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Home My WebLink About0028 HOLWAY DRIVE - Health • HOLWAY DRIVE • TOWN OF BARNSTABLE LOi ATION SEWAGE# a�I "I f �J VILLAGE c;, SSESSOR'S MAP&PARCEL 1,:3 /P 0 2 , INSTALLER'S NAME&PHONE NO. �C � ��oZ CF m G. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well Leaching Facility(If anyjwells 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 ,�,�� ,.�� r .. v-� O �� . = _ -,,,� F � ' _... Town of Barnstable Barnstable Regulatory Services Department I j �nxxsr�stE, 639 A�� Public Health Division m 200 Main Street, Hyannis MA 02601 2007 Office: 50E-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7012 1010 0000 2851 2699 May 22, 2014 - Jeffery French 28 Holway Drive West Barnstable, MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 28 Holway Drive, West Barnstable, MA was last inspected on 3/2512014, by James D. Sears, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Must replace distribution box • Must replace septic tank outlet tee. You are ordered to repair or replace the distribution box and repair the leaking septic tank and components within sixty (60) days from.the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH C, Thomas McKean, R.S., CHO Agent of the Board of Health y� a � r QASEPTIC\Sample Conditionally Passes\28 Holway Dr W.Barn Apr 2014.doc Parcel E-etail http://issgl2/intranet/propdata/ParceiDetaii.aspx?ID=8529 ,U¢j J �I� ��': `. �T, "�E �§ � _ : +�LPL✓.-^ frs,' "w .. r ��"� �� "'�` �LlS)'SAS, x-X Ile Logged In As: Pa rceI Deta I I Thursday, April Parcel Lookup Parcel Info Par Iel 136-031 , Developer LOT 16 D Lot Location 128 HOLWAY DRIVE Pri 160 Frontage Sec Sec Road Frontage re Village[WEST BARNSTABLE Dis Iti t W BARNSTABLE Town sewer exists at this Road i0734 address(No ) Index Asbuilt Septic Scan: Interactive � � Map I 136031 R3 _1 Owner Info Owner!LARSON, MILTON RTR Owner MILTON R LARSON REALTY TRUST Stireetl C/O CARPENTER, KRISTINA � Street2 IPO BOX 3865 City ILAGUNA HILLS State CCA Zip[92654 Country j Land Info Acres Use Single Fam MDL-01 ( Zoning[R _ ] Nghbd i011� 1 Topography1Level _ �� Road Paved Utilities I Gas,Wel1,Septic Location Water View Construction Info Building 1 of 1 Year Roof� —,� Ext ��' Built 1981 Struct I"able/Hip 1 Wall Wood Shingle Living 2031 J RoofWood Shingle ACNonernm T p Area Cover Type o D Style Colonial Int Drywall Bed 3 Bedrooms ( rxy -- Wall Rooms' Model Residential Int Wide Pine Bath FiFull+ 1 H Floor Rooms' Heat �� Total Grade Average Plus Type Hot Water Rooms Rooms Stories f 1.8 Heat Oil Found- o— erCdo nc Fuel ation Gross http:;/issgl2/intranet/propdata/ParcelDetail.aspx?ID=8529 4/24/2014 � l� I 'pr 071412:12p PA Commonwealth of Massachusetts IV Title 5 Official Inspection Form WN P Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Holway Drive Property Address Jeff French Comer Owner's Name information is West Barnstable MA 02668 3-25-14 required for every page. City/Town Stale Tip Code crate 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:put forms A. General Information filling out forms �,%%%v,IN OF 4M on the computer, I 3 `�."'�.• use only the tab 1. Inspector: :o?� '•�G key tomove,your :g: JAMES •u'= cursor.-do not James D.Sears use the return Name of Inspector = =C'a key. CapewideEnterprises LLC * F *� Company Name %� �F.S.. ..T�G' �• 153 Commercial Street ''��mn►��rn1��``� Company Address Mashpee MA 02649 City/Town State Zip Code 5OB477-8877 S1623 __- Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this addidss and tRt the(D information reported below is true, accurate and complete as of the time of thE,,,ihspection.-The Ir>s�ection was performed based on my training and experience in the proper function an'd,,maintenarac�of 9 siite sewage disposal systems. I am a DEP approved system inspector pursuant to section 15.346of Title 5 (310 CMR 15.000).The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority co 4-7-14 Spector s_ Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the sy§tern owner and copies sent to the buyer, if applicable, and the approving authority. "**This report only describes,conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3/13 Tdle 5 ofrxwi n Farm:Satuurface Sewage Disposal System•Page 1 of 17 Apr 071412:12p p.2 T Commonwealth of Massachusetts r.4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Holway Drive Property Address Jeff French Owner Owner's Name information is West Barnstable MA 02668 3-25-14 required for eoery . . .._ _ page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E l always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ® One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. " A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): Mils•3113 Tide 5 Dfridd hwpectfw Form:Subsafare Sewage Deposal System•Page 2 or 17 Apr 071412:12p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 28 Holway Drive Property Address Jeff French Owner owners Flame information is West Barnstable MA 02666 3-25-14 required for every _.. � page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System conditionally Passes (cunt): ® 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): Need to replace D Box wall's are cove. Need to install outlet tee in tank, baffle broken off. _ ❑ 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•3113 rdlo 5 Offldal Inspection Form:Subsurface Sewage Disposal System.Page 3 of 17 Apr 071412:13p p.4 Commonwealth of Massachusetts Title 5 official . Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Holway Drive Property Address Jeff French Owner Owner's Name reformation is West Barnstable MA 02668 3-25-14 required for every _ page. Citylrown 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 dogged SAS or cesspool ❑ ® Liquid depth in somMat is less than 6"below invert or available volume is less flian'/Z day flow P.7— t5ns•3113 TAIe 5 Wide!Inspection Fomr.Substrface Sewage Disposal System•Page 4 of 17 Apr 071412:13p p.5 Commonwealth of Massachusetts Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Holway Drive Property Address Jeff French Owner Owner's Name information is West Barnstable MA 0266E 3-25-14 required for every, - page. Cityrrown State Zip Code Date of Inspection B. Certification (cons.) 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. 151ns-3/13 Tills 5 Offioial Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Apr 071412:13p p.6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Holway Drive_ Property Address Jeff French Owner Owner's Name information is required For every West Barnstable MA 02668 3-25-14 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) 23 ❑ 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) 1310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 15:ns 3/13 Tille 5 Official Inspeclion Form Subsurface Sewage Disposal System•Page 6 of 17 Apr 071412:14p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Holway Drive Property Address Jeff French _ - Owner Owner's Name information is West Barnstable MA 02668 3-25-14 required for every page. Cityfrown State Zip Code Dale of Inspection D. System Information Description: The system is a 1000 Gal. tank D Box and pit. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d well water 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date Commerciallindustrial 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: t51ns•311 S 719 5 Official Insredon Fmir:Subsurface Sewage Otsposal System•Page 7 at 17 Apr 071412:14p p,8 commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 28 Holway Drive Property Address Jeff French Owner Ownter's!dame information is West Barnstable required for every fillA 02668 3-25-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 7-27-11 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): 95ins•3n 3 Tale 5 Mdel inspection Form:Subsurface Sewage Disposal system•Page a of 17 Apr 071412:14p p,g <L, Commonwealth of Massachusel#s Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �j 28 Holway Drive Property Address Jeff French Owner Owner's Name information.is West Barnstable MA 02668 3-25-14 required for every page City/Town state Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed (if known)and source of information: 1981 - Permit #81 -682 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑cast iron ®40 PVC ® other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 20+SCH 40. Septic Tank(locate on site plan): 11" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal.Precast Sludge depth: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Poo 9 of 17 I ' Apr 071412:15p p.10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 28 Holway Drive Property Address Jeff French Owner Owner's Name information is West Barnstable MA 02668 3-25-14 required for every --- page. Cityfrown 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 29" Scum thickness - 8' Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 17" 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 11" below grade. Two inlet tee's, outlet baffle broken off,need to install outlet tee.No sign of leakage or over loading 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 t.5ins•W3 Tile 5 Official Inspection form:Subsurface Sewage Disposal System•Page 10 of 17 Apr 07 1412:15p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Holway Drive Property Address Jeff French Owner Owner's Name Information is required for every West Barnstable MA 02668 3-25-14 - page Cityfrown Stale 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 wrins,8N3 Tntle 5 official inspection Form:sibsurface sewage Disposal System•Page 11 o117 Apr 071412:15p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Holway Drive Property Address Jeff French Owner Owner's flame information is West Barnstable MA 02668 3-25-14 required for every _ _ page. Cdyrrown 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.): D Box is 16"x16"-1 V' Below grade wlone line out. Need to replace D Box, wall's are gone i Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order ❑ Yes ❑ No' Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Olitaal inspection Fora[S&surlece Sw 4e,Disposal System•page 12 of 17 Apr 071412:16p p.13 Commonwealth of Massachusetts Title 5 Official-Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Holway Drive _ Property Address Jeff French Owner Owner's Name information is required For every West Barnstable MA 02668 3-25-14 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Type: ® leaching pits number. ❑ leaching chambers number. ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovative/altemative system Typetname of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is a 1000 Gal. Precast pit w/2' stone. Pit at 63" below grade w/cover at 22". Pit is dry w/stain line at 18". No sign of over loading or solid carry over. No high stain line. 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 [sins.3n 3 Tale 5 OfBdat inspection Form:SubsurfaCe Sewage Ellsposal System Page 13 of 17 1 Apr 071412:16p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Holway Drive Property Address Jeff French Owner Owner's Name information is West Barnstable MA 02668 3-25-14 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): 15ins.im Title 5 Offidal hspeuion Form Subsurface Sewage Disposal System-Page 14 of 17 Apr 071412:16p p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Holway Drive Property Address Jeff French Owner Owner's Name information is required for every West Barnstable MA 02668 3-25-14 page. City/Town State Tip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately z i -� � J3' o O. . 151M-31'3 Title 5 ONlclal"action Form:Subsurface Sewage Disposal System.Page 15 or 17 Apr 071412:17p p.16 CommonweaM of Massachusetts _IdErla-MMMTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Holway Drive Property Address Jeff French Owner Owner's Name information required for every, West Barnstable MA 02668 3-25-14 page. City/Town -State Zip Code Date of Inspection D. System Information (cons.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 40+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site abutting property bservation 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: Abutting property in rear drops off some 40'. Bottom of pit at 11'below grade. Before filing this Inspection Report,please see Report Completeness Checklist on next page. 155ns.3113 Title 5 Offlclat hspec ion Form Subsurface Sewage Disposal System-Page 16 of 17 r Apr 071412:17p p.17 a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Holway Drive Property Address Jeff French Owner Owner's Name informati for every on is required West Barnstable MA 02668 3-25-14 page_ Citylrown State Zip Code Date of Inspedion 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 t51ns•3113 71te 5 Offbal Inspecdw Form Subsurface Ssvrage Disposal Systan•Page 17 oT 17 No. D Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes fipfiratiou for Misposal 6pstem Construction 30erutit Application for a Permit to Construct Repair Upgrade Abandon Complete System Individual Components PP ( ) P 4/1 PSr' ( ) ( ) P Y P Lc,cation Address or Lot No. O er s Name Address and Tel.No. d a-�S �C��wG �, �2 r C ' •k v.c� Cc.pp��r�,n Assessor's Map/Parcel �?'eb� �" v n � p Installer's Nam ddress and Tel.No. Designer's Name,Address,and Tel.No. ` s Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 t I Board of Health. f S Date p r Application Approved by Date Application Disapproved by Date for the following reasons ' Permit No. j Date Issued Nu. +� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS j 2pplication for oisposal *pstem (Construction Permit Application for a Permit to Construct( ) Repair d Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. H ok\_�-Gy k Ow er's Name,Address,and Tel.No. Asse Cc,ssor's Map/Parcel V' S� � � f Ins t ler's NamAddress and Tel.No, Designer's Name,Address,and Tel.No. JC_ `�(Z�.1� �`3 vet) \/c;, U�`.(Z Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) 'Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. i Description of Soil C 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 t 's Board of Health. '' ( S Date l 1 I Application Approved by ; ; — Date v Application Disapproved by Date for the following reasons te Permit No. Date Issued - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by �Q r-�(_Ar at SC �ScC��4�G�! 2 U Al C'S� �('n Sb�as been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No dated ` Ins.aller Designer #bedrooms Approved design flow gpd The issuance of this-permit s)iall not be construedas a guarantee that the system ill func' n si.tied. Dale �a /�7 Inspector r --- ------- --� ---------- -- -- - - - - - = - - - - No. FeeI L� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposar *pstem Construction Permit Permission is hereby granted to Construct( ) Repair(V) Upgrade( ) Abandon( ) System located at Q J3 G rc C_ 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:Co.s ction ust b completed within three years of the date of this permit. Date Approved by / V No. �`7 ® �"� Fee BOARD OF HEALTH TOWN OF BARNSTABLE 01ppYicatiou _for Yell Cou5tructiou permit Application is hereby made for a permit to Construct( ), Alter( ), or Repair( ) an individual well at: O's U\U r� " 13(=, o j' Location-AdAress Assessors Map and Parcel A I. � � 'l l lo►�r^o e Owner ` Address Installer-Driller wv\` Address Type of Building �J Dwelling Other-Type of Building No. of Persons Type of Well �' y�V C Capacity Purpose of Well Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Co pli c 4beissued by4 a Board of Health. / Signed o�)bate �� Application Approved By Date Application Disapproved for the following reasons: , I l) Date Permit No. l� o 1`� �� 9 Issued tf� 3[/q Date -------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed N Altered( ), or Repaired( ) by Installer at C=7-r14ti ,� 1A) has been installed in accordance- th he provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the applic ion for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector No. lJoO Fee I BOARD OF HEALTH TOWN OF BARNSTABLE 01ppYication -for Yell Construction Permit Application is hereby made for a permit to Construct( ), Alter( ), or Repair( ) an individual well at: �8 �6\y"cs w 13(=� 031 Location-Ad•ress ^ Assessors Map and Parcel -� CO 4 Owner Address Shc�.vr �-�c.v.r��iY� �• C�. 3 a C 1Z� �y Q��.�,,� Installer-Driller J Address Type of Building v Dwelling Other-Type of Building No. of Persons Type of Well LA ?\ c- Capacity Purpose of Well Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Compli nc. as be;i issued by Board of Health. / Signed Date I Application Approved By On n Date Application Disapproved for the following reasons: hI� h Date Permit No. � � / Issued In d 3 Lf Date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well (N` Constructed Altered( ), or Repaired( ) by '1)1 ��o��e i !`� mac, Installer at has been installed in accordance vKith the provisions of the Town of Barnstable Board of Health Private Well Protection PP Regulation as described in the a lIc tion for Well Construction Permit No. Dated g THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector BOARD OF HEALTH TOWN OF BARNSTABLE ell Construction Permit L No. w�C/� —'O I � Fee Permission is hereby granted to `` C c' �Z \A ).Q �t Installer to Construct` I), / Alter( ), or Repair( ) an individual well at: No. 1 1 G� w� V-�) ' ) Street (/ as shown on the application for a Well Construction Permit No.�`� -� , �-.—Dated L V Date Approved By Od -n- Gam, 3 t sF QW WAIT XF � �\ _4,0 ` LwY-r OF wq:;e- v . . �� _ ��_�- � ��-:►fir s� No. Fee AQ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppficatton for of Spool 6pgtem Congtructton Vermtt Application for a Permit to Construct( ) Repair 0() Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Locztion Address or Lot No. p� lit Jt�y f'I V� Owner's N (e,Address,and Tel.No. 1%�1 G-�✓,W Assessor's Map/Pazcel � ��/ Installer's ame, ddress= nd Tel N , !QCLM41-r (J6Ai C Designer's Name,Address and Tel.No. 4A-nit Type of Building: SftJlR.,n Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) it ; e,3 �'L� . If 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 ' le 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by is oar of �ah. / Signe Date I(� Application Approved by Date Application Disapproved by: Date for the following reasons Permit No.t2O6.W Date Issued - No. 4 Fee�— THE,COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 3pprication for ]Digpoga[ *pMem Congtruction Permit j 4 r Application for a Permit to Construct(-) Repair V,) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. I��O�� Owner's+Name,Address\and Tel.No.A/_1�� Assessor's Map/Parcel Installer' Name,Address,and Tel No.UUC W�T�-r V�✓)+ Designer's Name,Address and Tel.No. 1t3S �.t c�Coc..S-�- U A i Q 5� � &.A✓1 i S Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan -Date Number of sheets Revision Date Title 'Size of Septic Tank Type of S.A.S. Description of Soil Nature of I epairs or Alterations(Answer when applicable) C Vt v A 41; W 434t +nl I 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 o 'tle 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by is oar of ea th.._ , ,.....r . .4 Signe• / Date Application Approved by [ Date u �. IV Application Disapproved by: Date for the following reasons Permit No-�V 4j_ W Date Issued Q , THE COMMONWEALTH OF MASSACHUSETTS- - I BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY`,that the On-site Sewage Disposal System Constructed ( ) Repaired (X ) Upgraded ( ) Abandoned( )by ' I I u e UJu _�1 !/✓1+ -e— at Ho I wl&. (�f, cu. [��.,rrl u h(�t has been constructed in accordance with-the provisions of Tittle 5 and the for Disposal System Construction Permit No. ^�- � dated 10h U 7 Installer �ItrcWwfi-a.r TLI'A<C Designer I #bedrooms 1 A Approved design flow WA gpd The issuance of this permit shall not be construed as a guarantee that the system will functio,sdesgned. Date f / r,/ Inspector , -•' —,----=-------------- �Qo7" No. �4 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS D gpogar *pgtem Con6truction J)ermit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at 0 AL,Jwy 1)r, (A) and as described in the abovdApplication for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Const ction must be completed within three years of the date of this pjrmlt. Date b 3 D Approved by t LOCATION SEWAGE PERI+AIT NO. VFLLAGE OwmcTi - )�I o I N S T A LLER'S NAME N ADDRESS VIA L S 77- S Wilt D E-R. OR &WN-ER r LL A-\ v DATE PERKIT ISSUED DATE COMPLIANCE ISSUED- J � i� s G=L L 7-0 ram/j _ 1 j. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTsKjEcT TO APPROVAL OF -FABLE C014SERVATION ......................•..........OF............................ Applirtation for Daip.asal Workii Towitrurtion rami# l 13 Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal !� System at: (jam V e ........................... .........................�.[......---.......--.-----------------................__.._........-- to Address No. , Owner Address W1 ! ar........-•---�.�`"-�-1--------------------------------- •--•-----.Jr`�.:. �'! Installer Address d Type of Building Size Lot.....2 .5_0...Sq. feet U Dwelling—No. of Bedrooms.............�----. ._ -Expansion Attic ( ) Garbage Grinder (k/0 ►-� Other—T e of Buildin No. of persons............................ Showers a YP g ---------------------------- P , ( ) — Cafeteria dOther fixtures -----------_-- ----------------------'--"-'-......-----'--------------------------- -----'----------- ----------'--'-........................... W Design Flow.._.......5_Y_........................gallons per person per day. Total daily flow.........3.2_.....................gallons. WSeptic Tank—Liquid capacity.14�0 J..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.....................sq. ft. SeeFage Pit No.......I-------------- Diameter.....1_Q--------- Depth below inlet__............... Total leaching area._2 ..sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a 0.4 Percolation Test Results Performed by........ �:�'"`:.._..�v.t ........................ Date... .(._:'_9__77� _. _....... Test Pit No. 1................minutes per inch Depth of Test Pit------j_/a....... Depth to ground water----- _. .?1&.e fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth jo ground water........................ ODescription of Soil------- ._...... ..0. ----•- - ••---------------------------------------------------------------------•-•----•-•---------------- x V ---------•------•-'---------------'.......-----------------------------------------...........------•-------------'----'----'-'-------------"-----------------'---'-----------•--•--------------------- ......................................................................................................................................................................................................... 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:ITS . 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been qeDd byte board o health. Signed -- �. .... . ...../.... ... ....... Date Application Approved By............... .............. '-------- Date Application Disapproved for the following reasons----------------•-------'-------------------------------------...---------------•--------------------.._..--•-•- ...---•-------------------•...--'••••----•'--•---••------------......------------•---•-•-------.....----..._.._.__...----•---------------------------------------------'-'--------------'---------------- Date PermitNo......................................................... Issued_....................................................... Date 76 S_ No.&A aty 2— st 3o ...................... ....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................................OF....... ............................................................................... Apptiration for DWposi'al Works .Tonstrurtion 1hrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: �q 1�.......... ..... -- ---------------------------------------- .70_4V Address *p*% I -- ---------------------------------**- --------------------------------------*.............. ....................................................................... .................................................................................................. C,i6.aJL-- L-VAP PA.I Add)pk oq Installer Address Type of Building Size Lot........2. -S'U Sq. feet . ............... U Dwelling—No.-of Bedrooms.............:1—--------__--_--Expansion Attic Garbage Grinder F13) Other—Type of Building ............................. No. of persons__.._____._____.._...__._._. Showers Cafeteria Othxtures ..............................................................................--------- ............ ................................... Design Flow...............................I _________gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid cap, y_-.all...gallons Length________________ Width______._____._._ Diameter________.._.____ Depth:__.________._.. Disposal Trench-No_ ____________________ Width.Ij.................. Total Length.... ........ Total leaching area. ..'.sq. ft. ....... ....... Diameter.__:____.__...___._.I- .......... Depth below inlet____.__...._.:.____.,,,Total:....... Seepage Pit No Total leaching,area..................sq. ft. Z Other Distribution box Dosing 1. X`L( - 0-4 4 Percolation Test Results Performed by....... ....................................16........................ Date_................... Test Pit No. I................minutesperinch Depth of Test Pit._________.:________ Depth to ground water______.._._______.__.__. 44 Test Pit No. 2................minutes per inch Depth of Test Pit__.__._.:.__.______. Depth to ground water______.__._____._____... P4 .................��.a... ............ .................................................................................................... 0 Description of Soil____. .................................114..........11-111,.....................................;..................................................... W ........*------------------------*---------------------- ----------------------------------------------- -------------*..........*------------------------------------------------------*---------I ..........................................................................................................................................................I.............................................. 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'TTLE 5 of the State Sanitary Code's de The undersigijed further agre/esn t to place the system in operation until a Certificate of Compliance has beertqs� e by e boar . ealth. 74 10) S 74 jf.... ------ ...i------------------ ----- -------------- --------- Application Approved By................................. ................................... .. ...... ................. ........................................ Date Application Disapproved for the following,,reasons:................................................................................................................ ..................................................7----------------------------r......................................................................................................................... Date PermitNo....................................... Issued..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , 44-,. .......................................... tom, ...... 1"0 A ............. ................................................................. Trrtffiratr id Toutphatirr TEJS ,,4jT0 CERTIF;S,That the Individual Sewage Disposal System constructed or Repaired ................. -14------------------------------------------------------------------------------------............................................................................ by............ r 1 )4�1) �6 Installer at.............................................................fl,---------------------------------I-------------------------------I------------I------------11------------------ has been instilled in accordance with the provisions of TIT f�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......... ....... Y� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -T 141% 00/-e 8 ..............................I.........OF..-- ......... ......... ......... ............................... 3 No......................... FEE........................ Permission is hereby granted_.____ .........1.,A�%................................................................................................. ........ ........ .... to Construct or Repair an Individual .wage Disposal System at No. ......................................I----------------------------------------------------------------------------------------------------------------- Street /A. le" as shown on the application for Disposal Works Construction Pff='t N0_1111 4/0��ate ................................... ............................................pp. .......... ; .R... ...................................... 2� Boar of Health DATE............... ........................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Rr{• pL• �3.vD SIG 'R�rIK• 7' 1�ram' � q•�ra �+"d- ' 'f�'�F W� ��r� rZ,do �� 1� �� T�r66�• T��1�4t� qt 25�0 . �1 l� •-�-}�� MrN7F�- �=.��,�-•-rah 1�'"1" i I P, 4C+MNcY. ��O' V15r IM- ivy �A Nb - I15[79> 0 Icy. ?,�-•�n � -� �. - 5 � c` /\ . y�v� f l I•i''"Ti'°�1 T�%��`r.�'6�F�r /�`i v..""'r"r }tea I = to,D' r:; �yi.. �.-Q 1r ! ONAL - - �T ( l l- -�� •-� u �j Ml�y a !3b 71 -v�( f�• �3.OD 744,17. F, >c I f 0 = 3=� E�pt7 PT1G 'fit lK• 1, L 4gr5_ I Tj' x 5Ox6x �7� C� SE� com Tr--�/15x�l M1 7"A(vr, l hf I. ->•f}mil F iKI KN? - �,�1 "1" 1� L� `�''`i• D �.�}-dam,,^•!:��.i t� �>,'�Lv�( . 4 f�HpCt= INLc 2�1-. I I dXb ECG. a �� N14. •IN�f� 40.0 fi?G.GANG. „� IWO :sL ryc1� 3(o•7q � �5 t CL• 35•� �� r I fie• I � � £�/ 34�.00 �s PIT+ 2� /�} TD wA-!'G-P -ALL Cb t 2 I L r� -� ,� M T TA"''- �,lt\ N OF�1 1, ON 41- �1L/ T IwV T�y ;P- `Ij5_::: 9 G o n cn if C� IONAI -7 A*/ 1'i 7 71 S TOWN OF BARNSTABLE LOCATION `y� Se SA SEWAGE # VILLAGE �P�,4� L�'/�� ASSESSOR'S MAP & -0 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY i�Op LEACHING FACILITY: (type) e`icA (size) ZX/?X1,.� NO. OF BEDROOMS .S BUILDER OR(CWI�3R PERMITDATE: COMPLIANCE DATE: Separation Distance Between.the: Maximum Adjusted.Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 4 �(A s, S .W✓0 . ,� �-._ a r uY � y�""� s }z�1r.:. a_€-:� 3 ,. t w�r � v * ,, � APPLICATION `FOR PERCOLATION TEST AND OBSERVATION PITS LOCATION Lam• Z°I �•pLwAq �ZIU 6 NO.� VILLAGE_ \AI SST ' ,c� �-x�.-ii DATE Z , 7--�. APPLICANT �zl-1 �:�(.-�ILLt/�'Wl.s FEE�1�� ADDRESS Pd? SKIS C�rc gI SCE; TELEPHONE NO. (Non-refundable ENGINEER_ T�Q .:1�4, TELE N N0. A' DATE. SCHEDULED �,�. Cy �--- (Applicantls signature • i'• • • e e e o' • e• e o e • o e • • • e o • e e e • • • • •e• • • • • • • • • • • • • e I•'• • • • • • •• • e i •.e i • •• • . ASSBSSOR'S b�1�P �.OT NO: SC � . SOIL LOG SUB-DIVISION NAME 10( j ��,L, � L DATE '' e? EXPANSION AREA; °.YE,S -NO ` ENGINEER: TOWN .WATER . PRIVATE :WELL - '' ` BOARD OF HEAL? _ 14L ILQT'SM?,EXCAVATOR SKETCH.- (Street nafne,etc. ,dimensions. of lr%4 exact location of; -test holes and percola ion ;tests, locate wetlands in proximity to test holes) l�LW4%/ jam„ Q ;� NOTES: . It , - � ♦ Nat• �o ' t�o•� , � `': Q % .00 22 47 0 40 ob `77 • • • /1� 0 • e•. ago so do, sop J• : PERCOLATION RATE: ' TEST HOLE: N0: t ELEVATION: TEST HOLE N0: _° ELEVATION 1 t ' e4 1 3 :L' ( ,U9 Cab P t: 4 3 5I LT Y $• 5 4 q 50wA ceKrovev oU Co rt .6 a 7 6 9 11 10 A li 12 t I, RY, 13 �Z 13 A ' 14 tr4 14 A` a n" alw A,l �a�" �•, 15 .,�.. 15 16 } 16 SUITABLE FOR SUB-SURFACE SEWAGE: . LEACHING FIELD LEACHING PITS 1< LEACHING TRENCHES 7` ji UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER- ASSIGNED .ON PERC TEST APPLICATION ORIGINAL: COMPLETED I N ENT R P COPY: RNED O BOARD OF HEALTH : RETAINED BY• APPLICANT vk i ', .. .. -'9"L �.W:i'H.v'Yfnb".� i t r S M, �Y•W- .- v _. r .•... ^ ,_ zz �'; x,•. �" r.r a { � `rp � � •, s fj,/�� I t+r..7.3 j• 1t i. ,-=?4 s{ ,•x 5 3. 4 '+•`'i y ,t' s X-'F i--iQ j, t^'L • J '/e. A(i�z `• V S �a !�('�(` s•.py^� \f S ;j ` 'Rf f ', t i }* 3 }: •4' t �011 ,•„J JG�„ll:.l�'. i s 't -� •4 s 5 tX- y' -t f+ it A .. .. r •, i' S � 'P, .t .'.3"sPix v:=sF �f { .`�i' {{��*.. (�P rr� ti k..; r C° .•:. t„rr {y•.• � t j i,.X �'.' t' s .. n�A Y....Y' yt'S.,t'! R M y'I&k ,S s 55 e^� #�, Novembier 4 1981t: t �+' ,t �, ., �. �'4 •y..- t 4 x c „3 x `:AV 4S++i1,k"i 9 f" A'S ^'. `r ,�,[� .�-Y �'f �:...34t zr.. Y•x 4 `y ♦} ht x.• • . y5 4 •°{- `° f.•d 1 � i ';5 R"^1 '(��t S, 1. A i a, k. + ..{� iv •# r•r !.. .., u11 n ~0 '' • ~. c Mr•: Wil liam .D. M .West -.i •. �•�° t %,r- la Y' � °' :r: a .s t r �f� � rF� 6�' t '4� a t ' Q$ .;, Barnstable Ma. =d26647 ` �� `��t e y, � •� }} , k 5 It F !. :` „ r "_ .�" € 'l k ` } 3f 1 j {. x ,•° 3 " y �� k ' , St ° 1�. H •5 � L^ f f R • � � {F ,..y{ t +;;.y R'. { y"' � t f Re• ; Lot 16 Holaay'Drive West Barnstable �I Dear Mr;:.r 'Mullin: , 'z a" nji + * Y ,• 'T � '.. 3 n •k r•yy . )S eY 5 +y.! il? y*r , /,:.' J. . Xou';ar'e ;granted`a''Fconditionalvariarice to in`sta341' a, well` 335 feet from `an .abutters septic system,iri" l 'eu of, the:°required r 1 i { 150r"feet, fon Lot 36;::Holtaay =Drive 1,est Barnstable: y i v5 ° However; prior, t' final' aj priova�, youi must�>submit,-an,-.on-sate sewage ;plan conforming to Title.55;, of the'' State' Erivxronmental Code; and 'the Town of Bagri'stable' ,Health Regu1'ations. �n ,ad4d it'-ni o `+ fprior-•j r Y �' •i F c �'•• 4t.4�' �'4'' n . (1-, � it-1 tty; t,h' Sen b • i L •kr 5t, s , well' uildi must be:installed.,and. the water ,tested.--"The -water. must meet all of.-4 the standards contained r 'the S t 4 i � e t af'e�Drn]cjng .,Act. Q r � .. +' The' designing`engineer i must certify, :in writ: Lng;,.;to the- Board, that his on-site_ septic W.system 'kd#sin has,; een strictly`adhered t o f vr° g i ,y ti t, to prior to�.the .ssuance of a "certa.fcateof comp].iarce. ' ��7* Y ^A other4pr_ovisions..contained` in.FTitle,,5,�tof+ the .State En °vHeal ,. ironmental.;Code; an the Town,:of:Barnstable•. Health,R "must be'`strictly, adh d'.ere ,to `' i `° , ' ' `�� ` a M V:71W, ru yours A' Ro ert `L. Chitldsx , chairman � �I.i � i. e �Z ��;,ti ♦.' iS. 'ti >.. s .S,t w tr r j ax, !F 4 .sue A ��• �k j P� r ty •'Ann-Janeshbau h .. r•4 � i 'i,a 3, z,' �..'ti„,� � �,F { ',�, ra } i }��. ..."i.a; 'd •c :.4 .{ � �_,. e-, y' F t �',{ 5ti r_ •�- .¢ •�� .:f: a q � ti ;� r �7•, 4 '.t' a' 'sh3 xt w ;;4 ,t t k': k .,. x '� 1r �� s' H• F. n: M• L! i ,y 't 1 .is., i• t �tr i- • a 2 �i Y `,4,,24 F' �.'i'iF r,y1 RSr r P _' 7 _,i } . iv ' y. u i• " '``"BOARD OF HEALTH Ch ti k . h TOWN OF BARNSTAiLt L.�SS,y P t ,. � a } i� x". 4'•�� '� � /��. •,{ ..S ik� •'- i LS ;{. ,L t - ? �,' 'N11S\�iliill •� t~ s, x;•;k t ;: .. � -.;C '.J. ,. .,rp, a" i n . �i " 5 ;. �'' F �. .'i `` } - - -e y} ,�-"� { s �.•ls '- 'e 'S• n a>i.'j- '.G+ + ! -•,.,�y'G. _ 4 •k• i is.6 , i +'L { 1. � irR� ; � . d' � s �. t . ,4� z - ., l^F �• !`.t`A .-. 1 r..+ �, .. ... 1,. - r, ,/[1;•- _ a v- .. f,. William D. Mullin, Jr. Cabinet Maker Period Furniture Designing Antique Restoration WEST BARNSTABLE,MA 02668 TELEPHONE: 362-4817 At L` W �v (axe ";Ve 0 Ae 0/ �� @E �Zi� �17/1kGXQ/yl/972�'/,�7/L� c�s'_�(G�LL�nJry/F �y/��/�]/✓4ZPP/I�L•y�j/�/ ANTHONY D. CORTESE Sc. D Commissioner PAUL T. ANDERSON Regional Environmental Engineer Septorber 144 1981 This Department is in receipt of an application under General Laws, Chapter 131, Section 40, filed in the � (dame Kam 'Lar 125 forth Street, stoo h ., Mat 'acha otts Owner of Land Sam City/Town t a 610 Location Lot 16, 11olway IrYriovv. The following information is required to be forzsarded to this office for a complete. filing: Notice of Intent ( ) Environmental Data Form ( ) Locus Map Plans This project has been -designai*d by File Number S - h) The plans for the* sewage disposal system (may) not meet the requirements of Title 5 of The State Environmental Code. Review with Board of Health. ( ) A Chapter 91 Permit may be required by the Division of Waterways. ( ) A Permit may be required by the Army Corps of Engineers. ( ) Coastal Wetlands Regulation should be reviewed- prior to hearing. #-X) Cr tot `level Itot .Shy... r Issuance of a file number indicates".onl`y completeness of the file--and--nq approval of the application. For the Commissioner Pau'l- T. Anderson, P.E. Regional Environmental Engineer . cc: Conservation Commission Q ) Board. of Health 4 i [ r c h = tot- . it a .� 9 � r ,�. S •- - •�.._s { 1 I..rt. .- • - "• r -' ` - _ -Y.'- , �.;i "c- .� '_''� r "':j'""`^"'�•.+a..irr r .,-a •vNc*r+k'.�*liiti, �.,, - t' - > ti ..• Y :e�," >�"�. •d•. 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