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LOCI�T � SEWAGE
VILLAGE ASSESSOR'S MAP & LOT/37
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- INSTALLER'S NAME PHONE NO.
SEPTIC TANK CAPACITY
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LEACHING FACILITYAtype) (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER _
BUILDER OR OWNER xs
DATi PERMIT ISSUED:
DATE COLIPL[�4NC:,I3tISSUEU: Ad — A —
VARIANCE GRANTED: Yes IV®
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LOCATION SEWAGE PERMIT NO.
d l/i/ � _ Lf - -
VILLAGEif
9
INSTALLER'S NAIVE D ADDRESS dti�
6UILDER OR OWNER
DATE R:ER.-:KIT ISSUED
DAT E COMPLIANCE ISSUED �'
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No. . ®� r I/ y Fee oa?5
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTHDIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
RpPlication for Mi5po5aY i§pgtem �"Ocomplete
tion ACrmit
Application for a Permit to Construct( ) Repair( ) Upgrade(r) Abandon( System ❑Individual Components
Location Address or Lot N"o. 1p1 Owner's Name,Address,and Tel.No.
tZ4�
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address and el.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date
Applicafion Approved by :Date
.Application Disapproved by: :Date
-for the following reasons
Permit No. Date Issued
....:'......'--/°-^',"-[i,;/...:.1 i.Y-•.a:,Y v 'r...1..-•is .rRw'1`r"'•^ti+.- .?'--`„ ..:.�•-.s-s= ....._is.:�, �+.«,r.,,. v......- rt .,.. .r-, ..
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC.HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01ppYtcation for �Bizponl 6pztem Con!5truction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon ❑ Complete System ❑Individual Components
Location Address or Lot No. .� 07 Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. ` Designer's Name,Address and el.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( )
Other Type of Building�/ZjJ �'��//� No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a`Certificate of
Compliance has been issued by this Board of Health. —
Signed Date `
Application Approved by Date
Application Disapproved by: Date
for the following reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CE 4 YFY,that the On-site Sewage Disposal System Constructed ( ) Repaired/ ( ) Upgraded ( )
Abandoned / �� r 61�s
at has been con tructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. /. 1 S dated
Installer��i46441_1z� Designer
#bedrooms Approved design flow gpd
The issuance of this permit shall not be cJ�nstrued as a guarantee that the syster(n�`f nc n:'tts\designed.
Date �II In/ Inspector\ �� ` �lJ
No. 60,(— 1 /. ) Fee l�
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
1wi!6poaf 6p!5tem Construction Permit
Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon (
System located at 2 t/ 1/!� /YLD )-1,�,< o C2 ct l �J 8Kr411S tv�
C
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this permit.
Date I (r, l D to Approved by b n 64- ►y l 1 y V Cc vt A 1
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TEL.+778-0700
Hirickley
.. Home
Centers
y � John Hinckley&Son Co.Est.1$72 TM
'- - LUMBER, BUILDING'MATERIALS-AND.HARDWARE
TED
' GIBBONS- HYANNIS. MA
w
02601
e-+�. ✓-- .SALES
7/18/82
LIST OF MEMBERS - CAPE COD MODEL RAILROAD CLUB, INC .
Baker, Capt . Reuben Baker Ave . Wellfleet 02667 349-2540
Barrows, Ralph Box 231 Pocasset 02559
Basler, Lloyd 62 Capt Small Rd So . Yarmouth 02664
Belcher, Bill 129 Grt Western Rd So Yarmouth 02664 394-1459 �
Black,Bob Main St . W. Barnstable 02668 362-3508
Borthwick, Bob 8 Phillip Ct Harwich 02645 432-0525
Brown, Henry 19 Sao Paulo Dr E. Falmouth 02556 540-0753
Campbell, Marvin 98 Elijah Childs. Centerville 02632 42 8-2027
Eldredge, A. Grenville D5 Linda La. Hyannis 02601 771-5182
Erdman, Harry 241 Capt Lijah Rd Centerville 02632 42 8-7307
Ford, Mayne & 7anbssa 13 Crestwood La Dennisp:ort 02639 394-3493
Franklin, Bob Satucket Rd Brewster 02631 896-5574
Gibbons, Ted 198 Grt Marsh Rd Centerville 02632 771-1087
• Hagens:, Dr. Al 49 Arthur Lane Yarmouthport 02675 362-3720
Holway, Lawrence 406 So Main St 'Centerville 02632 775-3234
Kinney, Mark 79 Hartford Ave . Marstons Mills 02648 428-9708
G
Korb, Walter 129 Hickory Hill Osterville 02655 42 8-5290
Marotta, Vito Box 496. Centerville 02632 42 8-5618
Mitchell, Bill 75 Chipping Green So Yarmouth. 02664 394-1082
Nickerson, Bob Old Post Rd Marst.ons Mills 02648 428=6757
Otis, Alton 26 Dundee. Dr. Yarmouthp.ort 02675
Parkhurst, F.Arthur- 55 No . Main Fall River 02720 67 8-8343
Proctor., Marsh 256 Old Bass River Rd So Dennis 02660 398-3330
Robinson, Dave 96 Pompano Way Yarmouthp.ort 02675 362-8356
Rosston, Jim 67 Sea ST Apt A4 Hyannis 02601 775-8875
Rowell, Fred 34 Brick Kiln. Rd E. Falmouth 02536 548-4614
Schneider, Jeff 180 Linc&ln Rd Hyannis 02601 775-647 8
Schumann, R.F. PO Box 549 Centerville 02632 42 8-4633
Sheperdson, Bob 9 Embassy La. Yarmouthport 02675 385-5098
Smith, Mike PO Box 542 lest Deni1is 02670 398-2812
Streeper, Jack 5733 Johnson Otis 0254-2 563-6675
Stucke, Don 49 Stoney Cliff Rd Centerville 02632 775-3785
Thompson, Bob 185 Grt ivarsh Rd. Centerville 02632 775-1693
Von der Schmidt, Geo . 50 Davis Dr. Berbenfield NJ 07621
Junior T'embers
f
CAPE COD MODEL RAILROAD CLUB, INC. WEST BARNSTABLE
FOUNDED: The club was founded Feb- ELIGIBILITY: Any person interested who
ruary 15, 1968 by 15 model attends two consecutive
railroad enthusiasts, prima- meetings.
rily from the mid-Cape area. MEETINGS: Second Thursday of the
PURPOSE: To promote the greater fel- month. Working sessions
lowship of model railroad- every Wednesday and Fri-
ing; to encourage and assist day at the Club car. Visitors
members in the design, con- always welcome.
struction and operation of
model railroads by accepted The Club car shown on the cover was origin-
standards of practice in the ally built for the New Haven RR as a horse
hobby, and to promote and carriage car in 1905 by Bradley & Sons.
public interest in prototype It was converted to a baggage car sometime
railroading in the U. S. A. between 1927 and 1930. It was bought from
Penn Central for $150.00 by the Club and
MEMBERSHIP: Thirty members. delivered from the Hyannis yard by Penn
Regular, 18 years old and Central to this location in 1969.
over - vote, hold office. Length over couplers: 64' 8'/2". 60' x 9' clear
Dues: $24.00 per year. inside.
Junior, 12 to 18 - all Weight: 86,000 Lbs.
priveleges except vote or
hold office. The car has been renovated and maintained
Dues: $3.00 per year. entirely by the Club membership.
CAPE COD CENTRAL MODEL RAILROAD LAYOUT INFORMATION
3®"
1. THE LAYOUT: The layout is designed The minimum curves are M radius.
to simulate the Old Colony Division of The maximum grade is 2%.
the NYNH & H between Boston and The trains, including engines, are not
Hyannis. club property and do not remain
2. THE MOUNTAIN: The mountain is
in the club after demonstrations.
symbolic of the peak of effort expended 5. COMMUNICATIONS: Head sets for dis-
in overcoming the many difficulties patcher and all cabs.
experienced in making this project 6. SIGNAL SYSTEM: The signal system is
possible.
powered from switch machine contacts.
3. STRUCTURES AND SCENERY: The 7, OPERATIONAL CONTROL SYSTEM:
structures are a combination of pre- The dispatcher sets up the power
assembled, scratch built, kit built and routing to the cabs and mainline
kirbashed buildings, built by members. turnouts.
The stone arched bridge was designed There are 4 cab controllers:
and built by Mr. Ken Morang, who also Shoreline Division - Yellow cab
designed the mountain, which was Mountain Division Green cab
built, by members using "Hydrocal"
soaked paper towels. Boston Yard = Red cab
Hyannis Yard - Orange cab
4. MISCELLANEOUS INFORMATION: There are separate controllers for
The scale is H.O. 1/87th of proto- yard facilities such as turntables
type (3.5mm = 1 ft.). and roundhouses.
Track guage is 0.650" between rail Controllers are solid state throttles
heads (approx. 11/16"). with reverse, brake, momentum
Rail material is nickel silver, 100 and remote control.
code and 70 code.
The track electrical system 'is com-
mon rail. There is over 1,000 feet
of track and over 75 turnouts.
000
4_
u <«Q
CAPE COD, MASSACH USETTS
OPEN HOUSE
I II d � � I I I������ �!! �,
h
sn4, 6. �iA41a. ,'gw ca.ut ,.I
1. " � I ! ' i
Z ANURN
AT
THE CLUB CAR
WEST BARNSTABLE STATION
ROUTE 149
��3
�l'/Q.r � g�„c
7, �� m.
�� �
--------------
en ®SENDSR: Complete items 1.Z.and 9:
c Add your address in the"RETURN TO"space as
reverse.
l. The following service is requested(check one.)
dhow to whom and date delivered............__ 4
❑•Show to whom,date and address of delivery... _e Q
❑ RESTRICTED DELIVERY
co Show to whom and date delivered............—Q
❑ RESTRICTED DELIVERY.
Show to whom,date,and address of dehvery.$--
(CONSULT POSTMASTER FOR FEES)
2. ARTICLE ADDRESSED TO:
In Mr. Edward C. Gibbons
241 Capt. Ei3:ah Road
CENTERVILLE MA 02632
s
3. ARTICLE DESCRIPTION:
m REGISTERED NO. I CERTIFIED Nil. INSURED No,
m
0523333
A (Always obtain signature of addrerme or agant)
so --
I have received the article descjPed above,
m SIGNATURE ❑Addressee PkAuthorized agent
V
z
r'? ¢_ iY
D'Alfi OF DE I Y TNr;A 0'
7
S ADDRESS(Complete wP,,if requested)
S. UNABLE TO DELIVER BECAUSE:
� INITIALS
7'kGPO:99'79-30C,-470
UNITED STATES POSTAL SERVICE
A OFFICIAL BUSINESS
6p PENALTY FOR PRIVATE
SENDER INSTRUCTIONS USE TO AVOID PAYMENT
Print your name,address,and ZIP Coda In the Baca below. OF POSTAGE,ssoo
ill-
• Complete items 1,2,and 3 on the reverse.
• Attach to front of article if space permits,
otherwise affix to back of article.
• Endorse articla"Return Receipt Requested'
adjacent to number.
RETURN
TO
BOARD OF HEALTH
(I1I of$ender)
TOWN OF BARNSTABLE -
P. 0. Box 534
(Street or P.O.Banc)
HYANNIS MA 02601 0534
(City,State,and ZIP Code)
CI
*THE jO� TOWN OF BARNSTABLE &
ss
� OFFICE OF
i 1BAHH9TABLE, i
MABB. p� BOARD OF HEALTH
D G�ATFpY p 367 MAIN STREET
HYANNIS, MASS. 02601
July 7, 1982
Mr. Edward C. Gibbons , President
Cape Cod Model Railroad Club
241 Captain Elijah Road
Centerville, Ma.
Dear Mr. Gibbons :
While investigating your complaint concerning The Village Store,
on Route 149 , it was discovered that your facilities at the
Cape Cod Model Railroad Club apparently do not have a septic
system nor do you have any plumbing.
These conditions would be a violation of Regulation 2 . 10,
Paragraph 19 , Minimum Facilities for Occupancy, of the State
Plumbing Code.
Please advise us within three ( 3 ) days of receipt of this
notice when you intend to comply with the above listed regu-
lations.
Very truly yours ,
J
n M. Kellyrector of Public Health
JMK/mm
cc: Board of Selectmen
Town Counsel
q4?
CAPE COO, MASSACHUSETTS '
PLEASE REPLY TO•
241 Captain Lijah Road
Centerville, MA 02632
June 24, 1982
Town of Barnstable
Board of Health Department
Town Building
367 Main Street
Hyannis, MA 02601
Gentlemen:
This will confirm the fact that Mr. Ron Gifford of the Health
Department confirmed to our Mr. William Mitchell, registered
engineer, that the new septic system installed in the rear of
the. Village Store on Route 149 in West Barnstable is faulty in
that it has been installed on property that is rented by our
club from the Parker Lombard Trust.
This means that it is undoubtedly also not in accordance with
the dimensional requirements of Chapter V of the Sanitary Code.
By this letter we are asking that. you take the necessary steps,
through your permitting controls, to see that this condition
is corrected and that the "system is properly located on the
store's property before an occupancy permit is issued.
Very truly yours,
CAPE COD MODEL RAILROAD CLUB
Edward C. Gibbons
President
mlp
os h Daluz
of Barnstable Building Inspector
CAPE COD CENTRAL
14odd
off°
CAPE COD, M4SrSACHUSETTS
y `*• :.v - - PLEASE REPLY TO:
241 Captain Lijah Road
Centerville, MA 02632
June 24, 1982
I
Town of Barnstable
Board of Health Department
Town Building
367 Main Street )
Hyannis, MA 02601 i
1 Gentmen•e
I
This will confirm the fact that Mr. Ron Gifford of the Health j
Department confirmed to our Mr. William Mitchell, registered I
septic s new se installed in the rear of '
engineer, that the e p c stem y i
the Village Store on Route 149 in West Barnstable is faulty in
that it has been installed on property that is rented by our
club from the Parker Lombard Trust. )
This means that it is undoubtedly also not in accordance with
the dimensional requirements of Chapter V of the Sanitary Code.
By this letter we are asking that you take the necessary steps,
through your permitting controls, to see that this condition
is corrected and that the system is properly located on the
store's property before an occupancy permit is issued.
Very truly yours,
CAPE COD MODEL RAILROAD CLUB
/ I
Edward C. Gibbons
President
mlp
os h Daluz
of Barnstable Building Inspector
i
APE COD CENTRAL
Mr. Edward C. Gibbons - ram t
Centerville, MA 02632
���i,/ I �%�7"Ia.+/� /l.J �}l��,Y �6n� c�•. Sd �� •f me+�°
Mryry
M[WTyONSi
�.M daM'r v
f
R$ j?w
Town of Barnstable � "e
Board of Health .Department
Town Building
367 Main Street
• Hyannis, MA 02601
Ogg
,�j P' 342 655 365
�
CAPE COO, MASSACHUSETTS ,
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17�.26pH
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ACTH
Bu °
BEDROOM SaR &2<R
42IR ;o
Fire Wall ° KITCHEN
10'-4"x 3'-9"
==(Existing II- 1668 Ir
]668
g
906B ^ O
N
L I VI N G
20'-1"x 13'-'1"
v
N sqs
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^
2b40VH 90BB
Proposed 20'-q"
DECK
20,-10"x T-11"
C
t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map `S Parcel 011
Health Division Application #
Date Issued
Conservation Division
Application Fe G
Planning Dept.
Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH — Preservation/ Hyannis
Project Street Address
f�
Village • ' Ott- �� L�
Owner Address
Telephone 6 b% `113� 3`1 '2�_
Permit Request
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation _ Construction Type
Lot Size J
Grandfathered: ❑Yes 4 No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units)
Age of Existing Structure Historic House: ❑Yes gNo On Old King's Highway: ❑Yes V[No
Basement Type. ❑ Full X Crawl ❑ Walkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing_ new = Half: existing new
Number of Bedrooms: existing L new
Total Room Count(not including baths): existing new
First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: Yes No Fireplaces: Existing New Existing wood/coal stove: ❑Yes No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size — Barn: ❑ existing ❑ new size_
Attached garage: ❑ existing ❑ new size —Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use Proposed Use
i
i
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name 5 � \
Telephone Number� �>
Address
License # 45
Home Improvement Contractor
Email .ti(�C ,\ J���Z ( — Worker's Compensation # WLCVLr y
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
Commonwealth of Massachusetts
Executive Office of Energy& Environmental Affairs
Department of Environmental Protection ,
Southeast Regional Office•20 Riverside Drive, Lakeville NIA 02347.508-946-2700 "
Charles D. Baker Matthew A. Beaton
Governor Secretary :r•
Karyn E.Polito Martin Suuberg
Lieutenant Governor Commissioner X
March 11,2015
Al Schofield RE: BARNSTABLE--Public Water Supply
Old Village Store Old Village Store
2455 Meetinghouse Way,Route 149 PWS ID#4020016
West Barnstable,Massachusetts 02668 Enforcement
NON-SE-15-5D040
Dear Mr. Schofield:
Please find attached a Notice of Noncompliance for failure to comply with the Department of Environmental
Protection(MassDEP or the Department)certified operator requirements in accordance with 310 CMR 22.00.
Please note that the signature on this cover letter indicates formal issuance of the attached document. If you
have any questions regarding this document,please contact Charles Shurtleff at 508-946-2879.
Since ly,
Richard I Rondeau, Chief
Drinking Water Program
Bureau of Water Resources
R/CPS
Y:/DWP,archive/SERO/Barnstable-4020016-Enforcement-2015-03-11
Cshur leff/NoC0/15.non.4020016
CERTIFIED MAIL NO. 7013 1090 0000 9295 1535
cc: Barnstable Board of Health
This information is available in alternate format Call Michelle Waters-Ekanem,Diversity Director,at 617-292-5751.TTY#MassRelay Service 1-800-439-2370
MassDEP Website:www.mass.gov/dep
Printed on Recycled Paper
.a
NOTICE OF NONCOMPLIANCE
THIS IS AN IMPORTANT NOTICE. FAILURE TO TAKE ADEQUATE ACTION IN RESPONSE
TO THIS NOTICE COULD RESULT IN SERIOUS LEGAL CONSEQUENCES.
The Department of Envi onmental Protection(MassDEP or the Department)became aware that the Old
Village Store does not have a Licensed Certified Operator responsible for the public water system at the
facility. Please be advised that the Old Village Store is in noncompliance with the certified operator
requirements in accordance with 310 CMR 22.00.
Attached hereto is a writt:n description of(1)the activity constituting a violation,(2)the requirements
violated,(3)the action the Department now wants you to take and(4)the deadline for taking such action.
If you fail to take any action the Department now wants you to take with regard to the water supply by the
prescribed deadline, or if you otherwise fail to remain in compliance in the future with requirements
applicable to you,you could be subject to legal action, including,but not limited to, criminal prosecution,
court-imposed civil penalties, or civil administrative penalties.Administrative penalties may be assessed
for every day from now on that you are in noncompliance with the requirements referred to herein.This
notice concerns only observed violations of the Department's water supply requirements. The Department
reserves its rights to proceed with respect to any and all other violations of laws administrated by the
Department.
2
4�
NOTICE OF NONCOMPLIANCE
NONCOMPLIANCE SUMMARY
NON-SE-15-5D040
NAME OF ENTITY IN NONCOMPLIANCE:
Old Village Store
PWS ID 44020016
LOCATION WHERE NONCOMPLIANCE OCCURRED OR WAS LAST OBSERVED:
Old Village Store,2445 Meetinghouse Way,West Barnstable,Massachusetts 02668
DATE WHEN NONCOMPLIANCE OCCURRED OR NOTIFICATION WAS ISSUED:
On March 9,2015,the Massachusetts Department of Environmental Protection(MassDEP or the
Department)became aware that the Old Village Store is in violation of the Drinking Water
Regulations by not being operated by a properly licensed Primary and Secondary certified operator
as required by the Drinking Water Regulations.
DESCRIPTION OF NONCOMPLIANCE:
Based on a letter of resignation from Donald Rugg,which was received by MassDEP on March 9,
2015,the Department was made aware that the referenced facility is currently not operated by a
properly licensed certified primary or secondary operator.
DESCRIPTION OF REQUIREMENTS NOT COMPLIED WITH:
In accordance with the MassDEP drinking water regulations, 310 CMR 22.11B,
(1) Operation. "Every public water system shall be operated at all times by a Primary
and Secondary Operator for the treatment and distribution of drinking water,unless
otherwise authorized in writing by the Department..."
ACTION TO BE TAKEN AND THE DEADLINE FOR TAKING SUCH ACTION:
NO LATER THkN March 27,2015,the Old Village Store shall submit to the MassDEP,
Southeast Regional Office two completed and executed"Certified Operator Compliance Notices".
A copy of said notice is attached for your convenience.
If you have any questions concerning this matter,please contact Charles Shurtleff at(508)946-2879.
DATE:
BY:
Richard J. Rondeau, Chief
Drinking Water Program
Bureau of Water Resources
3
OLD VILLAGE STORE
OLD OWNERS
2008-2014
FILE IN ATTIC
pug 01 1411:41 a p.1
Commonwealth of Massachusetts
Title 5 Official Inspection Form
y Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
r 2455 Meeting House Way
Property Address
Al Schofield _
Owner Owner's Name
information is required for every west Barnstable MA 02.668 7-30-14
page. CitylTown State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.Please see completeness checklist at the end of the form.
Important:When A. General Information
filling out forms ""��auulnprrq�i
on the computer, I ���� jH OF Aq 7�i"
use onlythe tab V 'ol
•� `r '�
1. Inspector: s�• . c
key to move your
cursor-do not James D.Sears =�; JAMES m
e the return Name of Inspector
key. =
CapewideEnterprises,LLC %* '
F7 -
�.� w Company Name '-'� Ti --
153 Commercial Street
Company Address Fit., � �.._...
Mashpee MA 02649
Cityrrown State Zip Code
508-477-8877 S1623
Telephone Number license Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and Complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system Inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
7-31-14
pector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
L5ins•3113 Title 6 Official Insp Subsurface Sewage Disposal System-Page 1 of 17
Aug 01 1411:41 a p.2
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
2455 Meeting House Way
Property Address
AI Schofield
Owner Owner's Name
information is required for every West Barnstable MA 02668 7-30-14
page. Cityfrown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E!always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
Village Store and Cheeze Shop. Note: Cheese shop was a. rest. in the past. Cheeze shop closed.
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no or"not determined"(Y, N, ND)for the following statements. If"not
determined," please explain. .
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
k A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
tMns.3M 3 Tine 5 Offldat InspeV lon Form:Subsurface Sewage Disposal Syslem•Page 2 of 17
Aug 01 1411:42a p.3
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
2455 Meeting House Way
Property Address
Al Schofield
Owner Owner's Name
information is required for every west Barnstable MA 02668 7-30-14
page. Cityrrown state Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumpslalarms are repaired_
B) System Conditionally Passes(cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t.lns•3113 Titre 5 ORciaf Inspeaton Fume Subsudace Sewage olsposat system•Page 3 of 17
Aug 01 1411:42a p.4
Commonwealth of Massachusetts
Title 5 Official Inspection Form
" Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
2455 Meeting House Way
Property Address
Al Schofield
Owner Owner's Name
information is required for every West Barnstable MA 02668 7-30-14
page. City/rown state Zip Code Date of Inspedion
B. Certification (cont.)
2. System will fail unless the Board of Health(and Public Water Supplier,if any)
determines that the system is functioning In a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system(SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
`*This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes"or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in is less than 6" below invert or available volume is less
than day flow,/£.4cjljAv C
15ins•3113 Title 5 ORaaal f spedion Form:Subsurface Sewage Disposal System.Page 4 or 17
pug 01 1411:52a p.1
Commonwealth of Massachusetts
_ Title 5 Official Inspection Form
n Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
2455 Meeting House Way
Property Address
AI Schofield
Owner Owner's Name
information is required for every West Barnstable MA 02668 7-30-14
page. Cityrrown Stale Tip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well-
El ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis,performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen Is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form-]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd_
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,
or answered"yes"in Section D above the large system has failed.The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins.3113 T)Ua 5 Offlclal Inspection Form:SubsuRace Sewage Disposal System-Pape 5 0117
Aug 01 1411:52a p.2
Commonwealth of Massachusetts
Title 5 Official Inspection Form
ti
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
2455 Meeting House Way
Property Address
AI Schofield
Owner Owner's Name
information is West Barnstable
required for every MA 02668 7-30-14
page. cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (if they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable)1310 CMR 15.302(5))
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): — Number of bedrooms (actual):
DESIGN flow based on 310 GMR 15.203(for example: 110 gpd x#of bedrooms):
t5ks•3113 Title 5 official Inspection Formc SLOsufaw sevrage Disposal System-Page 6 of 17
Aug 01 1411:52a p,3
Commonwealth of Mass
achusetts
AM- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
L
2455 Meeting House Way
Property Address
Al Schofield
Owner Owners Name
information is West Barnstable
required for every MA 02668 7-30-14
page. CitylTown Slate Zip Code Date of Inspection
D. System Information
Description:
The system is a 1000 Gal G.T. 1500 Gal Septic Tank D Box,Two Pits and Leaching Field
Number of current residents:
Does residence have a garbage grinder? ❑ Yes ❑ No
Is laundry on a separate sewage system?(Include laundry system inspection
information in this report.) ❑ Yes ❑ No
Laundry system inspected? F Yes ❑ No
Seasonal use?
❑ Yes [] No
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Sump pump?
❑ Yes ❑ No
Last date of occupancy:
Date
Commercialllndustrial Flow Conditions:
Type of Establishment: Village Store and Cheese Shop
Design flow(based on 310 CMR 15.203): NA
GaHons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.): NA
Grease trap present? 0 Yes ❑ No
Industrial waste holding tank present? ❑ Yes ® No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No
Water meter readings, if available: Well Water
t5ins•3113 Title 5 Offidal hspsaon Form:Subsumoe sewage Disposal System-Page 7 of 17
Aug 01 1411:53a p.4
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
4 2455 Meeting House Way
Property Address
Al Schofield
Owner Owner's Name
information is required for every West Barnstable MA 02668 7-30-14
page. CityfTown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: NA —Was system pumped as part of the inspection? ® Yes ❑ No
If yes, volume pumped: 3500 Gal.
gallons
How was quantity pumped determined? Pump Truck
Reason for pumping: Maint after inspection
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
® Other(describe):
G.T.
15ins-3/13 InUe 5 Ofridel hs pec5on Forrtc 9tdmuf®w Sewage Disposal Sy9[etll•Page 5 of 17
Aug 01 1411:53a p.5
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
2455 Meeting House Way
Property Address
Al Schofield
Owner Owner's Name
information is
required for every West Barnstable MA 02668 7-30-14
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components,date installed (if known) and source of information:
#
G.T. NA/ 1500 GAL. Tank and pits 1982 permit # 82-276. Leachfi 89-500 1 7-
e Id 1989 Permit
30-14 New D Box&Line Change
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
20"
Depth below grade: feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting,evidence of leakage, etc.):
Pipeing 4" PVC SCH 40
Septic Tank(locate on site plan):
V.
Depth below grade: feet
Material of construction:
®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
1500 Gal.Precast H-10
Dimensions:
Sludge depth
3"
t51ns-3113 Title 5 Offidal Inspectlan Form:SubsLaface Sewage Oisposal System-Page 9 or 17
Aug 01 1411:53a p.6
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M
2455 Meeting House Way
Property Address
Al Schofield
Owner
Owners Name
information is required for every West Barnstable MA 02668 7-30-14
page. Cityfrown State Zip Code Date of Inspection
D. System information (cunt.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
27"
Scum thickness &
Distance from top of scum to top of outlet tee or baffle
B.
Distance from bottom of scum to bottom of outlet tee or baffle
1 Q,
How were dimensions determined? Asbuilt-Tape
Sludge Judge
Comments(on pumping recommendations, inlet and outlet bee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank at working level. Tank and covers at 8"below grade.Two inlet tee's. Outlet tee. No sign of
leakage or over loading. Main pump after inspection.
Grease Trap(locate on site plan):
Depth below grade: 8
feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions: 1000 Gal.Precast H-10
Scum thickness
8"
Distance from top of scum to.top of outlet tee or baffle
8.
Distance from bottom of scum to bottom of outlet tee or baffle
28"
Date of last pumping: NA
Date
t5ins-3113 Tide 5 O(fldel Inspection Fwm:Subsurtaoe Sewage DisPosal Syslem Page 10 o:17
Aug 01 1411:54a p.7
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
2455 Meeting House Way
Property Address
Al Schofield
Owner Owners Name
information is West Barnstable MA 02668 7-30-14
required for every
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
G.T. is a 1000 Gal. precast H-10 Tank. Tank and covers at 6"below grade. In and out let tee's.
Tank at working level. No sign of leakage or over loading. Maint pump afther inspection.
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: —
gallons
Design Flow: g a I Ions per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
*Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No
t5ns•3M3 Title 5 Official Inspectlon Perm:Subsurface Sewage Disposal System-Page 11 or 17
Aug 01 1411:54a p.8
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
2455 Meeting House Way
Property Address
AI Schofield
Owner Owner's Name
informad for every tion is
requi re West Barnstable MA 02668 7-30-14
page. Cdyrrown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened)(locate on site plan):
Depth of liquid level above outlet invert 0
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
D Box is 16"x16"-20" below grade w/cover at 6' below grade. Box is new 7-30-14. Two lines out.
Pump Chamber (locate on site plan):
Pumps in working order: ❑ Yes ❑ No`
Alarms in working order ❑ Yes ❑ No'
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
`If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins-3113 Tdle 5 Official hispedion Form Subswraos Sewage Disposal System-Page 12 of 17
Aug 01 1411:54a p.9
Commonwealth of Massachusetts
IvyTitle 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
2455 Meeting House Way
Property Address
Al Schofield
Owner Owner's Name
inform is West Barnstable
requiredd revery MA 02668 7-30-14
page_ Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 2
❑ leaching chambers number:
❑ leaching galleries number.
❑ leaching trenches number, length:
® leaching fields number, dimensions: 12'x28'
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of
vegetation, etc.):
Leaching is two 1000 Gal. H-10 precast pit's and leach field. Pit(#1)at 18" below grade w/steel c
cover at grade.w/3Water.0ne inlet,no tee has outlet tee. Pit(#2) 3' Below grade w/cover at 6,,. 18"
Water pump after inspection. Camera out to field. No sign of run back or holding water.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth —top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction _ .._..
Indication of groundwater inflow ❑ Yes ❑ No
151rs•3113 Tllle 5 Official trspao6on Form:Subsurface Sewage Disposal System•Page 13 of 17
Aug 01 1411:55a p.10
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
2455 Meeting House Way
Property Address
AI Schofield
Owner Ovvner's Name
information is required for every west Barnstable MA 02668 7-30-14
Cityrrown State Zip Code Date of inspection
page. P P�
D. System Information (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins•3113 Title 50tfdal Inspection Force Subsuurfare Sewage Disposal System•Page 14 of 17
Commonweafth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
2455 Meeting House Way
Property Address Al Schofield _
Owner Owners Name
information is
required for every West Bamstable MA 02668 7-30-14
^—
page. CitylTovm State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
2- hand-sketch in the area below
drawina attached se arately
I 5'Wx25'L Leach Field
wl 3.5'stone around
�1
7 6
:ULU Za%Wr
4 1500 Gatton G
Septic Tank
3 �
_000 Gatton
Grease Trap
I 0
A 1 B A 1-15' B L-13"
rear of louliding 2-21.5' 2-15'
1 O 0 / 3-18.6
(far right Slde) 4-26' 4-29'
5-38-3' 5-38'
i 6-56' 6-59'
I i 7-59' 7-72'
Former
Restaurant 4 .24
f
Vett
Country Store
� l
I
2445 Meeting House Way Rt149
West BArnstoble, NA 02668
TUe 5 Olifdal tupeoicn arm:sw5ufacs Sexage Disposal System
Aug 01 1411:55a p.12
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
J
2455 Meeting House Way
Property Address
Al Schofield
Owner Owner's Name
informrequire for
is West Barnstable MA 02668 7-30-14
required for every
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells N�
Estimated depth t high ground water. feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked,date of design plan reviewed: Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health- explain:
❑ Checked with local excavators, installers-(attach documentation)
® Accessed USGS database-explain_
U.S.G.S. well SDW 252 at 46'w/2'ADJ.
You must describe how you established the high ground water elevation:
U.S.G.S. well SDW 252 at 46'w/2'ADJ. Bottom of pit at 7'-6"below grade
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-3113 Title 5 Official tnspedion Form:Subsurrace Sewage Disposal System•Page 16 of 17
f,
Aug 01 1411:56a p.13
Commonwealth of Massachusetts
Title 5 Official Inspection Form
1= Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
2455 Meeting House Way
Property Address
Al Schofield
Owner Owner's Name
information is West Barnstable MA 02668 7-3D-14
required for every
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary:A, B, C, D, or E checked
® Inspection Summary D(System Failure Criteria Applicable to All Systems) completed
® System Information— Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•3113 Tdle 5 Oftal Inspection Form:Subsurfeoe Sewage Disposal System•Page 17 of 17
f
` Barnstable
� �KMEr Town of Barnstable
AHmm
Regulatory Services Department 'ca #'
+ ll1RNSTABM +• 1
s 9 Public Health Division m
200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
April 30, 2008
R b�
Sharon Soles • `
Meetinghouse Trust
9 Shannon Way DO
Brentwood, NH 03833
c�-
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 2455 Meetinghouse Way, W. Barnstable MA was last
inspected on April 16, 2008,by Mike Hudson, a certified septic inspector for the State
of Massachusetts.
The inspection of the septic system showed that the system"Conditionally Passes"
under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following:
• The outlet baffle on the septic tank is broken and needs to be replaced as soon as
possible to keep system operating properly. The inlet cover on the grease trap is
broken and needs to be replaced to keep water run off from entering grease trap.
You are ordered to repair or replace the septic system within Two (2) years from the date
you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
GP ER OF THE B ARD OF HEALTH
c ean, R.S., CHO
Agent of the Board of Health
CERTIFIED MAIL# 7006 2150 0002 1038 7282
Q:\SEPTIC\Letters Septic Inspection Failures\2455 Meetinghouse Way.doc
Commonwealth of Massachusetts
Title 5 Official Inspection Form 4 s "°" A
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Z?-5 33
2445 Meetinghouse Way- Route 149 G—t 2.y�`J> 4�
Property Address
The Meeting House Trust, Sharon Soles-Trustee LA q 1
Owner Owner's Name lew
information is required for every West Barnstable MA 02668 04/16/08
page. Cityrrown State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.
Important:When filling out forms A. General Information
on the computer,
use only the tab 1. Inspector:
key to move your r y
cursor-do not Mike Hudson use the return Name of Inspector _
key. Septic-wiz Environmental Services �
V�I Company Name '
31 Midway Drive c_
Company Address
Centerville MA 026$2 _
City/Town State Zip Bode --5
508-367-5669 DEP#4254
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system:
❑ Passes ® Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
lt4 04/29/08
Inspect s Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
""This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
ti
2445 Rt 149-T5 Inspection•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
2445 Meetinghouse Way- Route 149
Property Address
The Meeting House Trust, Sharon Soles-Trustee
Owner Owner's Name
information is required for every West Barnstable MA 02668 04/16/08
page. Citylrown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
® One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not
determined," please explain.
❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.
System will pass inspection if the existing tank is replaced with a complying septic tank as
approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate
of Compliance indicating that the tank is less than 20 years old is available.
ND Explain:
The system conditionally passes by DEP standards. The outlet baffle on the septic tank is broken and
needs to be replaced as soon as possible to keep system operating properly. The inlet cover on the
grease trap is broken and needs to be replaced to keep water and run off from entering the grease
trap. See Page 16
❑ 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
2445 Rt 149-T5 Inspection•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�M ,•'�` 2445 Meetinghouse Way- Route 149
Property Address
The Meeting House Trust, Sharon Soles-Trustee
Owner Owner's Name
information is required for every West Barnstable MA 02668 04/16/08
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ distribution box is leveled or replaced
ND Explain:
N
❑ 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:
JA 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.
2445 Rt 149-T5 Inspection•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M ,•''� 2445 Meetinghouse Way- Route 149
Property Address
The Meeting House Trust, Sharon Soles-Trustee
Owner Owner's Name
information is required for every West Barnstable MA 02668 04/16/08
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
0/4 ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
�/� _ ❑ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than Y2 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.
2445 Rt 149-T5 Inspection•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�M ,•'°�V 2445 Meetinghouse Way- Route 149
Property Address
The Meeting House Trust, Sharon Soles-Trustee
Owner Owner's Name
information is required for every West Barnstable MA 02668 04/16/08
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
D) System Failure Criteria Applicable to All Systems (cont.):
Yes No
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
2445 Rt 149-T5 Inspection•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 2445 Meetinghouse Way- Route 149
Property Address
The Meeting House Trust, Sharon Soles-Trustee
Owner Owner's Name
information is required for every West Barnstable MA 02668 04/16/08
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ ® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
2445 Rt 149-T5 Inspection•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M ,. 2445 Meetinghouse Way- Route 149
Property Address
The Meeting House Trust, Sharon Soles-Trustee
Owner Owner's Name
information is required for every West Barnstable MA 02668 04/16/08
page. Cityrrown State Zip Code Date of Inspection
D. System Information
�J 1% - Residential Flow Conditions:
Number of bedrooms(design): Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
Number of current residents:
Does residence have a garbage grinder? ❑ Yes ❑ No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ❑ No
Laundry system inspected? ❑ Yes ❑ No
Seasonaluse? ❑ Yes ❑ No
Water meter readings, if available(last 2 years usage(gpd)):
Sump pump? ❑ Yes ❑ No
Last date of occupancy: Date
Commercial/Industrial Flow Conditions:
Type of Establishment: Country Store/Restaurant
Design flow(based on 310 CMR 15.203): 1,075 gal./day
Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.): maximum seating is 25 persons
Grease trap present? ® Yes ❑ No
Industrial waste holding tank present? ❑ Yes ® No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No
Water meter readings, if available: well
Last date of occupancy/use: 2006
Date
Other(describe):
2445 Rt 149-T5 Inspection•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
2445 Meetinghouse Way- Route 149
Property Address
The Meeting House Trust, Sharon Soles-Trustee
Owner Owner's Name
information is required for every West Barnstable MA 02668 04/16/08
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information: Barnstable BOH, Property owner
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: N/A
gallons
How was quantity pumped determined? N/A
Reason for pumping: N/A
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)
❑ Tight tank. Attach a copy of the DEP approval.
® Other(describe):
(1) 1000 gallon grease trap, (1) 1500 gallon septic tank, (1) 1000 gallon leach pit
acting as additional septic tank to 12'x28' leachfield
Approximate age of all components, date installed (if known)and source of information:
Leach field 19 years, installed 10/89 via as-built permit, septic tank and leach pit 26 years
Were sewage odors detected when arriving at the site? ❑ Yes ® No
2445 Rt 149-T5 Inspection•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 2445 Meetinghouse Way- Route 149
Property Address
The Meeting House Trust, Sharon Soles-Trustee
Owner Owner's Name
information is required for every West Barnstable MA 02668 04/16/08
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
Depth below grade: 22"feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line. 50'+feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
pvc joints in good condition
Septic Tank(locate on site plan):
Depth below grade: 10"feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: N/Ayears
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ® No
--------------------------------------------------------------------------------------------------------------------------
Dimensions:
5'8"Wx10'6"Lx5'8"H-1500 gallon
Sludge depth: 4'10" (2"thickness)
Distance from top of sludge to bottom of outlet tee or baffle
32"
Scum thickness
1"
Distance from top of scum to top of outlet tee or baffle
12"
Distance from bottom of scum to bottom of outlet tee or baffle
14"
How were dimensions determined? Measured probe w/rag, tape,
mirror, flood light
2445 Rt 149-T5 Inspection•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M s 2445 Meetinghouse Way- Route 149
Property Address
The Meeting House Trust, Sharon Soles-Trustee
Owner Owner's Name
information is required for every West Barnstable MA 02668 04/16/08
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Septic tank and grease trap should be pumped quarterly for commercial operation. inlet tees in good
shape, outlet baffle broken and needs immediate repair, all liquid levels normal, tank appears
structurally sound w/no evidence of leakage.
Grease Trap (locate on site plan):
Depth below grade: 6"feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
4'10"Wx8'6"Lx5'8"H-1000 gallon
Scum thickness
1"
Distance from top of scum to top of outlet tee or baffle
8"
Distance from bottom of scum to bottom of outlet tee or baffle
17"
Date of last pumping: November 07 via Wind River
Environmental
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
System has been pumped quarterly by Wind River Environmental, inlet and outlet tees in good
shape, all liquid levels normal, no signs of leaks or structural problems
Q/A- - Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
2445 Rt 149-T5 Inspection•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
2445 Meetinghouse Way- Route 149
Property Address
The Meeting House Trust, Sharon Soles-Trustee
Owner Owners Name
information is required for every West Barnstable MA 02668 04/16/08
page. CityrTown State Zip Code Date of Inspection
- D. System Information (cont.)
Tight or Holding Tank(cont.)
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: bate
Comments(condition of alarm and float switches, etc.):
"Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
Distribution Box(if present must be opened) (locate on site plan):
1' Depth of liquid level above outlet invert
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.):
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
2445 Rt 149-T5 Inspection•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M s 2445 Meetinghouse Way- Route 149
Property Address
The Meeting House Trust, Sharon Soles-Trustee
Owner Owner's Name
information is required for every West Barnstable MA 02668 04/16/08
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
® leaching pits number: (1) 1000 gallon
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
® leaching fields number, dimensions: (1) 12'Wx28'L
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Soil sandy loam, no signs of hydraulic failure or ponding, no damp soil or abnormally lush vegetation
over sas
2445 Rt 149-T5,lnspection•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15
. Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
2445 Meetinghouse Way- Route 149
Property Address
The Meeting House Trust, Sharon Soles-Trustee
Owner Owner's Name
information is required for every West Barnstable MA 02668 04/16/08
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
)� 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 scup layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
2445 Rt 149-T5 Inspection-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
2445 Meetinghouse Way- Route 149
Property Address
The Meeting House Trust, Sharon Soles-Trustee
Owner Owner's Name
information is required for every West Barnstable MA 02668 04/16/08
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
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 pi inrOw ontPrc the buildina.
5'Wx25'L Leach Field
w/ 3.5'stone around
7 6
5 6' (R=6') Leachpit
1000 gallon
4 1500 Gallon
Septic Tank
3 O � i�le4_ cover �-o be topIccecQ
� 1000 Gallon
2 Grease Trap
O
1
A B A l-15' B 1-13"
1 0 0 / + rear of building 2-21.5' 2-15'
(far right side) 3-18.6 3-23'
4-26' 4-29'
5-38.3' 5-38'
6-56' 6-59'
7-59' .7-72'
Former
Restaurant
Well
Country Store
2445 Meeting House Way Rt149
West BArnstable, MA 02668
2445 Rt 149-T5 Inspection•0810E Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15
10 —�
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M °�< 2445 Meetinghouse Way- Route 149
Property Address
The Meeting House Trust, Sharon Soles-Trustee
Owner Owner's Name
information is required for every West Barnstable MA 02668 04/16/08
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope � S 1
® Surface water � o o -�-
® Check cellar N i l\
® Shallow wells tJ I-N
Estimated depth to ground water: 10+
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health -explain:
Reviewed as-built plans and engineering notes, spoke to health agent.
❑ Checked with local excavators, installers-(attach documentation)
® Accessed USGS database-explain:
Reviewed USGS water resource and topographic maps.
You must describe how you established the high ground water elevation:
Reviewed USGS water resource maps and topographic maps for site location. Reviewed file and
engineering notes from Barnstable Board of Health.
2445 Rt 149-T5 Inspection•08l06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15
Town of Barnstable
THE r,
Regulatory Services
iARNSTABM ; Thomas F. Geiler,Director
ArEDyp Public Health Division
Thomas McKean, Director
200 Main Street,Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
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/copy of this
report; this Division does not warranty the functionality of the septic system in the future
not does this Division,agree with any technical observation s 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
Work Construction Permit".
If you should have any questions regarding this report,please contact the certified Septic
System Inspector who conducted the inspection.
04J.7/2K'.8 11:52 5084201536 ALEERT J SCHULZ EP PAGE 02/16
A.aIZ.-9,7_2ri013 M87SQ4�75 P.002
09-26 ARDITO,SWEENEY & ASSOC
®,� Camrtnonv+raalth of Massachusetts
ff' 'al Inspection
A�Ir4, r- H ��#�� Icy
`1'- _' s�efa�Sewage Dispogst 9ysiem Form-Mot for VoluntRry Assessmr,ts y
���
2"S Meat 1n h uea Wa -
PmpertyAddf s
he Meetin House Teas Sharron soles a Trustee ---�---
igrrfter me'. A 02668 0416103
Ir4!*gF4340191s l3afr15�bi® Staff 2P co e 68—m Of IP1spe�id"
rQV..1tAUWJ:i f�1r::,.lerif' ,
ow" n MAIN must be sub �
rniftd on this form.inaPeon forrrus may rjen be altered in any
lnyrr
ways
A. General Informalti®n
af,the raarr�c;ie
uox c rily thol't* 1. Ins tor;
r'tm L.,,rtc,v,l!PtUr --
6:1huf dm ro ; Mike Hudson
qi;>n ifti:PIatIOYro Name of jmapemr
t„v. ire tL,-�Environmesttal Services
31 Rdlld t?nve
r,wS Corrpany Addrem MA
111__�.ff'�dO1 C;erit�111rlile $Eatze �m :'�de
�0l�.3679 DEP 4254
Tak0ame KurptpAr
UCSF�leumber
l
1 certfy that I have personally inspected the se"ge dispel system at this ado rests and that the
infOrMO On reported belovlr Is ttu@,a�Ur3�gttd �n � or fu^rncte Of a aro�i6 i �anoe efi on site
was performed based on my training and expel on an l;Irml 16.340 of
sewage disposal systems.t am a DEP wr sYstOfn I"s r Po to
'Title s(31t)'G`MR 1s.000).The system:
ItsSes ❑ Candibonally Passes ❑ Fails
® Needs Further Evatuation by the Local Approving Authority
04M 6109
lentil Ps Sgnaat ��
The system inspect*r shall submit a copy of this inspection report to the Appmn ing Authority(®onrd
of Health®r DEP)within 30 days of romp%ting this Inspection.If the SYsteM 9S a shared systern®r
has a design flow of 10,000 gpd cr ,greater,the inspector and the system owner shall submit the
roportto the 9pprrapIF12te regional office of the DEP.The original should be S&Tj to the system ouu ar
and copies sent to the buyer,tf applicable,and the approving autherl�r-
""TM9 report Mly descritm conditlons at the tirrto of MPeCtio "d under t pn btu tit cwWliin the ons
Of O retell
at That time.This insprec tion does not address h*W the s m a
re
the same or dMiMrit ewditicns of 11M.
q*%owl Mparjw raw WIRVINA VMNP D"**d spatam•Parse P'x q W
,•.;5¢!:&4Q.93r ad19A Al2fl4S
04/1!r I20 °8 11:52 5084201536 ALBERT J SCHULZ EP PAGE 03,116
AF1;i•-17-2008 09!,26 ARDITO,SWRENEY & ASSOC
5097904775 P.003
a� Comrfiomsalth of Wlmachusettts
ff
Title ic6a6 inspection
S bsurbee swage OiBposal Syttwn Form-Notfor VoluntarY AsseSsrm"
2445 Meeti hVm—pefty Address
ouse tNa Rout®
no Mn Soles-Trustee
rAr'11W owners tame gyp, 02666 041'161�
is!a9r �°¢ke,9 is UV�t 6�Yf1S�bl ���� p4 en�pte[an
Fd9>3ti:ti:'19'v9P'::v10Yp .Qt82O
B. certification (=nt)
inspection Summary:Check A.B,G,D or Ei n&VYS complete all of Secdon O
A) System Passes:
® I have not fou1 303 or in 310 any 1CMR 15.304indrexist Arty fire criteria not ed are
�
in310CMR 1
indi®tad below.
�orr�ment*,'
asses by DEP standards.The outlet baffle on tho septic tank'
Th®system , s(�totae:n and needs to i
replaced soon as possible to;sap systern operating property.The in''At ecYYr:r�ota the grease trap is
®r®ken nd needs eo be re faced I�kee wajpr and run off out of the
B' Sys,Conditionally Passes:
® to be
one or more system components as descf�d in the"�ndit9oe�2t Fuss°eee�on need
replaced or repaired,The system,upon con+Plet an of the reptac®rrrerri�'a air, ss approvv
ed hN
the Board of Haalth,will pass.
Answer yes, no or next det®rmined(Y, N, NO)in ttte®for the following statr;tterrfs.If'not
aemrmined`please explain,
® The Septic lank is metal and over 20 years old'or the sepfic rank(whether rnr-tal of not)is
structurally unsound,exhibits substantial infiltration or exfiiltraMW a+°tank f2ilurs is iMMiFtent
System will pass inspection If the existing tank Is replaced vAth a complying septic rank
approved by th®13o8M of Wealth.
s A metal
Fian�i dflooertlnll pass that tite bnk is ass tttar¢ZO years old s�waillon if it Is structurally sound.not �b�r°�and if a Certifi�te
of O®mp 9
AID Explain:
le
Elevei in the diWbutirt box due
Observation of sewage backup or breek o b Ld or high
sidled or urn warseven der buhi box.Syst a gall
to broken of obstructed pipe(s)or due to a
pow inspection V(with approval of Board of Wealb):
broken plpe(s)are replaced
® obstruction is removed
;tr�AE�l�9ai8.Y�trmgoal�v
00 7/20%'.8 11:52 5084201536 ALEERT J SCHULZ EP PAGE 04/16
R:a'I;~i.7r�o0 09:26 ARDITO,SWEENEY & ASSOC 5007' C4775 P.004
commonwealth of Massachwfta is
Eli!ME rP I Inspection Form
:aim u� Title ida
LL _)� 1 rrn Not for VoluflMly Assessmen'S
Y s py Subwr%eg Bawage p[sposal System po
Route5;- 2448 Meertin house Wa
meryy Addresx
Tle qy Add House Trust Shamn Sales-Trustee
flilel Ome $Name MA �02668
€� C.4�'96d4�
err�e�era:;itlevn to VUe�13amstable
�q€�it���! �s�vt�r,�r Stag 7Jp Code
�ct�@a• C,ltYliawn
i . certification (cant.)
13) System Conditionally Passes(cons):
distribution box is leveled or replaced
N®Exptain:
® The system required pumping more then 4 times a year due to broKeTr,C?Obsti'ucted pipes),Y�0--
system will pass insp%don ff(vAth approval of the Board of Health).,
® brow pipe(s)are replaced
(� obstruction Is removed
N® Eacpl M
'NJ 0) Further Evaluation is Required by the Soard 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 er the environment
1. System will pass unles Board of Health determines In accordance with 310 CMR
'yM(l)(b)that de®system is not functioning In a manner which we'll prat public health,
safety and the envilmnment:
® Cesspool or privy is within W feet of a surface crater
® Ceaspod Of privy is within So feet of a bordering vegetated�metlaad or a gait marsh
X System will fal unless the Board of Health(and public ldlfet491 SUPP10r, if any)
determines that the sy3tern is funedaning In a manner that proteed"thO public heallr,
safety and environment:
® The sysWm has a septio tank and soil absorption system(SAJ)and 2he MS Is within
100 feet of a susfaee meter supply or tributary to A surfaw w2W supply'.
The system has a septic tank and SAS and the SAS is Ath in a Zom�1 of a public w
supply. nate v water
The system has a septic to nk and SAS and me SAS is witr€in S0ti of a p
supply well.
Rt Id!0-9S Ir®psd6n.
71tt!S OP.Ie4nt tfaoar!!on Fe�en:;�p�rtsoe 0�_�'�'.gaga 2 a(1 5
0�1I rI'z0'?2 11:52 5084201536 ALBERT J SCHULZ EP PAGE 05/16
y nl.• .•.17-21)09 09;'27 ARDITO,SWEENEY & ASSOC r'0873f1k':775 P.005
commonwealth of mass"husem
� t fficisl Inspection Form
Title 5 0 p
SGtn±i n
�
a Disposal System IFonYr-Not for Voluntary Asaessmei
( . __.ti Subs
9
e �, -
�,YS y' 2�Meetin house Wa -Route 149
ssr Address
Th Masse Trus Sharon Soles-Trustee ---�
CeroR�c o"Ce$Wme o�r1(i1Dl
it1@Ceti-glijfo kI !fl]®5t
or:Qtri°pit i'�Or��:r�rp �� w State Zp C®®e
g�tisrtw
B. Cartificaflon (corn.)
C) Fuaer EvAluatlon is Required by the SMYd of HeaRh (coat:):
® The aysGam has a se4c tank and$AS and&a SAS is less than 100 feet but 50 feat or
rnore frorj a private water supply well"*.
Method Lsed to determine distance:
This slralem passes if the well water analysis,performed at a 0 EP Qer'fieu vaba:'aiory,for colif "i
bete t8 indicates absent and the presence Of ammonia nitrogen and nitrate rih ag2r'Is equal to or
lless than 5 ppm, provided that no other failure criteria are triggered,A COPY 1 the,ae1®lysis must be
attached to this tbrm.
3. Othen
®) stern Future CfFt6rta Applicable to All Systems:
You indicate"Ygsr'or-No"to each of the following tee an 1a>sae'sr on��
Yes r4o
® Backup of sewage into faoQity or system oomponent due to OVIMOSded or
Clogged SPAS or cesspool
® ® 01schaMe or ponding Of effluent to the surface Of
use ground or surface w®t€:rs
due to an overloaded or dogged SAS or cesspool
Static liquid level in Sloe distribution box above outlet invert due to an Overloaded
or clogged SAS or cesspool
® Liquid depot In cesspool is less than S'below IrweA or available volume is less than'A day Flow
® Required pumping more than 4 times►n the last year NOT due to clogged or
obstructed pipe(s). Number of times purnped6_--.
Any portion of the SAS,cessp®el or privy is below high ground wales elevation_
Any portion of cesspool or privy is within 1 DO feet of a surface water supply or
® tributary to a surface water supply.
SiUo 3 91'Itld PmOs�tPl f•�nn!� � 0jgpMW Sygt=.Paps a,a i N
014/ _T/20z'8 11: 52 5084201536 ALEERT J SCHULZ EP PAGE 06f16
AF-R-17-2(ios 09:'27 ARD,T,TO,SWEENEY & ASSOC _ d5790 775 P.006
P•
:'Li1! II ,dk.+ fW.I LCI IVIIM1O ilN6lwl.
4 commonwealth of MassachuSi is
_ la Title 5 Official Inspection Form
fji Subsurbw Sewage®ftpoaal System Form-Not for Voluntary Assessments
�I fyj .
A `V,' l� 6S1AY�MIO 1'�use YYG �A�� \ter
°Gel
�i�D®f�3�61(E89
The Meetin douse Trast Sharon Soles-Trustee ---
cownc:a fuse MA 0266� 1�llMing
i1�i��rraa�tlar�i:5 1fi0 t> arnstable ZIP Cade Dace air Inspeair
is9qull�;i4.�,•u�eq State
�it�ft�n
�e Certification (cont)
®f Systsm Facture Criterla Applicable to All Systefris(cant.):
Yes No
® ® Any pordon'of a cesspool or privy is within a Zone 1 of a public well.
® Any portion of a cesspw1 or privy is within 50 feet Of a prlvam wgter supply well.
® ® Any portion Of a GMpool or privy is toes than 100 f�-'61 but groate+r than 50 teat:
frm a priva*ouster supply W811 with no acceptable d�t a�I�paca it s1s. his
m posses V the well crater anaVS s,p
Istiorator r,for fecal eotifortn b®cte►ia Indicator @b e® Ind the than 5 per,
of aenmonla nitrogen and nitrate nit" al to
provided that no other failure criteria are triggeredL A Copy of the anaoWIs
and chain of custody Must be attached to this forma
® The systern Is a awspool searing a facility with a design flows of 20ON pd-
10'onmpd,
® The tern ttil�l 1 have deLerrnlned t81at one-or more of tht.above failure
trite'a exist as desaibed in 310CMR 15.303,thorefolo ttiG system fails.The
s owner mould oon the Board of Halal to 69�mrfll;n0 what will be
ne ssary to correct the failure.
li) Large Systems: To be considered a(sage system the sySWM Must wrier a fac ty with a
g design IRow of`t0,000 gpd to Is,000 gpd-
For large sysoems,you m st indicate either"yes°or,no" to each of the,MI&Ang,in addition to the
questions in Section B.
Yea No
the tern is within 400 feet of a surface drinking water supply
® ® the 5ystern iswithin 200 fat of a tributary to a surFace drinldng meter supplgr
the torn is located in a nitrogen Sensitive aP*(j Rntearn Wellhead Proteetion
A —IWPA)or a mapped Zone 11 of a public cater supply well
if you have answered" "to any quegbon in Section E the sOMM is.Wnsidem.1 a significOnt tiri�t,
ar answered"yam'in 5 onto above the Isrge system has failed.Thy ®r®r oper�lor of any large
systarn considered a sigr lficant threat under 5ectliOn E 8r failed under SecWq ®shall upgrade the
syatem in accordance wil h 310 CMR 15.304.The systarn owner should contact tm appropriate
m9lonal office of the De rtment
11106 OMW Ynsoadw fvrw 810me s SgwP Diewsa1 Syron•F+Ce 5ot 16
0411/2KB 11:52 5084201536 ALBERT J SCHULZ EP PAGE 0/16
API -t.i-2. :06. 09:27 ARDITO,SWEENEY & ASSOC 5087904 ?5 P.007
commonwealth of Massachusetts
e��w nm
' P Title 5 Official Inspection F®rrn ,
sr 9t'� ate aeeS wage Disposal�►mte3m ForM-Not for Voluntary assessmenft
F f' ui Se'a
s ^ � � hOUSS Way.Route 149 ®---�
Peropen+J Address
The Mee}tix us Hoe Trust Sharon Soles- nsstee
tt�,wrr awnar's Warne Mp, 02668 Cb4J16J08 �-
BetiPherili;&"is, �1 SantB�ble
reg�;�ind f'or evIVY Slate Zip Coda patA of 11aptdiol9
us e. CiW'=
Ce Checklist
Check if the following have been done.You must indicate'�ee or"no"as tc dxac:'rt&the following:
Y" No
I& ❑ purnpin 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 1lCv,5 in the previ®us two wa(!,k period?
Have large volumes of water been introduced to tM myMet'n reosntly or as pars of
this inspection?
btained and
® Were as built plans of the 5yyst M o examined?(If trie.y were not
avalilabfe note as NSA)
® Was the faculty or dwelling inspected for signs of severe Uck up?
® Was the srie inspected fbr sign of break out?
® ® Were®II System components,excluding the SAS, lo=ted on site?
® Were the se3pile tank manholes uncewered,opened,and thel interior of the tank
inspected for the oondldon of ft baffles or tW.material of construction,
elitnens+ons,depth of li�iuid, depth of sludge and depth of Scum?
® ® Was the facility owner(and occupants if different fmm ownw)provided with
information on the proper mairttenance of subsurface savrage disposal systarns?
The sWa and location of the Soil Absorption S)jftt,n,f�2.lUb)on the eke hm
Wen determined based on:
F-xisting information. For examPle, a plan at the Board of'Kaalth.
®eterminead in the tleld(if arty+of the failure 066a related to Part C iS et isgua
approximation of distance is unaroeptable)[310 GARB 15.302(6)1
Ye:rB Rt SO.,PS Sao,Min me S orr4w lmwpce n Fame&Dfuhe*9e dp®dpa w System•Pan®e416
04117/20c`8 11:52 5084201536 ALEERT J SCHULZ EP PAGE 08f16
AL'Iti- i'-43r'!0� 09•:27 ARDITO,SWEENEY ASSOC g;087904775 P.008
Q Co mtol9vlrmlll ®f gllassachusetis
1 aPTitle 5 official Inspection Form° l� ►: I Not far Voluntary
P Assessments
.subsueaee Sewage Disposal s nr Form-
z
2445 Mestin house INa •let:te 1dg
'�" ProD��tY��eese
The Meeting Hou TrUM Sharon Soles-T
9elAreiL`x' ®uutlBPe Plate AAA �68 6�d IG1�
I�yr�:rii�„rV'd�e►'a�, �e5t® matable
51t4jLt'8�1br nnary stme Zip Code Gee A$p9spe�tl�n
®e SYStem InformalAoln
Residential Flow Condltiom= -Number of bedrooms(design): Number of bedrooms(acWal):
DESIGN flow based an 310 CMR 162D3(for example: 110 gpd x#of bedroorns): —'�'—
Number of currant residents;
Does residence have a garbage grinder, ❑ Yes ❑ tk
Is laundry on a separate sewage system?jif yes separate inspection requIRA ® Yes ❑ No
Lsundry system inspected? ❑ Yes ❑ N9
Seasonal use? ❑ Yes ❑ No
WaW meter readings, if available(last 2 y®8M US89e ON)):
Sump pump? ® Yes No
Last date Of occupancy:
Ccmmeccialfindustrial Flow Condit8orm:
Co_ uri ' S�rellRestaurant
Type of Establishment
1107
5
Design How(based on 210 CHAR 15.203): dons perdalr(W)
' mayamumtlin�is 25 persons r,°
Basis of design flow(seatsrpersonstsci t°, etc.):
Grease trap presenr Yes ❑ P>Io
Indatr'lal waM holding tank present? ® Yes ® No
Non-sanitary waste discharged to the Title 5 system? ® Yes No
well ----
Water meter readirs9s, if available:
2006 _ �—
Last date of occupancy/use: Date —"-"^
Other(des***): -
;l4 4°I lei to TS b °Ma41tle 1 Cfl1o1a1lnspe®on faen:�Cwfee6 S C�sp�s�l 50*n-PW 7 oMs
04/1 +-20E°8 11:52 5084201536 ALEERT J SCHULZ EP PAGE 09/16
.4P).R-i7-2008 09.28 ARDITO,SWEENEY & ASSOC 50879047175 P.009
e CommamNealth of massachuseds .
. � Title 5 Official Inspection Form
an
ram-Not for Voluntary Assessmenffi
Di
v�IP submriace Sewage Disposal item
F., u
2445 Meetin house Wa R,eute 1d9 —�
The Mgdnp House Trust.Sharon Sales-Trustee
6yuraa�: owrert Naffe
S. MA� D266a3 Ctd11ClOS
rrPti�rt.we Pt t' VNeSt arroetaOle Suit® code Date ofImPaction
t25;f l�i+:el`Per�,vEH'� Pitj!(Pautflt
D. System Information (coat.)
General Inform S11611111
)Pumping Records:
Barnstable 6OH Pro a ®owner
Souroe of information:
Was system pumped as part cf the inspection?
yes ® No
NIA
If yes,volume pumped: gallows
How war,quantity pumped determined?
NIA
E
Reason for purnping:
Tye of System:
Septic tank, distribution box,soil absorption System
® Single cwspool
® overflow cesspool
® Privy
® Shared system (Sues or no)(if yes,attach previous insPection records, if any)
Innovative/Alternative technology.Attach a copy of the curry-nt ape,Fatlon and
Cl nnairrtenanoe connect(to be obislned from system owner)
® Tlght lank.Attach a copy of the®EP aPproVW.
j� other(describe):
(1) 1000 gallon grease trap,(1)1500 gallon septic lank,(1)1000 gallon leach pit
actin as addi'oval se is tank to 12'48'leachfleld
Approximate age of ail components,date installed(if known)And source of information:
Leach field IS veers,installed 111J89 vie as-bruit its tic ink and felt:,0 rs
Were sewage odors detected when arriving at the site? Yam; ® No
�.9k5�Wia=7 e N�e�n-�0108 TNe 5OIR0�11ns�Cn Porerc 9�a9ufi��tP O�s�atl�ya°'i`'pagv'���o
0411;/20E:8 11:52 5084201536 ALBERT J SCHULZ EP PAGE 10116
Ai-i-,—'7•-2008 39:28 ARDIMSWEENEY & ASSOC 50S?904?719 P.Dio
Comnlanw ith of Massachusa is
Title 5 Official Inspection Form
n eSSMeltS
subsurface Sewage deposal System Fain'•Not for Voluntary Ass
2445 Meethouse VVa -Reut® 149
Propady Address
The hfieetlr�House Trust,Sharon Soles-Trustee
t„;a nor @wner's I�mve MAOMS r CW16106
E�1f[6f@�19�ICIr16S' � M.Nrnal" wp (its of1�apeCUan
u1a4,i�i11i Tar emary Oilyrrmnl StxM Code
SyStSM lnformatfon (oont.)
HuHding Sewer(locate on siM plan): 221
Depth below grade: Coat
Mateft of construction:
®cast On 40 PVC [J adder(explain)'
50'+
13'rsiance from pdvate water supply well or zm ion line: foe— --
Comments(on condition Of joints,ventirtg, evidence of leakag®.etr~):
. .einls� eod Condition
Septic Tank(locate on site plan):
D®pth below grade' teat
Material of construction:
®concrete ® mil fiberglass ®Po"Iftl®ne ®otW(exp4kin)
MIA
If tank is metalk list ag®' years
Is age confirmed by a Ceftifleate of Compliance?(attach a copy of certiftcMte) I� Yes IS Ind
.618" X11a1VIX5811114-1500 gallon
Dimenssoera3: - -- --
4'10"g"thlcknes;
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness �---
Distance from top of scum to top of outlet tee or baffle
1A7' .�.,
Distanco from bottom of soarm to bottom of outlet tee or beftie -- _
Insured probe w/rag, tape,
How were dirnettsfons determined? rnirn®r ftood li ht
Yc.c abcw Iruaoctiai ra.e,:s> s�06paee�8ycen•ft@.Old 9
�:-m,e;e,®_I�,napsaJer.aaer�
04/17!20f`8 11:52 5084201536 ALBERT J SCHULZ EP PAGE 11/16
:17-- i:108 09:28 ARDITO,SWEENEY & ASSOC a0®7JG4775 P.011
2,
v �k Commonwealth of Massachusetts
qg� 4; � ��t� 5 OTT,
Inspection Form
`-r '"' Assessments
' ` ��w ftb vkce sevnge Disposal SySt@ln Form Not W Voluntary
2445 Meetin house Vlla -Route 149 -'
foaerty Addmsa
The Wbleedn House Tntst Shaeon So(�-Trustee -
aun"er ors roame t1�11£Jpg
iwfow,ra ifz'ki. ®ere ar InsRe Wait BamStsble MA OAS
s ��i a!el Rare:va ry stme Zip code �i6st
I CAYfMWa
D. System Information (cant.)
Comments(cm purnping re®ommendations Inlet and outlet bee or baffle concUOM�Icl:;u�ural intlegri Y,
liquid levels as related tocutlet invert;evid;�ce of leakage,eta):
Septic tank and gr�trap St Ould be pumped quarterly fgr ocmmercc�l operation.ir�(at ®s in g®ad
shape,outlet barite broken and needs immediate repair,all liquid levels nurmai,tank appears
stmeturally sound wl no evidence le®ke
Geese Trap(love on site plan);
Deter below"w. tmr
Material of consirrtction:
®concrete ® metal ®fibergit3Ss 0 polyethylene ®oftr(explain):
4�1�"'Vtfx3��ml.�A"Ha1QO0 gallon
Dimensions.
Scum thickness
Distance from top of scum to top of outlet tee or baffflo
17,
Distance ftm bottom of scum to bottom of outlat tree or baffle
Nwember 07 via Wind River
Date of last pumping_ EnvIronrnenrl _
Commerce(on Pumping recommendations,inlet and outlet tee or ball a cGIditien,structural Integ"14,
liquid levels as r+elaW to outlet inv®rt,evidence of leakage,etca):
System has bow pumped quarterly by VAnd liver Environmental, inleIi and O-Laat toes in good
shaPe�all liquid Ie�ls ttAtArNtal,no al s of leer ex Lip roblemf
t•F -a Tight or Holding Tank(tank must be pumped at time of inspection)(lomte on sfte Plan):1 Depih below graft. mm�
Material of censtrvcion:
®concrete ®mete) ®fibargtm 0 polyedtylene ❑other(explain):
D�Si OW System ft2C
i'..4�$ `Lllg•'fi81ns[ ^OWNYIKe 8 GtfiGal►I�$6700n f91+n.$ubetsRaoa • 9i9 v4'19
0411 7/2&:8 11:52 5084201536 ALBERT J SCHULZ EP PAGE 12,116
Kpli-.1 7-20013 09:25 ARDITO,SWEENEY & ASSOC 50f37�o477r P.012
rommonwealth of Massachuse is
tolY�—c5! Tide 5 official Inspection Form
l Al°l °� essments
" a su�>rfa®®8CVIr3®®DISpa9at Faeeh.Not fi0r Voluntary A88
2445 M®etJ house Wa -13oute 1�19
pa®perly Adldmss
`tote lylgetin Hour®Trust• shar>3n Soles-Truster P---
DIM* ours Narne MA p� tb4�9�1 .m
s fia ��tRenrt u<,, ��—
UI t Barrt9r�ble y oste Of I sspeftr
?tRtl;tli:�Ld J�1 tituctry S1atc �Cod
EAade,
D. SYStern information (cont.�
Tight or Hokfing Yank(conL)
Dimensions:
Capacity: gallons
Design Flow: gallons Per day —
Alarm present: M Yes ❑ No
Alarrn level' Auarrn In%wrking or(*' ❑ YeS No
Dom of lost pur:tping' Deng _
Comrnerlts(condliion®l'alanm and fiWt sia lb2hes,ere.p:
Attach copy of currant pumping contract(required). Is copy attached"r yes ❑ Wi
Distribution Box(if present must be opened)(locate on site plan)•
Depth of liquid level above outlet invert
i ornments(note it box is level and distrlbutlon to outlets equal,any evidenoo of rAllds carryover,any
evidence of leakage into or out of box,etc.):
jt ® pump Chamber(locate on site plan):
pumps In working order. ® yea ❑ No
,4{arrns in working order. yes No
;��!;DEr gate.9b tr�oeettnn•Q@?46 11Ro S OtOdN MYSpEe0d1 ram:l3ub�6fmm C 6lseoaal�'M9R-PRv 19 re 16
0411/28c 8 11: 52 5084201536 ALBERT J SCHULZ EP PAGE 13/16
A; lR-'-7-2C!06 09129 ARDITO,SWEENEY & ASSOC a097304775 P.M
IN& Comflnonvvealth of yassaciht]s01"
n MES Title 5 official Inspection Form
.� [11 a Subsurface Sewage Di>rtp®sal System Fot7rt-Plat for Voluntary
4
445 IVfe®dn house�_A U- 149
Properi�r Addeo®®
�l,e M®etin House Trust S> aron oles-Trustee - m
i;iu,ntl�rOMWS Name �IIl4_ (14_�
srrl radllt�;l ra i'!. a �2rn5table stftxlp Coda bw o4 InopectiUn
I a��e�I Oda!�wes�r CkY/Tftn
®o System lttforMation (font.).
cornmerm(nota condition of pump member,condition of pumps and 2ppurmnances,eN-).
MI Absorpllkn SYSt AM(ems)(locate on sloe plan,excavadon rtot.rpquirad),
if SAS not located,explAin why:
Type. 1 t00Q alien
leaching pits number.
leaching chambers number.
® leaching galleries number --
leaching trenches number, lend, �—
leaching films number,dimensions;
(1) 12'W�Qa'L
� overflow cesspool
r.o pool number
® innovativelalternative system
Typelneme of technology:
Cangp�erTts (nova condition of$all,signs of hydrauflc Failure,level of POnding, damp soil, cond[ton a
vegetatlon, etc.).
Soil sandy loam, no signs of hydraulic failure or pending, no damp sailor abnoemally lush vegetaTian
ever sas
VWe;W•1,10-'reftpW1n-0 Tidy6OfiddlegeatpnPeen:s®wHeoe�ue��I,paaolBYaoan't'��� t5
041171205°8 11: 52 5084201536 ALBERT J SCHULZ EP PAGE 14116
r-2C1CIO 09:29 ARDITO,SWEENEY & ASSOC 5087904775 P.01A
a� Camw'rtoMmalth of MassaChusetts
y.i Inspection Form
Voluntary pssessmer
� =oer Not for
Subeorface Se"9e QiepA6®I Syst0
-4
s al 2445 Meeti house W -Route 1d4
tmpefty Adduces
The Maetln i Wause Test.Sl7aton soles-YruSfee
owmes N3m �/lA
'F�' '""Al`'�l' Wept 6aMS1able
i'a�aW%1WAjt5e cjuaorY A Zip 68 U3ffi Gt tYtSDs�Lten
;sage, f,°�yrlPDam
Da system Informatioln (cunt.)
pools(cesspool must be pumped as Pert of hNspection){late on:gite plan)_
Number and configuration
Depth—top of liquid to inlet invert
Depth of sofrds layer
Depth of scum layer
Oiimnsions of cesspool
Materials of ccins$uclion
Indication of gMundvamr inflow � Yes ® No
00mrnents(note condiVon of soil,signs cf hydraulic failure, level of ponding, comlit5®n of vegetation,
VP—Y
�p privy(locate on site plan)_
Materials af'construetion:
Dimensions
1Depth of sallds
Comments(note condition of soil,signs of hydraulic failure, level of pondin g,col1diflon of vege�tion,
n4� !'.� '1�Ifl®pa�� 89G6 Tdb S ARm��v ^ e7mPeaa 6e� exaaoval SsrRw�+ P�40 or 15
04i 1'i'12K2, 1,1:52 5084201536 ALBERT J SCHULZ EP PAGE 15116
09•:2s ARDITO,SWEENEY & ASSOC �i0B7SO4?75 P.015
Comen®nwealth of Massachusetts
o Form
,
Official Inspection
o i�i �. Title Eftvosar sys�em FormSubsurface SeW2
-Not for Voluntary AsMSSlTt!'► S
s OWE of 4 S — e
Fel'."AddMC6
The Nifte House Tru Stla n Soles-Tt� e�
c'�su ownees Name MA a2668 6419�J�
IYi'<<:rt71t?19�n is. ��> arn5tabi� state Zip Code •date of Insp®drari
cayfrown
D. SYSIem information (cont.)
SEt 1t®f Sewage DrsOesat System.Provide a 3k�fth of ft sewage diSp�I SYMOM includhg Its
to at Least two permanent r+eftrence landmarks or benchrr'►2ft.t.ocaEe all weft v�ltlhin 10�feet.
1_ocat�where Ql�r'�e.au9lat asirmv wr mm the bundi d.
S,Vx25'L Lem
•/ 3.55'S'tone aroLod
7 6
3 6` tR�6'3 Leac�,psr
Iona gatlsn
4 ISM &Aan
septic Tank
3
10®Q �tlon
Z Grose Trnp
1 A 1-15'
A 2�L�'l
1 V O 1 + ,•tar of ladtd9�g 3-a 3-23'
tfw- right swe" 4--P-6° 4-29'
5-126.3' S•30'
G-JE6' 6-S9°
7-in, p-72
Farmer ..
(aestauront
wait
country Stare
w�
244S tmee'tng House 11Q�668�9
West JArn6" %bte, MA
�rssree•Sli�t°: tee ®^ rA* awmhDdonForm 1AIA cn �eflutt i9��an�veget�er95
9
0�1f'1 '�20e'8 11:52 5084201536 ALBERT J SCHULZ EP PAGE 16,116
09:29 ARDITO,S►�EENEY & ASSOC 5097904776 P.016
e€ C®fr►M®nw®asth of Massachusetts
p Official Inspection Form
t i� mu ���I� ,assessments
Bubsutf ee Sewage Disposal System Form-Not for,Voluntary
511
i r;sL g' Meebn house 1N -Route�49
i �erpr Addrms
leAeettn House Trt�t, Mn Sales-Trustee
o wmrs name MA 02668
1,,fi3tYt't�e41 %I; IdVeStat0 at lnVacglon
se,rlei o Le!'gar a;nre t city/TownState �Ip soda
D. System Inf®rMafion (Cont.)
Site Ehmm.,
Ig Check Sbpe 1
Surlbft war O C?v 1
® Check cellar rj 4,
® Shallow wells r 4
Estimeted depth to ground ulster: feet
Please indleate all methods used to determine the high ground water elevation:
® Obtained from System design plans on record
If checked, daw of design plan reviewed: oel>e
[� Observed site(abutting propeVObsenratlon hole within t5h ket Qf SAS)
® Checked with local Board of Health-explain:
Rgoriewed 8"llilt plans 2ttd fl4ineeting nd$es
® Checked With local 8=vat0rs, Ingtalt®rs-(attach docurYl'entaton)
® Accessed USES database e eVlsin:
Revlewed USGS vu�r resource and'low rash maw.
You must daser be how you established the high:ground water elevatiOn:
Reviewed USGS water resource maps and topographic crops for site location, Reviewed hie and
en ineerill rtot�e from Barnstable Board of Health
�qa;i�1 9,6g••'Pd IASpO�®91^Q�8 Tide saMdei Imp gkinFDRn:£iL9B ggp�ge DIV00�•Pape NLI
ys d
120c'.8 11:52 5084201536 ALBERT J SCHULZ EP s PAGE 01/16
LAW OFFICES OF AL BEET J. ;,,�CHULZ
ATTORNEY AT LAW
WILLIAM CHARLES PLACE
7 PARKER ROAD
®STERVILLE, MASSACHUSETTS 02555-2034
TELEPHONE: (500) 4.28-0950
FACSIMILE: (508) 4204 6363
FACSIMILE COVER SHEET
�{
�II .°w
"S.
[3.Michael I.
C ulre
a a
0y 1 AGr,,S(including this cover sheet)'
<< 1,2
w • y. 1,�. fin®inf�r�at�on contained an this Aa, swmda u lIV9,32.
si ralcil Q;:1�`0�� a cup ant is a®nfident�al infurFaaat�on'ntended fog the individual it is
d;:c��8tt'�cls�t��s�. �f ynu are not the intended recipient,y�ua are htrel➢y.ra0tifaesi 4h2.r;tide
dyi�;;c �.Pa�.re, diss� in�fion or copyim�of this c®ac�rnw�nication is strictly prohibited- " you
1,�.,��Er�; !PE Leg� d this communication in error,Please immediately notify us by telephone and
In's-turn the en'gindi message to us aria the U.S.Mail. ''thank you.
No. �O G �( Fee 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01pplitation for Mispo8al 6pstem CDnstrurtion permit
Application for a Permit to Construct( ) Repair(� Upgrade( ) Abandon( ) ❑Complete System Individual Components
Location Address or Lot No. Jg55 wa*;eTwC_440oSS WAq Owner's Name,Address,and Tel.No.
;LT i 4q W o k /4 t i<4.t97 S d 4E 0 G i eE_7> !�
Assessor's Map/Parcel ( -5 -7 IZT- t o
Installer's Name,Address,and Al.No. ,517Q_44 17—$$77 Designer's Name,Address,and Tel.No.
U' 4D�lDE �Tc�2�Q1Sc3 (.LG � A
.¢ P&-25 H
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
r
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Healt
Signe Date 11 Q —,;Poi
Application Approved by Date 7 3 0'
Application Disapproved by Date
for the following reasons
Permit No. — 49k Date Issued 3 �-�
/ J }
No. /- — �" ;�' Fee O
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
PUBLIC HEALTH DIVISION -TOWN OFtiBARNSTABLE, MASSACHUSETTS
01pprication for Bisposat Wpsirm Construction Permit
Application for a Permit to Construct(° ) Repair(� Upgrade( ) Abandon( ) ❑Complete System NfIndividual Components
Location Address or Lot No. ;L4155 w4eeT#j6j400S-E u,,, %4 Owner's Name,Address,and Tel.No.
IX--[ 14q W.V1 14C1r4-ab 5d4 09:i ZD
Assessor's Map/Parcel ( D 7 V-T l .g .
Installer's Name,Address,and Al.No. S pg-CE 7 7-$$77 Designer's Name,Address,and Tel.No.
c'�40 (DE EQ�S25 C.LG N
IA
Go u ST .F p
Type of Building:
Dwelling No.of Bedrooms .'Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
a:.
Other Fixtures -
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title -
Size of Septic Tank Type of S.A.S.
r
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected: i
w
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Healt
Signed Date -, 7" O -�.01
Application Approved by Date 3
Application Disapproved by Date
for the following reasons
Permit No. )L_ 'C� L) Date Issued
----------------------------------------------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS ?/BARNSTABLE,MASSACHUSETTS I`
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(x) Upgraded
n�t' ( )
Abandoned( )by �L6 e-uj(t)E "C �i����sES
at has been constructed in accordance l
with the provisions of Title 5 and the for Disposal System Construction Permit No. - /�ated 3 /7
Installer &?,/7W .tS6_r (-LC- Designer AJ A
#bedrooms Approved design flow gpd
The issuance of this permit shall not be constrted as a guarantee that the system will ction�esigne
Date - J Inspector
- -------------- ----------'' ---L ------------------------------------------ - - --------------_------------------------ -------
No. d`q I Fee /O a
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
30isposal 6pstem Construction Permit
Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( )
System located at ,?CV r;Z- k6zrj Cy /P-T 149 (l( T L
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.
c
Provided:Construction must a complet I withi three years of the date of this pe trm t.
Date �7
M � / % Approved by
J _ .
--��No. . Fee
,THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Zippricattori for Bigpogal bpgtemc Cougtruction Permit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑ Complete System i❑Individual Components
Location Address or Lot No. -.q� I 'n t e p,1 �2 Ljgf Owner's Name,Address,and Tel.No. A 1�Sah �y e,
Assessor's Map/Parcel A4vq ry (O Q 3--7 7 p
Installer's Name,Address,and Tel.No. C4jLWi cJ{ t("S' Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) P.O q C44311 � 19 f b V
Date last inspected: —'GC--Loa
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 H th.
gne Date b
Application Approved Date 4
Application Disapproved by. - Date
for the following reasons
Permit No. Date Issued
v.-. . .y-F.,r.. � .� �..,..+.+'.-.^r< . .trr•�::�..e+�.^_""" `-' .so.r +.r"`W...� rr� ."'�^ �k �i:e
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
-PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ZippYication for Mitpogal *pttem Construction Permit
Application for a Permit to Construct O Repairs({.)- Upgrade O Abandon Compll System O ❑ �ete ❑Individual Components
Location Address or Lot No. _V415-Tsi �,('+✓1� F4,fie W4/ Owner's Name,Address,and Tel.No. A I'i
Assessor's Map/Parcel W 6 3"-7
Installer's Name,Address,and Tel.No.C4,W J4 '" Designer's Name,Address and Tel.No. -
�Z���
Type of Building:
Dwelling No.of Bedrooms Lot Size \� sq. ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) P_,p(+�c.�ti„�9,tii t S4vt
Date last inspected: d (o—too
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 Cdde and not to place the system in operation until a Certificate of
IN
Compliance has been issued by this Board of lth. �
igned Date
Application Approved y Date 0'
Application Disapproved y: Date
for the following reasons
Permit No. t�(�1S G� Date Issued G
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS °
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired Upgraded ( )
Abandoned( )by e (),k Q-�`� p—1 1 Z, ( S
at ?,1414V 41 e,6h L4j W o±!, t.() . !t/1 has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. t �-'' c3 dated
Installer C.► c rc��,•e E:, kU 0/�)—? Designer
#bedrooms Approved design flow gpd
The issuance of this permit shal notbe c strued as a guarantee that the system ll'fun io as designed.
Date �l�1,e Inspector
No. C U Fee
THE COMMONWEALTH OF MASSACHUSETTS `
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
lwi5po5al i�pgtem Construction Permit
Permission is hereby granted to Construct ( ) Repair) Upgrade ( ) Abandon ( )
System located at �.yc j M e',f hh L ,, _Q)A W,. t,t1�°�I _j3fffK1 t'r
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions.
Provided: Construc'ion m 't be completed within three years of tfhe date of this I47ermi
Date APPLved by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...----- . .... ....................OF.-.......-.................--.-........
Appliratioo for Ui4pooal lgorkii Tooitrortion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at* 4:;
....... -........................... .. .. .....4
..
Location-Address or Lot No.
W
staller Address
UType of Building Size Lot............................Sq. feet
�--� Dwelling—No. of Bedrooms_______ ___________________________________Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building .. ........ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures ...----•-----------------------•--------•-------••-----•-•---•-•••-•-•---••-•-----•----....--••-•-•-•••-•---•-•-••---••••-••-••....-------------•--••.
W Design Flow....................:.......................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length________________ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No---_---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date.......................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water---__-----..-.---------.
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ••-•••••••--••-•-•--•--•--•--••••-•-••••••-••••••••---•••----•••••••----•-•-•-•-•-•..............•--.........................................................
0 Description of Soil----------------------------------------------------------------•-----------------------------------------------------•----------------------------------•.....-•.-•---
x
V -••••---••••-•-•-••-••-••-•••-•••-••-•---•-•••-•••-•••---••---•------••--•---••••••-------•••-•--•••-•......-•-----••••-•-•--•..........................................................--------•-----
..---•-----------------•-----...-------------------------------------------------------••----••••-•------•-•----• ------..-- ... ------------••--•--- --• .......•--•,......•.............
U Nature of Rep ' s or Alteratio —A er when applicable....Am- .. �1 ---------..
, - ........................................................... -------------•--------------------------------......----•------.----- .
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITiU, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be n issued b the bo r of health.
Signed.•. . -- ................. ..................... -- --•-•--•--•--••••--- . .........'.
Date
Application Approved By................... ------•--•• --------
Date
Application Disapproved for the following reasons--------------------------------------------------------------------------------•------•-•-•------••-•••••.......
.....••---••••---...----•---•---••-•-•-•--•....----•-•-•----------•------------•--- ••------ ••------•--•-••------•-----•-•-•••-••---------••-•---....-•---
1� Date
Permit No....... .21......S -•-•----------------- Issued.......................................................
Date
_ 1" 1►
F:ns.......2:t:-.........
r...f"
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................O F................................_..........---------------................_------•-----•.
Appliration for Disposal Works T. nstrurtion Errant
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
1.
Location-Address r or Lot No.
.e....._..... .............
"
a rstner �� !:- Adds
� . .......: . :: � .
aller Address d Type f Building Size Lot............................Sq. feet
U Dwelling
—No. of Bedrooms__.-_- Expansion Attic Garbage Grinder
111 Other—Type of Building . :� ' ......... No. of persons............................ Showers ( ) — Cafeteria ( )
QI Other fixtures -------------------------------- '
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter---------------- Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
14 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
R+ •...
•------------------------
-......
-...........
--.---------------------
•......
•......
•-•----..............
-----
•--------------------------------------
--••'-
ODescription of Soil.........................................................................................................................................................................
x
U •-•-------------------------
•------------------------------------------------------------
-----------------
•-------------
----------------------------------------
-------------------------------------
UW __________________________________________________________________________________________________________________ ___________ ____ _ ....................... ..........................
Nature of Rep s or Alterati s—A wer when applicable =� ..... ... f�.2� ----•--•----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLi� 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b en issued by the board of health.
Signed•:;-� �. --- ..........................
..
--.....-'-'; .._......
Date
Application Approved By-••-------'••---C V SJ---- I---'e'Ll"L ,;r ....................... ...---- v�
N Date P
Application Disapproved for the following reasons--------------------------------------'--...............................---.....................................
...................'•----...--••---••------•---•-...-----------------'---...----•-------•-----------.......--------'------------•--'-------------------------------------....---------------------'-'---
_ Date
c
PermitNo....... .f....... /`'_...................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................% ......OF............ sr'�a .w...��-?2.................................
Trrtifiratr of Toutpliattrr
THIS_IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired)
by.....•......(_` -' ........... .,......314 ....................................................................................................
> 5 auer
at...................1 --t (u- �' ... - �P., `?!.....-----------•----------------•-.
has been installed in accordance with the provisions of 'I'Ir IF, 5 of The State Sanitary Code as described in the
c^
application for Disposal Works Construction Permit No---- --------- dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE
...
CO UE® AS`A rG UARANT THAT THE
SYSTEM pl F PCT1 SFACTORY.
DATE............. / Inspector :�•.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
4�...........OF......., k.��.....................................
No.?...................... FEE2..f ....
Disposal. Vorkv Tonstrtutott rrutit
Permission is hereby granted............. �' ..-----. ----•----------------------•----•------•--.......-•---------.................---
to Construct ( ) or Repair ) an Individual Sewage isposal—System
at No.-'---"'f. ..... r -"'-'-....? �� ...j
Street clel
as shown on the application for Disposal Works Construction Permit Noe121--_Y ... Dated..........................................
e r lvT Board of Health
DATE--------'••-f- - 1--•--•---•----------------------'--..
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS a
r f
s� No._9.L='2:.?4!5' FEE......cb .........
THE COMMONWEALTH OF MASSACHUSETTS _
BOAR® OF HEALTH
.................. ........................OF........................................------------..-..------------.-........-..-------
Appliration for 11ispntial Works Tonstrnrtiun ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
i
S ...........................
.._.. -
Location-Address or Lot No.
•--••--•-----•.............................................•---•---•----........._................ ......-----•---....•--•-•-...----..............--•--...---........._............................--
• Owner ••---••-----•-••••---•••-•----••Address
a .--•-••-•G
Installer Address
dType of Building Size Lot___________ ...............Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
Other fixtures ..-•-------•••---•--------•--•-- -
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date------------------------------•--------
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ------------•...............
0 Description of Soil........................................................................................................................................................................
-- -
x -----•---•- --�----- - - ...................................................
U Nature of Repairs or Alterations—Answer when applicable................................................................................................
----------------------------•------------------------------•----•---•-------•--•--•--••--•--•------•--•••--------•-----••......-----•--•-••-•--•••----•-•----------------•----•--••--••••--•--....-----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT!- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board,of health.
Si ed••-- '�J�•-•. ................. ..---•-••••••-
D to
Application Approved BY •--•--•-•--- '-/ r_._.. ,/�% ......................... - -----
Date
Application Disapproved for the following reasons________________________________________________________________________________________________ ______________
s'
-----------------------•---...----....---....-__.....---------------------•------•----...._..-------........---------••-••---------••----------•-------------•---•----------..__._...•------••--••-------
D,ate
PermitNo......................................................... Issued.......................................................
Date
le
F>ms........
Y::" ........
THE COMMONWEALTH OF MASSACHUSETTS y„ .
BOAR® OF HEALTH
...•........... .... ....................O F.........................................------------------.._............................
AVVlirFatiou for Disposal Works Cfnnstrnriiun Frrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
y
Location-Address or Lot No.
---•...................................•---•--..--................................................ ..........-..............................................................................._.--•-
a Owner Address
---- ................................................... ..................................................................................................
Installer Address
PQ
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ------------------------ ---------------------------------------- ----------------------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow.__...................._....................gallons.
WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width..................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1---------------minutes per inch Depth of Test Pit.................... Depth to ground water.........._-_-_----____.
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
x ------•-----------------------------------------------------------------------------------------------------------------------------------------------•------
O Description of Soil......... 7._ /
W g��------.. .. .II ....Ss ?'•e t ..,
U Nature of Repairs or Alterations—Answer when applicable._.__...........................................................................................
Agreement:
. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
� D e
Application Approved By--------- �,'. J��J -�'--�j��-�- A----------
" O-
Date
Application Disapproved for the following reasons:................................................................................................................
-----....-•--------------•-•----•--------•--•--------------..................------------..........------I-•••••••----•-------•----•--------------------•••---•••-•---•••-•--•-••------------------------
Date
PermitNo......................................................... Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......OF.......... �..`.:::"...............................................................
Tntifiratr of TompliFanrr
THIS IS CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by---------------- s..---------------......------------. . ------------....--------...........------------------........-----------.......------.....------------
` ,,,✓ Installer
at...... d - - ------........ -a.......-=�-��'-�-� ---------------------------------------------------------------
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No----- 2-- ........ da.ted................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISF CT
DATE....................................................6. --- Inspector ��� <
MY�
THE COMMONWEALTH OF MASSACHUSETTS
r -
BOARD OF
HEALTH
w ti ...OF........_... .^....
No.A.Z-:e2 46 FEE...................
Disposal Works Tonstrnrtion Vprrmit
M Y g _....._._Permission is hereby rante ...t �....
to Construct .-°r Re lair Kan Individual Sewage Dispos Syst ��- ff
_..._ �c
at No..---.. . ,R.... ---et ----- ;
Street
as shown on the application for Disposal Works Construction Permit No.._...ry...............,, Dated.............................4...._......_. /1`7
........:�-.... .✓:/...-.,%.!!' ......................................................
DATE DATE................................ ,. ..�_ _....... 0" 'Board of Health -
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -
._ram _.. ....
TOWN C BAItN3'rABLE
�..'rY
LOCA. JN ,, f Q _SEWAGE # OQ
V`ItLAGL�_ 4SSESSOR'S. MAP fa LOT
INSULLER'S NAME &t PHONE NO. 7i, Jr
SEPTIC TANK CAPACITY
LEACHING ACILITY:(typie) (size)
NO. OF BEDROQMS PRIVATE WBL OR PUBLIC WATER _
BUILDER OR OWNAOZ
ER
nAT pElt'-T ISSUED: !? 4 9
DATE COLIPLIA'NCE ISSUED
VARIANCE GRANTED: Yes
a
AS
e �
Otte �
4
r�
�> :..
`�
1 ,� "�Ii'
362-4541
926 main street rt 6A '
yarmouthport
mass. 02675 down cope engineering
civil engineers& land surveyors
structural design
Arne H.Ojala P.E.,R.L.S.
land court RichardR.Fairbank P.E.
surveys December 31, 1986
site planning
Nancy Leitner, Health Agent
sewage system Barnstable Health Department
designs Barnstable Town Hall
367 Main Street
Hyannis, MA 02601
inspections Reference: Old Village Store - Route 149,
West Barnstable, MA
permits Dear Nancy:
Septic plans were supplied to us for the Old Village Restaurant
and Pizza (behind the Old Village Store) by the Barnstable Health
Department.
According to these plans, the leaching facility consists of two
1000 gal. leach pits. Assuming two feet of stone around each, the
leaching capacity of the system is 1099 gal./day. The maximum
seating capacity of the restaurant, as recorded at the health
department, is 25, which would give a 875 gal./day flow rate. The
store was assigned a flow rate of 200 gal./day by the Health
Department, so the ccxnbined flow rates of the restaurant and the
store is 1075 gal./day. Therefore, the existing leaching facility
for the restaurant is capable of handling the additional flow fran
the store.
Maintaining proper pitch, the pipe fran the sink in the store
should be run to the grease trap, in order to connect into the
sytem.
Yours truly,
Arne H. Ojala, R.L.S., P.E.
LW/1mW
cc: Tan Stoner
Old Village Store
Route 149
West Barnstable, MA 02668
f
�FTHE rO� TOWN OF BARNSTABLE 00, y
OFFICE OF
i BAHH9TABLE =MASS. BOARD OF HEALTH
y p�
1639.0 MAR367 MAIN STREET
A� p`\
HYANNIS, MASS. 02601
June 24, '1982
Mr. John Klimm
Ch4i.rman
Board of Selectmen
Town of Barnstable
Dear Mr. Klimm:
Mr. William Mitchell , of the Cape Cod Model Railroad, claims that
The Village Store, Route 149 , West Barnstable, has installed a
septic system on property leased to the Model Railroad. This is
Lombard Farm property owned by the Town.
Title 5 , of the State Environmental Code, requires that systems
be located no closer than ten feet to a property line.
We have requested that the Engineering Department, of the D.P.W. ,
survey the property lines to ascertain if the complaint is valid.
In the meantime, we are withholding a Food Service Permit for The
Village Store until the situation is resolved.
Mrs. Jessie Mazzur informed our secretary that on the Lombard Farm
property, there are no property lines. If there are property
lines involved, the Selectmen could possibly grant an easement to
allow the system. The Board of Health would then have to grant a
variance from Title 5, of the State Environmental Code.
We do not feel that this system as presently installed will create
any environmental problems nor affect the Cape Cod Railroad Club in
any manner.
Very truly yours,
jpAh M.Te'
Y
15Arector of Pu is Health
JMK/mm
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