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Home My WebLink About2429 MEETINGHOUSE WAY/RTE 149 - Health 24?9 Meetinghouse Wy/rte,149 W. Barnstable A. 155 . 020 s i TOWN O,,F BARN,STTAB E LOCATION y a � JyI to e fi Ah OV X / � SEWAGE# VILLAGE We _t Balr6 Qe, ASSESSOR'S MAP&PARCEL ASS �O INSTALLERS NAME&PHONE NO. U/1 F-h OkIV\ SEPTIC TANK CAPACITY ) O O U v j LEACHING FACILITY:(type) DDO P 1 T (size) /► �p NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: 9 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) 43 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) "� 7 �� ry Feet FURNISHED BY L 1/S C G P i j� REA Z 42,. 17s* 62.12,11 A3 3a - 63"Y 1 ro�, 3 t f COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL.AFFAIRS DEPARTMZNT OF ENVUtONMF.NTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM- PART A CERTIFICATION 4 101 r Property Address: v� R�5�� 4rAs 4 ke �f 0266 J Owner's Name: � 1j �,GibQ PGvrts Owner's Address: Date of Inspection: $ l 6-- l o o g' Name of inspector.(please print) / Joseph M.Martins Company Name: Accu Sepcheck Mailing Address: 17 Northside Dr., S.Denny,MA 02669 Telephone Number: 508-385.5891 t/Passes ' Conditionally Passes Needs F er Ev "on by the Local Approving Authority Fails c Inspector's Signature- Date: d 7 �, The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of HeaM or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments: Sub poc f` j4--rj a & (( CC� �Ce_ ""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 diihreut conditions of use. ride 5 Inspection Form 6/15/2000 page 1 Page 2 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 2429 Meetinghouse Rd.,W.Barnstable,MA Owner: Parris Date of Inspection: 8/5/2008 inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: 1/1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional P tion need to be replaced or repaired.The system,upon completion of the replacement or repair,as roved by the Board of HeaW will pass. Answer yes,no or not determined(Y,N,ND)in the the following statements.If"not determined"please explain. The septic tank is metal and over 20 old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltratio exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a co ing septic tank as approved by the Board of Health. *A metal septic tank will pass' ion if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is than 20 years old is available. ND explain: 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: 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: 2 Tide 5 Inspection Form 6A R2000 Page 3 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 2429 Meetinghouse Rd.,W.Barnstable,MA Parris Owner: 9/5/2008 Date of Inspection: 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 a ance with 310 CMR 15.303(lxb)that the system is not functioning in a manner which will pro public health,safety and the environment: Cesspool or privy is within 50 feet of a surf water _ Cesspool or privy is within 50 feet of a ring vegetated wetland or a salt marsh 2. System will fait unl a 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 wit ' 0 feet of a private water supply well. The system has aseptic tank and SAS and the SA ' less than 100 feet but 50 feet or more from a private water supply well*.Method used to de a distance "This system passes if the well water an is,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compo indicates that the well is free from pollution from that facility and the presence of ammonia nitroge nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. py of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 2429 Meetinghouse Rd.,W.Barnstable,MA Parris Owner: 8/5/2008 Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for aU inspections: Yes No V Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or `clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _✓ Any portion of a cesspool or privy is within a Zone I of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _/ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.[This system passes if the well water analysis, performed at a DEP certified laboratory,for 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.] Ivy (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,M 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 abo yes no the system is within 400 feet of a surface water supply _ the system is within 200 feet of a to a surface drinking water supply the system is located in a . gen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 1I of a public w supply well if you have answered"y to any question in Section E the system is considered a significant threat,or answered "yes"in Section D a e the large system has failed.The owner or operator of any large system considered a significant threat un er Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15304.The system owner should contact the appropriate regional office of the Department. Title 5 lnsnection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 2429 Meetinghouse Rd.,W.Barnstable,MA Owner: Parris Date of Inspection: 8/5/2008 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health _ ✓Were any of the system components pumped out in the previous two weeks ✓_ Has the system received normal flows in the previous two week period ` 1 'Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) _ Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of brejk out? I✓I Were all system componentsewuamg the SAS,located on site? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on Yes no (Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)j Title 5 Inspection Form 6/15/2000 5 Page 6 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 2429 Meetinghouse Rd,W.Barnstable,MA Owner. Parris Date of Inspection: 8/5/2008 FLOW CONDITIONS RESIDENTIAL �,� Number of bedrooms(design):_j+Number of bedrooms(actual): IN flow based on 310 CMR 15103(for example: 110 gpd x#of bedrooms): Number of current residents: 1 Does residence have a garbage grinder(yes or no): /VV Is laundry on a separate sewage system(yes or no):R [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): Art) Water meter readings,if available(last 2 years usage(gpd)): (Its W R Sump pump(yes or no): rJO Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): F,pd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present r no):_ Non-sanitary waste discharged Title 5 system(yes or no):— Water meter readings,if able: Last date of occu use: OTHER(describe): GENERAL INFORMATION Pumping Records a () n Source of information: ?Oy P !/ Was system pumped as part of the inspection(yes or no):�110 If yes,volume pumped:_gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank, ex,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): Approximate age of all components,date installed(if known)and source of information: U n ICAVU — Were sewage odors detected when arriving at the site(yes or no):�a Title 5 Inspection Form 6/15/2000 6 Page 7 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2429 Meetinghouse Rd.,W.Barnstable,MA Owner: Parris Date of Inspection: 8/5/2008 BUILDING SEWER(locate on site plan) Depth below grade: /,k Materials of conduction: cast iron _40 PVC—other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:Z(Iocate on site plan) Depth below grade: kV II Material of construction: concrete metal fiberglass—polyethylene other(explain) — — — If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificaDimensions: Y�io X �'1 /1' ��"100o' a/lwt Sludge depth: / �� Distance from top of sludge to bottom of outlet tee or baffle:Scum thickness: Z i I i Distance from top of scum to top of outlet tee or baffle: 8 1 Distance from bottom of scum to bottom of outlet tee or baffle:—JK How were dimensions determined: mar s y4p Comments(on pumping recommendations,inlet and olklet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Hers D rl P tl Ii/v PL'/Itemc I o /eg,t L✓y".� /�-e/ 4r o✓f�.pf /`!W'< 7--- GREASE TRAP: (locate on site plan) Depth below grade:— Material of construction: concrete metal fiberglass—polyethylene other (explain): — — — Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or Distance from bottom of scum to bottom o et tee or baffle: Date of last pumping: Comments(on pumping reco elation,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet in v nce of leakage,etc.): Tide 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2429 Meetinghouse Rd.,W.Barnstable,MA Owner: Parris Date of Inspection: 8/5/2008 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete 1 fiberglass_polyethylene other(explain): Dimensions: Capacity: llons Design Flow: gallons/day Alarm present(yes or Alarm level: o'j Alarm in working order(yes or no): Date of last ping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: N — A 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.): AZP r L/lie , Pa K ,,?`"d �Ptd�i �/� PUMP CHAMBER: (locate on s' plan) Pumps in working order(yes or Alarms in working order(ye r no): Comments(note conditio of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2429 Meetinghouse Rd.,W.Barnstable,MA Owner. Parris Date of Inspection: 8/5/2008 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type ('rad P Tv V leaching pits,number: d �( � eaching chambers,number: fJ_ leaching galleries,number: ¢� leaching trenches,number,length: t leaching fields,number,dimensions: overflow cesspool,number: innovative/alwmative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): ST-PHIV L4U cd 61 Qu. jo tev d s Oae.4U,eZ �i//e smve,, /'4a ,r/r r"'x9opw- CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow es or no): Comments(note condition oil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): i PRIVY: (locate on site plan) / Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,si hydraulic failure,level of ponding,condition of vegetation,etc.): T 9 Title 5 'on Form b/15/20�Inspects Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2429 Meetinghouse Rd.,W.Barnstable,MA Parris Owner: 8/5/2008 Date of Inspection: 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. O hveL� 0 � bLsn- Ai os t �-Z 0 s Q 2- . �1 0 3 R-3 t3 y 3 _ /13 Title 5 Inspection Form 6/1512000 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2429 Meetinghouse Rd.,W.Barnstable,MA Owner: Parris Date of Inspection: 8/5/2008 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water n► �2 r'► Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation holevithin 150 feet of SAS) __/Checked with local Board ofHealth-explain: 14 -'n firI S S'Y,Y r£M , Checked with local excavators,installers-(attach documentation) ✓Accessed USGS database-explain: 7-pp o *YO You must describe how you established the high ground water elevation: 7Z) 4;a Clj_ P�9 i s /0 , 6 3 • �s tile- a wal�o 1- P0-- 4lc AV) Title 5 Inspection Form 6/192000 I l f Town of Barnstable F1HE tp� Regulatory Services saxtvsrABM ; Thomas F. Geiler,Director 9qj 163 prED,r,,�a Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. QASEPTIMisclaimer Private Septic Inspections.DOC /,5s- o.Z0 RECE6\,"E EAWROTECH1-4BORATORIES,INC. MA CERT. NO.:M-MA 063 2 6 2��2 449 Rte. 130 S E P Sandtrich, AAA 02563 508(888-6460) 1-800-339-6460 TOWN OF BARNSTABLE FAX(508)888-6446 HEALTH DEPT. CLIENT: Elizabeth Parris LOCATION: 2429 Rte. 149 ADDRESS: 2429 Rte. 149 ofaet"npA o us @ W. Barnstable, MA W. Barnstable, MA COLLECTED BY: DA Scannell SAMPLE DATE: 9/13/2002 SAMPLE TIME: 10:OOAM WATER SAMPLE TYPE: New Well DATE RECEIVED: 9/13/2002 LAB I.D. #: 0209352 WELL SPECS.: 547 4" RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Coliform bacteria /100ml 0 0 9222 B 9/13/2002 Pk pH units 6.5-8.5 5.98 4500 H+ 9/13/2002 Conductance umhos/cm 500 276 120.1 9/13/2002 Nitrate-N mg/L 10.0 0.82 300.0 9/13/2002 Nitrite-N mg/L 1.00 < 0.004 300.0 9/13/2002 Sodium mg/L 20.0 34.4 200.7 9/16/2002. Iron mg/L 0.3 <`0.1 ` 200.7 9/16/2002 f Manganese mg/L 0.05 . 0.021 200.7 9/16/2002 COMMENTS: Low pH indicates high corrosive characteristics. Sodium level is not a health hazard. WATER MEETS EPA STANDARDS AND 1S SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. <=less than Datd",I�'UbL- >=greater than %Ro4ta1d 1. SVir '�'� TNTC=too numerous to count Lal ratorytor ,. Town of Barnstable Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-8624644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. September 9, 2002 Ms. Elizabeth Parris 2429 Meetinghouse Way West Barnstable, MA ARE242`9Meetin houseWaWest Barnstables;. g _...,,,: ,.....�Y,._�.��.�,.,...KKK_... ... ... . ... ._ w _ . ,... . . .....,� Dear Ms. Parris, You are granted conditional variances to construct an onsite well at 2429 Meetinghouse Way, West Barnstable. The variances granted are as follows: PART XIV SECTION 3.00: The onsite well will be located one-hundr4ed (100)feet away from the existing onsite sewage disposal system, in lieu of the one-hundred fifty(150) feet minimum separation distance required. PART XIV SECTION 3.00: The onsite well will be located two feet away from the front property line, in lieu of the ten (10).feet minimum separation distance required. These variances are granted with the following conditions: (1) The onsite well shall be constructed in the location as shown on the submitted sketch plan designed by Weller and Associates. (2) The well water shall be analyzed for volatile organic compounds (voc's), sodium, nitrate- nitrogen, coliform bacteria, pH, conductivity, and other standard parameters on a regular basis, at least once per year, at a certified laboratory. These variances are granted because the physical constraints at the site severely restrict the location of the well due to the proximity of the septic systems both onsite and at neighboring properties. The homeowner testified that she has been without water for at least four weeks. It is the opinion of this Board that this is an emergency situation and the submitted sketch plan showing the proposed replacement well location appears to meet maximum feasible compliance standards. Sinc ely yours, i yn iller, M.D. Chair n Parris oo Vo P J', Fee------------------- .. BOAR OF HEALTH TOWN OF BARNSTABLE Rpplicat ion,forlVell Congtructionpermit Application is hereby made for a permit to Construct (�), Alter ( ), or Repair ( )an individual Well at: �4afl Meei-i WaY __J T-T ate — L on — ddress t Assessors Map and Parcel .�� Owner 1 Address v Installer — Driller — Address Type of Building Dwelling __— Other - Type of Building-!MLk ___— No. of Persons--- 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 —_— _— _ ` date Application Approved Byl "�a -� date Application Disapproved for the following reasons: --------------- ----- --_ date Permit No. l-'�2��2- �Q� — Issued� —---- � h date BOARD OF HEALTH TOWN OF BARNSTABLE C ertif irate Of Compliance THIS IS TO CERTIFY, That t e Individual Well Constructed (V), Altered ( ), or Repaired ( ) by--scam elf �rl n 0 ---- -- - - 'Installer —^ — Q P_ 1 C2C7 GLSe 1 at�1-+� 71 has been installed in accordance with the provisions of the Town of Barnstable Board of Health We Protection Regulation as described in the application for Well Construction Permit No W?�-G-'Dated_qj4_L -- 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 Ivell Construct ion i3ermit No. - — Fee- , (1 , Permission is hereby granted 'Sca h /�f'.� Nei �r l ►"? to Construct ( ), Alter ( ), or Repa' ) an Individual Well at: 4ee fto LA 5�e Street —� — — as shown on the application for a Well Construction Permit No.- Dated — ------------------- Board of Health DATE 's No.-� —---- -- v 1j") BOAR , 6� HEALTH TOWN ` OF BARNSTAS'LE ApplicationArVex[ Con5truct ion Permit Application is hereby made for a permit to Construct (V), Alter ( ), or Repair ( )an individual Well at: j hn Locaii n - Address ( f�A,sse�s�sors Map and Parcel../ Wei q Owner Installer - Driller Address — -- - - Type of Building Dwelling -------------- j Other - Type of Building No. of Persons-- J Type of Well Capacity---------- Purpose of Well -- ! Agreement: The undersigned agrees to�install-the aforedescribed individual well in.accordance with.the.p%visions of The Town.oftBarnstable Board of,,Health"Priva"te-Wel'1 Protection 'Regulation L-The undersi- `further agrees not to t . place the well in operation until a Certificate-Df Compliance has been issued by the Board of He lth.�" Signed t f f date/ Application Approved B -. < PP; PP y - C' !-i -I..- r� 1.;µ. i _ . -�' .�' ,r -�.,...-, � a .� j '..- date k: Application Disapproved for the following reasons: -f---- -' ----- = ' C/--' f ( i date Permit No. ` i7 - l C V — Issued .4- date 0. BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( , Altered ( ), or Repaired ( ) n,taller A 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.(-'- =�?mated I-`� -- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-- Inspector----- -- -- - - r BOARD OF HEALTH TOWN OF BARNSTABLE well Congtruct ion Permtt' No. - -- Fee- Permission is hereby granted 0 to nel _i n to Construct ( ) Alter ( ), or Repair. ( ) an Individual `/Nell at: No: O U W Q� - -- - - street as shown on the application fora Well Construction Permit No.- Dated- t _ r '*tx.' Boardof Health DATE 7 TOWN OF BARNSTABLE C PLIANCE: CLASS: 1.Marine,Gas Stations, Repair nters BOARD OF HEALTH satisfactory 3.A to Body Shops ,Q �,-� O unsatisfactory- 4.Manufacturers COMPANY 9 L'1 A9A/ //y�4�511st (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS ass: miscellaneous w'��f 1-✓',1.�� ! !!I TITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks = IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: L� / 1 : 4 G � DISPOSALIRECLAMATION REMARKS: J 1. Sanitary Sewage 2.Water Supply ' O Town Sewer OPublic ! ! cam- 1*0 n-Site 'rivate 3. Indoor Floor Drains YES NO O Holding tank:MDC_ O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES LNQ- ORDERS: 0 Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product Licensed? YES NO 2. Person(SWIMerviewed Inspector Date 1 7-- Z, Ln Ln 0 0 .QAI Q BATH #1 BATH V— u W N LIVING W r� V1 U � � 01 - yESTIBULE FAMILY I I � Q O II ' ��•� !j-1 --� � W II IL------- ' W z 30 II L -- ---J I . L --_ J I - - ___------- _ -------- O- SET 5Q S 00 up co 001 --- DN. L------ PANTRY KITCHEN 3 � _ REF. o o i Dw S rMIGRO Lu (j) J OFFICE lu azz s® 0. WQ Q W (D V +-- cN w AND N 3 9GGpp�� t OfTOM OF STAIRS SWEET 2 OF 4 FIRST FLOOR PLAN SCALE: 1/4" - 1'-0" e JOB: IOM DRAWN BY: KW DATE: 7/16/10 . 'Ln1 . J �+ 1 04 LU T W E ATER �-- -- WCLOSET / V -- ------- -- --- ------------------------------------------------------� (T DOUBLE VANITY Who E4RE9s / i CLOSET (� -\� DN Al) 1 ' tAl) W z i --------------------------------------------- D. I I I I Ul W /L---------------� k3 a z QC Z � Q \ L4 uM (1- , / N W v 3 N F SWEET 3 OF 4 SECOND FLOOR PLAN SCALE: I/4°. 1,-On t w 1006BY- KW 7/16/10 r 64'-0" IM) W 1 r v w = p �9 v � Wpci II 111 I I - 1 1 W n II W Z o II p 1 II v 37'-g" o o � � Q 3 � Z 1 D (D J FpQ OL uj u = I— f BZZ Z 0. iz W Q ~ X I— W U- N (V W N3 SHEET 1 OF 4 64_Ou EXISTING -FLOOR PLAN SCALE: I/4"' 1'-0" JOB: 1006 DRAWN BY: KW DATE: 7/15/10 . - A. U!5T Zv,2oo'Z--•3h SC�1t �• 1`�= Zc�� C6 � otl 4 nc/ d� j P*P1?lv dA,;, ofmex e - _ o 7 P • ' 7 5 v, , 3