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HomeMy WebLinkAbout0028 ADMIRAL'S LANE - Health 28 Admiral's Lane, Osterville 0 40) Fee 45- BOARD OF HEALTH TOWN OF BARNSTABLE 01ppYicatiou if or Yell Cou5tructiou J)ermit Application is hereb made for a permit to Construct(� ORepair( )Alter or an individual well at: ljmrr� ®Co7 dg. a D -f Me-k A 0 Location-Address Assessors Map and Parcel Owner 1 Alto A j[A-)A.,0 S C6t "Aj Cl� �� () QlC�nl6 s S YOU Al U d o-t9 AAA Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well_ pv� Capacity Purpose of Well IrrI Ga7i•«� Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Co plia has been issued by the Board of Health. Signed Ile Application Approved B J `G/ ✓ Date Application Disapproved for the following reasons: Date Permit No. 'j,') I l Issued Date -------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed(v7,' Altered( ), or Repaired( ) by ne NA_)/S` J Ce N N @// Installer at g . G [1tit Iledc 1 r+ has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection, Regulation as described in the application for Well Construction Permit No.�WI-2 0)$bated 6 // THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector No. G / Fee BOARD OF HEALTH TOWN OF BARNSTABLE Ofppfication -for Yell Cou.5truction Permit Application is hereby made for a permit to Construct(ta' Alter( ), or Repair( ) an individual well at: kd 11y)I A..'S - Location-Address /Assessors Map and Parcel Owner Address 1 /r AJ Ai'S G'�a n.��l�P/ �� (� JF' r. C \ d�'c� A,1 Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well L-/ /3o< Capacity Purpose of Well Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Co/mplia 6 has been issued by the Board of Health. / Signed Date Application Approved B}%� � / Date Application Disapproved for the following reasons: r Date Permit No. 1 i -/�U; ''-� Issued Date ----------------------------------------------------- ---------------------------------- —__ BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed(t�, Altered( ), or Repaired( ) by 1 /P"A)�c �CA N A,)t' // Installer at 1)" 1J6 c / h- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.1�,\ I Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector ---- ----- _ -- -------. ------------------------ BOARD OF HEALTH TOWN OF BARNSTABLE Vern Construction Permit No. 1 --^ ) a Fee Permission is hereby granted to e rj Aji5 Installer to Construct Alter( ), or Repair( an individual well at: No. 0g. CA O n t I/G Street as shown on the application for a Well Construction Permit No. Dated 41.- / Date �� Approved .. 7(�D/ . Asbuilt Page 1 of 1 WN/OFF BARNSTABLE 1PEG�1 n LOCATION,• a IV 1�11I IZ A I,s RA N P— SEWAGE# VILLAGE QS l£Ru ASSESSOR'S MAP&LOT / — 6.7 INSTALLER'S NAME&PHONE NO.a SEPTIC TANK CAPACrrY l oo g r A 1 V — LEACHING FACium(type) IDOO Q-A �T(size) X � ' NO.OF BEDROOMS (� BUILDER OR OWNER RNN _ 600er),El z . PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility &R0k a 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 f leaching facility) Feet Furnished by c � A s http://issgl2/intranet/propdata/prebuilt.aspx?mappar=119067&seq=1 6/28/2017 1^ IQ� Ir m m r Certified Mail Fee ru $ ru Extra Services&Fees(check box,add fee as approprAM) t C �w .. ❑Return Receipt(hardoopy) •, $ \�'X J I Y[/f ,. O ❑Return Receipt(electronic) $ Postmark ID ❑Certified Mail Restricted Delivery $ �'� Here ❑Adult Signature Required $ SAY 2 ❑Adult Signature Restricted Delivery$ 2016 O Postage ` ru $ rrq Total Postage and Fees $ �T3 LISPS Ln Seth Bilazarian 8 Paul Tivnan Drive r Bolyston, MA 01505 Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail labe�7- for an electronic return receipt,see a retail in A unique identifier for your mailpiece. assopiate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted retutB receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the isA record of delivery pncluding the recipient's retail associate. signature)that is retained by the Postal Service- Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent. Important Reminders: Adult signature service,which requires the in You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which is Certified Mail service is notavailable for requires the signee to be at least 21 years of age international mail. and provides delivery to the addressee specified ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a, certain Priority Mail items. USPS postmark If you would like a postmark on is For an additional fee,and with a proper this Certified Mail receipt,please present your , endorsement on the mailpiece,you may request Certified Mail item at a Post Office-for the following services: postmarking.If you don't need a postmark on this Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion.- of delivery(including the recipients signature). of this label,affix it to the mailpiece,apply ' You can request a hardcopy return receipt or an—appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Retum...-,.,.,.- «-»- Receipt:•attach PS Form 3811 to your mailpiece; IMPORFANI.Save this receipt for your records. PS Form 3800,April2015(Reverse)PSN 7530.02-000-9047 4 la Complete items 1,2,and 3. A. Signature a Print your name and address on the reverse X ❑Agent so that we can return the card to you. ❑Addressee ® Attach this card to the back of the mailpiece, B. Received y(Printed��Narne C. Date of Delivery or on the front if space permits. 1' / z.91AVe '�l 1. Article Addressed_tn -4 D. Is delivery address different from item 1? ❑Yes 0 Seth BilazarianF; If YES,enter delivery address below: [I No 8 PauI�T, an Drive +fir ;.B.o1y5W-,@, MA 01505 1, r 3. Service Type ❑Priority Mail E ress® ++ II I IIIIII IIII III I I I I i�'I III I II I II I II I I I II I III El Adult❑Adult Signature Restricted Delivery El Registered st red MalPRestrictedl 9590 9403 0521 5173 2829 06 ❑Certified Mail® Delivery ❑Certified Mail Restricted Delivery ❑Return Receipt for ❑Collect on Delivery Merchandise 2. Article Number(Transfer from service label) ❑Collect on Delivery Restricted Delivery ❑Signature ConfirnationTM ❑Insured Mail El Signature Confirmation ❑ l Restricted Delivery nsured Mai Restricted Delivery 7,015i 1520 0001, :22-73 ,3395; h�l� I (over$500) I; PS Form 3811,April 2015 PSN 7530-02-000-9053 Domestic Return Receipt I I UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 I • Sender: Please print your name, address, and ZIP+4®in this box* I I Town of Barnstable I Public Health Division 200 Main Street I Hyannis;-MA 02601 I G USPS TRACKING# 4 959(_ `c f i Town of Barnstable Barn"stakife -' oFt"E� - .�. Regulatory Services Department p EARNSTABIE s KAA , Public D � 16� , p ub c Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 _ Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1520 0001 2273 3395 Mayl8, 2016 K Seth Bilazarian 8Paul Tivnan Drive Bolyston, MA 01505 T ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 28 Admirals Lane, Osterville, MA was last inspected on April 4, 2016, by David B. Mason, a certified septic inspectoffor the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally, Passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Need to replace rotted distribution-box You are ordered to repair or replace the distribution box and repair the leaking septic tank and components within one(1) year from the date you receive this notification: Failure to-repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF HE BOARD OF HEALTH } f - omas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Conditionally Passes Ltr\28 Admirals Ln Ost May 18,2016.doc Parcel Detail Pagel of 3 k , sow— (4! (y�.� `IiN ,K•1. 'L Yks,Sv+P k .4thS, Logged In As: Wednesday,May 18 2016 Parcel Detail Parcel Lookup Parcel Info Parcel ID 119-067 I Developer 17T 2 Lot Location 28 ADMIRAL'S LANE I Pri FrontageF2 51 Sec Road 6 I Sec Frontage Village JOSTERVILLE I. Fire District C-O-MM Town sewer exists at this address NO I Road Index '0007 .-..., �. 4.* S r _ SAsbuilt Septic Scan: Interactive Map1190671 y r" Owner Info Owner BILAZARIAN, SETH &TINA I Co-owner I streetl 8-PA UL TIVNAN DRIVE I Streetz City BOYLSTON I state FM zip 1505 Country ' Land Info Acres 1.26 use Single Fam MDL-01 zoning IRF-1 I Nghbd F616j � I Topography Level .,� Road ;Paved •� � I. Utilities IPublic Water,Gas,Septic Location Construction Info Building 1 of i _" "`„" Roof :.� "" Ext Year 1980 I GableAIp I Wood Shingle Built Struct Wall 3 ; Living 2482 Roof As h/F GIs/Cm AC Central Area I Cover p p I Type style Ranch _....�.� .I wan Plastered I Rooms 3$edroom�s I 4 � �; , zn BMTj Model Residential I Floor Ior Carpet I Bath 3 Full-1 Half I F , �Rooms . 28y, ;-• 1,2 Grade Average Plus I Type ot Water I.Rooms 8Heat RoomI - Heat Found OUre Stories Story I Fuel rOII I ation: d COnC. I Gross 7894 Area e . • Permit History _ ____ .___-_�_ ._.____ _ ____.. ___ __ _m_.�___ ___ � FIssueDate Purpose Permit# Amount Insp Date Comments014 Remodel 201401104 $7,500 6/30/2014 EXTEND CLOSET/STORAGE INTO ATTIC, 12:00:00 AM UNHEATED,SKYLIGHT http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=7245 5/18/2016 ' Town .of Barnstable BARN9rABLE ,.� Regulatory services Department = �fb MAd� • Public Health Division- it 200 Main Street, Hyannis MA-02601�. Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPA IR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"X"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe 4 ❑ Backup of sewage.into the house due to an overloaded'or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box'above outlet invert due to"an overloaded or clogged SAS or cesspool - ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑'Any portion of the cesspool within'a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution); - TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover,relocation of.a pipe,'relocation of a driveway due to HA 0 components, etc) ❑ Leaching pit or cesspool with high liquid level, -<l2"below inlet-(per Town Code- §360-9.1.) - ❑ Leaching facility with standing liquid.level at or above the invert pipe (per Town` " Code §360-20 h) �I OTHER f - '_ • ro�ka d-6ox Repair deadline: e,�-r r Q:\SEPTIC\DEADLINES TO REPAIR&LED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessment 28 Admirals Lane, sterville Property Address Seth and Tina Bilazarian Owner Owner's Name information is Boylston MA 01505 May 4, 2016 required for every y Y 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. Please see completeness checklist at the end of the form. Important:When ng out forms A. General Information filli on the computer, l use only the tab 1. Inspector: key to move your cursor-do not David B. Mason use the return Name of Inspector key. Y David B. Mason ry Company Name 4 Glacier Path Company Address East Sandwich MA 02537 City/Town State Zip Code 508-367-1617 S1287 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 May 5, 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 �oe 1/S Commonwealth of Massachusetts N W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 28 Admirals Lane, Osterville Property Address Seth and Tina Bilazarian Owner Owner's Name information is Boylston MA 01505 May 4 2016 required for every y Y page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E i always complete all of Section D A) System Passes: ❑ I have not found any information which iindicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ® 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Admirals Lane, Osterville Property Address Seth and Tina Bilazarian Owner Owner's Name information is Boylston MA 01505 May 4, 2016 required for every y y page. City/Town 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 outlet baffle in cracked and needs to be adapted from sch20 to sch40 and a new tee put in place. Also, the distribution box is deteriorated and needs to be replaced. ❑ 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 28 Admirals Lane, Osterville Property Address Seth and Tina Bilazarian Owner Owner's Name information is Boylston MA 01505 May 4, 2016 required for every y Y page. Cityfrown 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 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 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 'h day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 28 Admirals Lane, Osterville Property Address Seth and Tina Bilazarian Owner Owner's Name information is Boylston MA 01505 May 4, 2016 required for every y Y page. City/Town 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 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 28 Admirals Lane, Osterville Property Address Seth and Tina Bilazarian Owner Owner's Name information is Boylston MA 01505 May required for every y y 4, 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 j ® ❑ 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? Wash i® ❑ the site inspected for signs of break out. P 9 ® ❑ 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): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 28 Admirals Lane, Osterville Property Address Seth and Tina Bilazarian Owner Owner's Name information is Boylston MA 01505 May 4, 2016 required for every Y Y page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ® Yes ❑ No Water meter readings, if available last 2 ears usage d Yes 9 ( Y 9 (gp ))� Detail: 2014; 44,000 gallons and 2015;49,000 gallons. The system is not designed for a garbage grinder and should be removed if ever installed. Sump pump? ❑ Yes ® No Last date of occupancy: UnknownDate 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 28 Admirals Lane, Osterville Property Address Seth and Tina Bilazarian Owner Owner's Name information is go Iston MA 01505 May 4, 2016 required for every y y 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: Board of Health 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 28 Admirals Lane, Osterville Property Address Seth and Tina Bilazarian Owner Owner's Name information is Boylston MA 01505 May 4, 2016 required for every y Y page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Compliance issued 4/26/1996 i Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+tee+ Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank locate on site plan): Depth below grade: 2 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: 1000 Typical Sludge depth: 2" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 28 Admirals Lane, Osterville Property Address Seth and Tina Bilazarian Owner Owner's Name information is Boylston MA 01505 May 4, 2016 required for every y Y page. Citylrown 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 36" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 3 Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Scour Stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Effluent level with outlet invert. inlet cover is to grade.. 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 28 Admirals Lane, Osterville Property Address Seth and Tina Bilazarian Owner Owner's Name information is Boylston MA 01505 May required for every y y 4, 2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) I 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): 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 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 28 Admirals Lane, Osterville Property Address Seth and Tina Bilazarian Owner Owner's Name information is Boylston MA 01505 May 4, 2016 required for every y Y page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert level with outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The dbox is deteriorated and must be replaced. 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.): * 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: l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 28 Admirals Lane, Osterville Property Address Seth and Tina Bilazarian Owner Owner's Name information is go Iston MA 01505 May 4 2016 required for every y y , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ 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.): 6 foot pit with 2' stone. Pit is 22 inches below grade. Riser is within 2 inches of grade. there was no standing effluent in the pit when inspected. No evidence of staining observed. Stone is leaching holes appeared clean. 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 - i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 28 Admirals Lane, Osterville Property Address Seth and Tina Bilazarian Owner Owner's Name information is Boylston MA 01505 May required for every y y 4, 2016 page. City/Town 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.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 28 Admirals Lane, Osterville Property Address Seth and Tina Bilazarian Owner Owner's Name information is Boylston MA 01505 May 4, 2016 required for every y Y page. Cityrrown 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 28 Admirals Lane, Osterville Property Address Seth and Tina Bilazarian Owner Owner's Name information is Boylston MA 01505 May 4, 2016 required for every y Y 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: 18 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: Groundwater Contour Map ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater Contour Map 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 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 28 Admirals Lane, Osterville Property Address Seth and Tina Bilazarian Owner Owner's Name information is Boylston MA 01505 May 4, 2016 required for every y y page. CityfTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Assessing As-Built Cards Page 1 of 2 TgWN OF BARNSTABLE 1�/°f Gfi1a rf LOCATION 9 9 A #11'6 I IS LANE SEWAGE M VILLAGE ©�l2J 1If ASSESSOR'S MAP&LOT / —067 INSTALLER'S NAME&PHONE NO.a �(!/sIIDU-� �Ja85�y0 SEPTIC TANK CAPACITY 100G cle-A I LEACHING FACILrry:(type) 1600 a_A �•�' (size) X a NO.OF BEDROOMS U BUILDER OR OWNER Ail/N �uRCl,�I� PERMLTDATE: COMPLIANCE DATE: r G Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Jgjlft�r dS 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 !leaching fality) Feet Furnished by �� �� cM'f=4f- 6 t �e` LA 3 Qo � � a J sV NJL D &Y la 33 6 http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=l 19067&seq=1 5/5/2016 e � w No. I Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppliLation for Veiposal e*pstrm Cunstrurtion VermIt Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot Nook Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Nam ,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 81 Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board alth. Si Date S �� Application Approved by 41 Date Application Disapproved by Date for the following reasons Permit No. MG — t 6 3 Date Issued R No. , / I " - Fee f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitation for �Misposal 4pstem Construction i3Prm t Application for a Permit to Construct( ) Repair(Upgrade Abandon( ) ❑Complete System Individual Components Location Address or lot Nook i P Owner'sName,Address,and Tel.No. �✓ Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Nam ,Address,and Tel.No. Type of Building: X Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) 4 Other Fixtures Design Flow(min.required) gpd Design flow provided WK gpd Plan Date Number of sheets£ Revision Date Title Size of Septic Tank Type of S.A.S. 3- Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate'bf Compliance has been issued by this Board alth. Sii Date Application Approved by 6 Date Z 1,6 Application Disapproved by Date for the following reasons Permit No. M( ' t 6 3 Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS J CPrtlfIrate of CDtt ptiance 4 THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed Repaired Upgraded ( ) Abandoned( )by n7 ZeeWoe!//C' ,jw T,e at <Po4; jl/�fr,�� �`� ��/fry ©�% has been constructed in accordance r with the provisions of Title 5 and the for Disposal System Construction Permit NO b"-1 83 dated Installer�J ,Gt��4f Designer #bedrooms Approved design flow gpd The issuance of thi perm' s/hall not be construed as a guarantee that the system wil functi as designed. Date St�al(� Inspector 4 r No. /6 ( S3 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstPm onstruction permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date (� Approved by , AsBuilt Page 1 of 1 TQWN JJOF BARNSTABLE 1��GT1n� LOCATION l 119 lS I ANE SEWAGE# VILLAGE W ER-, I I f ASSESSOR'S MAP&LOT � LL 6 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I QQ Gr 1 LEACIENG FACILITY: (type) /600 Q_A (size) NO.OF BEDROOMS U Y BUILDER OR OWNER ,RALN PERMITDATE: COMPLIANCE DATE: 7 r Separation Distance Between the: i Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 1VQ�'aT 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 f leaching facility) Feet Furnished by 'ZI tr 'D � OT http:Hissgl2/intranet/propdata/prebuilt.aspx?mappar=l 19067&seq=1 5/27/2016 Bk 28041 R:9261 -41F1 15 03-19-2014 a 03 = 15� DEED RESTRICTION WHEREAS, TINA BILAZARIAN and SETH BILAZARIAN, ("Owner") of 8 Paul Tivnan Drive, Boylston, Massachusetts 01505, owner of land situated at 28 Admiral's Lane, located in Barnstable (Osterville), Barnstable County, Massachusetts (the Property), and being shown as Lot 2 on a plan recorded in the Barnstable County Registry of Deeds in Plan Book 320, Page 27; . - : , WHEREAS, TINA BILAZARIAN and SETH BILAZARIAN as-the owner of said land has agreed with the Town of Barnstable Building Department and Board of Health to a restriction as to the number of bedrooms which can be included in the existing structure built on said lot, as a pre- condition to obtaining a Building Permit from the Barnstable Building Department; WHEREAS, the Town of Barnstable Board of Health, as a precondition to authorizing the issuance of a Building Permit from the Barnstable Building Department is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document; NOW THEREFORE, TINA BILAZARIAN and SETH BILAZARIAN does hereby place the following restriction on their above referenced land in accordance with their agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be biding upon all successors in title: 1. 28 Admirals Lane, Barnstable, MA have constructed upon the lot a house containing no more 1 than 3 bedrooms. Owner agrees that this shall be permanent deed restriction affecting the Property and being shown on the plan recorded in Plan Book 320, Page 27 as Lot 2. 2. At such time as the Town of Barnstable, through the Board of Health and/or Board of Water and Sewer Commissioners, directs the connection of the Property herein described to a municipal sewer, the construction of an alternative wastewater treatment system, connection to a shared septic system, or any other wastewater management option for the removal of nitrogen, and in the event that we, for ourselves, and our Grantees, covenant and agree to comply with such a direction,then this Covenant shall become automatically void. r' i� IN WITNESS WHEREOF, the said Tina Bilazarian and Seth Bilazarian, have affixed their 1 signatures,under seal, below,this\)"lay of March, 2014. Tina Bilazarian Seth Bilazarian COMMONWEALTH OF MASSACHUSETTS County of_ On this t-)*day of March, 2014,before me,the undersigned notary public, personally appeared Tina Bilazarian,proved tome through satisfactory evidence of identification, namely a 62-e r s o ji 00h Driver's License,to be the person whose name is signed on the preceding or attached document, and acknowledged to me that she signed it voluntarily for its stated purpose, knowingly and voluntarily. Notary Public My Commission Expires: r^ v� a �� a o 1 o ?oss goo COMMONWEALTH OF MASSACHUSETTS Co�►ofim0r , On this day of March, 2014,before me, the undersigned notary public, personally appeared Seth Bilazarian,proved to me through satisfactory evidence of identification, namely a da�-r oha[-1.� kr�Qua Driver's-License, to be the person whose name is signed on the preceding or attached document, and acknowledged to me that he signed it voluntarily for its stated purpose, knowingly and voluntarily. Notary Public My Commission Expires:. a 4, aU 7 5 SEAL,\ In�r�iii� <P PNrn.o IS A o� TRY OF DEEDS .�,r•.a`,', SARNSTABLE REGIS T< Assessor's OlTice`(lst floor) May; ! -,`1 � F%�' Permit# �(�� Conscrvaiion Office Oth floor n, Date Issued - Board of Health Ord floor. 0l►�1- <7 Engineering Dept. Ord floor) House# g ✓� °p ,, � Planning Dept. (Ist flood8chool Admin.Bldg.): Definitive Plan Approved by Planning$oar ii"' (Applicationsprocessed 8:30-9:30 a.m.&i00-2O0p.m.) TOWN OF BARNsi TABL.JE. r Building hermit Application Pro'e reet Address Village 5 CZvTLLS Fire District el (hyncr 2-4 4A � Address ay Telephone Permit Rcquest yv �r� � � L �Cu�1 �Ws-�t� ► S1'� S i Zoning District Flood Plain Water Protection Lot Size Nuz4.S Grandfathered Zoning Board of Appeals Authorization Recorded Current Use �� a �. ( S v c�7�.. Proposed Use -V -a tz__ Construction Type Eaistinp Information Dwelling Tyner Single Family / Two family Multi-family Age of structure 1 ,�25 "� Basement tunev Historic House A) Finished Old Kings Highway Unfinished Number of Baths No. of Bedrooms 3 Total Room Couni(not including baths) First Floor Heat Type and Fuel 111,1-tV v"—z -R-- Central Air Y03 - Fireplaces - Garage: Detached Other Detached Structures: Pool yyX Attached Barn /`-)o None Sheds Y"j Other Builder Information Name G�vr.�,� - 1,4-0 . --�,: Telephone number Address _ I loelo �2ii1- n�_i- PI License# US b 6 0 Home Improvement Contractor# /0 373 Worker's Compensation # tX.[a C 2q6L 100? l G/ NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS PROPOSED STRUCTURES ON THE LOT. 9 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �.� %S Project Cost 304 m2c> Fee C2:) SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM T f � Commonwealth of Massachusetts E 2 0 1996 -1 Executive Office of Environmental Affairs MAY Department of t v ft , Environmental Protection William F.Weld t 1� �' Governor Trudy Coxe Secrstnry,EOEA . David B. Struhs Commissioner a- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: Ci3l7e_ 65ieio—il 'L Address of Owner: Date of Inspection: y/r,1C,%�(,> (If different) Name of Inspector: L' el)e-r1 +.3C:rrhf�a5 Company Name, Address and Telephone Number: C-1 CC14,,) t/�-?P/.¢(� CC» 6). _5C,;r GAS% 1-7,1 G>14s r CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _X Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority ' Fails Inspector's Signature: LL •r Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,,the-inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to me system owner and copies sem to the buyer, if applicable and the approving authority`. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. 61 SYSTEM.CONDITIONALLY PASSES: One or more system components need io be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) _ The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 6/15/95) One Winter Street' a Boston,Massachusetts 02108 e, FAX(617)556-1049 a Telephone(617)292-SW A i' Primed on Recycled Pape SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t )4 PART A CERTIFICATION (continued) Property Address: Owner: Awa QuRc:kk1' Date of Inspection: 113-61 B] SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box; The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping,more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed CI 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soli absorption system and is within i00 feel lu a surface water supple or tributary it) a surface water supply. _ The systen, has a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm• D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 r� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Q- A I ni ' J Owner:rtyAfif'�1 QL1 RG nt�� �I s Date of Inspection: DJ SYSTEM FAILS (continued): 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 1/2 day flow. Requiied pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 10 P W 0 feet of,a surface water supply or tributary to a surface. ry water supply. Any portion of a cesspool or privy is within a Zone I of.a public well. Any portion of a or cesspool privy p p vy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen- LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the.criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) ie owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program quirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. evised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART 8 CHECKLIST Property Address: Owner: 1AIv-N BVQe_hd�/� Date of Inspection: "�Jo26 f 56 t Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ZAs built plans have been obtained and examined. Note if they are not available with N/A. 4 i _ZThe facility or dwelling was inspected for signs of sewage back-up. Zhe system does not receive non-sanitary or industrial waste Flow ZThe site was inspected for signs of breakout. ; ✓AII system components, excluding the Soil Absorption System, have been located on the site. ' _ manholes were n n h interior of the septic tank was inspected for condition of baffles or l�The septic tank ma o es e e ope ed, and the p pe tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. ' _The size and location of the Soil Absorption System on.the site has been determined based on existing information or approximated by non-intrusive methods. _V The facility o'�nc: iand occ::pants, if differen, from owner) were provided with information on the proper maintenance of Sub- " Surface Disposal System. (revised 8/15/95) 4 I i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART`C \1 ,. ' SYSTEM INF ORMATION 'roperty Address: Dwner: ON N auAc-�z 11 • ' ' Sate of Inspection: 7 J FLOW CONDITIONS :RESIDENTIAL- Design flow: , 1C, 'gallons '4umber of bedrooms: { Vumber of current residents: garbage grinder (yes or no):�I _aundry connected to system (yes or no): ieasonal use (yes or no):J11" Water meter readings, if available: Cra'�7 .ast date of occupant}-: ' ' u.i :OMMERCIAUINDUSTRIAL: ype of establishment: design flow: gallons/day ,rease trap present: (yes or no)_ „ ndustrial Waste Holding Tank present: (yes or no)_ ion-sanitary waste discharged to the Title 5 system: (yes or no)_ Hater meter readings, if available: .ast date of occupancy: )THER: (Describe) _ast date of occupancy: GENERAL INFORMATION :IOMPING RECORDS and source of information: 1993 System pumped as pan of inspection: (yes or no)Ae;S If yes, volume pumped. /�00 gallons Reason for pumping. TYPE OF SYSTEM _X 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) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: 1/ y,-S c14 �/b'�1;;�✓i�c _ Sewage odors detected when arriving at the site: (yes or no) (revised 8/15/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTE(vt•INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: tq ti N GoAcA L ll Date of Inspection: SEPTIC TANK:_ , (locate on site plan) Depth below grade: &i)r- Td Material of construction: N-concrete _metal _FRP —other(explain) Dimensions: /040 Sludge depth:'_ JI Distance from toTp of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffler Distance from bottom of scum to bottom of outlet tee or baffler_ Comments: (recommendation for pumping, condition of inlet and outlet tees w baffles, depth of liquid level in relation to outlet invert, structural ntegrity, evidence of leakage, etc.) Tee,; "" hilt r-'1 �1� �iv�dr U li��� �-'�" tuLtk Guth t gtD� . GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction. _concrete _metal _FRP —other(explain) Dimensions: Scam thickness. Distance from top of scum to top of outlet tee or baffle: Distance from bottom of crun, M hOttOm O! OLOet tee or battle' Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 8/.5/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C , SYSTEM INFORMATION (continued) f Property Address: Owner: A h)TV Date of Inspection: • �la�/S� t � TIGHT OR HOLDING TANK:_ (locate on site plan) { Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) i Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if le%el and d:str:bure e .:a' e• ;de^ce n<<^i,{< c?• vnver evidence of leakage into or out of box etc) PUMP CHAMBER:_ , (locate on site plan) Pumps in working order.(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) ` s (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , PART C SYSTEM INFORMATION (continued) PA �)s tj0 OSNI. I I� Property Address- Owner: Pp, Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: MOO OO " .OLD /Vi", �S Type: leaching pits, number: leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of.ponding, condition of vegetation,etc.) 1�0 S i f�z !' I Cja'Ci GcLa,P , trP j c�trrn Se 4.1 tdrti! CESSPOOLS: _ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: materials of construction: Indication of groundwate,. inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 8/15/95) 8 L e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C , ( SYSTEM INFORMATION (continued) Property ddress: 1�9�IS �(P C3s�C Ftu Owner: I� 0V G�£�j �NN C� Date of Inspection: uP-6/c� SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' ' I • • j II DEPTH TO GROUNDWATER Depth to groundwater: CPS feet 6-rVY,, p44- . method of determination or approximation: (vt�,��1'a"tin�Lt£ ��Gh j-Y,-rr� �,f S G Z d (E�U�.�p 5�,•y /yk,�n (revised 8/15/95) 9 T WN OF BARNSTABLE 1N� G1 ' LOCATION l A 1,5 SEWAGE # VILLAGE C� ��'ERur � ASSESSOR'S MAP & LOT /4 INSTALLER'S NAME&PHONE NO. • C!101 V 1 S✓��IO SEPTIC TANK CAPACITY 100 C,A 1 c� LEACHING FACILITY: (type) 00 -A (size) NO.OF BEDROOMS 2 BUILDER OR OWNER RAJ/V 1309C PERMTTDATE: - COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility AWO( aS 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 f leaching f ility) Feet Furnished by f - jcl. �00 sv l 9 No....-......6_y..... _e .............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..........................OF...., .................. ........................................................ Appliration for Biipnsal 19orkii Tongtrnrtiun Permit Application is hereby made for a Permit to Construct (V ) or Repair ( ) an Individual Sewage Disposal System at: .............. ......................... ---•--- a:...----•------------------.....-------------.......-------........----- Location-Address or Lot No. Owner ------------------•_--------•-.Address Installer Address d Type of Building Size Lot...&1.4t_ ....Sq. feet V Dwelling —No. of Bedrooms _ amjj ---------- ..... .................. Attic Garbage Grinder PL4 Other—Type of Buildin a_ - ---• ( ) No. of persons ____________________ Showers a — Cafeteria Other fixtures A--- -------• . W Design Flow..... D......./1e5_................gallons per person per day. Total daily flow...........3.3P._._....................gallons. WSeptic Tank—Liquid capacity.VPQ._gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No__________________ Diameter.................... Depth below inlet.................... Total I 'chi area______.._.____....sq. ft. Z Other Distribution box ( / ) Dosing tank ( ) e ,6_ G • Percolation Test Results Performed by.-t4 _.E_Ai ......e ____________________ '----- ,� Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------_................. 04 ----•----------- --••----•--•-----•-•--------------------_.__.._..---------•-•••------------------ ---•-• ------ O Description of Soil__. crr�`�°� 3�' ` U ----- -e----- 1 x ---------------------------------------------------- Cum - •-- -- U Nature of Repairs or[Alt rati n Ans wen app ' b L�� ? � ; .......................... Jam• - .-Agreement: The undersigned agrees to install the aforedescribed Individual Sew a e Disposal System in accordance with the provisions of iITi 1E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the oar f heal . Sig ---•-• = ......... �•9 Date Application Approved By____. ..... _ �. ,�-- Date Application Disapproved for,the following reasons-.................................................... ........................................................... .....--••-----------------------------------•---....-•-------...••-----------•----•-•---•----•---------•----•--------------------------•------------------•------------------------------------...------ n Date PermitNo......................................................... Issued .E ........................ Date No.-----......�f. _ Flcs... .................... THE COMMONWEALTH OF.MASSACHUSETTS BOARD OF HEALTH X41" L-- .-------_--_ ... OF....�j..... -----................................................. Applirafiun for Eliijiuual Workii Tom3 ratrfiun Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: --: �....... _. ............ - .. - ..............................:...:. ---------p Location-Address p , ' .y or Lot No. .. �ta!_.; }.. ...t�sak4��.... - $ - = ._sLo...../' iy ........�lf�.'�._.:..o ....3� Owner {; Address Installer z Address Type of Building Size Lot.A_ ".-4 ..Sq. feet U Dwelling—No. of Bedrooms-----�4__..•..�...� No. of persons ;( ) Garbage Grinder ( ) `LI Other—Type T e of Building P p,, yp g p __.:..... Showers ( Z) — Cafeteria ( ) Other fixtures ..9.....!-�i,�. .._.......��1 e G.------i...�-l ug ---•t--� ----------------------------........... W Design Flow.............Z4h......................gallons per person per day. Total daily flow-------3.3-r?...._..•..................gallons. WSeptic Tank—Liquid capacity./Pofa_.gallons Length"_.,.n, , 4..._. Width............:... Diameter-_.____..__--__- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......I............. Diameter.................... Depth below inlet..'. ........ Total 1 chi area.-I................sq. ft. l . Z Other Distribution box ( / ) Dosing tank '~ Percolation Test Results Performed by.....7,4.,._.A-..6..;:?ee*_'._.._............` s, 14 Test Pit No. I.............. minutes per inch Depth of Test Pit.................... Depth to`ground water........................ (s, Test Pit No. 2................minutes per inch Depth o?-, st Pit----_............... Depth to`ground water................... -------------------------------------------------------------------•----------- t-, O Description of Soil .-:.�.ert ................ x V t W ... UNature 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 TIT1E .5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boar f heal g 4 Date Application Approved B -••• _11A,44 ----------------------- $ Date Application Disapproved for the following reasons:................................................................................................................ ----•------------------ Date 1-... ------.. /Permit No......................................................... Issued.-- ---... .. ---- -------• -.--.:-: -- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. ...... OF........... . .. !L• ^t...................................... Tntif rota ,af Tantpliatta TH I TO CERI FY, h t the Ind vidual Sewage Disposal System constructed ( 4_orRepaired ( ) by ........ �: .-- .... .a--------- -------------------- --- ................................. aInstak ,± hasr b&`ip'Jnstalled in accordance with tie provisions of TI F 5 of The St e Sanitary Code as describe in the application for.Disposal Works Construction Permit No.--- ..... .:...G_.- ':", .__... dated-__._ -�.�--_-� d............ THE, ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GUARANTEE THAT THE SYSTEM WILL,FUNCTION SATISFACTORY. DATE.... ......2 ... inspector-.. ` THE COMMONWEALTH OF MASSACHUSETTS s BOARD OF ALTH .. ....... ..... No FEE ...................... fur � t Permission i eby granted ,.. .... -------- ------------•---•- ........................................... ...--- to Constr or Rep r ( ) i uaI Sewa Dij posal Sryst at No. /7L.... .* .... Street / r as shown on the application for Disposal Works Construction:Permit•" o. ...__ .... .� d.___ ....................- �._.. rek " r Board of Health DATE---- -- ....---- ......--F.d FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS - t, R ` /V --� --- I bV IN T .2 60 to G4 t 7o Tt _ v rvP Pk'oPosG'A �au,..�ATlo.ca" C� S3.3o d' A ' io o sync Y, ry I A G2' 1 Fox LEi I " (' n PiT i I N 10 P2,v, �TjM/,�?A4, D- a iv,TE- &U-vAmo.v:5 e,,VcD OM 4SSwi6D J CERTIFIED PLOT PLAN �li ��:�r� N• ,i r:f LOCATION SCALE DATE �;7 4. 7? PLAN REFERENCE .4347!Va . . . . . . . Z. �� SiGY��9D oA% -tn T SQL✓S! All` I'CERTIFY THAT THE ... ...... . SHOWN ON THIS PLAN IS C NHE GROUND AS SHOWN HERE `>'" CORMS TO TME SETBACK THE TOWN OF �LV/� /Z Vf �0 C1� WHEN CONSTRUCTED. Q%ow) . 2/n/D19JE� DATES?-. . . .. . . . . . PETITIONER: �y�if✓�t/�S, MASS REGISTERED LAND SURVEYOR ,N59345 30. . ... . TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS 4 CAST IRON 12°MAX. 177 r/r f 12"MAX. r rn�ns, • PI PE (OR 4 ORANGEBURG(OR EQUIV.) EQUIV,)— MIN. PIPE- MIN. LEACH PITCH I/4"PER. PITCH 1/4 PER.FT. PIT o,o PRECAST o' NVERT o Q LEACHING :.,.. EL.... INVERT INVERT P . a PIT OR o'. SEPTIC TANK So Zg DIST. ,oZ W EQUIV. o INVERT EL... . . . . . . . BOX EL......... >s /000 GAL. INVERT •. o; EL....�¢S.. INVERT ;. W uw p. %:�� 3/4"TO I I � EL i*! EI-0.So WASHED STONE PROFI LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE G3� SOIL- LOG WITNESSED BY : DATE� •.!s!978 TIME.!4:j° 4-Al ":If'AMZ.+y . BOARD OF HEALTH TEST HOLE I TEST HOLE 2NjAs ,�CE2tA�! PFo , ENGINEER ELEV. 2. ". . . . ELEV. .. .. . . . . . . DESIGN DATA ' S�8-Say(, NUMBER OF BEDROOMS 3. . . . . . . 3d TOTAL ESTIMATED FLOW . . 33c?. . GALLONS/DAY P?b'�iv y BOTTOM LEACHING AREA 78��0 . . SO.FT. /PIT CoTuiT" SIDE LEACHING AREA . . . SQ.FT./ PIT GARBAGE DISPOSAL (50% AREA INCREASE) TOTAL LEACHING AREA Z�709. . SQ.FT / PERCOLATION RATE 46�5. 7701Y .7WO. . MIN/INCH LEACHING, AREA PER PERCOLATION RATE O... SQ.FT. ./`P.WATER ENCOUNTERED NUMBER OF LEACHING PITS 1?!T w17N Tk!o Ft27" "-5 APPROVED . . . . . . . . . . BOARD OF HEALTH o� ,S�wE or✓AYG Si�,- 1-4 ` 7, aF .sro•vc-� per. A�' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . DATE . . . . . . . . AGENT OR INSPECTOR G�7- O . 4N " ED1f , 2LLEY Ne v PETITIONER LOCATION. j���,•�%-a�s G��cr SEWAGE PERMIT NO. i VILLAGE .3 e j INSTA LLER'S NAME i ADDRESS JORN A. AALTO BACKHOE SERVICE 150 Walnut Street West Barnstable, Mass. 02668 t U I L D E R OR OWNER c. DATE PERMIT ISSUED _ 7 DATE COMPLIANCE ISSUED2 — c� S w, 4.d rw r vq�s wa y Y Eve /Attic - AttIG AttIG Closet/ 5torage Bath Unheated 5oace Area of Construction w/ - in existing attic space Bedroom Chimney Own Eve/Attic - Eve /Attic Existi ng 2nd Floor. 1--/8 ,"in f � f - � Ir- BathKitchen Family Room s Master Bedroom Glos Dwn Garage Bath Clos _ los Fireplace Chimney j Bedroom- ,Glos Dini g Room ,. 5tudy Entry Living Room f U . los p } D CI os B i I a z a r i a n Residence DI-S6�t 13V».D,RE�U�A� Existing 1 st Floor 1 /8 i n `'i 1 ft 2 8 Admirals Way 33 North Main street y South Yarmouth, MA 02664 � (508) 394-0832 Wednesday, February 26 2014 osterviIIe� MA GeorgeDavisInc.c om f V . Vent Double Skylight Airspace Baffle ' Rafters & H er Add Collar Tie @ q0" Existing 2 x b Roof Assembly Install p. Board to ' G new walls & ceiling Construct Knee Walls New-ew J kyl i g ht Existing 2 x 10 Floor Assembly Insulate space to p ' ,. e m oV e:Y^'`�a l l � _ � � extent reasonably I'` i � pos si'ble Closet / 5torage , Unheated Space Save, re-install door to attic chimney r— Expanded Closet/ Storage Unheated Space Cross Section 1 /4 in = 1 ft t Own New walls Ali- Eve / Attic I } Proposed Storage Expansion 1 /4 in. = 1 ft Bi lazy ria n Residence IM'SIF01.0 NOVAIV O Admirals V Way/a 33 North Main Street OV y South Yarmouth, MA 02664 M o n d a Fe b ru a r 2 4 2 0 1 `i- o ste ry i l l e M A (508) 394-0832 Y/ y / / GeorgeDavisInc.com _ f-