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HomeMy WebLinkAbout0551 CEDAR STREET - Health r- - 551 CEDAR,� W. BARNSTABLE A=109-064 I) �1 f y i i �I i III i i� No. 4210 113 BLU o LESS E LTE p O D O TOWN OF BARNSTABLE LOCATION Ja"SI Cda-"' S '• SEWAGE # "vII.LAGE��= c�r►/1s-fA.I�.C. ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. JU 1 C h0C 1- I'K-P- L L 0-t-t t S SEPTIC TANK CAPACITY 1S00 !R a..&Lrn A S LEACHING FACILITY: (type) (size) NO.OF BEDROOMS A— B>i OE 6R OWNER s e✓en crow F00 t" PERMTTDATE: COMPLIANCE DATE: SrZq05'' 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 I Furnished by i Page 10 of I I OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(coadnued) I Property Address: Owner. p G Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two pmasoeat reference landmmrks or. bmcbmarks.Locate all wells within 100 feet Locals where public waier supply ebhrs the building. �S 7 . a7 �y �A � CERTIFICATE OF ANALYSIS Page: 1 4 M` Barnstable County Health Laboratory \'4 gcHL35� Report Prepared For: Report Dated: 5/14/2007 Ralph Secino Sotheby's International Realty Order No.: G0740422 851 Main Street Osterville, MA 02655 Laboratory ID#: 0740422-01 Description: Water-.Drinking Water -•- Sample#: Sampling Location 551 Cedar St.W.Barnstable,MA Collected: 5/10/2007 Collected by: R.Secino Received: 5/10/2007 Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen 0.21 mg/L 0.10 10 EPA 300.0 5/10/2007 Copper 0.12 mg/L 0.10 1.3 SM 311IB 5/10/2007 Iron ND mg/L 0.10 0.3 SM 311IB 5/10/2007 Sodium 9.4 mg/L 1.0 20 SM 3111B 5/10/2007 Total Coliform Absent P/A 0 0 SM9223 5/10/2007 Conductance 81 umohs/cm 2.0 EPA 120.1 5/10/2007 PH C.2 pH-units 0 SM 4500_H_B 5/10/2007 Water sample meets the recommended limits for drinking water of all the above tested parameters. Approved By: (Lab i ctor) T fV 4 V,T� , C= (F$; ZC 00 �1 Co-, co W rn C^r ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Ccurt House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 w CO�NfMONWTALTH OF IVWSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL- FFAI, vLE ' DEPARTMENT OF ENVIRONMENTAL PROT ECT ON A : 4b TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Addres - &e- i(-- s � hnA Owner'sName: S everOwner's Address:Date of Inspection: V d C68 S•= 3a�ls� Name of Inspector:fPlel se print) `ekct e. f Company Name: _ Mailing Address: n6 per fcaw3 Telephone Number: 0A q( 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: 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 I of DE the P.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 how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 o€11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE]HSPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: ,r( r 6 f' Owner: C ro Date of Inspection: 4, o — Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A../System Passes: y� 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 laced or repaired.The system,upon completion of the replacement or repair,as approved by the Board ealth,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following stateme .If`hot determined"please explain. The septic tank is metal and over 20 years old*or the septic hether metal or not)is structurally unsound,exhibits substantial infiltration or enfiltration or tank failur s imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approve y the Board of Health. *A metal septic tank will pass inspection if it is structurally so d,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available ND explain: Observation of sewage backup or break or High static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled uneven distribution box.System will pass inspection if(with. approval of Board of Health): bro n pipe(s)a=zeplaced o trurti m is removed istnbutioti box is leueled or replaced ND explain: The system requir pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with proval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address• Owner: C Date of Inspection: �t, 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 determine ' 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 CM 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety nd 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 a salt marsh 2. System will fail unless the Board of Health(and Public ater Supplier,if any)determines that the system is functioning in a manner that protects the publi ealth,safety and environment: _ The system has a septic tank and soil absorptio system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface Ovate upply. The system has a septic tank and SAS an the SAS is within a Zone I of a public water supply. _ The system has a septic tank and SA and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and AS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Metho used to determine distance "This system passes if the we water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic mpounds indicates that the well is free from pollution from that facility and the presence of ammonia n' ogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are trigger d.A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS 2i. SUBSURFACE SEWAGE D OSAL:SYSTEM INSPECTION FORM =� PART.A- CERTIFICATION.(continued) Property Address: $�,J�( C2JC41- T" 1 Owner: C f 003 Date of Inspection: Ct p A 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 d Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than''/day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Qi 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 wateuanalysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic.compoznds indicates that the well is free from-pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal..to:or less than 5.ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.) —9(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 serve a fa ' ' a design now of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of owing (The following criteria apply to large systems' dition to the criteria above) yes no — _ the system is within 400 fe of a surface drinking water supply — _ the system is within 2 feet of a tributary to a surface drinking water supply _ — the system is loca d in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone H of a pu c water supply well If you have answered' es"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D ove the large system has failed.The owner or operator of any large system considered a, significant threat der Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The s em owner should contact the appropriate regional office of the Department. 4 Page 5 of i l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: / -OL t Owner. Cmw Date of Inspection: O.S� 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) 4 _ Was the facility or dwelling inspected for signs of sewage back up? �P _ Was the site inspected for signs of break out? o- _ Were all system components,excluding the SAS,located on site? oo _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition 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: Yes no Existing information.For example,a plan at the Board of Health. d _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CUR 15.302(3)(b)] 5 Page 6 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: i Owner Date of Inspection: RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): Number of bedrooms(actual): 7 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):— Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no): /Rif yes separate inspection required] Laundry system inspected(yes or no):AJO Seasonal use:(yes or no): Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no):AL Last date of occupancy:4',""'- X f COMM ERCIALAND USTRIAL Type of establishment: Design flow(based on 310 CMR 15.203):— apd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no)._ Industrial waste holding tank presen es or no):_ Non-sanitary waste discharged t e Title 5 system(yes or no):_ Water meter readings,if ava le. Last date of occupancy/u OTHER(describ GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no):AO 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 gomponents,date installed(if known)and source of information: `'Rpf Were sewage odors detected when arriving at the site(yes or no): W6 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: C Date of Inspection: BUILDING SEWER(locate on site plan) . Depth below grade: 3 2 N Materials of construction:_cast iron __X40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: K(locate on site plan) Depth below grade: QLZ Material construction: K concrete_metal fiberglass_polyethylene _other ea xplain) _ ' If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: a Distance from top of sludge to bottom of outlet tee or baffle: �p N Scum thickness: 3�� Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee o baffle: I3 L How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): So Cc�c� fIA2..4-!be e e t GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:—concrete me fiberglass_polyethylene other (explain): _ —' — Dimensions: Scum thickness: Distance from top of scum to t of outlet tee or baffle: Distance from bottom or of sc to bottom of outlet tee baffle: Date of last pumping: Comments(on pumpin eccmmendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet in rt,evidence of leakage,etc.): 7 Page 8ofil OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: $' �A r Owner: u.J Date of Inspection: p TIGHT or HOLDING TANK: (tank must be pumped at time of impectio locate on site plan) Depth below grade: Material of construction: concrete metal fiber s---polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/da Alarm present(yes or no): Alarm level: Alarm in wor ' g order(yes or no): Date of last pumping; Comments(condition of al d float switches,etc.): DISTRIBUTION BOX:_e� (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:_"Ie I Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into r out of box,etc.): d PUMP CHAMBER: (locate on site pl Pumps in working order(yes or Alarms in working order or no): Comments(note con ' n of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of i I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(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 leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): K� Sur to b ego s w( 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' flow(yes or no Comments(note condit' n of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: (locate on site pl Materials of construction: Dimensions: Depth of solids: Comments(note co dition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 f Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C q SYSTEM INFORMATION(continued) PropertZAddress: n / Owner: c Date of Inspection: p 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. fiS o� 7 .. s8 S'a y0 16 ' I Page 1 I of 11 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ,Q + r� Owner: Date of Inspection: SITE EXAM Slope Pe5 Surface water Wrfa Check cellar ke�w,� Shallow wells Estimated depth to groundwater 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: 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 hi h ground water elev tion: Il May 08 2019 10:55 HP Fax page 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �l 551 Cedar Street ~ rn Property Address Simon Foster =- Owner Owner's Name f« information is West Barnstable MA 02668 5-4-19 required for every 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. \pN+tUtlfQN11JI)f p���i Important:When A. Inspector Information 6l (3�-$� ;mo filling out forms o= : 1,,�-% on the computer, James D.Sears R JA M E S 'yN use only the tab ?g; ;m c key to move your Name of Inspector cursor-do not use the return Capewide Enterprises s�•' �'� Company Name , 153 Commercial Street key. �i,��',FS.rNSp�```-'�� VQ ,,, Company Address Mashpee MA 02549 City/Town State Zip Code 608-477-8877 S 1623 Telephone Number License Number B. Certification certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true,accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 5-6-19 ;spe�=t_oesSignature 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: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. 15insp.doc•rev.7f2812018 Title 5 Official Inspection Fonn:Subsurface Sewage Disposal System.Page 1 of 18 May 08 2019 10:55 HP Fax page 2 Commonwealth of Massachusetts :. Title 15 Official Inspection Form ' i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 551 Cedar Street Property Address Simon Foster Owner Owner's Name information e is re wired for every West Barnstable MA 02668 5-4-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3,or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist,Any failure criteria not evaluated are indicated below. Comments: The system is a 1500 Gal. Tank D Box and Four Pit's. 2) 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 ❑ NO (Explain below): t5insp.doc•rev.7/2 61201 8 TNfe 5 Official InspecAon Form:Substsface Sewage Disposal System•Page 2 of 18 May 08 2019 10:55 HP Fax page 3 Commonwealth of Massachusetts Title 5 Official Inspection Form ii Subsurface Sewage Disposal System Form - Not for Voluntary Assessments '(� 551 Cedar Street Property Address Simon Foster Owner Owner's Name information Is required for every }(Nest Barnstable MA 02668 5-4-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval If pumps/alarms are repaired. ❑ 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 ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO(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 ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (Explain below): 3) 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. a. 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: t5insp doe rev.7/2612018 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 3 of 10 May 08 2019 10:55 HP Fax page 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 551 Cedar Street Property Address Simon Foster Owner Owner's Name Information is required every West Bamstable required for eve MA 02668 5-4-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a mannerthat 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. c. Other: I� 4) 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 t5insp.doc•rev.712512018 Title 5 Official Inspection Farm:Subsurface sewage Disposal System•Page 4 of 18 May 08 2019 10:55 HP Fax page 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,Tiv. 551 Cedar Street Property Address Simon Foster Owner Owner's Name information Is required for every West Barnstable MA 02668 5-4-19 page, Cltyrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level In the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in is less than 6"below invert or available volume is less than Yz day flow i7 ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 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. 5) 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 C.4. 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 I I of a public water supply well t5inap.coc rev.712612o16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of IS May 08 2019 10:56 HP Fax page 6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 551 Cedar Street Property Address Simon Foster Owner Owners Name information is required for every West Barnstable MA 02668 5-4-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cost.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15,304. The system owner should contact the appropriate regional office of the Department, 6. You must Indicate"yes" or"no"for each of the following for all inspections: 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)) I5insp.doc-rev.7/2612018 Tile 5 Official Inspection Form:Subsurface Sewaga Disposal System•Page 6 of 18 May 08 2019 10:56 HP Fax page 7 i Commonwealth of Massachusetts : Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `< 551 Cedar Street Property Address Simon Foster Owner Owner's Name information is West Bamstable MA 02668 5-4-19 required for every _ page, Cityllrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: 1500 Gal. Tank D Box and Four Pits. Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Well Water Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date 15insp.doc-rev.712512018 Tile 5 Offidal Inspection Form:Subsudace Sewage Disposal Syslem•Page 7 of 18 May 08 2019 10:56 HP Fax page 8 Commonwealth of Massachusetts Title 5 Official Inspection Form +i -Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 551 Cedar Street Property Address Simon Foster Owner Owner's Name information Is West Barnstable required for every MA 02668 5.4-19 page. C1ty/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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? Ye s ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: 3-2019 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.71ZW2018 Thee 5 Of tidal Inspection Form:Subsurface Sewage Disposal System•Page a of 18 May 08 2019 10:57 HP Fax page 9 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 551 Cedar Street Property Address Simon Foster Owner Owner's Name information is required for every West Barnstable MA 02668 5-4-19 page. City/rown State Zip Code Date of Inspection D. System Information (cunt) 4. 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): Approximate age of all components, date installed (if known) and source of information: Main system NA / Two Pit's 1996 Permit#96-376/5-2019 New D Box Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 40"teat 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.): Pi elm is 4" PVC SCH -40. t5insp.doc•rev.712MI S Title 5 Official inspection Font:Subsurface Sewage Disposal System•Page 9 or fa May 08 2019 10:57 HP Fax page 10 Commonwealth of Massachusetts 112 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments v 551 Cedar Street Property Address Simon Foster Owner Owner's Name Information Is required for every West Bamstable MA 02668 5-4-19 page. cityrrown State Zip Code Date of Inspectlon D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 30" 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 Gal. Precast H -10 Sludge depth: V. Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 18, How were dimensions determined? Asbuilt-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc,): Tank at working level. Tank and outlet cover at 30" below grade wlinlet cover at 1'. Inlet tee,outlet baffle. No sign of leakage or over loading 15insp.doc•rev.7W2018 Title 5 Official Inspection form:Subsurface Sewage Disposal system•Page io of 18 l May 06 2019 10:57 HP Fax page 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 551 Cedar Street 9 Property.Address Simon Foster Owner Owner's Name inform is required West Barnstable MA 02668 5-4-19 required for every page. OtyRovm State Zip Code Date of Inspection D. System Information (cost.) 7. 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc-rev.V26=18 Title 5 Official Inspection Form:Subsurface Sawage Disposed System-Page.1 of 18 May 08 2019 10:57 HP Fax page 12 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 551 Cedar Street Property Address Simon Foster Owner Owner's Name information is required for every West Barnstable MA 02668 5-4-19 page. CitylToun State Zip Code Date of Inspection Dr System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. 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.): D Box is 16"x16"-31" Below Grade w/Two line's out. Box is New 5-2019 wlcover at 6". l6insp.doc-rev.V2612018 Tile 5 Official Inspection Form:SubsuRaoe Sewage Disposal System-Page 12 or 16 May 08 2019 10:57 HP Fax page 13 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 551 Cedar Street Property Address Simon Foster Owner Owner's Name information is required for every West Barnstable MA 02668 54-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 4 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5lnsp.doc•rev.712612018 Title 5 Otiidel Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 May 08 2019 10:58 HP Fax page 14 y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 551 Cedar Street Properly Address Slmon Foster Owner Owner's Name information is required for every West Barnstable MA 02668 5-4-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is four pit's. Pits are 4'-5'below grade w'/covers at 20"-30" below grade. Pits 1 and 2 have 8"water both have outlet tee's Pit's 3 and 4 dry w/clean wall's No sign in pit's 3 and 4 of over lo ading. . 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc,): f5insp.doc•rev.712812018 Title 5 official Inspection Form:Subsurface Sewage Disposal Syslem•Page 14 of 16 May 08 2019 10:58 HP Fax page 15 �L\ Commonwealth of Massachusetts :. F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 551 Cedar Street Property Address Simon Foster Owner Owner's Name ed Information is required wired for every West Barnstable MA 02668 5-4-19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): iI 15insp.doc-rev.7IM2016 Title 5 Oficial Inspection Form:Subsurlace Sewage Disposal System•Page 15 of 10 May 08 2019 10:58 HP Fax page 16 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 551 Cedar Street Property Address Simon Foster Owner Owner's Name information is required for every }Nest Barnstable MA 02668 5-4-19 Page CityfTown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 t5insp.doc•rev.T/2512018 Title 5 Official Inspection Form,Subsurface Sewage Disposal System•Page 16 of 16 May 08 2019 10:58 HP Fax page 17 Apr 17 19,03:16p Capewide Enterprises 505-477-4977 p.6 �Ao r b. 9019 9;4AM No, 191, P. I Page loaf 11 OFFICIAL IHSpECTION FORM—NOT FOR VOLUNTARY ASSESSME1VTg SInIUKFACE SEWAGE DISPOSAL SYSTEM MprP _MON FORK PART C SYSTEM nyFORMATION(continued) Property Address: Owaer•_ Dete of Inspedten• ' SKETCH OF SEWAGE DLSPOSAL SYSTEM Provide a sketcb of the 96vr96 di'Pawl system including des to bmcbikw s.Lccate at least two permaaeut,efarenae laadmedcs or all",Is within i A7 feet I ocate wheaa public Imt supply anrganta th a builder g. F . rr . �1,3 i y i May 08 2019 10:58 HP Fax page 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 551 Cedar Street Property Address Simon Foster Owner Owner's Name information is West Barnstable MA 02668 5-4-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth tcfh 16"igh ground water: tees 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 propertylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H. 4'below bottom of pit's no G.W.. T.H.at 16'no G.W.. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5in5p.cloc•rev.71262018 Title 5 Official Inspection Forth:SubsuAace Sewage Disp®al System•Page 17 of 18 May 08 2019 10:59 HP Fax page 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 551 Cedar Street Property Address Simon Foster Owner Owners Name information is required for every West Barnstable MA 02668 5-4-19 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of- ® A. Inspector Information: Complete all fields In this section. ® B. Certification: Signed &Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3,or 5 completed as appropriate 4(Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included GRgaE 7 Q N° Gw t5insp.doc rev.72812018 Title 5 016cial Inspection Form:Subsurface Sewage Disposal System•Page 18of 18 I h. �a No. 21 -- 5 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpliLAtion for MisposaY 6pstem Construction Permit Application for a Permit to Construct( ) Repair N Upgrade( ) Abandon( ) ❑Complete System A Individual Components Location Address or Lot No. 55( 1C2 0:4P_ST Owner's Name,Address,and Tel.No. Assessor's Map/Parcel to 55l —(,q Installer's Name,Add ess,and el.No. ' dp�wt�� JRgo �(�—�7Z z;�17 Designer's Name,Address,and Tel.No. tick Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building PES b6jJT[A-L- No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision D e Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) _XFJ 5Z W 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 ealth. Signed r Date Application Approved by Date c — Application Disapproved by Date for the following reasons Permit No. < Date Issued c�G - - _---------------------------------- ---------- -- .w- No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:— Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS '`-- — 01ppliLation for Mispo8al 6pstern C onstrUttlOriV.P. Prmit Application for a Permit to Construct( Repair(A Upgrade( ) Abandon( ) El Complete System ®Individual Components Location Address or Lot No. SS( Ce rMe.ST (N Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 97 Installer's Name,Ad ess,and el.No. SOS-477 g$Z 7 Designer's Name,Address,and Tel.No. c,EA�wcbG f kao tj_dj Ad t,4 T�pe of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of 'ersons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided N gpd Plan Date Number of sheets Revision Da e Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ?AJ S Pf",A_:'1,J1dt 0 bAOx T/ h Date last inspected: »\ Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in ,t accordance with the provisions of Title 5 of the Environmental Codeand not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date Application Disapproved by Date ' for the following reasons Permit No. 5LDate Issued --------------------------------------------------------------------------------------------------------------------------------------- �-- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate Of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(k) Upgraded( ) Abandoned( )by at_S S! 0.. Sr —I `=3 has been constructed in accordance l with the provisions of Title 5 and the for Disposal System Construction Permit N4) q I e 5 dated TT / Installer Designer #bedrooms '" Approved design flow + gpd The issuance of this fermi shall of be construed as a guarantee that the system will fun io esi d. Date 3 Inspector No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal *pBtem (Construction permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at 5_51 CF-7,,A 317 ( A X�r kr and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must a com leted within three years of the date of this permit. Date Approved by T WN OF BARNSTABLE LOCATION S—J�/ .�r 67. SEWAGE # �'6 01LAGE Ly� CJQ/�1s7`�'��� ASSESSOR'S MAP& LOT e6 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY l6- O LEACHING FACILITY: (type) q`L '/r���`S (size) NO.OF BEDROOMS BUILDER 01�WNE ✓� �, PERMTTDATE: 'i' >44 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 facility) Feet Furnished by 1 2 _0- /9 `� ;� . r ��a _ ��� � ,�-� ��� �� �� . �. - ��� ��,� � _�-� � � � �� No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Misspogal *potem Construction 30ermit Application is hereby made for a Permit to Construct( )or Repair(1�)an On-site Sewage Disposal System at: Location Address or Lot No. ,575-j G Q y S Owne 's Name,Addres and Tel.No. a�ih Assessor's Map/Parcel l,�/, //'rIv !�<� Jrc7! GGGor fj 7;" Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ge r;tv 7 7 Z-?W Type of Building: Dwelling No.of'Bedrooms 7 Garbage Grinder(/V® Other Type of Building /ices,! G'14 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow O gallons per day. Calculated daily flow < gallons. Plan Date 1S 67— Number of sheets ` Revision Date Title Description of Soil Nature of Repairs orFAlterations(An wer whe ppl'cable) Jr � 0 5Y 7/ 2— life�v? Date last inspected: r Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss ued y of ealth. / /�� Signed s /�Date l Application Approved by Date' �Z/ Application Disapproved for the following reasons Permit No. C ^� �1� Date Issued No. - r Fee THE COMMONWEALTH OF MASSACHUSETTS - r PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS A ZIPPrication for Miopool bpgtem Construction Permit 'Application is hereby made for a Permit to Construct( )or Repair(Y)an On-site Sewage Disposal System at: Itt Location Address or Lot No. y c Ow 's Name, ddres and Tel.No. Assessor's Map/Parcel 'Ale 4r����Z le SAS i' Ce �r� �'� l�•� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: K '' Dwelling No.of Bedroomst 7 Garbage Grinder( � Other Type of Building ge 5;?�t-XCe No.of Persons Showers( ) Cafeteria( ) Other Fixtures �- • 1, Design Flow D gallons per day. Calculated daily flow �!� gallons. Plan Date /S�/3 Z Number of sheets / Revision Date Title Description of Soil .( PP , ) �r#5y l Z- Nature of Repairs or Alterations An wer whena licable CYG �J/r` fit// T _ i•�� " -Date,lastlinspected: <.. 4 greem nt: t. The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system i4 accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued y is oatd of ealth.� Signed _ Date Application Approved by 1/1 Date 7 Application Disapproved for the following reasons � t Permit No. o Date Issued k --------------------------------- ------- THE COMMONWEALTH OF MASSACHUSETTS I&Aq Q�j y It BARNSTABLE, MASSACHUSETTS t Certificate of Compliance i THI I T CERTIFY, On-site w installed,( or repaired/replaced on S S O C that the O stte Sewage e Dis os System tal g P Y �( O by) Installer 1D/"Z-e1_Z �0�13�`>'I.0 &LAI.S cT has been constructed i acco. an witih the provisions of Title 5 and the for Disposal System Constructi�bnit No.9 dated �?- �f . Date re ..--' Inspector THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS- TEM WILL FUNCTION.SATISFACTORY. ----�------------------ No. �©/ `-� -Fee `T THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migonl *p!tem Conztruction Permit Permission is hereby grant to to construct( )repair( V)n On-site Sewage System located at No.# r_�/ GeG�`�✓ Street and as described in the above Application for Disposal System Construction Permit. —. No. Date The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within three years of the date below. --� Date: .9� Approved by o�J Board of Health CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION rE1011IT (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated g�714 , concerning the property located at�� �/ GeGd/' 6�`_ �,da��sfvmeete all of the following criteria: V Thcre are no wcliands within 300 feet of the proposed septic system +, Thcre ire no private wells within 1.5o feet of the proposed septic system he observed groundwater table is 14 feet or greater below the bottom of the leaching facility Thcre is no increase in(low and/or change in use proposed ,There are no variances requested or needed. SIGNED: DATE: 5- 7l 7 6 LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER IAllach a sketch plan of the proposed system. Also if the licensed Installer posesses a certified plot plan, this plan should be submittcdl. '�-,� •`,�.�t r �'`.�'<� �.f ,3` ,.+:.- r.•_r �" '.'. l'r�y..% 8..a,+e.�,e•. :�, `x;I-'x ` stf r r m:s;"+�' +i .rit •.s. x,ti".,� -5 -.' ':3 r,i a."'* +w Y� h. �'Vt i.� :.t..4 �"' "• ii' "T�""'k��`".;: h,iY'n1f d�. :s+, �+•`i rid � `w Y S t �` I � r i - .,.:.�. .,c .-, .: xY.�.'S.2 a�F a.a- :ce. �:.. a33,.. .. `kd u. :. .:� .,�. •. -.'" G.�d -- .,� ��. �� ;� � � �. .=. r ,;, ,- �. i k I � i r N o C,.AQBdGb 6AZI = b �.POt .. ._ - --._-.�o• __ .. �. .-�` ".p�•-�� "'�_ . t ?.c t i DA l V�f G'ti.ou./ s 1 O d0 sc�nC 'rAWW- l5oyo A4iQ- 6,6106?f�- u5E (Soo ��5Po5AL' PtT vas= Z-tuw Gac,Pt+s. I N i4? 3 310E1+��ALL Ae6A �300 ,5r--f 30o S,F•X Z.S - 'jSo I-Pv BOTTOM . Ioo ,S;F..X i.m.- 1,oci.Gr?t7. ( � � : !Q• G+ ' _;j'� �"�''� t 1` TOTAL. '066% " 1(40 p o"T to1.1 QdTL' t I u Z hGsJ o2 LFf,S7, 7 4 t NF.t�S V"IL,I.Iae FWoeA: Tbvj.0 o(r -� i s l►Grr va t 8 L n� Pa I a� ..� wu • e�.o Lo/►Mti w �C ,P 5 twv SC,s .4 Par tuu c,aL. swat Do 86.6 S�rtc � ., 2 ltN. t �I TA U k !�• loco ac'o t�ay. i ,4 �. Pt T3 VI N VAT" V�c-oN�4 i �STaNt: w�►Su� I . : - ctu W is I t3orr Bo•� • C'E2 T t F t �LD R.aT pt_A,w ;.;,Qo Fri L-F-- W11=s-r t3 A 2 N s-rpC3 l..E— Vz N� K/A T� pL d trt 2E�ESZG.IC E-- l C¢tct•tFY T"AT *rv4U -DvJEl_t-tN(r- SwowN ►-�Es2E.ow " CAMPL-`f S WITH T"G. rtt*--Lir t5& G$ T'2A1t_VIwi t� ' AND Sk'TT3AGK R�Qv�e.E.M6.a.�Tsi GF 1'NE t Cbuv�.1 of 13A,Z.M5rrA5U- AMU Is KOT WITut ice! THE rLc>Ot:) Pt:.Att.l. ;n �Ax-rerz e, u�� tic.. 17s4.t5Tr. czeM� LAIDt> i;OZVejpt: PLAN4 LJ 1OT IWED OU AU I�YrTa)610M ► T OtTL2Vtu.6. MA.Sf>• .c�►evc/ T"r- .OFFS¢Tr. -,t- 000> UOT. t56 4.UrS LOCATION qS1WAGI PERMIT NO. VILLAGE IMSTAILEMSNAME ADDRESS ® UI DER R " OWNE GATE PER III IT ISSUED DATE COMPLIANCE ISSUED 4 0 t GO Fps.... .5................ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .................:.......... ..............OF............................ ....... Appliration for Diip.a ial Works Tomitrnrtinn Vantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at- Location,Ad ress or Lot No. �l.Chr�✓ !. -- �,��� - ------------------------------------------------------.......................................... O Address k. Installer Address rr Type of Building Size Lot_, �.fSJ.._..S eet U Dwelling—.No. of Bedrooms......_...../.............. .....Expansion ttic ( ) Garbage Grind Other—T e of Buildin No. of ersons.......... .............. Showers — Cafeteria P4Other fixtures -------------------------------• . -----------------------• - -------- - --------- W Design Flow............... ................ :.gallons per person per day. Total daily flow..__......._.�a....................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-..8------------- Depth below inlet...... --- Total leaching area._Y'Oq...sq. ft. z Other Distribution box ( ) Dosing to ( l aPercolation Test Results Performed by....... ._ y?_le........................... Date...�_.�. 7. ' _�........ ................ ,.� Test Pit No. minutes per inch Depth of.,Test Pit.................... Depth to ground,water_.�j_:_+......__.._i__. i. Gz, Test Pit No. 2................minutes per kinch Depth of Test Pit.........:....._..... Depth to ground water...............-......... P+' ---------- --- - - , o G -- - Description of Soil------ .-3.............0 ... . ..... -- - - = ... M ........................................................................................:................................................•----..............._.__......................_................ U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ---------------------------------•--•-----........------•--•-------------------•----•-------.......-----••-----------------------------------...._..------------------------------------.............--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIHE 5 of the.State Sanitary Code— The undersigned further agrees not to place,the'system in operation until a Certificate of Compliance has bee sued by the bo d ead#h. y+ Signed ------ .... ----•.-- '. .. ................................ Date j Application Approved BY ----------------- - 2 Date Application Disapproved for the following reasons----------------•----------------------------------------------------------------••--•-----......---------....--- ...........................•---------••--•------•-------------.............-----------•-----•-----••--....__....--------------•------------•-----•-----------•---------------------- .'---•-------- ' Date PermitNo...... ----------------------------- Issued............_........._......... ..................,, Date ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ----------- --------------- ...............OF........................................................................................ Appfiration for Dispoiial Workii Tomitriartion thrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ..................................................................... .................................................................................................. 1 at' A d�r,ss or Lot No. 4,_.0, ca tion, .. - � 'f .. ......................................... ....................................C ....................................................... .p Address............ ................................................... .....................U:....................... Installer Address ert Type of Building Size 4.....'Sq. feet U oms............. Dwelling—No. of Bedro ..........................Expansion Attic Garbage Grinder Other—Type of Building ............................. No. of persons------...- ............. Showers (Z) — Cafeteria Otherfi t S ................................................................................... ............................ .............................. Design Flow.............Ir....................gallons per person per day. Total daily flow..............Zy .................gallons. 1:4 Septic Tank—Liquid capacity.!T?.gallons Length________________ Width_:__.._.___.__._ Diameter__.__________._. Depth________._..._.. Disposal Trench—,No ___.......... Width...._____.__.____.__ Total Length...________....... Total leaching area............ sq. ft. Seepage Pit No.__ ... iameter---R----------- --- Depth below inlet.......C!....... Total leaching area...1 q. ft.0 Z Other Distribution box Dosing talc Percolation Test Results Per-formed by.______ .......................... Date.... ....... Test Pit No. 1.................minutesperinch Depth of Test Pit_____________-______ Depth to ground water_.___._____._...._._.__. Test Pit No. 2................minutes per inch Depth of Test Pit____._._..._____..__ Depth to ground water_______.________.______: .................. ....... ............................................................................................ ............................ Z------------------ 0 Description of Soil...... .............�94"A_ ------ -------------------- ------------------------ ...................................... ...4.........��Ife.... ..............;��........................................................................................ .............................................................................................................................................. U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ........................................................................................................................... ........................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIL4 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be sued by the bo th. 2, Signed........ ......... - - . - 3- f .... ........................................ ................................ Date Application Approved By......•...- .. ...... . .. ...................................... ......�F-­---'�-d'i --­ -----­----­-------- Date Application Disapproved for the following reasons:...............................................................................................................- .................................................................................................................................................................. .......................... Date PermitNo._____ ...................................... Issued.:......_...------- ------- --------------••------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF....... .......... &............................................................. Tntifirate of -Tompliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by............ ......... 1-2........................................................................................................................................... Installer Z_& r- at.........................................I..........I.................................................................................................................................................... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the _. ? /// --------------------------- application for Disposal Works Construction Permit No---- -- --4�.................. .)�S.T �4ted_--- 7-t_ THE ISSUAVCE OF THIS CERTIFICATE SHALL NOT BE CC AS A GUARANTEE THAT THE SYSTEM WILL U TION SATISFACTORY. DATE--- 40 Inspector..... .... ........................................................................ ------------".......*------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH If j r_AV�k/ ...........................................OF._. .........................i��....................................... No.... ......... FEE........................ ZO Disposal Workii TD11notrudion "amit Permissionis hereby granted.....n.............'`. .............................................................................................................. to Construct or Repair an Individual Sewage Disposal System at No..............Z.. .........................i—'4' . ........ ............................................................................. .......................... Street __1 as shown on the application for Disposal Works Construction Permit No.:_:................. Dated___ .------Z....................4..... ............................................ ........................................................... Board of Health DATE---------------- ............................................................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS pt►t`�f I--LA>%..i . Ito It 4 : A Ao G-P•T.t S�TzG T A4.t�C•� 150 yo 4 4410•� l60 u 00, �SPoSe1.L PST V�6 2-layo Gam ?rTs I H67 S1v�At_1_ Ae� ' �?a 5� ---- -•-• - �._.l ' � . .. � ...�..�. ice.- �$ BoTTOAA ARC.A•r I oQ ' Loo ;5;�.:�C 1.�._i boo�G,P p:' I j ' : 14• � ' '�i� ` 4.,`t- �- , �r 'Tc�fiAl-i 'pAtL :FitfiW=�}4v6. .;�?: ' Pic-.c�ti..a'rto+.i'. EATS' lattJ 2 Aw o2L.Fs{:. -i N OF �1t *l}H Of Main i —i } i. — r~ ► .. ir. bi BAXTF-R No.241A, V I .251 •' 1 i ' . I F S unw p►�cE F�cwt TV VJ 44 of � . � �� ,;�• 1 . �77G9 �'p,PE I goo ,���' WK o TUU K. - : ....., i r; --�Ji� - t•�- ' i 6s�. 6G.L a �. PITS �N h ; w►T►, r&TU►1 G� ' cMeTtt=Ias a.d-r Pt-A4J i?2o F:'t I �- ! i A, 101.3 1-7 �d V/A T[Z7� I P" EL;=ESL E-- I G¢=t'IFY T"AT Y64� vMjet-L-IN6s 5"awU -I6¢�Q►.1 - Go�cPi`-�(S Wir" Tua�. �StD .��ar� L.r>T G$ TR-A►I Lev t. AND Sk"TT3l�GrC Q�QJrC�M�uT� OF "�.BE:. i TO o f =3A.P..k15rrA81.f--- P Wr-> - I S K o`f' L-o,:.4T'Ej::> v/t rVAt N T"E: Fl.00b : .DATr- 3 k5t (� ; taAXrr3r� �, �•tYtrs I�JC. . ZZEfl LAub Sc32 THIS PI-a&j 14 uo'T BASED oU AU ILYT&)AtEJ�Y �r.T V1 /uA•�ira• Tb1G oFFSef; iµout.D UoT $E U4eD ApFn_%C_Aa1T �-oHhl ::5;ri5'p 14 To 'Dr-TaemeuL 1.oT LIWE.*. 3 F S J P j`a � ..44 't''tt a ti'3 •;•.w �Q 'fi D+ J F, •:, o r 1 .y� rJ t - fir. ^'�. `r+"f .y, - y a•�'�i �r5i'� r a. zt }� 4 y tji? • r .. r t S.r ^..�L•y t -.i x ,at r Y. 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[ F3JlHt ,y;Si I: J- w 4. ,y �`, i .� Ir �C".. ; { c ..'. '*:,• J/*1 �'... F .%y„i w a°t~i ry fi"7'+i a. S i.. P ; r r. X. r s, t•r y ,i r ,.ffrtwt [` t� a ;:r f M1 •n x i r., #'sM1 <z, J,y...5 C r i k s r as t # 'a t •i 'L. 4 r v? r + f+ -ss e .�, aj a rw ''�.}� �.y 4rf� s .�f •�.f rr}' s� "r.„w tti.14. '{ rx� „� �•'f t - w•n� TIC". .� t ... �,. P N�7 ,r. �ZrJfi if,y i 'rr' a�K o �xt. !� t,t t a�::t �" -.dry =.-g ".a' '�'e:�4'tsa .W;..:tt'.`..a �,rh 4 •,r� tT..�X:r""{ v. ')• yy Y r �d }�q. �' `Aix .'rfJohn3Steptienson` a + +, .� 1� ' - '' �� `r lY �••n+2 4 ittf v f F` -'^•' ' : '' ) -K .a 'a 3 V6 ,5:9 A4asthead Lane` `:. d { + a.,ets 1 t. x erville -M�:.•` tK�y:: } .r'rri` rlr+1.` `a ,fi••. j� �" z `� r. { t x a .1 S5S r, x ''t' `* .r kr wt. +'' a.'.: � K .�'.. a ' -' •" ,r .r ! t'� .F`. �` a '� ! + �f'��"t +fit••. r�{�� s i a;r ;,.Variance >£ortLbt ,68,�' =a�Iva.eW ='Nest Baristabi'e, _ � _' .r ,f "ir'� ,ti r ki Y �^� A�f�';` it~ €`4 1 4�..' ' ;as•.�•�yrr'� Y'a 4.3t*"Z �.r, e.:.,j.- r1 rrP _r r. ., ro r^ ♦`. 3 n,� + - i .�� ,a 'P: Sf ,`J rs jw4 r y a - r4� 1 yf` fey+-eY ♦ r7 r rry '• .Dear :Mr. �S'tephenson:�y ..,Py'r}v"; .'. j J.E« y y j 4s•!c ' ° 4-.. ,r'p{}Sr T� ,`4.. =4r v�y, .<. r v "��`p 5'' e 4 •y is r fi 's. .,y? .. r 4 ...� .r rry +. ..• a.t •e y r;-y ,} S „� 'JS.S;n "4 ,• tr f *}'�' r s S ram; o r' �•.>� � i. I &Y - •'i', w -' ' if +'ir: fi"ta v+t" •y,.�'. 4 etfraou are gt tins1 a v0ell' 18= m ar A ,•:t r5 y'? t W. •` ; k r� septic 14achif pit i cliety of ''the required:1 SO." otc�68, aTrai},v.i`ew,:West Barnstable, with the'.fo1'low ng condition's; r r 3,� - [ 'r ry r "'' s ,.�`.i r�2�. .S ;��y t ps' h�4'y -i � :.'.� t �-'.,t { t°• 'f � } r , ry � v v r - ti, -.> -.,r. . a t r•t: ' a, � 2 Y t �i 7 ., a" s. s ,`. •' r 1 r �• �J�' ! .. >t+� '� ,J r �;rPr �+� y t: � r*'...; s. ,� ., for to ;the issuance of" a building print, the ,dell ; r :(must be installed fans `the #waerJ tested` for2i, mical`s+ V�yt J ? v rr ved`"l�aborator .' � � t . h i r :.<�, i sF. ? rY f�`�}':t� F•+, �.n s (2�) All ©(her gultations contained ;n Town fdf- Sarnstab7 e iHealth� Regu1A`tibns' a idh 310yr Rf.15 b0,oaf'°thea e;`5t t` `'Er�� a fi 9f.� r ' „''�<k�varQnmenta�l '.Code, must b+s4com�lied>�,ri h. t•P sue' ?°'r. ny i�, gd 1 -j S r ;t f .1:. `.y � _`• r ar ti�.•r' •f`` �.sX ',� ft +v- "f1 t ,rw- )f veriance(3 Thi's � is granted beC use f.thi-placemerit�of�Vdljo' x + r and,i`septic.'1systems,,W ad3a"Dent;lo.ts area situated Yas make zany other planemient';impossible. r`r.` , '- 4r k _ � =•`'F !�„{. .�:.y. *. P� ,'S"4 .+7-�' � t:i .,,n _r+�4 J ,r-•t = c .�. "•+ ". � �� v �: j. :$, �! �;' ,,I�.. 2<°'" '`-;k ! ti r .. ` tfi' � � �;`:a�• C• { ray`a�.t• er p + - c .,, 4 nth r Y .'c.. t appears' ha is subdivision l,was ,approved prior 'to 'Apr31 ' `1974 -:,and rr, ,..,. {. iia�,� ariancea'taoulc fbe r,equi�red;. it>{yau have :a wEll $nar 'a :' r septic system ;on a lot less-,'than,'.j40' 000° giiare ,feet. ; `We feel G, •yrl, ''# ';,the `ranting;bfo-�th s rvaar�i mace w 11 hot�•confl ct wit h_ the .spina t; » is a ' n and ' ntentaof 'the ,Board of'.,,Health-.-regula.tton , `SY r tt x< w s�'�tr,`. + R'iw t..it n• •, +., ..*f'`r s.3 f p� :' N.";"+5 w •t� A'y"' Fr f . t ; w�r'-+ at Ka.'h"*z " •�}'t '�,' "}�.r'?�Q �. a 'r f µv ,!a i r h �`r=, r .� This�3vr�anCe.eXp1e9S =August 1;•,y'Jy+1,983,#;� + s6 ¢a •� �,-. `';_ ,(,'r "" :-ry �.. •. i 't s�iNt "°' tly} .y:a �. 1 °' .. r .� z.' ti :-,-• .:. �„ s,y Veer `truly. ursl! 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