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0061 ACORN DRIVE - Health
61 ACORN DRIVE `'DESTBARN STABLE 1 ; A = 216 611 1 / �l TOWN OF BARNSTABLE L4 =t°::iONrn r ki SEWAGE' VfLLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 1I) Inc-owl 044-011101) SEPTIC TANK CAPAC 6-1160 -41 LEACHING FACILITY: ( )dR NO.OF BEDROOMS 3 dlRaj P� 5a--�1,6" BUILDER OR OWNER CA Y nL rd- teach W PERMITDATE: t0 . �� COMPLIANCE DATE: Separation Distance Between the:c F S. Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i( I S2; 4 -- - - -- - -- � -- Sao r V ,� 7 -2 Ar 4,6 Q C r, r. s No. V" ?/MA of 3 Fee - BOARD OF HEALTH TOWN OF BARNSTABLE 2pplication _for Yell Construction Permit Application is hereby made for a permit to Construct , Alter( ), or Repair( ) an individual well at: (�� �or►1 (J r. 11�I. 1^Yk��ZL�)� 2 � c� n i l Location-Address Assessors Map and Parcel B ru c-e- hco r-n W. or rt�; z 61 p MA 02C62 Owner Address J:� sm6nd yyel i IDrl hcj YIC- Installer-Driller Address Type of Building ��// Dwelling x Other-Type of Building No. of Persons Type of Well SChed: 4 D PV(, Capacity q © Purpose of Well Q[D M S�1C, 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 Pro tection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed 2-5 ft1 Da I� 3 L s Zl Application Approved B PP PP Y Date Application Disapproved for the following reasons: Date 3 Permit No. ' " —�`1r�> Issued Date --------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate of (Compliance THIS(IS TO CERTIFY,that the individual well Constructed y(), Altered( ), or Repaired( ) by L-ycmc1f1a W61A Qrtt.1tWo Installer at Col Ac-orn br- W - i3UnSt-aM& has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private We 1 Pr tection Regulation as described in the application for Well Construction Permit No. V�1/� —6r 3 Dated 3 y 14 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector No. 0 " t 013 "t Fee x BOARD OF HEALTH 5. TOWN OF BARNSTABLE Zpprication _for Yell Construction Permit Application.is hereby made for a permit to Construct( Alter( ), or Repair( an individual well at: '-GI tNCOrr'1 211.P/011 �. Location-Address Assessors Map and Parcel PQ ter X-4 c,e- c nt4- Rc o� n V�).1�tar 1q�3z� Owner Address Q)esW0r)A we11 1)6 111 ng . I nc . Q.� I � �7 83 . r Ie uh n 026 53 1 Installer-Driller J Address Type of Building Dwelling ,X Other-Type of Building No. of Persons Type of Well 5C Vi d q l) loy, Capacity L1 ' q phn - r \J" Purpose of Well Agreement: The g undersigned r a agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection_ • Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed 1 r_ Z(25j2� h Date N, ` Application Approved By Date Application Disapproved for the following reasons: t 2 Date 1(�( Permit No. �'" 2 ` -M -> Issued Date ; r-,.-----,..�,o,�.w-..�.�...d�-��.»...s..��.��,®�-.ate.�.�,..�.�_...�a o�....�.o�v.�.�.....��._e-.._..-_.�.�.►��_...�......�.�y.�....�o..�.<._.e..3��,�.�e�. �....�.s.�....a�,�.me.4 e_: BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed J)<), Altered( ), or Repaired( by DD c-r�o r-N A Weill O r t i l!Yl/a1. l 1)(— Installer r" at ( t ACC r ry has been installed in accordance with the provisions of the.Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. 1 IMI 01Dated 5 I Z THE ISSUANCE OFtTHIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector -------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Yell Congtructton Permit _ No. IIV — t Fee Permission is hereby granted to u C,01 oy, w !l T Y 11 4n, l y1c-- Installer to Construct(14, Alter( ), or Repair( an individual well at: Street as shown on the application for a Well Construction Permit No. � � 'b Dated S L Date �l ` Approved By i a/�� � � L w - ,Y N 46 'L 6dwsad -01 ;r Johnson 4 +�! ��«. J . ..�. `t twit. •,.. ' "'aO'? ' ' °�� 32.600#x �y� �4� . • , 64 J AR%il VON r•t:; s fs ���CO •�' A.saw. ' pyw 'Ttl '440 nA e44 vs. AL .fi` f 1 24,400 #: ti ,� Ederw.�d R' Johnr<on . af. v -13 200 LF _ 2 3` REGISTRY R1E 0 nEEDS ( I AUG I I Isso 4 s" RECORDED ..�I V,e> Lot Are � ��/,�c�-./lac✓ wr " PVC U Z/j 'k-0, I ' . f Commonwealth of Massachusetts Title 5 Official, Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 61 Acorn Drive Property Address BONAIUTO, MARK L&MARIANNE Owner Owner's Name information is required for every West Barnstable MA 02668 8114/14 page. City/Tovm State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: U key to move your cursor-do not Trevor Kellett use the return key. Name of Inspector Aardvark Environmental Inspections ay. Company Name PO BOX 896 Company Address �N East Dennis MA 02641 City/Town State Zip Code 508-292-1056 S113744 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs F rther Evaluation by the Local Approving Authority �J 8 /20/14 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•W13 Title 5 Ottl' In 'on Form:Subsurface Sewage Disposal System•Page 1 of 17 n ' 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 61 Acorn Drive Property Address BONAIUTO, MARK L&MARIANNE Owner Owner's Name information is required for every West Barnstable MA 02668 8/14114 page City/Towri 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 ® I have not fodnd 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","h6"•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): Y t5ins•3/13 Title 5 Official inspection Form Subsurface Sewage Disposal System•Page 2 of 17 f Y Commonwealth of Massachusetts Title 5 Official Inspection Forte Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 61 Acorn Drive Property Address BONAIUTO, MARK L&MARIANNE Owner Owner's Name information is required for every West Barnstable MA 02668 8/14/14 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 ''f ❑ ® 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 t5ins•3/13 Title 5 Ofidal Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 61 Acorn Drive Property Address BONAIUTO, MARK L&MARIANNE - Owner Owner's Name information is required for every West Barnstable MA 02668 8114/14 page. City/Town State Zip Code Date of Inspection B. Certification (Cont.) - }! ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. r , B) System Conditionally Passes(coat.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health_in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board.of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Offidal 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 61 Acorn Drive Property Address BONAIUTO, MARK L&MARIANNE Owner Owner's Name information is required for every West Barnstable MA 02668 8/14/14 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOTdue to clogged or obstructed pipe(s). Number of times pumped.- ❑ [K 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 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. i5ins•3113 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 a . 61 Acorn Drive Property Address BONAIUTO, MARK L&MARIANNE Owner Owner's Name iref is requiequiredd for every West Barnstable MA 02668 8/14/14 o 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? ® ElWere all s components, the SAS, located on site? system P onents, excluding ® ❑ 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? ® ElWas the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form--Not for Voluntary Assessments 61 Acorn Drive Property Address BONAILITO, MARK L&MARIANNE Owner Owner's Name information is required for every West Barnstable MA 02668 8/14/14 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 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•3t13 Title 5 Otfidal Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts + Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 61 Acorn Drive Property Address BONAIUTO MARK L&MARIANNE Owner Owner's Name information is required for every West Barnstable MA 02668 8/14/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): , t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 c: Commonwealth of Massachusetts Title 5 Official, Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 61 Acorn Drive Property Address BONAIUTO, MARK L&MARIANNE Owner Owner's Name information is required for every West Barnstable MA 02668 8/14/14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: 6/29/01 per permit date Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.2 feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.).- Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 1" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 J Commonwealth of Massachusetts ti Title 5 Official Inspection, Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 61 Acorn Drive Property Address BONAILITO, MARK L&MARIANNE Owner owner's Name information is required for every West Barnstable MA 02668 8/14/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) I - Distance from top of sludge to bottom of outlet tee or baffle 35" 2" Scum thickness Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 16 How were dimensions determ,yned? measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank is structurally sound and functioning properly with both tees intact and liquid at the outlet invert Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle . Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official. Inspection. Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 61 Acorn Drive Property Address BONAIUTO, MARK L&MARIANNE Owner Owner's Name information fo is West Barnstable MA 02668 8/14/14 required for every page. City/Town state Zip Code Date of Inspection D. System Information (cont.) I— Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions.- Capacity: gallons Design Flow. gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in woridng order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): `Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts r . Title 5 official Inspection Form ` Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments 61 Acorn Drive Property Address BONAIUTO, MARK L&MARIANNE Owner Owner's Name information is required for every West Barnstable MA 02668 8/14/14 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 even 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.): D box level and water tight with no sign of caryover Pump Chamber(locate on site plan): Pumps in working order: ❑ ,Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order,system is a conditional pass. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3M3 Title 5 offidal Inspection Forth:Substrface Sewage Disposal System•Page 12 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Fori Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 61 Acorn Drive Property Address BONAILITO, MARK L&MARIANNE fie' owner's Name information is required for every West Barnstable MA 02668 8/14/14 page- City/Town State Zip Code Date of Inspection D. System Information (cont-) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): (2)500 gal leaching chambers with no high staining Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5i s-W13 Title 5 016aa1 Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 61 Acorn Drive Property Address BONAIUTO, MARK L&MARIANNE Owner owner's Name inquired for is West Barnstable 3 MA 02668 8/14/14 required for 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.): a Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurfaoe Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 61 Acorn Drive Property Address BONAIUTO, MARK L&MARIANNE Owner Owner's Name information is required for every West Barnstable MA 02668 8/14/14 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 B Front door A O 4 Shed r' ' C D A1)20' F2] _ - B1)33' ,, C2)52' 3 4 C3)56' C4)62' D2)53' D3)56' D4)64' t5ins•3M3 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 61 Acorn Drive Property Address BONAIUTO, MARK L&MARIANNE Owner Owner's Name information is required for every West Barnstable MA 02668 8/14/14 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: 95 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: i You must describe how you established the high ground water elevation: USGS Maps show ground water between 90 and 100 feet Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 61 Acorn Drive Property Address BONAIUTO, MARK L&MARIANNE Owner Owner's Name information is required for every West Barnstable MA 02668 8/14/14 page. City/Town 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 Z. Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3(13 Title 5 OfBdel hspection Forth:Subsurface Sewage Disposal System•Page 17 of 17 fi- ..t23Ys ,.d.e� #i°K`ix b . i .F. ?Y' xk `' fr_. �L1 `a�'✓+ ', v^ � v TOWN OF BARNSTABLE z LOCATION SEWAGE VII LACE ASSESSOR`S MAP & LO INST,�LLER'S NAME&PHONE NO. On SEPTIC TANK CAPAC j. l 6.r1 1 LEC HING FACILITY (type)a NO. OF.BEDROO MS. - �i BUILDER OR OWNER LMC . PERMITDATE le I` COMPLIANCE DATE Separation Distance Betweewthe Maximum Adjusted Groundwater Table and Bottom of Leaching Facl ty. Feet: Private Water Supply We11 and Leaclun Facet 8 ty (If any wells exist on site or w�tlun 200 feet of leaching facility) Feet ' Edge of Wetland and Leaching Facility.(If any wetlands exist wittun 300 feet of leaching facility) Feet Furnished by Z rx k. 02/22/2005 12:45 5083856000 KATE BYRON REALTOR PAGE 03 TOWN OF BARNSTABLE LOCAr;E10N n D SEWAGE14, SDI VILLAGIr ' LQ ASSESSOR'S MAP-&LO Ott INST&LLEf 'SggN►►AME&PHONE NO. SF_P'l�C TANAK"tC1 ' DM tak IL LEACHING FACILITY: (type (size) Nq.OF BEDROOMS BUILDER OR OWNER } .. PERMrrDATE: " COMPLIANCE DATE: Separation Distance Betweeq the: + a Maximum Adjusted Groundwater Table and Bottom of Leaching Facility : Private Water Supply Well and Leaching Facility (If any wells exist O y 'on site or within 2W feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist within 300 fat of Inching facility) Furnished by C ,K SHE 517 � 1r 52' 4 G r �r y CO?.alONWEALTH OF M SSACH t;SEITS EXECUTIVE OFFICE OF ENVIRONMENTAL AFF B',IRINSTABLE DEPARTMENT OF ENVIRONMENTAL PRO TE PROTECTION AM 9 54 4 v � H TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION /c/ Property Address: A Dr ve � Owner's Name: C U tic<G cs�?eG'4ytt�tyt Owner's Address• C. Jrlkai� Date of Inspection• Name of Inspector:(plea, print) acP t 1� I Company Name: ✓ar- viinmmex9ml lvv Mailing Address: V ` r9oa6Y� Telephone Number: ,!08.SQL 76 OR 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 the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: j Date: �3 �50 O.S The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DER The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address Mow the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/I512000 page I f t Page 2 of 11 OFFICIAL INSPECTION FORD-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DI[SPOSAL SYSTEM INSPECTION FORM . PART A CERTIFICATION(continued) Property Address: G 1 c or, owner: Date of Inspection: . O Inspection Summary: Check A,B,C,D or E 1 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 15303 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 nditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltrate r exfltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a comp g septic tank as approved by the Board of Health. *A metal septic tank will pass insp 'on if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less th 20 years old is available. ND explain: Observation of wage backup or break oRrt or bigh static water level in the distribution box due to broken or obstructed pipe(s)or ue to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board f Health): broken pipe(s)are.m*ced obswaicmisremoved distnTiudon box is Idled or replaced ND a air: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will s inspection if(with approval of the Board of Health): ` broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of I 1 OFFICIAL INSPECTION FORM-NOT FOR'VOLUNTARY ASSESSNMN'TS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A / /f 17'G CERTIFICATION(continued) Property Address: 6 G1/yt `✓a _ P. Owner Date of Inspection: p ` C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to Bete ine 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 3 CMR 15.303(l)(b)that the system is not functioning in a manner which will protect public health afety 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 tland or a salt marsh 2. System will fail unless the Board of Health(and blic Water Supplier,if any)determines that the system is functioning in a manner that protects th ublic health,safety and environment: _ The system has a septic tank and s soil ab rption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a ttrfac water supply. The system has a septic tank and S S and the SAS is within a Zone I of a public water supply. _ The system has a septic tank SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". thod used to determine distance "This system passes if th ell water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile org is compounds indicates that the well is free from pollution from that facility and the presence of amnion' nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are tri eyed.A copy of the analysis must be attached to this form. 3. Other: ..z 3 r Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DMOSAL SYSTEM INSPECTION FORM PART.A CERTIFICATION(continued) Property Address: GG n Owner• Date of Inspection: 3 ZOO D D. System Failure Criteria applicable to all systems: Yon must indicate"yes"or"no"to each of the following for all inspections: Yes No D� 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 —�r Liquid depth in cesspool is less than 6"below invert or available volume is less than VS day flow a Required pumping more than 4 times in the last year NOT due to clogged or obstructed pil*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- ef Any portion of a cesspool or privy is within a Zone I of a public well. A Any portion of a cesspool or privy is within 50 feet of a private water supply well. 04 Any portion of a cesspool or privy is less than ifl0 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.J'This system passes if the well water analysis, performed at a DEP certified laboratory,for coKWm bacteria and volatile organic compounds indicates that the well is free from pollution from that faulty 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.] (Yes/No)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 se a facility with a design flow of 10,000 gpd to 15,000 gld- You must indicate either"yes"or`tno"to 11f the following (The following criteria apply to large sys in addition to the criteria above) yes no — the system is within 4 feet of a surface drinking water supply _ the system is wi 200 feet of a tributary to a surface drinking water supply _ the system is cated in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone H of public water supply well If you have eyed"yes"to any question in Section E the system is considered a significant thre4 or answered "yes"in S on D above the large system has failed..The owner or operator of any large system considered a. si ' t threat under Section E or fated 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 Depart rent. a II Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CBECIMST Property Address: S GUI l'roC Owner• ABA Date of Inspection: ,3 Check if the following have been done.You must indicate"yes"or"no"as to each of the following. Yes No J( _ Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? _ Has the system received normal flows in the previous two week period Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(if they were not available note as N/A) _ Was the facility or dwelling inspected for signs of sewage back up? — Was the site inspected for signs of break out? Were all system components,excluding the SAS,located on site? — 1- _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition ofthe 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 mmtenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no — Existing information.For example,&plan at the Board ofHealth. — 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(3)(b)] 5 Page 6oflt OFFICIAL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 6 Qq, J�—,,-e Owner Date of Inspection: aS FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): _ Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: I I0 gpd x#of bedrooms): 33 Q Number of current residents: c2 Does residence have a garbage grinder(yes or no): A)O Is laundry on a separate sewage system(yes or no): A10[if yes separate inspection required] Laundry system inspected(yes or no): Ab — Seasonal use:(yes or no): {tom Water meter readings,if available(last 2 years usage(gpd)): J Sump pump(yes or no): it Last date of occupancy: COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): and Basis of design flow(seats/persons/sgft,et Grease trap present(yes or no): Industrial waste holding tank pr t(yes or no):_ Non-sanitary waste discharge o the Title 5 system(yes or no):_ Water meter readings,if av labie: Last date of occupancy/ e: OTHER(descri GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no):�IlD If yes;volume pumped:_gallons-How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM �( Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components, a installed(if known)and source of information: Lo / RA CH,czm Were sewage odors detected when arriving at the site(yes or no): 6 Page 7ofII OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: r �!`iu Owner- Date of Inspection: BUILDING SEWER(locate on site plan) . Depth below grade: Materials of construction:_cast iron V 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: (locate on site plan) Depth below grade: ea Material of construction: V concrete_metal_fiberglass__polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) / Dimensions: 10001�-'q Sludge depth: /N Distance from top of sludge to bottom of outlet tee or baffle: _ Scum thickness: / � Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee orlaflle: I a a How were dimensions determined: ea svnc Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of Ieakage,etc.). >EC4 k/G eP c Vt� GREASE TRAP:_(locate on site plan) Depth below grade:— Material of construction:_concrete tat_fiberglass`polyethylene_other (explain): Dimensions: Scum thickness: Distance from top/erMtsevidence outlet tee or baffle: Distance from botttom of outlet tee or baffle: Date of last pumpi Comments(on puations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outletof leakage,etc.): 7 r Page 8of11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 4 t dcor i Ve Owner Date of Inspection: TIGHT or HOLDING TANK: (tank must be pum t time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete etal fiberglass_—Polyethylene other(explain): Dimensions: Capacity: allons Design Flow: ons/day Alarm=present(yes or no . Alarm level: larm in working order(yes or no): Date of last pump' a: Comments(con ' 'on of alarm and float switches,etc.): DISTRIBUTION BOX:_(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 2VO-yl 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.): Y /, —141&S (Go ye( 49ACX c �' 64'�`f'(�t Ca-t-J�..�c M- PUMP CHAMBER: (locate on site plan) Pumps in working order s or no):. Alarms in working or (yes or no): _ Comments(note c dition of pump chamber,condition of pumps and appurtenances;etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM[—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFOR.'VIATION(continued) Property Address: Owner. _ Date of inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type Ieaching pits,number._ _ e Ieaching chambers,number. ^.5 leaching galleries,number: leaching trenches,number,length:. leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: . Comments(note condition of soil,signs of hydraulic failure,level of pond_ing,damp soil,condition of vegetation, etc.): D a CESSPOOLS: (cesspool must be p as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet. ert: Depth of solids layer. Depth of scum layer. Dimensions of ces 1: Materials of con ction: Indication of oundwater inflow(yes or no): Comments ote condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc_):, PRIVY: (locate on site Materials of constru on: Dimensions: Depth of soli Comments to condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: 3 O SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply ebters the building. �v 6 ti Page 1 l of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: cer'? ,tom Owner: _ Date of inspection: 3'3dloS" SITE EXAM Slope YeS Surface water Yg Check cellar Yew Shallow wells!t�o Estimated depth to ground water 7.6 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: If, 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 round te(r�elevat'on: 1 d wq eere �t, Q. 0 �l w '.04 of Kf► 1/Vl"JL 1 Date-- Completed by: HIGH Gp —0 OUND-WATER LEVEL"' MPUTATION' /I^r in % No. Site Location: 7�6 V-e, Lot---- Owner: - Address: Contractor: --- Address: Notes STEP I Measure dep-h to water table q, 0 : to nearest I/10 ft. ......... ------------ ------- ---------------------------- Date .313 a 6.5 month/dayfvear STEP 2 Using Water-Level Range Zone and Index Well MSP locate siu and determine: OA -------------- We.er-�,el range zone ......... -------------------- ------------------ STEP 3 Usirrg mon,,hlyreport"Current Wate-, R esoL-rces Conditions- determine m•rrent deoth to water level for index Wel, ............ STI EP 4 Using Table of Water-level Adjustments for index wet! (STEEP 2ML current dePth ?o euater leye[for index wre;l #STEP 3), and water-IL-el zone (STEP 281 determine water-levei adjustmertt ----------- ------------------------------------------------------------------------- STEP 5 Estimate depth to hto water by subtracti'19 the waftr- leve;adiuMient jSTEP 4) from measLred depth to water ----------------------------------------------------------------------------------------- ,evel at site:STEP 1) ............. FqM 1&—RW=k4*=flPAftn1WM- .f- March 27, 2005 Mark I. Leach 2680 Timberglen Drive Wexford, PA 15090 724-933-7355 To Whom It May Concern: I purchased the property at 61 Acorn Drive in West Barnstable, MA from Charles Coombs on September 26, 1980. At that time it was a two(2)-bedroom home. A bedroom and bath were added to the dwelling in May 1988. All permits were granted and inspections performed and approved by the Town of Barnstable at the time of construction. After the construction of the addition the house was a three(3)-bedroom home. The entire septic system was replaced in 1986 including the holding tank and leach field. The leach field was again replaced and upgraded in 2001 in order to conform to the Title 5 Regulations required by the Town of Barnstable. All permits and inspections for the upgrade in 2001 were obtained, performed and approved. I have attached copies of the invoices from R J Bevilacqua Company, John Graci (D.E.P. Title V Septic Inspector), and the Certificate of Compliance signed by Edward Barry dated July 18, 2001. At the time of the closing the property at 61 Acorn Drive met all Title 5 regulations, as determined by Town of Barnstable Inspection and Department Environmental Protection Engineer inspection. Sincerely, i Mark I. Leach March 2, 2005 To whom it may concern, When I owned the property at 61 Acorn Drive, West Barnstable, MA. ,from October 1970 to September 1980, it had two bedrooms. Charles R. Coombs I TOWN OF BARNSTABLE t� LOCATION SEWAGE VILLAGBV,�i?4cT.46/ ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY /DDD LEACHING FACILITY:(type) &Ile L S (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER_�Y�LL BUILDER OR OWNER DATE PERMIT ISSUED: v / DATE COMPLIANCE ISSUED: VARIANCE GRANTED: es No T � ° dr s g I 3 . 34 6-131 ` THE COMMONWEALTH OF MASSACHUSETTS BOARDf�OF HEALTH 7.luor.............:....OF.....8W.X)s 10.................................... ................. Appliration for Disposal Works Tonstrurtion 1'umit Application is hereby made for a Permit to Construct ( ) or Repair W-) an Individual Sewage Disposal System at: 1 .........Gee(.... s.Qrn...�r.1.! �.. sA�.�4rnbr ��...--•--- ......................-..............----------------------»-.........._.»......_.__-- 1 -Location-Address r�JJ l _ or Lot�xo. �1 ! _. ..................•••-...._.....•-•--......_.... .... Owner Address Iastaller Address Type of Building Size Lot.................... »......Sq. feet, U Dwelling—No. of Bedrooms............:...............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria a YP g P ( ) ( ) a Other fixtures w Design Flow............................................gallons per person per day. Total daily flow............................................. gallons. WSeptic Tank—Liquid'capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area_....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching arm..................sq. ft. Z. Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.................................................................:..•----- Date_---------•-----.....--------._......... ,aa Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ............. . !?.... Sh"�,...! V .----•-•-• ............. -------- •-•-•------- --------- ------------ --.---------------------- .• -- -------------- ---- t�1 ........---•---------•-•----•--•...................................................................•---........... .. U Nature of Repairs or Alter tiorls—Answer when applicable-...?f.p..--- -.-I.Q.aa � 4.. .. _....•......... T r �....4.0---c:.r. cr d...................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the �board of health. Signed.....--•---•-•---...�71 r...�o. e '��+i'"--------------- -- Date Application Approved By................................................................................................. --•-•----••--------• .._....» Date Application Disapproved for the following reasons:......................................................................................................»»»»_ ..................................•..........................................................--------•--•......-----•---••--•--......-•-•---•-•-----...-•----•-------•-••-••-•-•-... -- ..•-- ---- Dam — PermitNo......................... ................... Issued_....................................................- Date t� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF................... ............................................................. Tnrtif irab of fluntplianu THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired (< ) 1 Gam► CO .............»..........................»..........».......................»_.».:»».._ b ........................................................hn........... - .....................- Installer -----•..........................•-•-------•-------------..................... has been installed in accordance with the provisions of TITI4� 5 of The State Sanitary Code as described in..the application for Disposal Works Construction Permit No.....................J.3../..9..... dated....l /..fir/-Ft....................- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED.AS A GUARANTEE THAT YHE SYSTEM WILL fUNCTION/ SATISFACTORY. DATE......................Z/31.f� -----..---.-.:_------- Ins ----» pector....- - -----...•::............»....------•---............. t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH (�, ...........................................O F.....................................................................14.............. No..:.. ..6.:...>...� FEE._..................... Disposal Works Tonntrnmon Vrrntit Permission is hereby granted......... !:. to''Construct ( ) or Repair (�4 an Individual Sewage Disposal System tt 1�G� t atNo....-•-------•........................L.1...» ...:: ...1�.l................. .....----.............................._.................... ....... Street as shown on the application for Disposal Works Construction Permit No..................... Dated...... ......... ---------.-•.............•.............. Y3.. :... ..... -------•-•-•.......... 2! / oard of Health DAZE.... ..... ............( !v` FOR 125 OBBS 1 WARREN. INC., PUBLISHERS f TOWN OF BARNSTABLE14 J LOCATION SEWAGE AQ66 — 6 VII.LAG)r ' ASSESSOR'S MAP & LO —00 INST LER'S NAME&PHONE NO. &,V SEPTIC TANK CAPAC� Q�l G1i� 4—Ye jA It ' J 6- LEACHING FACILTTY:'(type) (size) 's NO.OF BEDROOMS ' BUILDER OR OWNER PERMTTDATE: ` COMPLIANCE DATE: Separation Distance Between the: fj�; 170,40"JI 'VP �wgo �p 3 {lbtir�s Maximum Adjusted Groundwater Table and Bottom of Leaching Facility / Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by � a-------- FES ERMIT F EB 2 b 2005 i TOWN OF BARNSTABLE No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Oigpogal *pMem Congtruction i3ermit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel (1) a - a Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. -Bey'tlCcp-C-oosipuC-b or) 0 Type of Building: so g •f?33 • A t,��� /v,M3�l�eD ,o M y Dwelling No.of Bedrooms �v� Lot Size - 1 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafetena( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations'(Ans er when applicable C Date last inspected: �� Go /Af Agreement: ��d�/(O//afi� �1escribed The undersigned agrees to ensure the construction n matnten eo t e ore on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place 4sstem in operation un 1 a Ce 'fi- fcate of Compliance has been issued s Board of D 4Sign d DateApplication Approved by ,. ` Date Application Disapproved for the following reas ns _ 7'4 r v r� Permit No. Date Issued i - Z.:No. /- .� � —"� � � '--+s Fee '. THE COMMONWEALTH OF MASSACHUSETTSEntered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEI*MASSACHUSETTS 3pplication for Mig ogar O otem\Congtruction ` ermit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( H'•, O Complete System E1 Individual Components + Location Address or Lot No. Owner's Name,Address and Tel.No. ?y ► o Assessor's Map/Parcel Installer's Name,Address,and Tel.No. n Designer's Name Address and Tel.No. v � Type of Building: 33 C� A�o _ 3 `;� k t��< Dwelling No.of Bedrooms Iv Lot Size j sq.0Garbage Grinder O Other Type of Building No.of Persons E. Showers( ) Cafeteria( ) Other Fixtures * + t Design Flow gallons per day. Calculated daily flow :, '+, gallons. Plan Date Number of sheets Revision Date N ` Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(An s er when applicable ` ,v /1 A /1 OAr sx " 14 fy cv C Date last inspected: Agreement: g g S�!�T// / �SJaflorekegtoMewage � �The undersi ned a rees to ensure the construction n maintenance o t dis osal s' ��ttem t in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation un 1 a Ce`' f1- `�(/ cate of Compliance has been issu d this Board of"th. Sig d L Date 61eq �1 Application Approved by C � Date Application Disapproved for the following reas ns V �' II Permit No. Date Issued U ------------- --------- ----V1 V I I THE COMMONWEALTH OF MASSACHUSETTS 00 BARNSTABLE, MASSACHUSETTS w Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by V00 + at X ,d e9- ,If. 0!� as e c.strued in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. deed Installer r9-4 901 Z.."d X,4 # a°;P$ Designer The issuance of this• ermit shall not be construed as a guarantee that the sys eig will function as-,desl'gped. Date Inspector No. ---------------------- --�— Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS IbMigogar *pgtem Congtruction Permit Permission is hereby gr to to C ns ct( ) pal p ra e )A a dgn( )) System located at / P��U o r v and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructio must a omp ted within three years of the date of peIM i Date: Approved by Assessment Reults Page 1 of 2 o Site Map I Contact ISM F151 MIWNW 4 f m o Friday,June 29,2001 Home I Search Site I Government Departments_ I Information Center I What's New Data is based on Fiscal Year 2001 Assessor's database and is provided for information purposes only. Data presented here will be reflected on the Tax Bills mailed late April, 2001. 61 ACORN DRIVE yMap Map/Parcel/Parcel Extension: Mailing Address: 216/011/ LEACH, MARK I & DIANE B Owner of Record: LEACH, MARK I & DIANE B 61 ACORN DRIVE Property Location: W BARNSTABLE, MA 02668 61 ACORN DRIVE Parcel ID:216011 Fiscal Year 2001 Assessed Values Building Value: Extra Features: Outbuildings: Land Value: Totals: Appraised Value $98,100 $2,400 $700 $60,000 $ 161,200 Assessed Value $98,100 $2,400 $700 $60,000 $ 161,200 Sales History Owner: Sale Date: Book/Page: Sale Price: LEACH, MARK I & DIANE B 3161/216 $0 Land and Building Description Land Building Lot Size(Acres): Year Built: 1 1960 Zone: Living Area: R F 1700 Appraised Value: Replacement Cost: $60,000 $ 121,136 Assessed Value: Depreciation: $60,000 19 Building Value: $ 98,100 http://www.town.barnstable.ma.us/Information_0.../results.asp?MAPPAR=216011&BI=Submi 6/29/01 Assessment Reults Page 2 of 2 Construction Details Style: Interior Walls: Ranch Drywall Model: Residential Interior Floors: Grade: Hardwood Average Grade Stories: Heat Fuel: 1 Story Oil Exterior Walls Heat Type: Wood Shingle Hot Water Roof Structure: AC Type: Gable/Hip None Roof Cover: Bedrooms: Asph/F GIs/Cmp 2 Bedrooms Bathrooms: 2 Bathrooms Total Rooms: 6 Rooms Outbuildings & Extra Features Code Description Units/SO FT Appraised Value Assessed Value FPL1 Fireplace 1 Sty 1 $2,400 $2,400 SHED Shed 100 $700 $700 http://www.town.barnstable.ma.us/Information_0.../results.asp?MAPPAR=216011&B1=Submi 6/29/01 �s M12^ a� � � � r £aY'cs x "�r >` } 2 r ev y.f ♦ .'I"� "z`t r .t °_. s 2 u N. r .. .,.r 7 k rt. er Y TOWN,OF. BARNSTABLE LOCATION: SEWAGE # , VILLAGE ,( ,gi2�J,q�/ ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO �A�w SEPTIC TANK-CAPACITY �DpD LEACHING FACILITY (type). NO: OF ,BEDROOMS_ PRIVATE WELL OR PUBLIC WATER_ BUILDER OR.OWNER Q DATE PERMIT ISSUED 4;r DATE ::COI=LPLIANCE ISSUED c / VARIANCE GRANTED. es No a - �-riot a r 1-7 a a t � r E: 3 I z - 'I r . � r PAGE;;-02' t , . /2001' 16 57 508375,000.1 STONE GALLERY < • rr ;. co. . lss�y•or � _ ._ _�. ,v tit x �• r K , r)(v k. I V h, JW— ZOJVZ:' 'KF" This MORTGAGE INSPECTION i.a > ar JF'LOOD ZONE ~C" TOWN: 17T+, fBa _--- -_-- REGISTRY O-PN R: _.6l�t�lf.L�,GI►_.:6��Qi�dN _,�,dC1iE L '6sK11__ DEEDS REF: - ---- --- -BUYER: -------------- r�o DATE: _ Cl--- - - - - -- -- PLAN REF: , 6 IJ -- -- - CA7. 1"=`---------FT.- ` I HEREBY CERTIFY TO tN " � •�* wow R �-,� YANKEE SURVEY THAT THE BUILDING 4� o� SHOWN. ON THIS PLAN' IS LOCATED ON THE GROUND AS � PAUL S At= SHOWN AND THAT ITS POSITION DOES :. � CONFORu s CONSULTANTS 1�0'THE ZONING LAW:SETBACK REQUUMUSNTS OF.THE No. a 143 ROUTE 149 1 x TOWN OF 881d1Y=$I AND,THAT 9� HA MNS Hi1,i,8. HA. 02648 y x IT DOES AW LIE WHIN THE SPECIAL FIAO:'AZARD Fs,�oagi�s� o° TEL• 428-0055 - AREA ,4S 9H 11P :!-ON. THE'.11,41D, I �1TFD,1�(1 FAX 420-5553 >' y No.---�-6.f.....l �'- 7 F Fina...oz°..-.......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH aW .......-... OF ns ...................... o ' ccr.... ��- -------.......................................... Appliration for Ditipog al Work.5 Tonotrnrtinn runfit Application is hereby made for a Permit to Construct ( ) or Repair ( —) an Individual Sewage Disposal System at: l ..... .&l.--Awn l�k Lmi---(.lA. �4t77sj-a oleo......... ............................................................•..................................... onAddress Lo No. 1410................. a iCLOwner .. �� Ad ess !4$ 4 A . d � leX a Installer� Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------- ............................ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No--_---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by........................................................................ Date------------........................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.................... ------------------ -•---------------------•--•-----------------•--.......-----------•-••-•--•............................................................... Description of Soil--4.............•---GZ.6.-A.......... --------- U ••-----------•------•------•-•-•----•----------•-•--••---•---•••...........................•-•----------•-•--• --•---••-•••••----------•...------------•-----------•----•--•- W •------------------------------------•-----•--•--•••--•-----...-------------•--•---•--...--•--------•••. ------ " V Nature of Repairs or Alter tiot}s—Answer when applicable +1 a _-- 91�Ydolti_.4 hia_� .. �............... ,moo �-- -- FAgreement: v The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 1-i .u p of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed.................... Q •.� .---•�tA_��------•--••---- ---�--•---Date ApplicationApplication Approved By......................•---------------••••........------------•.....----•-------••----•---•••-•--- ........................................ Date Application Disapproved for the following reasons--------------------------------------------------------------------------------------------•-------------.••.._ •---------------------------------•-•-------•--------------------------•--------------.......------------.. Date PermitNo..........................-........................... Issued_....................................................... Date 14 No................_....... 4—. 140k F:m$...........:................. THE COMMONWEALTH OF MASSACHUSETTS BOARD,OF HEALTH -..---- -r�-9,-- ._................0F....�.I.......r............ .. Application for Uiupuaal Works Tonstrnrtiun Vantit Application is hereby made for a Permit to Construct ( ) or Repair (k ) an Individual Sewage Disposal System at: �^ I ��,//�� ••tt 4t r' f' i•+^rtY'r f,:Y'I U£* I I,.-, � 1 r•r.t'7_ <�I ................_......'...._...-----2............._.......______...._..._.._................... _.........__..........._._._......._..............................._._.....__.._._............._.. Location-Address or LotfNo.7 ,j ert4 lj ,r` ( / to •- .f�/'ft•. rr t ti' Jc. �. - AOwner ,�r" - Address ( 1 4 1- Installer Address �. UType of Building Size Lot.................... .....Sq. feet �--1 Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—Type of Building No. of persons............................ Showers .P g ---•----------------•-•----• P ( ) — Cafeteria ( ) Other fixtures ----...--•--------•-----•-----'--------•----•---........ ----------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter__-____--___-- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_--____.--_____--------. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---------------- ------------------- -------------- ---------------- •------------------------- ------------------ ----------------- ---------------- O Description of Soil__.A.................6.0 n''SA..........�� '� � ' U -------•--'-•--•---•--------"-------•---...'•--'•---------------'-----------------------------•-'.....••-------••-.._..:•--•-•------------•-•-•-••-------------••......--••--I ------------ W j n!* - .'i _ �� U Nature of Repairs orn Alterations—Answer when applicable_.....__ .:__: 7 ....................................................u�...•lr... 7 '� 11 t, i7:S J'".-s'��%...i.....1' !Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Tim,. p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. ter,---- - --A'---------- f''- Signed---••-------•------•-•--...---�-?-------------------•-•---------•--....------------ -------------------"__.._..._ - r Date Application Approved B PP PP Y •--•••------------------•-•-------------------------•--•...._..._. ........................................ Date Application Disapproved for the following reasons:-•----•-------•-•-••----------------------------'-=-----------•--•-'--'---•--------•'•'......---•------......._ if -----------------------------------•----......__...--------....-----------------------•---••-------•-•--••-------......-•-------••--.................................................................. : Date PermitNo......................................................... Issued....................................................... Date i 11 ,1C�r THE COMMONWEALTH OF MASSACHUSETTS 1� BOARD OF HEALTH r. L 1 %'! rrtifiratle of ( ompliatta THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired 1..._'�_.. -'fep" --'•'-----...--"-'------------------------------------------------------------------------•--- Installer G �c C�IZ: 0 1-1 t (J-X v 0 , at--••---•-•--••'• •-•-----------'--•• " ---------------�-'••-•'•---...-----------------------•-----•----•._.....--------------•-----........------'--•--. has been installed in accordance with the provisions of TiT"— 5 of The State Sanitary Code as described in the application for Disposal Works Constriction Permit No.........`�.....f.3••1_ ..... dated-...1.z- �_ G..................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE.....................('Z/5 i-/5.6..................---------•-••... Inspector---- ----------------..::.-----------------•--••---••-•--'---•-•-'- L THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH oil OF.. r r t NO... 6..'.�.� - FEE..<:................... Disposal Works T-Funntrnrtion Upprutit Permission is hereby granted......... _.!....�?.............. 1 ------------------- ---------------------- ----------......... ............::........... to`Construct ( ) or Repair (\,4 an Individual Sewage Disposal System I A r v r........� �.Rl.� Vu 1 ......vvin at i�TO.......................................a.--•-•--•-• ---------------------• ---........_.._.......••------ ------ �- Street as shown on the application for Disposal Works Construction Permit No..................... Dated_._ �.f.= Health .1... ?:CG.......... oad of d DA1E.__... E .. ..-- _�:� ---•-•-•...--•. ....... FOR 125 ORBS & WARREN. INC., PUBLISHERS I IAAPY% I •/ permit For ADDITION Dwelling ._ n `. 1e it ' Si q Far. y Location 61 Acorn Drive West Barnstable Mark Leach CWner, wood Frame i Type of Construction '� Plot Lot J 94 May 2 191 — Permit;Granted I Date of inspection: 19 — Frame 19 — � Lg' j Insulation — 19 Fireplace 19 Date completed 4-J — i s 0 ' I V—C) .. - - 6►� �sors office(tst Floor): - SEPTIC SYSTEM MU BE ;essods map ano lot numb'. f P `L �f-� INSTALLED IN CO Conserva##ion(4th Floor): TIT Board of Healt (3rd floor 'ENVIRONMIENTA Sewage-oermit number 3 T®V4lN F3EGU o � �a► Engineering Department(3rd floor): /— l FJS '�to��r►`� House number% ( ' Definitive Plan Approved by Planning`Board 19 ------------ APPLICATIONS PROCESSED 8.30-9:30,A.M.and 1:00-2.%P.M.only TOWN OF BARN.STABLE BUILDING `INSPECTOR APPLICATION FOR PERMIT TO 17—/D N TYPE OF CONSTRUCTION U) 0'fl [`'Aiq-$10 . L 7 19 7 4- TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 6/ A C-o2f-( /) A , 1i r V2a(S7'd¢3Z-E f 0414 o V. G Proposed Use bI /Y I rf G— A26A Z A4 VD 2 e °A4 Zoning District Fire District Name of Owner MAIZIC L.E4Uf Address &f A co214 D P, Name of Builder-P4 y 1-- �� I Address 6 e a7-V 17- 11 ok44' 61�LOSS^ Name of Architect Address D Number of Rooms Foundation P D o keb C o CA•C TIC Exterior 1 D S t4 Roofing A5A ff l4L 7— 2�� 5 ��'G-LDS Floors �2D Interior S SEE T d2oCK Heating H-07— WG9- /� Plumbing Fireplace Approximate CostArea Diagram of Lot and Building with Dimensions Fee �Lor2-ry r� i 5J f 0� tp� • �k, to c7 �..�� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. N �`'� ame /"nn� n:Minn Cinon d�n.4. 1 ironCn v � �� `� Application to % � 4 e+Ear�t N .'� -Old-King's-Highway-Regional- -istoric-District-Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application Is hereby made, iri triplicate, for the issuance of a Certificate_of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs •accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ❑ New Building �( Addition • ❑ Alteration Indicate type of buildirig: ❑ House ❑ Garage ❑ Commercial ❑ Other Z Exterior Painting: f 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole V.Other i�EP1 PrCIE, &J 1r:5r7W(,) `7Ec r' (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE MPCRGM '- ; . ISLA ADDRESS OF PROPOSED WORK 61 Ppo?,O MR` O&Z Vn'ASMUEASSESSORS MAP NO. OWNER WARK + c- l0C, L� ASSESSORS LOT NO. patdo� HOME ADDRESS (Ot RroRl\) 'DROE .1ST1ARNS7M&Z.IYIA TEL. N0. 50g-3(02��3b1 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). , ►r .� R"T"T'�rl�� AGENT OR CONTRACTOR -� � TEL. NCB ADDRESS j t', 6Rt1 i DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done(see No. 8, other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). Ppa pLP?A0Y�0d!'& 3CO sk L.aA!e- add��o,n � �o uTkwe - ,A u_1, Co/if W u uh o t,-at' 11,t9© Gc VT a n�� Ge-cAG1L P' � us'IL �� �o Ma c�l� G- .�4z_ )1 0 0�b f aTik) �a� . Ou I;� C OACA0,_ tkol)vsndoho+n �ocigned �� Owner-Con ctar-Agent Space below li use. c eoyp. C. / Date he Certificate is hereby a.�_'W Date MAR 2 3 199A Time WN OF BARNSTAEI.E If; Approved IMPORTANT: If Certificate is approved,approval is subject to the 10 day appeal period provided in the Act. 5 Perrrsll for ..................ld••Addition . geamly....Dwelling............. - Road C. Locbtion .. Ac ?..... Barnstable.... � ..... .......... j `4ark �?•,ach s:.......... _ Owner .. ...............�. v . : . ........ Type of,Corrstructio n 4 r v ........ 3 Note ..... ...................... La - - r 88 l9 Perritgan'ed Ma -..... i `. p�ttion .: 19 Date© -Gres .• Date Completed z �c......1:9 Y: r 01 _. . I / Application to .-Old-Kings Highway Regional Historic District-Committee in the Town of Barnstable for a CERTI FICATE OF APPROPRIATENESS Application is hereby made, id triplicate. for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and .Resolves .of Massachusetts, 1973, for proposed work as described below and on plans, drawings .or photographs accompanying.this application for: CHECK CATEGORIES THAT APPLY: I. Exterior.Building Construction: ❑ New Building $3 Addition ❑ Alteration Indicate type.of building: 10 House ❑ Garage ❑ Commercial ❑ Other 2 :Exterior..Painting:-®. .Match. Existing 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign .4. Structure::,❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for.explanation and.reguirements). .. TYPE OR PRINT LEGIBLY : DATE M a v 2 . 1988 ADDRESS OF PROPOSED WORIO 1, Acorn Road .W. Barnstable ASSESSORS MAP NO., 216 OWNER ASSESSORS LOT NO. 11 HOME ADDRESS* 61 Acorn road . -W. Barnstable TEL. NO. 362-9361 FULL"NAMES AND ADDRESSES OF ABUTTING.OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary): See Attached Sheet Image Building & Remodeling , Inc . AGENT OR CONTRACTOR Re—nni , Tr TEL NO. 385-7156 ADDRESS 1317 Route. 134, E. Dennis, MA DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done(see No.$,other side),including materials .to be used, if specifications do riot accompany plans. In'the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet,if necessary). Signed 071117 Space below line for committee use. Received by H.D.C. n Date The Certi " to is hereby 94 - Date �C� Time ey . Approved MX IMPORTANT: If Certificate Is approved,approval is subject to the 10 day appeal period provided In the Act. Disapproved ❑ Assessor'.5 office (1st floor): /► J Assessor's map and lot number ..... . TNET O Board of Health .(3rd floor): / / Q� •-� Sewage Permit number ...g(LJ.�'(.�141.....,Ll.� . .... � Engineering. Department (3rd floor): J/ 6 / �( _, INy A .x. rrua House number ....................... 7j (0...... ................ Definiteva PlanA roved b Planning Bo ard ____________ APPLICATIONS 'PROCESSED 8:3d-9:30'A.M. .and 1:00'•2:00 P.M. only TOWN OF . BARNSTABLE BU 1LD 1 NG _.: INSPECTOR APPLICATION FOR PERMIT TO .Add....A...2.4......X...2.Z......b a o.r with . ...o...om....................b....at h......................................... TYPEOF CONSTRUCTION wo•od...f•r.a.me............................................................................................................ ...................M.a y...2.9..............19 A.$.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..6.1....A.c.o.r.a...Ro•ad,...4I.,...Ha.rus.tab.1.e,...MA................................................................................................ ProposedUse ........Res•id•e•n•t•i•a-1....................................................................................................... ............................. ZoningDistrict .... .V. ....................................................Fi,re District .............................................................................. Name of Owner .Mar,k...Le.ar_h...........................................Address ....6.1...A.co.rn...R.aa.d......W......Ear.nat.atI.e.,. ..MA Image Building & Remodeling , Inc . Name of Builder .....J.o.sap•h...J•.....P.e.tr•oai......J.z........Address ....1.31.7....Roux.e... 1.3.4�,...E.....Ae.nA1.S.,...MA... Nameof Architect ................N/.A...........................................Address .................................................................................... Number of Rooms .....an.e.....................................................Foundation ......4......p.on.r.ed...coacx.e.t.e........................ Exterior .....wh.i•to:..ced•ar....sh,i.ng•1.es...........................Roofing ...............as.p.hal.t................................................... Floors .......3./.k..'....T.&G....CD.X...p.1.y.w.oad...........................Interior sheetr.ack................................................................ Carpet and vinyl Heating ....add...to...HW...6ydtem.........................................Plumbing one full bath.................................................... Fireplace .............N/.a.............................................................Approximate Cost ....$.22.,,.0-0.0,0.0................................. Are ...:!'? /.:.!.. Diagram of Lot. and Building with Dimensions Fee /.. ..�° See Attached OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable. regarding the above construction. 0 Name .. ./.. ...... ........ oseph J etroni , Jr . Construction Supervisor's license ........000.9.9.6............. FOUNDATION BSMT. & ATTIC PLUMBI G PRICING LAND COST Conc.Walls ✓ Fin. Bsmt.Area Bath Room t ✓ Base /d 5,3 O EILDG.COST Cone.Bik.Walls Bsmt.Rec.Room St. Shower Bath Bsmt. p w ' PURCH. DATE /, .one.Slab Bsm-Garage St. Shower Ext. Walls PURCH.PRICE Brick Walls Attic Rec. &Stain Toilet Room Root RENT Stone Walls" Fin.Attic Two Fixt. Bath Floors -- Ners INTERIOR FINISH Lavatory Extra + S ' . i. Bsmt. F 1 2 3 Sink / Attic 'b 'h '/a Plaster Water Clo.Extra EXTERIOR WALLS Knotty Pine Water Only 77 Double Siding Plywood No Plumbing re Single Siding Plasterboard 3� Shingles a/ TILING r :onc, Bik. G F P Bath Ft. f Face irk.On Int.Layout `� Bath-PP.&Wain&. t /— �3Veneer Int.Cond. Bath Fl.&Walls /— Q Com.Brk.On H EATING Toilet Rm.Fl.Solid Com.Brk. Hot Air Toilet Rm.Fl.&Wains.Steam Toilet Rin FI.&WellsBlanket Ins. V/I )1BS HotWater •jr/� t/ St. ShowerT ub Areaoa Roof Ins. Ai r C ond. Floor Furn. ROOFING o G' COMPUTATIONS Asph.Shingle Pipeless Furn. a S.F. Wood Shingle No Heat 3 S.F. 3 3 Asbs.Shingle Oil Burner S.F. Slate Coal Stoker S.F. Tile' Gas S.F. OUTBUILDINGS -ROOF TYPE Electric 1 2 3 4 5 6 7 8 9 10 1 2 [3 4 5 6 7 '8 '9 110 1 MEASURE S.F. Gable Flat Hip Mansard FIREPLACES S•F• Pier Found. floor i Wall Found. 0.H.Door Gambrel Fireplace Stack t/ _LIST 'FLOORS Fireplace Slits.Sdg. Roll Roofing w Conc. LIGHTING Dble.Sdg. Shingle Root DATE Earth No Elect. Shingle Walls Plumbing Pine Cement Bik. I Electric Hardwood ROOMS PRICED Asph.Tile Bsmt. 1st , TOTAL / / / Brick Int.Finish Single 4 2nd - 3rd FACTOR c/ REPLACEMENT OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Cap. PHYS. VALUE Funct.Dep. ACTUAL VAL. l �a aed ao�o .176 DWLG. f //I. s>sC5 SN / 1 I 2 i 3 4 5 . 6 7 B 9 to TOTAL TITLE V CALCULATION CHART (1995 Code) _ > . COMPONENT 3 BEDROOMS 4 BEDROOMS 5 BEDROOMS 6 BEDROOMS Min. Required'area for<S,mpi soil(1995 Code) 446 sq, ft, 595 sq. ft. 743 sq. ft. 892 sq.ft. SEPTIC TANK 1500 Gallons 1500 Gallo,{. 1500 Gallons 1500 Gallons DISTRIBUTION BOX Distribution Box Distribution Box Distribution Box Distribution Box SOIL ABSORPTION SYS'FEW Cultec Recharger 330's 4 (334 GPD) 6 (471 GPD) 8 (606 GPD) -9 (674 GPD) , (NOTE:5 are ndt enough- INOTE:7 are not edough- �/ p O.3 34 X 8.3 x 2• provides only 401 GPDI provider only 536 GPD) /1.5 X XZ Cultec Recharger 330's(with 2'stone surrounding SAS) 49 x 8.3 x 2 64 x 8.3 x 2 Cultec Recharger 330's(with 3'stone surrounding SAS) 3 (332 GPDI) 5 (490 GPD) (NOTE:4 are 6 (569 GPD) 8 (728 GPD) not enough-pruvidei only 411 51 x 10.3 x 2 60x10.3x2 28.5 x 10.3 Y 2 GPD]43.S a 10.3 a 2 , Nigh Capacity Infiltrators 4 4 (394 GPD). 6(461 GPD) 7(598 GPD) 8(667 GPD) H.0 Infiltrators(with 4'stone on sides,31'stoncoo ends and 41inches underneath) 33 x 10.8 x 2.• 39.25 x 10.8 x 2 52 x 10.8'x 2 58 x 10.8 x 2 (NOTE: 4'stone is not recommeodeed,more infiltrator units are recommended) Infiltrator 3050's : ' 5(331 GPD) 7(448 GPD) (NOTE: 6 9•(557 GPD)•(NOTE:8 11(665 GPD)(NOTE:10 Infiltrators 3050's(with 2 ft.stone surrounding SAS) are not enough,only 399 are not enough,only 515 are not enough,only 631 34'x 8.2 x 2 GPD capacity] GPD capacity] GPD citpacity] 47x8.2x2 59x8.2x2 71z8.2x2 Infiltrators 3050's(with•3 ft.stone surrounding SAS)• 4(345 GPD). 6(445 GPD) 7 (550GPD) 10(660GPD) 30x10.2x2 39.5x10.2x2 49.5x10.2x2 60x10.2x2 Infiltrators 3050's(with 4 ft.stone surrounding S.A.S.) 3(335 GPD) 5 (443 GPD) 6 (551 GPD) 8 {665 GPD) (NOTE: 4'stone is not recommended,more Infiltrator units -25 x 12.2 x 2 34 x 12.2 x 2. 43 x 12.2 x 2 52.5 x 12.2 z 2, 'b are recommended] 500 allon Chambers 4 (395 GPD)' 5 (477 GPD) 6(560 GPD) 8 (724 GPD) 500 Gallon Chambers/Drywells(with 2'Stone) 31 x 9.1 x 2 46.5 x 9.1 x 2 55x9.1 x 2 72x9.1 x 2 500 Gallon Chambers/Drywalls(with 3'stone on sides&ends) 3 (384 GPDI) 4 (477 GPD) 5 (574 G$D) 6(669 GPD) 31.5x11.1x2 40x11.1x2 48.5x11.7x2 57x11Ax2 S00 Callon Chambers/Drywelis,(tdth 4'stone oa sides.&ends) . 2(335 GPD) 3(462 GPD) 4 (570 GFD) S(677 GPD) ' INOTEt 4'stone it NOT RECOMAMDED,more chambers are recommended) 25 a 13.1 a 2 33.5:13.1:1 •12 a 13.1 a 2 50.5 i 13.1 a 2 Flow Difftisors(with 2'stone surrounding SAS and 12"deep 4(343 GPD) 6(485 GPD) 7(556 GPD) 9 (698 GPD) stone on bottom) 36x8x2 - 52x8x2 60x8x2 76x8x2 Flow Diffusors(with 3'stone surrounding SAS and 12"deep 3 (340 GPD) 5(506 GPD) . 6(589 GPD) 7(671 GPD) stone on bottom) 30x10x2 46x10x2 54x10x2 62x 10x2 Leaching Trench * 60'X 4'X 2' or(2) 80'X.4'X 2' or(2) (2)48' X 4' X 2' or (2)57' X 4'X2' or •30'X4'X2' 40' X4'X2' (4)24'X4'X2' (4)28'X4'X2' Leaching Field 446 S.F.(330GPD) 595 S.F. 743 S.F. 892 S.F. ALL MINIMUM S A.S. SIZE REOUIItEMENTS LISTED ABOVE ARE BASED UPON THREE ASSUMPTIONS (1) No garbage grinder,(2)Class I Soil(0.74 GPD/S.F.),(3)No wetlands within 250 feet of S.A.S.and groundwater is greater than 14'below SAS 1:CHARTIry . RESIDENTIAL PROPERTY MAP NO. LOT NO. FIRE DISTRICT SUMMARY 2l6 STREET 61 Acorn Dr. W. Barnstable WB -73 LAND laooa 01 BLDGS. 70 O OWNER TOTAL oZ 70 . _ LAND RECORD OF TRANSFER DATE eK PG I.R.S. REMARKS: ,�O T u' A BLDGS. LAND -002 BLDGS. TOTAL LAND .. .: Leach,—Mark Isley,'& Diane Bache 9/26/80 3161 216 ($54,5 � Blpcs. TOTAL .. 6: C0R N .R, 1, �/e14 R _S I19b LL LAND SLOGS. J -b -9 A TOTAL LAND :1 BLDGS.. <— TOTAL N LAND ,• .. c � BLDGS., INTERIOR INSPECTEO___=. ffxCj (L0_ �y TOTAL DATE: �B/ LAND ACREAGE COMPUTATIONS BLDGS. LAND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE TOTAL 16USE LOT cU LAND :LEAKED FRONT 01 BLDGS. REAR TOTAL NOODS&SPROUT FRONT LAND REAR BLDGS. VASTE FRONT TOTAL REAR LAND � BLDGS. TOTAL _ LAND f BLDGS. LOT COMPUTATIONS LAND FACTORS Af TOTAL FRONT DEPTH STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND 1 ROUGH TOWN WATER 01 BLDGS. HIGH GRAVEL RD. TOTAL LAND