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HomeMy WebLinkAbout1490 SOUTH COUNTY ROAD - Health 1490 SOUTH COUNTY Tp� OSTERVILLE ' FA:--.: 120-001 . 005 / l w . f' r P I e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1490 South County Rd. " Property Address Mary Ann Tocio Owner Ownees Name information is required for every Osterville MA 02655 10-17-13 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:tformsert A. General Information filling out forms \\`P��tuunp �Si on the computer, H�� OF use only the tab 1. Inspector. / n ;•����` sq�'% key to move cursor-do not James D. Sears (J J = JAMES m" use the return Name of Inspector ^o; S Co z CapewideEnterprises,LLC 1 0� � Company Name _ �,'� ••.�RT I IF 153 Commercial St. Company Address Mashpee MA, 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number. license Number B. Certification 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 Q7 10-17-13 spector,s signature Date The system inspector shall submit a copy of this inspection report to the Approving AuthgAty (Beard of Health or DEP)within 30 days of completing this inspection. If the system is a shared y`+stem�# has a design flow of 10,000 gpd or greater, the inspector and the system owner shall subnnit they report to the appropriate regional office of the DER The original should be senNo the sysfemw"V"C 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 condi�r-on 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. 3 t5its 3/13 TWO 5 Official Inman Fam_SuDswefaee Sewage Disposal System•Page 1 of 17 ®� {VY 3'.. l'd d9ti:Ol•.£l• 91..'°�'. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1490 South County Rd. Property Address Mary Ann Tocio Owner Owner's Name information is required for every Osterville MA 02655 10-17-13 page. Citylrown State Zip Code Date of Inspection B. Certification (cunt.) 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: 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 anot 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 ❑ NO (Explain below): fqi 15ins.3113 ride 5 OfBdid fnspecxion Form Subsultece Sewage Disposal System•Page Z of 17 Z'd d9b:0l£1.,9t h0 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forrn-Not for Voluntary Assessments 1490 South County Rd. lug Property Address Mary Ann Tocio OwnerOwners Name information is required for every Osterville MA 02655 10-17-13 page. City/Town State Zip Code Date of inspection B. Certification (cont.) ❑ Pump Chamber pumpstalarms not operational. System will pass with Board of Health approval if pumpsialarms 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: r❑ 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 - El [IN ❑ ND(Explain below)_ C) Further Evaluation is Required by the Board of Health: 4 ❑ 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 16.303(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 salf marsh t5ins-3113 Trtte 5 Official Inspection Foam:Subsurface Sewage Disposal System-Page 3 of 17 £'d dLti:Ol £l• 91, 100 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .1' 1490 South County Rd. ' Property Address - Mary Ann Tocio Owner Owner's Name information is required for every Osterville MA 02655 10-17-13 page. Cityffawn State• Zip Code Date or Inspection B. Certification (cunt.) 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 aseptic 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: f D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No".to each of the following for all inspections: Yes No El ® 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 h ® Static liquid level in the distribution box above outlet'invert due to an overloaded or clogged SAS or cesspool ® Liquid depth in -7� is less than 6" below invert or available volume is less than Y2 day flow AI73. [Sins.3113 Title 5 Ofridal Irapectioo Form:Subagaoe Sewage Disposal System Pepe a of 17 b'd dLb 0l £6 9l"1c0 Commonwealth of Massachusetts, Title 5 Official Inspection Form — Subsurface Sewage Disposal System Form-Not for Voluntary Assessments' 1490 South County Rd. Property Address Mary Ann Tocio Owner Owner's Nance information is Osterville MA ' 02655 10-17-13 required for every page, Cityflrown 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 faits.`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 11 of a public water supply well. . If you have'answered "yes"to any question in Section E the system is considered a significant threat, or.answered"yes"in Section D above the large system has failed.,The owner or operator of any large . system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 16.304.The system owner_should contact the appropriate regional office of the Department Miw•M3 Tina 5 Orfi6al lnspeclan Form:Subaurfa a Swm ge Disposal System•Page 5 of 17 9 a dw:0101, 91:100 Commonwealth of Massachusetts -- Title 5 Official Inspection Form ` f a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1490 South County Rd. Property Address Mary Ann Tocio Owner Ownes Name informationfire fbr every is required fo Osterville MA 02655 10-17-13 page. Citylrown State Zip Code Date of Inspedion 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 bf 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? ® El information 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 15.263(for example: 110 gpd x#of bedrooms): 330 t5hs•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposer System•Page 6 of 17 9'd d9t, 0l,-c l•;91, 100 . Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form-Not for Voluntary Assessments P 1490 South County Rd. Property Address Mary Ann Tocio Owner Owner's Name information is required for every Osterville MA 02655 10-17-13 page. Cityrrown State Zip Code Date of Inspedion D. System Information Description: The system is a 1500 Gal.,Tank D Box and two pits Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ®, No Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): 2011-363,000Gal 2012-312,000Gal's Detail: Sump pump? ❑ Yes 21 No Last date of occupancy- NA p Date Commercial/Industrial Flow Conditions: Type of Establishment: ; Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatstpersons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes 0 No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ .'No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-.Page 7 of 17 L•d d8ti 0L.E 6 91•1100 NN Commonwealth of Massachusetts Title. 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1490 South County Rd. Property Address Mary Ann Toclo Owner Owner's Name information is required for every Ostervilie MA' 02655 10-17-13 page. CitylTown 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: NA Was system pumped as part of the inspection? r -❑ 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/Altemative 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): tSns•3/13 Title 5 Officialm Inspection For Subsurface Sewage Disposal System-Page B.of 17 8'd d8t,:Ol E6 9L..toO Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1490 South County Rd. Property Address Mary Ann Tocio Owner Owrtees Name information is required for every Osterville MA 02655 10-17-13 page. CityfTown state Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components, date installed(if known)and source of information: 1995 Permit #95-1551 1 10-17-13 New D Box Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 3- 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.): Pipeing is 4"PVC SCH 40. Septic Tank(locate�on site plan): 26" Depth below grade: feet Material of construction: ®concrete El metal ❑fiberglass ❑polyethylene . ❑other(explain) If tank i metal list age: to Syears Is age confirmed by a Certificate of Compliance?(attach-a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Precast Sludge depth: 15ins•3r13 Thle 5 official Inspection Forth:Subsurfew Sewage Disposal System-Page 9 of 17 6'd d6V:06'£t• 91•400 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1490 South County Rd. Property Address Mary Ann Tocio Owner Owners Name information is Osterville MA'"'{ ' 02655' 10-17-13 required for every page. Cityrrown State Zip Code Date of inspection D. System Information (cont.) Septic Tank(cunt) Distance from top of sludge to bottom of outlet tee or baffle 29" 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 1T' How were dimensions determined? Asbuilt Tape 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.): Tank at working level_ Tank and outlet cover at 26",inlet cover at 10". In and outlet tees. No'sign of leakage or over loading. Grease Trap(locate on site plan): Depth below grade: feet Material of construction:' 0 concrete ❑ metal ❑fiberglass , ❑polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle t, Distance from bottom of.scum to bottom of outlet tee or baffle Date.of last pumping: Date t5ins•3/13 _ q a ":, Tide 5 Olfigel Inspection Form:Subsulfaee Sewage DsposalSystem•QaW 10 of 17, Ol'd d6t:01• El• 91.100 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1490 South County Rd. Property Address Mary Ann Tocio Owner Owner's Name information is required for every Osterville MA 02655 10-17-13 page. Cityfrown State Zip Code Date oflnspection 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.): J Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: r Material of construction: ; El concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: t. Y 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 offal Inspection Fotm:Subsurface Sewage Disposal System-Page 11 of 17,; 6l'd d6-V0 C1.91:.160 Commonwealth of Massachusetts` Title 5 Official Inspection Form. k Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1490 South County Rd. Property Address Mary Ann Tocio Owner Owner's Name information is required for every Osterville MA 02655 10-17-13 page, CityfTown 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 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids'canyover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"-35"below grade w/cover at 8'.Two line's out. Box is new. 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: "i 15ins•3113 - - Title 5 official Inspection Form:Subsurface Sew"M Disposal System Pape 12 of 17 Z 6 d d�09:0 l,.£G 91100 i Commonweafti of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1490 South County Rd. Property Address Mary Ann Tocio Owner Owner's Name require for is Osterville MA 02655 10-17-13 required for every City/rown State Zip Code Date of inspection page. . D. System Information cont. Y (cont.) , Type: leaching pits ,. number. 2 ❑ leaching chambers. number. ❑ leaching galleries ;number: ❑ leaching trenches number, length: ❑ leaching fields number,.,dimensions: ❑ overflow cesspool number: ❑ innovativelalternative system , Typetname of technology: Comments(note condition of soil, signs of hydraulic failure, level.of pending, damp soil, condition of vegetation,etc.): Leaching is two 1000 Gal. precast pits. Pies are 4'+ below grade. Ck. D Box and camera out to pits. 6"-12"water in pits. 'No sign of overloading or solid carry over. 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 7 ❑ Yes El No t5ins•3/13 Title S Official Inspection Form:Subsuface Sewage Disposal Sys$em-Page 13 of 17 £L'd d09:0L 0L 91.100 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1490 South County Rd: " Property Address Mary Ann Tocio _ Owner Owners Name information required for every Osterville MA 02655 10-17-13 page. Cityfrown 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): Mat erials to als of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): r t5ins W13 Title 5 Official Inspec ion forth;Subsurface Sewage Disposal System•Page 14 of 17 �L'd. doq: 0 1,1£6:91100. Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1490 South County Rd. Property Address Mary Ann Tocio Owner Owners Name information is required for every Osterville MA 02655 10-17-13 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 a -r = 30 -`� R R 3 �- o ❑ o D'-3 -y_ s9� 15ins-3113 - Tdle 5 Of ial Irepection Form:Subs,aface Sewage Disposal System-Page 15 of 17 9l d al9:0t £l 9l 100 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments. 1490 South County.Rd. Property Address Mary Ann Tocio Owner Owner's Dame information is required for every Osterville MA 02655 10-17-13 page. Cityfrown Slate Zip Code Date of Inspection D. System Information (cont.),- Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar' ❑ Shallow wells Estimated depth t0fh1gh ground water. 12 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: 10-19-93 Dale ❑ 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: T.H. on Design plan 10-'19-93 12' no G W.. Bottom of pits at 10'below.grade. Bottom of pits at 2' above T.H. Depth. Before filing this Inspection Report,.please see Report Completeness Checklist on next page..: .. 15ins-3113 TNe 5 Official kispetl Form:Sub"dace Sewage Disposal System-Page 16 or 17 9l,'d . Wr d1901 £691,1c0 Commonwealth of Massachusetts Title 5 Official Inspection Form..: Subsurface Sewage Disposal System Form -Not for VoluntaryAssessments; 1490 South County Rd. Property Address A Mary Ann Tocio Owner owner's Name information is Ostervllle MA 02655 10 17 13, required for every page. Citylrown State „Zip Code ,' :Date of Inspection' E. Report Completeness Checklist a� ® Inspection Summary: A, B,,C, D.or E checked ® Inspection Summary D(System Failure Criteria Applicable to AIJ Systems) completed ® System Information=Estimated depth to.high groundwater A ® Sketch of Sewage Disposal System either drawn,on page 15 or attached in separate file .. 'p try i 'ir .<P . F. (Sins•3113 Tifia 5 Official kwedion Fom Subeurrace Sewage D*)oeal System•Page 17 of 17 d L rd�9 0 l`£�'9l 1�Q I0 No. — Fee 6 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippliLation for Misp08al 6pstem Construction Permit Application for a Permit to Construct( ) Repair()o Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. i L-14'1 0 5 p.�1� C�o�avt}1 (L 7• Owner's Name,Address,and Tel.No. e s-rE VL,/, Assessor's Map/Parcel )20/0 o e a In//��s88taller's Name,Address,and Tel.No. L4"t'7 — '!-I Designer's Name,Address,and Tel.No. 4 I C W w.—_ec_j - S P an►d�a Type of Building: Dwelling No.of Bedrooms Lot Size sq.8. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 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) V=eQ�A-, t) Date last inspected: fv c� Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Hea Signed �--� Date j C Application Approved by }1 Dates ��� Application Disapproved by Date for the following reasons Permit No. i Date Issued +`M No. 7 _� (r�. Fee f d �!^Ma, 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH'DIVISION =TOWN OF BARNSTABLE, MASSACHUSETTS applitation for Disposal *pstem Construction Permit Application for a Permit to Construct( ), Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1 Ll v` 6�� c o�� R 7. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 2v D 01 4o a < Installer's Name,Address,and Tel.No. -7'7 Designer's Name,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 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 d ` f Nature of Repairs or Alterations(Answer when applicable) n n I,.a.e_e_ ) II � Date last inspected: Agreement: rf 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 operatioft until a Certificate of Compliance has been issued by this Board of Hea . Signed r L---- ( Date to Application Approved by GM P2 Date a�s� Application Disapproved by _ Date for the following reasons Permit No. (2) Date Issued 10 — 11 TU F;COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifirate of Compliance THIS IS TO CERTIFY that the On-site Sewage Disposal system Constructed Repaired Upgraded Abandoned( )by CAYz2,,., , t,•e_ ,n v,1r e. L`` 0 at 114 Iqcv S O�J k d',, 1- . oS rcr-,,I ae has been constructed in accordance �c with the provisions of Title 5 and the for Disposal System Construction Permit No. 6 I3 "' y ydated Installer o J „ Designer ,4 �I?/ #bedrooms Approved design how, i I[A- gpd The issuance oft 's pe it shall not be construed as a guarantee that the system wi7b ction as desigled. Date �� � Inspector h^ 1 � --------------------------- ---- No. '� � � L/ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at (y q n e)" d,,. k,r C( 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. 1n- Date () Approved by ��rl 1/� C_V,J Gt. �_(.� AsBuilt Page 1 of 1 '2 04-357 / \Po•i h,� , LOCATION' <6X"'9V zll!'4z 11"g SEWAGE# SSA VMLAGE� 0 ASSESSOR"S MAP& r0} INSTALLER'S NAME&PHONE NO. 11 02 SEPTIC TANK CAPACM /<4Q ;gc�%;'/ LEACHING FACn=:(type) r(size) Gw ftiZ < [ NO.OF BEDROOMS . ` �` °� BMDER OR OWNER PERMTTDATE: �'`` -' CLIANCE DA E'. Z 7 Separation Distance Between the: Maximum Adjusted,Groundwater Table and Bottom of Lear-zing F Feet Private Water Supply Well and Leaching Facility (If any w.oUs exist on site or within 200 feet of leaching facility) = Feet Edge of Wetland and Leaching Facility(If any wetlands exist' w within 300 feet of leaching facility) Feet Furnished by http://issgl2/intranet/propdata/prebuilt.aspx?mappar:120001005&seq=1 10/9/2013 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �S Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ti 01poricatiou for Mi.5pool *pgtem Construction Per it Application for a Permit to Construct( )Repair( )Upgrade( �')Abandon( ) El Complete System Individual Components Location Address or Lot No.10M Soy ti OZIO 7 /1 Owner's Name,Address and Tel.No. �OClip Assessor's Map/Parcel t/. /d9-0 00/-00f ollr, Sad'- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 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 /s'Go ed, Type of S.A.S. a`Z - oco C46 Description of Soil: Nature of Repairs or Alterations(Answer when applicable) T�// ����- Pl pe TF�IyI ��►r37 g� 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 issued this of�Helth. / Sign Date ! c/-/�� Application Approved b Date Application Disapproved for the following reasons §`i d4 rv,�t Permit No. CO 35 Date Issued y (sn No. 9 Fee DG 1 computer:Entered in THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS .r w. ZlppYication for Oigpogal *p!Wmi Congtruction Permit Application for a Permit to Construct`(., )Repair( )Upgrade( ✓Abandon( ) O Complete System Zvidual Components Location Address or Lot No. C6vn 17 /1 Owner's Name,Address and Tel.No. -�- Sri lti Cc�w +� Assessor's Map/Parcel /ygo 1_ 7 /1 y / O O a-r- Installer's Name,Addre//ss'',and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms_ _ Lot Size sq.ft. Garbage Grinder( Ad 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 lrz o GxG Type of S.A.S. Description of Soil, Mature of Repairs or Alterations(Answer when applicable) �5�� S P �G h0iPc Y-��n9 Cx -S>li 44 Date last inspected: r 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 issued this o .d of Health. Sign a " Date Application Approved b Date �S —w.Application Disapproved for t e fol owing reasons r z I , Permit No. 0-00 7 Date Issued Lj ----- THE COMMONWEALTH OF MASSACHUSETTS i BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded Abandoned( )by ; 601)111,1A.4,i at /y 6 ,� t .."A.- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No" 6 37 5dated Installer Designer -- The issuance of this pe t shall not be construed as a guarantee that the system will-fdnctton$�as,designed. Date '�llt.� Inspector >, .1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS -Migpogal *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( v�'Abandon( ) System located at ,4 /9n 5�.��e. ��6�n-� � �� _� /��• 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 ate-of s e t Date:_ �� Approv6 by - ---�'� ga& ,(( ag 'TOWN ORB E ��� -3S'7 Podgy r ` LOCATION .S �G> ��i6� ���- SEWAGE# �J s 0 �, VILLAGE. �/ — ASSESSOR'S MAP&L./Ot INSTALLER'S NAME&PHONE NO. i SEPTIC TANK CAPACrrY LEACHING FACILrrY: (type) (site). NO.OF BEDROOMS E tt•�• ,,.yLw BOLDER OR OWNER PERMTTDATE: `—� � �° COMPLIANCE DATE - `� vG / Separation Distance Between the: t Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any_wdls exist �f. 4 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 A , i� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF YARMOUTH Application for Disposal Works Tonstrurtion f anti Application is hereby made for a Permit to Construct (V-/) or Repair ( ) an Individual Sewage Disposal System at t2 ..... ... ..... .... ............................................_.......... .. ._. . ..._. - ------•- ^- .._.. ....................................................... r— Owner � Installer Address .......... � Q p ` Type of Building Size Lot.__.•........................Sq. feet ,..� Dwelling—No. of Bedrooms......3...................................Expansion Attic ( ) Garbage Grinder (wo) Other—Type e of Buildin ld ' yp g _ .._.� :. No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ...................................... W Design Flow...............1.-O----------------------gallons per•pefson per day. Total daily flow........-..._�__..........................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter..................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by...................................... Date 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........................ w . ...............•---..........---................--••...........-•-•--......................................................... O Description of Soil__.... ... �. .. ....................... . V ------------------------ .......------------ -....... --------------- --------- ........ ------------ --...... ------------------------ --..--.----------- .... ----••---• --------•- 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'ITI.L 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 b oard o i Signed............... - -----•---- ..................... •--.....-•-------- p D Q Application Approved By....._.. ...................... ! i ...... Dat Application Disapproved for the following reasons.... ................................................................................................... ...........-•-•--•...................•-•---•---_... ...-•-....--••- - ---------------•-•----- --•--------• ..--•- .--- ------•--------- Date Permit No... --- ........._.... Issued.--- . .... .. ..--•----- ...... T// D V Yu+ `�i�sa�*r�- M�+:r+rp,,�� �4tttw► �47�tti.�t""'��"'E��`ARrs'`Ud'a�.v+t �:r�,s��titX3t��%�S�a"'Sri fr+W�4as�� 1,ja, �• No_ THE COMMONWEALTH`OF MASSACHUSETTS - BOARD 0F3 HEALTH I TOWN OF YARMOUTH Applirtttilan for Disposal Works Tonstrur#inn "prrntit Application is hereby made for a Permit to Construct (V-1), or Repair ( ) an Individual Sewage Disposal System at - atioa-A dress or Lot No........................................... • --- ..�/%�C�l:=r— _.=^............Loc ......../ �L.. c.(/T� Y.i. ( ,.�/1� r�'Z... ........ .::Y�.................................................. ... ......r.._.... .._ ....... • Owner _f w s%'� l,f> 'r rI a -- -------- •---......_�-................... .....-•--- --.........-•-------...._.......... :,....naa ----•--------.......------••---.._.........._.. Installer Address . Type of Building Size Lot_S'.fs.'..06__k_..._..Sq. feet Dwelling—No. of Bedrooms.........................................Expansion Attic ( ) . Garbage Grinder (4/0) Other—T e of Building�C� �i_��-e._. No. of persons............................ Showers a YP g ------•------ --- _...... --- ( ..->--- Cafeteria ( dOther fixtures ......................................-- -•----------------•-----------------------------•--._... ----_-•--- W Design Flow .................gallons per Pe>°san per day. Total daily flow....._._:3_�-�._............._............gallons. W x Septic Tank— capacity........____gallons Length________________ Width................ Diameter__-_._................ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by....................................•--•---............._......-.......... Date........................................ ,.� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ri ODescription of Soil.... lJ. : .............................................................................................................................. ... V -- ...................... .....................•- ••-------------------•••-----------••------•••--•---------- .... - __ -• :...: -......_.._...... 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 TITLE 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 o hlth. d Signe `� 11---• U e, -----------•-- ....-- - ............� ✓J � �, f� /' L, Application Approved !? � � on Approved By............. .....- ---- ..........._�,4 1..��.� ------{:�--�- 7n-...J / Date Application Disapproved for the following reasons: ...................Y_-_•____,__._______________..____._...__T......................................... ....................•-•--...-- � a Dte Permit No...� --- Issued.... ...... _ s -------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN of YARMOUTH �rrfif irtttr of f�um�littnrr THIS IS T-y0 CERTIFY, That the Individual wage Disposal System constructed (t/) or Repaired ( ) by -- -ltJ:.. _ C%/�/��-- ----------•..................:............................................... .--•- ............. -----••- - In taller at.......•---► ... .......4.V-�--�_:.-_C.�� ..-----.............................. ..--•--------•--...---......................-----•-- has been installed in accordance with the provisions of TIT 5 o Tie ate Sanitary Code as described in the application for Disposal Works Construction Permit N .. �...;�����:... dated................................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. w DATE............. '�-==----�� � •-- Inspecto THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH.. TOWN of YARMOUTH ® � No._!.�./// . `-� ' FEE... .................. 19isp as� lurks Tunstrurtion rr _mit Permission is hereby granted..._..%. ._...?� � f` - •- --` -�--------------------• ...............__-•--__.... to Construct ( �or Repair ( ) an Individual, Sewage-Disposal System at No..... ....z`_._ rt� _. /1 �? ._,l<fr�/:--•-•- ------------- street .e as shown on the applicatiod for Di posal Works Construction P rmit No d ______J-_____ ated_._Z�..!1._L>'.............. . IS Boar of HealNl ` " DATE........................ .•------- . •i............................... r 1Dc4616 N -PATA '514dZ FAMILY 4 . BE WW SNt3� l.. of 2 . I�o 64125AGE G210M _VAILam( FLOWd X N0= tl.4o OD %'Pf'lC TANIL d40 X ISo`,o=66o jo PD 4C QLbIa 04 5&e-e- WaEOF U4F- „-yi,w AL PIT I-I DOR.--AIL 51DEW" AO" , F E .'_ 3?] Sf X 2'S =' 942 l.PDI , , . . . •� �. , . vmom AwA = I s-i sF 15�1 ,c I'm lb' AL't*16N - 1099 6w• ; _ . . TOTAL VAgy ,MW A4o 6Pb <,OIL. OF DAVO wow I&L 33 i + T*6r i TF.mw SL law 1.0As,0% _ i1N t 8So14.. _ •. AD, (54p P V 49 %fit: r ' °er�AL vz! SAuo .��• �6m• Qua..5yxtcn m) wr . Am lm*p4 0''dam r to row osT zvlLLE -"Wormt�zolry r:o eLAN 9M fLE.1" '. 1 GEKTIFY �T+1xT TEIE�ou�lna�oN . . � S ' 1Dw u �IEIZ6bN coMr,L 1.oT e 6eTW ¢EQ. 0 q(C- 14N OF S e+dsme�x -7 eo 6-1 is L.o-CATLD WIT I°193 •fi Pc.�N J � �, . . . 55raJdt. Aft -5oEVirfeaf 7µK' FiJ►N l5 NCI' F3A<i® . OW, ;AA 1 i'�i 7+t+tfArt" Z w i L f N S . ' SUtwY ` AWID TNE.' QFET4 .il�cutp ;y oi' f o yr�,vi u.Ec MA44 . uepab ro c-JTarsr ; may: �► s a I APPLICANT-; Beys1vE Bviw�u�. Ca ,J� 7;3"Si;l: ------------ Vit. fq t , ! y ; , ! q i F i- I ' OW : i S400Tt-1 TY OF R nlolMpD i _ ' SUI lVAN' _KUM oi qf: z No.---IAT C1<-:i _ Fee------��-------- BOARD OF HEALTH q0 bo� Ioc� TOWN OF BARNSTABLE Appticat ion ArMelt Con!gtruct ion Permit (� � A pli ation is hereb made for p rmit to Constr ct (�, Alter ( ), or Repair ( )an individual Well at: Location — Addres Assessors Map and Parcel Ow r Address -- �F- - -- ------ -- -°-�-- ---�-�----- �F f� Installer — Driller Address Type of Building Dwelling---------------------------------------------------------- Other - Type of Building ------ No. of Persons----------------___-_____—__—_—_______ Type of Well-—C, {�i-��-- --fo----- --- --- Capacity-- �� - -- ——— Purpose of Well------7--"—P - �-- ------- Agreement: The undersigned agrees to install the aforedescribed 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 un ' tificat nce has been issued by the Board of Health. Signed ------------------------- --�� � te �---- Application Approved By _____—___________— f y d i - 1 ,Y date Application Disapproved for the following reasons:------------------------------------_- ---- --- ---------------------------------------- ---------------------- p� date Permit No. VV el-Z —--- Issued--- -- -- - --- -------- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of (Compliance THIS IS W CEgTIFY That the Individual Well Constructed (,<), Altered ( ), or Repaired ( ) Installer / at-�-C` fi �5 �O��iTG.- C L�:�C� c� _ �----------- has been installed in accordance with the provisions Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.W-9!9!"46-Dated----THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE -- -- Inspector-- - --- - -- --- --_ • ..+. .. ....yam 'h..�.... ...,:�'f...,-- r` -;" t r I•wr-«- .. .n.. •,y '. ...r. L.; ..+- � .e. :-r No.-- ee----- --- r. 'BOARD OF .HEALTH ' i �jUIjUDS "TOWN OF BA RNSTABLE : Appti at iori,for 1VeC[ tortgtruct on Permit ' ll�t� A pli ation.is'hereb ..made fora rmit`to Constr .O0 Alter ( ) or Repair ( )an individual Well at: pe yy��ct Location Address �a Assessors Map and.Parcel Ow r Address --- ;� _C'`( i f d /3 ak d sow Installer, Driller ---- — e. Address — � i Type of Building Dwelling - -- - --- - ------------------------ Othera 1 - Type of Building = No. of Persons-___ YP 8 -- — - Type of Well 1 ype — ----—= - Capacity-- �--�o Purpose of Well Agreement:. : for'd scribed individual well in accordance with the rovisions of Th to install the a e e e The_undersigned agrees p Town of Barnstable Board of Health Private Well-Protection Regulation The undersigned further agrees not to place,the well in operation until a Ce tificat C p nce has been issued:by the,Board=of,Health. Signed -- --- - -- - -- date Application Ap'roved'BY date Application Disapproved for the following reasons: ----------------=------= =----------=---=----=- . date Permit No. Issued=-- ------ -------- date --- —— -- 5.'A 4.!.e4�9Miwu tai ..!i3i��4,90sYee±w.eP.eC+i4w4sRa��!+�!'�TO�'i6L!.i964�'e'�dYY�3T�lA4LT6e�sP i±iAStG!i!inOWei9clSl Qbdl6�ib Bb9ta'1>Yd.LVs.Ni9e.Rif6N9:.N21iV89u!r9G!al:ToVa�liSmw�.4if.ClwRa-eQi s t BOARD OF HEALTH -TOWN: OF B.ARNSTARLE Certif irate Of Compliance } THIS IS —_TIFY at,the Ind;vidual Well Constructed (f�) Altered ( ) or Repaired CE G( -c '�-F by— -- -- ---- — — — — —— = Installei at77 4Q �- SOCi Tlti C'.(,G�nl7` c_✓ f. lJ. - - — - -- -- has been installed inaccordance with the provisions.of the Town of Barnstable-Board of Health Private Well Protection i Re ulation as described in the"aPP •licatio for Construction Permit No.W Dated— - { g "--t-�- ---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE.WELL (' SYSTEM WILL FUNCTION SATISFACTORY. ` DATE Inspector------ - - . -- �i+'ilia:±:•Beam+Sri.9e•liTieassc'a+aRaur•s»iVxi9a2asramabsea2s4..e..ec^c."a�isea!JYSi�s K�i�rsicea:!iT.:sraiYale:s 1:Si�a?r :.+;:�.i49,••e�Aed/±ilr2ea!J.l�4are�.w?:�.:w.�a�e�asa!p�w�:z�i�o�« BOARD OF HEALTH TOWN OF BARNSTABLE April Construction Permit' No. —��-� Fee'_ _ r Permission is hereby granted "`" _- 1 to ConsWxt Alter ( ),.or Repa' ( ) an'Individual Well at:, Street -- r` as-shown on the application for a Well. Construction Permit No.- Dated -------- F • 1 = — --------- 1 Board of Health ! DATE F sting Conditions @ 1490 South County Road., Osterville, Ma. ared For : Dou las Tocio sor's Map: 120 Lot: 001/005 Baxter Nye Engineering & Surveying munity Panel Number 250001 0018 D Registered Professional F.I.R.M. Map Zones: C Engineers and Land Surveyors Plan Reference: Land Court Plan 7697E N Sheet 1 Of 2 78 North Street, 3rd Floor Certificate of Title: C 138,520 Hyannis, MA 02601 Certi Phone - (508)-771-7502 Fax — (508)-771-7622 Owner. Mary Ann Tocio Job Number. 2006-020—cpp2 Scale : 1" = 50' Date : 07-11-2006 .00 SB/DH FND HELD 297.66' (RECORD) _ 297.63' (FIELD) CB/DH FND HELD 0� 1 N62310 � 1` O� O OG C��0 .N10�o6 � 1G GKE�P P CB/DH FND `fiiP n Z EGG f 10& 0 OQOGV �00 •� POG y GR��P PO ��NGE O Z GON S�oc�p,OE. O. ro ¢ 5a'�3� 1• �OO�o g 6 Z85 yz •" � L(J W 00 � U U � LWREGISTERED FY THAT TO THE BEST OF MY KNOWLEDGE THE FOUNDATIONS SHOWN HEREON ARE IN RELATION TO THE MONUMENTS SHOWN AND ARE NOT LOCATED WITHIN A SPECIAL FLOOD HAZARD AREA. N IS NOT TO BE RECORDED NOR IS IT TO BE USED TO ESTABLISH PROPERTY LINES. �. ax PRO ON LAND SURVEYOR N BAXTER NYE ENGINEERING & SURVEYING DATE -7 0 0 MA L LtC r4�111 r1613' TM &T 6" To 7-C-x 1IT- . r 2 2.� �'o 75 L if n' Np�.1 CLk tt6M1�L� CAN CAL._ LV1Tt.lM br Me 0 n' G WT£.S Q 6� t • S N a�rr t ce�vvo-ry owwa ' No woo MAP • , � � � ,off p�- o� �c./ c67Z74 Y'o ,.5'4 r� -S' r w•�a ANC E .L.0 CA 7"�,C) Ls//T�/�c/ T •��apPG4 �! .'PROPOSED. jO) c 0 3S-Y TOC10 POOL HOUSE 3 J / OSTERVILLE,MA- .2,0 66 ( 12 _ F ` -p n 1 I .1, J. r ''=' z,L.x _ ..._... —— —---- --- TOM REARDON/ARCHITECT — — —--— 7 _5 I -- ----"----- MWGN,MA 0157z 171—..,. _ ��sunseT Drove.eoaTllso k I - . � 1 F 11 ; Gj dr • 11 , , v I - k .. .. � � � �(": ,_._-; ��.-' �,:�_��!<.��4_i � _•_ E - 1-u .. � -� �__-- - -'. ©TOM.REARDON I ARCHITECT — NO. ; DATE ' :REVISION: - - �f ! � r i �, �•ate\ I 51 amm REARDON -- = - I ND.7497 I j L NONDIBOIgIRN 1 1L r 62 !.': 3' III —{ . .,., .. .L_-._.r..m•.,-:'1%x � .. :. 'T. 2.:..Y ,;.1 i l _ ���•C 5 YVJ.... 'ORYWIH6 NAME: { A ' .. I V i= FLOOR PLAN& ELEVATIONS PROJECT NUMBER: 0-BY; —:UE: .AJTR DATE.' AS �I �. .ter ✓.�. I'. i/ �:-�. L 1'r AS NO � r .. - 00' • ' PROPOSED: TOCIO — POOL HOUSE - + OSTERVILLE.M kj plim i` r ,I _ TOM:REARDON I ARCHITECT .. .�. - T SUNSET DRNE,NORTH GN;MA IT 'i F 41 i P ct 4 cam. t �?p-Il.� E s , Y ' j' i a � - .. ©TOM REARDONI ARCHITECT NO. DATE REVISION I _ 1IL?4v I —t-'r J I ' Y — ER STRUCT AL -- PLANS B�DETAILS _ — t i t I + ` PROJECT NUMBER: � DRAWN BY: 2006J1 JTRiL . AS NOTED 7 9 f c. 1 r . X