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HomeMy WebLinkAbout1645 MAIN ST./RTE 6A(W.BARN.) - Health 645TMa1ri Street/Rte 6A (W.Barn) ` -W. Barnstable P A e 197 038 ti Town of Barnstable t"E'0tio Regulatory Services Thomas,F. Geller,Director BARNSTAB, ®� Public Molt-.Division, r�n►na'�`" Thomas McKean,:Director 200 Main Street,'Hyannis,:lVlA.p2601 x= i f Office: 509-862-4644 Fax: :50&790-6304 Installer&Designer Certification Forma Date: 2 6. U20 Sewage Permit## 2 o!9- 337 Assessor's IMap\Parcel Designer: bown -nevim Installer: & Gad 9f,D1iC St NiUs. Address: p Address: 50 M Q In 0 93°t M A) 3fe 28 UM-D ft PQYJ MA 07.05 Wlif $WoAdAk 02-03 On g�re_yas issued a permit to install a (date) (installer) septic system at 1 45 P_ftft W 84f hS LL based on a design drawn by' (address) ::, I .P dated 8. 2 (de igner) Ve I certify that the septic system referenced above was installed substantially according to the design, which,may include minor approved.changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the"SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan.revision or certified as-built by designer to follow. N10FMgs DANIEL& a OJALA r (Installer's-Signature) " CIVIL in ` a No,46502 0n� SSIONAI (Designer's Signature) (Affix Designer's Stamp Here) a 'W ;AS gltyh}�� low,V�►,�-t,�lot�r,S` 'off' PLEASE RETURN TO BARNSTABLE. PUBLIC HEALTH" DIVISION. CERTIFICATE COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM .AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. g Q:Health/Septic/Designer Certification Form 3-26-04.doe I E f TOWN OF BARNSTABLE LOCATION ( G q-5 M e 1�(1 Sf. R4-,l ASEWAGE# dO 19 3 3 g VILLAGE J3 g, +�SteASSESSOR'S rMAP&PARCEL/cJ 7 3�S INSTALLER'S NAME&PHONE NO. CO.12 COG r�n SEPTIC TANK CAPACITY J,(n D Q G cA-I LEACHING FACILITY: (type} �j 66 C{ c rn.&r5 (size) NO.OF BEDROOMS OWNER S U Saill S"yo0 y-r, 5-, i PERMIT DATE: Io 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 BAR ok 71 lu s � 4Q 7 6;, � 3 - 5- gs Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN F BARN Yes O STABLE, MASSACHUSETTS ftpfication for Misposar 6pstem Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System Ondividual Components Location Address or Lot No. Owner's Name,Ad e s„and Tel.No. /GyS"iatavit .J� t.,.�s></ f-1w s^6� su sin l Assessor's Map/Parcel /971_AP ! OQ �r7 /1�a z-eyg, Oo9^7 r ,2 was Ins�}1��N�ar�t ees�cd T�1.N� Designer's Name,Address,and Tel.No.J"40-315!z-y�"fGl Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building / No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3o gpd Design flow provided gpd Plan Date 7�� l9 Number of sheets f Revision Date Title �>`ffi�e� Size of Septic Tank�� ID00 . Type of S.A.S. f_2 -,?2 ' X- _! 1 Description of Soil Nature of Repairs or Alterations(Answer when applicable) 'rtsf4!/ �-'.S�Od Cal r ��T.S /�•d�9 X 2s`�v z � 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 Healt Signed { 6�" ' Dated�d' Q Application Approved by 6' ,L t > Date �7 7 it Application Disapproved by Date for the following reasons Permit No. <<- Date Issued 2 � 1 q, 4� .No. �'" 1 � i �,�� _. Fee s THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2ppliLation for -Misposal 6patem,Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System aindividual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. I��5'�U�iT Assessor's Map%rcel Inser's Name,Address,and Tel.No Off' 7 VS" ?4;5 4-orDesigner's Name,Address,and Tel.No,I :9P die'-2-y� l are l ,*�C'FL+'lfC9 9' 7 Type of Building: Dwelling No.of Bedrooms Lot Size 2 5,o1'fV sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) / ?j 30 gpd Design flow provided gpd Plan Date Number of sheets Revision Date t Title Size of Septic Tank nno Type of S.A.S. 1_2 4 3 < Description of Soil Nature of Repairs or Alterations(Answer when applicable) ", ,,lam �-/w� .Z—ZZ9-4 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,'Signed . �. �.� -- -Date / �'f� 9 Application Approved by 1b' Date Application Disapproved by Date for the following reasons F 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(41151" Upgraded( ) Abandoned( )by a�,_{I ?las�."n at /t/is'v,sto ,+ r���, -7,z , , e6 has been constructed in accordance With the provisions of Title 5 and the for Disposal System Construction Permit No t 3 - dated Installer fir/ ..�,. �.--� Designer #bedrooms 3 Approved design w S/;P gpd The issuance of this permit shall not be construed as a guarantee that the system 1 nc on as:2,',,ed. Date l/ Inspector La ------:-------------------------------------------------------------------------------------------------------------------------------- No. (� �J FeeOn =- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS 30ispoSal *pstem Construction 3permit Permission is hereby granted to Construct( ) Repair(✓� Upgrade( ) Abandon( ) System located at ZG<!�fS �Z!S_6a�ey s 4 -, / c,, fy5^„ ► 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 mustbe completed within three years of the date of this permit. Date � -" //7 Approved by AAA / A- n E down cape engineering, inc. SIEVE SOILS ANALYSIS 1645 ROUTE 6A, WEST BARNSTABLE DATE OF REPORT: 7111/19 JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 1645 ROUTE 6A, WEST BARNSTABLE LOCATION: DCE TEST HOLE SIEVE ANALYSIS Weight Sample(Grams): 138.4 SIZE :WEIGHT RETAINED € % RETAINED % PASSED (sum) 1 --"-----------:..............................................0.......:---------------0----0%-_.............................100..0%....... .. . 0.0: 0.0%; 100.0% -------------:......................................................---------------------------------------- 1/2" 0.0: 0.0%: 100.0% --------------i......................................................r---------------------r------------------ 3/8" 0.01 0.0%: 100.0% #4 --------------:....................................................0...---------------0----0%----; ---------1-00.0%---0. . 0% #10 13.2: 9.5%: 90.5% ------------ .......................................................---------------------..................................... #20 63.7: 46.0%E 54.0% -------------......................................................>---------------------..................................... #40 103.3€ 74.6%E 25.4% -------------......................................................:---------------------,..................................... #50 118.0 85.3%: 14.7% -------------:......................................................>---------------------..................................... #80 130.4: 94.2%: 5.8% ------------ ....................................................... .---------------------:..................................... #100 133.1€ 96.2%E 3.8% -------------......................................................>---------------------------------------- #200 136.5: 98.6%: 1.4% ------------ ......................................................----------------- ---------------------- PAN: ------------------137.2+----------- 100 0/° ----------- 0_0/° 0 . 0 SAMPLE: 138.41 NOTE:TEST ON PASSING#4 ONLY, 5.5% RETAINED ON #4 <45% O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A-1-b (SAND & GRAVEL) (UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING #4 SIEVE : #4 100% (TEST ONLY MATERIAL PASSING #4) OK #5010%-100% OK #100 0%-20% OK #200 0%-5% OK SAMPLE MEETS TITLE 5 FILL SPECIFICATION �HOF��yssgc >98%SAND �� DANIELA. yes o CJALA RESULTS: PERMEABLE MATERIAL-CL`ASS=1=<2-MINJIN MATERIAL CIVIL N NONCOMPACTED 0 �No.465020 SOIL DESCRIPTION: MEDIUM SAND ��F s(o/ST NG`��. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE CIer#ifi ate of Tontplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( K ) by .....3AIe1C. ` .........C. i...-....... -..... .R........................................................................ ................................................... Installer at ....I.byS............. o ` ...- ....-.G.... w..-.. ►asp . ..... ...................................................................... . ........ has been installed in accordance with the provisions of TI E 5 of The ateate Environmental Code as described in the application for Disposal Works Construction Permit o. .- .. . .. dated ----.....�..�...' ..................... THE ISSUANCE OF THIS CERTIFICATE SHALL OT BE O'NST UED AS A GUARA TEE THAT THE SYSTEM L FUNCTION SATISFACTORY. DATE..... ......... ........1?::� ... ....................................................... Inspector .. ....... C......... f f lF CERTIFICATE OF ANALYSIS_ Page: 1 Barnstable County Health LaboratoryIVED sficfitv�. Report Dated: 4/15/2003 Report Prepared For: APR 1 R- ?� 03 Order Number: G0319377 Patricia&James Burke TOWN OF BABNSTABLE HEALTH DEPT. 36 Moon Penny Lane Centerville, MA 02632 Laboratory ID#: 0319377-01 Description: Water-Drinking Water Sample#: 19377 Sampling Location: 1645 Main St.(Rt.6A),West Barnstable Collected 4/10/2003 -ollected by: James M.Bur 197-038 Received 4/10/2003 Routine ITEM RESULT UNITS MCL Method# Tested LAB: IC Lab Nitrates <0.1 mg/L 10 EPA 300.0 4/15/2003 LAB: Metals Copper <0,1 mg/L 1.3 SM 311113 4/15/2003 i Iron 0.4 mg/L 0.3 SM 311113 4/15/2003 Sodium 55 mg/L 20 SM 3111B 4/15/2003 LAB: Microbiology Total Coliform Absent P/A Absent 309 4/10/2003 LAB: Physical Chemistry Conductance 280 umohs/cm EPA 120.1 4/10/2003 pH 6.1 pH-units EPA 150.1 4/10/2003 Note: Based on the results of the parameters tested,the water is suitable for drinking,but may present aesthetic problems(taste, odor,staining)due to Iron. Sodium level above average.Those on low sodium diet may wish to contact physician. Approved By: !1 1� o-' (Lab Director) fi i i Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 L r a 1�., � ��7 I � �� -. _ _.... _ .. ... ���,� _ ..: � � _. �, , . _ i,� .�,, �� � / ,r�� _. � � ��� . �,� � � � 1 X' - g'c�A uip, -MICIIAEL,SiTRY�E } x' Real.Estatb--t f µ= r _ •4 J R :BURKE PROPERTIES, 105 Ferndoc St ;. .•P.O: Box 24271 r Tel 508-771 6633 Hyannis,MA'02601 Faz 508-771-9312 r :;tip OF N,tR�ST CERTIFICATE OF ANALYSI SEP 12 206F : 1 Barnstable County Health Laboratory TOWN OF BARNS1Af3�E ysr^` HEALTH RNSI Report Prepared For: Report Dated: 09/11/2003 Order Number: G0322714 Patricia&James M.Burke 36 Moon Penny Lane Centerville, MA 02632 Laboratory ID#: 0322714-01 Description: Water-Drinking Water Sample#: 2271401 Sampling Location: 645-Main Street'West Barnstible'MA P _ _ � Collected: 09/08/2003 Collected bv: J Burke Received: 09/08/2003 Routine ITEM RESULT UNITS MDL MCL Method# Tested LAB:IC Lab Nitrates <0.1 mg/L 0.1 to EPA 300.0 09/09/2003 LAB: Metals Copper <0.1 mg/L '0.1 - 1.3f SM 3111B 09/10/2003 Iron 0.7 mg/L 0.1 0.3 SM 311 113 09/10/2003 Sodium e-35 mg/L 1.0 20 SM 3111B 09/10/2003 LAB:Microbiology Total Coliform Present P/A 0 Absent 309 09/08/2003 LAB: Physical Chemistry Conductance 147 umohs/cm 1 EPA 120.1 09/08/2003 pH 7.0 pH-units 0.1 EPA 150.1 09/08/2003 Note: jRecommended maximum contamination level exceeded due to Coliform Bacteria.Retesting is recommended.Sodium level- above average.Those on.low sodium diet may wish to contact physician.There may be aesthetic problems(taste,odor,stainmgy due to Iron. - ----- r fu i c r t t Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 I Page: 2 CERTIFICATE OF ANALYSIS m Barnstable County Health Laboratory Report Prepared For: Report Dated: 09/11/2003 Order Number: G0322714 Patricia&James A Burke 36 Moon Penny Lane Centerville, MA 02632 Laboratory ID#: 0322714-02 Description: Water-Drinking Water Sample#: R143 144 149 150_ Sampling Location: 1645 Main Street West Barnstable MA Collected: 09/08/2003 Collected bv: J Burke Received: 09/08/2003 EPA 524.2- Volatile Organics by GC/MS ITEM RESULT UNITS MDL MCL Method# Tested LAB: GC/MS 1,1,1,2-Tetrachloroethane BRL ug/L 0.5 EPA 524.2 09/09/2003 1,1,1-Trichloroethane BRL ug/L 0.5 200 EPA 524.2 09/09/2003 1,1,2,2-Tetrachloroethane BRL ug/L 0.5 EPA 524.2 09/09/2003 1,1,2-Trichloroethane BRL ug/L 0.5 5.0 EPA 524.2 09/09/2003 1,1-Dichloroethane BRL ug/L 0.5 EPA 524.2 09/09/2003 1,1-Dichloroethene BRL ug/L 0.5 7.0 EPA 5242 09/09/2003 1,1-Dichloropropene BRL ug/L 0.5 EPA 524.2 09/09/2003 1,2,3-Trichlorobenzene BRL ug/L 0.5 EPA 524.2 09/09/2003 1,2,3-Trichloropropane BRL ug/L 0.5 EPA 524.2 09/09/2003 1,2,4-Trichlorobenzene BRL ug/L 0.5 70 EPA 524.2 09/09/2003 1,2,4-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 09/09/2003 1,2-Dibromo-3-chloropropan BRL ug/L 0.5 EPA 524.2 09/09/2003 1,2-Dibromoethane (EDB) BRL ug/L 0.5 EPA 524.2 t 09/09/2003 1,2-Dichlorobenzene BRL ug/L 0.5 600 EPA 524.2 09/09/2003 1,2-Dichloroethane BRL ug/L 0.5 5.0 EPA 524.2 09/09/2003 1,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 09/09/2003 1,3,5-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 09/09/2003 1,3-Dichlorobenzene BRL ug/L 0.5 EPA 524.2 09/09/2003 1,3-Dichloropropane BRL ug/L 0.5 EPA 524.2 09/09/2003 1,4-Dichlorobenzene BRL ug/L 0.5 5.0 EPA 524.2 09/09/2003 2,2-Dichloropropane BRL ug/L 0.5 EPA 5242 09/09/2003 2-Chlorotoluene BRL ug/L 0.5 EPA 524.2 09/09/2003 4-Chlorotoluene BRL ug/L 0.5 EPA 5242 09/09/2003 Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 pF NqR`. Page: 3 CERTIFICATE OF ANALYSIS <s: Barnstable County Health Laboratory �.S,tCHi,S'�',• Report Prepared For: Report Dated: 09/11/2003 Order Number: G0322714 Patricia&James M. Burke 36 Moon Penny Lane Centerville, MA 02632 Laboratory ID#: 0322714-02 Description: Water-Drinking Water Sample#: R143 144 149 150 Sampling Location: 1645 Main Street West Barnstable MA Collected: 09/08/2003 Collected by: J Burke Received: 09/08/2003 Benzene BRL ug/L 0.5 5.0 EPA 524.2 09/09/2003 Bromobenzene BRL ug/L 0.5 EPA 524.2 09/09/2003 Bromochloromethane BRL ug/L 0.5 EPA 524.2 09/09/2003 Bromodichloromethane BRL ug/L 0.5 EPA 524.2 09/09/2003 Bromoform BRL ug/L 0.5 EPA 524.2 09/09/2003 Bromomethane BRL ug/L 0.5 EPA 524.2 09/09/2003 Carbon tetrachloride BRL ug/L 0.5 5.0 EPA 524.2 09/09/2003 Chlorobenzene BRL ug/L 0.5 100 EPA 524.2 09/09/2003 Chloroethane BRL ug/L 0.5 EPA 524.2 09/09/2003 Chloroform BRL ug/L 0.5 EPA 524.2 09/09/2003 Chloromethane BRL ug/L 0.5 EPA 524.2 09/09/2003 cis-1,2-Dichloroethene BRL ug/L 0.5 70 EPA 524.2 09/09/2003 cis-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 09/09/2003 Dibromochloromethane BRL ug/L 0•5 EPA 524.2 09/09/2003 Dibromomethane BRL ug/L 0.5 EPA 524.2 09/09/2003 Dichlorodifluoromeihane BRL ug/L 0.5 EPA 524.2 09/09/2003 Ethylbenzene BRL ug/L 0.5 700 EPA 524.2 09/09/2003 Hexachlorobutadiene BRL ug/L 0.5 EPA 524.2 09/09/2003 Isopropylbenzene BRL ug/L 0.5 EPA 524.2 09/09/2003 Methyl-tert-butyl ether ! 3 ug/L 0.5 EPA 524.2 09/09/2003 Methylene chloride BRL ug/L 0.5 5.0 EPA 524.2 09/09/2003 n-Butylbenzene BRL ug/L 0.5 EPA 524.2 09/09/2003 n-Propylbenzene BRL ug/L 0.5 EPA 524.2 09/09/2003 Naphthalene BRL. ug/L 0.5 EPA 524.2 09/09/2003 p-Isopropyltoluene BRL ug/L 0.5 EPA 524.2 09/09/2003 sec-Butyl benzene BRL ug/L 0.5 EPA 524.2 09/09/2003 Styrene BRL ug/L 0.5 100 EPA 524.2 09/09/2003 Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 CERTIFICATE OF ANALYSIS Page. 4 Barnstable County Health Laboratory Report Prepared For: Report Dated: 09/11/2003 Order Number: G0322714 Patricia&James M. Burke 36 Moon Penny Lane Centerville, MA 02632 Laboratory ID#: 0322714-02 Description: Water-Drinking Water Sample#: 11143 144 149 150 Sampling Location: 1645 Main Street West Barnstable MA Collected: 09/08/2003 Collected bv: J Burke Received: 09/08/2003 tert-Butylbenzene BRL ug/L. 0.5 EPA 524.2 09/09/2003 Tetrachloroethene BRL ug/L 0.5 5.0 EPA 524.2 09/09/2003 Toluene BRL ue/L 0.5 1000 EPA 524.2 09/09/2003 Total xylenes BRL ue/L 0.5 10000 EPA 524.2 09/09/2003 trans-1,2-Dichloroethene BRL u2/L 0.5 100 EPA 524.2 09/09/2003 trans-1,3-Dichloropropene BRL u0L 0.5 EPA 524.2 09/09/2003 Trichloroethene BRL ue/L 0.5 5.0 EPA 524.2 09/09/2003 Trichlorofluoromethane BRL ug/L 0.5 EPA 524.2 09/09/2003 Vinyl chloride BRL ue/L 0.5 2.0 EPA 524.2 09/09/2003 Note: Approved By: (Lab Director) l / 0 Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph; 5087375-6605 TOWN OF BARNSTABLE i LOCATION 6J Q3EWAGE # T 'i VILLAGE W - — ASSESSOR'S MAP & LOT I ` INSTALLER'S NAME C rHONE NO. �iC SEPTIC TANK CAPACITY • � (size} (,O� LEACHING FACILITY:(type) �- IVATE WELL PUBLIC WATER NO. OR BEDROOMS BUILDER ORS` DATE PERMIT ISSUED: DATE COLIPLIANCE ISSUED: VARIANCE GRANTED: Yes NO I I i I I `KE Town of Barnstable do s Regulatory Services �39 A�`� Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 i DATE: NUMBER OF PAGES TO FOLLOW: TO: FROM:�Vg &-.k J PHONE: PHONE: (508)862-4644 FAX PHONE: -,'-FAX PHONE: (508)790-6304 cc: NOTES/COMMENTS: Q:\HF,ALTH\Fax Form.doc 5 J COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION MAP 9"� PARCEL - O LOT TIME 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM FORM PART A CERTIFICATION Property Address: 1645 Rt 6 a W Barnstable Owner's Name: Patricia Burke ec�lt/ ® Owner's Address: Date of Inspection: JUN 3 2u03 ro vvty OF Name of Inspector:(please print) Wi 1 1 i am E_ . Robinson Sr. —HEAD H p,zPIvS ABL EPT. E., Company Name: William E. Robinson Septic Service Mailing Address: P 0-Box 1089 `.,r Centerville, MA Telephone Number: (5 0 81 7 7 5-8 7 7 6 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and.that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the.proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector.pursuant to Section 15340'of Title 5(310 CMR 15.060). The system: /Passes . Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature:/., Q .-- Dater 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 bas 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 ± r Page 2 of l 1 " IAL OFFIC INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENT o SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ` PART A CERTIFICATION(continued) 1645 Rt 6a Property Address: W Owner. _o Date or Inspection: y nspection Summary: Check A,B,C,D or E/ALWAYS complete,all of Section D a' System Passes: 1 have not found any information which indicates that any of the failure criteria described in 310 CMR exist.Any failure criteria not evaluated are indicated below. 15. 03 or in 310 CMR 15.304 Co meats: .. B. System Conditionally Passes: ---One or more system comid or' ponents as described in the n of the replacement or epa'>rtlonal as app owed by the Board of Health ew'tll pass. repaired.The system,upon coin p es no or/not determined(Y,N,ND)in the for the following statements.if"not determined'please An er y explain. The septic tank is metal and over 20 years old#or the septic tank(whether metal or not)is structurally unso` d,exhibits substantial infiltration or exilltration 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 4etal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indic ling that the tank is less than 20 years old is available. ND xpla'tn:. Observation of sewage backup or break out or high static water level in the distribution box due to'broken or ob tructed 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 obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 tans a year due to broken or obstructed pipes) The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of l 1 f OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM PARTA CERTIFICATION(continued) Property Address: 1645 Rt 6 a W Barnstable - Owner: Patricia Burke Date of Inspection: —© C. Further Evaluation is Required by the Board of Health Con "'ions exist which require further evaluation by the Board of Health in order to determine if the system`` is failing to p tect public health..safety or the environment. 1. System ill pass unless Board of Health determines in accordance with 310 CMR 1.5303(1)(b).that the system.is of functioning in a manner which will protect public health,safety and the environment: Cess ool or is within 50 feet.of a surface water privy Cess ool or.privy is within SO:feetof a bordering vegetated wetland or a salt marsh 2. System ill fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is.f 6 'oning in a manner that protects the public health,safety and environment: _ e system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface ater supply or,triliutary 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 ystem has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The stem has a septic tank-and SAS and the SAS is less than 100 feet but 50 feet or more front a private w ter supply well••.Method used to determine distance m "This sy tem passes if the well water analysis,performed at DEP certified laboratory,for colifor ."-.bacteria d volatile organic compounds indicates that the well is free from pollution from that facility and.. the present a 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. Othe . 3 r Page 4 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS = ° SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ` °PART A CERTIFICATION(continued) Property Address: 1645 Rt 6a arnstable Owner: a ricia Burke Date of Inspection: Y = D. System Failure Criteria applicable to all systems:. You st indicate"yes"or"no"to each of the following for all inspections: Yes g '. p Backup of sewage into facility or system dace f the u ound or sourfa a waters due to an overloaded or Discharge or ponding of effluent to the surface o ground 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'/:day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed oil' Number Hof times pumped P p vy ground water elevation. _ Any portion of the.SAS,cesspool or ri is below high gr _ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface Iwater 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 apnvate water; supply well with no acceptable water quality analysis.[This.system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic'compounds indicates that the well is free from pollution from that facility ro died that no other failure criteria nitrogen and nitrate nitrogen is equal to or less than 5 ppm,p are triggered.A copy of the analysis must be attached to this form.] o The system fails.I have determined that one or more of the above failiire esM ) Y 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. La a Systems: To be c nsidered a large system the system must serve.a facility.with a design flow of 10,000 gpd to I5,000 gPd- You mu t indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary.to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well if you ave answered"yes"to any question in Section E the system is considered a significantm Con to�tiered °`yes"ita Section D above the large system tras failcd.The ownr or operator any g signific nt threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. he system owner should contact the appropriate regional office of the Department. 4 Page 5 of 1 I ' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS ' SUBSURFACE SEWAGE DISPOSAL:SYSTEM INSPECTION FORM 1 -' PART B CHECKLIST Property Address: 1645 Rt 6a Owner: Date of Inspection: 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 I/Were any of the system components pumped out in the previous two weeks? Has the system received normal Bows in'the previous two week period,? l/ Have large volumes of water been introduced to the system recently or as part of this inspection7-- Were as built plans of the system obtained and examined?(If they were not available note as N/A) . t/ _ Was the facility or dwelling inspected for signs of sewage back up? Was`the site inspected for signs of break out? i/ 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: Yes no n/ 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(3)(b)] 5 i Page 6 of 1 OFFICIAL INSPECTION FORM , NOT FOR:VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1645 Rt 6a ti Bar ns table Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):. Number of bedrooms(actual):3 DESIGN flow based on 310 CMR L5.203(for example: 110 gpd x N of bedrooms):,c� Number of current residents: /U/°i Does residence have a garbage • der(yes or no) Is laundry on a separate sewage system(yes or no):A,0 [if yes separate inspection required] Laundry system inspected(yes or no):A Seasonal use:(yes or no):Ae fO Water meter readings,if available last 2 ears usage d N/A well g . y g BP �:, Sump pump(yes or no):2L Last date of occupancy: dy� L�o3 COMME IAL(INDUSTRIAL ' Type of esta Iishment: Design flow based on 310 CMR 15.203): QUa Basis of desi flow(seats/persons/sgft,etc.): Grease trap 1 resent(yes or no):_ Industrial w ste holding tank present(yes or no):_ Non-sanit waste discharged to the Title 5 system(yes or no): Water mete readings,if available: Last date o occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as padof the inspection(yes or no)vl,0 If yes,volume pumped:_-gallons--How was quantity pumped determined? Reason for pumping: TYPXOF 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/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of inf tion: Were sewage odors detected when arriving at the site(yes or no): /• ) 6 Page 7 of 11 OFFICIAL INSPECTION FORM—: NOTYOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued}:, Property Address: 1645 R t 6 a W Barnstable Owner: Patri cla Burke ~ Date or Inspection: BUILDING SE R(locate on site plan) Depth below grade: Materials of constru tion _cast iron 40 PVC ._other(explain): Distance from pri to water supply well or suction line: Comments(on ndition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: (ocate on site plan) Depth below grade:�_ Material of construction: oncrete metal_fiberglass_polyethylene j other(explain).. If tank is metal list age:— Is age confirmed-by a Certificate of Compliance(yes or.no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: ✓ [ Distance from top of scum to top of outlet tee or baffle: [, Distance from bottom of scum to bottom of det tee or ba e:—� How were dimensions determined:_ 19 CO�� �• Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of.lea ec,etc.): GR E TRAP:_(locate on site plan). Depth bel w grade:_ Material o construction:_concrete_metal_fiberglass_polyethylene_other, (explain): Dimensions Scum chic is: Distance fro top of scum to top of outlet tee or baffle: Distance fro bottom of scum to bottom of outlet tee or baffle: Date of last umping: Comments n pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 I Page 8 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION, FORM' PART C SYSTEM INFORMATION(continued): 1645 Rt 6a Property Address: arnS able Owner: Patricia Burke Date of Inspection: TIGHT or HOLDING K: (tank must be pumped at tune of inspcction)(locate on site plan). Depth below grade: - ofeth glass _� y ylene otherexplain): Material of construction: concrete- metal fiber Dimensions: Capacity-Capaci Design Flow: allons/day Alarm present(yes or o): Alarm level: Alarm in working order(yes or no): Date of last pumpin Comments(conditi n of alarm and float switches,etc.): ON BOX: if resent must be opened)(locate on site plan) DISTRIBUTION P Depth of liquid level above outlet invert: C) Comments(note if box is level and dis tribution to outlets equal,any evidence of solids carryover,any evidence leakage into or out of box,etc.): PUMP CHAMB R: (locate on site plan) Pumps in work' g order(yes or no): Alarms in wor ng order(yes or no): Comments(no a condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY,ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 1645 Rt 6a Property Address: W l�asia� Owner: Patr-1eia Burke Date of Inspection: SOIL ABSORPTION SYSTEM(SAS):Zoocate on site plan,excavation*not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system .Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CE SPOOLS: (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: Depthlloof scum layer: Dimen ions of cesspool: Materi is of construction: lndicati n of groundwater inflow(yes or no): Co me is(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materia s of construction: Dimen ions: Dept of solids: Co ents(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 1 l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1645 Rt 6 a W Barns Owner: Patricia Date of Inspection::2- SKETCH - - '- OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two Permanent referencc landmarks benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the buildin , or g 3 -ki 10 Page I I of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1645 Rt 6 a W Barnstable Owner. P tri_cia Burke Date of Inspection: Y 6-0�3 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water t j feet Please indicate(check)all methods used to determine the high ground water elevation: btained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: 66"W 6 9- Checked with local excavators,installers-(attach"documentation) �- Accessed USGS database-explain: You must describe how you establishco the high ground water elevation: 11 JUN-13-2003 16 :22 Afl P. 01 BOARD OF FiEALTH G "TOWN OF BARNST'ABLE Well ConCructionPermrit Fee---- -5----No- -- ------------------- -Alt_( ....... ........_. ................... Permission is hereby granted - �--t�.:�.. -- '------ to Construct ('✓), Alter ( ), or Repair ( ) an Individual Well at- 5 t as shown on the application for a Well Construction Permit ! ! 01 N,. ....... .. C�`. .> Da ed ......_...... ... �.. .......... ._.... t .� .- ----------....-------------- --- --- ... .... .... Board of Health DATE_........ .�... _ .._............._..........._. - -- - ..... f 4 Fee— BOARD OF OF HEALTH TOWN OF BARNSTABLE F D__ Zpplicat ion ArVell ongtruct ion Permit � Ap lication is reby made for a permit to C s r ct ( ), Alter ( ), or Repair )an indivi ual Well at: Location Address Assessors p and Parcel --1�r � �2� �2�l -- — _,SIT/Ir hZ�� l 1JCL -- Owner Address ^ Installer — Driller Address Type of Building Dwelling --- —— — ---------- Other --Type of Building------------- No. of Persons_------------------------- Type of Well L I��� —__ — ---- — Capacity--------------------—---- ——— Purpose of Well --------- Agreement: The undersigned agrees to install the aforedescribed 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 Complianc has been issued by the Board of Health. Y51 �1Signed Application Approved By, --------— date Application Disapproved for the following reasons: --- - -- date ---- Permit No. ------- d e BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of (compliance THIS IS TO CERTIFY, That the Individual Well Constructed (/), Altered ( ), or Repaired ( ) — ----------------- — — — —— --- ----- ----Installer at---1 T i tx;; l S+ E;n-------------—------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Yro ection Regulation as described in the application for Well Construction Permit No. WQ�3—!��Dated—44fN93 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- ------- — - -- Inspector—__- —--- --- -- —----- L _J Fee--•-hh—((—"= - BOARD OF HEALTH t., - 1 r TOWN OF, BARNSTABLE f ~hApplication rVefr Congtruction ertnit' Ap lication 1s reby made for a permit to Cons r ct ( ), Alter ( ), or Repair )an indivi ual Well at: Location - Address Assessors Map and Parcel - Owner f Address ti ------ ------ -------- ----- ---- Installer - Driller Address Type of Building Dwelling —-- ------ -— Other - Type of Building---- ------- No. of Persons.--------------- 4/AM -------- ---- Type of Well — Capacity---------------------- fPurpose of Well--` Gp—--___—_----- Agreement: The undersigned agrees to install the aforedescribed 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,aa Certificate .of Complianc has been issued by the Board of Health. —` Signed " date Application Approved By, ------ - ,- date Application Disapproved for the following reasons: --------- -- -- - -- ------------ - -- ------- ---------- -- ----- ---- date--t--- Permit No. — Issued--------- BOARD OF HEALTH TOWN OF BARNSTAB'LE C ertif irate ®f COMPhance THIS IS TO CERTIFY, That the Individual Well Constructed (/) Altered ( ), or Repaired ( ) byce_z ---- ---- — ---- -- -- — Installer has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Pro ection Regulation as described in the application for Well Construction Permit No. Dated THE THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--------- — - -- Inspector----— - ---------- - —--- - E BOARD OF HEALTH TOWN OF BARNSTABLE _ Vell Con$truct ion 3pr mit No. — --- ----- Fee— �— I Permission is hereby granted t, — — -------- to Construct (V/), Alter ( ), or Repair ( ) an Individual Well at: - -------------------------- NO. — street I as shown on the application for a Well Construction Permit UI2 V3- 02.5" _�3 _ jNo.---- — --------__ Dated--- -- ^ ----------------------------- f �S ? / Board of Health DATE—41— v� I I TOWN OF BARNSTABLE LOCATION (6�S '� SEWAGE # q�� St'3 VILLAGE 1 ASSESSOR'S MAP & LOT INSTALLER'S NAME & rHONE NO. %0e --T ST- SEPTIC TANK CAPACITY 0®� LEACHING FACILITY:(type) p (size) ®Z� NO. OF BEDROOMS Z tyATE �WELL PUBLIC WATER BUILDER ORS `�wNL<<G DATE PERMIT ISSUED: A ` 1 b DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �`� a� ' � 1 .� ai J1$SF.=RS MAP* 1 9.4? ob PARCEL NO: 3 No.._� ::: �?_� //� �>''/ i £PC- THE 2. Fps.37. ............ COMMONWEALTH-QF MASSACHUSETTS BOAR® OF HEALTH 6o__1 TOWN OF BARN STABLE Appliration for Dispasal Works Tonstrnrtion 1hrmit Application is her by made for a Permit to Construct ( ) or Repair (�an Individual Sewage Disposal System at: M q l to 4 J eourvz" 6 W< lam 0. %r4L S\-�_ .....---•- -_--___................. .-- ..._....... •-•---------- -•.....-•---•--••--------.......••-•--------••-----•-----........................................ Location.Address or Lot No. ..................... _. !` C T.................................. .••--•---------------------------------------••--------------•--------•------•-----....------••--- Owner Address / © -ox 2 3 t. C'_C s✓i ve vi�l��� Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures .......................................... W Design Flow...............•......_........._.._.._._.._gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ xDisposal Trench—No..................... Width.................... Total Length.................... Total leaching area....._-------------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ ,aa Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ PL Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a+ ------- ---------• -�-----------------••--------------...........................................---••----• ________-�•---•--- ..... Description of Soil.______^__/ ..................................................S 4 `+ C i� ® , --- / -S- S rt ►J f............................................................ ••----•--•_.... c-� •-•------------------------------------------------------------------------------------------ •-------------------------------------- •-----------------------x -----•-••----------•-------------•-•--•----•----•--••---•----------•••-••••-•----•-••••-------•-•-•------------•••-----------------•----••----•---•--•----•------•---------•-•.......•••••-•--------•--• U Nature of Repairs or Alterations—Answer when applicable.../?!. L......111-Ooo CA.L_4_0u, ....... __...•_D^By< ..............(;?Ob....... ........ C N Q.'--!E..........:� ............ ...................... l_ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beell issued by the board of health. Z'� Signed -- — > .:— 1 �--- �-...................... Date Application Approved By ---------- Date Application Disapproved for the following reasons: ----------------------------------------------------------------------------------------------------................................ - ------- ---------------- --.-----..............----------------------------------.............................--------....--------------- ----------------------- ---------------- / �z, ------------------to ------ Permit No. 6✓ v ✓-- --------- Issued -----------------------------------------------------�..------ Date L _ ------ ----- l 9 t? z_ No---------•-•---- Fss.. ............_ -- �'�"I�I2Gf NCB THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applira#ion for lliipuiia1 Workii Tonstriir#inn,ramit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: M q t N W. S1L1`- � Location-Address or Lot No. r r cc1 f�Z'!1 ------------------------- ----------------------------------------------------•------------- ^= :........ Owner p Address Installer r Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................. Showers ( ) — Cafeteria ( ) 0 Other fixtures ----------------------------------------------------------•••-••-•----------------•---------.._..------------•------•----•-•--•- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—Np..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0 0�' aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1_______________•minutes per inch Depth of Test Pit.................... Depth to ground water_-______________..._---. 44 Test Pit,No. 2..._............minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 --------------------r....................................................................................................................................... Description of Soil CA.--•-��=�----•---�-u 65--�---�--L!�-�. - = =�� ....�►? .. U ..............••-•--••-•...--••--•-•--•----•----...--•-----•--•--------------•----•--•-•----------•--••--•--•-•-••-----•-•------•----••••--••-------•-•-•--- ....................................... W Z. ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable._;,jj=I�T L:t_ ../_ ,a .......gam,......; ...... "_;� ..-_..- .,:.• kLrJ�1 6 Q 2a C'. r�•e.t `�' " c r�r 4 A= s= '! Tom" .................. ce ...................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Com fiance has been issued by the board of health. Signed-- r^ =(� `-- ..... ... C -� ----'-�-` ^-_ ._���...................------ _ � Date 1 Application Approved By e ,v ' Y ------------------ ------- �......-� w /off--�; U v Application Disapproved for the following reasons- --- ------------------------------------------------------------------------- - -- --- ----- ----...................... ----------- ----- ---------------------------------------------------------------------....................................................... -------------------------------------------------- ------------- --........--------------- q• � Date Permit No. /fJ ..� .�� A-------- Issued --------------------------------- -- -- ---------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C riliftctt#e of Grapttanre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by .......... ...........--- -C�IVT.�............6'..M.,...Y_...__ Nd nstaller ..............................................................._---..._....................------------....__._._..._ rr , , has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. '- .__-A-dated ..__.___...______�=' _.._.. .................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------------- ............................,7 Inspector ....----...- 1r v . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Disposal Workii Tnn#riirtilart frrutit Permission is hereby granted....+ ....... ............................. ---------------------------•--.....•----•.....--•.....----•---- to Construct ( ) or Repair ()1:51) an Individual Sewage Disposal System at No..... KnA.S. (Zp a tz L >A .... a.....::' Street as shown on the application for Disposal Works Construction PermitN)91...��_ Dated.......................................... ...............................:.••• .. ------......-----------------•--•----------------••-------------- �{ of Health Board DATE. Y� - ---"..; 'L7 .... Il r/! FORM 36508 HOBBS dt WARREN.INC..PUBLISHERS --- BOARD -- BOARD OF HEALTH TOWN OF BARNSTABLE 0[pp[ication-*rVell Con5truct ion Permit Application is hereby made forGr. �a e '` �to Construct ( ), Alter ( ), or Repair ( )an individual Well at: ---- --------------------------- r Location — Address Assessors Map and Parcel — � — --— —--- —— — — — ------------------------------------------------------------------------------------------- Owner® Address ( ------------------- ------- /---------------- Installer — Driller Address Type of Building Dwelling -�---------------------------------------- Other - Type of Building ----------- No. of Persons---------------------------------------------------- Type of Well-- � ------ - � �,�_ ,,Q Capacity - ----------------------------- Purpose of Well- 'IA--- ------- - -"'------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signed - -- -- - - -------- - - SIC - date — —— ;� Application Approved By— 1---f z date Application Disapproved for the following reasons:---------------------------------------------------------------------------------------------- ----------—-- - -----_ -- — ----- - - - ------------------------------------------------------------------ / date Permit No. -- —r-- i --------- Issued— -- !-- - � -------------------- -------------------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TOgE) TI, That thqjndividual Well Constructed ( ), Altered ( ), or Repaired ( ) by-------- ------ _- -------- SjInstall r at has been installed in accordance with the provisions of the own of Barnstable BqarjJ of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ----=--� P -Dated -���- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------- --- - ---- -- Inspector--------------------------------------------- ----------- No.- -------�------ BOARD OF HEALTH - TOWN OF �-BAR'NSTARLE .� Appttcation,forMill Cootruct ion Permit Application is hereby made for,a. �e to Construct ( ), Alter ( ), or Repair ( )an i dividual Well at: Location — Address Assessors Map and,Parcel ---------------------------------------------------- '--`------------------------------ Owner Address { _-- G�---------------------------- = Installer — Driller Address ' «'t Type of Building Dwelling -----=!=,_•__ Other - Type of Building --- ------------------ No. of Persons.---------------------------------------------------- Type of Well- -�1-� --} - �'_/ Capacity------------------------------- -------------------------------------- Purpose of Well---- - ------ _--- -- �' Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. �. Signed date ——— Application Approved By �j —�` —— —�� �� � —— —� gqr ate Application Disapproved for the following reasons:-------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------- �/qr date Permit No. ---�/�---Y--f-/-, ----------- Issued--�---------------------------- - ---- ------------------- �. date BOARD OF HEALTH TOWN OF BARNSTABLE f` Certificate Of Compliance� -' THIS IS TO� egE TIFY, That the/ndividual Well Constructed ( ), Altered ( ), or Repa'e/d ( ) by-----------`=� �/O _ i _ - ', / --------- ��-------------- --6C,- i�_� ---------- at- - !'-�, ------- ------------------------------------------- has been installed in accordance with the provisions of the Yown of Barnstable B aro of Health Private Well Protection Regulation as described in the application for Well Construction Permit I Datedz=" - 70 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- --- —------- — - - ----- -- Inspector----------------------------------------------------------------------------- fi ,✓ a _ _a.of:.A.w,...Y.ri.cr.re.a.:.��,.we.�...rs.:e..�..ew..+..r+�..rer:+.�6� �+r.4G-•,;.�e�r.,�:!�r ,.�Nr.mwMe.arrr:awir�rfp +r�w.u�ri:�+N+wW.+fy r�lOYa:.+a..a�+-0W+ ..-, ... .. -. BOARD OF HEALTH TOWN OF BARNSTABLE Yell Congtruct ion Permit No.6�--- �-- � Fee Permission is hereby ranted- - �� <------ ------ - ------ jJ to Construct ( ),_Alter ( ), or Repair (Van„Individu 11 at: <-j No. _ -- --'- ------- - f ------------------- Street as shown on 'the application for a Well Construction Permit l• -07 No.- - _ - Dated-- s- -----'5!----------------- ------- - - - - - - ---------- -------- /� ��` • . Board of. Health DATE--/—- -------4/-- --- --- - 4 J CERTIFY THAT THE STRUCTURES ARE —77 1 CERTIFY THAT THE STRUCTURES LOCATED IN FLOOD PLAIN ZONE C AS U j LOCUS ARE LOCATED ON THE LOT AS SHOWN. SHOWN ON FLOOD INSURANCE RATE MAP 1929 LAYOUT OF RTE. 6A COMMUNITY PANEL NO. 250001 0011 D / AND THAT FLOOD PLAIN ZONE C IS NOT A S 22 03 YL SPECIAL FLOOD HAZARD AREA. DATE ' REG!,STERED PROFESSIONAL LAND SURVEYOR S 22 0 3 DATE RE STEREO PROFESSIONAL N/F '7 coLAND SURVEYOR / � Q DOROTHY K. RICHARDS p AND EXISTING BARBARA HILFERTY WELL �G N/F WEST BARNSTABLE FIRE DISTRICT LOCUS MAP NOT TO SCALE d h �N 43.5 c9Al 45. p , N 05*48'15" E 30 04 108.00' 43 _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . l2 45 7 83 ?42" 4' Op CBS 47.5 GAS METER BORDERING VEGETATED WETLAND d d6 WOOD N d a i T :r B NG E `n 45. 7 2" TREE ABANDONED 4 �j W—#2 M 5. �QT 2 SIGN , CIRCA 1870 21 ,314 f S.F. ��� � °c SIGN a0 i� 2 '42.,3 N 15.4 CO R E COVE �� 2" TRt:E t1� W— 1 u7 34.3' 26" HEMLOCK H p\N N 5 2' �—� _j 'OR , NOTICE • f BUIKFEMC? ", O gr 46 7 ��� Unless and until such time as the original (red) stamp of the W- 3 4� 0 DOSTN6 WELL �? SyST 2„ E " responsible Professional Engineer, or Professional Land Surveyor # / F,y appears on this plan: W— 2 4 �!' , 4 26' HEMLOCK A no person or persons, Including an municipal or other PVC ° O ��, ?�.3• 47.2 public(official may rel upon the information contained herein; and 62. 5 6 ? 0��� 20" A Q (B) this plan remains the property of Holmes do McGrath, Inc. CONCRETE � Q O O �'� COVER / 4 0 ` sz. �� �`��3� ���, 46.9 `� wEu�NG L T 1 /, ' •.�00 CI �2 ' HEMLOCK s" OAK -�r� � *46.9 p°�' Ch � � N/F 2" o.aK �� �. �� HELEN MARKE MARVILL GRAPHIC SCALE 4F 20 10 0 20 60 J, Oo N/F C� D 46. 3 IN HOLLY L. ROGERS Q o s8' 2° TREE �� ( FM 46. 7 ��/ 1 inch = 20 ft. Uj (Y W WELL, �' Q SToNf � J N/F s3 / o � 46 Q SUSAN A. MAKI TRUSTEE ��--- 03 47 ��d� / ��' M.I.G. REALTY TRUST 5/21/03 ADD CONTOURS. SPOT GRADES AND ABUTTERS NAMES SGL 0 S_ 7 rb _j f 5/16/03 ADD EXISTING AND PROPOSED WELLS . HANDICAPPED SGL PARKING SPACE. OVERHEAD WARES AND GAS METER ��. 47.0 2" TREE 1 /1 �1 �b 47.2 0, DATE DESCRIPTION jDrawn,Checked —46- 16' CHERRY a R � $ O� qA 47. 7 WE R E V I S I O N S 70.07' ,�/ `- LEGEND PLAN OF EXISTING CONDITIONS L.Li— S 04'38'21" W % 45.7 SPOT GRADES —�_ Q 47.67 PAVER �` Fi/iC -C�l'1W . OVERHEAD MARES PREPARED FOR o FLOW BF �,� 7 IGHT OF WAY �� yo�ow / so0 LOCH <13 UTILITY POLE PATRICIA BURKE POLE PB C- GUY MARE FOR #1645 MAIN STREET / � 4 FLOOD LIGHT IN N/F /` NOTES: FIRST LUTHERAN CHURCH ;� GAS SERVICEGV WEST BARNSTABLE MA HOUSE NUMBER: 1645 MAIN ST. �� SIGNSCALE: 1" = 20' DATE: APR. 5, 2002E ASSESSORS NUMBER: 197-38 OWNER: C9 ® WELL ZONING DISTRICT: AP PATRICIA BURKE ,� - h of m eS and m cgrath, Inc. U, sT�i L r FLOOD PLAIN ZONE: C MOONPENNY LANE ® EXISTING �► HYDRANT civil engineers and land surveyors NO,2C rn TOPOGRAPHIC- INFORMATION BASED ON AN CENTERVILLE, MA 02632 WELL Q' X--X FENCE 200 main street (508 548-3564(PHONE) /sT �``��F% , ON THE GROUND INSTRUMENT SURVEY PHONE: 508-771-6633 UoCDC> STONE WALi. falmouth, ma. 02540 508 548-9672 (FAX) ELEVATIONS SHOWN ARE BASED ON AN ASSIGNED ` BENCHMARK ELEVATION TAKEN FROM 0vN0 / SHRUB DRAWN: MES, PJR CHECKED. TOWN OF BARNSTABLE G.I.S. MAP # 196 MNB F B DURKE PATRICIA 20123a 201423PP.DWG JOB N0: 201423 DWG. NO.: 79-2-3 gEET 1 of 1 I T I SYSTEM PROFILE ALL MAR ED TE WITHCMAGNETICTTAPEAOR LL BE NOTES COMPARABLE MEANS FOR FUTURE LOCATION. PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) 1. DATUM IS NAVD 88 ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE 2. MUNICIPAL WATER IS EXISTING TOP FOUND. EL. 46.5' FILTER FABRIC OVER STONE o � 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. � y ate o 0 \ MINIMUM .75 OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 45.0' d v �� Wa erg e PRECAST H-10 NOTE: 2" MIN. WALL BLOCKS OR , UNI4. TS 0 BE AAIGN ISHO HNG R LA(ZLL PROPOSED PRECAST Parker Roa Lan THICKNESS REQUIRED RISERS (TYP.) PRECAST RISERS 13 Locus 2 m 43.4' 4"4SCH40 PVC MORTAR ALL H-10 6" MIN. SUMP PIPES LEVEL 1ST 2' COMPONENTS 5. PIPE JOINTS TO BE MADE WATERTIGHT. ' 12" MIN. INT. DIM. 4 (TYP.) 3 4' , Cape Cod ENDS SIDES 42.06 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE Community " �° � College 10" **EXISTING 14 ° WITH 310 CMR 15.000 (TITLE 5.) TEE SEPTIC TANK TEE ° ° ° ° O��O mmffm F 0� —L70�� 'o°o°o Pond *42.0' ° ° 0 o WATER TEST D'BOX ��D��DO�OCIO ooa®aaa�o ;00000000 0 0 0 0 0 0 0 > ° ° ° o �����00� ® � �0 , 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND0 0 0 0 0 OO O°°°°°°°°°°° FOR LEVELNESS �i ;°o°o°o GAS BAFFLE �. _' °°o°o°°° �000��0�0®®��CID a000aaaaa ,�o�o�o�o NOT TO BE USED FOR LOT LINE STAKING OR ANY Mo ° 39.23 OTHER PURPOSE. °p ��Ood 41 .52' 41 .35' ° ° ° ° °°°°°°°° +: 4' LIQ. LEVEL (ACME OR EQUAL) ': °°°°°° ° ° ° ° "0°°°°°°°°°°°oo;0000° °0000°oa0000000o i 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 0000°0°°00°0000000000000000000ononon00°oo009 H— 5OO GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. (2) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR ALL AROUND PRECAST STRUCTURES CONCEALED WITHOUT INSPECTION BY BOARD OF to 6 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X 12.83' THE INSTALLER SHALL VERIFY THE LOCATIONS OF ( [ ]) � /�� HEALTH AND PERMISSION OBTAINED FROM BOARD * COMPACTION. 15.221 2 / � N ALL UTILITIES AND ALL BUILDING SEWER OUTLETS 1�� ,J OF HEALTH. Sera AND ELEVATIONS PRIOR TO INSTALLING ANY PORTION ( 1 % SLOPE) ( 1 % SLOPE) -3,` ���� � 10. CONTRACTOR SHALL BE RESPONSIBLE FOR OF SEPTIC SYSTEM �� CALLING DIGSAFE (1-888-344-7233) AND FOUNDATION— EXIST. SEPTIC TANK 48' D' BOX 12' LEACHING 6 tue�' 30.0' BOTTOM TH-1 VERIFYING THE LOCATION OF ALL UNDERGROUND & LOCUS MAP FACILITY NO GROUNDWATER FOUND I OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF SCALE 1"=2000'f **INSTALLER SHALL CONFIRM MINIMUM SEPTIC WORK. TANK SIZE AT 1000 GALLONS AND ITS SUITABILITY yam"' '»v�l 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL ASSESSORS MAP 197 PARCEL 38 FOR RE-USE. REPLACE WITH 1500 GALLON BE REMOVED BENEATH AND 5' AROUND THE SEPTIC TANK APPROPRIATE TO SITE CONDIT ONS IF " /�\ \ \ \ \ 2 r of PROPOSED LEACHING FACILITY. LOCUS IS WITHIN FEMA FLOOD ZONE X NOT SUITABLE 1\ v U i S \ 12. EXISTING LEACHING FACILITY SHALL BE PUMPED (AREA OF MINIMAL FLOOD HAZARD) AS � i SHOWN ON COMMUNITY PANEL #25001 CO553J \ AND REMOVED. \ DATED 7/16/2014 LEGEND- \ VARIANCES ED ATELY OGRANTEDC SYSTEM REPAIRS BY THE BOARD OF WHICH HEALTH A E AGENT NT OR BY 99-- EXISTING CONTOUR �' W \ HEALTH INSPECTOR � X 99 1 A � PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED BY EXIST. SPOT ELEV. THE BOARD OF HEALTH REVISED DURING A PUBLIC HEARING HELD —[99]— PROPOSED CONTOUR F 1 ON DEC. 10, 2013 198.41 PROPOSED SPOT EL. �� �A 1) ALL SYSTEMS TWAT HAVE NO INCREASE IN FLOW — SEPTIC TH1 z SYSTEM COMPONENT TO FOUNDATION SETBACK (NO MORE THAN 50% REDUCTION IN REQUIRED SEPARATION DISTANCE) TEST HOLE � � � �7\ 3) FAILED SYSTEMS ONLY, SAS TO PRIVATE WELL SEPARATION SYSTEM DESIGN. 2� SLOPE OF GROUND 1 0 o LOT AREA 9S DISTANCE VARIANCES, IF LOCATED IN THE SAME GENERAL o LOCATION AS THE OLD SAS AND MORE THAN 100 FEET UTILITY POLE 22,471±S.F. SEPARATION IS PROPOSED BOTH FROM ON—SITE WELL AND ANY goo. GARBAGE DISPOSER IS NOT ALLOWED FIRE HYDRANT /1�911 �ry \ AND ALL WELLS ON ADJACENT AND NEIGHBORING PARCELS. / \ / NOTE NOT ALL SYMBOLS MAY APPEAR IN DRAWING DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD _\ \ USE A 330 GPD DESIGN FLOW f 5 REMOVAL OF UN UITABLE SOIL— .• I b REQUIRED AROUN RIMETER OF .` / \ SEPTIC TANK: 330 GPD (2) = 660 TEST HOLE LOGS LEACHING FACILIT DOWN TO / '' \ _ TH1 \\ SUITABLE SOIL LA R. REPLACE �. WITH CLEAN MED. S ND, TO MEET - �\ **RE-USE EXISTING 1000 GAL. SEPTIC TANK ECIF ENGINEER: CRAIG J. FERRARI, SE #13871 1 ( TIONS F 10 CMR ) / '• � / � o�\�� \ � LEACHING: S = WITNESS: DAVID W. STANTON IRS IDES: 2 (25 + 12.83) 2 (.74) 112 GPD+Ftic / ���\ 'f' � \ DATE: 6/28/2019 ��( \ \ \ ° / BOTTOM 25 x 12.83 (.74) = 237 GPD PERC. RATE _ < 2 MIN/INCH \ \ \ TOTAL: 472 S.F. 349 GPD CLASS I SOILS P# 19-56 z �. \� EXISTING \ I USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) o �• o f \ DWELLING \ WITH 4 STONE ALL AROUND 1 ELEV. ca �. � oo � TOF=46.5 .� 0„ n 4 45' � \ \ rJ, A o� \ — /LS UNSUITABLE SOIL / �2 \ �r°Jr / MA 10YR 3 2 \ DECK APPROVED DATE BOARD OF HEALTH 6" / \ / \ x RAVFL DRIVE 100, TITLE 5 SITE PLAN /LS _ BVW 5 \ \ OF 03 24„ 10YR 4/4 43, B�' DING ING \ z #1645 MAIN STREET (RTE 6A) BVW 4 \'\ WEST BARNSTABLE, MA I \ o C1 I \ \ Co PREPARED FOR S% SUSAN MAKI 10YR 6/3 " BVW 3 �., 4 �. a DATE: JULY 8, 2019 i OF AdgS� ZN OF AflS, ., 174 30.5 41 43 9c si r S"1_ BVW "All _� \ A 'IEL Gam. o� DANIELA. ti� off 508-362-4541 C2 NOTE: CONFIRM 4' OF 401\ 83*44'02 fo A.� N o a�AtA fox 508-362-9880 156.9E BENCHMA K: I CIVIL I downcope.com SIEVE' FS NATURALLY OCCURRING /�`� CORNER OF A N .40980 NoIz- .46502 3 SUITABLE SOILS AT VOr -BULKHEAD �0"Sss\°� � °���GISTER�°��� flown cope enginee�ift �nC. 180" 10YR 6/6 30' TIME OF INSTALLATION - \ NAVD 8 lgNa SURN �SS�ONAL ECG civil engineers \ BVW 1 F /� GROUNDWATER ENCOUNTERED Scale: 1"= 20' � - _ ` land Surveyors NO G �Q � J\ \ j �°� 939 Main Street ( Rte 6A) YARMOUTHPORT MA 02675 DICE # > 9- 1 76 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. 19-176 MAKI.DWG � o�' P►N s I CERTIFY THAT THE STRUCTURES E ARE l —77 1 CERTIFY THAT THE STRUCTURES LOCATED IN FLOOD PLAIN ZONE C AS 1 LOCUS ARE LOCATED ON THE LOT AS SHOWN. SHOWN ON FLOOD INSURANCE RATE MAP j 29 LAYOUT OF' RTE. 6A COMMUNITY PANEL NO. 250001 0011 D / 19 AND THAT FLOOD PLAIN ZONE C IS NOT A SPECIAL FLOOD HAZARD AREA.1 511?/,0 2 / DATE GIS RED PROrESSIONAL AND SURVEYOR 3Z14 zoi ,-7/ DATE RE tTERED PROFESSIONAL / % LAND SURVEYOR 1 Q 1 � EXISTING WELL LOCUS MAP NOT TO SCALE 003 Fpb 040 Np N 05'48'15" E \mil 30, 108.00, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N 0 27.3' \ 1'42. 2 12.4' 83 00 QP 'o GAS METER \ �dh BORDERING VEGETATED WETLAND l 1 STORY N d- WgU� J L 2' TREE Qj ABANDO�m :t LDINGME `n i S. ',� ��- LOT 2 SIGN , , CIRCA 1870 _ 219 311 f S.F.\ ����� °` SIGN LAWN TREE co 22.2' NCONCRETE COVE 26" HEMLOCK W #1 -- � 34.3'CY) LC� c° 5 r _I qAA NOTICE 299'f TO WELL � � �n \ - __ BRICK � S cry- � _ * . ._---_ _. ...._ -, _. _ . euuar s,�, F,or� STD 'yqr ��/ Unless and until such time as the original (red) stamp of the W—� Z � � K N, SYST 2 E appears sresponsible Professional Engineer, or Professional Land Surveyor Aplan: W—#2 4 0 �O ??3 �M 26" HEMLOCK (A) no person or persons, including any municipal or other public officials, may rely upon the information contained herein; and 62.4' ? �_� 20" OA Q (B) this plan remains the property of Holmes & McGrath, Inc. zk �� COOVER TE 6 O ti � ?e i 174f EXISTING LOT 1 �-6) ;� WELL 8" OAK PINE �0 rye• O " OP• 1 ��/ 12 OAK �� � GRAPHIC SCAM Q. v -0" HE C 20 10 0 20 60 K- —401 �z CO) N O _ ( IN FEET ) 36'8 w 2" TREE \ I 1 inch = 20 ft. Oyu. w P G a _ - n J \ LL ) STONE 3� CIO `C I o � 0d� \ z J 5/16/03 ADD EXISTING AND PROPOSED WELLS . HANDICAPPED SGL PARKING SPACE, OVERHEAD WIRES AND GAS METER 2" TREA / r DATE DESCRIPTION lDrawnEhecked EXISTING 16 CHERRY � �6 WELL R E V I S 1 0 N S .1� 7 •07' SIGN _ LEGEND PLAN OF EXISTING CONDITIONS 0 h I— S 04'3821" W / \ Gv g o Q PAVED rLow 6/.c�F �\ , / oH`v OVERHEAD MARES PREPARED FOR PoLE�PIGHT F WAY ,`o�ow S0\ cico unuTY POLE PATRICIA BURKE \ �o C- GUY MARE FOR #1645 MAIN STREET � V FLOWucHT IN GV WEST BARNSTABLE MA ^ \ / GAS SERVICE a � �� 4\ SIGN � _ ' APR. 5 2002 NOTES: ,e\ , / SCALE. 1 20 DATE. WELL • c 4 HOUSE NUMBER: 1645 MAIN ST. OWNER: ��'� ® holmes and mcgrath, Inc. ' PATRICIA BURKE HYDRANT �T ASSESSOR'S NUMBER: 197-38 EXISTING civil civil engineers and land surveyorsI 36 MOONPENNY LANE WELL �o �T FENCE 200 main street 508 548-3564(PHONE ZONING DISTRICT: AP CENTERVILLE, MA 02632 falmouth, ma. 02540 508 548-9672 FAX FLOOD PLAIN ZONE: C PHONE: 508-771-6633 o�oo STgdE yyALL ( ) �� m REFERENCE: PLAN BOOK 158, PAGE 137 Fo�No / i SHRUB DRAWN: MES, PJR CHECKED: MNg B BURKE PATRICIIA 201238 201423PP.DWG- JOB NO:_ 201423 DWG. NO.: 79-2-3 EET 1 0f 1 i I CERTIFY THAT THE STRUCTURES ARE I —77 1 CERTIFY THAT THE STRUCTURES LOCATED IN FLOOD PLAIN ZONE C AS LOCUS ARE LOCATED ON THE LOT AS SHOWN. SHOWN ON FLOOD INSURANCE RATE MAP J UT OF RTE. sA -COMMUNITY PANEL NO. 250001 0011 D 1929 LAI'0 AND THAT FLOOD PLAIN ZONE C IS NOT A 3 SPECIAL FLOOD HAZARD AREA. DATE IRWSTERED PRO ESSIONAL ol / AND SURVEYOR l DATE Rpl`�TERED PROFESSIONAL �` ��a t) LAND SURVEYOR 1 Q 1 0 EXISTING WELL \ LOCUS MAP \ NOT TO SCALE �� N 05'48'15" E � l 108.00' _ . . . . . . . . N 0 27.3' 1'¢2 , to 12.4' } 83 00 -2 Q? \ � BORDERING VEGETATED WETLAND wOoo TORY N 04 GAS METER 'l LO 2 THE "S ABANDONED `F SAME \ • BUILDING i M � 5. _ � LOT 2 SIGN CIRCA 1870 219 311 ± S.F.\ bS�h fx SIGN 0 - LAWN ,� TREE 7 tK Ov D 00 n 22.2' N a- CORE COVE \ 26' HEMLOCK ' W—#1 to 34.3' — N C6 5 2' L �j 299'f To WELL Lo oMo "I, qAp \ NOTICE _ R BRICK i BD AD 6 , \FpTFc/S N/GATEY� �,T j Unless and until such time as the original (red) stamp of the Z responsible Professional Engineer, or Professional Land Surveyor W—#3 EMMG ORL rSTF 2" TREE appears on this plan: W—#2 TOP (A) no person or persons, including any municipal or other PVC PIF E ro ?? 26" HEMLOCK o public officials, may rely upon the Information contained herein; and Q 62.4' `�, \ \ 20"'OA Q (B) this plan remains the property of Holmes do McGrath, Inc. CONCRETE 174't EXISTING 4COVER 4T §6 lb _ WELL LOT 1 OAK PIN E 300 V�G�tiA> �o�• v ?? 12" OAK h Q� GRAPHIC SCALE ¢ v �/1ZO" HE CK 4F 20 10 0 20 60 _ 'Ii'✓ o @0 N 36 I ( IN FEE'P ) 2" TREE v 1 1 inch = 20 ft. tj e-f• /1, I C J o jLr r' SWELL STONE 44� I o G S \ dh Q 5/16/03 ADD EXISTING AND PROPOSED WELLS , HANDICAPPED SGL PARKING SPACE, OVERHEAD WIRES AND GAS METER s r f�2„ THE ji� j 05 ^ 44V DATE DESCRIPTION Drawn hecked EXISTING cqA 16' CHEP,P,Y Ft� �. WELL R E V I S 1 0 N S SIGN •07' _ cv to LEGEND PLAN OF EXISTING CONDITIONS I— S 04'38'21" W / Q PAVED _ E/. \ / oHN OVERHEAD WIRES PREPARED FOR �IGHT F WAYW �F N pow o• o � UTILITY POLE PATRICIA BURKE F� �S POLE PB C- GUY WIRE FOR #1645 MAIN STREET -4 FLOGHT I N OD LI \ y/ GVGAS �M� WEST BARNSTABLE MA SIGNNOTESSIGN��� �� ,`�` / � SCALE: 1' = 20' DATE: APR. 5, 2002 NUMBER: -1645 MAIN ST. OWNER: WELL holmes and me rath, Inc. HOUSE NU PATRICIA BURKE HYDRANT I' ASSESSOR'S NUMBER: 197-38 EXISTING = o civil engineers and Ian surveyors . 36 MOONPENNY LANE WELL � o� �508� � >E---�c FENCE 200 ream street 548-3564(PHONEZONING DISTRICT: AP • C CENTERVILLE, MA 02632 FLOOD PLAIN ZONE • OK 158 PAGE 137 PHONE: 508-771-6633 � � � �,o STONE WALL falmouth, ma. 02540 508 548-9672 (FAX) REFERENCE: PLAN BOOK DRAWN. MES, P,1R CHECKED: SHRUB MNg B BURKE PATRICIA 201238 201423PP.DWG - JOB NO:_ 201423 DWG. NO.: 79-2-3 EET 1 OF 1