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0054 ACORN DRIVE - Health
E54.ACORN DRIVE, W. BARNSTABLE' A= 216 015 f _ o 5 L e o TOWN OF BARNSTABLE LOCATION �54 AcOr�� pr SEWAGE# VILLAGE Vl+cs I ,garN5t�ole ASSESSOR'S MAP&PARCEL �"NSTALLER'S NAME&PHONE NO. CDe(,v)C.C� En r) SEPTIC TANK CAPACITY jt5Ga) (�.a i LEACHING FACILITY:(type) 70 ARC 36 HC 1♦rdA(size) ,/ K NO.OF BEDROOMS 3 OWNER Q 1' 4 avicl Kc4veV1ickey PERMIT DATE: _I �Z COMPLIANCE DATE: T Separation Distance Between the: rr Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 6. 5 Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) `002 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) 1 5 Feet , FURNISHED BYQW,CI'� A-1= aO� 46,5 13-3= 7d� i'o h A-�=6 4 6 I q- A-7=64,6� 6-7=6q 6 ® A-8--7', 8-8= 701 A-9= 73 ' - iQ=75 ' -ID 776 04 03 3 6 07 08 01 Ve J 010 Fee 7 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpliLotion for -Misposal *pstem Construction permit Application for a Permit to Construct( ) Repair pgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. elt, � Owner's Name,Address,and Tel.No. Assessor's Map/Parcel / 4CO [JR K0 AM, 5n Wan W. &(Pntv Installer's Name Address,and Tel.No. f-op Sl.0 L6'f Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ' gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 7e mot /sue i�—Qa / -�/r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environment a o e and not to place the system in operation until a Certificate of Compliance has been issued by this Board of th. Si Date Application Approved by Date / Application Disapproved by Date for the following reasons Permit No.26/9� W4 Date Issued 10 .' ._'- .. ,w r _ .. , .. -.r...n'7, ..r �.-,.!v-tiT.r-.-._ ,1-S, {` _s � r �' ,r G•. �• .L X Now ! / y .7 i7d Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS r. 2ppYication for disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. r,✓S7� a' ,n elP �' Ownerr's iN1a�me,Address,an``�d�Ttel.No. Assessor's Map/Parcel rly A C- tom/ / lJ �t 9 tL ri d �1i nt ���< Installer's Name Address,and Tel.No. 1"®f ell f Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ,�' Design Flow(min.required) OA— gpd Design flow provided�/�,� gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. j �• • Signed""'"?..= .._._... � .�,�'t'":�. Date '•. Application Approved by � � »- " ". "-" `^� Date Application Disapproved by Date for the following reasons Permit No. Date Issued --- -= -- =----- ----------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS < Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No, dated Installer Designer f #bedrooms Approved design flow A_ gpd The issuance of this permit shall/not b- //ee construed as a guarantee that the system will fiurictib.as dest`g ed. Date �C /�V 8 - Inspector T Y _____________________T_--___---__---.---------.--------------.----------------------------------------------------------------------- ______ z - � -6 No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS disposal *pstem Construction Permit Permission is hereby grant�ed/to Construct( ) Repair( ) Upgrade( ) ,; Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Cons ction in st be completed within three years of the date of this permit. Date l0 7. 1 Approved by BOARD OF HEALTH TOWN OF BARNSTABLE Application Ar'Vell Me0ruction Permit Application is hereby made for aeermit to destruct an Individual Well at: Location — Address Assesso s Map and Parcel -E?-I' - kt't e 4CO Owner Address Installer — Driller Address Q`v Type of Building Dwelling------_--__---------- Other - Type of Building-— --- — No. of Persons----------- T e of Well—� EL`�r£l c_ ___________ Capacity Agreement: The undersigned agrees to des t the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of He I Private otection Regu on. Signed —_____ —_----- -____-- _ �&fie_ _ d to Application Approved Bye—NA'' � —%`� ---------- _ da Application Disapproved for the following reasons:----------------_-______—___—____ -----------date — — Permit No. Issued------------------ date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate (Of Compliance THIS IS TO CERTIFY, That the Individual Well destructed by i 9 0A-)1D L (, Installer at . . . . . . >!2 . . . .Q (��. . . . .•4> -"� . . .1�3J�'!� .� L . . . . . . . . . . . . . . has been destructed in accordance with the provisions of the Town of Barnstable Board of Health as described in the application for Well Destruction Permit No.. . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at. . . . . . . . . . . . . . . . . . . . . . . . . . . . .'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . .. . . . . . . . . . .. . .. . has been destructed in accordance with the the provisions of the Town of Barnstable Board of Health as described in the application for Well Destruction Permit No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .. . . . . . . . . . . .. . . . . . . DATE -— —__ -----------____------ Inspector r � No.�-�t) �v��—�J� ,� - Fee BOARD OF HEALTH TOWN OF BARNSTABLE 0pplitation Ar Well Mefstruction Vermit, Application is hereby de for a permit to destruct an Individual Well at: Location — Address Assessor's Map and Parcel S F}cl c i cD Y�_!� S _ I C — Owner — — _ Address Installer — Driller Address U G Type of Building Dwelling-- -- ---- Other - Type of Building----—--------___________:____ No. of Persons----- �� Type of Well-- -— ----- - -- Capacity _ Agreement: The undersigned agrees to des act the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of He ltl Private W II�Pgoteeccttion Regull'ion. g }' date Application Approved By�-•)� r �'--�.�-' - L't°--iL- --_--- 1 Application Disapproved for the following reasons:--- -------- ----- ------ — — date Permit No._______—_------------____—__—__—_ Issued — date BOARD OF HEALTH TOWN OF BARNSTABLE Certifitate Of Compliante THIS IS TO CERTIFY, That the Individual Well destructed by L-Q'P ylU�) L0Gz L, L IL.L/X Installer at . . . r2.r�. . . �.dZ l J ?. . . . . S 1. . .I�- �a �� .�.?�'�.!�`.U.. . . . . . . . . . . . . . . . has been destructed in accordance with the provisions of the Town of Barnstable Board of Health as described in the application for Well Destruction Permit No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . .. . .. .. .. . . .. has been destructed in accordance with the the provisions of the Town of Barnstable Board of Health as described in the application for Well Destruction Permit No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . .. . . . . . .. .. . . . . . .. . .. .. .. . DATE-----_-----_____—_------------___ ___ Inspector BOARD OF HEALTH TOWN OF BARNSTABLE Well Ze5truction permit Permission is hereby granted _ _ to destruct an Individual Well at No.—�� l� c-U_ (� I Ur'Z_ !� �( N�( H(1 Street as shown on the application for Well Destruction Permit No. Dated Board of Health --� DATE v J I f CLOCUS E M %6 NG CONTOUR:---- E!STIN EDCONTOUR:-----2" NOTES: EXISTING SPOT EIEvpTICN:25.5 'FS PROPOSED SPOT ELEVATION: 1.VERTICAL DANM:ASSUMED ACORN TEST HOLE. pq ~ UTLTTV POLE:4 2.MUNICAPAL WATER IS NOT AVAILABLE. Y FENCE LIPS: AND HYDRANT:b - 3.ALL CONSTRUCTN]N DETAILS APE TO BE IN CONFORMANCE WRH THE STATE OF MASS.ENVIRONMENTAL q�yp H' N CODE(TITLE FIVE)AND LOCAL HEALTH REGULATIONS. RETAINING WALL: XC�s 4 6.COW ACTOR TO VERIFY WCATIONS OF ALL UTWTIES PRIOR TO CONSTRUCTION. ISOLATED i 5.FIELD SURVEY PROVIDED BY TERRY A.WPRNER,PLS.,WIRWICH,MA. yL _ LOCATION IMP VEGETATED B.THIS PLAN REWIRES THE REVIEW AND APPROVAL OFONE OR MORE TOWN DEPARTMENTS AND LOT AB 132,6905F) YIETLANp NO.1 # E%ISTING WELL IS SUBJECT TOCNANGEUMIL SUCH TIME. ASSESSORS MAP:219 PARCEL:15 (99 BOXWOOD OR) T.EXISTING WELLTO BE ABANDONED.PROPOSED WELL TO BE STAKED OUT BY SURVEYOR. PLAN BOOI(:113,PAGE:13 i N Y92 tF1' Sf --`" _ 4•F A Cy1 FIELD /1 � 11✓✓ �v //�`(// s4, EXLSTWG VA III/I}` ISOLATED VEGETATED WETLAND NO.2 ' 43 j I b b j aLSG TOE A \ - / PG0 SITE PLAN SHOWING NEW WELL LOCATION LOCATION: 54 ACORN DR.,W.BARNSTABLE,MA L ISOLATED# PREPARED FOR: byT t VEGETATED # KARL&.iENNIFERHEMR 0 WX ING ®�# WETLAND NO.3 ' DATE:8-ISIB SCALE:1"=30' PROPOSED BASS RIVER ENGINEERING WELL THOMAS].MCLELLAN.P.E. P.O.BOX 1163,EAST DENNIS.MA 02641 5I8-3M-9048 rI t i No. �� Fee BOARD OF HEALTH TOWN OF BARNSTABLE Zipphratton _for 3061 Con.5trnction r it Application is hereby made for a permit to Construct f�/), Alter( ), or Repair( ) an individual well at: Location-Address B Assessors Map and Parcel Ld �en�l i >7 �gl ��r fir. rc�• rya 't,3t b Cc �l Owner Address Installer-Driller Address Type of Building Dwelling Other-Type of Building / No. of Persons Type of Well q � y( — 5lS 5��� � -` Capacity k) fh'L Purpose of Well_ Mg C3 %A ®g Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Ce c t of Comp, been issued the Board of Health. / Signed / /l8 Application Approved By p � , = - Date Application Disapproved for the following reasons: Date Permit No. �1\ Issued ,1 Date ------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE (fertificate of Comphance THIS IS TO CERTIFY,that the individual well Constructed� Altered( ), or Repaired( "^sm f� ) by l� n4 J`�P� �)l'711/ ; � Installer at �6V CD 12� ! �'� f� _ h� S !2LQ-- �2'li9 d olf � has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector No. W AO V Y—b Fee 1� BOARD OF HEALTH TOWN OF BARNSTABLE 2ppricatiou _for Yell Con5tructtou.pern, � 3 r4 L y/'S l/1q G _ Application is hereby made for a permit to Construct(�� Alter>( ), or Repair( an individual well at: W<<( _ 5y AG)r...n be 1, rc,`10. 9,4" s444,V, „• , Location-Address , ?lF/A Assessors Map and Parcel i Alfi V r-cr fkkl Y� I-1 Latz o /)r. W. Owner �y Address / (YY1ty1 � � � �Y/�f117�6 16?C'_. -10, �� ? lc�'.� ( �k/.�QI�S Y1�/� Installer-Driller Address i Type of Building Dwelling Other-Type of Building / No. of Persons ' Type of Well Capacity �t� r�' L Purpose of Well (f AVi&<J gyp( - J 0)J Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not t place the 1. well in operation until a CertificateJof ComplC�nce-ia been issued the Board of Health. Signed L� , � g t'..Date Application Approved By ����,� _7t./ ! ( �' I Date t Application Disapproved for the following reasons: Date Permit No. W ��� '� Issued Date --mem»a4.ssay. - Qe—ve -----e—._°ees__=__e odaemoeemebeooee—doao—e__-----_.._ BOARD OF HEALTH -ACT -- TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed�', Altered( ), or Repaired( ) by Installer at has been installed in accordance with the provisions of the,Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector BOARD OF HEALTH TOWN OF BARNSTABLE Verr Con$truction Permit No. LAJ a-� �� �a�� Fee Permission is hereby granted to / e vY?!SYyt We( ( D�1 111/'�Cl , /'`7r_ Installer to> Construct(/�, Alter( ), or Repair( an individual well at: I Street /11 4/� as shown on the application for a Well Construction Permit No.(�(��f)�� ��f� Dated (a�� f Date Elll ( Approved By1_ �� No. C90/�/ -0 ) I Fee /y 6 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:_� PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpflration for Construction ipPrmit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 21 IV/ O t 6� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 5q A-Coec4l -V�w U!• Installer's Name,A dress,and Tel.No. tf 3 CCrw.a.esu6C t t Designer's Name,Address,and Tel.No. 4-now � ,► �oq�s '��,• mod» s Type of Building: Dwelling No.of Bedrooms Lot Size Z sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3o gpd Design flow provided 33 gpd Plan Date L 2 3 I t ( Number of sheets Z. Revision Date Title Size of Septic Tank Type of S.A.S. to Description of Soil Q _ �'•_ l� SZ st> ArL 36 ILL Nature of Repairs or Alterations(Answer when applicable) e ( cloo �— t3o X I�b tgMe ft� Co�jJ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He tigned Date 20=2 Application Approved by Date r� Application Disapproved by Date for the following reasons Permit No. J91 "� / r Date Issued No. C v —Q I 11 Fee /0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION: ;TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpIication for"Misposalisp ern Constratib+Vermit Application for a Permit to Construct( ) Repair'(�Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 2 I L, b I : Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel S'C( 'D2V 7-op W pVvu 400t Installer's Name,Address,and Tel.No. I i j torf+,•.,e is i nC y s C Designer's Name,Address,and Tel.No. l CAIp ,ickDe � ( t�'�S �-L '*"' JL.r2-v-e t�P1`r�1 (.�}OAt S ! L GcJ • C!v�� F �� S� Type of Building: Dwelling No.of Bedrooms Lot Size Z �� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ^� Design Flow(min.required) O gpd Design flow provided / gpd Plan Date 1 Number of sheets Revision j � Z � �.-- Date Title f Ozof -�" Size of Septic Tank Type of S.A.S. t �4 t Description of Soil I S. �G 5� (-1 v-) lat c 3 Nature of Repairs or Alterations(Answer when aPPlicable) �C�51 � q j � Date last inspected: Ii Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He i ed Date �' - Z O I Z Application Approved by Date' Application Disapproved by Date for the following reasons Permit No. ! �) Date Issued �-- : - - _ = - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired-(_ Upgraded( ) Abandoned( )by L A_U AA.) l�{,�(o v i. -e at �j I�Go(n ;�,(, u2 L").??Ae has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �� �� dated kAD Installer("I�� �1, ,/J✓�j LS Designer E�j ��2 Qf2�t !_,J o n #bedrooms Approved design flow 3 3(o gpd The issuance of this p rmit sh 1 not be construed as a guarantee that the syste wig 1 n•tio a igned. Date �� , 1 � � Inspector\ ���� �® -------------------------------------------------------------------------------------------------------------------------/--------------- Fee ( � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair(�) \\ Upgrade( ) Abandon( ) System located at �j L( ►`�C.y✓�, U��� a) t `36434-1-t NO-0(' Y 't 1 t and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with i Title 5 and the following local provisions or special conditions. Provided:Construction must a completed within three years of the date of this pe' it. Date J /5 l Approved by : ENWIROTECHLABORATORIES,INC. MA CERT. NO.:M-MA 063 8 Jan Sebastian Drive Unit 12 Sandwich,MA 02563 (508)888-6460 1- 0-33'94460 FAX(508)A8-6446 Client Name Kinlin Grover/Ann Burbie Location 54 Acorn Dr Address 3221 Main St.,Route 6A W Barnstable,Ma Barnstable,MA 02630 Sample Date 10/20/11 Collected By Envirotech Sample Time 14:40 Sample Type WIIWell Date Received 10/20/11 i Lab Order Number DW-113064 Well Specs NA _ Locpteon Sogree Date Collectkd Tame Collected Comments . A Analysis Requested Units Recommended Limits Analysis Result Method Date Analyzed Analyzed By I Total Coliform /100m1 0 0 SM9222B 1 0/2 012 0 1 1 RS --........ ------...... pH pH units 6.5-8.5 6.52 SM4500-H-B 10/20/2011 LL i Specific Conductancen umhos/cm 600 178 EPA 120.1 10/20/2011 LL ----..._..._........- - -------•--- --._...----._._... ---.__._.._....-- ........ ---..._..._....----- - .._.—..__.._.......---............... --....... Nitrite-N mg/L 1.00 40.004 EPA 300.0 10/20/2011 LL i Nitrate-N mg/L 10.0 2.68 EPA 300.0 10/20/2011 LL Sodium mg/L 20.6 19.1 EPA 200.7 10/20/2011 MC .... --.__.. -- Total Ironp mg/l_ 0.3 0.19 EPA 200.7 10/20/2011 MC --- ---- ._...- ----- ---- --------- ---—......... --- Manganesea- - ---........._._ mg/L.......... ----...__.0.05 - ._._...__- 0.023... _—EPA 200:7- 10/20/2011 ---- MC---- Comments: Water meets EPA standards and is suitable for drinking for parameters tested. Date G Ronald J. aari j /,aboratory irector BRL=Below Reportable Limits *See Attached Page 1 of 1 ❑Ceritftcation is not available for this analyse for non potable water samples.. r. Bk 25982 PS222 0-EB9 41-05-2012 ar 03 ' 28ro. F.......... DEED RESTRICTION Whereas, William F. Hemr and Marjorie E. Hemr, of 54 Acorn Drive, West Barnstable, Massachusetts 02630, are the owners of Lot 4B, as shown on a plan of land recorded with the Barnstable County Registry of Deeds in Plan Book 157, Page 13, located at 54 Acorn Drive, Barnstable (West Barnstable), Barnstable County, Massachusetts (hereinafter,the"Lot"); and Whereas, William F. Hemr and Marjorie E. Hemr, as the owners of the Lot have agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built or maintained on the Lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; and Whereas,the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage,is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the Lot be put on recorded with the Barnstable County Registry of Deeds and/or the Barnstable Registry District of the Land Court, as applicable, by recording this document. Now,therefore, William F. Hemr and Marjorie E. Hemr, do hereby place and impose the following restriction upon the Lot in accordance with his agreement with the Town of Barnstable Board of Health, which said restriction shall run with the land and be binding upon all successors in title: The dwelling constructed and/or maintained upon the Lot shall contain no more than three (3) bedrooms unless and until it is connected to the municipal sewer or the Board of Health of the Town of Barnstable permits otherwise. Property Address: 54 Acorn Drive, West Barnstable, Massachusetts For title, see deed recorded with said Registry'of Deeds in Book 25891, Page 1.87. Executed as a sealed instrument this 5—*—-day of January, 2012. William F. Hemr Marjorie . Hemr COMMONWEALT14 OF MASSACHUSETTS Barnstable, ss. On this._day of January, 2012, before me, the undersigned notary public, personally appeared William F. Hemr and Marjorie E. Hemr, proved to me through satisfactory evidence of identifiication, which was/were 1Y\,4 LtLa,,A. ,to be the persons whose names are signed on the preceding or attached document;and acknowledged to me that they signed it voluntarily for its stated purpose. Ile Notary Public My Commission Expires: HELEN C.GRANGER �s Notary Public My Commission Expires January 3,2014 Commonwealth of Massachusetts 2 01/11/2012 09: 50 5084775313 ENGINEERING WORKS PAGE 01 Town of Barnstable Regulatory Semces Thomas F. Geiler,Direetor Public Sea th Division Thomas McKean,Director 200 Main Street, Hyannis,MA 01601 Office: 508-862-4"4 Fax: 508-790.6304 Date: Sewage Permit# Z81 a: ' ( Au=wr's MapMarcel Z-LG —0 15— Installer&Daimer CecbikL igo Foy Designer: _7^ga? We'r4r. Inc. . Installer: "'t"A v►�-Q+' 1� � Address: iZ W. Cjb s S C4 IQ1 Rd. Address: tg3 Co y, Vtiert�4 Sr 3-4fl4 M/1- 07_41_� MI_ o2(.gg on 5 l C4 (54f,,p(415 issued a permit to install a 1(date) (installer) septic system at ACAS Pr� based on a design drawn by (address) �e l-Cl e-5n�- Q �- dated 11 23� 11 (designer) —' I certify that the septic system referenced above was installed substantial]y according to the desir, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stnpout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required)wa ted and the soils were found satisfactory. - PETER 7. I er,s S MOENTEE CIVIL a 9 Mo,eb/09 (Designer'sSignature) (Affix Design ) PL DI 1€ CERTI�1£ATE 2r��Q LIAly E WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT !QARD ARE RECEIVED BY THE BAMSTABLE PUBLIC HEALTH DMSIAN. THANK Y2U. - ----- - -- q:Wff ca tbmn\deft mmardnc dan form.doc ' TOWN OF BARNSTABLE I Cti�:'y y^eel ` t SEWAGE # r VIIs 3 AGE �� C� SSESSOR'S MAP& LOT v21 to —U 13— <..,r RP STALLER'S NAME&PHONE NO. 4 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) c NO.OF BEDROOMS 2:2 BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: la Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Qc. ...........ems..,.....•..,...�..�.s+-...�..._� T. k•�� ®® �~ .... �.«...�.....+__.._...... _ •••A•....3 u,.� a.. �.1..•,.•.. .a r3._...�...�....�.......�...........s._.._.,_._ w_..'�'7`� i� ., s. ......" .> ., ..I� a... .• .. r l EXCERPT FROM THE BOARD MEETING MINUTES OF DECEMBER 13, 2011 I. Variances — Septic (New): A. Peter McEntee, representing Brian Hickey, owner—54 Acorn Drive, West Barnstable, Map/Parcel 216-015, 32,600 square feet lot, variances. Peter McEntee attended and discussed the proposed septic plan. Upon a motion duly made by Dr. Miller, seconded by Mr. Sawayanagi, the Board voted to approve septic plan dated 11/23/11 with the following conditions: 1) Needs water quality test to be performed on the on-site well prior to installation, 2) Must record a 3-bedroom deed restriction at the County Registry of Deeds and, 3) Must provide a proper copy of the Deed Restriction to the Public Health Division. (Unanimously, voted in favor.) co Ir o B. *ALASE co Postage $ $0.44 N Certified Fee $2.85 r-q Return Revel t Fee q/� . ostmark 13 (EndorsementRequired) $2.30 C o Restricted Delivery Fee (Endorsement Required) ©.00 <Z ..D C Taalp.&o.ea c .. a: $5.59 11/29/2011 r- Prop ID:216010 C3 5 PYE,CRAIG S&RUNE A rq 43 ACORN DRIVE - - [�� $o W BARNSTABLE,MA 02668 Certified Mail Provides: o A mailing receipt a A unique identifier for your mailpiece n A record of delivery kept by the Postal Service for two years Important Reminders:' { ,3^i^ gip` 4gt,Y-li-,C 1 +'I—IL; a Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile, e Certified Mail is not,available for any class of international mail, o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured)orRegistered Mail. n For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return' Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece°Return Receipt Requested".To receive a fee waiver for, a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may.,be restricted to the addressee or, addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement'Restricted-Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti-, cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3600,August 9006.(Revem)PSN 7530-02-000-9047 � /r • rMom r r • r r•r ru O WF N JE a VAL USE co Postage $ 80.44 -pGc-;' ru r/ Cenft Fee $2.$5 07 r i P ark Retum Receipt Fee ��6 �0 ; O (Endorsement Required) $2.30 C3 Restricted Delivery Fee $0.00 1� O (Endorsement Required) 0 Total Poster-". $5.59 r9 p nt ° Prop ID:216011 r3 BONAIUTO,MARK L&MARIANNE r- or PO Box N 61 ACORN DR ciry sieie,'z W BARNSTABLE,MA 02668 Certified Mail Provides: a A mailing receipt n A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years t Important Reminders. ;?r:,3�,f1 T? ,! o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mailg. o Certified Mail is not available for any class of international mail. n NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee;a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece'Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. 1�7 o For an additional,fee, delivery,.may be restricted to the addressee or addressee's authorized agent.AdVise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". a If a postmark on the Certified Mail receipt is desired,please present the artiw cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry.- y �I PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 RPM- tL � 'A 6O • !d B Co Postage $ $0.44 ru Certified Fee $2.$5/ Oi'' \'��. �He simark Return Receipt Fee .-� O (Endorsement Required) $^,30' �tire)� Restricted Delivery Fee 1 .� Q (Endorsement Required) $0.00 / o Total Pr -- _--- $5.59 llf r-R Sent o Prop ID:216016 r=l OWENS,JOAN D o s`ieer,A 9 BOXWOOD DRIVE orFoer WEST BARNSTABLE,MA 02668 Ciry Sfa r Certified Mail Provides: o A mailing receipt a A unique identifier for your mailpiece -t a A record of delivery kept by the Postal Service for two years Important Reminders: „�: 'f , a Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail(: o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGEFIS PROVIDED with Certified Mail. For valuables,please consider Insured or.Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of, delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 38111 to the article and add applicable postage to cover the fee.Endorse mailpiece Return Receipt Requested'.To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. k,.•vy o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement°Restricted Delivery°. o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an Inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000.9047 � D fYl/.lfil � s � Ir I r • r Ram ..D ru WO BPSFNI 643A Co Postage $ $0.44 Certi$ed Fee $2.8 i j( ) 0.1 Ql gstrnark Retnm Receipt Fee 2 ' Here M (Endorsement Required) $�.30 �� !e Restricted Delivery Fee O (Endomemerd Required) $0.00 —0 0 Total Pod-- $5.59 11M/2011 r:l E3 Sent o Prop ID:216015 ra HICKEY,BRIAN&KAREN .,. r ` or PO B a 54 ACORN DR - sma------• crgs W BARNSTABLE,MA 02668tam- -----` i Certified Mail Provides: e A mailing receipt n A unique identifier for your mailpiece n o A record of delivery kept by the Postal Service for two years Important Reminders: ,. a ;;).,k:, ,, T•. ,. o Certified Mail may ONLY be combined with First-Cla§s Mail®or Priority Mails. e Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,.please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt.sennce,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. V • - o For an additional fee, delivery..may be restricted to the addressee or. addressee's'authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". - o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail' receipt is not needed,detach and affix label with postage and mail. IMPORTANT,Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 off . o .. • • . . ru o H I 1 3. co Postage $ $0.44 0644 ru Certified Fee $2.85 Q7 ? r C3 Return Receipt Fee Poste.pp?O/, O (Endorsement Required) $2.30 Here Restricted(E dorsementRequ Fee i d) $0.� �5,� .s o Total Post---o. � $5.59 11/29/2011 rq . E3 Sent To Prop ID:216060 p weer iipt BARNSTABLE,TOWN OF(CON) orFoBox CONSERVATION COMMISSION City,siaie; 200 MAIN STREET HYANNIS,MA 02601 ISO Certified Mail Provides: o A mailing receipt o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years a. Important Reminders: PC,,f2 (} Airi;f, a Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®: o Certified Mail is not available for any,class of international mail, o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or,Registered Mail. v. a For an additional fee,a Retum Receipt maybe requested to provide proof of', delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the' fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. o For an additional fee, delivery-may. be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the. endorsement'Restricted-Delivery". - a If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail' receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry.-~ PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 'i COMPLETE THIS SECTION C.N DELIVERY SENDER: COMPLETETHIS SECTION ol Complete items 1,2,and 3.Also complete A. $i 3 / Rertt 4 If Restricted Delivery is desired. X Ci j ❑Agent M ■ Print your name and"address on the revers ❑Addressee so that we can return the card to you. B. Re ived by(Prfnted Name) C. Date .Del' ery ■ Attach this card to the back of the rpailpiece, \ � Y I or on the front if space perm D. Is delivery address differeld from item 1. Article Addressed. : � _�\ If YES,enter delivery address belo ; No Prop ID:216015 Al C/-. �']I e /may HICKEY,B AN&KAREN J ((WWW"✓✓✓ / // ���/// 54 ACO R 3. Service Type l W BARN ABLE,MA 02668 PICertified Mau ❑Express Mali E ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. .Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number .. _.(Transfer from service lat',r- ?'0,10 10 6 0 '0 0 01' 2 8 4 0 2 6 8 2` j PS Form 3811,February 2004 Domestic Return Receipt i02595-02-M-1540 UNITED STATES POT �. ,� �"►������ Paid � a .s , YPermit No.G-10 ZL IS • Sender: Please print your name, address, and ZIP+4 in this box • Engineering works, Inc. 6 12 West Crossfield Road Forestdale, MA 02644 }:�: 111111111111111!llt11,111I,a121111,fr„III1lt11tr11„1111111:1 SECTIONSENDER: COMPLETE THIS •MPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,,and 3.Also complete A. Signature item 4 If Restricted Delivery is desired. Xi1n��� 0 ls�nt ;I Print your name and address on the reverse I 1 [�Cddresses so that we can return the card to you. B. Received by(Printed Name) Cl. Date of Delivery ■ Attach this card to the back of the mailpiece, ?2_ 0—4 1 or on the front if space permits. W 1. Article Addressed to: D. Is delivery address different from item 1? 0 yes If YES,enter delivery address below: IIZ No ;t. Prop ID:216011 BONAIOTO,MARK L&MARIANNE 61 ACORN DR 3. Service Type W BARNSTABLE,MA 02668 Certified Mali ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number ^r r t'i (Transfer from service labeq I it `1 i7 010 110 6 0 0001 ,2 8 4 0~2 6 9 9,i►l PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE 't First-Class f"- Paid • Sender: Please print your name, address^and ZIP+4 in this box • `�k',. I I I Engineering Works, inc. I 12 West Crossfield Road e Forestdale, MA 02644 I ` 4 1!1!!!!i�A M 1!fu llq!11IL1 q l!1i{i!}3iiir!!!!}'.itl.li}iiFlF:�l� SECTIONSENDER: COMPLETE THIS .MPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,,and 3.Also complete SI ature Item 4 If Restricted Delivery is desired. ❑Agent 11 Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. R ce ed by(Printed Naqq C. at of elivery 0 Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from hem 1? ❑Yes 1. Article Addressed-to: If YES,enter delivery address below: ❑No Pye 9 ��we 3. Service Type �?1 _ PLCert�ed Mail ❑Express Mail �R 1 ' ` ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes z. Article Number 7 D;1O�1O 6 Ok 0 01•`:• 2840 26 6 8'==' s (Transfer from service/abed _ _ PS Form 3811,February 2004 Domestic Return Receipt 102595.02-M-1540 i UNITED STATES POSTAL SERVICE , w first-1rTnI y 1 It�No.G-10: e:x • Sender: Please print your name,.address,..and ZlP+4 in N' b`dz!"i Engineering Works, Inc. 12 West Crossfield Road Forestdale, MA 02644 i iSENDER: SECTION. DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sig at item 4 if Restricted Delivery is desired. ❑Agent X ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Re ived (Printed Name) C. Date f Delivery ■ Attach this card to the back of the mailpiece, Ilona 4 L ( ( �� 4 or on the front if space permits. D. Is delivery address different from item 11 ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No Prop ID:216059 BARNSTABLE,TOWN OF(CON) 3, service Type CONSERVATION COMMISSION 200 MAIN STREET ®Certified Mail ❑Express Mail HYANNIS MA 02601 ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number ` (transfer from service iabeq�. .. 70101060. 0001 2840 2705 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1 5401 I UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 I I i I I • Sender: Please print your name, address, and ZIP+4 in this box • 3 f � I � I � I Engineering works, Inc. 12 West Crossfield Road Forestdale, MA 02644 i �=' �t! !tf{iE�l�lfllil! �t!!!S �itkS!t }S !i1l:ltl I�11lt..l � I i SENDER: COMPLETE THIS . DELIVERY s Complete Items 1,2,,and S.Also complete A. Signature •ftem"4 If Restricted Delivery Is desired. ❑ s Print your name and address on the reverse X � �l Mk ddressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, �z or on the front If space permits. W C(I 0 u 1..Article Addressed to: D. Is delivery address different from Item 1? If YES,enter delivery address below: No Prop ID:216011 i{. BONAIUTO,MARK L&MARIANNE 61 ACORN DR 3. Service Type W BARNSTABLE,MA 02668 [WOertified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise _ -- -.------------_---- -- ❑Insured Mall ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number r t # ! f i(Transfer from service labeq 70 1 D 1060 0001 2840 2 6 9.9 Ps Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION CF4 DELIVERY ■ Complete hearts 1,2,and 3.Also complete A. SI ite614 it Restricted Delivery Is desired. X L ❑Agent ® Print your name and'address on the revers ❑Addressee , so that we can return the card to you. B.� ived b � y.(Printed Name) 0. Date .Delivery Attach this card to the back of the 'Ipiece, \ �, or on the front if space perm) D. Is delivery address diffe from item 1. Article Addressetl _�\ If YES,enter delivery address belo No x I e � � Prop ID:216015 ' HICKEY,B N&KAREN IS ra'�54 ACORN R 3. Service Type W BARN ABLE,MA 02668 P&Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise l ❑Insured Mall ❑C.O.D. 4. .Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number. -- --- -- --- —-- - - - - - - _.(Tn3irsfer from.Hike tail r 010 1060 0001 2840 2682 i PS'Fdrin 3811,1Fe'6ruary 2004I I I I D6mestle Return Receipt i02595-02-M-1540 SENDER: COMPLETE THIS SECTION I COMPLETE THIS DELIVERY ■ Complete Items 1,2,and 3.Also complete A. Sig at item 4 if Restricted Delivery Is desired. X ❑Agent e Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Re ived (Printe Name) C. Datetf De ivery ■ Attach this card to the back of the mailpiece, �Q ( or on the front If space permits. D. Is delivery address different from item 1? ❑ es 1. Article Addressed to: If YES,enter delivery address below: ❑No Prop ID:216059 BARNSTABLE,TOWN OF(CON) 3, service type CONSERVATION COMMISSION O Certified Mail ❑Express Mail 200 MAIN STREET ❑Registered ❑Return Receipt for Merchandise HYANNIS,MA 02601 ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service label),. 7 010. 1060 0001 2840 2 7 0 5 _ :F ; PS Form 3811,February 2004t t r Domestic Return Receipt 102595-02-M-1540 W. ,« SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS ON DELIVERY i ■ Complete items 1,2,•and 3.Also complete SI ature Item 4 If Restricted Delivery Is desired. Q ❑!Agent Is Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Rjdved by(Printed N C. at of Oelivery 0 Attach this card to the back of the mailplece, / 13 or on the front if space permits. 91111 D. Is delivery address different from Item 1? ❑Yes 1..Article Addressedto: If YES,enter delivery address below: ❑No Pve Lc-al of 11r� rT� 3. Service Type PLOertified Mail ❑Express Mail 1 ` ❑Registered ❑Return Receipt for Merchandise ❑Insured Mall ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number , .I} 1 7010 1060 0001 -2840 2668 ( (Transfer from senilce labeq PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 co ru ° We BOW co Postage $ $0.44 ,-064 nj Certified Fee $2.85 07 postmark ! r Return Receipt Fee � � Here C3 (Endorsement Required) $2.30 ,... C3 !! •• Restricted Delivery Fee r ■ D (Endorsement Required) $0.00 . / . . ..• . .-. O Tntm P—t—a u--- @ _ $`..59 111,2912 i)11 Prop ID:216010 • s : • 1 C PYE CRAIG S&JUNE A ,,pp W $ � Q4JA S,' 0 9 43 ACORN DRIVE - 9 W BARNSTABLE,MA 02668 _.... _ --Postage $ $0.44 064���� ., q .......... Certified Fee $p 85 ' 47 ostm°°ark t Return Receipt Fee t0�1 Here ' (Endorsement Required) $? 30 ��}(� •• Restricted Delivery Fee `• ■ (Endorsement Required) $0.00Er �� ��, `: ! D ►I � ■ o • r�4•II Total Pr-'--^^ a` ... $5 59 111c r'°011 0' . . . .•. -� Prop ID:216016 � Sent To Sent OWENS,JOAN D •s o � � . treet,� 9 BOXWOOD DRIVE or POCc s WEST BARNSTABLE,MA 02668 _ ti Postage $ $0.44 Oti44 criy'si�l � � Certified Fee $�°gg 07 ?. . ffi a Return Receipt Fee !!�60.%mark a (Endorsement Required) $ .3f} u4 II��AQN O Restricted Delivery Fee C3 (Endorsement Required) $0.00 M Total posts,-" $5.59 11/c�1/tfilj. 0 ent To Prop ID:21601.1 C3 S;TW Apt� BONAMTO,MARK L&MARIANNE - or PO Box 61 ACORN DR cm; W BARNSTABLE,MA 02668 p ru nj cc Postage $ $0.44 Certified Fee $2.8.5 ('° 07 Ai� 3 Return Receipf Fee 1 �stmark f a (Endorsemerd Required) $2.30 \ Here ®, Restricted Delivery Fee 0 (EndorsementRequirad) $0.00 -- ' o Total Pon---- ^--- Q $5.59 11/29/2011 a Sent o Prop ID:216015 o 'Street�d HICKEY,BRIAN&KAREN r._ or PO SO 54 ACORN DR W BARNSTABLE,MA 02668 I D (iY,7/1tYi r e p • . -� � I fU J. o H lI 4r�2d 1A U .} . ru Postage $ $0.44 %44 ra Certified Fee $2.85 07' *01k.?o `1 C3 Return Receipt Fee PostmaR491 J ' O (Endorsement Required) $2.30 Here O Restricted Delivery Fee n (Endorsement Required) $0.00 o Total Post $5.59 11/29/2011 M Sent To Prop ID:216060 EF-g3,Ap(Boxi BARNSTABLE TOWN OF(CON) di47-§aiel CONSERVATION COMMISSION ...... 200 MAIN STREET HYANNIS,MA 02601 TOWN OF BARNSTABLE , -4- LOC'F►'I'f P�N> ` ..., . ����� .[tom( I V` ._ SEWAGE.# - �.. . VII.L?:G ASSESSOR'S MAP& LOT961 — � I :rALLER'S NAME&PHONEwo; . SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �r � (size)NO.OF BEDROOMS BUILDER OR OWNER l"Patzscot PERMTTDATE: f^ '7!51 W" 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 leaching fa�ci 'ty) Feet Furnished by " 4 V i SUD ST, i p-&r .r. 3 r � Ln e. Lf) .: .. IU ,n m Postage $ , 02601 M certified Fee X QQsn� CO Retum Receipt Fee P` re (Endorsement'Required) 0 Restricted Delivery Fee rq (Endorsement Required} y QGj r-3 Total Postage&Fees •P O � Karen Hickey l� 54 Acorn Drive West Barnstable 02668 Ee ified Mail Provides, (aSIenea)zoozsunCooss8d Ama uuod III receipt „j o A unique identifier for your mailplece a A record of delivery kept by the Postal Service for two years Important Reminders: e Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. a Certified Mail is not available for any class of International mail. u NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. p For an additional fee,a Retum Receipt may be requested to provide proof-of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece'Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. is For an additional fee, delivery may be restricted to the addressee or addressee's authorized a ent.Advise the clerk or mark the mailpiece with the endorsement"Restricted�elivery W If a postmark on the Certified Mai(receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail i receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery Information is not available on mail addressed to APOs and FPOs. ' ' "' J SECTIONFSENDER-ZOMPLETETHIS SECTION' COMFLETE THIS ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. S)by&ture Item 4 if Restricted Delivery is desired. ❑Agent X ■ Print your name and address on the reverse �UCkT ❑Addressee so that we can return the card to you. B. tied by(Printed Name . Dat ftDrvery ■ Attach this card to the back of the mailpiece, � or on the front if space permits. D. Is delivery address different from item 1? s - 1. Article Addressed to: If YES,enter delivery address below: ❑No I K�ai;en Hickey I I 54;-Acorn Drive West-Barnstable 02668 3. Service Type i ❑Certified Mail 0 Express Mail f ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number I I1 , 7p06 i�810 00�� ► 3524 5454' I (r-nsfer from service fabeo �i .11 I PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 } UNITED$TATEc� o& ptE� fitx +': �, "a :, ,.�,Z` yyb�r yCq� �eQ®6Id os :��'+�.�•�'„y'Ta�. �x.��'.:y.a �J:fV:,S. � �� ..aG ..��.Tip�s W l IvOy �•,o' • Sender: Please print your name, address,;aiid Z4 n=this bx N 'Town of Barnstable Public Health Division 200 Main Street ` Hyannis, MA 02601 s j �. i ij- 1-ll}}lills(i1�})��i}}4};iiil:11Fl,�i1}tlIitt.i711�1�tf J�if�ifill�I f r ODA $a {� ft • �,'� ,ley.. Lr1 L_j UP ru� �=� vim• � � Ln Postage it _.,_. .. .._ \ C1 Certified Fee - � Return Receipt Fee POq� (Endorsement Required) 7Jere C3 Restricted Delivery Fee a rl (Endorsement Required) cD \\ PQ C3 Total Postage&Fees O �+ N � Karen Hickey 54 Acorn Drive West Barnstable 02668 �I -SEN •'i • SECTION' • ON DELIVERY E Complete items 1,2,and 3.Also complete A ture /a item 4 if Restricted Delivery is desired. X G, ❑Agent • Print your name and address on the reverse (, ❑Addressee so that we can return the card to you. B. t eived by(Printed Name . Dat f D ery ' ■ Attach this card to the back of the mailpiece, 9� /J �/ or on the front if space permits. D. Is delivery address different from item 1? 0 Y6s 1. Article Addressed to: If YES,enter delivery address below: ❑ No Karen Hickey r... 54Acorn Drive Wrist Barnstable 02668 3. Service Type ❑Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 1 -7 2. Article Number 7006 0810 0000 3524 5454� It ll (Transfer from service/aihe0 t � {� � . PS Form 3811,February 2004 Domestic Return Red eipt 102595-02-M-1540 " ai r ' • t � ���� ��/ I v , , SHE Town of Barnstable Barnstable �pp Tp�y Regulatory Services Department j etcaM j IIARNSTABLE, • . 9 � Public Health Division s639. �39 �0 Alf°"'A�p 200 Main Street, Hyannis MA 02601 �e07 Office: 508-862-4644 Thomas F,Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7006 0810 0000 3524 5461 November 8, 2011 Karen Hickey 54 Acorn Drive West Barnstable ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 54 Acorn Dr.,West Barnstable, MA was last inspected on 8/18/2011, by Mark Polselli, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails"under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • SAS is in Hydraulic overload You are ordered to repair or replace the septic system within one (1) year from the date you receive this notification. Failure to repair/replace the septic system with the deadline period will result in future enforcement action. R ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures\54 Acorn Dr.,W.Barn..doc f Commonwealth of Massachusetts Title 5 .Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M 5a`'P 54 Acorn Drive Property Address Karen Hickey Owner Owner's Name information is required for every West Barnstable Ma 02668 10/26/2011 page. City/Town 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. dm When A. General Information fillingng out out forms I on the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. Capewide Enterprises Company Name 153 Commercial St. Company Address Mashpee Ma. 02649 Cityrrown State Zip Code 508-477-8877 SI 4522 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 1.5.340 Title 5 (310 CMR 15.000).The system: == Y ❑ Passes ❑ `Conditionally Passes ® fails ❑ Needs Further Evaluation by the Local Approving Authority 77 , 10/26/2011 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.lfthe.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 atthe 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. 1 t5ins•11/10 Titles Official inspection form:Subsurface Sewage isposal System•Page 1 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 54 Acorn Drive Property Address Karen Hickey Owner Owner's Name information is required for West Barnstable Ma 02668 10/26/2011 every page. Citylrown 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: 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): L11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts P. Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 54 Acorn Drive Property Address Karen Hickey Owner Owner's Name information is required for West Barnstable Ma 02668 10/26/2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 ( P ) ❑ 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 i ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Acorn Drive Property Address Karen Hickey Owner Owner's Name information is, required for West Barnstable Ma 02668 10/26/2011 every page. City/Town 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 Y2 day flow l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 54 Acorn Drive Property Address Karen Hickey Owner Owner's Name information is required for West Barnstable Ma 02668 10/26/2011 every 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 54 Acorn Drive Property Address Karen Hickey Owner Owner's Name information is required for West Barnstable Ma 02668 10/26/2011 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® 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): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Acorn Drive Property Address Karen Hickey Owner Owner's Name information is required for West Barnstable Ma 02668 10/26/2011 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No 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: unknown 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 54 Acorn Drive Property Address Karen Hickey Owner Owner's Name information is required for West Barnstable Ma 02668 10/26/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Wass stem pumped as art of the inspection? Ye s No Y P p p p ❑ 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 54 Acorn Drive Property Address Karen Hickey Owner Owner's Name information is required for West Barnstable Ma 02668 10/26/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: system repaired 1996 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints ok, no leakage, vented through roof Septic Tank(locate on site plan): Depth below grade: 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: 1500 gallons Sludge depth: 5" t5ins•11/10 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 ;M 54 Acorn Drive Property Address Karen Hickey Owner Owner's Name information is required for West Barnstable Ma 02668 10/26/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 3.5' Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers and took measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years as maintenance. Water level was ok, tank was not leaking and was structurally sound. Outlet tee was intact and in good condition. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Acorn Drive Property Address Karen Hickey Owner Owner's Name information is required for West Barnstable Ma 02668 10/26/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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.): i Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No l5ins•11110 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 ,M 54 Acorn Drive Property Address Karen Hickey Owner Owner's Name information is required for West Barnstable Ma 02668 10/26/2011 every page. City/Town 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.): 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 54 Acorn Drive Property Address Karen Hickey Owner Owner's Name information is West Barnstable Ma 02668 10/26/2011 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 10x30 with 330 rechargers ❑ 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. was video inspected and found to be hydraulically overloaded resulting in a failing septic system inspection. The water level in the leaching facility was well above the inlet with a stain line approx 2' into the pipe. This was confirmed by running a camera from the septic tank through the d- box into the leaching facility. 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 i Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 54 Acorn Drive Property Address Karen Hickey Owner Owner's Name information is required for West Barnstable Ma 02668 10/26/2011 every 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 54 Acorn Drive Property Address Karen Hickey Owner Owner's Name information is required for every West Barnstable Ma 0266B 10/26/2011 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 RIEA o ydEp SAS. I t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Acorn Drive Property Address. Karen Hickey Owner Owner's Name information is required for West Barnstable Ma 02668 10/26/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 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 not established Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Acorn Drive Property Address Karen Hickey Owner Owner's Name information is West Barnstable Ma 02668 required for 10/26/2011 every 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Town of Barnstable ,P# ' ' Department of Regulatory,Services Public Health Division Hate aaJA �� 200Main Street,Hyannis MA 02601 ' "Date Scheduled r [ ~1 •�- Time, Fee:Pd. Soil Suitability Assessment for Sewage Disposal , Performed By: �e r f 5L .$ Witnessed By: F ..... LOCATION&GENERAL:INFORMtTION Location Address Owner's Name j1, �A�yhW l�' � ^r+ vi41 / Address Assessor's.Map7Parcel.• 'li L( O t Engineer's Natge c`°f`�j4j4C ,,,. ... G NEW C RUC ONSTTION REPAIR 1. / r Telephone# g -7 7. Land Use:— J?_rej'cta,'lam'.yo,:I �•- . Slopes G(96) - y: s,r Surface Stones _5%. Distances from: Open Watiiaody- NIA- ft Possible Wet Area �Cl ft Drinking Water Well •� �--tt Drainage Way AJ14' ft Property Line " ft Other` ft SKETCH:(strict name,dimensions of lot,exactlocations of test holes&pere.tests,locate,wetlands.In proximity.to.holes) �b ` ?fit 5 �G! Parent material(geologic) V-1�a�t�`� T Depth to Bedrock ,Depth to Groundwater. Standing Water.in Hole:- /"I6— Weeping from Pit Face 1 Estimated Seasonal High Groundwater 1. t S 13 2 , ) DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used:. I Z�D Ct " Depth Observed standing in obs.hole: in. Depth to soil mottles: 1 In. Depth to weeping from side of obs.hole: In, Groundwater AdJugtMenf ft. Index Well# Reading Date: Index Well level_:,-,,., AdJ, hetor Adj.Groundwater level PERCOLATION TEST bate _ Time;II&m Observation Hole# / Time at 4" Depth of Perc �Go Time at 6" 10 Start Pre-soak Time @ Jay�Q M , lime(9"-6') _- End Pre-soak Rate MinJlnch /0 Site Suitability Assessment: Site Passed �_ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEPTICVERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# I _ Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. �y.96 t3rave1l 1 Z-34 W21YN -7'.5 DEEP OBSERVATION HOLE LOG Hole# . 7,- Deptfi'from.µ.' Soil,Horizon Soil Texture Sol talor Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. �j,,..tQ;ct �. •... �� to ,� �Jz v (lj ry�- Ln t2S DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ConsistencZ e au , L DEE#z.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil'Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders. o . { Flood Insurancel2ate Mau: Above 500 year-:flood boundary No Yes , _. Within 500 year boundary No Yes a :,Wittih 100 year fldod boundary No.J�' Yes \ Death of Naturally Oecurrink Pervious Material Does at least-four feet Ofnaturally occurring pervious material exist in al1%areas observed throughout the area proposed for the soil absorption system? v If not,what 11i;the depth of naturally occurring per ous material? Cei-fification I certify that on (date)I have passed the soil evaluator examination approved by Department of Environmental Protection and that the above analysis"was performed by me consistent with the°required�trat xpectise and experience describedin 3.10 CMR`,'15.017. Date Signre atu ll Q:\.4BP-nOPERCFORM.DOC O N — l9 O a v. - of u 0 3 m m RHODODENDRON � m —I o ENCL05ED PORCH m 1 TREE TO BE REMOVED C) O N —GIA55 BLOCK p m CluKITCHEN LUK P E'5 BEDROOM N2 BATH 5 rilenoOR R OR wcmo.FicOlc. �Vl l OUTDOOR u aErl � _ SHOWER WINDOW TO BE REMOVED Ac)'.2.1/.o!'_ DINING N -� WOOD PIW. R GAS METER o O wDOC FItpR Q CIliJGT � tD WELL TO BE RELOCATED cl= N aOSe7 J 4A' 7 U O s WINDOW TO BE REMOVED LIVING OM LL ROOM —� MASTER BEDROOM AVA5 BEDROOM#3 W-=ROD. ++ CWft7 FIWR «vron 11,00K - �--) en ELECTRIC.METER L ' r_ _...... .......--- U 01 N TREE TO BE REMOVED _ Q EXI5TING FIRST FLOOR PLAN x 5CAIX:114-I-0' NORTH LEGEND -FXl_STING WALL TO REMAIN APPROVED ®-EX15TING'WALL TO BE REMOVED D 2 4 G 8 IO MAY N 3 2019 Oid;t of's HiglIM- GRAPHIC 5CALE IN FEET- 1/4 SCALE pd Ktttg's Nig2iwey Cuvnmittee � o � av 4+ (. O 0 ADDITION EXISTING HOUSE Q A A-4 O 1 G'0` .. I O'O' O m 1 � l (� -- ENCLOSED PORCH °� O n_ DECK FIBERON-COMP051TE DECKING Q n -WWW.FIBERONDECKING.COM .O — COLOR:BURNT UMBER 2G-0' O b _ —...... — Qll N —... ®U O -. ---- � O IH•1 Lw/ I i A OA Q OA F o c NEW WINDOW EX15TING KITCHENEXIST O I_ L 1 2'- ONG 2"�I1� B'-I. y _ BATHI#I - C� II EXISTING OUDOTOR 11 _ ExiSTua[; SHOWER II II NI[W WALK-IN >^ AVA'S BEDROOM#3 an✓tT — — — C OSET II � - rtcoft V © NEW BATH#2 �EXtSTING WALLS 10 BE KEMOV VI ED I I I I I IIY�('LGGF:! 11 I 4,0, 11 O r I I I I I lciJJ(JI - - - D Ir II C6 N O N�TBD �, .JL J Op O O L` INFILL EXIST&DOOR OPENING S._. O I I II r ,� IGw MOVE EX15TIPJG CLOSET DOORS TO�THER SIDE O III �II IIII -N LIVING JOM DINING N I qb' 25- 11EW WOOD"R IIC.Y INJOD PLDOR ALIGN.SUB f-LOORS I I t II II m 11GW ClOStT IIEW LIfN tY NE\V LIAStT M1b -N HEW U05Et A _ - �.Tit-CF.PM A = _ _ _ _ - - _ _ " > A-4 NEW LUKE'5 BEDROOM#2 �. OA CATIiEDRN.CEIIJHG O o vO°D"LDR I PROPOSED PIRST FLOOR PLAN o — — iraneAea I Senn:ua'=I'o' NORTH Q Q LEGEND EXISTING WALL TO REMAIN µ_ =Lo oA OB O Q -NEW WALL 35'-62' — 'a5" —.-- APPROVED 0 2 4 G 8 10 ' MAY 2 3 2018 GnAPn1C Si.ALE IN FEEI- I l4 SCALE 'own of E3arnsiable Cud King"T HIdH�ay O�rnrnl;ice Commonwealth of Massachusetts Executive Office of Enviroiunental Affairs Dept. of Environmental Protection One winter Street Boston Ma. 02108 John Grad ' D.E.P. Title V Septic Inspector Y.O. Box2119 Teaticket, MA 02536 WILLIAM F.WELD (508)< A� ;$ 3. Governor ARGEO PAUL CELLUCCI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ��� PART AJ CERTIFICATION .� 1p Property Address: 54 ACORN DR.W.BARNSTABLE MAP 216 LOT 015 Address of Owner: �' Date of Inspection: 10/23/98 (If different) Name of Inspector: JOHN GRACI BRUCE YAKOLA:BOX 72 BARNSTABLE 1 am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number: ,, i CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: x Passes This Inspection Is based on criteria dented InTtile V Conditional) Passes co de310CMR16203.My findings are of how the system is Y performing at the time of the inspection.My inspection does _ Neediibmit r er Evaluation By the Local Approving Authority not Imply any warranty or guarantee of the bngevityofthe Fails septic system and any of Its components useful life. Inspector's Slgnature: Date: 10/23198 The System Inspector shall s a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: _One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes, no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Co7hpliance(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 conforming septic tank as approved by the Board of Health. (revised 04127)97) One Winter Street • Boston,Massachusetts 0210E • FAX(617)556-1049 is Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPEC I IUIV rumlVI PART A CERTIFICATION (continued) Property Address: 54 ACORN DR.W.RUCE YAKOLA:BOX 0t5 Owner: 7 BARNSTABLE 02630 Date of Inspection:10123199 _ Sew.aae backup or.breakout or hicih.statiC water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed 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 the public health,safety and the environment. SYSTEM WILL PASS UNLESS BOARD OF HEALTH INES THAT THE SYSTEM 1) NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH ANDIS 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. ATER LIER,IF APPROPRIATE) 2) THAT HEISYSTEIMtIS FUNCTIONING pIN A MANNER THAT PROTECT THEPUBLIC PHEALTH AND SAFETY A DETERMINES AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. — The system has a septic tank and soil absorption system and 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 presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation 3)Other D] SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged cesspool. SAS is in hydraulic failure. (revised 04127)97) (revised 04r27B7) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 54 ACORN OR.W.BARNSTABLE MAP 216 LOT 015 Owner: BRUCE YAKOLA:BOX 72 BARNSTABLE 02630 Date of Inspection:10123198 Check if the following have been done:YOu must indicate either"Yes"or"No"as to each of the following: _x_ — Pumping information was requested of the owner, occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. x — As built plans have been obtained and examined. Note if they are not available with N/A. x The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. _c_ _ The site was inspected for signs of breakout. x All system components, excluding the Soil Absorption System, have been located on the site. x The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees,material of construction, dimensions, depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is unacceptable)[15.302(3)(b)] (revlsed 0412719T) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 54 ACORN DR.W.BARNSTABLE MAP 216 LOT 015 Owner: BRUCE YAKOLA:BOX 72 BARNSTABLE 02630 Date of Inspection:10123198 FLOW CONDITIONS RESIDENTIAL: Design flow: 3w g.p.d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: 1 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings, if available:(last two(2)year usage(gpd): nla Sump Pump(,des or no): No Last date of occupancy: nla COMMERCIA'_/INDUSTRIAL: Type of establishment: nla' Design flow.0 gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: nra Last date of occupancy: nra OTHER:(Describe) rda Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Na System pumped as part of inspection: (yes or no)No If yes,volume pumped:0 gallons i Reason for pumping: Na TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool OverFow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records,if any) I/A Technology etc.Copy of up to date contract? Other. APPROXIMATE AGE of all components, date installed(If known)and source Information: NEW SYSTEM WAS INSTALLED 1996 Sewage odors cetected when arriving at the site: (yes or no) No (revised 0427)97) r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 54 ACORN DR.W.BARNSTABLE MAP 216 LOT 015 Owner: BRUCE YAKOLA:BOX 72 BARNSTABLE 02630 Date of Inspection:10123199 SEPTIC TANK: x (locate on site plan) Depth below grade: 2' Material of construction:x concreate_metal_FRP_Polyethylene_other(explain) If tank is metal, list age Na . Is age confirmed by Certificate of Compliance Nc (Yes/No) Dimensions:'LJo'S"W5'8"H5'7" Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle: 32" Scum thickness:3" Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: 15" How dimensions were determined: MEASURED 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.) SEPTIC TANK AND,ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING MRYTWO YEARS. GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: _concrete_metal_FRP_Polyethylene_other(explain) Dimensions: rya Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom cf outlet tee or baffle: rda Date of last pumping;,f 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.) Na BUILDING SEWER: (Locate on site plan) Depth below grade: 2'6" Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction llne:TOWN Diameter: nfa Q@mments: (conditions of joints,venting,evidence of leakage, etc.) (revised 0427)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 54 ACORN DR.W.BARNSTABLE MAP 216 LOT 015 Owner: BRUCE YAKOLA:BOX 72 BARNSTABLE 02630 Date of Inspection:10123198 TIGHT OR HOLDING TANK: (locate on site plan) Depth bellow grade: rda Material of construction:_concrete_me.al_FRP_Polyethylene_other(explain) Dimensions: we Capacity: rda gallons Design flow: Na gallons/day Alarm level:_nla Alarm in working order?_Yes No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) We DISTRIBUTION BOX: x (locate on site plan) Depth of liquid Vevel above outlet invert: LIQUID LEVEL wMH BOTTOM OFPIPE. Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) DISTRIBUTION BOX 15 STRUCTURALLY SOUND. PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_Yes Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) nla (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 54 ACORN DR.W.BARNSTABLE MAP 216 LOT 015 Owner: BRUCE YAKOLA:BOX 72 BARNSTABLE 02630 Date of Inspection:1003198 SOIL ABSORPTION SYSTEM (SAS):x (locate on site;plan, if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: rda Type: leaching pits, number: rda leaching chambers,number:a•CHARGERS 10730• leaching galleries, number: nla leaching trenches, number,length: wa leaching fields, number, dimensions:nia overflow cesspool, number:nla Alternate system: rda Name Of Technology:_r9a Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) THE LEACH FIELD IS FUNCTIONING PROPERLY. CESSPOOLS: (locate on site plan) Number and configuration: rda Depth-top of liquid to inlet invert: nla Depth of solids layer: rda Depth of scum layer: Wa Dimensions of cesspool: rda Materials of construction: Na Indication of groundwater: nia inflow(cesspool must be pumped as part of inspection) rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) rda PRIVY: (locate on site plan) Materials of construction: rda Dimensions: Na Depth of solids: rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) rda (revlaed 04r27197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 54 ACORN DR.W.BARNSTABLE MAP 216 LOT 015 BRUCE YAKOLA:BOX 72 BARNSTABLE 02630 10123198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) c +qA 1`t AC �Il CC f®3 Page 9 of 10 (revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 54 ACORN DR.W.BARNSTABLE MAP 216 LOT 015 BRUCE YAKOLA:BOX 72 BARNSTABLE 02030 10123199 Depth of groundwater 12 Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers x Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS MAPS AND CHARTS (revlsed04r27197) ?ago 10 of 10 No. /6 —3 7 �/Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Migpont bpgtem Cottgtruction permit Application is hereby made for a Permit to Construct( )or Repair( an On-site Sewage Disposal System at: Location Address or Lot No. OG " ,� Owner's Name,Address and Tel.No. Assessor's Map/Parcel w4 � �f� �wc��`�,�•V o-/�-01.5 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of 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 133 Z) gallons. Plan Date Number of sheets Revision Date Title Description of Soil s Nature of Repairs or Alterations(Answer when a plicable) 5e C - 661V Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of a afore described on-site sewage disposal system in accordance with the provisions of Title 5 of th EnvironmentalCod ,not to place the system in operation until a Certifi- cate of Compliance has been iss and Si ed Date Application Approved by Date ' - Application Disapproved for the fo owing easons Permit No. 3 Date Issued No. �!O ' .� - Fee THE COMMONWEALTH OF,MASSACHUSETTS - - PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS a 01pp�fication for.. Dioaar *pgtem Construction Permit Application is hereby Ymade for a Permit to Construct( )or Repair( an On-site Sewage Disposal System at: Location Address or Lot No. 61�6" Owner's Name,Address and Tel.No. 1(Z1lI�A Assessor's Map/ParcelW- Map/Parcel � �// ., O , Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. e—VIA k Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder( ) Other Type of Building No.of Persons ` Showers( ) Cafeteria( ) Other Fixtures Design:Flow S gallons per day. Calculated daily flow 7—) gallons. Plan Date Number of sheets Revision Date Title Description of Soil 0 qj?S--e sw".0 ' Nature of Repairs or Alterations(Answer when a plicable) '-)e t%f '"t W(K__ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance ofoe afore described on-site sewage disposal system in accordance with the provisions of Title 5 of thlo Environmen Cod not to place the system in operation until a Certifi- cate of Compliance has been iss mar Q_7-�/- P Si ed Date zJ t Application Approved by Date jApplication Disapproved for the fo owing easons >Ili- . Permit No. !I,> Date Issued --------------------------------------- a THE.COMMONWEALTH OF MASSACHUSETTS> BARNSTABLE, MASSACHUSETTS Certificate of Compliance that the On-site Sewage Disposal System installed( or repaire replaced(V<on by Installe H-cl_1 'pfw at c has been constructed in accordance with the provisions of Title 5 and the for Disposal System ConstructionOrnut No. r `� dated Date 's Inspector r THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE/THAT THE SYS- TEM WILL FUNCTION SATISFACTORY. —— ———————————————----———————— ———————- No. - :'t Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLES MASSACHUSETTS lig"��1 _*TmXo,51ruction hermit Permission is hereby granted to to construct( )re air'( n On-site Sewage System located at No.# r-i Street and as described in the above Application for Disposal System Construction Permit. An 71 No. Date The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. 1 All construction must be completed within three years of the date below. Date: ' T 4�7 Approved by r Board of Health CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) , < f hereby certify that the application for disposal works construction permit signed by me dated -Z��t , concerning the`. property located at `f PICO Vj r f V-e- C-c c� meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within+%feet of the proposed septic system too • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed There are no variances requested or needed. i SIGNED: DATE: . LICENSED SEPTIC YSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. z do 4 CD 4 ' i 1 ro �� EXISTING S.A.S. (#9 Boxwood Dr) LEGEND ISOLATED 9031 Jl (APPROXIMATE) f WELL EXISTING CONTOUR N VEGETATED A SIZE AND TYPE UNKNOWN. - 18 °o ENCLOSED PORCH ® ut WE1'L�ND N0.1 � I�. DISCOVERED DURING FAILED x 16,82 EXISTING SPOT GRADE 10'x36' ENTRY % V star F TEST HOLE ATTEMPT. • EXISTING WELL 5 ENTRY V102 0 WELL __& 92. BED RM. KITCHEN (SEE NOTE 11) 100 _G EXISTING GAS SERVICE R0 le Rapt 13'x11' BATH 10'x14' CX. _,_._. H.W.OVERHEAD WIRES viol v % � sq �/' I iol V204 WETLAND FLAG HALL 8e,6 F�R� tp`L / 91.810 1 C . C LL. CL.CC } JF / / A. WETLAND SYMBOL a LIV. RM. 89.21 /�� s r�Ce sc BED 3Dx10M. BED10RM. 13'x16' Y c3%0�. ' TEST PIT BENCHMARK LOCUS EXISTING SEPTIC TANK ' ' `' o ENTRY FLOOR PLAN n�� sT (TO REMAIN) ��. �•� _r" _l s I ,/ TOP OF TANK=93.98f LOCUS M A P �';:[ `. / INV.(OUT)=92.65f NOT TO SCALE SPIKE (� GENERAL NOTES: WORK LIMIT/ SILTATION BARRIER(TYP.) VENT ��_ =? � *=-Jr-_ 92,94+ �� F Benchmark Set r" i-"�_ i r'"' i _�_ EL/ 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 1' "�T_=r'�:i--� TP JF/� 91��� CORNER OF CONC. SLAB BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS ��- "_*� 0I��'� ' 61 EL.=95.55 (Assumed datum) OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE s,43 e ° -- 0 LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: v2os `op ed� 9 -310 CMR 15.405(1)(b)&(g): /Oj "'`'' x 94.54 S D 9a,6o' gtiS 1 A 1' variance to the 3' maximum cover requirement, for 4' .29 1 %K cD' x 95,05 CS}94 6 x,gg�2 x 98.41 of max. cover. S.A.S. shall be H-20 and vented. SPIKE - 97,88 98� 2) A 3' variance, S.A.S. to slab (shed), for a 7' setback. , 95.8�65,� ` y\o° --- 7,86 98.99 3) A 15' variance, S.A.S. to water supply well (locus), for an 52 0. I B ULDER 85' setback. �_- 97,63 98,s4 -LOCAL REGULATION Chapter 397-8 E Well Locations: 9?8 /1 / ctio 99.15 99.08 \\ 4) A 48' variance, S.A.S. to Well (Abutter at #9 Boxwood Dr.), ISOLATED 91,oa x 9�ss .41 cn a�0 ' ' o' : for a 102' setback. +s999 ' PO 9G` `. 5) A 65' variance, S.A.S. to Well (locus), for an 85' setback. VEGETATED 6S + 59.: .F� `y WETLAND NO.2 \\ a� g8'�� 5� 99.69 6) A 3' variance, D-Box to Well (locus), for a 97' setback. x �5J3: ' i 0 / 1�P x 91 9 ''' � � ' � 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR /O�� % J x 9a. EXlST1NG �-_ 00.0 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE V203 % \ HOUSE(#54) 49 9 �� DESIGN ENGINEER. 90,56 9 20 1 . T.O.F,=101.1 ' ; �, G+ .:., 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING �1•/ f`y'1 \��� �� 94 100.12 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN `4,, 93.52 i % 00.17 --99,9 99:9a;,• - ENGINEER BEFORE CONSTRUCTION CONTINUES. x 92.19 �} x 97.4 --- 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. Al ,-arl� / �n'P r� t(`e 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF % e V202�/ ; i x 94,50� (LOT 4B) WELL '��,3� �•"� t loo.lox >c of THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF �6y9, � � .iAPN 216-01 S o '' \ x 100,52 01 „ Q HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. S � �j O 10 ,29 7. WATER SUPPLY PROVIDED BY PRIVATE WELL. +92.71 ''GS 5 / 32.600 S.F.f R BOIJAE�R a � � •� --___� FF�' ��,�0�1 .�`'� B. WELL LOCATIONS ARE AS SHOWN ON PLAN. x 94.34 x 94,40 % ;' 12�/ �� i �Ilk e 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS ( 100/'J�• +a g AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE / N 1 j3 90' �� �� I V 98.79 ? 100,00 DIRECTED BY THE APPROVING AUTHORITIES. x 100,32/ 1 PK ,5 0" W % �` �� `� /' x t 00 0 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY /•/' x ,0 99,2o THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING J� 5,51 / s0. •/' ,�' �, CONSTRUCTION. °r ./ "97.73 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS o / c}6------- \` 44;: 50' BUFFER IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255 3). •�' TO 1.V.W.-3 � � .6 P 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE o PETER T. y„ F of i 98,48 INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. McENTEE 1p��,�/ pOVe�e `32 �c�QS�'' �' 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND CIVIL �/ /' IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. No. 35109 �p 97,89 9 VE /SZE�����`Z� O/Qn/ ,•/' PROPOSED SEPTIC SYSTEM UPGRADE PLAN AL FS OEG� r DR 54 ACORN DRIVE, WEST BARNSTABLE, MA t `Ii L't 302 V303 Prepared for: Capewide Enterprises, 153 Commercial St., Mashpee, MA 02649 OWNERS OF RECOED WETLAND DELINEATION v2.6 VACCARO Environmental Consulting � � 92,60 -0•78 1.V W. Engineering by: SCALE DRAWN JOB. N0. HICKEY, BRIAN & KAREN P.O. Box 955 E 0•� Engineering Works, Inc. 1"=30' P.T.M. 255-11 54 ACORN DRIVE V3o1 p / ISOLATED g Sandwich, MA 02563 loo,oz E,/' 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. 91.77 VEGETA TED WEST BARNSTABLE, MA 02668 (508) 888-5855 WELL 508 477-5313 11 23 11 P.T.M. 1 Of 2 � WETLAND N0.3 ( ) t� ) NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL.89.8 FOR A OF 15' SEPTIC TANK PROPOSED D—BOX PERIMETER TOFCTHE S A.S.AROUND THE INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT PROPOSED S.A.S. OUTLET AND SET TO 6" OF FINISH GRADE COVER SET TO 6" OF GRADE INSTALL INSPECTION PORT OVER END UNIT CHARCOAL T.O.F. VENT ��_ 50 EXISTING IF EL: 91.0 to 93.8(MAX.) A•S i `�¢?• F.G. EL.=94.5 (MAX.) F.G. EL: 92.Of T PROPOS'- CO 5 r; MAINTAIN 2% GRADE (MIN.) OVER S.A.S. 1�; �, , 27.0sP sEr �r .6• L L47O( L = 13'(MAX) INSPECTION r . �— © S=1N.) O S=1% (MIN.) PORT 6 - 4"SCHVC 4"SCH40 PVC 8 �� �B. SHED cS, 10" 14" a 10.75" TO EXISTING 48" LIQUID INVERT I I SPIK SET j LEVEL ADD INV.=90.47 PROPOSED INV.=90.3 7 ROWS OF 10 UNITS AT 5.0'/UNIT =50.0' GAS BAFFLE INV.=92.65t D—BOX INV.=89.40 EXISTING SOIL ABSORPTION SYSTEM (PROFILE) EXISITNG SEPTIC TANK QORG ESTABLISH VEGETATIVE COVER 0y�o BACKFILL WITH CLEAN NATIVE OR C EXISTING PERC SAND TO TOP OF CHAMBERS F HOUSE(#54) NOTES: BREAKOUT=TOP T.O.F.=101.1 TOP ELEV.=89.83 '`' 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INV. ELEV.=89.40 INVERTS, PRIOR TO INSTALLATION. 2) D—BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV.=88.50— GRADE ON A MECHANICALLY COMPACTED SIX 2 83' INCH CRUSHED STONE BASE, AS SPECIFIED IN 4' MIN. ABOVE BOTTOM OF 3) 10' CMRN15. &(OUTLET TEES AS REQUIRED. T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH=19.8' EXISTING SUITABLE S.A.S.LAYOUT 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE ESTIMATED HIGH G.W., EL=82.0 — MATERIAL AS MANUFACTURED BY TUF—TITE, ZABEL OR EQUAL. USE 7 ROWS OF 10—ADS Arc 36HC UNITS WITH NO SEPARATION BETWEEN EACH ROW & NO STONE 63.25" SEPTIC SYSTEM PROFILE TYPICAL SECTION ,6" N.T.S. 34.5" DESIGN CRITERIA SOIL LOG NUMBER OF BEDROOMS: 3 BEDROOMS DATE: NOVEMBER 17, 2011 REF 13,468) SOIL EVALUATOR: PETER McENTEE PE TOP VIEW SOIL TEXTURAL CLASS: CLASS III WITNESS: DONALD DESMARAIS R.S. HEALTH AGENT s ELEV. TP— 1 DEPTH ELEV. TP—2 DEPTH END CAP END CAP DESIGN PERCOLATION RATE: 60 MIN/IN 93.0 0" 92.5 A 0' FRONT VIEW SIDE VIEW DAILY FLOW: 330 G.P.D. END CAP r SANDY 4/2 M SANDY 4 02 M DESIGN FLOW: 3.3n �.P.n. / REAR/TOP VIEW 92.Q 12' 93.3 10„ GARBAGE GRINDER: NO B H NOTE: UNIT CONFIGURATION AND AVAILABILIff SUBJECT SIDE VIEW SANDY LOAM SANDY LOAM TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY LEACHING AREA REQUIRED: (330) = 1 650 S.F. 90 0 10YR 5/8 36„ 89 3 10YR 5/8 38 DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. .2O Cl Iffzwe HI640 LL ARDU OH 0 EMAN 3 VD 026 K GALLON CAPACITY PERC Arc 36HC DETAIL EXISTING SEPTIC TANK: 1000 G LL 48 /60" ADVANCED DRAINAGE SYSTEMS.INC. UNITS MUST BE STAMPED H-20 PROPOSED D—BOX: 1 INLET, 7 OUTLET (MINIMUM) SILT LOAM SILT LOAM 10YR 5/3 10YR 5/3 PROPOSED SEPTIC SYSTEM UPGRADE PLAN MOTTLING I MOTTLING 54 ACORN DRIVE WEST BARNSTABLE MA USE 7 ROWS OF 10—ADS Arc 36HC UNITS WITH NO 82.0 132" 82.0 126" SEPARATION BETWEEN EACH ROW & NO STONE 7.SYR 5%8 7.SYR 5/8 81.0 144" 81.0 138" WEEPING G.W. I WEEPING c.w. Prepared for: Capewide Enterprises, 153 Commercial St., Mashpee; MA 02649 BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF UNIT) 79.5 162" 79.2 1 1160" Engineering by: SCALE DRAWN JOB. NO. (Arc 36HC Units) 70 UNITS x 5.0 LF x 4.80 SF/LF = 1680.0 SF PERC RATE=60�MIN./IN, NTS P.T.M. 255-11 . ESTIMATED GROUNDWATER, EL.82.0 Engineering Works, Inc. O. DESIGN FLOW PROVIDED: 0.20(1680 S.F.) = 336.0 G.P.D. NOTE: TEST PIT 3 ABANDONED DUE TO ENCOUNTERING S.A.S. 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET(508) 477-5313 11/23/11 P.T.M. 2 Of 2 2 l� LOCUS KEY: O EXISTING CONTOUR: ———— �'�� PROPOSED CONTOUR: ............• NOTES: EXISTING SPOT ELEVATION: 25.5 � PROPOSED SPOT ELEVATION: 5.5 1.VERTICAL DATUM: ASSUMED ACDORRN TEST HOLE: 2.MUNICAPAL WATER IS NOT AVAILABLE. UTILITY POLE: —O— �r FENCE LINE: C.9 SOti Q 3.ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE STATE OF MASS.ENVIRONMENTAL -p !y OF O N HYDRANT: CODE(TITLE FIVE)AND LOCAL HEALTH REGULATIONS. �� 9Y </N RETAINING WALL: 2, 4.CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO CONSTRUCTION. 5.FIELD SURVEY PROVIDED BY TERRY A.WARNER,P.L.S.,HARWICH,MA. � ISOLATED LOCATION MAP VEGETATED 6.THIS PLAN REQUIRES THE REVIEW AND APPROVAL OF ONE OR MORE TOWN DEPARTMENTS AND LOT 4B (32,600 SF) WETLAND NO.1 EXISTING WELL IS SUBJECT TO CHANGE UNTIL SUCH TIME. J (#9 BOXWOOD DR)ASSESSORS MAP:216 PARCEL:15 �F�' 7.EXISTING WELL TO BE ABANDONED.PROPOSED WELL TO BE STAKED OUT BY SURVEYOR. PLAN BOOK:113, PAGE:13 GQ, N 90 .• ...,.. 90 9? 92 e� EX�S?ING LEACH FIE►-O g� O a0°b 6 9 .�. ..�_.. _. .... _... TC '; 9a APPROXIMATE LOCATION OF EXISTING LEACH PIT �ppa 92„_ G� patio 100 ISOLATED VEGETATED WETLAND NO.211 �� O � Q i� ,✓ \ � OQ' � �,0 43 S ORNOVsrc# �pS\GS� 'lEMF So G S 90' 10.W \ \ 96 CSITE PLAN SHOWING NEW WELL LOCATION , 3 LOCATION: �� 5r I 54 ACORN DR.,W. BARNSTABLE, MA Gti ISOLATED 7 F T eASJ° PREPARED FOR: �. ��' VEGETATED gb �, I EI_l Z EXISTING WELL ,� WETLAND N0.3 �` 3 Ci° '` KARL & JENNIFER HEMR (#61 ACORN DR.) 4' .'�;� DATE:8-15-18 SCALE: 1"=30' PROPOSED BASS RIVER ENGINEERING WELL TH6-MAS J. McLE L N, P.E. P.O.BOX 1163, EAST DENNIS,MA 02641 508-364-9048