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0311 CHURCH STREET - Health
311 Church Street West Barnstable A= 153 - Ol l �J • I i e 1 I 1 i a No. 4210 1/3 BLU a n cari, am 10�/a I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 311 Church Street Property Address Suzanne Driscoll Owner Owner's Name information is required for every West Barnstable MA 02668 8/9/13 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. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew Gilfoy f use the return Name of Inspector key. B & B Excavation,lnc. Company Name 14 Teaberry Lane Company Address Forestdale MA 02644 City/Town State Zip Code 508-477-0653 S113640 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority ( J� 8/12/13 Inspector's Signatu a 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. #J / 3 l5ins•11/10 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 311 Church Street Property Address Suzanne Driscoll Owner Owner's Name information is required for every West Barnstable MA 02668 8/9/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"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): t t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 311 Church Street M Property Address Suzanne Driscoll Owner Owner's Name information is required for every West Barnstable MA 02668 8/9/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I - Commonwealth of Massachusetts W Title 5 official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 311 Church Street Property Address Suzanne Driscoll Owner Owner's Name information is required for every West Barnstable MA 02668 8/9/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 311 Church Street Property Address Suzanne Driscoll Owner Owner's Name information.is required fo-every West Barnstable MA 02668 8/9/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system-must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 5 311 Church Street Property Address Suzanne Driscoll Owner Owner's Name information is required for every West Barnstable MA 02668 8/9/13 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms(actual). 5 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 550 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 311 Church Street Property Address Suzanne Driscoll Owner Owner's Name information is required for every West Barnstable MA 02668 8/9/13 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? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage n/a 9 ( Y 9 (gPd))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 f Commonwealth of Massachusetts w Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 311 Church Street Property Address Suzanne Driscoll Owner Owner's Name information is required for every West Barnstable MA 02668 8/9/13 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 311 Church Street Property Address Suzanne Driscoll Owner Owner's Name information is required for every West Barnstable MA 02668 8/9/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: new leaching 2010 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 114"feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >100'from wellfeet Comments(on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in working order. No sign of leakage or blockage. Septic Tank(locate on site plan): Depth below grade: 8"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 Sludge depth: 4" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 311 Church Street Property Address Suzanne Driscoll Owner Owner's Name information is required for every West Barnstable MA 02668 8/9/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? scour stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appears to be structurally sound. No sign of back-up. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 f Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 311 Church Street Property Address Suzanne Driscoll Owner Owner's Name information is required for every West Barnstable MA 02668 8/9/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 311 Church Street Property Address Suzanne Driscoll Owner Owner's Name information is required for every West Barnstable MA 02668 8/9/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At time of inspection d-box appears to be in good condition. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 311 Church Street M Property Address Suzanne Driscoll Owner Owner's Name information is required for every West Barnstable MA 02668 8/9/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: (25) bio-diffusers ❑ 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.): At time of inspection leaching appears to be in working condition. No sign of hydraulic failure Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 r Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 311 Church Street Property Address Suzanne Driscoll Owner Owner's Name information is required for every West Barnstable MA 02668 8/9/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I _ t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 COfY MOnwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - -''� 311 Church Street_ _ _ Property Address burner Suzanne Driscoll - - - Owner`"s Name - - informalion is reC Vi ?d fior every West Bamstabl'e- __—�`_ _ MA 02668 8/9/13 r—__s — — "'"' GityfTown —Code- —-- page: State Zip code Date of Inspection D. System Informati®n (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: 0 hand-sketch in the area below ❑ drawing atached separately 0 0 AI ° CIILJII 0-2) 1-3 1 - A I- 'Ili 3 ii A ._ 7� i _3 it Ar _ -djl ,�I 1 ,' :._ cl�--,, 2 tt f51n"s i i116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts E Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 311 Church Street Property Address Suzanne Driscoll Owner Owner's Name information is required for every West Barnstable MA 02668 8/9/13 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: >12'feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 4/23/10 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Plan on file at BOH Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 311 Church Street Property Address Suzanne Driscoll Owner Owner's Name information is required for every West Barnstable MA 02668 8/9/13 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 ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 ' AsBuilt Page 1 of l TOWN OF BARNSTABLE LOCATION 31 l (2�urc'A S #• SEWAGE# 2010- 109 VILLAGE ItI, /&in SAg 6(, ASSESSOR'S MAP&PARCEL . INSTALLER'S NAME&PHONE NO. em,wi 14 L}iiA,,o&,�n,t �2 i VO 2 Y SEPTIC TANK CAPACITY _1SOG LEACHING FACILITY(type) ��� // 1?1a )1 ,0 (size) /Y,S NO.OF BEDROOMS S OWNER PERMIT DATE: Z.o t o COMPLIANCE DATE: 2.~Z o 10 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /Z. Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) 1!,d Feet. Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) jj Feet FURNISHED BY CA !T cr t L L I� At Y tt2 2z,3 Z t H 7/,0 4q -77.L f#S s•6,`I �31 ��•s gv zo.� • �3 9v,2 - p http://issgl2/in{ranet/propdata/prebuilt.aspx?mappal=153011&seq=2 10/7/2013 r r i 6D 45 I 1 : 1 +...nr�•w•nm-.n�rn...•�n,a:•:se+.mmm.,c,v'+rnl,n+,..�..wm.n.•ric•nn-,...,� - _ d�. ...�rt�,•^ � .. ........... .. « ... .. ... i : I t R rLN 't+>•tnY..n44anrlslxCnlrva; .,,. ` . I ...., 4r ., •I ... .. .. - +an;:•,W..>„'.,..Ic.,;pri;:,.w•.�I ._.. ...•. . ....... ....: ... ....•. . ........ ...._... .. .. ...�, jnv�.cttwavWr ' Vx W CM1a�w'�unV.WC3^s ' � 1 �I i ,.... ........... .......... ... ... .. ,r x .. �. I e I tl •x I I , : I I I i 1 1 + f I 4r'. vS i I ; y I I I . I : : .i i r� 1 i � •� �, q,g yr+ , {^ ... .�. .• .... ... .... .. ... ... .. .. ...... .. .... .. .... .. t '+pf , : /^� CV, -4 r _ i r , , i � I r f cif : 1 1 4 �1V ' � � .. ! .1 4 ,. _ - .. ...,��., ... ..... ,.fit .. _ ........ .. ... . ..... ... ... ..... ff _.. 0. Appraisal Associates of Plass. DEED HOOK 3157 PAGE 79 as PLAN BOOK PAGE LOT Michael Driscoll ICANT: Same ASSESSORS PLAN PLOT MORTGAGE I NSPECT' ION PLAN OF LAND N N 91 , < , B A R N IS T A B L E -s=" MARCH 26, 1987 SCALE: 1 100 "= '4,i-Z \; . s: tyl AP - I f c 011 UPC 6� -Sir eef A ASS OCIATES OCTA TE S OF MASS., SENTRY FEDERAL SAVINGS BANK, I CER TIFY TO APPRA IS L ENC ROACHMENTS R OA CHM EN T S ' VISIBLE A THE RE E AR E N 0 AND ITS TITLE INSURANCE COMPANY, THAT OR EASEMENTS EXCEPT AS SHOWN AND THAT THIS PLAN WAS PREPARED UNDER MY IMMEDIATE SUPERVISION. THE LOCATION OF DWELLING AS -SHOWN IS IN NOTE, INSPECTION LIMITED TO COMPLIANCE WITH THE LOCAL ZONING BY LAWS VICINITY OF STRUCTURES. WITH RESPECT TO HORIZONTAL DIMENSIONAL ..y REQU I REMENTS. ; THE DWELLING SHOWN HERE DOES NOT FALL }e1 WITHIN A SPECIAL FLOOD HAZARD ZONE AS 'DELINEATED ON A MAP OF COMMUNITY #250001C, o, . `DATED 8/19/85 .BY THE F.I .A. NOTE; LOT CONFIGURATION TAKEN FROM -ASSESSOR'S MAPS . OF RECORD AND IS NOT NECESSARILY ACCURATE. Land Surveyors Civil Engineers x .':THE EXACT LOCATION OF THE BUILDINGS SHOWN 1001be�0010n�Nllh ,�1Tr1Tcg fQ0-, nc. y �`+ :CANNOT BE DETERMINED WITHOUT AN ACCURATE 172 Aillinnc,,it. INSTRUMENT SURVEY, e&, ebfnrb 027`10 .`fa � . ' 1, :Av. 1 " ; GEN[RAL ROTES: (1) The declarations ■ode above arc on the basis of ■y knowledge, information, and beliefas the '� 1 result of a mortgage plot plan tape survey inspection made to the normal standard of care of registered land .� --surveyors practicing in Massachusetts. (2) Declarations are made to the above named client only as of this �aF'u e v per t, ( p g P P use; date: 3) This lam was not made far recording ur oses, for use in preparing deed descriptions or for con- ['v�l'E'' structiods. (4) verifications of property line dimensions, building offsets. Fences, or lot configuration may -be accomplished only by an accurate instrument survey. _ .:: Flynn, Judith From: McKean, Thomas Sent: Tuesday,January 02, 2018 10:34 AM To: Flynn,Judith Cc: Crocker, Sharon Subject: 1) 311 Church Street,West Barnstable. 2) 339 Church Street, West Barnstable. 3) 359 Church Street, West Barnstable./ Request#2018-0115 : New Request Received Judith. Please retrieve the hazmat and septic files for these locations, scan them into the computer,then e-mail the scanned documents to me this week. --------------------------------------------------------------------------------------------------------------=------------------------ ---------------- Request Detail: Board of Health/Health Division records for three (3)properties. 1) 311 Church Street, West Barnstable. 2) 339 Church Strut, West Barnstable. 3) 359 Church.Street, West Barnstable. From: admin=barnstable.foiadirect.gov(a)townforms.com [mailto:admin=barnstable.foiadirect.govotownforms.com] On Behalf Of admin@barnstable.foiadirect.gov Sent: Tuesday, January 02, 2018 10:27 AM To: McKean,Thomas Cc: Quirk, Ann Subject: [ Probable SPAM ] Request# 2018-0115 : New Request Received Barnstable, MA Public Record Request Number:2018-0115 311 church St/339 church St and 359 church Si mailed 1/9/2018; RequesterLTodd Everson Request Date: Tuesday, January 02, 201810:26:01 AM Response Due Date:Tuesday, January 16, 2018 Request Detail: Board of Health/Health Division records for three (3)properties. 1) 311 Church Street, West Barnstable. 2) 339 Church Street, West Barnstable. 3) 359 Church Street, West Barnstable. Hi Thomas McKean : We just have received a new Public Records Request. The request details are shown above. By design you are receiving this request first. Please evaluate and assign to the proper department and personnel in order to start working on the response. Please click the following link to arrive at your log in screen. 1 https://www.townforms.e.om/FOIADirect-BamstableMA/ Thank you. Barnstable FOIADirect Administrator Please be advised that the Massachusetts Secretary of State considers e-mail to be a public record, and therefore subject to public access under the Massachusetts Public,Records Law,M.G.L. c. 66 § 10. "This electronic message and any files attached hereto could contain confidential or privileged information from the Barnstable Board of Health Department.'This information is intended to be for the use of the individuals or entities to whom it is addressed only. If you are not the intended recipient, be aware that any disclosure, copying, distribution or use of the contents of this information is strictly prohibited. If you have received this transmission in error, please notify the sender by reply email and destroy all copies of this message." 2 McKean, Thomas From: McKean, Thomas Sent: Friday, November 15, 2013 8:37 AM To: Dabkowski, Cindy Subject: Bevis/311 Church Street West Barnstable/Amnesty Apartment Application F.Y.I. Five bedrooms are authorized at the above-referenced property. The septic system questionnaire form was approved today and was FAXED over to your Office this morning. 1 Town of Barnstable Health Inspector ofTHE roy� Regulatory Services Office Hours 8:30—9:30 Thomas F.Geiler,Director 3:30—4:30 x BARN * ASS. � M ` Public Health Division � nss. m �A 1639. �� Thomas McKean Director rFD Mp'l A � 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT — SEPTIC QUESTIONNAIRE, Date: October 9,2013 1. General Information: Size of Property: 2.60 acre Address:311 Church Street West Barnstable,MA 02668 Map 153 Parcel 011 Name: Kristy A. Bevis and Jason E. Bevis Phone#:508-364-2491 2a�How many bedrooms exist at your property now?5 2b. Are you planning to add any bedrooms?NO If yes,how many? 0 2c. How many bedrooms total are proposed at this property(including the amnesty unit)?4 in main house 1 in accessory apartment 2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Show all existing rooms in the home and the proposed amnesty apartment. Provide width measurements of any open doorways. Please label each room clearly. 3. Is the dwelling connected to public sewer? NO If the dwelling is connected to public sewer, skip questions#4 through#9 below. 4. Location of dwelling is OUTSIDE a Saltwater Estuary Protection Zone? 5 . Location of,dwelling is OUTSIDE a Zone of Contribution to public supply wells? 6. Is the dwelling connected to an ONSITE WELL 7. Is a disposal works construction permit on file? YES or NO 8. If yes,how many bedrooms were approved according to this permit? Bedrooms. 9. Were any building permits obtained for construction of additional bedrooms? YES or NO 10. Is there an engineered septic system plan on file at the Health Division? YES or NO 11. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO --- -- ------- ----------------------------------------- ------------------=------------------------------ --------- FOR OFFICE USE ONLY The Public Health Division has t�%k obje 'on to bedrooms at this property. Special Conditions: dpJ , i� C( � i'ze�1r S n, s Signed: _ Date: / 06/03/2010 11:25 FAX 5084283928 CAPEWIDE Q 001/001 Town of Barnstable Regulatory Services Thomas F.Geller,Director i Public Health Division .'� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 509-8624644 Fax: 508-790-6304 Date: �p- 3-Tot o Sewage Permit# 2010-l0 Assessor's Map/Parcel a y.d -0 1� Installer&Designer Certification Form lc.�e. �u�-lyer Designer: 'Daa�-n tA !'t�.�a Installer: eo.p�w PC:Se,r Address: Address: 'P-0 • �O 7(a 3 On 23 0 C'dpew,CX4 C-n I2.- (I{eras issued a permit to install a (date) (installer) septic system at 3 l l � -� S} .� based on a design drawn by (address) Po,.0 r-e-vN C 'F-S dated 3 L 23 t O (designer) I certify that the septic system referenced above was installed substantially according to the design; which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if requi. ected and the soils were found satisfactory. DFA�p= PETER T. c W NTEE teller's Si ) " CIVIL 9 No.33169 o {Besigaer's Signature) (Affix11111.� Here) "9 PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE Aae--' OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS. BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAolSce kbrimWosipercertiflcafi=formdoc { TOWN OF BARNSTABLE LO;.CATION SEWAGE# Z®10— 101 VILLAGE It/, 8xW SA 6(, ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. �4�e 1 c d�+ �s�. ,��,s� �'L VU 2 60 SEPTIC TANK CAPACITY /.S'Ob #/0 LEACHING FACILITY:(type) W // ,f A& ) IP (size) !4.J� —1 NO.OF BEDROOMS Ss OWNER _bC iScc.-i PERMIT DATE: g I Z S Z o t b COMPLIANCE DATE: Co-2- Z 10 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) `!7 y Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ] Feet FURNISHED BY e4ll?.kJ i de 'Ch `1 S C j U-L f Ai v n2 2z3 2 � R3 7/.o 4q `17,1 D3 goa 'yv YY 3�. 4 1 1 r No. U U a Fee O d THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitatiou for Misposal *pstrm Construction Vrrmit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System individual Components Locaf n Address or Lot No. Ch S f 1 Owner's Name,Address,and Tel.No. S Assessor's ap/Parcel i lj v Installer's Name,Address, Tel.N 5 yZ$ (u c3$ Designer's Name,Address,and Tel.No. s ota 3 4o y o 8 9y g5-0 "7 Type of Building: _ Dwelling No.of Bedrooms Lot Size c�, (Q ACC`—sq.ft. Garbage Grinder( ) Other Type of Building 2 S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) SS gpd Design flow provided gpd Plan Date 2,� C�. Number of sheets _ Revision Date Title51m Wslc1l n Size of Septic Tank l Type of S.A.S. TI.,16rit Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. V Date L l - 20 to Application Approved by_; Date T- �_ Application Disapproved by Date for the following reasons Permit No. 2 010— f)� Date Issued ��,�3�2 t,/� `..-...rwrs.+,r--,--++os--...wr--�•---,,y..,..,, ,,, .�...�.. _......_ �...4,N+r•^-,,yY+�rA'l5tr,?'W"t`ai:Si7r.::�.i+'._. .yj .... ...._ ..w„r.d..-=o:..ti.�a.,-.....,.-. ...«,......- ,.....--..._-.,, ...,,,�.�. � ,.... - No. v U U ��"I -- Fee q THE COMMONWEALTH OF ME1SS CHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes-,- ~ 2ppfication for Misposar 6pstetn Construction a—m-it f Application for a Permit to Construct( ) Repair(a,,Upgrade( ) Abandon( ) `❑Complete System 56ndividual Components Locat on Addressor Lot No. '3 l Q,�ch' ��F Owner's Name,Address,and Tel.No. Assessor'sap/Parcel �j�! -01 ` 1 Installer's Name,Address,and Tel.No; y-2 J,&\, Designer's Name,Address,and Tel.No Cc q O S c3(/' ,4.�0 -7 1 L l c� ,v�v t-�. ��r ��U tom_ o1C `3 C `>A t.-7 tt_ I VA V U Z )^ Type of Building: _ Dwelling No.of Bedrooms �� _ Lot Size (o )are('esq.ft. Garbage Grinder( ) Other Type of Building VC, S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) S Sty gpd Design flow provided gpd Plan Date 5 Z -., 10 Number of sheets Revision Date Title ����, ' 1 r „ 1/ r Size of Septic Tank Type of S.A.S. ',// /1 ;4 0l Description of Soil Nature of Repairs or Alterations(Answer when applicable) " ;• ti:� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in r .. accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. edA Date �- 2! - 7-C)/0 i rI Application Approved by y/ /Ire ,) 0 Date !V—-?3-2g-1 o Application Disapproved by Date for the following reasons Permit No. U U - f t) Date 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 C cw;)r to l at 1 C v\ -u,. C has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. D l0-�10 / dated 1'� _,2�/D Installer ( ia.alr 1A ( AL 1-e(al �-P Designer j`� e c j,� f;� 6 < #bedrooms 7 Approved design flow S -_4r(� gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date (0 ,) _ (0 Inspector / - �.._..___ _.-_.-..=a.�=..-�._-_�:-�-_,_._tee_--e...-• � __--..re;=._.-_..-..v .s u -...+-.....-..-- ..---.. _- � _�_- -_—_•--__.__-..Fx.-___ --—_�__y�__-.-__-_--_-_ '.,. - -- - No. 7(J/a ' U Fee 16L THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION , BARNSTABLE,MASSACHUSETTS Misposai 6pstem Construction permit Permission is:hereby granted to Construct( ) Repair( Upgrade( ) A` Abandon( ) System located at �,l\ �ti t c, ( C`Vn St and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this pe i. it. Date LJ - 2 7 - /v Approved by v WEDNESDAY, MARCH 1, 2006 THE LOG Shoeless children flee.W. Barnstable fire By HILARY RUSS the two-story house on Churches STAFF WRITER Street blackened and drip- WEST BARNSTABLE --Avo' ping with foam'used,to put out children escaped a house fire the fire. West Barnstable Fire so'.quickly yesterday afternoon Chief,Joe Maruca said the fire that they didn't even have time appeared to have begun in the to put on their shoes. furnace area of the basement. Sitting under a. blanket in "The kids did a good job,"said. 1 a neighbor's minivan after .Sgt. Stephen McGuire. of the Y the fire, 13-year-old Hannah Barnstable Police'Department. t Driscoll recounted how she saw Most of the family pets smoke and then flames coming escaped unharmed.The fate of' from the second-floor bedroom another cat was unkown yes- STEVE HEASLIP/Cape Cod Times of her 11-year ,old brother, terday afternoon. A West Barnstable firefighter 1 Josiah.He was downstairs at the Suzanne Driscoll said the checks out the charred exterior time. She ran down screaming family had called the-fire depart- of a home on Church Street yes- t to her brother, who called 91.1. merit earlier in the day because terday afternoon. r They grabbed Riley, one of two . she smelled what she thought' 1 family cats,and ran outside'into was an electrical fire. She said workers came to .clean the ` the snow in only their socks and the'department determined the carpet in a downstairs apart- ` school uniforms. odor was coming from.the fur- ment at the house that Driscoll Their mother, L Suzanne nace and advised her to shut it was hoping to rent out. l Driscoll,was on her way home off,which she did. 1 from work at the time. She said it was switched back Hilary Russ can be reached at 'The fire left a back area of on for a brief time later when hruss@capecodonline.com. 08-771-3292;smyers@capecodonline.com v" IESS, ! WEDNESDAY, MARCH 1,2006i 1 i pu§h ' .Cape bus. service , , as yet to take off_ Commuter b.1- W sproaram, , n"I'm going to educate them big time," Capp busrn�esses can partners with the Cape Cod i Johnson said yesterday at a meeting with Regorial TranrtxtPtlirrty�nhe Transrt=Coin Cape employers in Eastham.The group's M y: Ater benefit Program tb find the,Wiest ways o' focus: how to encourage employees to ;to use pub/rc transprtat�on on the Cape and :access a federal tax rredit Th'e program works x , take public transportation. prrmanly rn tw©ways In the past, he said it has been nearly � _ „ impossible'to attract employees who live >■The companubsid slzes pullic transportation farther than five miles away-about as far for emp esloye up to$106 per employee each as someone will travel to work by bike. month and wrjtes'off cost as'a tax deduction He plans to push the Flex service riot xmplpyees py fors�rbl�c trnsrt on-them own. ' only to foreign workers here for the and the;cost is deducted from their paycheck summer, but also to unlicensed teens Q�;lefore taxes This mmimiies an employee's,in r ; 'come taXi as well as tl a employer`s payroll tax 1 Please see TRANSIT IA-9 i, 1 Town of JBAr astable P# � Department of Regulatory Services • ' ' Public Health Division Date a a 3 r Mese. i6 9. ems$ 200 Main Street,Hyannis MA 02601 l � Date Scheduled f / �° 'Time _�°___ Fee Pd. i Soil Suitability Assessment for Sewyge Disposal � >��1A K. KEYM. , Pcsformed By: _' Witnessed By: i LOCATION & GENERAL IIVTORMATION Location Address I l G 4 U P-CH 15T. Owner's Name p R\�jCAl.t 31 t G WV A-C4+ ST W . Q�n /�• I/� VY� Address W� � S_ M Assessor's Map/Parcel: I G'/2O I"�I ' li I Engineer's Name D61 f-fe.` NEW GONSIRUtON REPAIR _L\— 1 Telleephone# Land Use R i�EN7�A'e, Slopes(5a) e(• Surface Stones � Distances from: ripen Water Body ZJ ft Possible Wet Area ��U ft Drinking Water Well l� ft Drainage Way rid ft Property Li l ft Other ft SKETCH:(Street name,dimensiods'of lot,exact locations of test holes&Pere tests,locate wetlands in proxitnity to holes) I 312311 i i I I i i i . t I epth to D Bedrock Parent material(geologic) u )� Depth to Groundwater. Standing Water in Hole:' i Weeping from Pit Face I Estimated Seasonal High Groundwater ►`� A i D&ERM NATION FOR SEASONAL HIGH'WATER TADIX Method Used: � in, Depth to soil mottles: :Depth dbperved standing in obs.hole: in, groundwater Ad)usttnent Ile• Depth to weeping from side of obs.hole: ; A {actor,,, �..- Adj.froundwater Level Index Well# — Reading Date Index Well level �, PERCOLATION TEST Date 'xle fus Observation I Tithe lit 9" -------- Hole# ' M •��5ex Sa" Time at G" _,�,_,_�,f�•' Depth of Pere ��- b Time(9"-6") Start Pre-scak Time.9 ---�- - ; End Pre-soak 15 Rate MinJinch Additional Testing Needed(Y/N) Site Suitability Assessment• Site Passed X Site Failed; — — Observatioti Hole Data To Be Completed on Back— OriginaL•.Public 14101th Division i ***If P ercola ion test is to be conducted within 100' of wetland,you mriunt first notify the C•_AnserVation Da�zsion at least one (1)week prior to begin g DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsistenc %Gravel A L04,w and (o`lr�ly ►'l �- �a�t_ t3 fah C� Ca R,SA co`(- `<. S1'(f L04M 10 � g DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling- (Structure,Stones,Boulders. C;gnsistencv.%Gravel, Ott_ io4 /o n N� S -1, D� ?21- IX (- Mud 2. 7�3 DEEP 0 RVATION HOLE LOG Hole# 1 f Depth from' Soil Horizon oil Texture Soil Color Soil Other Surface(in.) ( A) (Munsell) Mottling (Structure,Stones,Boulders. Consistent 'Yo Gravel DEEP OBSERVATION HOLE LOG Ho le A Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. m I Flood Insurance Rate Map: Above 500 year flon-d boundary No— Yes t" Within 500 year boundary No k Yes,. Within 100 year flood boundary No x' Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist.in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring per sous material?y,_„•_._, Certification I certify that on 10 4� (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the require i ,experti a and ex erience described in 3.10 CMR 15.01 Signature ° Date 2� Q:\.SEPTIC\PERCFORM.DOC TOWN OF BARNSTABLE LOCATION ":;,/'J Ci4� _SEWAGE VILLAGE A -.ZA!m ASSESSOR'S MAP & LOT ,3®®i INSTALLER'S NAME & PHONE NO. - ' SEPTIC TANK CAPACITY LEACHING FACILITY:(type) S"(s i z e) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER2&]a4 BUILDER OR OWNER DATE PERMIT-ISSUED: ®- z . � DATE COMPLIANCE ISSUED: y -Sly! VARIANCE GRANTED: Yes No _ s¢' 96�' s3 i�r.i ` � No......?1._20 _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a_�� _...OF...........- ./V .............. .. ..... .................................. l��-01( Appliration for Uftipoiial Works Tomitrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ........... . ......................... ....................... ......................... ............................................................... Lon-Addvess t......... ..... . ........... .... ........................... . ............... ...... .. ..... ....... ow ddress ........................ .... .......... ....................................... ..... .. ... . ...... Installer Address e of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...... ----------------------------------Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers Cafeteria A4Other fixtures ...................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. IY4 Septic Tank—Liquid'capacity/W...gallons Length................ Width........_._.,... Diameter___..........._. Depth....._.......... leaching area....................sq. ft. Disposal Trench—No .-h ---------- Width..._..........._._.. Total Length.._................. Total leachi Seepage Pit No...IP&__ -IdDiameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed by...................................... .................................... Date........................................ 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.___._..............__.. M --- - 6..�......................................................................................................... 0 Description of Soil......... ------ ........................................................................................................ W U ........................................................................................................................................................................................................ W ......................................................................................................... ----------------0... ..... ....................0 U Nature of Repairs or Alterations—Answer when applicable------. -------V-4- --------------- -------------------- .................................................................................................................................................................... ----------*Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of TL I Ti LE 5 of the State Sanitary Code—,The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been j#%ued by he board of health O,j 'ji " 'Ti ..................Signed...... ........<A"...... ......................... ................................ Date Application Approved By........... .......... Date Application Disapproved for the following reasons:.............................................................................................................. ........................................................................................................................................................................................................ Date PermitNo.... ---------------------- Issued_....................................................... Date ------------- ......—----------------------------------------- .d No..... .: :z Fas..... �. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .... .--..OF. l.. .. Appliratinn for 14spunttl Works Tonstrurftu rumd Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..................... ......................!�.,!. rf_�_v- ; r .. ......_........_. ....... _ ..... ... ••Address . .......... `......... .... .. . Lot N .... Ow �� - ddress �- .... ...-- ................... ... __. .......... ---------------------- Installer --......... .. - Address e of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms......................... .....Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building No. of persons............................ Showers a yP g ............................ P ( ) — Cafeteria ( ) p' Other fixtures W Design Flow........................:...................gallons per person per day. Total daily flow............................................gallons. 0: Septic Tank—Liquid capacity/$DO...gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No...f�,-�-�--jj.......... Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No...1 fl�VY.1iSY Diameter.................... Depth below inlet.................... Total leaching area.................sq. ft. tan Z Other Distribution box ( ) Dosingk ( ) '-, Percolation Test Results Performed by----------................................................................ Date........................................ ,`4l Test Pit No. I................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........................ a ......... ...................... ............. D Description of Soil......•••• - . .... . (?:� C,-- V ------------------------------- •------------ ...... ---------------------------------------------------- --------------.....----------- •----•---------......... -•----.... W ......------•••-------------•-•--•...........-----...--•-•-••------------------------------•----••-----.........---.._.------. — UNature of Repairs or Alterations—Answer when applicable - .... . .................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of 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 ' ued by Pe boar of health Signed...... ...........�................ .. ------------------ -------------------------- ----- Date Application Approved By........... _ ........ .. ................._ ... .-�'� Date Application Disapproved for the following reasons:........................................................................................................---- .....................................••--•-•-•----•--•-•--•--..................------------.--.........-•.-•---•-----------•----------••------•-----......---.................---.............--......._ _ Date PermitNo....`"`' = ................. Issued............................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... ...........OF........... .. ' (Irrfif iratr of faomplitturr THIS I TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (.•k-) by...................jJ..._.------.�. .F::_�:: :� .........._.....-•-- -----•---. ._._.................................................................._..._.... ......._ �.- -Installer at..................................................................................................................................................................................................... has been installed in accordance with the provisions of TIT�F 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........?.. ..: ......... dated.............. .............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................ ............................ Inspector.............•....... --- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTHn .-•- - t ......... .OF...........e.� 1�,>j.............................. Dispustt Works Tunu#rttrti an rrruti# Permission is hereby granted............. I ""- .. ......--•------ . ------------ � -------- --.f.;�,......... ..........__.. to Construct ) or Repair � an ndividual Sewage D}'s�p�o System (, at No.............. .. � :: Q�-•--•- Z .............._................... `-=r t-••---•----•---•- �. rc............-----......---••-••-------............ Street as shown on the application for Disposal Works Construction Permit No..k. ... . Dated.......................................... ..............................y, ... .._..._... ................................................ . DATE.....................•-•--..............................---•-------------....... // Board of Health FORM 1255 A. M. SULKIN. INC.. BOSTON II T b Home: Departments:Assessors Division: Property Assessment Search Results New Search 311 CHURCH STREET Owner: 2006 Assessed Values: DRISCOLL, SUZANNE Appraised Value Assessed Value r Map/Parcel/Parcel Extension Building Value: $238,800 $238,800 153 /011/ Extra Features: $2,600 $2,600 Outbuildings: $ 1,100 $ 1,100 Mailing Address Land Value: $217,200 $217,200 DRISCOLL, SUZANNE Totals $459,700 $459,700 311 CHURCH ST W BARNSTABLE, MA. 02668 Tax Information: Tax information is currently not available for 2006 Construction Details Building Property Sketch Legend I Building value $238,800 Interior Floors Carpet Style Conventional Interior Walls Plastered Model Residential Heat Fuel Oil Grade Average Heat Type Hot Water if Stories 1 1/2 Stories AC Type None / ,rY �X"�>safi 3 f Exterior Walls Wood Shingle Bedrooms 5 Bedrooms d 3 f Roof Structure Gable/Hip Bathrooms 3 Full Roof Cover Asph/F GIs/Cmp living area 2743 9 Replacement Cost $280916 Year Built 1914 Depreciation 15 Total Rooms 10 Rooms 3 t' Land Lot Size(Acres) 2.6 Ma requires Plug in: Interactive Property Map. Appraised Value $217,200 1 have visited the First time users maps before g PP P ��►���,F'mr Show Me The Man Click Here Assessed Value $217,200 April 2001 photos available `a' Sales History: Owner: Sale Date Book/Page: Sale Price: 71 AISA01, SUZANNE Dec 23 2003 12:OOAM 18063/070 $0 DRISCOLL, MICHAEL J 3157/74 $0 Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL2 Fireplace 1 $2,600 $2,600 SHED Shed 140 $1,100 $ 1,100 Property Sketch Legend i' BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area (Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) I' 1' All s re OMA 460 / f Logged In As: + rce I Detail Friday, March 3 2006 Parcel Lookup Parcel Info Parcel ID J 153-011 Developer Lot Location 1311 CHURCH STREET Pri Frontage 1280 � ................ Sec Road ( Sec Frontage village;WEST BARNSTABLE Fire District IW BARNSTABLE Sewer Acct Road Index 0308 Owner Info owner,DRISCOLL, SUZANNE Co-owner Streets 1311 CHURCH ST Street2 city W BARNSTABLE State MA Zip 02668 Country .USA Land Info ..._ _.. ,._..._ .... _ ...._.. ........._... Acres 2.60 Use Single Fam MDI zoning i RF Nghbd 0105 _...... .... .......... ....................................... ......... ......... ......... Topography Level Road E Paved ...._ _ ......... utilities Gas,Wel1,Septic Location Construction Info __ -_... .. .. ....... ........................ .... ......... ......... ................... ..... . .................................. ......... ................ Building of I Year 1914 Roof Gable/Hi............ _......._. AcNone Built Struct Type Effect _ ... __....___._. Roof ....... „ Bed ....._ 2967 !Asph/F GIs/Cm 15 Bedrooms Area Cover Rooms Int __, Bath j ' a�i33 r rr Style Conventional Wall Plastered. ? Y Rooms Model Residential Total 10 Rooms Rooms?..... ... ©P Grade Average Int Bath / Floor Style „ r Stories 1 1/2 Stories Kitchen Style' m,.4 �,�3 Ext .. Heat Bath ... Wood Shingle Hardwood Wall Fuel Split Heat 3 Found _.... „_. Type Hot Water ation 011 Permit History ......... ......... ..... _ .................................... .............. ................................... Issue Date Purpose Permit# Amount Insp Lute Comments 11/1/1991 B34697 $70,000 1/15/1994 12:00:00 AM WB ADD'N Visit History Who Purpose /2000 12:00:00 AM Paul Talbot Meas/Listed 15/1993 12:00:00 AM ML Sales History _ ......... ......... ... ............ Line Sale Date Owner Brook/Page Sale Price 1 12/23/2003 DRISCOLL, SUZANNE 18063/070 $0 2 DRISCOLL, MICHAEL J 3157/74 $0 - Assessment History r........ ........_ .........................._._ .......� Save# Year Building Value XF Value OIL Value Land Value Total Parcel Value 1 2006 $238,800 $2,600 $1,100 $217,200 $459,700 2 2005 $204,300 $2,400 $1,100 $197,500 $405,300 3 2004 $165,900 $2,400 $1,100 $227,100 $396,500 4 2003 $145,500 $2,400 $1,100 $84,000 $233,000 5 2002 $145,500 $2,400 $1,100 $84,000 $233,000 6 2001 $145,500 $2,600 $1,100 $84,000 $233,200 7 2000 $113,100 $2,500 $600 $58,700 $174,900 8 1999 $113,100 $2,500 $600 $58,700 $174,900 9 1998 $113,100 $2,500 $600 $58,700 $174,900 10 1997 $116,500 $0 $0 $45,600 $162,300 11 1996 $116,500 $0 $0 $45,600 $162,300 12 1995 $116,500 $0 $0 $45,600 $162,300 13 1994 $96,000 $0 $0 $64,500 $160,700 14 1993 $67,300 $0 $0 $66,200 $134,700 15 1992 $76,700 $0 $0 $71,700 $148,600 16 1991 $64,800 $0 $0 $104,300 $169,600 17 1990 $64,800 $0 $0 $104,300 $169,600 18 1989 $64,800 $0 $0 $104,300 $169,600 19 1988 $63,000 $0 $0 $39,100 $102,600 20 1987 $63,000 $0 $0 $39,100 $102,600 21 1986 $63,000 $0 $0 $39,100 $102,600 Photos Fr �- SURVEY REFERENCE: �_o ,MAP.•040 ' �___.---EDGE OFtjvq MENT C H U Cal J H STREET PLAN OF LAND BY DOWN CAPE ENGINEERING_, INC. --o--o------_-_ o --- m� LOT: 065 DATED: APRIL 21, 1995 — N N - 52_ ------w �-------------- �4 LCC#.•128610. k N� N' 3E �52 O f SITE �OPO CHURC QP� HST ) I cn 0 PARCEL 11 I SrRf LOCUS MAP N.T.S. AREA 2.60= ac +- � I � I 11N nl i/ ` GENERAL NOTES: c,� I ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS / P OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 54.`` ' ' ' (A ( `�' LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: % 1 (A'�"6' _ � _ - BARNSTABLE BOARD OF HEALTH REGULATIONS ~/ `� 1) A 50 FT. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING a P.c 0 N\� TO BE 100.0 FT FROM ON-SITE PRIVATE WELL VS REQ'D 150 FT. �1�\ BENCH M A R�< N 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 1 '`+ � PAINT SPOT ON IUP TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE i o• DESIGN ENGINEER.STEP CORNER - (J, i .0. 1 I $ ELEVATION 1 = 55.79 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING I_, I � x FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN cn n I 11tN,i• BARNSTABLE GIS DATUM ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. c/ I i 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF ( ( I c0i HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. i;mN 6; 56 �Xi S 7/N G A \�� i i 7. WATER SUPPLY PROVIDED BY PRIVATE WATER SERVICE. ^' f1. I 'Fop wEL_ NG _ I___ _ 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED 1 " - 54 TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. EL o8•Fn�N 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING �EX15T.LEACH PIT �� �\ N _n Pr;��t e CONSTRUCTION. `5r ox.lowbon) n 00 (SEE NOTE 1 O) N o r 10. EXISTING LEACH PIT TO BE PUMPED, CRUSHED AND FILLED. Al .� i ; 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 14 I 12. THIS PLAN IS TO.BE USED FOR SEPTIC SYSTEM PURPOSES ONLY cn rn y } ; $ AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY P• Fi �, ;' ,' 13. NO OTHER PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING �' �. 14. ALL PIPING TO BE 4" SCH 40 0 1 8" FT UNLESS SPEC. 100 _UNPAVED RI VEVV.g, ' to --56 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW ------ FOR THE USE OF A GARBAGE GRINDER ' NIII 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING } I i 136.65 ft ----_—_._..—. S--- r� `�,�y/ro `/ PROPOSED SEPTIC SYSTEM UPGRADE PLAN R `� ® TH-1 41 ' �= f No. 140 H ,��'� rn 311 CHURCH STREET, WEST BARNSTABLE, MA ; N �� � Prepared for: Bluewater Septic / Engineering by: Surveying by: SCALE DRAWN 1 sgNITAR�a .° i DARRENM.MEYER,R.S. 14'oo-Teoh Bnvironmeatel 1" - 30' DMM ry ` POBOX981 (508) 364-0894 E4STSANDWICH,MA02537 DATE: CHECKED SHEET NO.�' cm. o 'r, ,%� 03/23/10 DMM 1 of 2 508-622922 NOTE: TO PREVENT BREAKOUT, THE PROPOSED DESIGN CRITERIA ' NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:52.14 FOR A DISTANCE OF 15' AROUND THE NUMBER OF BEDROOMS: 5 BR EXISTING (PROPERTY HAS PRIVATE WELL) PERIMETER OF THE S.A.S. SOIL TEXTURAL CLASS: CLASS I SEPTIC TANK PROPOSED D-BOX r' PROPOSED S.A.S. DESIGN PERCOLATION RATE: <2 MIN/IN T.O.F. EL.=58.58 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) 'AND SET TO 3" OF F.G. DAILY FLOW: 110 G.P.D./BR F G EL.=56.23t F.G. EL.=56.27t F.G. EL: 55.0f F.G. EL: 55.0-54.60 (MAX.) DESIGN FLOW: 550 G.P.D. (Min. . . GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) PROPOSED SEPTIC TANK: 550GPD X 200% = 1,100GPD USE EXIST. 1,500 GALLON TANK 9" MIN COVER/ LEACHING AREA REQUIRED: (550) = 743.24 S.F. L = 10'"t L = 75' L = 15'(MAX) INSTALL TWO INSPECTION PORTS (MIN.)0 S=1% (MIN.) 36" MAX COVER ® S�1% (MIN.) 0S=1X (MIN.) 74 4'SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC DISTRIBUTION BOX: 5 OUTLETS (MINIMUM) LLLPRIMARY S.A.S. 10 14• a INVERT USE 5 ROWS OF 5 - 11" ADS 1100BD BIODIFFUSER UNITS-NO STONE INV.= 54.51 48"LIQUID INVERT LEVEL INV.=54.26 AND EXTENDED 0.75 FT WITH CONTOURED WEDGE. INSTALL M INV.=52.55 BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.70 SF/LF OF BIODUFUSER) • GAS BAFFLE 5 ROWS OF 5 UNITS AT 6.25'/UNIT + 0.75' WEDGE = 32.0'/ROW ( ) 25 UNITS x 6.25 LF x 4.70 SF/LF = 734.38 SF •' . BIODIFFUSERS INV.- 51.75 INV.=52.75 - SOIL ABSORPTION SYSTEM (PROFILE) (BIODIFFUSERS) 5 UNITS x 0.75 LF x 4.70 SF/LF = 17.62 SF EXISTING 1,500 GALLON SEPTIC TANK DESIGN FLOW PROVIDED: 0.74GPD/SF(752 SF) = 556.48 GPD > 550 GPD req'd RESTORE VEGETATIVE COVER EXISTING SEWER OUTLET BACKFILL WITH CLEAN PERC SAND 75" TO TOP OF CHAMBERS NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING c. ;. • .•' ;• PLACE FILTER FABRIC PIPE INVERTS PRIOR TO CONSTRUCTION f "'.>'':'.:':::>. •••:': OVER ALL UNITS 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BREAKOUT=TOP ELEV.=52.14 K.... .: (RECOMMENDED) GRADE ON A MECHANICALL COMPACTED SIX INV. ELEV.= 51.75 ' INCH CRUSHED STONE BASE, AS SPEC IED IN(r11 BOTTOM ELEV.= 51.22 `• / EXISTING SUITABLE 310 CMR 15.221(2) (,500 2.83' MATERIAL 3_INSTALL INLET & OUTLET AS REQUIRED (4.41 OF SUIT. MATERIAL PROVIDED) r� 76 _ 4) REPLAC GALLON SEPTIC TANK WIT (7.44 PROVIDED ABOVE BOTTOM OF TH) EFFECTIVE WIDTH = 5 x 2.83 = 14.15 BOTTOM OF SUITABLE MATERIAL EL. 46.75 USE 5 ROWS OF 5-1100BD ADS PROFILE 00 GALLON SEPTIC TANK IF FAILED, DAMAGED, OR BIODIFFUSER UNITS-NO STONE LESS THAN 1,50OG IN CAPACITY. BOTTOM OF TESTHOLE EL: 43.78 = W1 CONTOURED WEDGE SEPTIC SYSTEM PROFILE TYPICAL SECTION lips N.T.S. N.T.A 6 SOIL LOG P#: 12852 _L_ I - i P ( -34" � DATE: MARCH 1, 2010 OF Mq SECTION END CAP SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. #1614 ���� sr WITNESS: DAVID STANTON, BARNSTABLE B.O.H. �`' 9�y D/�REN M. 11" ADS 110OBD BIODIFFUSER UNIT � Elev. TP- 1 Depth Elev. TP-2 Depth 54.25 A LOAMY SAND 011 54.45 A LOAMY SAND D 0 } O MODEL 11" HICAP 53.42 10YR 3/2 10" 53.62 10YR 3/2 loss1 '�6/ E�� O LENGTH 16" B SANDY LOAM B SANDY LOAM NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT 1OYR 5/8 10YR 5/8 + NITAR�a EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY 51.75 DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. C1 LOAMY FINE 30 51.78 C1 LOAMY FINE 32, Z SIDE WALL HEIGHT 6.35 • 10YR sD PERC ®50.09 �j , a OVERALL HEIGHT 11" 49.25 2 _ 60" 48.45 IOYR 6/6 72" OVERALL WIDTH 34 4640 TRUEMAN BLVD MEDIUM SAND 2 MEDIUM SAND 9 21 CF H/LLIARD, OHIO 43026 2.5Y 7/3 2.5Y 7/3 CAPACITY 46.75 1 (68.4 GAL) ADVANCED DRAINAGE SYSTEMS, INC. 10YR 6/8 10YR LOAM C3 " SILT LOAM 90 43.95 C3 SILT 6/M 126" 8 PROPOSED SEPTIC SYSTEM SITE PLAN 44.25 120" 43.78 128" 311 CHURCH STREET, WEST. BARNSTABLE, MA PERC RATE <2 MIN/IN. ("C" HORIZON) Prepared for: BlueWoter Septic NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN DARRENM.MEYER,R.S. Boo-Tech Enrironmeatei NTS D.M.M. • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 pO BOX 981 (508) 364-0894 DATE: to conduct aoil evaluations and that the above analysis has been performed by me consistent with the EgSTSANDWICH,AM 02537 CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Evol. Exam in October, 1999. 508-362-2922 03/23/10 D.M.M. 2 Of 2