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HomeMy WebLinkAbout0233 BRIDLE PATH - Health 233 BRIDLE PATH;MARSTONS MILLS _ M4/p /4-9-os9 pF�rOk,���+ Town of Barnstable Barnstable MR`STAB`& ' Board of Health 11111.1 9A 139. .`�$ �fn►+ '° 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Paul J.Canniff;D.M.D FAX: 508-790-6304 Donald A.Guadagnoli,M.D. Junichi Sawayanagi December 6, 2017 Mr. and Mrs. Kameliya and Dimitar Dimitrova 233 Bridal Path Marstons Mills, MA 02648 RE: 233 Bridal Path, Marstons Mills , 1.15 Aacre Dear Mr. Wilson, You appeared before the Board of Health at the public meeting held on September 24, 2017. You are granted permission to utilize provide four bedrooms at this property, located at 233 Bridal path, Marstons Mills, Massachusetts. This permission is granted with the following condition: • The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to four bedrooms maximum. This permission is granted because you provided multiple documents (including a real estate purchase affidavit, assessors' records, a septic system inspection report, and a September 14, 2000 building permit application) which supported the approval of or existence of four bedrooms at this property. Sincerely yours, 0,4"1 VV au n i M. Chairman BOARD OF EALTH Q:\WPFILES\Dimitrova 233BridalPath FourBedrboms 2017.docx Dimitrova 233BridalPath FourBedrooms 2017.docx �tHE Tp� Town of Barnstable Barnstable ` '"R`MASS. ` Board of Health 9� t6� RFD 39. s 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Paul J.Canniff,D.M.D FAX: 508-790-6304 Donald A.Guadagnoli,M.D. Junichi Sawayanagi December 6, 2017 Mr. and Mrs. Kameliya and Dimitar Dimitrova 233 Bridal Path Marstons Mills, MA 02648 RE: 233 Bridal Path, Marstons Mills , 1.15 Aacre Dear Mr. Wilson, You appeared before the Board of Health at the public meeting held on September 24, 2017'. You are granted permission to utilize provide four bedrooms at this property, located at 233 Bridal path, Marstons Mills, Massachusetts. This permission is granted with the following condition: • The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registri of Deeds restricting the property to four bedrooms maximum. This permission is granted because you provided multiple documents (including a real estate purchase affidavit, assessors' records, a septic system inspection report, and a September 14, 2000 building permit application) which supported the approval of or existence of four bedrooms at this property. Sincerely yours, au WnYi M. Chairman BOARD OF EALTH QAWPFILES\Dimitrova 233BridalPath FourBedrooms 2017.docx Dimitrova 233BridalPath FourBedrooms 2017.docx Kameliya Dimitrova 233 Bridle Path,Marstons Mills 02648 MA 508-496-5304,di.mitrova.kameli.ya@yahoo.com r.� Board of Health Meeting, Town of Barnstable Dear Members , Me (Kameliya Dimitrova) and my husband (Dimitar Dimitrov) recently purchased house in the town of Barnstable - 233 Bridle Path , Marston Mills 02648 MA . The house was listed as 4 bedroom 2 1/2 baths build in 1987 with more than an 1.15 acre.S land . The inspection made on 06/05/2017 for the septic system shows that the property have 4 bedrooms and 2 1/2 baths. The inspector Sean Jones presented full report to the health department showing that the system has a flow of 440 gpd. The assessing department in town of Barnstable always had the property as 4 bedrooms and it has collected taxes for A of the past years as 4 bedrooms house . The building permit shows that the house have 7-8 rooms but at the health department the house is marked as 3 bedrooms and 2 1/2 baths . (AW Ye My lamer as well and the septic inspector help me investigate the issue with this property and it shows that in 1995 the previous owners added one more pit to the septic system for fourth bedroom , but wi=h no correction on the permit found in the Health Department of Barnstable . In our research we discover that in 2002 the Town of Barnstable placed the area in WP Zoning,but all of the correction are made way before this year . I was able to speak with some of my new neighbors and there are houses with 4 bedrooms on the same street with even half of the size of my lot. We purchase the house as a 4 bedrooms house and payed the full asking price. We know that down the way this misrepresentation of the house in the different town departments will be a headache for us or future owners. I am asking you to please review all of the attached papers and documents for this case and help us solve the issue with this property . Thank you for your time and help. Sincerely yours, / Kameliya and Dimitar Dimitrov A;FFIDAW` 'We,llaAs A.C4&aetdel6v,Kameli"8G Diwitrova and Dimitar lvanov Dirnitrov,being sworn,depose and say the following:, 3. We purchased the prmPerty knomorn as 233'firidle Path, ar ras Mills,6ai is bl€County, Massachusetts on jvne 30,2017 2. The property was rrwketed and listed,for sale on the AaRuWpte Listing Service(MLS)as a four(4i) bedroom horne,; 3. The Sarnstabk!►gsessoes Departrneapt"fie-ldcard"lists the horne as a bur Jd)bedrogrfwt,o 4. The Title S is a four(4)b€drive]n systern- 5. 'Are purchased this property Iriteiiding to occupy it as-a four(4)bedroom borne jc that Fs how:it was marketed.. 6. As far as we know,'the property,is intended to be a iour.(4)bedroom home. Pagel of 2 i Signed under the pain$and e.mItles of perjury this 3Q day eaf A�t,2017 Mfis A_C' del Karneliya.6.Dirnitrava Dunitar Evan imiltrov COMMONWEALTH OF MASSACHUSETiS Barnstable County on Au g¢ t.30,20171 Before me,the undersigned Notary Public perwrtally appeared CorisA. C.ikandelw,Kart e9iya'B,Dimitrova ark(?irr7itar htana iDimstr wr,Wad to€ate through satisfy .ary id e ence of identification which Ewa$, 1f t���. to the Persons whose naapes are signed on.this doe?mejnt and who acknowledged to me that they lived thi$dwim.ent voluntarily for its stazecl purpose and as;theirfree act and deed and thatthe contents of'tWis document are truthful aid accurate tag the brvst_if their kno.vAed&7 �l+ota blip My Commission Ex. .„e$- $fi t l S A C711€5 r�cxtarY��,bt�� r,F� Page 2 of,2. ok + cAlSrs�i 3Ar19SCas�`+_, 3.5 13R.� p � E ST -0 IF I—0 i�, c�� tip CA 6 _O Li✓ING 1�a�� i �c:lo$° �'jiFTttRcv�t Fft THE COMMONWEALTH OF MASSACH[ISEWS PUBLIC HEALTtd OMSION T0-M OF- BA N$,TAB1:E,; ► ACHU -IT. ZIP tr tiara far Ai od. ipgtemm ConsiTuctiali Permit Applcat on i3 6iere6y Made f(w a Perryclt to't onstlW{ )w Repair 1 L4ca&a Add..&a W Lw NO, Adrt za#rgTs1 Ng, _ h i:. itubtDlsaShRQG.AStSI[SSR md WrNr7 `�tt b\tts#g9�d EGt\Q. dUffdiM� cwtuin No of Beci MyFjI4 78Y 9 51tk CP other 1'}Ts of Ru.'adims Of PMWM _ Suers E � vj p. Chher Fi9erute� CakuDiwd dnY y f ow S i) gallons: Pitt€: _.. - Fowi:ion . Thscnpt%on of Soil lKAMM of Rtp aias or Aft on (Am w .r lteu py�g]ie lc) it Dane Uv iiuspw x8;: s'!.gmeui: "£heut)dusiipedagmcestoea5cre,The cotaftActionv. , n *e :of the afawcdc-mriw on si te wwwp cfis pq!)jstso ill sc9rdance with the PFOAS44 of'1di s vfthc l nveiiroatttt-t)L C. and not to p ee jbg:,Wbjcm in opt.calio�i ttritil:a Gci&'i%i.- Cate of Compliance has ban.i d bg fh* Roardof lth. ., Siagned `g _ Date,��� !�� . Application.Approved by 77 Applicmion 04sapproved for the following.masms Drrte•ds. :� .-� -- .�..�,w:�.;.��,.. ,,�...,y.�a c��cups..,asp.-�.--..�,.�:.•-•�-- ._..: ,,,aa„ �..-.s-..�:. .� ..�-�.�+4 THE COMMONWEALTH OF IllfA°S CHUSEM PUBLIC HEALTH DIVISION—BARNSTABM M!#SSACIiUSBTf$ TsiIs IS TO l the.Om its Scw a$isposal sysc &c ammued )of rtp " eagkc�i )tom- by for s wilb ift 4W&isimStif Title 5 and r]wfor spQsatSystemCuatstr aaE i' tliia.._ / d'stecB Vsc of this.s ls�tn�coil0t-owd oti. c�I c a v—�via�the p�;�;s S�e forth�la�� T b or f YHE COOMONWEALgN OF MA%SACOOSEWS, BOARD OF HEALTH A i r for Miter 01d. Itiorka (9-muWu ftn ujft� Applieatian is hereby,made,for Tem-A to Gaass ,ct (1d or Repair .[ .D an ZrteE;aidxW Sewagc'.,Mgx ssi Syshm at: aa. 3 kh T of j3%v d ng a. 3 _ 0 -..—. ---pansion Attic. Q5Yb r Wider C . aOther—Type of f3ui3diam No. d prrces2&.aa..b.. a W.r Saws d Otha fr u2 sign I aver.... ftr persoe per day- Tftd ft x Di" TTench ` o: LevgtIt....._____Toeal lauel ilig sire,.,.tea.:...., fL r Seepage Pit No J— _..__mamerer_ cz _ Dept; W*w Tataf Other Distnbution box '.• %xvlaum Test Results Perfan ied ;.ro, I'�-Pit No f..��,,..�zsisttttrs per imb Depth off 'hest-Pit_L&a ]�epffi w jpc ._ 04 Test Pit No_2—�_7' mhune=s per inch J)qvjki of Test E`iLAaV__ Depth to grQJUW WO _AY 4 Description of SoiI__.— e__ U 13atetre of Repairs or ftitcaaxioaes—1�aus�rer vcdt�ap&a1�,,.�,,.,, - -- - -- the.k nders<gmtd agrees-to install the.aforedesembed IrvjividwLI Sewage Disposal System.ia accord-act with The provisions of sITO, S of tie St�,#e S*wibry c—The wmlcisimi cd further al; ',n sy not to Oabe the stem iia *Per'at oes unW A Certificate �rtpiaaace of.Co tras b��su,-d by .. board of beW rlpfrTuataan Approved By_' A AppUmfion Disapproved for the foUamin rKwom -___ vm ftrt,itNo_17— ► aoc9 �...�....,, r TF4x c4�+ mor4wr.Avrti of AWAC__4USC t`S Z ffiS I TO CERTIFY,Pmt the fed iduai 5"%e Disposal STw=constructed. or Repamv ( } bas been iaas filled in aocarda with Ok e poo4 i;�iops v6 TITIS 5 of The State- as dcscr� ae� a pp ii-ition for Disrotgd.Worim Construction Permit Wo ¢� �`�y+s THE fSSUAMCE�CIF.YM C FtCATE'$HA t WGT 6E`CONSTItUWI,A'A GU/filt; THAT TfiHIF' SYS$Elm! WILL_ fUNCTIONJ SATtS,FACTOM x Catounomealth of Massachusefts Title 5 Official inspection Forts Subsurface Sewage Disposal System F -Nut for V4irr y fsssessmeAtS- ._ 233 BMW Patti PCOPerty Admess Thom 8 Eflew Fazio G"er Offfiefs NSM k ttnit v.6ft is Mamtons tvl:ll is 02M _y_ S1M017 cVrired fir eves �..m, ¢ � CrytTown u Code 4erspeci d. System Information (cone) Sketch Of sewage ofsposals.ystem Pfavide a viexr of tbe.smrmSe disposal system.including tics,tp at Cease Wo peTmanent reference landmarks oft ch,=R&Locate,all welts ti i .t%feet Locate where pubtic water supply eaten the,buildft,CbeM. one of the boxes helov harrd-sketch in.the sea bet ow drawing,attached 15epa atety �V- -------------------------------------------- 1 2 . At A2 01W q f Commonwealth of_Massa us- 0ttft wj__ Title 5 O i�ci l aspect nForm. Subsu face Sewage:Dspc sal S'gstem Form�Not for�04UrdaPf�rnents 233 gndte€rath ert�ArsityP,�r>sss Thomas&Eileen Patio ---t7�+ncr Ovn�P:iA4iir5te ir.*%mation MquRCd fbrs4uesy+ 1�( tQtlfi Adis 02646 6[512017 par- we Zip Code Date offrGy n fnstposbon results,must be submitted on this fblm.lnt pecboj%forms rnay ot.be Itered;in.any way.Please se completeness checkltt at the end of the farm,_ imp9rt�rtt:tk��n _. _ tilling out(bails A. General Information S1 nit 7►r_•�utpi', Usa onlyths;ab 1. Inspector i;eY.to r joir CUTS -do F101 Sean M_Jorsea lie ���3 a ths'retum ` kcr, M:ft or bispedor -- s Jones TlUe V Sophie-iiLapecUort nymme 74 Belden Ln. Centerville Ma 02632 hyrrowa Zip Code 774 24848�t sqones#U,e5 $14622 Yci�hgne M�ntr_r' ,.•,. 3IG+@il'�+3 f+��'r+tar .••'�. B. Certification l Codify#et t nave personally inspected the sewage disposal syystero at this address aAd that the inforraMn reported belovr lipo true,accurate and c orrlplete as of the time of the inspecAloft.The inspection was perl'ormed based on my training and e?ipdrience in the proper function and r>mainkmanace of on site sewage digp€sal systems:I am a DEP approved system 9nspocr purrsuarntto Seetlon 15.340 of Title 5(310 CMR 15 00©)_The system: L Passes n c dita�+na r Passes Fails Needs Fuller r`valeation by the Local Approving Authontyr &512017 tfls�a�s�P7s'S�nrtiuie I�a;g , The system inspector shall sub it.a copy of this frtspectroii report to the.Approving.Autt by(Boartl of Health or plan')within:30 days of mmpletingth Inspection.l#the system is a stirred stern be. has a,design flow of,10,0OQ gpd or g=tdr°,the inspector and the sysitern dyiner- 1191 subM t the repon.to the appfoopte gionall oftiee of the.DEP.Ttie original iotfld be s¢nt trt die sysasM orvrt and orJies.sent to tree Wyer° if appkaele,and the approving eutboritf; '",This report only describes condiWns at the time of inspection and udder the c ond'►tiorm of use: st.tthat time..This inspection does net ardcfrcss how t system will;pea irirm in ttee future urrdeg the same or difforem Conditions of use. •'kt3 Tessa Asst -smgsVow-I '.PWAior 17 r"OM monwvea#th of Mawar- tasei Title 5 Official Inspection Form I SUbsutface SevMc IDiWt-,= f s,yslc Fo"n-Not for VOIUM S�_ wen 233 Bridle Pall' �rbp�y Address T'r�o Gleen Fazio . f)w x dean NG�ra�n 8d!#2017 Martbns1r11>; _„� mwwre.4 fix even, __.> ---Nr---w -- S��G: L�D'��. ' at jr4pedibn �� Citylrarrn - Co Checklist tJfi t if the fblics+tiir. have dc�rt2a.You Mu. indicate"yes"or"rtsr.as to e R€t#the f�flo��4ng= Yes No pumping ici€or€nntich r Provided,.by th*owner`s �PentF or Board of lieeltt ( 9e arr{of the sys4ew Compgneat pumped out In the per y ot>s�re w ? Has the sygtam sew-Wed normal ftws in the previous two Meek per ? Have large Volumes of watw been.introduced to-the systeclri MIME ntly or as pad 4t fi !bi this in5pecionl) -Word as built plans of t ie system obWned aPnd exam. ed (ff they were reot... a alable note as NIA) Was the f861 y or dwelling 1pspeeMd for signs of serge beck up? j Was the site inspl ec5l:d feigns of break out'? ] e ap zyswni�asar�iponenis,eixiu8lt the a located an site? C Were the seprtie tank marib.0"uncovered,opersed,and the,intenar of the tank inspected fur flee cundi6m.of(he hales or is ,rnota( aF esmstr�rfion, dimensions,depth of liquid;depth of M.Podge and 015111 of SC+uiyi? Was Ilia fadl'ify ovmec(and aocup9r�if different fry a n04 prOvde , :vim €nfprrt`eat n ore the prow maintena of sUbsu> se age d p 7 zy s?' The�s zo and location of#te Sotf Afrorooh System(SAlSI on tt*sits h been determined basAd ern: . [ tlsiirt9 iPtfgr�rt fiore,Fo rumple;aptan atVi l?,o��d Of Fle0h. Determined in the:Weld(i#' ny of the failure crr�ria related to Part C it at i z�ea opprox4notionof distance.c unaooep ble} 3lU t R 9 (S�� D. System Information ResidenUaf.ROW ib-a dlfionaa Number 63 bedrooms( NlurnW of bedroorrts(designy. 4 — DESIGN flow adn.3p Cldli�1b-2a3(for Uarrdp 11i�gib x ofbedrgars}. 11 5 Ori[iA Gk } Pt Ca Stuff U t? �'P d 1.7 r Assessor's offioe (1st floor): f< oFTacro Ast essor's map. and lot number ....�. :�— Q S............................ Bord of Health (3rd floor): zq Swage Permit number ...L(........ :............................:....:.:: { esaa9xsn�a. E-gineering Department Ord floor): Z 3 rb a Housenumber ......................................... .......................... o�aY a + APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00.2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR Y APPLICATION FOR PERMIT TO .. r�?...�.`:.'.::� 1�Si ....... ..........................................'I`1 v C�•G ] )-� /cl� � ;z ... ..... ........ TYPE OF CONSTRUCTION ............................. ............ `..................'.............1'9........ TO THE INSPECTOR'OF BUILDINGS: ; The undersigned hereby applies for a permit according to the following information: Location ��.:..1...... CJ .... ........: a!S!1. �:. + .'..�.. ...... :Lc�(.....`..... �.. ProposedUse ..... :1 ./tl.�:.::(:.k:.....�:Y 'I..l.�: I... .�.. ........h.................................................................................... .. ........ : Zoning District ............... .. ;.....1.... ./.....Fire District ....... _"..(/.r �..(�(..1� ( � u ......... .................Address ....I..LL�...G.. '...�J C'.........�..1..�aw..I,�aR�4�Q Name of. Owner ..-C .r ..... . w l • f Name of Builder .......� :. 1 .�.,,a!!..1� '. .. .Address .....�.tia. ...T�� ?\.�.. (�.�.`. . ..1` f Nameoff Architect .....•.............................................................Address .................................................................................... Number of Room's ::....... ..:..... ..............................................Foundation ...... .. Exlerior // �. .1. �... 21J.fl�C.:r�..`::...<? .ft....�,�.!:t.L ..-?.............Roofing .... 1.1.1..:.. ....... ... ..)..[.v....:.f:.�,...,.................. Floors ....... .f ;..... f.... .../'-'i,j `..1 �................................Interior .r,....k.(::;: ..j.. t:!.(... ,,,,_.......... ........................... Heating :::::::..:::......:....:...:..i.:..:....:.......:Plumbing ..:..: !``.:...(...e��:...... : ..). :.....''1..?........................ r'.��N . .r.l<�:: (../.���{x.?.........r Approximate Cost . ....S 1 +.�..-.......,:�.. t. Fireplace ....... ..... ..� ............... ... ........................... CL-j Definitive Plan Approved by Planning Board ____ :,.:_ --' � �" Area ... .=?.........11-1 ,i ,�' Diagram of Lot and Building with Dimensibns 1_P:�! �'1 1'� ( Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH ,YA 1l i f OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS i . I hereby agree fo conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..... ..I�;....... . .?�....... Construction Supervisor's License ........ti. � :.:............ 1� 0 �CC TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 1. Map Parcel 05 Permit# 4d (09, J Health Division U^�7 � � Date Issued Conservation Divi Fee ��cJd • Tax Collector • ' � �+'`�� �`"�'�=� SEPTIC SYSTEM MUST BE Treasurer � L,AL Le 9//,S D?ll INSTALLED IN COMPLIANCE Planning Dept. / WITH TITLE S ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street'Address Z 1� I E 4 Village �l Q 4)i'1 S l' S m Pf O 2 6 Owner 0 Yvl 1 0 Address Telephone 2 14 ' 3 Permit Request 0 (k�oUfl 0 POO (V/ `e 2 V q� Tuare feet: 1st floor: existing proposed 2nd floor: existing proposed Total new OG� _ luation ����ng District Flood Plain Groundwater Overlay Construction Type Lot Size 2br Grandfatliered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ,-kNo On Old King's Highway: ❑Yes ❑No Basement Type: ❑ Full. ❑Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing Z ' new Half: existing new Number of Bedrooms: existing_ new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: 4Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes / ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing new size/9 33 Barn:❑existing ❑new size AttaAed garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION _ (� Name Q I'y1 f3 Telephone Number in 1 �� Address 77:2 19 0-14 5 License# _ C n VA S �1— M 0 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTIO DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATEo TOWN OF BARNSTABLE LO:ATION � SEWAGE# _`� — vILLAGE`2yada 'AMA ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. 2 - SEPTIC TANK CAPACITY /� � LEACHING FACILITY: (type) A/ ron,: .� size) NO.OF BEDROOMS BUILDER OR OWNER _ PERMTfDATE: Id-l? ELL COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility"(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of ea c 'ng facility) Feet Furnished by .GBbs pp� E � j� I No. � f Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(pp[ication for Wgpogat bpgtem Congtruction Permit Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Installer's Name,Address,and Tel.No. Desig is Name,Address and Tel.No. ft44A q1AAA,1A1 tpef Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 16,0 gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alteration,s(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction andAuaiataance 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 i ed by this ,oar of a lth. _ Signed Date L6�— 19— 9 Application Approved by Application Disapproved for the following reasons Permit No. 9S—- 12' Date Issued ' No. �� ate*" a �v �'' Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for Migagar *pgtem Comgtruction Vermit Application is hereby made for a-Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. f Installer's Name,Address,and Tel.No. Des' er's Name,Address and Tel.No/y�,, n -, ryry '7/y��yn am-, r'1 uiJj�q, pe of Buildin Dwelling No.of Bedrooms Garbage Grinder( ) { Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ' Design Flow gallons per day. Calculated daily flow gallons. i Plan Date Number of sheets Revision Date Title Description of Soil 'u Nature of Repairs or Alterations(Answer when applicable) Lf y k i o n Date last inspected: Agreement: The undersigned agrees to ensure the construction andWA4Uaaa=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 i ed by this oard of Ppith. �. Signed Date Application Approved by 1 Application Disapproved for the following reasons Permit No. Date Issued /,o t THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS'TO CERTIFY that the On-site Sewage Disposal System installed( )or repaire replaced'<)'on by for t�,C+ . Z ' 1 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. - dated Use of this s stem is conditioned on compliance with the provisions set forth below: e � D-O No. ��" �� Fee � 6 THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpogal *pgtem Congtruction Permit - Permission is hereby granted to to construct( )repair an On-site Sewage System located at t _6 f ► AA AM 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. I ' All construction must be comple ed within two years of the date below. ' Date:. 6 Approved by �/� r.. . P. Sp 44 eb {r.FL. i 3•So 4s.ts s.o 44.35 44•I5 44 75 4 z 44. qp JB ✓o 3Z I 30 Rx1s'IF1n,7 Ground Profs/e HO,e/Z. SCHLE: /"-/C —o—o—o—o— Proposed ground Praf•ile 1' IV a' o � LOT 39 47, S.F.+ Af- 1 44 \ Ac 1 \ � \\ `�\ 01 •so,l CiE.-Ju-Irinrz�, \ a \ 1kv� KY \ v \ %, \° 30, 1'1 SLOPE � 8 x 150: 15.6 / I \ \ 4b 4p Az 44 PLAIN (ScHLE: V ) VIEW o.00 ex�s�/nq elevation BLDG. SETBRCK REQUIREMENTS : r--t J e/e vatiori I ll- SLOW RATS 3�� GALS.1n•ar C _ �I�1 1arZK•EL..SO.00 � SEPTIC TANK : - � i uSE: Icon GAL. TA/.JK 1 4L I _ i srDEWA4L' 113.4 I.o-. t13.1 � BOTTOM: I TOTHL G.P•D. d u I�4' CV �1ns�! . a:r _ r MAfx- 11 .pf , \` ` i I a F 11, FW i} 35.3 IpTE �l ndls s ruGJ'G� 51 THE �!c / CERTIFY THAT THE B..Cl/LD/NG Hlar e wesE L � \ \ ae. F ucGS Fo�ll1� \ 5o PROPOSE D ON THE iG�l?oUND A5� 3r SHOWN ON TH�s P[.H�Cl ooESk - S/ TE - SEGJF�GE PLAIN - COti/Fo21l TO THE B.LI/GD/NG \42� BAG K 2E G?u/2E/"!k -AY,7S OF THB f TOWN OF 6AtzrJS'f%k[Y�E = 1 FOf2: �,p i 5q bet�E PATH HAPS;;I:c�!S i PREPARED FO2:4-4 I C / i '�{ SCALE: AS RIOTED DF�TE: JVVr y n , IOW. '? � ;ss P� p a ~�SuRVF. VIE DATE BL DG. SETBRCFG r � �` tie. REQUIREMENTS : APPROVED : ,� - r. -t LOG�I GJELLE2, Inc. EAL I-f ` - P�ornt ?O f'1. BoAQV, �P5 � �` 714 MAIN 5T2EET YA,eMOUTH P02T, MF75 s. rear 1� �� �"� '- + �,,�rv�,�ir PRoFE55lONfiL E,uGINFERS fr CAA/D.5V2VEti!0Q.5 a7-ISO j ,.c ioj. i. x i v sly' .'75 44.35 44.!5 � NOTE C _ A ' E?CTE/VD f4LL HPPLlC ofi/e SE C �� O/V VE/2T. SCALE: /"=/O MRNHOLE COVE.eS To [ /2" PF F/N/SHED G.2F)G FLOW - Cr»/n. %4'par FLOW `SCHED. 40 P.✓O. OR Crninimum %"Per -Foo- � EQUf9L To SEPT/c pipe To BE 2- layer of �� —�3•M�u. r•?- _ — LEVEL FO,¢Z'. 3�B'PeoS"fo ne � q._o. .�. 1 LevED D/ST. BOX 'i'-'�� �• • . . 6..Sump � � .. <- washed stone 6 � .. l000' GHL. SEPTIC T'A Ae = , 40 5o j E TA / L S \ ` / LEACH P17- 4 - DES 0lV - � � aaT•E�S g TE� a � L O C BElAQOOM HOUSE �`� ~ L.1_L-I F- \ - �1 ' � 'sd.l C�EtiJCtI�Iv2K•EL.. SO.c� GLOW Q.9TE- 3'�`- GfiLS-�D°�Y s"` �Z SEPr/c -oNK : 32C x/.5= 1S SFJ w�. cY VSE:. •GAL. Tf1N>C a a �\ I �, � 11 � m � �� �Ef�CH/NG H2Ef�• 4� �:•'•�-ice 4_� �::7_0�. 4po\ p TOTf9L 490P•D- \�� �'� 4T -us E:U�4'•� l,F�t�-) Pr �,•1�3 GF�ltis�!_o�is -_ _ - , . ..Y. 3 �' s� �w�lEARNSTABLE A :: 15'c LOCATION _ ,� SEWAGE # d VILLAGE ASSESSOR'S MAP 6z LOT INSTALLER'S NAME & PHONE NO. EPTIC TANK CAPACITY G LEACHING FACILITY:(tyge) xf (size) (� NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATE BUILDER OR OWNER , DATE PERMIT ISSUED: 3- DATE` .iCOMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 1 Fic Y THE COMMONWEALTH OF MASSACHUSETTS BOARDPF HEALTH t 1-.C:).L),).. ----....OF.............. Qi1��L .!e................................ Appliration for Disposal Works Tonstrixrtion Prrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: . ... ... ..... .__.. ._ L9c tion-Address r Lot No. .�Q. ..._. .1. : .................. .......................---- - Il.�j .......o�. ..t t-------.._(f.21.�1_...._........ Owner 1/ Address " a ••-•----••------••-••-_ --•--` --- - --- ------------•---•.....-•-- ---•------------------ --•_••----•- --.............------••--......_.......---------.... Installer Address Type of Building Size Lot..y7D�..__._...Sq. feet' aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures .------••---•--••-------------------•--•---•--------...-----•--•-•-=---•-......--•-•--------•---•--.........--•-•-----•-•---•-•-•--•-•--••........--•- WW Design Flow.........S5..:.•.....................gallons per person per day. Total "ly flow_.........�.....�.___-__-...._____gallons. W , Septic Tank=Liquid capacity gallons Length�Vj(e".-Width._S.__ _`". Diameter................ Depth....`(.'_pA x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area...................sq. ft. 3 Seepage Pit No-------1............. Diameter..JV.......... Depth below inlet....4........... Total leaching area.4ag:l...9 -. .. 4f 00 Z Other Distribution box (4) Dosing tank a Percolation Test Results Performed'b . ..St .. ��............. L!l ....: Date. /^Z3 ..g Y } ---•-. .. �-------- a Test Pit No. L.4..........minutes per inch Depth of Test Pit....Ql ` _._ Depth to ground water...L!;?�e>a....... Test Pit No. 2...e-Z___minutes per inch .Depth of Test Pit.... Depth to ground water...... a .................... .....................--••-......_...----- ------.._..... ....-.----.._....: ................--.....--------- O Description of Soil---_-----�_le......fD)Q.tl-1...................... 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 iITLP. 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 byktheboard of heal i.Signed---- ----• .•--- ----•- --• ...............-............. ......................... Date Application Approved By...... 'V .-"'�.............................................. ........... 1�1.-.`►�? Date Application Disapproved for the following reasons:...............•_____._._.•....____________._____._______._________-:_-________:._._....._...._...__________ .........-•---•-----•---•-••..........................................•---•-----=----------•-------...._.----.....------....----------------=------------------•-----_--...-•---......:....------..._.._ Date Permit No.---- 7-- 1-•-•--••-•••.:.:......... Issued........................................ .. -•---......._. ._....._ Date � r � Fxim ~' THE COMMONWEALTH OF MASSACHUSETTS '' - r----~ BOARD OF HEALTH OF...............G±. .:..._...... ''= ............................... Appliration for Bisposal Works Tonstrurtion 11rrutit Application is hereby made for a Permit to Construct (� or Repair ( ) an Individual Sewage Disposal System at: _ -- �-- Location-Address -«•or Lot No. ---------------M/.-�~ -•• .. " __ I �P�-'.................................................. ...�..:1.?`�----- Q�-M ? �. •-.--_ -�-� J ` Owner V Address W ......4 ---•--------------------- ----•-••----------------••--------•••---••--••------•--•••------•••-------------•---------••---•- a ..............•--...•-- Installer - Address _ Type of Buil ing Size Lot_17.3et?..........Sq. feet—Dwelling—No. of Bedrooms............ ...........................Expansion Attic ( ) Garbage Grinder ( ) `k Other—T e of Building No. of ersons____________________________ Showers � a YP g --------•----•----•--------- P ( ) — Cafeteria ( ) QOther fixtures ------------------------------------------•---•-•-----•------.....-----•-----•--------------------•-------...-------------------•-••-•-----------•--•- WW •Design Flow........ �5..........................gallons per person per day. Total daily flow.___....�_73.�... ......._..._gallons. WSeptic Tank—Liquid capacityfgallons LengthP�. Width._S'b`'. Diameter________________ Depth... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. 3 Seepage•Pit No...___�_............ Diameter._I_-7_(...__.._.. Depth below inlet.._ `._....... Total leaching area.A� :!.._:sq-ft. (:qFb Z Other Distribution box of Dosing tank ( ) Percolation Test Results Performed .................. Date.... ........................__...._.. ►a - Test Pit No. 1__< Z_.____minutesperinch Depth of Test Pit...!QEh...... Depth to ground water...It2P,a....... Test Pit No. 2---2-Z...minutes per inch Depth of.Test Pit.... ....... Depth to ground water.:_..nv� __._. pG _.......••-•• --••-.....--•-••...................•--.._....•-••-----...........-•---_............................................................. O Description of Soil.........{4F4. 1a ?-------------------------------------•----------- W ------------- .......----------- •---------------- -----------------------•----___------------------------------------------------------------ - -------•--------------- ------••-----•- •---••-•-•------------•-----•---•----•--•-------•-•--•--••---------•----•--••--....•----------•---••-----•-•---••---••---------•._...-•---•--•---••-•-._.....--•---------------------•••-••--•-•------.. U Nature 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 iITA LE 5 of the State Sanitary Coke:—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been sued by the board of health. Signed_-------- - •- - --- --- • •.....- Date Application Approved BY_----- _�follmudn - - ...........`__�-_c_-_l.._._..^ _ Date Application Disapproved for t g reasons--------------------------------•-----------------------------------.._..-------=--------------------......--- ..........................•-----------•------•-------....._..._..._...-----------------..........-----....-----•-----•---•-------------------=---------.._...---------.....---------.......-----...._.._ Date PermitNo...... ,7-.... ------------------------- Issued...........................................—........-- Daft THE COMMONWEALTH OF MASSACHUSETTS { BOARD OF HEALTH 4(Rcu. ........OF........ ....................................... TrrtifiratP of Tompliaurr THIS I TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ._....-• - _-_--+ ........................... ( ) tt ..- - ------------------------•-----------------------__...-•••---------•-- -- ............___------bY---- � • Installer at:........ ..... �---- ........PSik ---•-------- -74 ...M..... •----------- ----- --- ---------------- ----------- --------------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit ............... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. C DATE....................�.::�-.—.1_�1:--=--�--�---------•----------... Inspector...... =------------•----.--...----•-•---------------•----•------............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No..{ .. :... � scr.L_............OF...... - � 4E:.............•-------......._.... F$E..2 6`....... Disposal Marks Tonstrnrtian f rrnt t Permission is hereby granted...... ------•'-------------- ................... ................• ............................_.... to Construct ( or Repair ( ),J)In�ivlduafAS�evkrageposal System atNo..... ....�.C/... . .._ .. t:----------------...- .........----..........................--.............................................. Street as shown on the application for Disposal Works Construction Permit NoV -F .. Dated.......................................... ............ -......................... ; --------_______------•-------•-------•--••----- Board of 'Health DATE.............I ;L—- -•---•---- Fermi t Numbrr : Dat c : Completed by - .—.— HIGH GROUND-WATLR LEVEL COMPUTAIION ._ Site location: Lot No. Owner: Address: Contractor: Address: Notes: STEP 1 Measure depth to water table to nearest 1/10 J t . . . . . . . . . . . . . . . . . . . . . . . . . . •y date ' STEP 2 Using Water-Level Range Zone and Index Well Map .locate site and determine: A) Appropriate index well . . . . . . . . . . . . Water-level range zone STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to >, water level for index well . . . . . . 1(5' mo yr STEP, 4 Using Table of Water.-level Adjustments for index well ' (S1EP 2Aj, current depth to - a:ater level for index well (S1EP 3) , and eater-level zone (STEP 213) determine water-level adjustment _ . . . . . . . . . . . ir. . . . . . . . . . . . . . STEP 5 Estinate depth to high water by subtracting the water- level adjustment (STEP from measured depth to 4:ater level at site (STEP 1 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . p Commonwealth of Massachusetts Title *5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 233 Bridle Path Property Address Thomas& Eileen Fazio Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/5/2017 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 A. General Information filling out forms sit# 1.13 S q— on the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones g � i o . LPZ use the return key. Name of Inspector S.M.Jones Title V Septic Inspection Company Name 74 Beldan Ln. Centerville Ma 02632 Cltylrown State Zip Code 774-248-4850 smjonestitle5@gmail.com. S14522 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 6/5/2017 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 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,.� 233 Bridle Path Property Address Thomas& Eileen Fazio Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/5/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The dwelling located at 233 Bridle Path Marstons Mills is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and 2 precast leach pits in series. The system was found to be in proper working condition at the time of inspection. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 L i Commonwealth of Massachusetts u . Title 5 Official Inspection Form i; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 233 Bridle Path Property Address Thomas & Eileen Fazio Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/5/2017 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Rim Z. . Title 5 Official Inspection m Subsurface Sewage Disposal System Form - Not for Volunta sessments 233 Bridle Path Property Address Thomas& Eileen Fazio Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/5/2017 page. CityrTown 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 '/day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 Bridle Path Property Address Thomas& Eileen Fazio Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/5/2017 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 I I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 233 Bridle Path Property Address Thomas& Eileen Fazio Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/5/2017 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms (actual): 4 � DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 L Commonwealth of Massachusetts 4 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 233 Bridle Path Property Address Thomas& Eileen Fazio Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/5/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 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 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 iL f Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 Bridle Path Property Address Thomas & Eileen Fazio Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/5/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe. below): s General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 l Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 233 Bridle Path Property Address Thomas& Eileen Fazio Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/5/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: original system installed 1987, leach pit added 1995 Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): Depth below grade: 5 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.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): Depth below grade: 4 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 gallons Sludge depth: 6" t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 Bridle Path Property Address Thomas & Eileen Fazio Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/5/2017 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) Distance from top of sludge t of outlet tee or baffle 3" Scum thickness 3" 611 Distance from top of scu p of outlet tee or baffle Distance from bottom o scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers, tookmeasurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet cover on riser, outlet baffle intact inspected with mirror. Tank should be cleaned soon and again every 2 years for proper maintenance. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): ' Dimensions: Scum thickness ` Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 233 Bridle Path Property Address Thomas & Eileen Fazio Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/5/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ 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 .' 233 Bridle Path Property Address Thomas& Eileen Fazio Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/5/2017 page. Cityrrown 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 carryover, any evidence of leakage into or out of box, etc.): Distribution box was functioning as intended. 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: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 233 Bridle Path Property Address Thomas& Eileen Fazio Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/5/2017 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® Teaching pits number: 2 ❑ 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.): s.a.s. consists of 2 600 gallon leach pits in series. Second pit was located and opened and was found to have 2.5' of available leaching with no signs of past hydraulic overloading. Cover is on a riser. 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 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 233 Bridle Path Property Address Thomas& Eileen Fazio Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/5/2017 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 233 Bridle Path Property Address Thomas& Eileen Fazio Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/5/2017 page. City/Town 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 P L S Al 2S ) 2 3 3 ) f3 AZ 21 07- ► 1 c3 Z3 0 3 H( �r)3 � y 31 Dw K( cs 2S DS 67 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ,••' 233 Bridle Path Property Address Thomas& Eileen Fazio Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/5/2017 page. Cityrrown 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: 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: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 233 Bridle Path Property Address Thomas& Eileen Fazio Owner Owners Name information is required for every Marstons Mills Ma 02648 6/5/2017 page. Cityrrown 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 r , O� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION �w Map 4,9 Parcel C9. Permit# 4d o(lJ Health Division Date Issued y Conservation Divi 'onS� Fee aJ��cJt� - Tax Collector, �,� � '�"�_-�" SEPTIC SYSTEM MUST DE Treasurer er l �,(� 91/,5_1Zd1h INSTALLED IN COMPLIANCE Planning Dept. WITH Tffu 8 ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street'Address Z 3 6 I E P i 'F 4 Village � r, Q-� �'1S �l� MP- a260 Owner ! Y►0 Yet � Z f y Address Telephone 2 3 Permit Request (LQ(/(l 0 POO .24x q( Tuare feet: 1st floor: existing proposed 2nd floor: existing proposed Total new p691 luation g District Flood Plain Groundwater Overlay Construction Type Lot Size /Tv29- Grandfathered: O Yes O No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes �No On Old King's Highway: ❑Yes ❑ No Basement Type: O Full O Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing Z new Half: existing new Number of Bedrooms: existing_ new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: &Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:O existing ❑new size Pool:❑existing new sizelI K33 Barn:❑existing O new size AttaAed garage:❑existing ❑new size Shed:❑existing ❑new size Other: ZoningBoard oa d of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# •. ,, Current,Use Proposed Use BUILDER INFORMATION Name 1-11 6 (Z - �� Telephone Number Address —7:2 19)91� License# C,5 D 6 2-Z8� 1#03 'f P ( (A) Home Improvement Contractor# Worker's Compensation# 6 z 5 Y Ug?( ALL CONSTRUCTIO DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 47* SIGNATURE DATE Assessor's offioe (1st floor): / /<• /1� oFTNEro As�jessor's map. and lot number ..../.. .`J. —... .`S ....... eWQ� o Bo�(rd of Health (3rd floor): tf ! -- S wage Permit number ........ .:.............. .......;1 t BAB39TODLE, . E gineering Department (3rd floor): � Z_3 3 ,csK K.� �aa M63q. �00� Housenumber ........................................................................ 'rtoraY°'• I APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only.. TOWN OF BARNSTABLE i BUILDING INSPECTOR ' APPLICATION FOR PERMIT TO .................................................... ........s. . . ..... ...tom.... ..:1 . TYPE OF CONSTRUCTION ..................... i . .. TO THE INSPECTOR OF BUILDINGS: f The undersigned hereby applies for a permit according to the following information: Location ��'...'...... ...! Y...1/..... ..... ....... �. G 1� �'� f ��(.....``�..! ).. ............. .. .......... .} Proposed Use {.�< « 1. r �..� t. ..:: .. .... ¢►M..1. :..1....... .{;......................................................................................... .............. Zoning District ............... .. �.. .�'-'"'`�'.. ...... ./.....Fire District ..... Name of Owner ....... ... . ...... .. .Address ....T 0i...`ny. ....t14�..d....W.......1.� �R vvl Name of Builder .......�`��. .. :�'1,.�...�.�!..`�.�. . .�. .. .Address .....i.�.�...'�ta��.l. .��.\.�:1�..\�� Nameof: Architect .....•.............................................................Address. .................................................................................... t Number of Rooms :...... ... ............................................Foundation .... (;� ........... Exterior � ,1 ;;.. rE:: ...�'?/�.E .r .. ::.. ..ff���.!::.<< .. ............Roofing .. .(.� �.�;. r..t. . .............t)..i.�.....�.f:: -., ................. Floorst.i. . r..............................Interior >.�. f.�': .)7.� 1fs'., ,........... ................................. 4;t> :( ':".. ::-'.. .. . ' ...............`Plumbing-. ..�.. 4.d!:.. i,I L:rf( r}�d.i?.. Heating ...:.f.Y:..t.� a :.4:..: .... -- .... 2....... ��:�.::U.�-1.1 � :: ......... .Approximate Cost .......L — ;. Fireplace ...... - {• ..........f rr ............................................ Definitive Plan Approved by Planning Board ------ ___� __ _ r Area .... ........ Diagram of Lot and Building with Dimensions ( ,4 ec-,4 c�i Fee l: l/ ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 1 G OCCUPANCY PERMIT R F S REQUIRED D OR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nome .....�.....L �.�........... :L�..U�' ....... %Construction Supervisor's License ...f �2 � .�............ r .. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL TECTIO f c ONE WINTER STREET, BOSTON MA 02108 (617)29 f5500 , , toVIA 2 3 199L9 to �� Y COKE Secretary ARGEO PAUL CELLUCCI A B. STRUHS Governor s Commissioner ' cc SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -- �-J PART A V�V CERTIFICATION Property Address- `t Z3 �� Name of Owner/� ,L W-�, Z1C) 1 S Lql�► ,5 Address of Owner: Date of Inspection: IZ I q Name of Inspector:(Pleade Print) V 112 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: / 7,e_ Mailing Address: Telephone Number: CERTIFICATION STATEMENT 1 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: ✓/Pass/es — Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails ILI Inspector's SignatUu Date: z �� The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)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 tovw system owner and copies sent to the buyer, if applicable,and the approving authority. NOTES AND COMMENTS uA L 'A5 w i revised 9/2/98 Pagel of11 M ;� Printed on Recycled Paper r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 23 � LQ 1 r� � T7-}� Yu� �Tbt�15 U�1 v�5 �Z l O Date of Inspection: l Z/ ) �(gj INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: V I have not found any information which indicates that any of the failure conditions described in 310 CMR 1-5.303 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. Indicate yes, no, or not determined(Y, N,or NO). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank, whether or not metal,is 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 complying septic tank as approved by the Board of Health. 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-n re than fourifines-a year-due to broken or obstructed pipe(s). The-s s w911lass^ inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Au2i�` l�z i o�� �4 7 ►mil. S V�l��-LDS Date of Inspection: I Z/I I cis C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: CJ 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 IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH..WILL PROTECT THE PUBLIC HEALTH.AND SAFETY AND THE ENVJBONMEPLT:. Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT T SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a sep-ic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS 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. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 P2ge3of11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: ?j� �l{7L F, F'-� 1: t ��\ Owner:(j-�, K.:5 Date of Inspection: LZ,l rl,6 e> D. SYSTEM FAILS: � t' You must indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described 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. Yes No Backup of-sewage into feciht"r-e"tem component-due tto an overloaded or-clogged•SAS•ar 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 1/2 day flow. ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). / Number of times pumped_. ✓ Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. 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. - E: LARGE SYSTEM FAILS: �(,��, You must indicate either "Yes' or '•No to each of the following: The followirg criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system-is-within2a0 feetaf-a44butery-to-a,&urfaoe•drir► k+9,water•supyly-.. - —. . .--.... -.- 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: owner:- � Zl Date of Inspection: 1-7 N'Zis Check if the following have been done:You must indicate either "Yes" or "No" as to each of the following: Yes No _ Pumping information was provided by the owner, occupant, r Board of Health. ------------------ None of the system-components hawsbeen pumped:foratJeast two a oWw and-the-system hasbeeol+eceitaagawsraal.flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this / inspection. _ As built plans have been obtained and examined. Note if they are not available with NIA. The facility or dwelling was inspected for signs of sewage back-up.C�XT'�fZ.10e— The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components, excluding the Soil Absorption �-►c� ystem have been located on the site. �/ — l '� �-E��18�.� woC3� ��wugltl►� The septic tank manholes were uncovered, opened, a d the interior of the septic tank was inspected for co dition of baffles or 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 onJ¢7']o� _ Existing information. For example, Plan at B.O.H. _✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [15.302(3)(b)] The facility owner(andloccupaats.if different from owner):.were.provided..with iafa=ation on 1ha4xoperinain an=ti^^of SubSurface Disposal Systems. revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: �Tj- 'jQl VL�E Owner: TF-b h'11t� K Z O Date of Inspection: l Z�f tl g / FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom. Number of bedrooms(design): 3 Number of bedrooms(actual):_ Total DESIGN flow 13.3 "�' � Number of current residents: l�W1010L Lj � Garbage grinder(yes or no):�C /f�il�t 0�+' � 1 )IV ]C Laundry(separate system) (yes or no): If yes, separateinspection.required _ Laundry system inspected (ye,s or no) C-_3 Seasonal use(yes or no): Q �C��6 9 4/ �l 7 ��j 4 ' 19?6 �� 000 Water meter readings,if av table(last two year's usage(gpd1: / l�Gf l�v �1 Sump Pump (yes or no):A / J Last date of occupancy:GUt.1i?. %-7T COMMERCIAL/INDUSTRIAL: �� ppG.lGyg3��. Type of establishment: Design flow: gpd ( Based on 15.203) Basis of design flow Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings,if available: - Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING REC RDS and source of information: / o�.D b� �--774 �S ut0 Dom! CC) System pumped as part of inspection: (yes or no)_ Q If yes, volume pumped: gallons Reason for pumping: y"T 'Tc�► �'�l """���,,,��� TYPE YSTEM 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date instaNed$f known)-end souse Of information: 0 4 41 � s ysrr��1 u Aj r-kja��. > 7o �y' Sewage odors detected when arriving at the site: (yes or no)Al revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued)Property Address: Z3 g►ZlVILE, Owner: Date of Inspection: Z /1 BUILDING SEWER: / (Locate on site plan) Depth below grade:--i—s- Material of construction:_cast iron_Ve"40 PVC_other(explain) Distance from private water supply well or suction line Diameter _ Comments: (condition of joints, venting,evidence of leakage,-etc.} SEPTIC TANK: (locate on site plan) Depth below grader a /�'T="I</�e lcS�S fother(explain)Material of con struc ion:�concrete_metal_ iberglass _Polyethylen other explain} If tank is Fnetal,list age_ Is-age-confirmed-by Certificate of Compliance_(Yes/No) Dimensions: 8 S 100,)< S , X S/ Sludge depth: •i Distance from top of sludge to bottom of outlet tee or baffle:1?0 n -- Scum thickness: /11 -7 Distance from top of scum to top of outlet,tee or baffle: / W Distance from bottom of scum to bottom of outle tee or baffle: How dimensions were determined: U E Comments: (recommendation for pumping, condition of inlet and outlet tees or-baffles, depth of liquid level in relation to outlet invert, structurel4ntegrity, evvWgnce of leaks e, etc.) %�l+A- �DOaE L.7 rD*1.P1&J Z— o V L v 2 v 4S V/ Cam'" cS�t.CJ V P GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (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.) cSF�-1 G. 7�9'' /4—'-, I revised 9/2/98 Page 7of11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contimieed), L Property Address: Z Owner:1Z—�p►v1►9S/ Zlb Date of Inspection: Z/ TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) TIGHT OR HOLDING TANK.k (locate on site plan) Depth below grade:_ Material of construction:_concrete metal_Fiberglass_Polyethylene_other(explain) Dimensions: �u Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order:Yes_ No_ Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX: +� (locate on site plan) / lh Depth of liquid level above outlet invert: �� Comments: ��'✓F�2�'l�-77v� �3�C.OLJ� (note.if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) Z>57P1F077 C7 X ,L OG'�T T� O VT A./C7­/ 5U O 0 o LE'�4GH �/T PUMP CHAMBER:�C/9 (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) revised 9/2/98 Page 8of11 I - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Z 3.� -�I z>t-.E -:F-Na �--� Owner: i 1-k0 MKqtr_—> C-�Z.tO Date of Inspection: 12/1 /�g SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,if possible;excavation:not required,location may be approximated by non-intrusive methods) If not located, explay.21 Type: �� ^"[��I ►�C. leaching pits, number._ leaching chambers,number:_ leaching galleries,number:_ ��� �c7d�%�H leaching trenches, number, length: leaching fields, number,dimensions: �( /� -D�� Lk)/� 7 /DID overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) G,[.& O .s/ �.!5 O J4-UC�l� i v ow c-c r- o i2 TT O CESSPOOLS:—.A-lc-T' A9 A-1-A3GE". (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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure,-level of.pending,condition of,vegetation, etc.) PRIVY: 4.k-5-7- A�PL/G�9BLE . (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 9/2/98 Page 9of11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: =F*Z 3Z.(�.E—t-4� Owner:►�p1►/�14 F''C�ZI C� Date of Inspection: I SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) i 1 r7 )4 .,9 6 001G7- 14/ 02 mi}T7b, F-14-E 601 revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Z �� `32.��L� +— -1-j „�M �`� ': owner:—r}-tC:)rv1 qdt->/ V9 Z /,:;, d Date of Inspection: t' t NRCS Report name �L-- �v� tit SQL-E GCx� Soil Type 64,7A.) [./¢/ 40A Typical depth to groundwater USGS Date website visited / Observation Wells checked ����Z3 �/Gt7A � -7�l �" ���/�`, Groundwater depth:/Shallow Moderate Deep 7_ SITE EXAM Slope ✓ Surface water k_),- r Check Cellar Shallow wells /�T ��OG/GALE Estimated Depth to Groundwater�b Feet Please indicate all the methods used to determine High Groundwater Elevation: J Obtained from Design Plans on record 1/ Obser ed.Site(Abutting property, observation hole, basement sump etc.) V Determ' ed from local conditions Checked with local Board of health ChecW FEMA Maps �Checl d pumping records Che&4 local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) w►�-�- -2 revised 9/2/98 Page 11of11 �.� TOWN OF BARNSTABLE ' LOCATION ,-�-;g 4�m , SEWAGE # C`.� —/ 7 7 VILLAGE t&ad�j � ASSESSOR'S MAP& LOT29�--d { INSTALLER'S NAME&PHONE NO. ;' 1 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) NO.OF BEDROOMS -� BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: �'"�, E3 i Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of Je4qWng�facility) Feet Furnished by 0 r f 4 i 1 TOWN OF BARNSTABLE LOCATION - - � SEWAGE # J VII LAGE`�✓lr� / /CZ ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ( i 2. ) LEACHING FACILITY: (hype) YL(size) NO.OF BEDROOMS BUILDER OR OWNER s� PERNffTDATE: le— COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Edge of Wetland and LeachingFeet Facility (If any wetlands exist within 300 feet of ea0ung,facility) Furnished by Feet �-�je ... f.r ti -i .•.. s.'j y;,Wit:.^ / `� � 7 •ter,,, � � � i t TOWN OF BARNSTABLE I.OrATIONQa3,pv�nyto SEWAGE # VILLAGE/PO4M Al _ ASSESSOR'S MAP & LOT f -Q INSTALLER'S NAMEA PHONE NOQjP SEPTIC TANK CAPACITY LEACHING FACILITY:(type) P,: ,4 Qj (size) 61 AQ NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER BUILDER �:OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No i �y ; � ��� r' �� 0 � � � �� S r I G � � HE COMMONWEALTH OF MASSACHUSETT earn?; oration Depa, wawt,� 03 „� O A R D OF HEALTH , TOWN OF BARNSTABLE Appliration for Diripmial Wor1w Towitrnrtinn Famit Application is hereby made for a Permit to Construct ( ) or Repair b.,14- an Individual Sewage Disposal System at: �24� �.Cl ..................................................................•._______..__.........---•-"__-- _-- -•-•-----•-----•-•--•-----•----------__..............•....; ...................I............ or o. `-s �d`'�!v c-C:-...... IT/t N.............!.r ✓{=/.�.v ....._. �_A?_�f' Owner Address ..--------•-..............._...---� ----•-.G'd'�- � ---•?4.' -y------ d� t� -------------- ------ --------- Installer Address d Type of Building Size Lot............................Sq. feet U ................................Dwelling— No. of Bedrooms.__....._._ Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ..................• -------•--------•-•------------------------.----.------ W Design Flow............._..._._......_...gallons per person per day. Total daily flow...___._...�&Q............_...gallons. WSeptic Tank—Liquid capacity44F®gallons Length................ Width................ Diameter----............ Depth................ x Disposal Trench—No. .................... M�idth.................... Total Length............ Total leaching area....................sq. ft. 3 Seepage Pit No-------- p l g q,.__.__ Diameter.__.�.._..___. Depth below iniet..__�r............. Total leaching area.._...._._...._.._s ft. Z Other Distribution box ( ) Dosing tank ( ) `" Percolation Test Results Performed by.......................................................................... Date........................................ a 4 Test Pit No. 1................minutes per inch Depth of Test Pit...._............... Depth to ground water........................ GZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+ ---------------------------------------------•-----------------_•---------..........._----_------............................................................ ODescription of Soil........................................................................................................................................................................ x w -- •---------------------------------------------------------------------------------•-•------....----------------.._.-_.......--•-_•---•--_....... .............................................. U Nature of Repairs or Alterations—Answer when applicable____/ __...._._J�i p_ ....._._............. =�T---•--................... ---............................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliant s b n i ued y the rd of health. Signed ........1% ............ . .:....................................................... .. � .... Dace Application Approved BY ....� ...... _..................................................................... g�.^.. . Application Disapproved for the following reasons: . ............................ .... .. .... ....................................... ......................... ......... .................................. . . .. . ............ ......................................................................................... .-- .............................. Dare PermitNo. ............`j..I...-....... ........... Issued ......................................................... Date No................_....... - — Fim...............`............ _ THE COMMONWEALTH OF MASSACHUSETT BOARD OF HEALTH ��--�,,,�L--� CAP,-, TOWN OF BARNSTABLE , pphration for 11bipotiul Mnrbi C omitrnrtion rrnttt Application is hereby made for a Permit to Construct ( ) or Repair �' an Individual Sewage Disposal System at .....-•- -•-----------•--••-••....................•--...._••-••• -- . 4�/b4 ------------------ Location-Address or Lot No ----.....� 1....!.......................................................................... •---�-�----------I_-----�--_./'�-�7�/ a Owner Address v t)7 / .................. ................... ....... .............. j Installer Address d Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms_____________�--..___-------.-_-. ----Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures --------------------------------------------------------------------------------------- ---••-•----•-•-•-•----------•-••-••-•------•.._.............. W Design Flow.................a ................gallons per person per day. Total daily flow----------- ................gallons. WSeptic Tank—Liquid capacityZ/ -gallons Length__............. Width-.--__--_-_--- Diameter................ Depth................ x Disposal Trench--No. .................... Width..... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No....... -_--. Diameter....ZO------.-- Depth below inlet----tl..-......... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) '~ Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................mmutes per inch Depth of Test Pit.................... Depth to ground water........................ Lt, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 --------------------------------------------------------------------------•-••......._.._._.................................................................. ODescription of Soil........................................................................................................................................................................ x U •.......-•--•-•---•---•--•-------------•--...........----•-•---.........-----------•-----......----•----•--------•---------••-----------••----••-----•-••--•-•-•-.......••---•----------•............... w ................. U Nature of Repairs or Alterations—Answer when applicable.____. a'�__....___�/%A�G�-4 ........ :j sl....���! �- --------------------------................................................................................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance lias been issued by the board of health. Signed ........L ................... ' ....::/4-........ ".........................-... -'--....... .. ....�`�/ . Dare Application Approved By --------��j... ' .. ...%../................. .......... ........................... �..� c/.-.... Application Disapproved for the following reasons: .. - .............. - -'- "' ................... ......- ........ -..-..............-- ................. ........................................................................... . ................................ ....... ....................................-'................................ ........................................ Permit No. ........ — -.... Y�. � ��........... Issued ..... .................................................Dane...... .......___ Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�er#ifirtt#e of C�omplianre THIS IS TO CERTIFY,,That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by .......... ..... ............................... .....--- 0. -s..�....1�.4�c-�-r u! 1..... I! at .................: r .... G----�..C----------- I , has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .._�� --------- dated ...__.............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........ ._.�.. .1J.:. .................._...... .............__. Inspector -...' ----- 1...:.1. ._....._... . .. ................................... 'i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No._. 9 - .7� FEE... 76 ..................... Rspoiial Vorkii Tunitrurtion "antit Permission is hereby granted................ ....... �= ................... to Construct ( ) or Repair ( '_) an Individual Sewage Disposal System at No....................................... 11:�.?`)-.e__- 2��-1--7-/ AIJ"7 1 '047-/(/.5......... Street as shown on the application for Disposal Works Construction Permit No����7�__ Dated.......................................... .......................... -, �: - --------------------------------------------••--------- " e� Board of Health DATE................. '�` [._--.. ............................... FORM 36508 HOBBS♦!n WARREN.INC..PUBLISHERS ' i I t S 44 EEC fT, i;i,, �i 3•� 45.Zs �s.�s 4�.a5 �t4 t8 42 s,00 - 40 _ J 3g ii 3d- 3Z wo re EXTE-AJD e9Z-L APPLICABLE 1� /r' SG C lrI O � VEi2T- $c=f�L.E- . / "= /O' t f HO,e/Z. SCALE : =lo MANf-IDLE GO(/E.eS TO G.I/TH/AJ ' jl o—o—o—o— Proposed cfroUnd PI'ofI/e /2" O-F F/ti//SHED ZA--A9D� , i ! f FLOW - Crr-min. %4'pew FLow 7 SCH�Z> ¢o /:>l/•;^. ore � rntnlmut» .. Per foOf EQUflL To SEPT/o Z- layer or 7f1N'aC> PIPE To BE 3�e3" ctS'f'one I --�3'MiA-I. E cr B DIST OX LVEL _ - { _ r rn o washed stone 3 -1000 LAC.. SEPTIC ... TANK qJ 3 Ln 39 s � i \ 1 LEACH �P/7- s G All r L?AT E : !!�Z3-87 TESTAc BY= Lo J' �,J�112 t1G. 1 a \ \ \ V � �• � n o d r s ose r -. - t� 1+�* ��;��Ct •-- t=��STD?C-�1.� a�A U�1 ICI AAJ RA zJr? GAL;,.Jrv. Al 1�i C -r19/ilk . �3 _ x /.,5= !F,-� t�•i,� �� 't 1 I G t9 Q ,� �EfjCHIN _ `�Z� ��r 4�- 51DEWf9L -- t ' I N o ® L - G��fJ G�-C-Lv J BOTTOM 1 \ . � To-r ��o•I G.P..D. F3L us 6-0 4' IN 0 t CE2TIFY THAT THE SUJt_D/tile >z ���Q�S� + 10 e P,�?OPO$ED OAJ THE GX2oUAJD FJS uy,s >~ofz�AaLx> g 1 \ C v o�M o T J� B�lL AivDSEr- — S1 TE - SElJ1gGE PLlq l j x 150 = IS.g � 4& , BAC AC 2E G?UIQEME/tl7'"S OF .THE 4� TO W AJ OF 8A�>\1S`r mil✓ :F012 :_ l.c�I 3�i l3�t l�� r Tod S �{ I i L S 4d I _ -4Z 44 _> PREPARED FOB: • " GEo Low. .; ao� N SCALE: AS NOTED DATE: PLA /V VIEW -.0 /98/ y D119TE o• oo extsflnc/ e /evaflon BLDG. 16E7-0pcK /Cvatlon eEQL)h2EMEAJTS : - o.o o = proposed � .�'.f. R f'P,2o V E D LO� � G�.l E L L Eh, Inc . n f 30 Bo�9,2D of HEAL-F N ' AJ - -- - - — — e x1:5-�'I n 9 Con-l'oUr-s $I d£'_, _ S - 7/4 /"IJV S TREET - -�a propo�d con fours _MASS• Ygk>.t-?OUTH Po2T, MHSS relit,r S P2oFE55tONAL ENGINEERS Cf��tD_SU2VEY025 �j-7 ISC