HomeMy WebLinkAbout0483 MAPLE STREET - Health 483 Maple Street
W. Barnstable
A 108 006 i
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No. 4210 1/3 BLU
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10%
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No Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y-�
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
2pplitation for Disposal 6pstpm Cons"ttion Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System [Individual Components
Location Address or Lot No.yt3 Mopk Sk.1Q. (�ocn5ku54. Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel 10 a 10 o(0
Installer's Name,Address,and Tel.No.e) Pj rt,xc aw o.}i o n Designer's Name,Address,and Tel.No. 9,n9lneerin t Works
30.4 Rauk-c l30 Swnjk,; ., Ma. o2S�3 Jlz���.►ts+ c coajs - & VA. F ,re's�da. $qs 411•5S(S
Type of Building: ao S�7$1 N��C Id? S ft►ff!"A�J
Dwelling No.of Bedrooms o A C�l Lot Size 116, 0016 sq.ft.', Garbage Grinder(NM /
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 1500 polloh Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) Add Mij Sg.pFic, +Gn�)n hA [Oi'ana
Date last inspected:
Agreement: .
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health. ,
Si Date N V- -
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. J '7 1j, Date Issued
C�
Fee
3 THE C-O MONWEALTH OF MASSACHUSETTS Entered in comp
PUBLIC HEALTH DIVISION.- TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Zippfication for Disposal *pstem Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete Sys
stem 4Individual Components
Location Address or Lot No. t S M c,pj,. S1• \,4. (J n c{�.,},t Owner's Name,Address,,-and Tel.No.
Assessor's Map/Parcel `
Installer's Name,Address,and Tel.No.(�? P Y,. ,.�r A a Designer's Nanrie,'Address,and Tel.No.,q-n c;n e c
l
0?"S�Co' 17-
Type of Building: t a ( S N�1 t GIP .,$' f-CQ�)
-Dwelling No.of Bedrooms 4,4 r,1 �{ -Lot Size 1\� OOC; sq.ft/ Garbage Grinder(WO)
i Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
t
Title
Size of Septic Tank 1500 nr\kkoi� Type of S.A-S.
a
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) AAA n e;', °; _}F. ,, { ��,. ,,-R n „
Date last inspected: %y
Agreement:1 ti4
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 s Date M,,i - ,tj_
Application Approved by �. ft Date
Application Disapproved by Date
for the following reasons ,
Permit No. 00 —eI?J Date Issued �>
/ V
-----------7---------------------------------------.------------------------------------------------------------------------------------
�,-- THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
P
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(�/ ) Repaired( ) Upgraded( )
Abandoned( )by
at , �, M �,i 4 \�o i .n h �..t:+ has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.,01 -6q,3 dated '7 a5 La-(
('� �� r, r�,., ; . , Designer 9
#bedrooms Approved design flow gpd
The issuance of this permi shall 7tbe construed as a guarantee that the system will
Date 4' ,<X ana Inspector
vi
-------------------------- ----------------------------------- ----------- ---------------- --------- ---------)--�-,---�-------
No. .t , ' 3 Fee
THE COMMONWEALTH OF MASSACHUSETTS
% PUBLIC HEALTH DIVISION—BARNSTABLE,MASSACHUSETTS
Disposal *pstem Construction Permit
Permission is hereby granted to Construct(V) Repair( ) Upgrade( ) Abandon( )
System located at y$S M,.- c r,r,,((,sA,-o 6.,
u
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 ust be clomppll',etted within three years of the date of thi(permit.
Date 0~5�� Approvedhy C\ _,.�:�--------
, � TOWN OFBARNSTABLE
LOCAT ON LAS3 Maple S{ceeA W. &rnSEObk`SEWAGE# 1 00 - 093
VILLAGE W. Qarns-able. ASSESSOR'S MAP&PARCEL 1 4 006
INSTALLER'S NAME&PHONE NO. 63 G �Ycaua{►on Sob• q89 I93(o =�=
SEPTIC TANK CAPACITY 1500 N- 2.0 '
LEACHING FACILITY.(type) UAL :no 1A%(X btrS (size) M S'00 gallon �..'
NO.OF BEDROOMS
OWNER -0 IC 10,b-on of 4a4 Qn6 d boz on4k !� r
PERMIT DATE: 3 1 1 S. 2 0 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 6 Q c.Y Lau0.hOn 1lIL•
qg w. gc. 1%.
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Town, of Barnsta:b-le
y Regulatory,StrVI es
R.rchArd V.Scab,Interim Director
• BARNSTABLE..
Public lfialfh Division
aT�ata+s Thomas McKean,Director
200 Main Street,Hyii:iinis,.MA 02601
Office: 508-8624644 Fax:,508-790-6304
S Tnstafter&:Desiaoer-t'.ertification"Form
Date; b Setivage Permit#I O' OgjAssess.or'ssNlap. arcel �C� o
Designer; awe�.; l .{wt Installer: �Ct�.�tc��`rcT
Address:
Adil1 ess: l _
Oiaas'issued.a permi€.to insta)li a,
(elate) (installer)
septic.systein at e S ` ��"^ based oil a design drawn by
-- (address),
l' erg�-1 f'tic�r Less." dated.. l;l. l ' o
f.
(desio er)
../ I certify fliat dze septic syslern,referenced..hove was:installed sul stantially'accordillg;to
the_design;which may.inci; de minor"approved,clianges such asp latei`al,relocation of the
distribution box hana6rlseptic tank. Strip.c�uf (if required) was nspdcted and";the soils
were found satisfactory. j ,'t,: ,, 9:_tea C6r?1R'cQa� cl�r c i-1y
I certify,that the septic "systerii tefereil ei, above:was installed with iirajor changes fix.
eaCer tYian-IO''lateral reloeation`ofthe;SS or any vertical ielocation ofi'any aompcinent
ottlie septic systerxr) but-in accordance with Statt Local„Regtilatrous:. Ilan revision.or
certified-,as-6ut1C 11v':desigier to.iollaw Strip 60t,('if required)was inspected and the soils
were found.satisfactory.
I certify that the System referenced above was-constructed iu., with the terms
of
the IA'approvat',le`teis(f.applic'able)
(Instiiilet's.St"giza trrt;: iypi35108
V O
(Designer's Signature)' (`Affi�e Design
PLEASE ftTUR:N TO BAR:NSTABLE I'UBLI.C.:HEALTH DIVISION:. CERTIFICATE
OF COMPI IA WILL NOT.-BR.ISSUED UNTIL BOTH'THIS:FOR:11 AND .AS-
BUILT CARD ARG RRWRI'VED BY THE BARNSTABLE PIlBI,It''H 4LTH'DIVISI:ON
'T-H- NE YOU,
C2.Septt :i7es finer Ceriiflcgiiori FtrwRev 844-11doc
Engineers note:This-certification is.'iimited to an as-built lnspeetion of system components as installed pnor igbackhfl.The
engineer.did not supervise-construction of thecsystem The°ms,altar assumes-responsibility for all maferiaYs,work 'anship,;backillling'
to specified grades wifh:pioper cempactwn and°salting^iser"s/covers-as shop+iron the: esign plan.
TOWN OF BARNSTABLE
LOCATION SEWAGE#
VILLAGE SSESSOR'S MAP&PARCEL I09'—E —
INSTALLER'S NAME&PHONE NO. R. C. 1-
SEPTIC TANK CAPACITY -cf-<1 15M /O
LEACHING FACILITY:(type) G t — (size) �3.<x 9'x�r
NO.OF BEDROOMS
ao
OWNER 1<J t, 00
PERMIT DATE: 40 ZZO<i S— COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility .-1- 1 - Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) 15® Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY �ci..-•rynf �o.-�(p
04
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a
1O �
TOWN OF,B}�ARNSTABLE
LOCATION T�^ n(z S J SEWAGE #
VILLAGE _����� '�� ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY 5C)
LEACHING FACILITY: (typep)L l /J =2—+ize) '
NU. OF BEDROOMS
BUILDER OR OWNER `
r
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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Health Department Drop-Off Hours: 8:00 AM — 4:30 P.M
Town of Barnstable Receiv y Health
BIKE rah Regulatory Services DepatRnent on
Richard V.Scali,Director r+
ELAMn"M CM
MA-QaPublic Health Division �.
Thomas McKean,Director N
200 Main Street,Hyannis,MA 02601 1 ~
Office: 508-862-4644 Fax: 508-790-6304
ACCESSORY AFFORDABLE APARTMENT
SEPTIC QUESTIONNAIRE
Property Address: 4 K3 Mayl.e 5+. W a.rn 54-a..b 1 e
Assessor's Map/Parcel Number: I o'F /00(P
Applicant(s) Name: &a4`)V S I�i.e-be e c of Woo L,
Phone: !p E-Mail: 0- �l h }� yahco • C C)rn
Size of Lot: a• to 4 oz.
2a. How many bedrooms,exist at your property now?
2b. How many bedroom are you planning to add as part of the Accessory
Affordable Apartment Program application? NI 4
2c. How many bedrooms total are proposed at this property (including the .
Accessory,unit)?
2e. Is the proposed Accessory Apartment contained within:
the main house; OR
a detached structure
2f. Submit floor plans for all buildings on the entire property.
Show all existing rooms in the dwelling and the proposed
accessory apartment. Label each room clearly. Label measured
width of all open doorways. Use straight edge for hand drawn
plans and be sure all beling is legible.
Signe Date:
1
ACCESSORY AFFORDABLE APARTMENT
SEPTIC QUESTIONNAIRE
FOR STAFF USE ONLY
1. Is the dwelling connected to Town sewer? ❑ Yes %No
2. Dwelling located ❑ INSIDE ❑ OUTSIDE the Saltwater Estuary Protection Zone
3. Dwelling located ❑ INSIDE ❑ OUTSIDE public supply well Zone of Contribution
4. Dwelling is connected to �OWSITE WELL ❑ PUBLIC WATER
5. Disposal works construction permit on file? O Yes ElNo
6. If yes, how many bedrooms were allowed by this permit: A bedrooms
7. Were building permits obtained for additional bedrooms? ❑ Yes ❑ No
S. Engineered septic system plan:
a. On file at the Health Division? Yes ❑ No
b. 'If proposed accessory unit is detached from principal dwellina, is that plan
on file? ❑Yes ❑ No
9. Existing septic system capacity is bedrooms
For the accessory unit to receive approval from the Health Department the
following action must occur:
❑ Existing system accommodates proposed additional bedroom(s)
❑ Upgrade existing system to accommodate additional bedroom(s)
❑ Must remove a bedroom from the main house
❑Must connect detached structure to the existing septic system
❑ Must install septic system for the detached structure
❑ Other
Signed
Date
2
Deck
42'
Dining
Room Area Earthen
• Deck
V
?8' � UKQ2
/ 2V
OfFi`aRoorn
Room
Foyer
4r
42'
Maater
closet Bath Beth
Bedroom
21r AV
Master
Bedroom I Bedroom
Ir
Lott
T T
1B'
n
���'S � • 1 � a UD 12,
GLOSF'r � J► �� -
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window
493; MAPLE �57
2�
IV
DEC-23-2015 22:52 From: To:15oe7906304 Pa9e:1/1
To +n of.Barnstable
Replator'y services
' Rickard V. S.cali,.intertin.Director
Y .Y,
•
Z apflN87A$[� .
Public Health Division
,aa+ Thomas McKegoi Director
200 Main Street,Wadnis,IV,C 0260i
Office: 50"62-4644 Fax: 508-M-6104:
Iestaller..&Designer-Certification Form
Date: Sewage Permit# Assessors Map\'P�rcel
Desigeer: tv%e:.Iustaller:Address: 17z Oa9'� s Q' t` Address: 41 "K. --7��
tA
-jab 7�- . 5 [�J -1+issued a permit-to install a
(date) (inst's er)
. '�-, fib. based do&.design drawn by
R.0.Pq�+r`.•
sept<c.system aC� � .. ,
(address).
-p r
t cent•f, that the septic_sysreMref'erenced.above waa it stalled substantially accord ng.to
the de."s%gn, i�vliich may include.minor_ap�irbVed ct�aiiges.such'as latest;relocation of ttie
distribution. box and/or septic,tame. Sfit: out (if requixwnsecd an the;sojlsed p
w.ercIound-satisfactoty.
.I.certify�tha"the septic system.referenced.. move was.installed with,�ajor changes (i.e.
greaterthart 1.Q` lateral xeloratyan of the SAS or any .1 tical refoca'66 of and.compOcrt
ia£:fhe.septic;sys#em) but in'accotdance'with;$tate&Local Regulations: ;Plan,rewisiolu or
corfifEd a`s=bu�lt;tiy designer to. ollow.. Ship out' if Yequue.d)yvas inspected arid:the soils.
were found satisfactory.
I ct xtify tbiat.the system:refer tired;al7ove'was cdnsCructed.i ctr lUdte,with die teciitis,
of the, appr tters,I I applicable) uE'
AS
PEWR ' . ..
M cEN•IEE.
statler':s Signature) C1v1t.
Afo= :�510g ,
esigzter's Sigrianire) Affix Des ' ere)
PLEASE'-RE'X'LTRN_To.B STASLIMFUBLIC.]DEALT" 101WSIQp1. CERT , CATE
OF COMPLIANCE WIL.L.,NOT,BE ISSUED UNTIL. ,BOTH. THIS FORM AND. AS-
BUILT CARD.ARE.RECEMD BY THE BARNSTABLLPYJBLY ALTK DIWSIONi
THANK Yo
Q_\$epti6Z&gnerCe ti&c tsort yoft.Rev 8 C413:d'oc
TOWN OF BARNSTABLE
LOCATION !!5hn ti� � ,� SEWAGE#
VILLAGE �Q--3�ASSESSOR'S MAP&PARCEL
hINSTALLER'S NAME&PHONE NO. �
SEPTIC TANK CAPACITY -C:<I
LEACHING FACILITY:(type) C_14— (size) .<K f K
NO.OF BEDROOMS C4W,0zq
OWNER I-,J q00 a o
PERMIT DATE: tiro��<a COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility -4- 4 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
300 feet of leaching facility) Feet
FURNISHED BY
/3
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z
j � _ _ _ _
2 T
y �
No. ( } Fee "d
THE COMMONWEALTH OF MASSACHUSETTS Entered in co 'puter:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01pplitatlon for Misposal *pstem CottBtCUttion Permit
Application for a Permit to Construct( ) Repair(Y�Upgrade(�Abandon( ) ❑Complete System endividual Components
Location Address or Lot No. -y,*3 s-'• ,� `/l/ Owner's Name,Mldress,and Tel.No.
7a�u4n i-Jory-Seaca+ -9 3 hk�l�SF
Assessor's Map/Parcel /68 oGrD
Installer's Name,Address,and T 1.No. �'7�(•-g��9 Designer's Name,Address,and Tel.No.
; nc• P0•[60x'>6 1r riv_ Cc,?„�'�Cs,Zrx / cvCy�6ssyC�a/d�1
s o-RL&(1
Type of Building:
Dwelling No.of Bedrooms V Lot Size #5 )R a—sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures ��//
Design Flow(min.rered) gpd Design flow provided 76 gpd
�qui9 Plan Date /s r Number of sheets ` pp�� Revision Date
Title (� 83
Size of Septic Tank�j�j6 ��Z1'j�� Type of S.A.S. �'X /a• ehlao
Description of Soil 141)"
Nature of Repairs or Alterations(Answer when applicable) f1 '3
ok(@AOL1liA a e t S+l X (01 $'W S"p iog,! Un 1 t Qo
(E� • 40 ae' A4c G5��r k-c 'Ta_(k
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 C , t to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. -''�
Signe Date
Application Approved by F—L Date
Application Disapproved by Date
for the following reasons
Permit No. � � 3 Date Issued 1.0 i
No. U( � -J ,�-. -h,. Fee O�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
��
A PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01pplicatlon forlDisposaf *pstrm Construction Permit
Application for a Permit to Construct( ) Repair(V�Upgrade(—) Abandon( ) ❑Complete System Ondividual Components
Location Address or Lot No. V93 Map Sf•' Owner's Name,Address,and Tel.No. S'09
&U /,3ztn5��' tzapl��n i rJor ct 5 t ysf 3 i j�t�z..S
Assessor's Map/Parcel /Oy 006 s �l resk6ge AG'a&6
Installer's Name,Address,and Tel.No. SDI'7 0( i 3Cl r7 Designer's Name,Address,and Tel.No. JZ6- �-57W3
�c Motu_Clonsf rv_�-icm�e• P•0-f3ox '��C/ ;, -0. Ce br/� Z �s, r is ze.Cr,-
asSyCcnld.�c{
mcArs�o s IuiNs i'E D ' eras � 0
Type of Building:
u f�
Dwelling No.of Bedrooms 7 Lot Size //J} U 3 3_sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons_ Showers( ) Cafeteria( ) i
Other Fixtures
Design Flow(min.re79//
red) yU gpd Design flow provided 7S7• Y gpd
Plan Date p7( s Number of sheets Revision Date
Title n ) C/ /[At1 �✓op�. (1 c<l- fs�c�,lc EL
Size ofSepticTanke!(i.1-;:M j5�c�,Q Type of S.A.S.�3. fl( /�•S .�i���e � �f•i�o) ,,yrfJ/�. 5
n J
Description of Soil rlwk 1-cuA011,1 ILIQ (aC
Nature of Repairs or Alterations(Answer when applicable)np,,, 1�7c}
�^(ft,V 1/i1 ..�A. CA_ JJ� I X1, •� tj �{-rnlf liGrrn�� �ir�1 � � fl�i/It �lt�a ryS� 1 ac 1,�ZaPr� 4-
Cbm -14 u- k 4*1._9.1 J m!' l+, "'�"l�"e•,i! ._
Date last inspected: v /�
-
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.
_ Signe Date
Application Approved by IA,, Date v 1.
Application Disapproved by V Date
for the following reasons
i ?
Permit No. a � 5 - > Date Issued To
r �
--------------------------------------------------- -----------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,_thaat the On-site Sewage Disposal system Constructed( ) Repaired(J)� Upgraded( )
Abandoned( )by �..7yrk)A&1 do 5 t Y[x)40n , Z�
at 7 93 / is o A2 S 4_0 &J, e m s 4-�(0 Ito has been constructed in accordance F
with the provisions of Title 5 and the for(Disposal System Construction Permit No. p r dated J U 3 t
Installer(r� aO& �Gr1c reKKnt� 7 Ia•C Designer G�Y�i ,p��?�r rye L(�c�((�,n,, Y�G
```' , d a
#bedrooms Approved design flow gp
The issuance of this permit shall of be co strued as a guarantee that the system w�f m ,ion signed.
Date /r� c2/ S - Inspector\ ^�
....................................
---------------------------------------------------------------------------------------------------------------------------------------
No. G '�(I Fee 1(r1—
THE COMMONWEALTH OF MASSACHUSETTS r
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal bpstem Construction Permit
Permission is hereby granted to Construct( ) C Repair(�� Upgrade( ) /Abandon( )
System located at 418 3
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:Constructio must be completed within three years of the date of this permit. I
Date dl Y'1/ ( 1 Approved by '� `
1
i
jE Town of Barnstable P#_ _
o f IHE,
c Department of Regulatory Services
BARNSTABLE, Public Health Division Date
+
MASS.
v� 1679• $� 200 Main Street,Hyannis MA 02601
Alfo MA1 e
Date Scheduled ` 2 f ( t��Time Fee Pd. l-aG C1 d
Soil Suitability Assessment for Sewage Disposal
Performed By: ���-e�I t G�n � Witnessed By: dw4 0, T�► �
LOCATION & GENERAL INFORMATION
Location Address (1�� S� Owner's Name 0---L spa C
1 t� p,
(�'. a�itSiZib�l Address /0 60-0( `177, .M-0-A 6F44F
Assessor's Map/Parcel: f o B '6�CQ Engineer's Name6op—p-r YvLe 1— �
NEW CONSTRUCTION REPAIR � Telephone# 56� 7w
Land Use //TI'6 1 04P1046, Slopes(%) 1 3 Surface Stones
Distances from: Open Water Body 7 16-0 ft Possible Wet Area 1.5-27 ft Drinking Water Well 12M )3
i Drainage Way ft Property Line 3O d ft Other ft
SKETCH: (Sheet name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
w
i
� ��,�l.J✓ �Jo�r TO S CR�E
i
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II Parent material(geologic) rat` r Q,q Depth to Bedrock_N C�
Depth to Groundwater: Standing Water in Hold"d r'k Weeping from Pit Facie_ PIV(5�"2
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
i Depth Observed standing in obs.hole: in. Depth to soil mottles: _in.
Depth to weeping from side of ot.)s.hole: in. Groundwater Adjustment _ft.
i Index Well# Reading Date: index Well level Adj.factor Adj.Groundwater Level
i
PERCOLATION TEST »ate Time
Observation ,�---
Hole# Few (j^ Pje Timeat9"
I -
Depth of Pere 1 Sy Time at 6" _
Start Pre-soak Time @ 2 M / LTimc(9"-6") _
I End Pre-soak
i
i
Rate Min./Inch
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
S4 d Le('W 1 �t 1 d cx�1�o, (mot S t of 1(0,4
Original: Public Health Division Observation Hole Data To Be Comp eted on Back--------- e
o 9( G J t a -t—n— S G,,.d, �aJw t s-1
***If percolation test is to be conducted within 100' of wetland you must first notify I p � Y Y the TV° 3 S��tir1
Barnstable Conservation Division at least one (1) week prior to beginning.
Q:\SEPTIC\PERCFORM.DOC
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DEEP.OBSERVATION HOLE LOG Holm
Depth from Soil Horizon Soil Texture .Sdil Color Soil Other
S irface(in.) (USDA) (Munsell) Mottling (Structure;Stones;Boulders.
_ Consistency.%Gravel'L
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DEEP OBSERVATION HOLE LOG Hole)# Z -
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Consistency.%Q vel)
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DEEP OBSERVATION HOLE'LOG Hole#_
Depth from Soil Horizon Soil Texture Soil Color Soil Other
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Flood Insurance Rate Map:
Above 500 year flood boundary No_ Yes
Within 500 year boundary No Yes
Within 100 year flood boundary Nc Yes
D�enth of Naturally O.ccurrim Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the,
afea proposed for the soil absorption system?
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on l 1 t°�� (date)I have passed the soil evaluator examination approved by the
DIepartment of Environmental Protection and that the above analysis was perforated by me consistent:with .
the required training,expertise and experience described in 510 CMR 15.0177. '
S}gnature Date 1 .
I
Q;1S.BP-MCTERCFORM.DOC
LO.(v �tI'ION ��ap/�' . Jdt^cc2` No f !"
nYi .A013 I l. sT '/�f�'/1�t L/71L3LF DATE
' 1�G13 -
APPLICANT (,rul�i�nc.; �'' lu)ri�l�-l' '.
. (Non-refundable)
ADDRESS ',,257& 1� Act_ Lva lihIs TELEPHON13 NO. 77/
ENOINEER', { Cv ;' face."cck'cry i' (Ancjog'r- TELEPHONE NO. _ '77�-2Z4-q �
DATH SC.JIBDULEll `�c�.F��.,�1-xr [��" l`f`�O _
(Appllcant's Signature)
.....:...... .., .... ............................................................ ......................................:...::.:::.::..:.................
ASS&SSOR"9 MAP 6 LOT NOs 1'Y%c..e k08_s Pc (c,
SOIL LOCI
SUB-DIVISION NAME DATE �-,�'�.�.t�er �, � ( `t4d 'rimB \`)tm _
EXPANSION ARBAr•YES X NU Sr`soh�r� A. Cam./sue ENGINEER
TOWN.WA•I'BR PRIVATE WELL 06rr BOARD OF HEALTH
• 1",-1120 6rQS . (Ca� EXCAVALTOR
SKBTQIIr"(Street name, etc., dirnenalona of lot,.exact location of test holes nn•rl percolation tests,
locate wetlands In proximity to teat holes)
NOT.. r -
z:'
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al.
Al" 10,
OLATION "'IT-: I \�
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MULE NO: / "r,j,r,VA T10N: //6,S TEST MOLE i10: ELEVATION : //4,�
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9 9 ,
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ABLE FOR SUB-SURFACE S1 WAGE: LEACHING !:TELL LEACHING FITS �
LEACHING TRENCHES X
ITABLE FOR SUB--SURFACE SEWAGE. REASONS:
ENc3INEiRJIM FLANS I-IUST SHOW. N HBER. ASSIGNED ON I?ERC TEST APPLICATION
INAL: CQ1IPLBTED IN EIJT11113 Y 13Y P . E. AND RETUIINED TO BOARD OF IIBALTII
s RETAINED BY APPLICANT
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Project No._1 .i2 4 Client_ 0r,F h it TEST PIT ;t"'-3
Date SLO, Im i 14 4 n Location N*10 .S;'. !<.Fst L in Logged by s• IV, &),IsC"
Ground Elevation Health Agent E& :aor•r•.-A P" 76¢O
Weather w(4p&%/a 1)N n.6
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And: 31_S 50`S Start Presoak
Groundwater With: 2" 35% Did Presoak
Some: 1.5 25`;0 )
`� Seasonal Max. Tune at 12"or 1
Little 5 15`,
`C Observed Elevation TraCc,: G 5.�IX, Tane at 9"or% )
Excavation Effort Time at G"or 1 )
Perc. Test Bedrock' "()A
F Easy
Flev.of To,: IIII=1111=t111 J111=III(=11U El;rpsc(i Time 9"-6'
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Town of Barnstable Barnstable
mericaCiiy
Regulatory Servi s epar ent */
y
i r DArtNSTABLE,
IN1AS8. �Q Public He - th�sion 20
i639.p ,0
PIED M a 200 Main Street, y:nnis A 02601
email: Barnstable.Rental: gistron ow .barn table:ma. s
OFFICE: 508-862-4644 \ ho s A.dVic 1
.FAX: 508-790-6304 V
APPLICATION F RENT GISTRATI (�
Date:
Fee: $90.00 Per Unit-Plus$25 fo
'each addtl.unit on the same parcel
Property Location: ff3 N n Wes �' _
UNIT# If Applicable,BUILDING#
Assessor's Ma and Parcel: `I 99 Y l
p 1 /
Total Number of Rental Units You Own At This .roperty(including this unit)
Owner's Name: mednc9 5ea _t �a07&5
Telephone Nu (— a�e)� 37v�, 71i 90
(Home Phone)Sot (Cellular) ,.5/4 Rge Z
Owner's Address:
Mailing Address: (if different than above) P?® S 22 7�¢I1/. 4?1�b)e
Email: jc�D�l�)� ✓�?i'�ln.��L
Owner'slRepresentative's Name if Applicable): Al/R
Address:
Telephone Number:
Occupant's Name:
Daytime Phone Number: Cellular
Number of Bedroom . Check One: Is this a single family dwelling unit?
[ ],
an apartment buildi g? [ ] or an accessory apartment? [ ]. /Private Drinking Well? [ram'
Do You Have Z `ing/Building Division Approval for,an accessory apartment?
Will there be Zy children under the age of six who will be occupying the rental unit?
(circle one)/ Yes
Was the d ellmg constructed prior to 1979? Yes o
I certify that the information provided above is true:
*Inspections Done Annually. Appl' nt's S, tW//
CADocuments and Settings\bamrentalregOesktop\RentalRegistAppForm w 25 fee May 2012.doc
r
Town of Barnstable
Regulatory Services Barnstable
of THE Tp� g y
Richard Scali Director A&AmericaCity
Public Health Division
* BARNSTABLE,
9 MASS. Thomas McKean, Director �007
i - s`� 200 Main Street
.ol�D MAC
Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
September 8, 2015
SEACAT, DONA L & KINNEY, JAMES J JR
P O BOX 227
WEST BARNSTABLE, MA 02668
As of October 1, 2006 a new rental registration ordinance was put into affect requiring
all property owners of rental units to register them with the Town of Barnstable Health
Division. This includes all Summer Rentals. According to our records, you own the rental
property,at 483 MAPLE STREET, WEST BARNSTABLE and have never registered.
Enclosed is an. application. Please use a separate application for each rental unit you own.
Should you need more applications, they are available online at www.town.barnstable.ma.us.
Go to the Health Division page by looking in the Department Menu. There is a link to the
Rental Registration information on the Health Division page. You may print out as many as
you need and return them to the Health Division with the appropriate fees included. This must
be completed within (14) fourteen days of your receipt of this letter.
There is a fee of $100 and $35 for each additional unit (which includes a late fee for
each). A $10 late fee is assessed for each unit that is late registering after January 31, 2015.
Failure to comply with this ordinance will result in the issuance of a non-criminal ticket
citation in the amount of$100. Each day of non-compliance is considered a separate offense.
Should you have any questions, please feel free to call 508-862-4072. Thank you`in
advance for your cooperation.
Kathryn Soto
Rental Registration
Public Health Division
Direct#508-862-4072
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This Cettlfica[e indicates acceptable IIvulmnnl habitable requirements per Massachusetts State B uldtng Code ;
iy� ,� and Town:gf Barnstable Toning ordinances m a`ccordance with'the Amnesty_program. Ib` "
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r Location= M et, W s arnsta e, MA ;. r s �n
483 aple Stre e t B
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Unit CapacityP 'One bedm not to exceed 2v eo ie v
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tF1E
Town of Barnstable
+ BARNSTABLE, = .
'"�: ,, Office of Community and Economic Development
EO MA'S
230 South Street, Hyannis,MA 02601
Kevin J..Shea' Office: 508-862-4678; or 508-862-4683 Fax: 50-862-4782
Director
August 5, 2003
Re: Certificate of Compliance/Occupancy Permit
Dear Donna Seacat:
Congratulations! You have completed all the necessary steps in order to receive your
Certificate of Compliance allowing tenant occupancy in your accessory affordable unit.
Enclosed is the actual certificate for your records. Starting next year,you will be
asked to complete an annual inspection with Bob Shea, and sign an affidavit verifying that
you're still current with the Amnesty Program.
As the saying goes, "you've come a long way,baby," and we're pleased that you are a
participant in a program that provides housing for some of our year-round residents in the
Town of Barnstable. Thanks again.
Sincerely,
M Vhjmbt!n Mary
Monitor Agent
Q:CommDev/PT/MWCONGRATS
REGULATORY AGREEMENT
AND DECLARATION OF RESTRICTIVE COVENANTS
THIS REGULATORY AGREEMENT and DECLARATION OF RESTRICTIVE COVENANT'S,is made
this / day of C7a�i2 ,2003,by and between Dona L. Seacat and James J.Kinney,Jr.of .
483 Maple Street,W. Barnstable,MA 02668,and its successors and assigns (hereinafter the "Owner"),and the
TOWN OF BARNSTABLE (the"Municipality'),a political subdivision of the Commonwealth;
WHEREAS the Owner has been granted a Comprehensive Permit under Massachusetts General Law Chapter
40B.and local regulations by the Zoning Board of Appeals to permit the.creation of an accessory apartment in
an owner occupied dwelling which will be rented to a Low or Moderate Income Person/Family(hereinafter
"Designated Affordable Unit";and
NOW THEREFORE,in mutual consideration of the agreements and covenants contained`herein,and other
good and valuable consideration,the receipt and sufficiency of which is hereby aclmowledged,the parties agree
as follows:
I. PROJECT SCOPE AND DESIGN:
A The terms of this Agreement and Covenant regulate the property located at 483 Maple Street,W.
Barnstable,MA,as further described in Exhibit"A"hereto annexed.
B. The Project located at 483 Maple Street,W.Barnstable,MA will consist of one accessory apartment unit
which will be rented to an eligible low or moderate income individual or family(the"Designated Affordable
Unit" or the"Unit").
C The Owner agrees to construct the Project in accordance with the terms of the comprehensive permit,
Appeal No. 2003-12 and any plans submitted therewith and all applicable state,federal and municipal laws and
regulations (A copy of the comprehensive permit is annexed hereto as Exhibit"B").
D.• The Owner agrees to occupy the principal dwelling unit located on the property as their year round
residence in accordance with the terms of the comprehensive permit.
H. THE OWNER'S COVENANTS AND RESPONSIBILITIES:
A THE OWNER HEREBY REPRESENTS,COVENANTS AND WARRANTS AS FOLLOWS:
1 In receiving the comprehensive permit to create the Designated Affordable unit,the Owner agreed that
the Designated Affordable Unit shall be set aside in perpetuity for the public purpose of providing safe and
decent housing to persons of low income(herein defined as 80% or less of the median income of Barnstable-
Yarmouth Metropolitan Statistical Area(NSA) and that the Designated Affordable Unit shall be deemed to be
impressed with a public trust.
2. The Designated Affordable Unit"shall be rented in perpetuityto a household with a maximum income
of 80% of Area Median Income or less of the Area Median Income (AMI) of Barnstable-Yarmouth
Metropolitan Statistical Area(MSA) and that rent(including utilities) shall not exceed the rents established bythe
Department of Housing and Urban Development(HUD) for a household whose income is 80% of the median
income of Barnstable-Yarmouth Metropolitan Statistical Area. In the event that utilities are separately metered,
the utility allowance established by the Barnstable Housing Authority shall be deducted from HUD's rent level.
3. The Designated Affordable Unit will be retained as permanent,year round rental dwelling units with at
least one-year leases.
4. The Owner has the-full legal right,power and authority to execute and deliver this Agreement.
TOWN CLERK
BARNSTABL.E, 'MASS...
r.
Town of]Barnstable
Zoning Board of Appeals
Comprehensive Permit.Decision and Notice
Appeal2003— 12= Seacat
Applicant: Dona Seacat
Property Address: 483 Maple Street,W.Barnstable,MA
Assessor's Map/Parcel: Map 108.Parcel 006
Zoning: Residential F
Groundwater Overlay: AP Aquifer Protection Overlay District
Applicant:
The applicant is Dona Seacat,who resides at 483 Maple Street,W.Barnstable,MA..
Relief Requested:
The applicant has applied for a Comprehensive Permit under the General Law of the Commonwealth of
Massachusetts,Chapter 40B-S 20-23 and in accordance with the General Ordinance of the Town of
Barnstable Chapter III,Article LXV,"Pre-existing and Unpermitted Dwelling Units and for-New Dwelling
Units in Existing Structures," more commonlytermed the"Accessory Affordable Housing Program" She
wants to convert an apartment into an accessory affordable unit at a single-family owner-occupied residential
dwelling in accordance with all the conditions of this permit. The issuance of this Comprehensive Permit
would allow for an owner-occupied single-family residence with an accessory affordable apartment within the
single-family dwelling:
Locus and Background:
The property is a 2.64 acre lot that is developed with a 4-bedroom,21/2-bathroom,4,760 square feet single-
family,Colonial style home. The applicant built the house ten years ago and later she and her husband built
the unit with the intention of using it in the future for his parents. The applicant has been renting it off and
on to friends. The applicant heard about the program through the local media and decided to apply for it.
The proposed accessory unit will be converted within a pre-existing basement apartment. It is a one-
bedroom and approximately 600 square feet. The locus is in the AP Aquifer Protection Overlay District.
.The unit qualifies for the Accessory Affordable Housing Program as an Amnesty unit.
Procedural Summary:
'Phis application for Comprehensive Permit was filed at the Town Clerk's Office and the Office of the
Zoning Board of Appeals. A public hearing before the Zoning Board of Appeals Hearing Officer was duly
advertised and notice was sent to all abutters in accordance with MGL Chapter 40A. The hearing was
opened on April 23,2003,at which time the Hearing Officer took a question from a neighbor,Bonnie
McNally on Title V regulations. After a brief explanation of how public health approves a septic system
based on its capacity handle the property's bedrooms,and reviewing the competed application,the
Comprehensive Permit was granted. The Hearing Officer,Gail Nightingale,presided over the public
hearing. Also present were Paulette Theresa-McAuliffe,Accessory Affordable Housing Program
Coordinator,and Mrchelle McKinstry,Barnstable Housing Authority.
f
jeopardizing the health and safety of the occupants provided all conditions of the Comprehensive
Permit are strktlyfollowed.
Ruling and Conditions:
Based upon the findings,the applicant, Dona SeacatJs granted a Comprehensive.Permit to permit the
conversion of an accessory apartment of 600 square feet within a single-family owner-occupied residential
dwelling, subject to the following conditions:
1. The property owner shall occupy the principal dwelling as her year-round residence.
2. _Occupancy of the affordable unit shall not exceed two people.
3. This unit shall not be occupied by a family member.
4. To meet the requirements of affordability,the applicant must rent the unit to a person or family
whose income is 80% or less of the Area Median Income(A1vff) of Barnstable-Yarmouth
Metropolitan Statistical Area(MBA),adjusted by household size. The monthly rent payable by a'
household inclusive of utilities shall not exceed 30%of the monthly household income of a
household earning 80% of the median income,adjusted by household size. In the event that utilities
are separately metered,the utility allowance established by the Barnstable Housing Authority shall be
deducted from rent level so calculated.
5. All leases shall have a minimum term of one year.
6. Before.the issuance of an occupancy permit for the accessory affordable unit,the building
commissioner must determine that the unit both conforms with the approved plans as submitted to
the file and meets state building and fire codes,plus,complies with applicable state on-site
wastewater discharge requirements.
7. The applicant may select their own tenant(s) provided the tenant(s) meet all requirements of the
program and provided that person(s) income is reviewed and approved by the Barnstable Housing
Authority as a qualified individual. The applicant will be required to work with the Housing
Authorityto provide information necessaryto document that the tenant(s) qualify. To insure that
the unit is rented in an open.and fair basis to an income eligible individual or family,the unit must be
listed with the Barnstable Housing Authority(BHA)'and the Housing Assistance Corporation
(HACj whenever a vacancy occurs. Also,the applicant must notify the monitoring agent of a
vacancy whenever it occurs.
8. Every twelve months the applicant shall review the income eligibility of those individuals occupying
the unit. No later than a year from the date of issuance of this Comprehensive Permit the applicant
shall file with the Barnstable Housing Authority an annual affidavit listing the rent charged and
income level of the occupant(s)of the unit. The applicant shall provide the Barnstable Housing
Authority any additional information it deems necessaryto verifythe information provided in the
affidavit. Upon any report from the Barnstable Housing Authority that the terms and conditions of .
this permit are not being upheld,the Zoning Board of Appeals or it's Hearing Officer shall have the
ability to hold a hearing to show cause as to why this permit should not be revoked.
9. The Accessory Affordable Unit shall be affordable in perpetuity(as affordable is defined herein)
unless this Comprehensive Permit is rendered void.
10. This Comprehensive Permit shall not be transferable to an other person or entity without the prior
- P y P n'
approval of the Hearing Officer or Zoning Board of Appeals. This decision,the Regulatory
3
Agreement and Declaration of Restrictive Covenants and all other necessary documents shall be filed
at the Barnstable•Court .Re s of Deeds. If the ownership of the property is transferred the
ty � trY p P P
Barnstable Housing.Authority shall be notified within 60 days the name and address of the new
owner.
11. All parking for the dwelling and accessory unit shall be accommodated on site,and no lodging shall
be permitted on site for the duration of this Comprehensive.Permit.
12. This Comprehensive Permit must be exercised and the unit occupied within 12.months of its
issuance or it shall expire.
Transmission of the Decision of the Hearing Officer to the Barnstable Zoning Board of Appeals
In accordance with Pan H,Section 4.02 and Part III,:Section 3.72 of the Town of Barnstable Administrative
Code,the hearing officer transmitted her written decision to the Zoning.Board of Appeals on April 23,2003,
and fourteen days having elapsed since said transmittal with the Zoning Board of Appeals taking no action to
reverse the decision,this decision becomes the decision for this Comprehensive.Permit application.
Ordered:
Comprehensive Permit 2003-12 has been granted with conditions. Appeals of this decision,if any,shall be
made to the Barnstable Superior Court pursuant to MGL Chapter 40A,Section 17,within twenty(20) days
after the date of the filing of this decision in the office of the Town Clerk The applicant has the right to
ap eal this cis' n as outlined in.MGL Chapter 40B,Section 22.
r-
A �T�Q
G Nightuigale g i er Date Signed
I, da HutcheClerk t
!6r,
he Town of Barnstable,Barnstable County,Massachusetts,hereby certify
that twenty(20)days have elapsed since the Zoning Board of Appeals filed this decision and that no appeal
of the decision has been filed in the office of the Town Clerk
Signed and sealed this day of under the pains and penalties of perjury.
Linda Hutchenrider,Town Clerk
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STRUCTURAL r?
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JOHN t+
HENRY .
CIARCIA
J �F 106M
/.�/ .Y...`r u0 .r
i A PROFESSIONAL LAND SURVEYOR, AMERICAN SURVEYING COMPANY
I DO HEREBY CERTIFY THAT THE
ABOVE
yy MORTGAGE
pp INSP VpN 1264 Main Street,Waltham,MA 02451 (781)893-6477
PC.Jjl7la �REMOL� a __ iN
CONNECTIONWITHANEWMORTGAGE pp��
AND IS NOT INTENDED OR REPRE- MoYtgage Inspection Plan
SENTED TO BE A LAND OR PROPERTY
LINE SURVEY. NO CORNERS WERE THE LOCATION'OF THE ORIGINAL RECORDS AT COUNTY REGISTRY OF DEEDS
SET. IT CANNOT BE USED FOR ES- DWELLING'SHOWN HEREON EITHER BOOK PAGE_ # _
I TABLISHING FENCE, HEDGE OR WAS IN COMPLIANCE WITH THE LOCAL PLAN REFERENCE:-P4
62
3 BUILDING LINES.THE LAND AS SHOWN APPLICABLE ZONING BYLAWS IN EF- DRAWNPER,TOWNOF ASSESSOR'S
i HEREON IS BASED ON CLIENT,FUR- FECT WHEN CONSTRUCTED WITH RE- MAP# C AT D
} NISHED INFORMATION AND MAY BE SPECTTO HORIZONTAL DIMENSIONAL ADDRESS:
+ SUBJECT TO FURTHER OUT-SALES, REQUIREMENTS ONLY),OR IS EXEMPT BL-2 Az
TAKINGS,EASEMENTSAND RIGHTS OF FROM VIOLATION ENFORCEMENT AC- BORROWER:
WAY. MQ RESPONSIBILITY IS EX- TION UNDER MASS.G.L.TITLE VII,CHAP.
TENDED HEREIN TO THE LAND OWNER 40A, SEC. 7, UNLESS OTHERWISE SUBJECT DWELLING LIES IN FLOOD ZONE
OR OCCUPANT,IT IS NOTINTENDEO NOTED OR SHOWN HEREON.A CON-AS SHOWN ON NATIONAL FLOOD INSIJvANCE 1MGRAM FLOOD
TO BE RECORDED. FIRMATORY INSTRUMENT SURVEY INSURANCE RATE MAP DATED ft c9jGfGrJ 1 0�l G
IS ADVISED WHEN STRUCTURES ARE COMMUNITY_PANEL#
DATE SHOWN TO BE 1' OR LESS FROM
x FIELDED DRAFTED CHECKED
+ CUENT PROPERTY OR REQUIRED ZONING BY -
CUENT R F 0 G60 SETBACK LINES. DATE 1.10. l•Irj. /'/51 F.B. PGE.
J.O.tt
u storner Service Report
ENVIRONMENTAL tl
,ARCEL. i .d-,..,..�.
OT
System V er Systerr location b
:.nn i V ,i dYA a ,.ter .,Tr^,z C _ .
r.508)-362-'768 ) ?i ; t� -3, 2 %h%tj
1; 7
'usfomer 6 : 11272.4
Customer Home - hkxrsehold Size
Technician 1 2 3 4 '5 6 7 8
:System Type J•.��il.-�. 1 Tank Size 1W0 22 20 18 16 14 12 12 12
_'-Previous Service 1250 22 20 18 18 16 14 12 12
Next Service �n r,e ri 1500 24 22 20 20 18 16 14 14 -
'.(�te of Service 1750 26 24 22 24 20 18 16 16
Servic-e X16Ae i nb-,-e"'pftr6 inches .Firs 0-D;) '.: 511,111({charge $0 I U Score From Table
l.lT[1rJ i.:1 q ()1.'"1 J n U LOO _1 i� l% Y:�4:.• ��� subtract 6 for garbage disposal
5ubtroct 5 if system is older than 10 years
Add 8 for seasonal use
Add 5 if system additive is used:
Net 5core:
ScoF�e Frequency.
Less than,5 „Every,6 months.
er Subtotal 6 to 15 Every Year
Payment Type: Expires: Tax .� 7 16 to 23 Every 18 months
Credit Card;id: Total greater than 24 Every 2 years
f
Technician Comments: r ,. /� Tank Olsations
Leachfield Runback
Riding High(liquid ievei)
it►' ,, i r
,✓� Excessive Solids (top/bottom)
�! Use W Powdered Soap
Heavy Grease
Roots
Outlets Baffle Missing
Inlet Baffle Missing
r, _ , 2 (' -- roe e C- e n _ �f A 104r,
-
Js_I1:7 N:Lvr-� r En __ Dri1[t�3R_r-._. ._,i � _ _ ..r3 -dfi. v^ _. _'t {( , }E S r ., .. ]-:,.<t?_'_ ', __ �
Terms Du C:1 Re.C el i
Customer Signature r-
Custer Copy
Health Complaints
12-Jan-05
Time: 1:09:00 AM Date: 1/5/2005 Complaint Number: 17870
Referred To: DONALD DESMARAIS Taken By: Judith Flynn
Complaint Type: CHAPTER II HOUSING
Article X Detail: UNSANITARY CONDITIONS
Business Name:
Number: 483 Street: Maple Street
Village: WEST BARNSTABLE Assessors Map_Parcel:
Actions Taken/Results: DD SPOKE WITH AND SHE
GAVE ME THE RUNDOWN ON 1/5/2005.
APPOINTMENT FOR 4 PM ON 1/6/2004. DD
WENT AND SPOKE WITH MS. HANDY, SHE
TOLD ME THAT THE LANDLORD IS
LIMITING HER USAGE TO 2 MINUTE
SHOWERS. SPOKE WITH THE LANDLORD
AND SHE PRODUCED A TITLE V
INSPECTION REPORT DATED 3/27/2003
DONE SINCE THE
INSPECTION IS ALMOST TWO YEARS OLD,
THE FACT THAT THE SEPTAGE BACKED UP
INTO THE HOUSE AND THE TENANTS
WATER USAGE IS BEING CURTAILED, I
WILL ORDER A TITLE V INSPECTION. DD
WILL NOTIFY LINDA EDSON ABOUT THE
WATER RESTRICTION.
1
I
Health Complaints
12-1an-05
Investigation Date: 1/6/2005 Investigation Time: 4:00:00 PM
2
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COMMONWEALTH OF MASSACHUSETTS d
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAI
x
DEPARTMENT OF ENVIRONMENTAL PROTECTION 110py
d ( R4 J i
ti • i
,
APR 1 5 2003
TITLE 5 `` TOWN OF B NST.STABLE]
OFFICIAL INSPECTION FORM—NOT FOR 13:,"O N`_"AiRy ASSES ,
h�ltil��5-
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 483 MAPLE ST W. BARNSTABLE 02668 M108 P006
Owner's Name: DONNA SEACAT
Owner's Address: BOX 227 W. BARNSTABLE
Date of Inspection: 3/27/03
Name of Inspector: (please print) JOHN GRACI,INC.
Company Name: SEPTIC INSPECTIONS
Mailing Address: P.O. BOX 2119 TEATICKT:T,MA.02536 MAP ,PARCEL
PARCELTelephone Number: 508-564-6813 FAX 508-564-7270
• o 0
LOT
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this ac dress,:.id that the information reported below is
true,accurate and complete as of the time of the inspection.The inspection N�Fas 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:
X Passes
_ Conditional asses
_ Needs Fu Evaluation by the Local Approving Authority
Fails
Inspector's Signature: �t " .%.:: /27/33
The system inspector shall suTbay of this inspection report to the Approving:authority(board of 111eaith or DEP)within
30 days of completing this inf the system is a shared system or has a design flow of]0,000 gpd or greater,the
inspector and the system owner shall submit the report to the appropriate regional o:5ce of the DEP. The original should be
sent to the system owner and copies sent to the buyer, if applicable,and the approvi.:g authority.
Notes and Comments
THE SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING EV`S,RY TWO YEARS.'I'O PROLONG THE
SYSTEM'S USEFUL LIFE.
****This report only describes conditions at the time of inspection and under :ae 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.
Page 2 of'11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 483 MAPLE ST W.BARNSTABLE 02668 M108 P006
Owner: DONNA SEACAT
Date of Inspection: 3/27/03
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310
CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG
THE SYSTEM' S USEFUL LIFE.
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.
Answer yes, no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain.
n/a 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.
ND explain: n/a
n/a 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
_ obstruction is removed
_ distribution box is leveled or replaced
ND explain: n/a
n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass
inspection if(with approval of the Board of Health):
_broken pipe(s)are replaced
_obstruction is removed
ND explain: n/a
r
Page 3 of 91
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 483 MAPLE ST W.BARNSTABLE 02668 M108 P006
Owner: DONNA SEACAT
Date of Inspection: 3/27/03
C. Further Evaluation is Required by the Board of Health:
_ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to
protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is
not functioning in a manner which will protect public health,safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
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 n/a
"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 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:
n/a
r
Page 4 of'I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 483 MAPLE ST W.BARNSTABLE 02668 M108 P006
Owner: DONNA SEACAT
Date of Inspection: 3/27/03
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all-inspections:
Yes No
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
SAS or cesspool
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
X Liquid depth in cesspool is less than 6"below invert or available volume is less than 'h day flow
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times
pumped 2 YRS AGO INFO FROM OWNER.
X Any portion of the SAS, cesspool or privy is below high ground water elevation.
X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X 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 coliform bacteria and volatile organic compounds indicates that the well is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.]
NO (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in
310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.
You must 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
X the system is within 400 feet of a surface drinking water supply
X the system is within 200 feet of a tributary to a surface drinking water supply
X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat
under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
4
I
Page 5 of II l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 483 MAPLE ST W.BARNSTABLE 02668 M108 P006
Owner: DONNA SEACAT
Date of Inspection: 3/27/03
Check if the following have been done. You must indicate "yes" or"no" as to each of the following:
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks?
X _ Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection ?
X Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up?
X _ Was the site inspected for signs of break out?
X _ Were all system components,excluding the SAS, located on site
X _ 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?
X _ 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
X Existing information.For example, a plan at the Board of Health.
X _ 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)]
Y.
5
Page 6 of'I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 483 MAPLE ST W. BARNSTABLE 02668 M108 P006
Owner: DONNA SEACAT
Date of Inspection: 3/27/03
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 10 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 1100
Number of current residents:3
Does residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required]
Laundry system inspected(yes or no): NO
Seasonal use: (yes or no): NO
Water meter readings, if available(last 2 years usage(gpd)): n/a
Sump pump(yes or no): NO
Last date of occupancy: n/a
COMMERCIALANDUSTRIAL
Type of establishment: n/a
Design flow(based on 310 CMR 15.203): n/agpd
Basis of design flow(seats/persons/sgft,etc.): n/a
Grease trap present(yes or no): NO
Industrial waste holding tank present(yes or no): NO
Non-sanitary waste discharged to the Title 5 system(yes or no): NO
Water meter readings, if available: n/a
Last date of occupancy/use: n/a
OTHER(describe): n/a
GENERAL INFORMATION
Pumping Records
Source of information:2 YRS AGO INFO FROM OWNER
Was system pumped as part of the inspection(yes or no): NO
If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a
Reason for pumping: n/a
TYPE OF SYSTEM
X Septic tank,distribution box, soil absorption system
_Single cesspool
_Overflow cesspool
_Privy
_Shared system(yes or no)(if yes,attach previous inspection records, if any)
_Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from
system owner)
_Tight tank Attach a copy of the DEP approval
Other(describe): n/a
Approximate age of all components,date installed(if known)and source of information:
1993 INFO FROM OWNER AND PERMIT 93-474
Were sewage odors detected when arriving at the site(yes or no): NO
6
Page 7 of'l1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 483 MAPLE ST W.BARNSTABLE 02668 M108 P006
Owner: DONNA SEACAT
Date of Inspection: 3/27/03
BUILDING SEWER(locate on site plan)
Depth below grade: 66"
Materials of construction:_cast iron X40 PVC_other(explain): n/a
Distance from private water supply well or suction line: 150n
Comments(on condition of joints,venting,evidence of leakage,etc.):
WELL WATER
SEPTIC TANK: X(locate on site plan)
Depth below grade: 60"
Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a
If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate)
Dimensions: H 10' 6" H 5' 7" W 5' 8"
Sludge depth: 3"
Distance from top of sludge to bottom of outlet tee or baffle: 31"
Scum thickness:3"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 15"
How were dimensions determined: 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.):
SEPTIC TANK AND ALL SEPTIC TANK COMPONENTS ARE STRCTURALLY SOUND AND FUNCTIONING
PROPERLY.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.
GREASE TRAP: _(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
Date of last pumping: n/a
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related
to outlet invert,evidence of leakage,etc.):
n/a
7
f
Page 8 of11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 483 MAPLE ST W.BARNSTABLE 02668 M108 P006
Owner: DONNA SEACAT
Date of Inspection: 3/27/03
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Capacity: n/a gallons
Design Flow: n/a gallons/day
Alarm present(yes or no): N/A
Alarm level: N/A Alarm in working order(yes or no): NO
Date of last pumping: n/a
Comments(condition of alarm and float switches,etc.):
n/a
DISTRIBUTION BOX: X(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into
or out of box,etc.):
D-BOX WAS VIDEO INSPECTED AND APPEARS TO BE STRUCTURALLY SOUND AND SYSTEM SHOWS NO
SIGNS OF FAILURE.
PUMP CHAMBER:_(locate on site plan)
Pumps in working order(yes or no): NO
Alarms in working order(yes or no):NO
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
n/a
R
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 483 MAPLE ST W.BARNSTABLE 02668 M108 P006
Owner: DONNA SEACAT
Date of Inspection: 3/27/03
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
n/a
Type
1000 GAL 6' X 6' leaching pits, number: 2
n/a leaching chambers, number: n/a
n/a leaching galleries, number: n/a
n/a leaching trenches, number, length: n/a
n/a leaching fields, number: n/a
n/a overflow cesspool, number: n/a
n/a innovative/alternative system
Type/name of technology: n/a
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation,etc.):
THE LEACH PITS APPEAR TO BE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.ONE PIT
WAS NOT EXPOSED AT THE TIME OF INSPECTION.THE OTHER PIT HAD T OF LEACHING LEFT AT THE
TIME OF THE INSPECTION-BOTTOM AT 8'
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: n/a
Depth—top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer: n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater inflow(yes or no): NO
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
n/a
PRIVY: (locate on site plan)
Materials of construction: n/a
Dimensions: n/a
Depth of solids: n/a
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
n/a
9
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 483 MAPLE ST W.BARNSTABLE 02668 M108 P006
Owner: DONNA SEACAT
Date of Inspection: 3/27/03
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.
Locate all wells within 100 feet.Locate where public water supply enters the building.
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Page 1'1 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 483 MAPLE ST W.BARNSTABLE 02668 M108 P006
Owner: DONNA SEACAT
Date of Inspection: 3/27/03
SITE EXAM
_Slope
_Surface water
_Check cellar
Shallow wells
Estimated depth to ground water 21 +feet
Please indicate(check)all methods used to determine the high ground water elevation:
YES Obtained from system design plans on record-If checked,date of design plan reviewed: n/a
NO Observed site(abutting property/observation hole within 150 feet of SAS)
NO Checked with local Board of Health-explain: n/a
NO Checked with local excavators,installers-(attach documentation)
NO Accessed USGS database-explain: n/a
You must describe how you established the high ground water elevation:
GROUNDWATER WAS DETERMINED FROM ENGINEERED PLANS ON SUPPLIED BY HOMEOWNER-21+
FEET TO GROUNDWATER
t
�INNE Town of Barnstable Health Inspector
OffiRegulatory Services 8f 00 Hours 9:30
yMASB"AmS.i a Thomas F.Geiler,Director 1:00—2:00
163 Public Health Division Only
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-8624644 Fax: 508-790-6304
AMNESTY PROGRAM APPLICANT QUESTIONNAIRE
1. General Information: -
Address: MN L,� S T YLt E J. &RI'. Map (. Parcel 00(0
Name:1 Qd k �`-PrCW Phone: 57DB 2— '-&go
2. How many bedrooms exist on your property now? ��
2a. Please include a copy of your floor plans.
3. Is the dwelling connected to public sewer? YES or DNo 10t-Js "�'�"
If the dwelling is connected to public sewer, skip questions 4-9 below.
4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public
supply wells?
S. Is the dwelling connected to an NSITE WEL or to PUBLIC WATER?
6. Is a disposal works construction permit on file? E or NO 13
6a.If yes, how many bedrooms were approved accor mg to this permit? Bedrooms.
7. Were any building permits obtained for construction of additional bedrooms? YES or NO
8. Is there an engineered septic system plan on file at the Health Division? YES or NO
9. H septic system been inspected by a DEP certified inspector within the last two years?
ES or NO
r FOR OFFICE USE ONLY
TO BE SIGNED BY A HEALTH INSPECTOR/AGENT ONLY
The Public Health Division has no objection to 5_bedrooms at this property. Cy 4jiffooAs
Signed: Date: /2,LO.3
Inspector(Prin . S M c
'lip
COMMONWEALTH OF MASSACHUSETTS ®�
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
"'
DEPARTMENT OF ENVIRONMENTAL PROTECTION
F
4 Y
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ti
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1p, See
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 483 MAPLE ST W.BARNSTABLE 02668 M108 P006
Owner's Name: DONNA SEACAT
Owner's Address: BOX 227 W.BARNSTABLE
Date of Inspection: 3/27/03
Name of Inspector: (please print) JOHN GRACI,INC.
Company Name: SEPTIC INSPECTIONS
Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536
Telephone Number: 508-564-6813 FAX 508-564-7270
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is
true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and
experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system
inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
X Passes
_ Conditional asses
_ Needs F Evaluation by the Local Approving Authority
Fails
Inspector's Signature: ! Date: 3/27/03
The system inspector shall submi a copy of this inspection report to the Approving Authority(Board of Health or DEP)within
30 days of completing this inspe ion. If the system is a shared system or has a design flow of 10,000 gpd or greater,the
inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be
sent to the system owner and copies sent to the buyer,if applicable, and the approving authority.
Notes and Comments
THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE
SYSTEM' S USEFUL LIFE.
****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.
Page 2 of 1 f
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 483 MAPLE ST W.BARNSTABLE 02668 M108 P006
Owner: DONNA SEACAT
Date of Inspection: 3/27/03
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310
CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG
THE SYSTEM' S USEFUL LIFE.
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.
Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain.
n/a 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.
ND explain:n/a
n/a 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
_ obstruction is removed
_ distribution box is leveled or replaced
ND explain: n/a
n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass
inspection if(with approval of the Board of Health):
_broken pipe(s)are replaced
_obstruction is removed
ND explain: n/a
Page3of11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 483 MAPLE ST W.BARNSTABLE 02668 M108 P006
Owner: DONNA SEACAT
Date of Inspection: 3/27/03
C. Further Evaluation is Required by the Board of Health:
_ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to
protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is
not functioning in a manner which will protect public health,safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
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 n/a
"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 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:
n/a
Page 4 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 483 MAPLE ST W. BARNSTABLE 02668 M108 P006
Owner: DONNA SEACAT
Date of Inspection: 3/27/03
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for alLinspections:
Yes No
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
SAS or cesspool
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
_ X Liquid depth in cesspool is less than 6"below invert or available volume is less than''/2 day flow
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times
pumped 2 YRS AGO INFO FROM OWNER.
X Any portion of the SAS, cesspool or privy is below high ground water elevation.
X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X 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 coliform bacteria and volatile organic compounds indicates that the well is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be
attached to this form.]
NO (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in
310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.
You must 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
X the system is within 400 feet of a surface drinking water supply
X the system is within 200 feet of a tributary to a surface drinking water supply
X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat
under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
I
Page 5 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 483 MAPLE ST W.BARNSTABLE 02668 M108 P006
Owner: DONNA SEACAT
Date of Inspection: 3/27/03
Check if the following have been done.You must indicate"yes"or"no" as to each of the following:
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks?
X _ Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection?
X Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up?
X _ Was the site inspected for signs of break out?
X _ Were all system components,excluding the SAS,located on site?
X _ 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?
X _ 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
X Existing information.For example,a plan at the Board of Health.
X _ 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)]
Page 6 of l I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 483 MAPLE ST W. BARNSTABLE 02668 M108 P006
Owner: DONNA SEACAT
Date of Inspection: 3/27/03
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 10 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 1100
Number of current residents: 3
Does residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required]
Laundry system inspected(yes or no):NO
Seasonal use: (yes or no): NO
Water meter readings,if available(last 2 years usage(gpd)): n/a
Sump pump(yes or no): NO
Last date of occupancy: n/a
COMMERCIAL/INDUSTRIAL
Type of establishment: n/a
Design flow(based on 310 CMR 15.203): n/agpd
Basis of design flow(seats/persons/sgft,etc.): n/a
Grease trap present(yes or no):NO
Industrial waste holding tank present(yes or no):NO
Non-sanitary waste discharged to the Title 5 system(yes or no): NO
Water meter readings,if available: n/a
Last date of occupancy/use: n/a
OTHER(describe): n/a
GENERAL INFORMATION
Pumping Records
Source of information:2 YRS AGO INFO FROM OWNER
Was system pumped as part of the inspection(yes or no): NO
If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a
Reason for pumping: n/a
TYPE OF SYSTEM
X Septic tank,distribution box,soil absorption system
_Single cesspool
_Overflow cesspool
_Privy
_Shared system(yes or no)(if yes,attach previous inspection records, if any)
_Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from
system owner)
_Tight tank Attach a copy of the DEP approval
Other(describe): n/a
Approximate age of all components,date installed(if known)and source of information:
1993 INFO FROM OWNER AND PERMIT 93-474
Were sewage odors detected when arriving at the site(yes or no): NO
Page 7 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 483 MAPLE ST W.BARNSTABLE 02668 M108 P006
Owner: DONNA SEACAT
Date of Inspection: 3/27/03
BUILDING SEWER(locate on site plan)
Depth below grade: 66"
Materials of construction:_cast iron X40 PVC_other(explain): n/a
Distance from private water supply well or suction line: 150"
Comments(on condition of joints,venting,evidence of leakage,etc.):
WELL WATER
SEPTIC TANK: X(locate on site plan)
Depth below grade: 60"
Material of construction: Xconcrete_metal_fiberglass—Polyethylene other(explain)n/a
If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no):NO(attach a copy of certificate)
Dimensions:H 10' 6" H 5' 7"W 5' 8""
Sludge depth:3"
Distance from top of sludge to bottom of outlet tee or baffle: 31"
Scum thickness:3"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle:
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.):
SEPTIC TANK AND ALL SEPTIC TANK COMPONENTS ARE STRCTURALLY SOUND AND FUNCTIONING
PROPERLY.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.
GREASE TRAP:_(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
Date of last pumping: n/a
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
to outlet invert,evidence of leakage,etc.):
n/a
f
Page 8 of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 483 MAPLE ST W.BARNSTABLE 02668 M108 P006
Owner: DONNA SEACAT
Date of Inspection: 3/27/03
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Capacity: n/a gallons
Design Flow: n/a gallons/day
Alarm present(yes or no): N/A
Alarm level:N/A Alarm in working order(yes or no): NO
Date of last pumping: n/a
Comments(condition of alarm and float switches,etc.):
n/a
DISTRIBUTION BOX: X(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into
or out of box, etc.):
D-BOX WAS VIDEO INSPECTED AND APPEARS TO BE STRUCTURALLY SOUND AND SYSTEM SHOWS NO
SIGNS OF FAILURE.
PUMP CHAMBER:_(locate on site plan)
Pumps in working order(yes or no): NO
Alarms in working order(yes or no):NO
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
n/a
Page 9 of 11, '
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 483 MAPLE ST W.BARNSTABLE 02668 M108 P006
Owner: DONNA SEACAT
Date of Inspection: 3/27/03
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
n/a
Type
1000 GAL 6' X 6' leaching pits, number: 2
n/a leaching chambers, number: n/a
n/a leaching galleries, number: n/a
n/a leaching trenches, number, length: n/a
n/a leaching fields, number: n/a
n/a overflow cesspool, number: n/a
n/a innovative/alternative system
Type/name of technology: n/a
Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.):
THE LEACH PITS APPEAR TO BE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.ONE PIT
WAS NOT EXPOSED AT THE TIME OF INSPECTION.THE OTHER PIT HAD 2' OF LEACHING LEFT AT THE
TIME OF THE INSPECTION-BOTTOM AT 8'
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: n/a
Depth—top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer: n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater inflow(yes or no): NO
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.):
n/a
PRIVY: (locate on site plan)
Materials of construction: n/a
Dimensions: n/a
Depth of solids: n/a
Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.):
n/a
4
Page 10 of H
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 483 MAPLE ST W.BARNSTABLE 02668 M108 P006
Owner: DONNA SEACAT
Date of Inspection: 3/27/03
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.
Locate all wells within 100 feet.Locate where public water supply enters the building.
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Page-I I of 11,
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 483 MAPLE ST W.BARNSTABLE 02668 M108 P006
Owner: DONNA SEACAT
Date of Inspection: 3/27/03
SITE EXAM
_Slope
_Surface water
_Check cellar
Shallow wells
Estimated depth to ground water 21+feet
Please indicate(check)all methods used to determine the high ground water elevation:
i
YES Obtained from systein design plans on record-If checked,date of design plan reviewed: n/a
NO Observed site(abutting property/observation hole within 150 feet of SAS)
NO Checked with local Board of Health-explain: n/a
NO Checked with local excavators,installers-(attach documentation)
NO Accessed USGS database-explain: n/a
You must describe how you established the high ground water elevation: '
GROUNDWATER WAS DETERMINED FROM ENGINEERED PLANS ON SUPPLIED BY HOMEOWNER-21+
FEET TO GROUNDWATER
Ft roy, Town of Barnstable Health Inspector
Office Hours
Regulatory Services 8:00-9:30
BAMSPABLE. * 1:00-2:00
v MASS. $ Thomas F.Geiler,Director
1639. Only
Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
AMNESTY PROGRAM APPLICANT QUESTIONNAIRE
1. General Information: pp
Address: `4 U 3 T"O-PIE_ St I� I�&(LdS 2,Map Parcel O C�
Name: 2�)9^14- Sc'k}C Phone: -:5
2. How many bedrooms exist on your property now? 4f
2a. Please include a copy of your floor plans.
3. Is the dwelling connected to public sewer? YES or NO
If the dwelling is connected to public sewer, skip questions 4-9 below.
4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public
supply wells?
S. Is the dwelling connected to an E93
- or to PUBLIC WATER?
6. Is a disposal works construction permit on file? YES or NO 93_f'7 1 G'
6a.If yes, how many bedrooms were approved according to this permit? Bedrooms. (c`euAk
7. Were any building permits obtained for construction of additional bedrooms? YES or NO
8. Is there an engineered septic system plan on file at the Health Division?Q6 or NO
9. Has the septic syst inspected by a DEP certified inspector within the last two years.
YES or N
----------------------------------------------------------------------------------------------------------------- "� � �.
FOR OFFICE USE ONLY
TO BE SIGNED BY A HEALTH INSPECTOR/AGENT ONLY
The Public Health Division ha no objection to bedrooms at this property.
Signed: Date: l
Inspector(Print):
!vim
Dedc
42'
FarrdiY Dining
Room Area IQtchen
Deck
8' WV2
2r
2LIWng
Room Bath
Dining Room
sow
4r
4Z
Master
Closet Bath Bath Bedroom
28' Master
x Bedroom ( Bedroom
jL�j
47
tg
Loft
T T
18'
' r
I
..._—.._................_......---..._.___... ..........._._..__._....__.._____...._. .... .._.._-__._._____—______......._......_................_._....-.__.. _ .. . ......._—...__
GIe
wlI tK SN ..s
c1.0s9"r s Oct
1 Y y � �
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cN EvR��M R� j
nau6le
yriadaw �
w»+do+N
495 MAPLE sT
TOWN OF BARNSTABLE
LOr:ATION SEWAGE # �" �
VILLAGE (A) (I. ar rNVA- l--t ASSESSOR'S MAP & LOTI 0 - 6b L
INSTALLER'S NAME & PHONE NO. -I 8 i aA L , [)Lp n 4..2.E oS �.
SEPTIC TANK CAPACITY f '
LEACHING FACILITY:(type) C I• (size) e- y Je
_
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER i ►'i V.
BUILDER OR OWNS G-rnm n no-L I)6nA, of-Lq C-
DATE PERMIT ISSUED: °2
DATE COMPLIANCE ISSUED: ^"
VARIANCE GRANTED: Yes No
ASSESSORS MAP NO:
THE COMMONVVAqL` %
\ BOAR® OF HEALTH
�\ j r
�� TOWN OF BARNSTABLE `~
Appliration for Uiripo!ml Workii Cnonotrnrtion Prrutit
Application,is e,gbyrpa�i�fa I it to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: � -� �'// �-E._
......1�4. 6 m � s !. ...........................Gl/ r ! N S.� r..................
---------------- --•-•..._...-•---•. .. .....--------
Locstion-Address or Lot No
sft
- _....____.. ...............
- Address-----------_---•------ ---------� ...?��
Installer Address
4 Type of Building s�•- Size Lot............................Sq. feet
U DwellingNo. of Bedrooms___________________ ____________________Expansion Attic Garbage Grinder
04
04 Other—Type of Building S/..a`!GeC._F1 _�!:�No. of ersons.........'�------------ Showers ( ) — Cafeteria ( )
ad Other fixtures ......____ _�1..1_.._.� .!
W Design Flow....................�/__0.-____----_---gallons per person per day. Total daily flow............
WSeptic Tank—Liquid capacity/-.!!-..-_gallons Length................ Width---------------- Diameter---.------------ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No.-__-.�-.------- Diameter..........ly......__. Depth below inlet....... ....... Total leaching area..................sq. ft.
Z Other Distribution box 0-Y Dosing tank ( )
aPercolation Test Results Performed by----•--------------------•--------•--------•-•-•..•---;••--•---••••--..... Date........................................
04 Test Pit No. I--------- ....minutes per inch Depth of Test Pit..... 1........ Depth to ground water.....H.P�
ri Test Pit No. 2......... ...minutes per inch Depth of Test Pit-----`Z f...... Depth to ground water......N...0.....kv_%? 67Z_
----------------------------------------------------------------•-•-•-----------•----...--------.............................••.I...................------...
O Description of Soil-------- -P f S o 3 S U!.t-....... ."3._�...__.S7_1t-,.n...rg1"6 C1...Ile .�.....�.'e��
U ----------------- ---- '. ."' ...........................................................................................................................................
z..••••---------•-•-----•--------••••----••-----•--•-----••••-•-•----••••-•••-•--•------•-••-•............•--•--
W
UNature of Repairs or Alterations—Answer when applicable........................_......._......................_................................._._....
....----•-•------------------------------------------------•------------•----•----------------------------------------------------------------•----•---...............................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned furthe ree�k/7T
ace the
system in operation until a Certificate of Compliance has been is d by t board healt�
...
Signed --- .....
Application Approved By ..... .l�.. ... . . .. ............................ ... J`y. r`'1....=e�J�
Date
Application Disapproved for the following reasons: ......................................................
......... .......... . ............ ......... ........ ........ ....... ............................................
................................................................................................. . ..... . --- . ... .................................. ........................................
Permit No. .r'�.. -'y..yy.................. Issued .......��..t'......6.. ...,���..................
Dace
v
#
No..9...................... .................
THE COMMONWEALTH OF MASSACHUSETTS
`` BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Diripagal Worlai Towitrurtion ramit
Application is ereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at: AW -'e't - eAj
A 0 7" )'►' 1?�E_ S 7- E S 7-
.................................................................................................. ................................................................................................
Location-Address or Lot No.
...................... ......3...9 ................................................................................................
Owner i AdS dress
........................ ........... ....MZ.G& .........1619.............................
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms---........Y.- ---------------- Expansion Attic Garbage Grinder
--
Other—Type of Building No. of ons---------72-............. Showers Cafeteria yers
Otherfixtures ----------:W�_/)-In------Zt.R .... ..............................................................................................
Design Flow....................//...o...............gallons per person per day. Total daily flow............V�.d..... ...........gallons.
IY4 Septic Tank—Liquid capacity 4ML-al Ions Length---------------- Width_.............._ Diameter..........._.._. Depth.................
Disposal Trench—No- -----------........ Width.............._.__.. Total Length.._.___............. Total leaching area....................sq. f t.
r
Seepage Pit No........ ........4_.
------_----- Diameter.- ...... Depth below inlet....... .......... Total leaching area..................sq. f t.
Z Other Distribution box V1_)_ Dosing tank ( )
Percolation Test Results Performed by......................................................;.................... Date........................................
Test Pit No. 1....... __._minutes per inch Depth of Test Pit---_71........ Depth to ground water-----RP�.A.:6.]Z;Q
Test Pit No. 2.........3:...minutes per inch Depth of Test Pit..... ...... Depth to ground water......"..0.....w-IT70Z,
................................................................................................................................I............................
0 Description of Soil.........�.P -f- 5()P_4, 0/ L_ 0 —j 5 P..... ......
.............. .
V1161) . ..........................Ir '2-/................7--------------------
................................................ .........................................................................................................................................
U
............................................... .......................................................i................................................................................................
U Nature of Repairs or Alterations—Answer when applicable!------- ........... ............................................................................
............................................................................... ........................I...................................................... .........................................
Agreement: ( i
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 furthen-jagrees n t to place the
system in operation until a Certificate of Compliance has been is 'd by t board o healt
Signed .... . ................................................................... .......... .. ... ...
Application Approved By ..... . .............z---------------....... ........
.;;,
-------------------------.. ...... ...
- D=
Application Disapproved for the following reasons: .....................................................f--------------------------------------------------...........................
............................................................................................................................................................................................................... ........................................
Permit No. �.. .................... Issued .......q,_7.... ......Z. 47
......... ............
100' Da,e
——————————————————
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
TE1tifiratE of CQT<Y plinure
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( �/ ) or Repaired ( )
Co 4 c vc �/
by `�v2��v �1 ��..... 7� d
at ........................../} �CL°y.........- /... . l��'.G`4 �....../N/(�L.- ------------ .......... .......... ........................... ............... . ......_
has been installed in accordance with the provisions of TITI.E 5:of The State Environmental ._ de as described in
the a Pp P lication for Dis osal Works Construction Permit 'No. �'' dated ...F
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED-AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
Ins ector .. .. "' - ......-.._..........
DATE............� -.........�..........._._.-.�-..../-.- p �
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH //��TOWN OF BARNSTABLE FEE.A.. ...Ao '
No. ..�......
Dis;iusal Warkii Ti itri dWit OV"an it
Permission is hereby granted - I-v 2 C...'� �_- _ -/V ._....
to Construct (C-,) or Repair ( ) an Individual Sewage Disposal System _
^ Cc�
atNo....... -�/9oG ,..�./.:.............CST ........--.................
--------------.....------•----............................
•------ --
st�«t ,�
as shown on the application for Disposal Works Construction PVe rmr it .; o: � Dated
--------- i -/ % C` 1-
/ . --_. -•- ------------
Board of Health
DATE--------------------• y ; .,...�. .......................
FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS
No, ---------------- Fee---
BOARD OF OF HEALTH
T01l N OF BARNSTABLE
;[PpYitationArIverr con6tructioupermit
A plicatiog is hereby made for ermit to Construct ( ), Alter ( , or Repair ( )an individual Well at:
' 1,vation — Address AZessors Map and Parcel
Q -------- ---------------------------------—---------------------
�, / Ow r Address 1i
----
--_ _ — - - -
—Installer — Driller Address —
Type of Building c 'Y`R,�
Dwelling—�--- J-- - -- --
Other - Type of Building-------------------------------- No. of Persons-- -----------------------------
TypeCc
of Well -C�� o Capacity
----- --- ------------- -
Purpose of Well - d— ---- ---------------------------------
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Priva e Well Protection Regulation — The undersigned further agrees not to
place the well in operation uViaert' to f pliance has been issued by the Board of Health. f7------
Signed ante
Application Approved y------- ------ --- ---------------------- -- --------- ----------------
date
Application Disapproved for the following reasons:-------------------------------- - -- —--- -— —___—____—__
---—----------------------------—----------------
— -- —— — --——-- —— --- — — —LL-- ----— — date — --
J
- - Issued----------- --------
Permit No.-----r-�—�------------------------- - -------------------------------------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
ttCertifirate (of Compliance
THIS IS TO CERTIFY, Tha n idual Well Constructed ( ), Altered ( ), or Repaired ( )
=----------------------------------------
bY- - - — ------------ - - --- — —
Installer A
at - - ------------ =- L - - ------
has been installed in accordance with fhe provisions of the Town of Barnstable Board of Health Private Well Prot ction
Regulation as described in the application for Well Construction Permit No. Al 3--�J-Dated- -��� -�� ---
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY. <
ector--------------- ----------------------------------------
Ins -- - - -DATE--------------------------------------------------------------------------- P
K. TNo��--��-_��-� ;:�° �••=s .,� `Fee �-
--� -
�J
BOARD OF HEALTH
TOWN OF BARNSTABLE
2ppritation-*rVell Con5tructionVermit
Application is hereby made for a permit to.Construct ( ), Alter ( or Repair ( )an individual Well at:
Location — Address A essors Map and Parcel
Ow r Address
—--=----------
Installer — Driller Address
Type of Building /
Dwelling -
Other - Type of Building -- No. of Persons_------ ---------------------------
Type of Well -- --- —=-—------ -- P Y- ---
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 Co pliance has been issued by the Board of Health.
Signed-�--- ------ ---r--------------------------------------- -
�� _ dateey�
V Application Approved By - ��� =________�--------------- — 4!%7 _?-
/date
Application Disapproved for the following reasons:
r
date
PermitNo. --------r-------------------------------- Issued------------------- .------------- ---- ------------------
� date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of_ Comprianre
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( )
(7) � �--------------------------------------------------------------------------------------------------------------
--—
— Installer
at-------- -e`cf=- -�n � _�:__��__,=---------
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. A9-��--a�9-Dated --r�—,�-��—
f
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE ------ ______--- ----- — --— Inspector---------------------------—---------- -------------------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Melt Cwtructionjermit
No -— '- -
Fee---=--=---
V 0
)�
9Permission is hereby granted-------- - — - - -- ----- - -- --- —--
to Construct ( ), Alter ( ), or Repair ( ) an Individual Well 7at-
.----�------�- ------------- ----------------------------- ------------------—-----------------------------------------
---=--Street
as shown on the application for a Well Construction Permit
No-----------AEi --.3 C) -------------------------------------------- Dated------ /1 --------- ----
Board of Health
DATE -----7// --
V ti^a W1 .
xa c
/' •W�tV1 '.Cgiq�.rvo.f�on ..�c.F
/Vo cvc //� U♦ ,�� /s0 f«t f �l
N F B �►(/J � /. -/ Bonnie McNally
N/F Andre P.
Assessors Lot .6 E�sie Sampou
118-"""
2.64 Acres f •
l ,
'2�
a j 87 112"
116 116 114.. • i '
�` �___ / �• 1012
�f./r< 00
4I Jlirr t� � �♦'a c^C�ill � ( 1
Pro O�
120
120 .' 7p-1
122 1 MITS of
CLEARING , / 0
118
AIL
/►.�/� Thy
B.M. EL.EV.=1F3.06' � / � 5 s
� ho a 6'a• '��- r ,.t ,•.,� G / l � / // • na,`',/�
o tt arI If 0AL
116
100
Owners Unkn
/ Existing �� / / , , AL
2 v Well116
,tIIL
118,
#17 Wetlands
` 1
120
AL
N,I $
r / 1•
JIL
I I '
JIL
o #1.8 -
/ 2
�\
122 �.
12 4 �� �6:SO' \` `` ` ' iV 10
. ^ ,.. SCALE ; " aC�/
120 1 \ r
r
ENVIROTECH LABORATORIES
Mass. Cert. #:MA063
449 Route 130 Sandwich, MA 02563 - (508) 888-6460
CLIENT: James Kinney LOCATION: Lot #6 Maple Street
ADDRESS: 47 Saddleback Road W. Barnstable, MA
Mashpee, MA
COLLECTED BY: Fred Clifford SAMPLE DATE: 8-6—A,3 TIME: 10:00AM
DATE RECEIVED: 8-6-93 SAMPLE ID:M8
JOB #: New, well WELL DEPTH: i S
RESULTS OF ANALYSIS:
Parameter Units Recommended limit Result
Coliform bacteria/100 ml (MF Method) 0 0
pH pH units 6.0-8.5 6.55
Conductance umhos/cm 500 109
Sodium mg/L 28.0 12.6
Nitrate-N mg/L 10.0 0.15
Iron mg/L 0.3 0.15
Manganese mg/L 0.05
Hardness mg/L as CaCO3 500
Sulfate mg/L 250
Potassium mg/L 20.0
Alkalinity mg/L 200
Chloride mg/L 250
Turbiditv NTU 5.0
Color APC units 15.0
Background bacteria
COMMENT:
M NO WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARA TERS TESTED.
EkX ❑
DATE '43
f!I'lliT,111111"f!ililt,"!r.IltmTT!'"I1ITTiitll!Im!T TTit?iTMiTTi!iiii?ifTimill.',it?iti'It':i":11?itliit?'1I?'tiMMIITiiilliifllil?iii M??l!ml!IT nil l"ITT lIIT,I"Iiiitl"iiIIIIITii'i111?l it.lii!Tiiiiiili[iii"T'I iilliir??�
" ENVI ®TECH L'BO T® IES
449 Route 130 Sandwich, MA 02563 0 (508) 888-6460
CLIENT: Whitney Wrfght LOCATION: . Lot 483 Maple St. -
256 Ocean Ave W. Barnstable, MA _
-- ADDRESS:
r Hyannis, MA 02601
COLLECTED BY: Clifford Well Drilling SAMPLE DATE: 10-3-90 TIME: 3PM
_
DATE RECEIVED: 10-3-90 SAMPLE ID: WW-3
JOB New We11 WELL DEPTH: 115'
RESULTS OF ANALYSIS: =
Parameter Units Recommended limit Result =
F
Coliform bacteria/100 ml (MF Method) 0
pH pH units 6.0 8.5
Conductance umhos/cm 500
- Sodium mg/L 20.0
_= Nitrate-N mg/L 10.0 _
Iron mg/L 0.3
Manganese mg/L 0.05 --
Hardness mg/L as CaCO 500
-= 3 =
Sulfate mg/L 250
T
Potassium mg/L 20.0 _-
Alkalinitv mg/L 200
Chloride mg/L 250 --
e _-
Turbidity NTU 5.0
Color APC units 15.0
Background bacteria
COMMENT: _
TEST RESULT
EPA 601/602 See Attached =
YES NO WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMET S TESTED. =
MXY
g/� DATE
:fl4lllii3111{llllllilliillilliili.tilllllil{i.11 ili{ilil Ul IIIILU 1{111iU113111..1Jlllll{i1:3a::{I I:::A lt {: 11 {3137 11 11 i
:a ::a11: I: :1i{3ali.aiiii iiiiii iiii it tlatl Ili tA{{ll i III:iiiiSuiiiiil illiiiliii iiiiiliii iiiiiiiiii
l '
GROUNDWATER
ANALYTICAL EPA METHODS 601 and 602
Volatile Organics (GC/PID/ELCD)
r
Field ID: WW-3 Lab ID: 027732
r Project: Clifford QC Batch: VGA-631
Client: Envirotech Sampled: 10-03-90
Cont/Prsv: 40ml VOA Vial/Cool Received: 10-04-90
Matrix: Aqueous Analyzed: 10-05-90
PARAMETER CONCENTRATION DETECTION LIMIT
(ug/L) (ug/L)
Dichlorodifluoromethane BDL 5
Chloromethane BDL 1
Vinyl Chloride BDL 1
Bromomethane BDL "5
Chloroethane BDL 1
Trichlorofluoromethane BDL 1
1,1-Dichloroethene BDL 1
Methylene Chloride BDL 1
, trans-1,2-Dichloroethene BDL 1
Methyl tertiaryy Butyl Ether * BDL 10
1,1-Dichloroethane BDL 1
cis-1,2-Dichloroethene * BDL 1
Chloroform 2 1
1,1,1-Trichloroethane BDL 1
Carbon Tetrachloride BDL 1
Benzene BDL 1
1,2-Dichloroethane BDL 1 '
Trichloroethane BDL 1
1 ,2-Dichloropropene BDL 1
Bromodichloromethane BDL 1
2-Chloroethylvinyl Ether BDL 1
trans-1,3-Dichloropropene BDL 1
Toluene BDL 1
cis-1,3-Dichloropropene BDL 1
1, 1,2-Trichloroethane BDL 1
Tetrachloroethene BDL 1
Dibromochloromethane BDL 1
Chlorobenzene BDL 1
Ethylbenzene BDL 1
m+p-Xylene * BDL 1
o-Xylene * BDL 1
Bromoform BDL 1
1, 1,2,2-Tetrachloroethane BDL 1
1,3-Dichlorobenzene BDL i
1 ,4-Dichlorobenzene BDL 1
1,2-Dichlorobenzene BDL 1
QC SURROGATE COMPOUNDS SPIKED MEASURED RECOVERY QC LIMITS
Bromochloromethane 30 28 93 % 83 - 117 %
Fluorobenzene 30 29 97 % 87 - 113 %
BDL = Below Detection Limit. Non-target compound. "Trace" indicates probable presence below listed
detection limit. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable
Aromatics, 40 C.F.R. 136, Appendix A (1986).
r .
CENTRAL STEEL SUPPLY CO. Inc.
FOl_EY STREET • P.O. BOX 906 • SOMERVILLE, MA 02145
617-625-3232 «.
� l
1 1
11 �/
TOLL FREE 1.800.345.3232
I .
i'
� F
CENTRAL STEEL SUPPLY CO. Inc.
FOLEY STREET • P.O. BOX 906 • SOMERVILLE, MA 02145
617-625-3232
�p
W
Steel'♦
TOLL FREE 1.800.345.3232
TOWN OF BARNSTABLE
LOCATION �� � 4-V- S SEWAGE #
VMLAGE e (JnN-bi,:)L ASSESSOR'S MAP& LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type�✓�;t (size)
N6. OF BEDROOMS '
BUILDER OR OWNER '
e
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) --- `—\,,, Feet
Furnished by
_4
• {. �
.�
D. �7 �
� � � � � a
o �
a
m
� �
AsBuilt Page 1 of 1.
1TOWN OF BARNSTABLE
LOCATION 1� .3 ,'� SEWAGE #1
VILLAGE i 62�.v r��{-�L�(2 ASSESSOR'S MAP & LOTI 0 -6b
INSTALLER'S NAME & PHONE NO. --b rn-p aS ..
SEPTIC TANK CAPACITY
LET
E CHING FACILITY:(type) ^=f�� L_(size)
NO. OF BEDROOMS PRIVA,T/E WELL OR PUBLIC WATER ��i�.
BUILDER OR OWNER.. IG-Y eS nr1Qc �r4�/A O-Q.Ca_ r
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No.
A o 0
0,11
ISO
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- _
http://Issgl2/Intranet/propdata/prebullt.aspx.mapparq 1 8/21/2015
03/26/2003 22:44 5083621510 JAMES KINNEY PAGE 01
i
i
March 27, 2003
ATT: Tom McKeon,Director
The septic at 483 Maple Street,West Barnstablie,MA, can definitely]Handle five
bedrooms. Septic report will follow this fax letter from Dona Seacat and James Kinney
signed by John Graci within five business days.
e �
Post-lt®Fax Note 767, Date pagesi:
To From ;h
rMn
Co./Dept. Co.
Phone#
Phone# C
Fax# 1 l — 3
i
I
I '
APPLICATION FOR PER(;OLA'IION lt817 AND OBSERVATIO14 I'1'IS
rl
'I,OCA'1TION J�u
.. ,moo �- ��-•t r-t
�Iii�1.AO13 p�'..ST •i3���2�L`'�'�alF UATB S 3a Sc•
APPLICANT r(.tul0t+-yv ; PLB.'� -
•
' � � .(Non-refundable}
ADDRESS TBLBPHON11 NO. 72/-
BNGINP,BR'. �c.• f:(�Ft�<< c4v I.l�nc..t�P.r= TELEPHONE NO.
U11TB.SCIiBUULBll (c( tQ
t (Applicant's Signature
••..•.•.•.•....•.•.••1•..•.•....•..•1•..r.••.....••..../...•/.•..1.........1•........../..11••/•...... ...•.............1..���•.���_�..:���.�••.•........•.....
ASSB33OR"S MAP Q LOT NOt map 108 c1
• SOIL LOG
SUB-DIVISION NAME DATE 5-,� �.t7er } ( `e cC) TIME �� Y�t►l
EXPANSION ARBA:•YES X NO Snl7�✓� A. C[,./sue ENGINEER-
TOWN.WATER PRIVATE WELL X _0_WAX 'e ® BOARD OF HEALTH
_ Z/G /J/1D '�/bS. .l�C��^ 225��_EXCAVATOR
SKBTCIit� (Street name, etc., dimennionn of lot,.exact location of test holes and percolatlon tests,
locate wetlands in proximity to test holes)
4 l
7
NoT,IF��a -
'
' •r
-.yam � -_ �;•,iI'r/ /_ ' � �'••
7{ 1 K
OLATION R1 M:;
ELEVATI011: //6r5 TEST HOLE PlO: c', ELEVATION : //9,
1 '
%o F 1 --x- /oP f
2 s.,bso./ 2 <
. 5 5
62��nst..
13
, 9 ,
10 - 1U
. ��.
12 ,' WK�Q �,•� / I
13 Sa�cQ Z.
1
14
ABLE FOR SUB-SURFACE SEWAGE: . LEACHING FIELD LEACHING PITS
LEACHING TRENClIEF Y
ITABLE FOR SUB•-SVRFACESEWAGE. REASONS!
i..: ENGINEE2RING PLANS MUST SNOW. VUHHER. ASSIGNED ON PERC TEST APPLICATION
INAL: COMPLBxE1D N ENTJRE'T 13YP. E. AND RE'i'URNED TO BOARD OF HEALTH
'g RETAINED BY APPLICANT ��
t
Sd'3
Project No. / 5 54 Client it TEST PIT
Date_S`si,I- i l4%o Location M;&& Atst &Ig Logged by Wi/iOV
Ground Elevation Health Agent kd 3- rr4 �� 7640
�, �, E Weather wnan/.• s o N h.
o _ o a �' n =
= o
-a C7.s o_ Contractor C. Oa I ao �It�s
�. 5m �b
rEn � of o> om n o N
� �U C7 U
�swl,s' Sd6soi/
3�
ill �Pac�ccts �.( s�►,uQ
D
17'
2� Na Gibhr
Legend Percentages Remarks Percolation Test Time
And: 35 -50 i'o S!aft Pre-soak
Groundwater
l/Vith: 2i -3�i`e End Presoak
Some: 15- 25%
`� Seasonal Max, Some:
at 12"or i )
Little: 5- 15%
Observed Elevation i�,
lrac�.: 0 5 T;;ne at 9"or i )
Excavation Effo Time at 6"or! )
Pere-. Test Bedrock'
)_ rt � d� -
Easy 9••_
P„ ;:•r;:;,,. G� Ei,:pseci Time J 6""
Elev o}
liil=IIII=1111=JI11=111IIq
' ASSESSORS MAP N0: -
No.-1N- D_ '� PARCEI.NO:
._ ��-
Fee-----------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
2pplication-*rVell Con5tructionPermit
Application is hereby made for a permit to Construct (K), Alter ( ), or Repair ( . )an individual Well at:
Location — Address Assessors Map and Parcel r
go
/owner Address
Installer_ Driller Add As
Type of Building
Dwelling iC�r. !`� v----- ------
Other - Type of Building ----- - No. of Persons--------------- ----
c�Type of Well------- --�---�-- — _— 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
• dto
Application Approved By ----- — -—---- - 2—
date
Application Disapproved for the following reasons:
date
Permit No. ---- -b--- --- Issued------7 _2- a�
ate
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate ®f Compliance
THIS IS TO CER , That the Individual Well Constructed ( , Altered ( ), or Repaired ( )
—�lL�---- ---------- - — - - -----------------------------— _ — --
by__—_ Installer
athas been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well'Construction Permit No. K-1-0 Dated—
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------- — - -- - -------- Inspector------------------
a1�tt11ti111itt111i1tiIT I Ii1t1itttttttt(1((ittitttt(tit1,-I13tt1"Tiif111ITM111M 1111111,11111V.1tittttM,TITtttitiftttt(?iitt(it(ITIMT1111111111it1((iI(ittittt[iitttiittii(ititttt(1(jtitTt(t(tititt(tfit(if(tit(i(ti(ttttti(11tTi(1/��
>
ENVIROTECH LABORATORIES a
449 Route 130 Sandwich, MA 02563 • (508) 888-6460 =
r�.
c' CLIENT: Whitney Wright LOCATION: Lot 483 Maple St. _
256 Ocean Ave W. Barnstable. MA ADDRESS: "
_ Hyannis. MA 02601
COLLECTED BY: Clifford Well Drilling SAMPLE DATE: 10-3-90 TIME: 3PM.: _
DATE RECEIVED: 10-3-90 SAMPLE ID: WW--3
JOB #: New We11 WELL DEPTH: 115'
;r
RESULTS OF ANALYSIS:
Parameter Units Recommended limit Result
_ Coliform bacteria/100 ml (MF Method) 0
pH pH units 6.0-8.5
i` Conductance umhos/cm 500
Sodium mg/L 20.0
Nitrate-N mg/L 10.0
Iron mg/L 0.3
Manganese mg/L 0.05
z:
.= Hardness mg/L as CaCO 3 500
Sulfate mg/L 250 -
Potassium mg/L 20.0
Alkalinity mg/L 200
Chloride mg/L 250
Turbidity NTU 5.0
c Color APC units 15.0
E �?
E` Background bacteria
COMMENT:
TEST RESULT
EPA 601/602 See Attached
' YES No WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMET S TESTED.
DATE
++iWiiiUiiil ills Uiluil+lllilUUlliillUlililtuu+all+tu:lUltlacliiiiliiiilliiiliillll
A
GROUNDWATER
ANALYTICAL EPA METHODS 601 and 602
Volatile Organics (GC/PID/ELCD)
Field ID: WW-3 Lab ID: 027732 °
Project: Clifford QC Batch: VGA-631
Client: Envirotech Sampled: 10-03-90
Cont/Prsv: 40ml VOA Vial/Cool Received: 10-04-90
Matrix: Aqueous Analyzed: 10-05-90
PARAMETER CONCENTRATION DETECTION LIMIT
(ug/L) (ug/L)
Dichlorodifluoromethane BDL 5
Chloromethane BDL 1
Vinyl Chloride BDL 1
Bromomethane BDL 5
Chloroethane BDL 1
Trichlorofluoromethane BDL 1
1,1-Dichloroethene BDL 1
Methylene Chloride BDL 1
- trans-1,2-Dichloroethene BDL 1
Methyl tertiaryy Butyl Ether * BDL 10
1,1-Dichloroethane BDL 1
cis-1,2-Dichloroethene * BDL 1
Chloroform 2 1
s 1,1,1-Trichloroethane BDL 1
Carbon Tetrachloride BDL 1
Benzene BDL 1
1,2-Dichloroethane BDL 1
Trichloroethene BDL 1
1,2-Dichloropropane BDL 1
Bromodichloromethane BDL 1
2-Chloroethylvinyl Ether BDL 1
trans-1,3-Dichloropropene BDL 1
Toluene BDL 1
cis-1,3-Dichloropropene BDL 1
1,1,2-Trichloroethane BDL 1
Tetrachloroethene BDL 1
Dibromochloromethane BDL 1
Chlorobenzene BDL 1
Ethylbenzene BDL 1
m+p-Xylene * BDL 1
o-Xylene * BDL 1
Bromoform BDL 1
1,1,2,2-Tetrachloroethane BDL 1
1,3-Dichlorobenzene BDL 1
1,4-Dichlorobenzene BDL 1
1,2-Dichlorobenzene BDL 1
QC- SURROGATE COMPOUNDS SPIKED MEASURED RECOVERY QC LIMITS
Bromochloromethane 30 28 93 % 83 - 117 %
Fluorobenzene 30 29 97 % 87 - 113 %
BDL = Below Detection Limit. * Non-target compound. "Trace" indicates probable presence below listed
detection limit. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable
Aromatics, 40 C.F.R. 136, Appendix A (1986).
4;
Fee--��- ---- -----
BOARD OF HEALTH }
TOWN OF BARNSTABLE
Zpprication-for VrIl (Cootruct ion Permit
Application is hereby made for a permit to Construct %), Alter ( ), or Repair ( )an individual Well at:
Location — Address Assessors Map and Parcel
i
-- a=-4' -srr--------------
—---
--------------- J-v-------- ----- a-
Owner 'Address
--f --->./lr - - _fit - S --!�m/
--------------------
Installer — Driller Adders
Type of Building
Dwelling
� ��✓��.�t fi --- - - --�--
Other - Type of Building No. of Persons--------------------------------_____________
Type of Well , --- - ---------------------- Capacity---------------------------------- ---- ---
Purpose of Well-T --------------------- -----------
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--------------------------------------------------------------------------- —---d to-_--
Application Approved By--- �'/ ------- --- -- =�� 'Z 3 f-�7--C-)
date
Application Disapproved for the following reasons:-----------------------------------------------
---------------—----------------------------------------------------------------------------------------------------------------------------
date
Permit No. -- -- -�-= — - -------
Issued
------- - - - - - --- -- —--- -
- date
i
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate ®f Compliance
THIS IS TO CER�(f �•, That the Individual Well Constructed ( -)Alt eer d ( ), or Repaired ( )
by---------------- J------------------------------------------------------------------------------------------------------------------ -— - -- --- —-
Installer
at--- $ - ► /�(� ------ --------------------------------------------------------------------------------------------------
--
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. Dated---- �.�-z �
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-------------------------------------------------------------------------------- Inspector----------------------------------------------------- -
BOARD OF HEALTH
TOWN OF BARNSTABLE
Yell Con�tructionpermit
No. , � r Fee---
/ ti
Permission is hereby granted----f !-
-! --- - ---------------------------------------------------------------------------
to Construct ( -)/, Alter ( ), or Repair ( ) an Individual Well at:
No- ----------4 41-----rn ( e N---s-- - -------------- Street ------------------------------------------
as shown on the application for a Well Construction Permit
No.--� - I�- -�7---- -- ---- -- --- Dated __- - - =�/5L)----
---_-------------� �
' Board of Health
DATE - ?�2 ----------------------
Sa-
if J y t .dge Moss coostol R"'r°°d
eo" Mdl
and
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I 86 6`L I Ra"h�ii ��F
1 6 5ti Cedor �\3
LA
t1°�\� Sfrse
I � I
LOCUS Church S
ki
I I
LOCUS MAP
PARKING
238'64 HOUSE NOT TO SCALE
#483
I I
m
A
GENERAL NOTES:
PARCEL ID: 108 006 v 1 BOA CANGES TORDHOF HEALTTHTAND THE D SIGNHIS LAN MUSTBENGIINEORED BY THE LOCAL
115,033 ±SF I I 2• ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
OF
2.6421 ±AC. LOCAL THE
RULES STATE
AND ENVIREEGULA IONSCODE, TITLE V, AND ANY APPLICABLE
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
n I I TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
DESIGN ENGINEER,
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
120.13' 0 65.84' FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
107 29 I ENGINEER BEFORE CONSTRUCTION CONTINUES.
5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
72.20 1 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
0 �� THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
7'210 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
N - - _ _ _SEE SHE_ET�- - - - - - - 7. WATER SUPPLY PROVIDED BY PRIVATE WELL.
30 SCALE 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S.
9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS
o AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE
DIRECTED BY THE APPROVING AUTHORITIES.
10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
CONSTRUCTION.
11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
cO IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND
k REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3).
OCL
12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE
INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL.
13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND
NOT CONSIDERED TO BE A PROPERTY LINE SURVEY.
16g•15' 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC
OF *Sj,' SYSTEM COMPONENTS NOT SHOWN ON THE PLAN
o PETER T.
E STREET
Mc
CIVIL MAPLE PROPOSED SEPTIC SYSTEM UPGRADE PLAN
CIVIL No. 35109 483 MAPLE STREET, WEST BARNSTABLE, MA
RfG/SIC Prepared for: James Seacat, P.O. Box 227, West Barnstable, MA 02668
S �
AL��G� &
OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO.
AMESTJ DONA L & KINNEY, Engineering Works, Inc. 1"=60' P.T.M. 216-15
(6191 � JR
P.O. BOX 227 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO.
a
WEST BARNSTABLE, MA 02668 (508) 477-5313 10/9/15 P.T.M. 1 Of 3
MOVE DRIVEWAY OFF OF TANK CONTOUR
117.96
•• EXISTING SEPTIC TANK x 100.98 EXISTING SPOT GRADE
TOP OF TANK, EL•=118.00 6'L ♦ EXISTING WELL
f� INV.(OUT), EL.=116.67E 117.98 �g6 U UNDERGROUND WIRES
uala I x 114.93 v9 810 WETLAND FLAG
i
WETLAND SYMBOL
BENCHMARK 118.06 STRIPOUT BOUNDARY
OUTSIDE CORNER 118.73 �¢'•��'
BBOTTOM STEP i VENT ESTIMATED STRIPOUT DEPTH=20' 'TEST PIT
OTTO SPIKE SE/- TP-1 1 (SEE NOTE 11)
• ( s,ea. .' I $ BENCHMARK
120.00 _ ---- -----� 117.23': .�,: ., , w LEGEND
rl 1
TP-2 x 113.39
O
1 1 116.04 W x 115.04 1
1 121.22 1 ,72 ;\: : O w Q?
x115.20 �.(\ 1121.13 x % ,:';'4'`` o-iC�'N (7+ 11 ( 00 x O' �
x / 4
' 1,22 PORCH I /-, g5 EXISTING LEACH PIT v
\� 116.72 11 ua.7s x \ 11 0 eg TO BE REMOVED
+ ` �.:�-��..11 (SEE NOTE 11)
\ �.: �1 2.8.• •:.' 115.09 1 V
EX/STING L
9 7 �-
HOUSE(#483) 11 .43 ` ,S��
121.42 ":7 ,. •:. :'.;'.•..��114 :'` V \
115.09 T.0.F.=122.6± 116,04 -------------
o j r , t\ / 114.81 113.78 EXISTING LEACH PIT
'115,59 TO BE PUMPED, FILLED WITH
99 ~ 120.49 SAND AND ABANDONED
�� 114.66 I I i j v 113,57 :. ".. 11�.53
x 113,08 ` 1 1 I "� 118. 2 114.43 L 1
` 114,601 120.3
13.50 y ��� Ll 119.11 15.87 4
WELL 1 A__
11'r3- , 10�Q1dF 14 30
117.54 �..� x1114.13
�,.�•wt FROM B.V "ate ------- 111.55
x 113.52 // it}-
x v320 �-�M 1y1.59
.92
115,05
111,91 110,66`'�-. _
`- 'h�Z PIKE3
-----x..�10,01 �` �� _--_- 110.48
cs PETER T. ✓
_- . .
McENTEE
CIVIL
97-
No. 35109
+111.59
G/SZFR��
9
PARCEL ID: 108 006 \ ��------------__1�¢ - , - 1$�
115,033 fSF A� 9-------106 ---- - _ _,_` ,,,� �.. Lot
2.6421 ±Ac, -------48.4---- _- �� _ -'1Z�'
WETLAND DELINEATION
/,,�------ 5107 -yg,`1�6 --'� �� �'.: 68.84 JACK VACCARO
v1a8
96.44 P.O. Box 955
Sandwich, MA 02563
107.29' �•� �'' 6 __ �96\ 1�B,` (508) 888-5855
96.45 ' v106 `--------- / \
/ V109 4k `y.�"� `66. �o ' PROPOSED SEPTIC SYSTEM UPGRADE PLAN
` k 95,57 �•` �a� ?G' J'�`.
o �' s-- 483 MAPLE STREET, WEST BARNSTABLE, MA
93.01 x '1p• vlos___ _� �g6. Prepared for: James Seacat, P.O. Box 227, West Barnstable, MA 02668
92,01 v1o2 VEGETA TED WETLAND Engineering by: SCALE DRAWN JOB. NO.
W Engineering Works, Inc. 1"=30' P.T.M. 216-15
i N
cA 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO.
(508) 477-5313 10/9/15 P.T.M. 2 Of 3
f
NOTE: TO" PREVENT BREAKOUT, FINAL GRADE
SEPTIC TANK SHALL NOT BE AT, OR BELOW, EL.=113.5
INSTALL RISERS & COVERS OVER INLET & FOR A DISTANCE OF 15 FROM THE EDGE
OUTLET AND SET TO 6" OF FINISH GRADE PROPOSED D-BOX OF THE PROPOSED S.A.S.
INSTALL H-20 RISER, FRAME PROPOSED S.A.S. SPIKE SET 12.8 r
& COVER AND SET TO WITHIN INSTALL H-20 RISER, FRAME & COVER OVER ONE CHAMBER 46.
T.O.F-122.6t 1
�--s- 9'
- 3" OF FINISH GRADE. AND SET TO 3" OF F.G: TO SERVE AS INSPECTION PORT 6 ..�
F.G. EL.=119.0t F.G. EL.=118.4t F.G. EL.=117.5E F.G. EL.=116.0t
MAINTAIN 2% SLOPE OVER S.A.S. g
sg 0 1w
6
• L = 26' L - 13' PORCH 0" cn
®"SCH40(PVC) 0S=1% (MIN.) 2" LAYER OF 1/8" TO 1/2" 1A
4"SCH40 PVC DOUBLE WASHED STONE 5066z.8' ..�
�a 6• (OR APPROVED FILTER FABRIC)
14" aaaaaaa EX/STING
EXISTING 48" LIQUID Baaaaaa -3/4" TO 1-1/2" DOUBLE
LEVEL ADO PROPOSES 4' 5.2' 4' WASHED STONE HOUSE(#483) �yd yy
cAs BAFFLE INV.=114.87 INV.=114.70 T.O.F.=122.6E
7
t � EFFECTIVE WIDTH = 12.8.
INV. 1 16 6 3 OUTLETS
'EXISTING INV.=1 13.00
H-20
EXISTING SEPTIC TANK � 3-500 GALLON LEACHING CHAMBERS
SURROUNDED WITH STONE AS SHOWN
H-20 RATED
TOP CONC. ELEV.=1 14.1 t
BREAKOUT ELEV.=113.50 SEPTIC LAYOUT
NOTES:
INV. ELEV.=113.00 ®®®a®
aaaaaaaaaaa
®aaaaaaaaaa
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & BOTTOM ELEV.=111.00
INVERTS EXITING HOUSE, PRIOR TO INSTALLATION. 4' OF NATURALLY OCCURRING 4' 3 x 8.5'=25.5' 4'
2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE EFFECTIVE LENGTH = 33.5'
ON A MECHANICALLY COMPACTED SIX INCH CRUSHED PERVIOUS MATERIAL
STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 5' (MIN.) ABOVE G.W. LEACHING SYSTEM SECTION ®®®® 0
3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTTOM OF TEST PIT, EL.=97.0 z
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE f- ®®®®®® ® ®®®® 37"
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. w ®
04 Z ®Q��®®® ® ®®® ®
SEPTIC SYSTEM PROFILE
102"
SOIL LOG
4" KNOCKOUT
DESIGN CRITERIA DATE: SEPTEMBER 21, 2015 (REF#14,825)
SOIL EVALUATOR: PETER McENTEE PE 20" DIA. COVER
NUMBER OF BEDROOMS: 4 WITNESS: DAVID STANTON R.S. HEALTH AGENT
ELEV. TP- 1 ELEv. TP-2 DEPTH 4" KNOCKOUT / 4" KNOCKOUT 58"
DEPTH
SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF)
115.9 0" 116.0 0"
DESIGN PERCOLATION RATE: <2 MIN/IN FILL FILL
DAILY FLOW: 440 GPD 112.9 A 36" 113.2 A 34" 4" KNOCKOUT
DESIGN FLOW: 440 GPD SANDY LOAM SANDY LOAM
GARBAGE GRINDER: NO-not allowed with design 1 1 1.9 10YR 4/2 48„ 112.8 j 10YR 4/2 38„
LEACHING AREA REQUIRED: (440 GPD) = 594.6 SF B SANDY LOAM 500 GALLON CAPACITY, H-20 LOADING
SANDY LOAM.74 GPD/SF 109.9 10YR 5/6 110.0 10YR 5/6 72" CHAMBERS
PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY C1 72 C1 N.T.S.
PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-20 RATED
USE 3-500 GALLON LEACHING CHAMBERS IN SERIES PROPOSED SEPTIC SYSTEM UPGRADE PLAN
SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES NO GROUNDWATER SILT LOAM SILT LOAM 483 MAPLE STREET, WEST BARNSTABLE, MA
ENCOUNTERED 1OYR 5/3 1OYR 5/3 NO GROUNDWATER
SIDEWALL AREA: 2(12.8' + 33.5') X 2 = 185.2 S.F. ENCOUNTERED Prepared for: James Seacat, P.O. Box 227, West Barnstable, MA 02668
BOTTOM AREA: 12.8' x 33.5' = 428.8 S.F.
98.1 214" 97.0 228' Engineering by: SCALE DRAWN JOB. N0.
TOTAL AREA:.............................................................. 614.0 S.F. NOTE: SOIL EVALUATION ON FILE SHOWED SUITABLE SAND AT 15' & 17' BELOW N.T.S. P.T.M. 216-15
.
GRADE. EXCAVATOR COULD NOT DIG DEEPER THAN 19' RECOMMEND THAT Engineering Works, Inc.
DESIGN FLOW PROVIDED: 0.74 GPD/SF(614.0 SF) = 454.4 GPD SUITABLE SOILS BE VERIFIED AT TIME OF SEPTIC SYSTEM INSTALLATION 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
BASED ON PERC RATE FROM P#7640, 2 MIN/IN. EST. DEPTH TO SAND=20'. (508) 477-5313 10/9/15 P.T.M. 3 Of 3
I
w'° n Mass Co
9e
17eo md/
and
°�%
c
/PROPOSED �, Bonnie/McNally Cedor ° o,
/ IN-LAW APARTMENT P Q mo
N/F / 1 !�° Streef
Owners Unknown I / / _ I e
/ 1U LOCUS Ch�rQh S
Re°ry°% CL
Im LOCUS MAP
238 64�� 1� EXISTING PARKING �a I NOT TO SCALE
HOUSE
' #483 OPOSED1
G AGE
I/ \ m
a CD
A
100' BUFFER \ I � v
_ , mac
PARCEL ID: 108 006 ---' FR°"' B�w'•�. N� 3m7-
115,006 ±SF
I2.64 ±Ac. --'- �`♦
a„
120.13' ♦♦ 68.84'
107.29'
o, EDGE• Of-
-91- �
72.1 O' I / VEGETA TED �•� ' ► c
� w m
WETLAND _ �. TO _ _ _ _ _SEE SHEET 2
�.� � J' 30 SCALE FLOOD ZONE DESIGNATION
0 coo FLOOD MAP 25001CO534J, EFFECTIVE 7/16/14
w% NON HAZARD-ZONE X
r' o I i \ °1a z ZONING CLASSIFICATION: ZONE RF (RPOD)
SETBACKS: FRONT YARD=30'
N/F SIDE/REAR YARD=15'
Owners Unknown to I ; \ wco c LOT AREA = 87,120 SF
ao �
OVERLAY DISTRICT
L — — — — AP - AQUIFER PROTECTION DISTRICT
30' Frontyard
WIND EXPOSURE CATEGORY: Exposure B
169.15'
Mpi Y4ss,Cy�'d �� T PLAN REVISION - 12/3/19
MASS
MAP
1 REDEFINE COTTAGE AS IN-LAW APARTMENT
v RICHARD R. r ���� q�yG PROPOSED ACCESSORY BUILDINGS & SEPTIC TANK
L'HEUREUX o PETER T. s
N 1. 4312 0 McENTEE 483 MAPLE STREET, WEST BARNSTABLE, MA
o v CIVIL "' Prepared for: R.W. Anderson & Sons Inc., 6 Willow St, Sandwich, MA 02563
StE�gJQ, No. 35109
OWNER OF RECORD Engineering by: Survey Review by: SCALE DRAWN JOB. NO.
WOOD, CHARLES A & REBECCA L Engineering Works,Inc. CapeSury 1"=60' P.T.M. 265-19
\
$/ 483 MAPLE STREET 12 West Croddfie 0 Os Road West Bay Rd—Suite G DATE
Forestdale, MA 2644 Osterville, MA 02655 CHECKED SHEET N0.
12,`3 I WEST BARNSTABLE, MA 02668 (508) 477-5313 (508) 420-3994 11/12/19 P.T.M. 1 of 3
5
i+
11 5�1b `^ --99 --EXISTING CONTOUR
EXISI TING S.A.S. (PER RECORD AS-BUILT) 117.96
>i �� � x 100.98 EXISTING SPOT GRADE
PROPOSED CONTOUR
EXISTING SEPTIC TANK 117.99 �g6 ^2` / �� \ 115.7 PROPOSED SPOT GRADE
119.14 ♦ EXISTING WELL
� W EXISTING WATER SERVICE
BENCHMARK � s _ } PROPOSED PERGOLA OVER W
1l PROPOSED WATER SERVICE
OUTSIDE CORNER 11e.7 DECK OR PATIO
�� / I 'vs
�\/ I U UNDERGROUND WIRES
BOTTOM STEP !y
EL. 120.15 ��.
j I � zk WETLAND SYMBOL
120,00 ,f • ' 3:` �I '`it I t w BENCHMARK
�i Vic:.;. PROF�OSED
1 \'':''':�i•;;', \ 116,04 , IN-LflW APT. �, LEGEND
TOF 16.5/
\�6 \\ 121.2 1 .72 / 1 I •...\ , x \
115.20 \ ` �121.13 /fix 1 1 '�i:',. 0• 115.04 \ \\ I
qo !117; '. ...,' �. w.J'.' 15.55 f 1
\\ \ y 1e1.z21 PORCH I 11 1 p'.'J' oo <s\\ \ x P -POSE T �o
@, 1 ::,.:�a.. �A�GE I
116.72
x` TOr=116.5\ r_
11s, 9 , CIS=115.7 1
/
EXISTING 119,577\
\ HOUSE(#483) 121,42 ,
> O =122.6f 1
99
T. .F. X:. To"
116.04> ::;.>• PROPOSED DRIVEWAYS
^ �� '
115.59 PRO P'6SED
r
113.99 W x 120.49 \ SEPTIC TANK - J 3
T �appra>�� 11q.66 i _ 1 / U 11 .57^ .: z
_ - 112.53
--- ate' 114.43
w x 113.0e x �1`� zn02/ F 114
\ 114.6 Illy 1�0r36 -' g11f3.17 /1 87�
WELL -
� \ \ // 1 114,30 .. .:
113.50 \ \ -�� 117.54 1 1-4xJi14.13
1�k2\\ 111.55
'�>� --_----_---_�\ �� \\ FLOOD ZONE DESIGNATION
X�\IX \\ �..r 1}I 59 \
.92 FLOOD MAP 25001CO534J, EFFECTIVE 7/16/14
_
100 u1 so.;.. \
1 ' OFFER '- - NON HAZARD-ZONE X OF
ZONING CLASSIFICATION: ZONE RF (RPOD)
0,66 C
�. "_ 494-------) I ♦ .�1�__ ':. s 3__ SETBACKS: FRONT YARD=30'
`\ S�0.'01--�- ��� �♦ r--__ 110.48 � SIDE/REAR YARD=15' o PETER T.
_ _ McENTEE
`\��`•��' - I \� \ - \ ---- - �� HED/ "` �� LOT AREA = 87,120 SF v CIVIL "'
- 1A i ♦ ti'', No. 35109
\ \ ����•0 � \ OVERLAY DISTRICT EO
O - _ AP - AQUIFER PROTECTION DISTRICT
\b \$\- \\\\ \�09_-_--__ - /� ♦ `\ '.'. WIND EXPOSURE CATEGORY: Exposure B , c
\`\x 106.59 -
��105------- ------ J �p3 \�\ \��\ '� WETLAND DELINEATION
PARCEL ID: 108 006 �10°------,_____ -_--_; �:; ��
\ --- BRAD HALL
115,006 ±SF \w,- ----_ ;, ae2
2.64 fAc. /, 99 ',--9�- `� \`� :�.:, 68 OWNER OF RECORD
9s. \ /"-`\\ `.\ �`� `\ 1' WOOD, CHARLES A & REBECCA L
483 MAPLE STREET
`
107.29' + �_� ` -y, v 104'� WEST BARNSTABLE, MA 02668
96,45 -__95-57 __----------� c.+ \ `\ -__� PROPOSED ACCESSORY BUILDINGS & SEPTIC TANK
��,�----- o�_`_ +� _ ---+97.74 483 MAPLE STREET, WEST BARNSTABLE, MA
VEGETATED ' 3�1 �0 +2�9- 9`�� '� `--r96.91 Prepared for: R.W. Anderson & Sons Inc., 6 Willow St, Sandwich, MA 02563
WETLAND Engineering by: Survey Review by: SCALE DRAWN JOB. NO.
w Engineering Works,Inc. CapeSury 1"=30' P.T.M. 265-19
N 12 West Crossfield Road 23 West Bay Rd-Suite G
CA Forestdole, MA 02644 Osterville, MA 02655 DATE CHECKED SHEET NO.
v� (508) 477-5313 (508) 420-3994 11/12/19 P.T.M. 2 of 3
SEPTIC TANK
INSTALL RISERS & COVERS OVER INLET &
OUTLET AND SET TO 6" OF FINISH GRADE
T.O.F=116.5 (COTTAGE)
F.G. EL.=115.7t F.G. EL.=115.30f F.G. EL.=116.5t F.G. EL.=116.5t
VENT
L = 10' L = 52'
S=1% (MIN.) @ S=1% (MIN.)
4"SCH40 PVC 4"SCH40 PVC 2" LAYER OF 1/8" TO 1/2"
1. s" DOUBLE WASHED STONE
6" a®a�iBaa (OR APPROVED FILTER FABRIC)
14., aaaaaaa
13.30A 48" LIQUID I TING aaaaaaa —3/4" ro t-t/2" DOUBLE
LEVEL 4' S.2' 4' WASHED STONE
GAS ABAFFLE INV.=112.25 D-BOX INV.=112.08
INV.=113.05 3 OUTLETS EFFECTIVE WIDTH = 12.8'
INV.=113.50 SIM PROPOSED SEPTIC TANK H-20 EXISTING SYSTEM & DESIGN CRITERIA
3 EXISTING 500 GALLON LEACHING CHAMBERS
SURROUNDED WITH STONE AS SHOWN SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF)
H-20 RATED DESIGN PERCOLATION RATE: <2 MIN/IN
NOTES:
DAILY FLOW: 440 GPD
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE DESIGN FLOW: 440 GPD
INVERTS, PRIOR TO INSTALLATION. aaEa Baas
aaaaa eases GARBAGE GRINDER: NO-not allowed with design
2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND aaaaaaaaBaa owe
aaaaaaaaaaa
TRUE TO GRADE ON A MECHANICALLY COMPACTED LEACHING AREA REQUIRED: (440 GPD) = 594.6 SF
STABLE BASE OR OR SIX INCH AGGREGATE BASE, AS 4' _ 3 x 8.5'=25.5' 4' .74 GPD/SF
SPECIFIED IN 310 CMR 15.221(2). EFFECTIVE LENGTH = 33.5'
3) INSTALL INLET & OUTLET TEES AS REQUIRED. EXISTING SEPTIC TANK FOR HOUSE: 1000 GALLON CAPACITY
EXISTING D-BOX: 1 INLET, 3 OUTLETS, H-20 RATED
4) A GAS BAFFLE SHALL BE INSTALLED ON OUTLET TEE EXISTING LEACHING SYSTEM SECTION
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. EXISTING S.A.S. IS 3-500 GALLON LEACHING CHAMBERS IN SERIES
SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES
SIDEWALL AREA: 2(12.8' + 33.5') X 2 = 185.2 S.F.
SEPTIC SYSTEM PROFILE BOTTOM AREA: 12.8' x 33.5' = 428.8 S.F.
TOTALAREA:.............................................................. 614.0 S.F.
P DESIGN FLOW PROVIDED: 0.74 GPD/SF(614.0 SF) = 454.4 GPD
PROPOSED ADDTION TO SEPTIC SYSTEM
NUMBER OF BEDROOMS: 4 IN MAIN HOUSE, REDUCED TO 3
1 IN PROPOSED IN-LAW APARTMENT
TOTAL BEDROOMS TO REMAIN AT 4
PROPOSED SEPTIC TANK FOR IN-LAW APARTMENT: 1500 GALLON CAPACITY
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PROPOSED ACCESSORY BUILDINGS & SEPTIC TANK
483 MAPLE STREET, WEST BARNSTABLE, MA
Prepared for: R.W. Anderson & Sons Inc., 6 Willow St, Sandwich, MA 02563
Engineering by: Survey Review by: SCALE DRAWN JOB. NO.
Engineering Works,Inc. CapeSnry N.T.S. P.T.M. 265-19
12 West Crossfield Road 23 West Bay Rd—Suite G DATE
Forestdole, MA 02644 Osterville, MA 02655 CHECKED SHEET NO.
(508) 477-5313 (508) 420-3994 11/12/19 P.T.M. 3 of 3
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400 ; s - NOTES.
N/F Bonnie McNally 1. Limit of work shall consist of :staked
haybales or silt fence.
34 N F Andre P. & 11 , ,
os / A 2. No work shall roceed until an order
00.73• ` P
. Elsie J. SampQu ' - cO '8
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Assessors Lot 6 108 of conditions Is Issued.
#10
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87,.• 112 ;_r sue, 3. Limit of vegetative wetlands flagged
118 1
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: 114 - ' � 10 b Bradford L. Hall on September 1, 1990.
116 116 1 2 ,�' :alllc �a1a}c t��,;r`►, Y P
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NOTES.
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MATERIALS SHALL CONFORM `TO D.E.P.
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S
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3
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' � PERCOLATION -SOIL ES P 7640
,o
i
S(DEWALt :AREA- GPD. S F. BOTTOM AREA. GPD. S.F.
6 1 9 A T SEPT. 0
DATE' OF SOIL, TEST .�
_ � ,_ SIDE WALL 21T 2 � S1=` x GPD' SF GAL DAY
+4 ;MULCH , ,
S L N
TEST BY
D A,o
WITNESSED By R
BOTTOM ?T 2 SF.x GPD SF — -'GAL DAY
ED 8A RY
2G ? 5
b
AN ING
PREPARED 'L T 2
PERCOLATION RATE MI I CH x x z
.K. .OIL MIX
�. � SF;, 11Qn GAL DAY
s
I
n ...
BREAKOUT CALCULATION:
TEST PIT 1 TEST PIT 3 E
._
V— 14. _ 9
UNDISTURBED OR ELE .
. ELEV. 119.
Ifl 0 S1l8GR A
_ a _I COMPACTED II#I III _ ;. OH1
�roP . o SUBSOIL
SUBSOIL
TOP k L
3
DE
NSE STONY
DENSE STONY_ . :- � SANDY TILL
SANDY TiLL W POCKS-f5 �OF
SAND
15
7
MEDIUM SAND
MEDIUM SAND
'� ING _
SHRUB PLA NT
NO WATER) NO WATER
SECTiON ', ,
2 21
r
BOTTOMOf TEST HOLE BOTTOM-a TEST HOLE
93.6
9$.9
OR WATER ELEV. OR WAFER ELEV.-
'ROOT . _ .
40<BARK MULCH TREE ;
BALL ,
-}r i
. A
W V T N n WATER LEVEL ADJUSTMENT.- ,
2 S0. OAK
STAKES OR
0.D. A V
C
;SALVAGED 2 . 0 G L .
CHAIN LINK STEEL K
1 W,16
`4. �.� J�# As b � {.�/ � v � •r is s W
� > FENCE Posts t-rYel - TEST DATE WATER LEVEL �
.. _ REQUIRED) {
3 PER TREE Q ED) Q�{ � � 5' .� �Y ac in✓ram w,t- .r. ..�
INDEX L WEL
•,�. / `_ � 1( `/ j
WATER RANG ZONE ATE LEVEL E E 1 p
,. _ � /o '/ 9 9 IN1T1A ISSUE
- 5R
Z � TREE REFER TO PLAN FOR L
tSPECIFIED
_. TYPE
--- D PTH 0 WATER LEVEL FOR INDEX WELL--_ _ E T R X L NO. DATE :.DESCRIPTION BY
OOUBLE STRAND t2 GAUGE GALV
F MONTH
TREE ...WRAP _�.:
ANNEALED WIRE OR M OF
-A _
i R OS ,
2 PLY REINFORCE[) ROBBER HOSE
A r w •
4 9 RK MULCH'
-O LONG AK fiAK OR ' ADJUSTMENT
--.__ _,...�.,2 z2 x s L Q s E WATER LEVEL
CHAIN W PLAN
SALVAGED 2 0_D. GALV. STEEL � WETLAND A N D PERMIT T
LINK FENCE POST YP,
u tr I DEPTH TO HIGH WATER
TEMPORARY SAUCER OR
N IN LAWN AREAS
PLANTING
- _ 1
AP STREET
LOT 6, MAPLE R
-----TREE ROOT BALL W/ FOLD ;
1 DOWN BURLA
P,
#�
m_ z
O _ ,
PREPARED PLANTING-SOLI. MI
X
_ N MASS.
_ s - � WEST BAR STABLE ASS
. pa_ _ .----UNDISTURBED OR COMPACTED O --
z I A�'PROVED. BOARD OF HEALTH
_
SUBGRADE
• . , PHEN
8TE . .
a
ALLY N -
- 34 JOB NO 15 6c�4
WiLSON �
wx
No.3021
6
BATE AGENT
LEVY, 8c WAGNER .
ASSOCIATES INC.
8t PLANTING
• i
TREE STAKINGPLA T ' . , _ �
IJ1�IDs 0 JI�SI= Ri WID stIR1�Y�Rs
AN SECTION NO 'SCALE _ �
�c. a sr` � - PERMIT
STREET . A '02632
889 NEST -:MAINS CENTERVILLE M