` 7� " rr, - Date last inspected: Agreement: The undersigned agrees to ensure the construction andjayintenance of the afore described on-site sewage disposal system in accordance with tpe provisions of Title 5 of he Envrro etital Code and not to place the system in operation until a Certifi- cate of�Cgtn Ocfe as been issue'" I 1 .o ff Signed Date 1 g lication Approved by Date y PP PP , Application Disapproved for the following reasons ——Permit.No��7 -f ro,I�7 n� � �,�� .. Date Issued —-`�_— /9 " —�)T6ETU& &WEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTI tha -he On-,'Ie Sewage Disposal System Constructed(r )Repaired ( )Upgraded Abandoned( )by at has been constructed in accordance with the provisio s o i e 5 d the for Disposal System Construction Permit No. % dated Installer Designer The issuance of this permit shall n� e construed as a guarantee that the system wi unction as designed. Date / �, 8 Inspector / —————————— ----------- —————— rv` — No. f-t ' — t1`0 Fee-5-0 G THE COMMONWEA �H OF MASSACHUSETTS PUBLIC HEALTH DIVISION - 4,RNSTABLE., MASSACHUSETTS agaf� t'n� Cougtructio Vkrmit Permission is hereb" '"a".ted,, 'On ct Repair Upgrade , band Y ,V ( ) P ( ) g �+ E'► ( ) System located at` - ����SF Co and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. % Date: �7/57 Approved f 10/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) Ir S , hereby certify that the application for disposal works construction permit signed by me dated 02 �,concerning the s , property located at cp O ® S meets all of the It'2following criteria: d �U r • There are no wetlands located within 100 feet of the proposed leaching facility E • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. %• If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will=be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) f-- B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED: 0 DATE: QznR-'� —'9 1 /,.' -- 1001 / LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:cert c � f \ 1 C � © 4Sr6lip 1 it TOWN OF BARNSTABL / LOCA'TIOi+I: D � � SEWAGE # n `l ASSESSOR'S MAP & LOT —Doi VILLAGE INSTAI:IER'S NAME&PHONE NO. r L'W ^H?4 SEP'I'IC'T'ANK CAPACITY LEAt?HING FACII.ITY: (type) S ( ze)F/'d NO.OF B> DROOMS r BUIIDEROR OWNER PERD�TE: 0 7 NfT COMPLIANCE DATE: A Separation Distance Between the: Maxlin�m Adjusted Groundwater Table and Bottomof Leaching Facility Feet Private Waiter Supply Well and Leaching Facility (If any wells exist Feet ors ice.;or'within 200 feet of leaching facility) Edge`of!Wetland and Leaching Facility(If any wetlands exist - Feet wituYi;300 feet of leaching facility) Furnished by sl Zt- a cn p r _\ _� 't � /,Fz_ A— I � 1-1Z— 1 fL0CA.?'JON � SEWAGE PERMIT NO. �( :t'70 ggu e-7T Rc( 7 k — 6 g 9 —,PILLAGE �� ► cot �U I I'll STA LLE 'S NAME R ADDRESS i C Y � BUILDER OR OWNER y o v DATE PERMIT ISSUED DATE COMPLIANCE ISSUED - � - WL �3 5 Z 5'` l , No......G y ....... - . Fim.... ... ...�............. THE COMMONWEALTH OF MASSACHUSETTS r BOARD' OF HEALTH /.LtM............OF......... ,,- ." �--------------------------•-------•--- ApplirFation for Disposal 10orkfi Tonotrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .........�-' ,�!_r?. :: ..� !` - .... ................7...�. ..�-�--•--........��... �® cation-A dress �� _ or Lot No. Owner �. Address a ......... '/�c..r,Y...... NS ............. nstaller f Address Type of Building f •-`Size Lot- 0. ..:..Sq. feet V Dwelling—No. of. Bedrooms.........IV................. .Expansion Attic (. ) Garbage Grinder (4 ) pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other fixtures ....._.'.......................... W Design Flow.. ............. .s. ^........ 'gallons per person per day. Total daily flow..........:7-......_........ ......gallons. WI Septic Tank Liquid capacity/_WS^::gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No.�................... Width.................... Total Length............ _.... Total leaching area............._./-..sq. ft. Seepage Pit No------/............ Diameter........Id..... Depth below inlet.._._........ Total leaching area.. -9.2-_&� sq. ft. Z Other Distribution box ( ) Dosin tank ( ) ,�-�- - 7�-• '-' Percolation Test Results Performed by... ............... Date.....0................•2- 7�- aTest Pit No. 1................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........................ a --------- . . r 1 - ---.._... z..�......_.3 _ O Description of Soil....:'-._. `... . ...�U......-•----....--•--•....1. ........ x W ••............................................................................................................................... ---------------------•----------•-•---------•-------------------...... VNature of Repairs or Alterations—Answer when applicable._.............................................................................................. --------•----------------------------------•-------•-------------------••------------.........-•--•-----........-----•------------------•-•--•------•-•••------------------•----••-----------......---•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of LI IE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ued bey board health. igned-- ......... .... ............. ... ®... .Q C/-------.-----.------.- Date Application Approved By----.---- / ......0.... .... .- Dace".:.... Application Disapproved for the following reasons---------------------------- ---------••-------------•-•-----------......-•----••---------...-•--••----------••---........------........------------......------------------------ ====--------•-----------•------------------- ' (� Date Permit No......................................................... Issued /,, ........ ate Date No.-•-.Li....... Fes$..... . ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :1 O F.......... . ./�I� AG�G�- ..................................... Appliration for Dispoii al Works Tomitrur#ion ramit.. Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .........• - ._...... �.� :c ....... ...................................... ..............•------•----••-....=..- or Lot N .......................................... .cation-Address No. W wner Address ......•.. y .......... ffAe Ohl.....r,f1/�.Ir.................. {� .................. ••-................ •...... Installer Address Type of Building Size Lot.Y }ZS�.....Sq. feet a Dwelling—No. of Bedrooms---------`,,//...................•...._...._Expansion Attic ( ) Garbage Grinder (A ) aOther—,Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -•-•-------•-------------------•---------•-----------......--------•-----------------•--...---•••........-•--- W Design Flow................... ............gallons per person per day. Total daily flow............y...........................�. gallons. WSeptic Tank 4 Liquid capacity./2_)J' allons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length............__ Total leaching area............ ..Sq. ft. ._... Diameter............. Depth below inlet....... // e.Z. f � Seepage Pit No._.....�...._ fD..._. p .Lt._._._... Total leaching area q. t. z Other Distribution box ( ) Dosing tank ( ) -�- 7�-• Percolation Test Results Performed by.. yam. �_ ;�" a .... � � !v d- ----.L/1!lt -------------- Date-----. _.... -------•- ....... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per; inch Depth of Test Pit.................... Depth to ground water................. ...... P+ r=, . . ........ Description of Soil...... I ....�.. j ( L` .........-.-.............................../U _ W ......................................................... --------------------------------------- ------------------------------------- •------------------- -------------------- ----------------- U Nature of Repairs or Alterations—Answer when applicable............................................. ----------------........................................Z..........................................................................r", - Agreement: j The undersigned agrees to install the aforedescribed Individual Sewage"Disposal System in accordance with the provisions of TTTLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been rued by/he board health. _ igned ------•-••• ... _ -- Dat 1.. -e.............. � Date Application Approved By........ .• � •�.w= 7 l�f/l/1.. �-... 1 . Date Application Disapproved for the following reasons-----------------------------------------------------------------------------------•-------- ••---••---••-•-•-- ...............••-•-..............---......--•-----•-•••-•---..............----••-----••---•---•---••--...--•-•----•-•------•--------------•••-•-••----•--••----•-----••-•------••......-•--•-....------ __ Date PermitNc........................................................ IssuecL........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF �EALTH ......�.., oF............... .�,..�.( -� -- Tntif irtttp of TootplittYtrr T S I , TO -'--E IFY, That the Individual Sewage Disposal System constructed ( '�"or Repaired ( ) at L '1 = ------------------ -------- -2 has been installed in accordance with `the provisions of TX I ` of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.(_.. .__. `1�Cl.....----•-... dated /-G = /.--'............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM VIAL FUNCTION SATISFACTORY. Inspector__.._! DATE. '`�.......e®........................••------ ; THE COMMONWEALTH OF MASSACHUSETTS BOARD OF-)HEALTH 4 .............. ..... ............ No......... .... . ...• FEE---........:............ giivid, ork TI1notrurtiA11T �/� mit Permission is hereby granted. . d---- -- e.. --•------....to Construct (�or R�air ( ) nal Sewa a D' osal yst 7 at No.. ....... Street as shown on the application for Disposal Works Construction Permi No... ............... Dated...._ ..7t_.'.-_.... ----................_ DATE. ,, -,/' " ------------------- Board o Heap FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 1 x- ! . s I -� :..�-•"_'—___—_...._ __._' "—( p`p-- '+'�f c` Fit � '� fit, y� I ; n w' r� r7 ?a I M tti SI c ; l •R _.. 75 F _ TM I t _...1_L i 9. t � ......._ lf. lrS. �1 _ • a gj 1.4 i� I. � !! i L t•''•�, •; `S��q�— �_ '.—_ ?i��s r���.�.3-�_+X-�.n+� .3' ._..,_�r._u...,,•-F`� - e eta'; XI? j /tom ===zt�` t .. ! II: IiIL1 V, It IV � 5 I� •mom- / {` o- � - ; � r_ � i ,r fi xyf c - E � i� -;,fss;'' !i:i �1---� t-_•_-------_� k3�� c+i at r.. - ,tas`, �, 1 it ! +rt ' !!!�'' �` I t I� =�� s t•�t.a,' ¢.'uri ���- I.y ! 14- aAA it r "e '• •� ���-�1 ij �! CA ,` s' '•�� �j��i I �M i /� � !__}L_ Il i G`! t`�` i -,i j .t` 1��� 1 I� I ! i1 ,a S I •...Lr} • I,t.� -'r tr," '" i� ftwtiL'.r !f4enn9Jn`^y^'�^•^rt r Iz a 4 - r _ ':Q I L- A' S f P t2T�.+•'i'�'!" #' ] "'"Tf". c s '\� v . - - 1. -_ —� - _ . �_ - ... • - i �, 1c t c- '-qt .2 s I '�_ !Y-. z tip'= ..g t,.I.} ., -E= k J�' f - 2� '�3i-Sc rn tr.r A i �F r s • Itz Y ,� S L2 I,na Wit. _ r4�. z* { r o.. �. - 2 r t s .1. fit„ ''"�" Is. •� is y> 1�i -- r L . :` . %;' r•s , t I q'. 7 I t-I .� - i - 1..} - f .•` 3T s �r 2 •tc ,. si. 6i. 'i L i(-��._., _ �. , r a m''s 11 �, [ - 1 il 13. t I IS ' 4 s-1 ' 1 t-- I. T "1. i-z s :a . ,i 3�l_'� "a :-��. 5 I t i _ t i i i" �.I$ . ,'� t •.�. i i t+ =t-" -� t r y I` -r ; i •-rI i : r i i " 1. --�- _ a»- - i i i --- � setts- 'A is I: i s ----- 1-*' � 11 I : tiT.~ s=. Y-- i s .. r'- «t,a C .. } 2. .ar ' z Y ��,w �( i, a-. �,., ,• } �i A i _ .2 .3.;4r. ; �I } - " t "•r. 11 , t ¢� -"[' .�. '^�'i'�as.«7.",m-3'L' r—^-r 2"�-;r<- ". 1: j ; T. i i it_ it t 1'� Y n ' S rxi1. rr - G <s --z— - „:; ; t I= ; ! �^ $ A t Il i{... '1, i -., } r Sb i ..-•..w~�S:•Z -•- i t ' - 3 _ s� "« s a� x sue--t --� e. c ' ie I i iI _ tM � ix It a k li t If. 0 M-it K.-- �k �^ , i if t �in _ t . 1 2 i I 3, {`� � tt t � t I' r Za �'s x�✓�t '3 "-mac }.t 1 , s""" b i t I.c t r u s2�` rr!-2 ' _�a.; "� �7 -11 i I i 'ate.. ~� t ;:T. i :, - t `� r ra� ` Sz -^a¢ew y� ;4. ems - -y ` i ai s 1 4 j--- tt^ `sSy. M� 't ram. - cF I;�; i a. 1. ... "�.r f ._ I -. R;,': s #;.t '¢. "'�,z'y i4 r._�'uF- '.; } �_:xZ r�� s"' '"=__. _ t ,_•_-.,,;ice.._`°.'.•-":'-» I i; i I S x i rr r x -�Lr - w aWT„ oc a ` - ..0 n= 2 (1 "' z - . �q ? �-gin - - H a" . , ,i f ( I1[.i sir xapa - i 7 7 i-�.: "Y� i. _YI.- 11 '`.} *`fN'y7W'kjt' _ _Yx ry ' [ t{{j 1 Ii _ 4; t s q c t x " 73_3� t - i _ _ a� r, n « _ r s �} i %, z II - �Ij —L - l' .� e L. i.4 , -. _4• :.�a .:tom �' tl, `Vr`-"' ...-- i 1. 7,it ; �8 i --:c-1; -I -- , - . . .-_ � --- . I-- . 21 1I _ - - nq}fit v 1 i. �..,_ �---_ '.* �.. ., . + -.. - a.. L i Ii i I r a n F t . . f !I - i .e{ i }; 1 + r., ; "' I i a i , ,� s �•- 2 r :c:... i 1 : t. t. j s u t I. p a- IW it y a fi I( i t k t i ( �2i �A '-{ L`. g- r' zr ? x r, (Ia. r 7 ( f t ' 1, I 1 i .r ,.. .i z'` r ' - awl-'ter T. 1• p ., ti. t:s i i i\ a ac / I I t .. * a t.r t' ajr E I e e ' L R It �+ pp 11 ,,yy s'� S .: ; ;tom•_ I -_ C�3 t t _ li, _ ._._ _ _ . 3 1 Y:3 1K �. i— 1. ..s. E..,�.U O i L I •e._., ',SF �-.e.. t p.l e'_•�. I t..t:.""'l 3""" h,1 1 f s.' f i i i1�i Ir. . ^=-•,-- r, , r s*1 y;. G i , Ip.� t1 �: !i'ti .i z i - ( t i i'( a t a i y31��r ,i ii i a I I .~-_.,�•i , s ! t t t 4 j. ix ': i ;� ry t f. ,, '- i• ( slut(, ( !r— 't r--- i} r _. . I; _i y,_T - i J l s. Ff' j r is r.. i i i i i } . _ -._..- ._ ..i i E a } 2, ; --�- .,y -t - 2 t I ( ;i ! t'3 1-i-i r,%k Ti t ,i 1 N - -i 1. t 1jQ .._ -r i �� ((r4it .. _ i .f f'_`•Y?. ! L' it I i _ Y_ _ e'<s''}I� } - I { t I . r i3 i ,Ft�{ - i i j �.'/ f `'� 1 r's-'''^�,.s,<,..'��'•"�ca i .kvcm� _ ,i6'`+3. y� - - s t J 1. V ,, ii It smay, . . . i iI— I_.a r,.!I I i V 1 ( x li T. { , _ _ _ i 1 1. i ..: , *N �Y t i +I I �...ip• -1 f——S.t ' - Ir- —il°"•.li- I t--' —,:�-i -yl -�- t �.�..---- i , r ; i i it i1 i} I ii t( 1ij ,1 �' It i i(i 1 �+ I T , s i i i i r t T_— ' i 1�--a (, ':� i i if! iil, li jii i ii i I 1'� l I F `. I ice_ 7..,._--_•1. " ' ! I z,, .. � i ; i „; ": 'Si ii, G i i I t (; ti ((. ri . S t 2 { I }I it 11{ Ii:1 Its it i; ijpl ; (, n C 1= �_s 'i 1 i i ( ( i 1 i i 111 1 i �f ( t; I A i I I ; =.,-s „_, "I i �i1 ii� a: i� 'i; tr i,t :.L (� !i� t ,"•saI 'i _ , ----- ._.�*.�-. i 4.,a__. t I -y i-='It Eie a ti 1° ( iti (ji (jt .-1 t a, - n-� _ _ - I 1 �� F i( E1' ;rI iiy I�i ( iii I i !1 t:I I(i Y ;i j _� t_-- _� —ae_ i iq .. ;I i'I # + lI �ii �!I i� I'� 111 i ( I �i i I i 1 1 s t I i > !' s n1 1q 11 iy t, jI_ 1v 1 4 ttx 1 { V (r. .~ _ 6 i r p it? 1( I t t�, ('� ( , qt ui ,Ii s} 11 ii iu :i' i" t tiI 2 { :.: �'� ~ _. i �L'if+'= }Ll i i!� ii( 11 i 1 II I i i� . t}S (�i (i' !" u1 `@ �k F ! `I-,-I, •' 0 s a I- t �= ytti ' �E i' 1! i ti . I �1 r 11 q: .,_ i; \ _k,j� I,� „z tF I. . --11 1";3ir : •1i ii t; il. t is 8 N3 r I. z ,,I,_ I , i i tr i;.i it ` r i i�i i1i S1 , 7 y I ", , iy? I t1.I i (•t i•, i11 ;1 il� x ii1 III lio , r; tit it ---,"asses E- � 'r:$ `�( t (}ii ili ik z tti } it '^ I rt11 I t I� n r•. t ,,, t �-�` ( � }; i11 (i.; eta , n 1i_ iH t i a ' I rz tI �' _,, Iry ti a! N1 S(j3 �I iF j' _' i`t_ . tr.,,t. x..>_..• ` Ss� i � � E: _' E �` '- i i<l, !{� 71 jC ;h itM. " Yi t � . tk� 1 t t I di r� gg s � s Ef.1. �t t. - _ ` i EfI j ji ( iR Ialr'fy g r1:.:# �'�t . ss�� '`� p s+ I �7 �31. i 3� r *. . R t .. ,�,,fi�tr k I.. - �.. , x3 mot_ ti4! S. f iE.d lt 2S 3'cZ } jj� .3 R .-3, - -- ,vas.-tpr1. 1. • j . . . T ..-_ _. .. K..... MSLt ! SDP o{ fou"Clml�yot7 , 34 In t7 4-O 358� 35_ 00 35.4- ` >q } I v profile— V. <-. (✓ 7/ 0 A- 1/C- )eT- SGf1L � �/rY- `G. o Ah C� �•f Per f oof , / T EQt/.q` 7-0 6&.-r/C 0.0 2" o� �8 - /2 waSh �a/ Stone fo< - - --- 0 G � L "Z /-7- SOX 1 3 1 �rJ tit+ ° �• 1 6" ScirraFr c , • /\ �• ,,,;^ Pr,4ehifG�'. /000 6AC . .SEPT/C Ti9NiK Of /�f t 1 ` to .`J4)\ `� � ��� ' � .- '~�Syr �� V O • - . lq p 3 S.GAGE : %~ /=O" G�tAGH / T - r FF 4+. 4 be- A L3EOE'00 ✓J A/0C,,5 !DTE: � /%8 TEST / A it P P!i` . MiN /.vG T�vE S S — �i - DATUM ,Z r n57�c1 /� V oI. : ti,� tz -.. .17 — Z- O 7- / C_ ' /e� T. - 44 J S._ GAL �OAY .pe, Z S'f - TEST 14OL6- # / TEST NO4- E � Z �C l-'SE GAL 7.9A./A s • � D� ?/ SivElvAt-L a 1 4.s GALS/ ^ T T O 1-7 O AS oAY ��.� S' F C /• O � = _SLR'—�c' „ Q TOTf�L - 8-/ G�9GS. /O.AY GIcdn P/7- I rn&-JivrM �. n7' ' � \ z s-7 N , /J1 I —.'7D Gva firr.�c.ot�r+ CrGd 1 o w/-7 G 4. e. 6 --7 q 1-7 e e r it-7 c/ / T �"-- cs Lit/� L /Z? AJ = LA�vp Scrc= v� 7-0 Gs LOT /8 GOTU T /✓J�> OF '•� SG� LE . .45 SHo"IA-1 ..- S l T 67 F� L � /-/ I.5& h/I9 G �- S YS 7-67 /L-- 7 Bo.q,4eG OF t-/E�LTH -o—o—o—o — propoSC► d Gor�fot�r•S - -- ,EA,/.� ' F' �L.F• , MASS: