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0031 HOLWAY DRIVE - Health
31 Holway Drive, West Barnstable a I law-031 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M 31 Holway Dr. %g Property Address Howe Owner information Owner's Name is required for every page. West Barnstable V/ MA 02668 4/11/18 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. A. General Information 5-/# aq 1. Inspector: �`yy Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 13010 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 �9 4/11/18 Inspector's ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original 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. 15ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 L o Iyp VS f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Holway Dr. Property Address Howe Owner information Owner's Name is required for every page. West Barnstable MA 02668 4/11/18 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: ® 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): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 31 Holway Dr. Property Address Howe Owner information Owner's Name is required for every page. West Barnstable MA 02668 4/11/18 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 (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): more than 4 times a year due to broken or obstructedpipe(s). The ❑ The system required pumping o e t a y 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 16.303(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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts DIML Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 31 Holway Dr. Property Address Howe Owner information Owners Name is required for every page. West Barnstable MA 02668 4/11/18 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 '/2 day flow t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' M 31 Holway Dr. Property Address Howe Owner information Owner's Name is required for every page. West Barnstable MA 02668 4/11/18 Cityrrown 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 amappa 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.doc•rev.6/16 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 31 Holway Dr. Property Address Howe Owner information Owner's Name is required for every page. West Barnstable MA 02668 4/11/18 City[Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(5)] D. System, Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Holway Dr. Property Address Howe Owner information Owner's Name is required for every page. West Barnstable MA 02668 4/11/18 Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Well water Sump pump? ❑ Yes ® No Last date of occupancy: Occupied 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M g 31 Holway Dr. Property Address Howe Owner information Owner's Name is required for every page. West Barnstable MA 02668 4/11/18 CityrTown 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: Pumped 2 yrs ago per owner 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.doc•irev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M , 31 Holway Dr. Property Address Howe Owner information Owner's Name is required for every page. West Barnstable MA 02668 4/11/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Existing septic tank, new d-box and chambers 2012 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 6" Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: >10 feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) H-10 septic tank appears to be structurally sound, decking over approximately 1/2 the tank inhibits acces to the inlet cover, outlet is accessible If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000g Sludge depth: 5" l5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Holway Dr. Property Address Howe Owner information Owner's Name is required for every page. West Barnstable MA 02668 4/11/18 Cityrrown 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 '12 Scum thickness 1" Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3 years to prolong the life of the system 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,. 31 Holway Dr. Property Address Howe Owner information Owner's Name is required for every page. West Barnstable MA 02668 4/11/18 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.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M , a 31 Holway Dr. Property Address Howe Owner information Owner's Name is required for every page. West Barnstable MA 02668 4/11/18 Cityrrown 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.): H-20 D-box is 2'6" below grade, cover to 6", very 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.): * 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.doc-rev.6/16 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 M SV>r 31 Holway Dr. Property Address Howe Owner information Owner's Name is required or West Barnstable MA 02668 4/11/18 . every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Chambers were video inspected, effluent level appears to be approximately 8" below the invert, top of chambers approximately 3' below grade, no indication of past 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 t5ir•s.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 31 Holway Dr. Property Address Howe Owner information Owner's Name is required for every page. West Barnstable MA 02668 4/11/18 Cityrrown 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.): Soils are compact and dry Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 31 Holway Dr. Property Address Howe Owner information Owner's Name is required West Barnstable MA 02668 4/11/18 or every page.. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 0 � �q5q C 51T LGq . 6 c.,'30 M EASurfEm CARS Ea_ Qv� (ZEcv2� t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Holway Dr. Property Address Howe Owner information Owner's Name is required for every page. West Barnstable MA 02668 4/11/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 1977 NGW 14' 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: Topo mapping shows the site at 50'msl and nearby surface water at 5' msl You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 31 Holway Dr. Property Address Howe Owner information Owner's Name is required for every page. West Barnstable MA 02668 4/11/18 Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 2 A_A 4+ D `EED RESTRICTION WHEREAS, I L �' (owner's narneH Of 3/ *1� /R,e, 14/ ,40,V:50 V 4F_ MA (address) is the owner of 3 0,11V OR, located (address . I MA (hereinafter referred to as -0-(' 7 i and being shown on a plan entitled "Subdivision of La nd in 5 I MA Property of d 1 eJ U. i et al,of /2 1/ duly recorded in Barnstable County Registry Deeds in Plan Book Page 9 7 Or on Land Court Plan Number WHEREAS,IAN es P. � Yas the owner of said lot has (owner's namey — ;==:T agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum , Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compiance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single family home on this property, is requiring'that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, deedr -TAWS P 4446re NOW, THEREFORE, LywA - -17 BTU does hereby place the (owner's name) following restriction on his above-referenced land in accordance with his agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: 1. 'N 4T 2V) jI►0 may have constructed (addre upon the lot a house containing no more than (3) bedrooms. r1gjj LrNq0,r 14A99iM agrees that this shall be permanent deed (owner's name) restriction affecting Lorr Zel located on1&4_4 A AZ.W� nd being shown on the plan recorded in Plan Book 2 , Paged !O Or on Land Court Plan For title of see the following deed: Book 3 Z �, Page C. Or Land Courtertificate of Title Number . T' I Executed a sea d instrument r-,� day Ow er's Aignature J, Owner'i signature-/' T__' Owner's signature COMMONWEALTH OF MASSACHUSETTS ASS 20 l`63- Then personally appeared the above-named U' s '7P. + iY,-Nrx>A _I W—ate� ' known to me to be the person who executed the foregoing instrument and acknowledged the same to beT j free act and deed, before me, Nota ry P u b i i ca -gee' ,yprgMUI L ...•,� .° ,% y, My commission expires: (date) 4 BARNSTABLE REGISTRY OF DEEDS deedr aV, ,s°°•� e� ®'*°.B. �°a John F. Meade, Register y IL TOWN OF BARNSTABLE LOCATION 3 l 1 D/4f4M b,1_1 V SEWAGE# t VILLAGE J','6&r0 ' y ASSESSOR'S MAP& i PARCEL INSTALLER'S NAME&PHONE NO. fS0v5-AP_ �cL �� �U/6 SEPTIC TANK CAPACITY /000 e-4("11r4o . LEACHING FACILITY-(type) Uoyyi'h l.��. (size) NO.OF BEDROOMS \j OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 4J 4 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` f 300 feet of leaching acility) Feet FURNISHED BY ��— � . ��� a ,::� � ,. .�' '' a i� ;- � � ,. .. Sys,, a � �-� ti � �� g � a ^�� ` ._ No. O • Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in com afar: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS YeS application for DISposat6pSt1PUt (Construction permit Application for a Permit to Construct( ) Repair qe) Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No."3( 4401 wAri t 0=A 9.rcv P_ Owner's Name,Address,and Tel.No. W,eST 43Ar..,S4aSle 40L. e Assessor's Map/Parcel ( 3 o�_, 3`1 3( 4-1(-,A-1 led W IgA ,,446-e Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Bo.,SA-e(c_ 3'c1n: nt 52�•��c¢ 7_"c 1,A C- NVi -E SAn we (n T�-pe of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building S+Jtj(Q E Asx No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 4 gpd Design flow provided 3"(0. gpd Plan Date V. ( `l'"`(2 Number of sheets ( Revision Date Ata",e_. Title Size of Septic Tank CEO Q Type of S.A.S. C* S-bo Gk 4".,k,z,-r Description of Soil Se-e tot Aq Nature of Repairs or Alterations(Answer when applicable) C.ao�d c e ):;a %ea( LP 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. S' Date 2-—( L Application Approved by Date 1:—d2 —� Application Disapproved by Date for the following reasons Permit No. U -7 Date Issued ------------------- - .. «.y+. .. i "`•-'fFs•+^t».r.A:`w....rr+r'iew../"yi� ...+..�....,r r.....- .... v,...�-'o— •++..... w No. o a I 1 sty � .r is Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplicatlon for j3isposal'�' P PIY� ConstructionPrttllt Application for a Permit to Construct( ) Repair(1/) Upgrade'( Y,Abandon( ) ❑Complete System f Individual Components a Location Address or Lot No.3( 4-(0A wet<1 IE4',(Qi(`v 2 Owner's Name,Address,and Tel.No. WesT gA,- .3Pabte , C 2ftSTk Nowe Assessor's Map/Parcel ( -2 In•�staller'/s Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 7 ax (,E 9 5A11c.+c,",cI- M4 071' l�gC E N V 1 G7 SA C(�, 3 -7 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 5'✓+c, (e F,Qn, y No.of Persons Showers( ) Cafeteria( ) Other Fixtures �11. . Design Flow(min.required) 3 3 0 1 gpd Design flow provided J T d. q gpd Plan Date U-( 5- (Z Number of sheets Revision Date 416 iV CL. Title \' Size of Septic Tank Type of S.A.S. ( 5"D0 <f ti A,�'a 'r Description of Soil S(, e x Nature of Repairs or Alterations Answer when applicable) tl III Date last inspected: Agreement: f 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. �4 S � G/ Date �--2_ -( Z- ApplicationApproved by ) a Date '( .-.2 -/ Application Disapproved by Date for the following reasons Permit No. 2 G( Date Issued ' ' .2 ------- --- ----•---------- _ -- --.-------•--- -•------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS •BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CCEERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(,V) Upgraded( ) Abandoned( )by l70Qh+/-e at 31-4r �4 o(w a 1'7 ! .x! has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �)G(2 - l/7dated �- Installer t_J104'uT1,e t rl Designer o 6 C N ( #bedrooms Approved design flow 3,4 0 1 4 gpd The issuance of this permit shall%ot b construed as a guarantee that the system wil°1'functio de igned. Date Inspector Inspector No. )d Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS BispoBal 6pstem Construction Vertu Permission is hereby granted to Construct( ) Repair 0- Upgrade( ) Abandon( ) System located at Or Ft b( � 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 musp be completed within three years of the date of this perm' . Date f Approved by ( Town of Barnstable P It 510 Department of Regulatory Services . ABLE, : Public Health Division Date 0 9. �� 200 Main Street,Hyannis MA 02601 Date Scheduled b Tune /l Fee Pd. �lJ 0 Soil Suitability �fAssessment for S e Disposal it Performed By: �/ 7G •�/"/Cam/ Witnessed By: 4 LOCATION&GENERAL INFORMATION Location Address 31AA �q -f]2. Owner's Name^�a//, ,I�w.ry>• �/,e�f` r� W� Address ` Assessor's Map/Parcel: � /�g Engineer's Name,GrM4V4e;d NEW CONSTRUCTION /// REPAIR Telephone# 6 1017 Land Use Slopes I%) Surface Stones Distances from: Open Water Body A Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line It Other ft SKETCH:(Street name,dimensions oflo4 exact locations of test holes&perc tests,locate wetlands in proximity to holes) � I zo W r'i"1 Parent material(geologic) Depth to Bedrock Depth to Groundwater:Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ PERCOLATION TEST Date Time Observation Hole# Time at 9" Depth of Perc Time at 6" Start Pre-soak Time r@ / Time(9"-V) End Pre-soak /2 Rate MinAnch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- **If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\S EPTIC\PE RCFORM.DOC DEEP OBSERVATION HOLE LOG Hole# - Depth from Soil Horizon Soil Texture Soil Color Soil Other —' - Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel) V /G� I' r DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other - Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency%Gravell DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. - - Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other - Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. - Consistency,%Gravel) . Flood Insurance Rate Mao: / Above 500 year flood boundary No k Yes Within 500 year boundary No Yes Within 100 year flood boundary.No_ Yes Death 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 natu Ily occulting pe io�rial?—4 Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Envir mental Protection and that the above analysis was performed by me consistent with --- the required training,expel se el erience described in 310 CMR 15.017._;� �tfO/ Signatu Date Q:\SEPTIC\PERCFORM.DOC R. A. Bousfield Backhoe Service 17 Burbank Str-eet Sandwich, Massachusetts 02563 t flame �., �- �`� Sewer Permit No. 7 -1"7 Location: " �I w)au Builderfs Name and Address NA, Date Permit Issued: C2 :13,—'T Date Compliance Issued: 7 W, 77 `Cl . '7f ,r f No.........1 T Fsla....../�l................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H A H .............O F........ ... `..........-.....-.-................. Appliratiun -fur Biiipuuttl Workii Totuitrurtiun Vrrmit Application is hereby'made for a Permit to Construct (/) or Repair ( ) an Individual Sewage Disposal System at ..................... --•-----••----•--•-----....-•-•---•-•-------••----•-•---•--•--•-••-•---- --•-•-•--•-•----------------••--�- Q ......................................................... ... K_( ML ddr.ess ............................................. W ID,loZ ��� � �� Address Installer Address Q Type of Building Size Lot............................Sq. feet Dwelling-3-No. of Bedrooms__3 .......______________________________Expansion Attic ( ) Garbage Grinder e q aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Otl�r fixtures ------------------------------------------------------ W Design Flow----�A_d________________________________gallons per person per day. Total daily flow___l©"...............................gallons. WSeptic Tank—Liquid capacity/�!�,�gallons Length---------------- Width................ Diameter---------------- Depth................ x Disposal Trench—Y o_ __________________ Width._........._._._.... Total Length_................_.. Total leaching area__-_-._.___--__.f..sq. ft. Seepage Pit No..____ ____________ Diameter.AQ'Z_____- Depth below inlet.................... Total leaching area-------------�..sq. ft. z Other Distribution box ( ) Dosing tan ) d. '40C 2 2j Ig 7,�;. Percolation Test Results Performed by--- --- / __ _ _ .: ................ Date._.,!V.:nA .-- - a Test Pit No. 1----------------minutes per inch Depth of Test ---------------- Depth to ground water----_-._-.__--_.__-__--- �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_._-._--__.___.____---- 9 ------ f/---- ----- ,.---- - - -- --------- ----------I---- - O Descriptio of Soil-------0--�i..- `3 � 3 p 1 ------------ - - - - ---------- (Sl d ----- -------&-f V Nature of Repairs or Alterations—Answer when ap icable........ ...... -----------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------.. Agreement: ' The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i tied by the oard of health. Sign Date Application Approved BY �� - ---- ------ -----�s------. •.. Date Application Disapproved for the following reasons:................................................................................................................. .............................................................................................................................. Date Permit No. Issued. `. --- --te....... Date 1 t No. . ........ _ FicE...... i... ' .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HF�A, ��j H �. .......�.. r .- ........ OF ....... . ................. Appliration -for DiBpviial lVarkii Towi#rurtion Permit Application is hereby made for a Permit to Construct (� or Repair ( ) an Individual Sewage Disposal System at: `L ocatio -Address _ f or t No. ...__.•________________________ ------------ /�•./_�i______.''-/r .,JJL ........� W `���� /,��✓�//��n��/� Address _ Installer Address Type of Building w Size Lot----------------------------Sq. feet Dwelling No. of Bedrooms____________________________..___..Expansion Attic ( ) Garbage Grinder Other—Type of Building ---------------_-..----__ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 0.1 Ot1Vr fixtures --------------- ------------- W Design Flow-----%------------------------------------ allons per person per day. Total daily flow---0.0-------------------------------gallons. 9 Septic T:.nl:—Liquid capacity/Q''1gailons Length................ Width------------.--- Diameter.....-- Depth..-.-_--_--.-... xDisposal Trench—No- -------------------- Width-------------------- Total Length-------------------- Total leaching area--------------------sq. ft. 3 Seepage Pit No......I------------- Diameter_Zf�"_--.---. Depth below inlet.................... Total leaching area-------...........sq. ft. z Other Distribution box ( ) Dosing taM"11-1 ) - ��- C 1— d� 27i /y 7, . Date....!_1J__— _ ---_'_�� .a Percolation Test Results Performed by.___ '.. ._j,�_:__ ___ Test Pit No. 1----------------minutes per inch Depth of Test it-------------------- Depth to ground water_- ------_-_._--.-.-. rT4 Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water-_.-.._--__.-_-----_---- a p / . ................_.. . (t =•--.•---• �.. --------------!-•---•---......_...._ O o �---Descrpto f Soil_ � 4 x ' / . !�_ _ V Nature of Repairs or Alterations—Answer when applicable. i ll ------ .✓....� GL =�f :-%---'------ . -----•-•-•-----------------•-•---•-•-------------•-•--------------------------------------•-----------------•---•---------.----••----------•----•----------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signj ............................... Date Application Approved B ...... -"'2 7` 77 ---------- Date Application Disapproved for the following reasons:---•-------------------------------•----------------------------------•---------------------------------•--'---- ----------------------------•--------------------------------------------------------------------------------------------------------------------------------------------------------------------------- / Date Permit No......................................................... Issued.....•�-' ---� f--�.-- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... ............OF......... � ?� ...... Tntif iratr of f'.lintpliattrr THIS T C RTIFY, ha e Individual Sewage Disposal System constructed ( or Repaired ( ) by...._.... r ,/� • Inst 11 r ............................ ............�4...... ...... ../..... ............. {; �/ . has been installed in accordance wit he provisions of A� XI f The State Sanitary Code as described in the application for Disposal Works Construction Permit No. 7,.__..13_____________________ dated..._ -..?. -_�.�5...._........_.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST ME AS A GUAR NTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE_...'- l/�7 --•----......................... Inspector-----' ----- •-----------•---.._... �.. ,�- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTFL ...........OF........ ------------------------- 1J N ........ � FEE........................ S Dirivgii IV k Clam it it Permit Permission is hereby granted----- - -.— ------------------------------------------------------- to Consprpct ( ) or ep 'r ( ) an Individual Sewage is sal System at No. dy ----- ••... --- _ .. et as shown on the application for Disposal Works Construction P t NO.-....... ...... . Dated----1'a__7'.7. ____........ .. Boar, of Health DATE.................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS r S �• ' �2G ;�diK I � Q r a ny . y lei Ot 5 ' TO it 6r ov , F .\IIA r,: Fj S T c \�4C ' J#'. _ _ i l q` 7 x { _ �' r a ' f r rranwr ail &r rr r r��r s a r i:i Bousfield ac h k oe Service 17 Burbank Stree t J Sandwich,Massachusetts 02563 Sewer Permit No. -1'7 jiOcation° -�iri `f t 1� 4 LO -i?.ry C T-P,R L Builderi s'Name and Address` ni'I f Date Permit Ie seeds Dat:6 Complianc6 -Iesued l 1. .. §' / - i Town of Barnstable �11 ram, Regulatory Services ti °s Thomas F:Geiler,Director BAMSTAB MASS Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 50 862 4644 Fax: 508-790-6304 Date: Sewage Permit# DI Assessor's Map/Parcel Installer &Designer Certification Form Designer: .��,��/, �� Installer: ` ✓ Address: oy J, Address: �� On — �� / NvG was issued a permit to install a (date) (installer) septic system at ���• based on a design drawn by (addr ss) dated 4 � (designer) certifythat the septic stem referenced p y 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 R '-rions. Plan revision or certified'as-built by designer to follow. Stripout (if rP- cted and the soils were fo nd satisfactory. OF H 116 DAVID 9�y B-6 . MASON (Insta er ignature 9 No.1066 /sT 4 q I (]Te-s-igqe ignature) PLEASE RETURN TO BARNSTABLE PUBL._ fE OF COMPLIANCE WILL NOT BE ISSUED UTN i iL Hsu i g i H16 r RIVI AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoftice fonnsWesignercertitication fonn.doc ._w,-.-::_�.:: •,y. ,__- ..::.ems-,..... - -`"-'-.' EEIBTIN6 T E'ROPOSI'D� . E G CAPH COO'&t10M8 BllIDER I AX. i A 24 S°hool Street a a PO Box 186 — weae Iaa�ie,ru 02970 r-a t:508.394.3090 9� 1:508.780.1408 STEEL.BEAM ASOJE POINT M LOAD PROM RIDGE PROPOSED SCREEN PORCH PROPOSED 7'-2' N'-q S/Ii' w'-Io ai4' 'III GARAGE n lets, Li I --- —i O OOITl ST -D vCOATS SO'RANGE LOAD N EXISTING OISTING KITCHEN _ -__ __ - I _-_ DINING ______M- ____ __ __I` o �M ROOM r ---- - -- -- 1 �1'-s' —- - d a! _ Orr. Q 1•, v� �`. A DGT. u A .� Q Cd I� ENTRY � IL •WJ 3 GJ _ _ ; ' WDOD 3 ❑ I - ___ POST ___ ____ __ -- - TILE p FROM RIDGN .--� Q Ets REP FR2 DROP Q1TR PANTRY I I 251-4. ED Cloy ENTRY lXIBTING � XSISTING 6l IN9ROO CO LIVING b_ PROPOSED ROOM OFFICE D' 14'-0' As- u'-o' PROPOSED FIRST FLOOR ADDI ION I onSTING PROPosm� SOAI t'-0' -------------------------������— -----J ii ii it I ❑ j I ED ROO�FFD CK I BEDROOMED � b' j li QZTI z OISTM6 1� ❑ SMOKE +Y-Id I o o SATN �; a PET. m N SOa� 1F OD1 1 AS.1 Ae.t - z 11 _ -----_—�--------------- o '1 - — .-:, a� 1 �,�, IILINE?l 1 EXISTING ''¢S lXfIeTING ---------� SNLP n - BEDROOM BEDROOM 11 LA BATH 11 11 --------------------- q A 1 .j'-2. 1 I eXIISTING I JH BATH u - 8 AI 1 54• 'AN " a Y FLOOR ll. PLANS 'EXISTING SECOit-ofND FLOOR ,�, ECOND FLOOR ADDITION A2. 1 i 1 ��. ASSESSORS MAP :. �c3C� NOTES: TEST DOLE LOGS PARCEL: * �� ---- --__.__ ---- I- SO I L EVALUATOR: l� = Cy l) The installation shall comply with Title V and Town of �l3oard of o FLOOD ZONE: /�IV7T Iq�PG�C� L 0 ---- WITNESS: ) l lealth Regulations. REFERENCE: �� Q� ,���-/� � DATE: - , 2) The installer shall verify the location of utilities, sewer inverts and septic 5 -- -- - PERCOLATION RATE: 1;�77 . �. � , l • components prior to installation and setting base elevations. ):/ �4C6 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first '!� 7H- I TN-2 two feet out of the d-box to the leaching shall be level.4) This plan is not to be utilized for property line determination nor any other Q� Ip 3 lD 5) All septic"components must meet Title V specifications. ti ) purpose'other than the proposed system installation. hA'i n "\ SINN b 6 Parking shall not be constructed over H 10 septic 1 components. b� rt 7) The property is bounded by property corners and property lines. \� 8) The property owner shall review design considerations to approve of total LOC i ON MAPAG yet, 1A �� lA �� G1 design flow and number of bedrooms to be considered for design. Receipt 'S� 7/ �1 A _ �� (.I 1�0 (p of payment for the plan and installation based on the plan shall be deemed , � /6C�-DID � I �, � I°`t ,o approval of the design flow by the owner. ` , jYkj� 9) The existing leaching or cesspools shall be pumped and filled with material GL 1 vl. per Title V abandonment procedures. Those within the proposed SAS shall �, be removed along with contaminated soil and replaced with clean sand per —_ 1 q �1pd0 � 11 Title V specs. O .�� �p (�(LuD� >�4i �L v p( 10)System components to be 10 feet from water line. Sewer lines crossing the /' O / water line,.shall be sleeved with 4 inch SCH 40 PVC with ends grouted if applicable. The proposed SAS is being installed below the water service SEPTIC SYSTEM ' DES I GN line. The line is to be sleeved as aforementioned and maintained in place. I / ( 11) If a garbage grinder exists it is to be removed and is the responsibility of the F LOIN ESTIMATE owner to ensure such.. ' 12)The installer is to take caution in excavation around the gas line if such / ex-.sts. 1 3 3, EDROOMS AT �� GAL/DAY/BEDROOM 3J'�O GAL/DAY 13)The installer shall,verify the location,quantity and elevation of the sewer limps exiting the dwelling"'rior to the installation. SEPTIC TANK 14)Th!s plan is representative only that a system can fit on a property meeting - b Title V requirements. 3 ,:-AL/DAY x 2 DAYS GAL �..� X USE''00D GALLON SEPTIC TANK E;X.kt 11 W lr ,� � ��h OF , UAVID 8.S01 Lf ABSORPT I 0 1F—SYMM; �— . a � PvIASUN rr'.! s �• 5y ,b,a„µ,.,' 1\ `,�•N 6� t1 W IM ✓ iD(4 I& SIDE AREA: 2,X ►� ��/'�Z . 2' X BOTTOM AREA: --_ 5' _ = 1 o, N EPT I C SYSTEM SECT I ON -tit I C1P of KvW1a� ' Y l.4 (p' „ ,00 may' II Y X 5i rI J� Bb0 W, I y ILil � I V o /000 GAL `�i JE k�. -- ► SEPT I C TANK - I o nF Tfi� ��o/JOS�J c5i�5 / Zy 2. OF dF TAT tour of M�$ DAVID �y\t I B MAS. SITE AND SEWAGE PLAN ON �� No.1066 4 � r L..00AT I ON : Wt� Ive oIZ PREPARED FOR :3X'�eA_:ID 17C _ - - ---- I SCALE:—[N, at Z Y I)AV I D B . MASON 15 DATE: W yDL !� �4 1)13C ENV I RONME14 AL DESIGNS z EAST SANDWICH . MA W DATE HEALTH AGENT ( .`)08 ) 833- 2 I-77 Z I x47.4 f i West Barnstable, ZONING TABLE wehded BENCHMARK: MA Storm Runoff - ' Top of PK Nall In Pavement LOCUS AP-AQUIFER PROTECTION OVERLAY JAL ) I + EL-50.0± (1985 NAVD) 747.3 RF-RE51DENTIAL D15TRICT REQU(REMENT5: / / LOT SIZE 43,560 5F a4� Edge of Wetland '- r FRONT 5EfBACK 30 FEET 51DE 5ETBACK 15 FEET REAR 5EfBACK 15 FEET ' Holway Drive, BUILDING HEIGHT 30 FEE( FRONTAGE 150 FEET / (40' Wtde -Private Way) Rouge WIDTH &isttng Driveway 6,y NA $G�� / TO ESE MODIrim / 50.9 r PROP05ED COVERAGE /� -,.-�,^ 5 NOT TO SCALE ranLOT AREA 35.200 5F ` 50.1 .....�'"""` sl.l L a_ -�(48.9 ,� o I b0.00'! PLAN BOOK 249 PAGE 107 BLD. COVERAGE: �...... , �� HouSE t,o�i 5F ._ ., , N DEED BOOK 31275 PAGE 149 �► ��, --- --- / -� ASSE550RS' MAP 136 PARCEL 39 5HED NEW GARAGE .......4 1 16 5F 50'Buffer 0'4 Past an fad Fence 52.6 O ENTRY WAY+f Zone: 5VW PORCH 1,417 5F \ LEGEND TOTAL 2,614.5E n x 52,e �0' \ '' � •- . .� x 53.0 a•� ' • x s ,6 ---- 32 EXISTING CONTOUR BLD. COVERAGE=(2,614/35,200)X 100%=7.4%a 4 4 w -32 PROPOSED CONTOUR Gc Landscared /. Fie Area J �]o�/' o x 12.34 M5TING SPOT" GRADE `�^% �C s3s • (• '" 24x5 PROPOSED SPOT GRADE ir s3a =w-- WATER SERVICE LINE x 5s.t1 -----o- OVERHEAD UTILITY SERVICE -----U- UNDERGROUND UTILITY SERVICE _ �52.6 _�-e , GAS SERVICE LINE 2.7 TEST HOLE I BORING LOCATION ST SEPTIC TANK ,,.• o '. �f o w DB D15TRI13UTION BOX o in e' r, x 53.3.i 00'Buffer ,,,,, ••-+'' .• •x 53, - � � SA5 SOIL ABSORPTION SYSTEM `+ Zone: t3VW ...+ -+-- + ^-" sz.7a, f • • w . 52.7 Reserve RESERVED POP,FUTURE x 5 . '.'�ei f o a 53:1 Oz UTILITY POLE : o 52 y�\ o x m ' 10 " x�sa. ID CATCH BASIN a FIRE HYDRANT q ,,,,, _-• a ' ' a : e { \�.. r,,,,.. ', ,. ,r. � WELL DRAINAGE MANHOLE o o � .ARivr;:i�5}4PORCI� / CONCRETE BOUND, FOUND x 52.7 1 u !�i<,+nv nr _ __- ;o 31? �nz �' TOP Of BANK 7� n 4 .5,�•S ' t�.4 ta' if rt � �l�k a UWellino, fUF l L=5 4.2± 1�{4Ai�tetrfi --x-x-- LIMIT OF WORK i i `k tIuS. 3^§ l ; : iV - _,_,�,_ � :.i... x 52.3 J,• s1�7 fi 5 T . �} FENCE • (r• �' " \l ?t;�rt�rYr' , WE 4 'J 137r1•t , 5 s.1' r3 dw IFb :a`r�a i, ` S1.7 o EDGE OF CLEARING ' N -•....�: -'-."'_ ---�._ i€`i}x fa a.. � ,��t.; {}�;�4.•c"`1 PROPOSED � < ' 49. 1 , WAYS Af7D I,De:fir. S Sid;s : �,s; --- X Exis ng ' UG•Electric. s G `;��, i, -r t } 0.5 '.r...._E-.'.�"E ..-•-E•if"�J1.�T." �3 ;�Q��$�I.J rr`�r�»� ilr :1'.¢,:y' �3 ';z, .,fi. 2.9 %'� Well 6 p �: se a 7; r��t x 50.2 2-,: _. �F�y`uf 5016 • ,Lt. ... ", ,�Es i,t�'<`'',:' 4r* `ii N �Co I / I - , WN 'k Septic Ta k iw"<l }7rR� t, x 46.7 'S \ •. O .. � _ peoUhrl.,tl.�(,x.LS}7..�4�.d±^w,.». e x 49.4 } C}Box ❑r� 47.9 49.2 Ex15bnej Well a / 5A5 TO BE PLACED N H 20 RISERrn 52 COVER TO GRADE x 4655 F o �9.5 = � F1{i5' q PP OF�gq� Basketball x 50.6 n Court ��/ _ I � i_�__ _� 7 46.2 x 44.4 ppq N 9 Concrete Slab ;Shed OHN M. 9cyG q� TO BE REMOVED / M, J n OTEILLY O'REILLY ` x 45.D CIVIL Edge of Clearm 10. T33 O NO.33200 51.0 x 47.3 U. F d' PLAN X 50 sDsu ..� � 1 .SCALE 201 �� •y/; x 47.0 Existing SeptlG Per Health Records w 4�4 p 6 >k� - Macjerty Re5ldence txrD/x 45,2 r 31 Holway Drive, West Barnstable, MA 02G3 I LOT 24 CONSERVATION AREAS - Area=35,200 SF± _ PROP05ED 5ITE PLAN 31 Holway Drive, West Barnstable, MA 0-50'BUFFER VEGETATED WETLAND I G0.00' PROPosEsa ALTERATIONS o 5F J.M. O TEILLY & ASSOCIATES, INC. O 20 40 60 Professional Engineering & Land Surveying Services 50-100'BUFFER VEGETATED WETLAND SCALE I"=20' 1579 Mena street - Bouts eA P.O. r, 1773 PROPOSED DRIVEWAY 153 5F (508)89t3-8601 Office Brewster, MA 02631 (508)896-6602 Fax DATE: SCALE: BY: 1 CHECK: 70B NUMBER: ' IG:\AAjobs\Hagerty3 l Holway8591 Proposed5lteFIan.dw,3 9/12118 A5 Noted MT F JMO JMO-8591 fir___-- --7----- ------ F- 1 �