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HomeMy WebLinkAbout0019 TILLAGE LANE - Health 19 Tillage Lane W. Barnstable A = 136 004 v� . Lc tom ' J C .-4- v 1toy- )k wr-`7 ram" --�(�- •`�� � �� ?'�l ��' / �4ew P� k { a 1 e P , p f s x Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Address owe -to Qom ' Owner's Name information is �_ .A �l► t tequhed for (� rCa Q 4a C T t4 (�I t every page. cityrrown Zip Code Data of Inspection y- 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. tmportaft A General Information r When tilling out I fortes on the cor"puter,we 1. Inspector. only the tab key " to move your �,1- '�i21 /e, /�1 �./�e 14 tf j cursor-do not Name of inspector use the return key. �6 =4 J�i G Ar.te-Lf E .S��t!t r_6 mpnY Name 0 l3- ✓ZT ieR4. Company Address '® Citylrown state zip Code Telephone Rumber t.icrose Number , � a B. Certification i <7i 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 15.34,0 of Title 5(310 CMR 15.000).The system: asses Condifionally Passes 0 Fails c�- ❑ Needs Further Evaluation by the Local Approving Authority Inspector'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. pgtpg Tithe 5 offkW hgmcdon For[st6mobw Sew ap Disposal 1 of 71 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Propetty Address Owner OHmer's N&ne information Is �►i 2 3 9 t l required for every page frown State Zip Code Da�of hipeCBon IF B. Certification (cunt.) Inspection Summary.Check A,B,C,D or E/always complete all of Section D A) System Passes: 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:. Sil 5-�r= M r S 1loi2Je-1 N& Itj yio41f I f dA Si kAj r C.a v�o to � STEM ©O E NO T vg-r--- P(i r 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 exttration or tank failure is imminent System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): ism,09108 rde 5 00d01 bapsciion Fam SW=dece sere syshn•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owner's Name requiredf�s W. r �� O Z-6 6 required for t every page. CiWrown State Zip Code Date of Ins 'on B. Certification (cone) B) System Conditionally Passes(cost.): 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): ,,t.\[] 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: N o❑ 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 CHAR 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 Wins•Mae We 6 Opal hopeedon Form Subsurface Sewage Disposal System-Page 3 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments I g 7► l/A-A6 L,a wi ice, 13 l f�- ti-)A Property Address Owner Owners Name information is j required for �A 5 T-,4/31 every page. cityrrown to Zip Code Date of Inspection B. Certification (cunt.) 2. System will fail unless the Board of Health(and Public Water Supplier,N 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 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 dogged 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 ❑ 01 Liquid depth in cesspool is less than V'below invert or available volume is less than%day flow t5'ms.om rift s owem hVectim kum Subadow Sewage Disposal System•Pap 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments C Property Address Owner Owner's Name Informrequired tD is l L-w � required for 16I r �4 2 J�:4.-r`-14 Q►�' J every page. Citylrown state Zip Code Date of inspedion B. Certification (cant) Yes No ❑ �equired pumping more than 4 times in the last year NOT due to dogged or obstructed pipe(s).Number of times pumped: ❑ 0--'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. ❑ Q.� Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ lr 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.] ❑ 0/ 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 System: 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 11 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. t5Ms.09108 Two 5 olfi�Mspedton Fomr Subsuftoe Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments GrA r l \aZ, if y4 ti( s'r�4 B/►G 1` /� . Property Address 64---1S Owner Owner's Name information is required for MA- k 3) 91 1 r every page. Cityrrowwn state Tap Code Bate of Irupectim 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 th owne ,occupant,or Board of Health ❑ Ej"" 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? L�' ❑ Were as built plans of the system obtained and examined?(if they were not available note as N/A) ❑--' ❑ Was the facility or dwelling inspected for signs of sewage back up? [�❑ _ Was the site inspected for signs of break out? ❑ Were all system components,excluding the SAS, located on site? [� ❑ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ Existing information.For example,a plan at the Board of Health. ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): MIS.09108 TM9 5 olfieml Wpedon Fay&"wbw Sewage Doosel Systain-Pap 6 of 17 f Commonwealth of Massachusetts. Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Ptopparty address s-�r---1 f3 s3 Owner Owner's Name Information is required for ��• 13AeN- every page. Citylrown state Zip Code Date of Inspection D. System Information Description: L{AC 9 C1-441`et 9 y1-(e-ou N D i> Ym N 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 9'1qo' Laundry system inspected? cy✓� ❑ Yes ❑ No Seasonal use? ❑ Yes B-Nro- - Water meter readings,if available(last 2 years usage(gpd)): Detail: P 2-1 Sump pump? ❑ Yes B-Iqoo' Last date of occupancy: Date /l CommerciaUlndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No} Water meter readings,if available: t5 ,09I08 Tft 5 Of kW kopeCdon FOM SubaIrfaCe Sewage Oisp"System•Pegs 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owner's Name information is W, EA£a i�4 f3� � l�`}A- �2 5191>I required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: a Source of Information: �� N Was system pumped as part of the inspection? ❑ Yes No If yes,volume pumped: gations How was quantity pumped determined? Reason for pumping: _- Type of System: 0__� 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/Aitemative 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): t51ms•OM Tft 5 OWdW Ind Form:Suter Sewage MpoW Syatwn•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface.Sewage Disposal System Form-Not for Voluntary Assessments Property Address `TvF1 BEZ2 Owner Ownees Name information is ! +� required for tom_ / ! every page. CilyfTown State Zip Code Date o Inspection D. System Information (cunt.) Approximate age of all components,date installed(if known)and source of information: orjq?1+ Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): Depth below grade: 61 feet Material of construction: ❑cast iron 310 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting,evidence of leakage,etc.): ni TS ✓A-a. -D A t UF—N T-t-e-1Z&ca 014 H00 S Jr—, N o Evi P ta)4 c6- Septic Tank(locate on site plan): 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 Dimensions: /e2`G!'L, 5-W'Y4 S''6 "14 Sludge depth: MIS.OM Tfe 5 OWidW Fame sta."Seam System-Pap 9 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address T6'(�-S a f'�r-y Owner Owner's Name information is � � Z(06, 3( g! t required for -�AL 174tZ 4 3M)a Q every page- Citylfown state Zip Code Date of inspection D. System Information (cons) Septic Tank(cunt) Distance from top of sludge to bottom of outlet tee or baffle � 11c Scum thickness tt Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to,bottom of outlet tee or baffle L y' 5 How were dimensions determined? • f�M 6 r4 A 6 6 !)4F411c;6- Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural'integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): S 7 ctc, -t-ANK-t-oP t S7 D60 M 52'r 12"2}26PL-rig I NSF i AM D o � M 0 CA,' .9J4(—i=1 A-Q—L- l'n 1 1�� , 7-AN 14 15 5 5r-ieycTc:A i l 6K- , L, aot D D 9 T-4 15 uk-'` cy t! L---W-3 f r ®2 0u—t GFTAhue- . -rAIiiC, D6f (320j(2 1-jN� lk Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t*W,09= Tine 5 MW t wWfion Fam Substance SOMP 0405W System Page 10 of 17 r Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner&i 663.51 Owner's Name j information's required for N every page. Citylrown State Zip Code Date of Inspedion D. System Information (coot.) Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth blow grade: Material of construction: ❑concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: Capacity. gallons Design Flow. gaib„s W 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 t5hu.OM -nue 5 Owmw mvediW Fomr subsurface sewage oisposal SYstem Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t q 7-/ tl �-6 1Am V-1i 13.A,-NYrA 0j M�4 Property Address Tor-,I GE-53 Owner Owner's Name information is required for \4✓-6A 9,N 37-4(31 1!5--' rVI,_bk 6 '3 9111 every page- Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert N A Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): c V (30 Cc--r��,2 Dow N 13 , NC; Evt D emc.E c� 1\0 S 1 is-Id S' 6 r— 6G;A- i M 6/Z, (n `f` y r— Q.SC Y 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.): Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located,explain why. MW.ORM rdle 5 OraM kopedw Form:SW=n m Sewage Disposal system•Page 12 0117 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property address Z-6&�1 Q GAS' Owner owners Name information is required for YJ. 6A Q AY-1 A(3)f MA 6Z-6("? every page. Cityrrown State 7p Code Date of Inspection D.-System Information (cont.) Type: ❑ leaching pits number. leaching chambers number. 3 /o tr X Z� ❑ leaching galleries number. ❑ leaching trenches number,length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number. ❑ innovative/aitemative system Type/name of technology. Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): y (fib S!G-rlg �-/gyp 2e1c+i�c �741 I u � Car` '[ S fl2 ub Lt ac)t o / g C3 TTc2 Jet 6 C AI-V4 fc,l3 Fz Q-51 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 ME•09= TWe 5 O&W Ngedion Form:&fturfaw Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Properly Address Owner Owners Name information is required for Wt 6 AatJ every page. Ctity/rown State Zip Code Date of Inspection D. System Information (cunt.) 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.): tSm•09M Tide 6 OMM Inspection Fonm Sfswfame Sewage Disposal System•Wage 14 of 17 r Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Plot for Voluntary Assessments Property Address TCi'f 6�55 Owner Owner's Name information required forte A64EAR 14.7 j AB1 r 1 A every page. City frown State Zip Code Date of Inspection D. System Information (cons) Sketch Of Sewage Disposal System:Provide a view of the sewage disposal system,including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet Locate where public water supply enters the building.Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately s I4 © i 56- p A- D -5.1,� �� =(I- Y tsm.09108 Mae 5 OMM kqndw Fomr Sutudace Sewage Mposal System•Page 16 or 17 S - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ! S PropedyAftmw xbc-5 (f oww Oa NHWS tmee bft'roft is every Page. wrom state Zip Code Date of Limon D. System Information (corn.) =Slope ❑ Surface water ff-C'heck cellar ❑ Shallow wells f Estimated depth to high Wound water. tit et 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: at ©n Date ❑ Observed site(abutting propertyiobservation hole within 150 feet of SAS) Q� Checked with local Board of Health-explain: c � PrgICTES'% (4otj 92-163af-rS ❑ Checked with local e)ccavators,installers-(attach documentation) ❑� A=ssed USGS database-explain: You must describe how you established the high ground water elevation: t=p Gf a F �-►�T L�4 ti D r i� 2�/r4"f-tc n1 � �t E v A'i"re N. �� t3 t--rz__ +� e p t�2L, DES'7- LAIC t E 191,0 0&,-r-T6 N► ter- ct t►�M fs �d:,7 N 6 H---e 1 hk Pclz c 04)r Before filing this Inspection Report,please see Report Completeness Checklist on next page- Tme 5OMM bwecdw Fame s MWasd -wage 18 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Prbperty Address (365;.7 Owner Owners Name information is 3 4/ required for )(L 6"t-4 S1J4(31-19 It every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Inspection Summary.A, B, C,D,or E checked nspection Summary D(System Failure Criteria Applicable to All Systems)completed a-tS- Information—Estimated depth to high groundwater ketch of Sewage Disposal System either drawn on page 15 or attached in separate file tan.09108 Title 5 oMdal hqpeetion Fomr Sfsedaee SmW Disposal System•Page 17 of 17 / FORM30 C&W HOBBSBWARRENrm THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE TH CITY TOWN ` F t6ePARTMENT ADDRESS M SVey`0 'A / TELEPHONE Address Vv Occupan Floor Apartment o. No. of Occupants No. of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units_ o.Stories Name and address of owner Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches.- Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation-.- Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen. Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 ¢ Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: S cks, Flues,V ts,Safeties: Kitchen Facilities i a n ove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats,Mice, Roaches or Other: Egress Dual and Obst'n.- General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATION CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSfflT T IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIE A'�����" �� INSPECTOR TITLE 1' i f P�q. DATE — 1-7— O� TIME I `v'' P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. I 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. TOWN OF BARNSTABLE LOCATION Pq � SEWAGE # VILLAGE W e ST G4 et d S1'o 1J L e ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. S'G01'f"ff %o2a ey Sbe. g88. 3863/ SEPTIC TANK CAPACITY ,S-0 LEACHING FACILITY: (type) 3 (size) 16 'oe O i NO.OF BEDROOMS D BUILDER OR OWNER kAT Y /JOSS PERMITDATE: '. COMPLIANCE DATE: q Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �1'� Feet Private Water Supply Well and Leaching Facility (If any wells exist t�o on site or within 200 feet of leaching facility) H14Wv Feet Edge of Wetland and Leaching Facility (If any wetlands exist t within 300 feet of leaching facility) 9.5' -4-o Feet Furnished by A 7-62a-,Y A oe 9 T-- -1�Nk DJT 63 , 1,�', _ VA f-JA AICI� 1* No. 7 THE\COMMON A H OF MASSACHUSETTS FEE BOARD OF HEALTH/ OF APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT v Application for a Permit to Construct (,V� Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete System ❑Individual Components Location Owner's Name 13V/ Map/Parcel 4 Address L Tele ne# V. yE ®�2 e�Installerf�pme � � Designer's Name ay �rAdds �,9 Address Telephone# Telephone# Type of Building: ✓GS Lot Size �f° / Sq.feet Dwelling—No.of Bedrooms � Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required) 3 ° gpd Calculated design flow 3 3 gpd Design flow provided 3 3 gpd Plan: Date Number of sheets I Revision Date S v Title 4 i IT-e -- 49CA. ---1 o1r 14 T%wA ezng ✓ram. Description of Soil(s) a-ate" I—5 g - � VS , '?si'- t"5f�. /h S -�!" I.S , �_30�,� �? •�� ( �Z. �`'I S Soil Evaluator Form No. Name of Soil Evaluator L. L-y o✓t s Date of Evaluation Z �{- DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and furth ace the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed � /-2"' Date --� 16 Inspections 6 f U 5 FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 FO*,p^ '�� 1����` � "1�T /f�/(�/(/_'�(�''�y/Jj//f!/ (x�. '� I � V V—!�/v�X '�• `'j' ). j -No.. C >S 7 7 THECOMM'ON AL H2OF MASSACHUSEITTS `,FEe .. + �B OARD OF HEALTH APPLICATION'FOR DISPOSAL. SYSTEM ` CONSTRUCTION RUCTION PE RMIT Re air ( Upade (Application for a Permitto Construct gr Abandon ❑Complete , System ❑Individual Components t L E aiin / l Owner's Name • Map/Parcel ' C Address �.. L i Telegone# o Installer' me esigner's Name ©gaeIEY K�+ S`k�ow ��A yAe Add s Address Telephone# Telephone# NL 8^ Type o1 Building: I�l �' Lot Size ° Sq.feet Dwelling—No.of Bedrooms 113 Garbage Grinder.,}( ) s�-- Other—Type of Building No.of persons "' Showers ( ), Cafeteria ( ) Other fiziures x" DesignTfOw(min.required) gpd Calculated design flow 3 3 gpd Design flow provided 3 3 5 gpd Plan: Date '� `� Number of sheets 1 Revision Date 5 - •} Title T�T� Gi Gi I T4- PLA�.,1. o ,q — -1 1--� Description of Soil(s) +� t- 5 �' S 2q '- t �5 ., S q.. 4S 31,. �� �`1 - 1 �Z,. I� S Soil Evaluator Form No. Name of Soil`Evaluator t- • v e.-I Date of Evaluation 2 - I DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and furthe agrees`nduto'place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed xv, cd Date -.� -' 16 Inspections t FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 � "(� THE c No. COMMONWEALTH OF MASSACHUSETTS �� —FEE63 S BOARD OF OF HEALTH �. 4 CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) �t Complete System 1. The undersigned hereby certify that the Sewage'Disposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned( ) by: Eat PN�i has been installed in accordance Vith the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built Vplans relating to application No. dated e Approved Design Flow (gpd) Installer Designer: Inspector Date The issuance of this certificate shall not be construed as a guarantee that the system function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No.9W5T'4 THE COMMONWEALTH OF MASSA6H_JSETTS FEE /50 �rSb�)� BOARD OF (HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT i Permission is hereby gra�ted Construct b�/) Re�P iT, ( Upgrade ( ) Abandon ( ) an individual sewage disposal system at _a 1 \ G'. W -t'►�`� ,Q as described '1 in the application for Disposal System Construction Permit No. aoo SC3�4 y dated / r e Provided: Constructio shall be completed within three years of the dat of this l�local conditions must be met. Date �C) ! Board of He ith --- FORM 2--'DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBS&WARREN'"' PUBLISHERS-- BOSTON } FROM :down cape engineering inc FAX NO. :15083629880 Jun. 07 2006 03:01PM P1 = Town of Barnstable Regulatory Services € Thomas F. Geiler,Director s KAMM Public Health Division Thomas McKean,Director 200 Main Street,Hyannis, MA.02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Desianer Certification Form Date: j' R" off' Sewage Permit# Go()$_')04�Asscssor's Map\Parcel 13,61- 11 _CA , Designer: �OLIJ _In t 1 i✓w Installer: sCof Address- <, a e n, Address: 6/-M0� On (date) (installer) was a permit ermit to install a q / septic system at based on a design drawn by (address) �-� / dated (de.'gner) V I certify that the septic system referenced above was installed substantially according to T such as lateral relocation of the the design, which may include minor approved char es s Y � distribution box and/or septic tank. ;! I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with. State & Local Regulations. Plan revision or certified as-built by designer,to follow. H OF M,q,SS9, ARNE H csG� O,JALA T, (Installer's Signature) N CIVfi,. No 30792 �Q1'3 T E. '()NAI_ Et1G (Designer's S>gnature (Affix Designer's Stamp Here) rL_E sE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CFIZTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL. BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THA.NK YOU. y Q:Health/septir/1);-signer C Ttification Form 3 26-04.Joc � v Town of Barnstable q Board of Health A 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,RS. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. January 21, 2005 Mr. Joel Bess 12 Briar Lane West Barnstable, MA RE: 19 Tillage Lane, West Barnstable A= 136-004 Dear Mr. Bess, You are granted variances to construct an onsite sewage disposal system at 19 Tillage Lane, West Barnstable. The variances granted are as follows: PART XIV SECT. 3.00: The soil absorption system will.be located 138 feet away from the neighbor's well, in lieu of the 150 feet minimum separation distance required. PART XIV SECT. 3.00: The reserve area for the soil absorption system will be located 118 feet away from the neighbor's well, in lieu of the 150 feet minimum separation distance required. PART XIV SECT. 2.00: To place a private well on a parcel of only 36,631 square feet, in lieu of the minimum 40,000 square feet required. The variances are granted with the following conditions: (1) No more than three (3) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to three (3) bedrooms maximum. A copy of the BessTillage I - _ recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. (3) The engineering plans shall be revised to show the three variances requested (listed above). This variance is granted because physical constraints at the site severely restrict the location of a soil absorption system due to the topography and. size of the lots. It is the opinion of this Board that the proposed new septic system is designed to meet the maximum feasible compliance standards contained within the State Environmental Code, Title V. Sin rely y r , ay e , M.D. Char an I I BessMage DECLARATION OF RESTRICTION We, Joel F. Bess and Katy M. Bess, of West Barnstable; MA, owners of land conveyed to us.by George A. Quadrino, Trustee of the Margaret R. Graham Revocable Trust 1989, u/d/t dated March 30, 1989, recorded with the Barnstable County Registry of Deeds in Book 11098, Page 300, which deed is dated January 29, 2003 and recorded with said Deeds in Book 16321, Page 57 declare that said property is subject to the following restriction: The property shall contain no more than three (3) bedrooms as defined by 310 CMR 15.002. z a e Witness our hands and seals this day of March, 2005. Joe . Bess ess o-- COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. f On this - day of March, 2005, before me, the undersigned notary public, personally appeared Katy M. Bess, proved to me through satisfactory evidence. of identification, which was personal knowledge to be the person whose name is signed on-the preceding or attached document, and acknowledged to me that she signed it voluntarily for its stated purpose. Notary Public My commission expires: Welt i tr+e DATE: FEE: $J fA r BARKSrwatF - y KAaa � 039. REC. BY Town of Barnstable,CHED. DA Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862+644 Susan G.Rask,R.S. F,\,(: 503-790�304 Sumner Kaufman,M.S.P.H. Wayne A Miller,M.D. VARIANCE RtQUEST FORM LOCATION Property Address: �I►� * l,h.;.t E Assessor's Map and Parcel Number. �}— Size of Lot: Wetlands Within 300 Ft. Yes L Business Name: No Subdivision Name: APPLICANT'S NAME: T y 43 E 5 s Phone Did the owner of the property authorize you to represent him or her? Yes X No PROPERTY OWNER'S NAIE CONTACT PERSON ; i Name: . I Ty ES 5 N Joe oe Address: 1 Z- �a - rL r..t Address: Phone: (a Z — y 3 -q- Phone: C:D r VARIANCE FROM REGULATION(L=Reg.) REASON FOR VARIAiNCE(May attach if L space needed) 1�2 X tt_ SAC:i\ot-1 3 NATURE OF WORK: House Adn =`C House Renovation C2 Repair of Failed Septic System 0 Checklist(to be completed by office staff-penan receiving variance request application) _ Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.-septic system plans) _ Four(4)copies of labeled dimensional floor plans submitted(e.-house plans or restaurant kitcben plans) Signed letter stating that the property owner authorized you to represent himfher for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Tide V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) Variance request application fee collected (no fee for lifeguard modification renewals. grease no variance renewals (same ownerAeasee only],outside dining variance renewals(same ownerileasee only],and variances to repair Failed sewage disposal systems (only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE.APPROVED Susan G.Rask.R.S.,Chairman NOT APPROVED Sumner Kaunman,M.S.P.H. REASON FOR DISAPPROVAL Wayne A.Miller,M.D. . C:\Docamencs and Sett4:53\Owner\Local Settings\Temporary Internet __^es\\Content.IE5\2L7QK2K/S�\VARIHEQ.DOC --- z 3 A-J� 5 � Joe.- SO 36 -737 -23L131 i i f tel.(508)362-4541 939 main street rt 6a fax(508)362-9880 yarmouth port mass 02675 down cape engineering civil engineers& land surveyors structural design January 30, 2005 Arne H.Ojala P.E.,P.L.S. Daniel A.Ojala,P.L.S. land court Thomas McKean, RS Timothy H.Covell,P.L.S. surveys Director, Barnstable Health Department 200 Main Street site planning Hyannis, MA 02601 Re: Bess, Tillage Lane, West Barnstable sewage system designs Dear Tom: Enclosed are revised plans for the above-referenced site. You had requested during inspections the variance meeting of December 21"that the plan list an additional variance: "Well to be located on lot with less than 43560 square feet" and we have done so. - permits We apologize for the delay in getting these revised plans to you. Thank you. ' Very truly yours, Sarah B. Ojala Down Cape Engineering, Inc. F T : r� tel.(508)362-4541 939 main street rt 6a fax(508)362-9880 yarmouth port mass 02675 down cape eftgineefing civil engineers& land surveyors structural design Arne H.Ojala P.E.,P.L.S. Daniel A.Ojala, P.L.S. land court November 15 2004 Timothy H.Covell,P.L.S. surveys Barnstable Board of Health 367 Main Street site planning Hyannis, MA 02601 sewage system Re: 19 Tillage Lane, West Barnstable designs Dear Board Members: inspections The enclosed represents a variance filing for the construction of a new 3 bedroom dwelling at the above-referenced site. The following variance is requested: permits reduction in setback, proposed primary leaching facility to abutting well, 150' to 138' (12' variance) and reserve facility to abutting well, 150' to 118' (32' variance). No other variances are requested. Due to site constrictions(topography, wetlands and the presence of wells), a variance is necessary to the abutting well to the west of locus. There is no place on the site that a well and septic system can be installed without the need for a variance. The groundwater map indicates a generally northeasterly flow, so that that abutting well is not downgradient from the proposed leaching facility. We feel that by granting this variance, the same degree of environmental protection can be attained without the need for strict adherence to the Barnstable Health Department Regulations. To deny the variance would create manifest injustice, so as to make the lot unbuildable. Thank you for your consideration. Very truly yours, Arne H. Ojala, PE, PLS Down Cape Engineering, Inc. cc: Katy Bess tel.(508)362-4541 939 main street rt 6a fax(508)362-9880 yarmouth port mass 02675 down cape engineering r civil engineers& land surveyors structural design Arne H.Ojala P.E., P.L.S. Daniel A.Ojala, P.L.S. land court Timothy H.Covell,P.L.S. surveys November 15, 2004 Katy Bess 12 Briar Lane site planning west Barnstable, MA 02668 sewage system Dear Mrs. Bess: designs A public hearing has been scheduled for the Barnstable Board of Health to take action on a request for a variance from Barnstable inspections Board of Health Regulations for the proposed septic system at 19 Tillage Lane, West Barnstable. The variance requested is as follows: permits Barnstable Regulation Part XII, section 3: reduction in setback, proposed leaching facility to abutting well (150' to 138' for primary leaching facility, 150' to 118' for reserve) . Said hearing will be held in the Town Hall Selectmen's Conference Room, South Street, Hyannis, December 21, at 7:00 pm. Please check with the Health Department to confirm date and time. Sincerely, f . Ojala pe Engineering, Inc. cc: Abutters file Barnstable Board of Health barnboh ABUTTERS LIST FOR MAP 136 PARCEL 4 MAP 136 PARCEL 5 DOROTHY ANNE EIDE&PATRICIA JANE GLEICHAUF 1222 ELLISON STREET FALLS CHURCH,VA 22046 MAP 136 PARCEL 3 WILLIAM&ANITA PHIPPS 162 CLINTON STREET HOPKINTON,MA 01748 MAP 136 P[ARCEL 54-1 JOEL BESS 12 BRIAR LANE WEST BARNSTABLE,MA 02668 MAP 136 PARCEL 18 JOHN&LORRAINE GABELLINI 43 POINT HILL ROAD WEST BARNSTABLE,MA 02668 MAP 136 PARCEL 17 EMMANUEL&SOPHIA LEMBIDAKIS 87 EGERTON ROAD ARLINGTON,MA 02174 r. s� tel.(508)362-4541 939 main street rt 6a fax(508)362-9880 yarmouth port mass02675 gown cape engineering civil engineers& land surveyors structural design Arne H.Ojala P.E., P.L.S. Daniel A.Ojala, P.L.S. land court November 15, 2004 Timothy H.Covell, P.L.S. surveys Barnstable Board of Health 367 Main Street site planning Hyannis, MA 02601 sewage system Re: 19 Tillage Lane, West Barnstable designs Dear Board Members: inspections The enclosed represents a variance filing for the construction of a new 3 bedroom dwelling at the above-referenced site. The following variance is requested: permits reduction in setback, proposed leaching facility to lot line. No other variances are requested. Due to the presence of abutting wells, there was no area on this site that could support a leaching facility and its attendant well without the need for a variance to a well. We have proposed a septic system easement on the abutting property to the south (owned by Joel Bess and containing 1.77 acres), to allow a 3 bedroom septic system to be installed without the need for a variance to a well. Per conversation with Brian Dudley at DEP, he indicated that for new construction this would be a lot line variance request, and would likely be granted by them. We feel that by granting this variance, the same degree of environmental protection can be attained without the need for strict adherence to the State Title 5 Regulations and the Barnstable sewage disposal regulations. To deny the variance would create manifest injustice, so as to make the lot unbuildable. Thank you for your consideration. Very truly yours, Arne H. Ojala, PE, PLS Down Cape Engineering, Inc. cc: Katy Bess L / 3 i � c., � eft 1.14 AG �-' ,' s " ,•„' -, v4 GI /• 'e^ A o �, •1 2 1 r i 84 I.I�.Ac (� 2-0 Ac- 55-4 y 4Z �,,�1.00A .c 2(A FIPZ 80 Al i / D Tyi 80AC ; oA O ' 4q 43 1 Cn'ly aa. s;7 ;:iC T`! �R£CrCM CI T 7 : f AE99Cr C3 i-ria9'?3� 'vO ! 's— CC'�+ECT�•JT � ;;�'y sr:--.f—r_ ' %, iZ Ms.Patricia Gleichauf Won"son E v- 4 34 Highland Street Newton,NH 03858-3605';,;\ /�� .�-- P i 27 o-,c3v � /0 a,as �Y'?'. � a.�3r �I1�t111t1tJl��ti11lltliti�lt� t}1�-tltiil�lelll�Yltlliitielti�i �� • _. J, l -• 4'� _ a �� `w1 � \\\ `� / ,\ ��+. ,\``! \`\\ �._ /� � ��' � ` � � y � � ``~\ _ J ^� i - i � _ SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,.and 3.Also complete A. Received by(Please Print Clearly) B. Date f Deli ery item 4 if Restricted Delivery is desired. /�� /�` i ■ Pririt your name and address on the reverse. so that we can return the card to you. C. Signature ■ Attach this card to the back of the mailpiece, "r X Agent or on the front if space permits. i ❑Addressee D.-Is delivery ddress different f om item 19 ❑Yes 1. Article dressed-tp_. nn II c - If YES,er �delivery address below: X0 L?t �( n 3. Servi ype L9.,Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number(Copy from service lat,� r� 70O3... 22600` 24j 5872263;9 E 1 i,$Form 3811,July,1999. i i i Domestic Return Receipt 102595-00-M-0952 UNITED STATES POSTAL SEfWICE p First-Class Mail `+A f,1 Postage&Fees Paid USPS } e... Permit No.G-10 • Sender: Please prinf'� ro ,Kame, address;a d ZIP+4 in fis box • ~ a � own SO vwtMoath Nit s P� Z. . � ;2-/ Q - co v 3/ Azl- LP Y Z44, r � � r DNO. Fee-- --------------- BOARD OF HEALTH TOWN OF BARNSTABLE Zipplication_*r Well Congtruction Permit Application is hereby made for a permit to Construct ( /, Alter ( ), or Repair ( )an individual Well at: pp /- - /fi/arle- ovation — Address Assessors Map and Parcel Owner �, /� Address -Shcsu�jn _ __ �cilK' 62 ABCs l� --�-)4�- rev._ ✓ -- c57_b�?_ Installer — Wer Address Type of Building Dwelling—� �1-K�-`�----------------------- Other - Type of Building---- ----- - No. of Persons--- ------------- Type of Well Capacity--_� — —---- ——— Purpose of Well--.gc 1¢----- —_—_-- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Pr tection Regulation — The undersigned further agrees not to place the well in operation until a CertiftcW.of Co liance has been issued by the Board of Health. 4 Signe —— ----- a -- 9 ® ---- B ----- — — Application Approvedy dat I Application Disapproved for the following reasons: ------- - ———----- ---—----- ------------ --- ------------------------------------------- date Permit No. Issued-------------- ------------ — date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of ComPliante THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) y Installer at- -— --_----- -- -- -- -------has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. --------------Dated----- --------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----- - Inspector-------- ---- ------- /ram na. •�-�.nr:r �,. �;�y t. / �.-1-,.�✓_ No. Fee7. BOARD OF HEALTH TOWN OF BARNSTABLE 21ppticationArlVefr Con5tructionPermit Application is hereby made for a permit toConstruct ( /, Alter ( ), or Repair ( )an individual Well at: ocation — Address Assessors Map and Parcel Owner / —— Address --- --- — _ ,e ZC- -�.7 ew5 e� l�(�R oZ& Installer — D.ler Address Type of Building Dwelling ---------------------- Other - Type of Building--- ---— - No. of Persons--------------------------------- Type of Well-- 'P v�----—— Capacity--� �- —--— --- Purpose of Well Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town df Barnstable Board of Health Private Well Pr?`ection Regulation — The undersigned further agrees not to ! place the well in operation until a Csoific ,td of Compliance has been issued by the Board of Health. Signe Application Approved By ` ✓ - - `�— „-r date 1 / - (../ --- Application Disapproved for the following reasons: t date Permit No. — Issued---— ------------- ----- 4 date f i 4 � BOARD OF HEALTH , TOWN OF BARNSTABLE (Certificate Of COMP iante THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by—— Installer at- -—-- - ---— ---- -- - — - --- ------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -------------------Dated------ ----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. I i DATE—----— — —_ Inspector-- - ------------------------—----------- BOARD OF HEALTH TOWN OF BARNSTABLE 3"ell (Congtruct ion Pertnit No. � Fee Permission is hereby granted �-'' OMt— 06 4 to Re Construct ( ), Alter ( )., or air an Individual W .1 at." NO. ` �c�� , - Repair - - --------------------------- `°Street � as sho ni t e application for ells Construction Permit ( ��� -� No.- Dated-- ——^- -- - _ i ---------------------- o'f - J r V Board Health DATE— l —0 -- 1 lr / i r G l J,. Page. CERTIFICATE OF ANALYSIS c 1 i' Barnstable County Health Laboratory Report Dated: 10/22/2004 Report Prepared For: Shaun Harrington Order No.: G0428275 All Cape Well Drilling P O Box 126 Brewster, MA 02631 I I Laboratory ID#: 0428275-01 Description: Water-Drinking Water I Sample#: 28275 Sampling LocationC19-Tillage_Lane W Barnstable MA - - J Collected: 10/12/2004 Collected by: MLH Received: 10/12/2004 I Routine +Ammonia ITEM RESULT UNITS RL MCL Method# Tested LAB: IC Lab Ammonia BRL m /L 0.1 g EPA 350.3 10/13/2004 LAB: Inorganics Nitrate as Nitrogen 7.7 mg/L 0.1 10 EPA 300.0 10/12/2004 LAB: Metals Copper BRL mg/L 0.1 1.3 SM 311113 10/20/2004 Iron BRL mg/L 0.1 0.3 SM 3111 B 10/20/2004 Sodium 22 mg/L 1.0 20 SM 3111B 10/20/2004 I LAB: Microbiology Total Coliform Absent P/A Absent Absent 307 10/12/2004 LAB: Physical Chemistry i Conductance 180 umohs/cm 1 EPA 120.1 10/13/2004 PH 6.0 pH-units 0 EPA 150.1 10/13/2004 EPA 524.2 - Volatile Organics by GUMS ITEM RESULT UNITS RL MCL Method# Tested LAB: GUMS 1,1,1,2-Tetrachloroethane BRL ug/L 0.5 EPA 524.2 10/12/2004 1,1,1-Trichloroethane BRL ug/L 0.5 200 EPA 524.2 10/12/2004 1,1,2,2-Tetrachloroethane BRL u /L 0.s g EPA 524.2 10/12/2004 1,1,2-Trichloroethane BRL ug/L 0.5 5.0 EPA 524.2 10/12/2004 I,1-Dichloroethane BRL ug/L 0.5 EPA 524.2 10/12/2004 1,1-Dichloroethene BRL ug/L 0.5 7.0 EPA 524.2 10/12/2004 RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 _ 1 r.of wq�ti CERTIFICATE OF ANALYSIS a Page: 2 ,v M Barnstable Count Health Laboratory ysr�ritvs�'�� y Y Report Dated: 10/22/2004 Report Prepared For: Shaun Harrington Order No.: G0428275 All Cape Well Drilling P O Box 126 Brewster, MA 02631 1,1-Dichloropropene BRL ug/L 0.5 EPA 524.2 10/12/2004 1,2,3-Trichlorobenzene BRL ug/L 0.5 EPA 524.2 10/12/2004 1,2,3-Trichloropropane BRL ug/L 0.5 EPA 524.2 10/12/2004 1,2,4-Trichlorobenzene BRL ug/L 0.5 70 EPA 524.2 10/12/2004 1,2,4-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 10/12/2004 1,2-Dibromo-3-chloropropa BRL ug/L 0.5 EPA 524.2 10/12/2004 1,2-Dibromoethane (EDB) BRL ug/L 0.5 EPA 524.2 10/12/2004 1,2-Dichlorobenzene BRL ug/L 0.5 600 EPA 524.2 10/12/2004 1,2-Dichloroethane BRL ug/L 0.5 5.0 EPA 524.2 10/12/2004 1,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 10/12/2004 1,3,5-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 10/12/2004 1,3-Dichlorobenzene BRL ug/L 0.5 EPA 524.2 10/12/2004 1,3-Dichloropropane BRL ug/L 0.5 EPA 524.2 10/12/2004 1,4-Dichlorobenzene BRL ug/L 0.5 5.0 EPA 524.2 10/12/2004 2,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 10/12/2004 2-Chlorotoluene BRL ug/L 0.5 EPA 524.2 10/12/2004 4-Chlorotoluene BRL ug/L 0.5 EPA 524.2 10/12/2004 Benzene BRL ug/L 0.5 5.0 EPA 524.2 10/12/2004 Bromobenzene BRL ug/L 0.5 EPA 524.2 10/12/2004 Bromochloromethane BRL ug/L 0.5 EPA 524.2 10/12/2004 Bromodichloromethane BRL ug/L 0.5 EPA 524.2 10/12/2004 Bromoform BRL ug/L 0.5 EPA 524.2 10/12/2004 Bromomethane BRL ug/L 0.5 EPA 524.2 10/12/2004 Carbon tetrachloride BRL ug/L 0.5 5.0 EPA 524.2 10/12/2004 I Chlorobenzene BRL ug/L 0.5 too EPA 524.2 10/12/2004 Chloroethane BRL ug/L 0.5 EPA 524.2 10/12/2004 Chloroform BRL ug/L 0.5 EPA 524.2 10/12/2004 Chloromethane BRL ug/L 0.5 EPA 524.2 10/12/2004 cis-1,2-Dichloroethene BRL ug/L 0.5 70 EPA 524.2 10/12/2004 RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 I y OT 10 �� � � CERTIFICATE OF ANALYSIS Page: 3 Barnstable County Health Laboratory Report Dated: 10/22/2004 Report Prepared For: Shaun Harrington Order No.: G0428275 All Cape Well Drilling P O Box 126 Brewster, MA 02631 cis-1,3-Dichloropropene BRL, ug/L 0.5 EPA 524.2 10/12/2004 Dibromochloromethane BRL ug/L 0.5 EPA 524.2 10/12/2004 Dibromomethane BRL ug/L 0.5 EPA 524.2 10/12/2004 Dichlorodifluoromethane BRL ug/L 0.5 EPA 524.2 10/12/2004 Ethylbenzene BRL ug/L 0.5 700 EPA 524.2 10/12/2004 Hexachlorobutadiene BRL ug/L 0.5 EPA 524.2 10/12/2004 Isopropylbenzene BRL ug/L 0.5 EPA 524.2 10/12/2004 Methyl-tert-butyl ether 2.7 ug/L 0.5 EPA 524.2 10/12/2004 Methylene chloride BRL ug/L 0.5 5.0 EPA 524.2 10/12/2004 n-Butylbenzene BRL ug/L 0.5 EPA 524.2 10/12/2004 n-Propylbenzene BRL ug/L 0.5 EPA 524.2 10/12/2004 Naphthalene BRL ug/L 0.5 EPA 524.2 10/12/2004 p-Isopropyltoluene BRL ug/L 0.5 EPA 524.2 10/12/2004 sec-Butylbenzene BRL ug/L 0.5 EPA 524.2 10/12/2004 Styrene BRL ug/L 0.5 too EPA 524.2 10/12/2004 tert-Butylbenzene BRL ug/L 0.5 EPA 524.2 10/12/2004 Tetrachloroethene BRL ug/L 0.5 5.0 EPA 524.2 10/12/2004 Toluene BRL ug/L 0.5 1000 EPA 524.2 10/12/2004 Total xylenes BRL ug/L 0.5 10000 EPA 524.2 10/12/2004 trans-1,2-Dichloroethene BRL ug/L 0.5 100 EPA 524.2 10/12/2004 trans-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 10/12/2004 L richloroethene BRL ug/L 0.5 5.0 EPA 524.2 10/12/2004 richlorofluoromethane BRL ug/L 0.5 EPA 524.2 10/12/2004 inyl chloride BRL ug/L 0.5 2.0 EPA 524.2 10/12/2004 Sample has higher than average levels of Sodium.Those on a low Sodium diet may want to consult a physician. Sample has higher than average levels of Nitrates. Monitoring is recommended(2-3 times per year)to establish any upward trends. Approved By s r-�s�� (La Director) RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Town of Barnstable OFTHE, Regulatory Services Barnstable Thomas F. Geiler, Director ;merlcaCity Public Health Division saxxsrnste, 9 MASS. $ Thomas McKean, Director zoos �Ar 1639. A`� 200 Main Street Fp MAC Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 21, 2011 James J. &Mary C. Cahill 63 Gardner Street Hingham, MA. 02043 RE: Assessors (map-parcel) 136-004 As of October 1, 2006 a new rental registration ordinance was put into affect requiring all property owners of rental units to register in accordance with Chapter 170 of the Town of Barnstable Code with the Town of Barnstable Health Division. According to our records, you own the rental property at 19 Tillage Lane, West Barnstable. Enclosed is an application. Please use a separate application for each rental unit you own. Should you need more applications, they are available online at www.town.bamstable.ma.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate 2011 fees included. Please contact me to schedule inspection of the property as soon as possible. If there are tenants presently occupying the property please provide the contact information being sure to include a daytime phone number for all tenants. For your use an occupant's permission form has been included to allow for inspections to be performed in the tenant's absence. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of $100. Each day of non-compliance is considered a separate offense. Should you have any questions, please feel free to call 508-862-4072. Thank you in advance for your cooperation. - (Y Teresa Wright Division Assistant �� +S ►� C�vt.�� �^-� — �-e Town of Barnstable ll Public Health Division � `� Z►1� W�e:�C-2�. � €w��` ���'/ �� Direct#508-862-4072 QO-_Health Master Detail Page 1 of 1 `"r Health Faster Logged In As: TOWN\wrightt Health Master Detail Tuesday,June 21 2011 Application Center Parcel Lookup Parcel Septic Perc Well Fuel Tank Parcel: 136-004 Location: 19 TILLAGE LANE, WEST BARNSTABLE Owner: BESS, JOEL F &KATY M Business name:1. _ `J Business phone: J Rental property: r- Deed restricted: Number of bedrooms T ; Contaminant released: F Fuel storage tank permit: F Save Parcel Changes I Return to Lookup Parcel Info Parcel ID: 136-004 Developer lot: Location: 19 TILLAGE LANE Primary frontage: 122 Secondary road: Secondary frontage: Village:WEST BARNSTABLE Fire district:W BARNSTABLE Sewer acct: Road index: 1718 Asbuilt Septic Scan: 136004_1 Interactive map: 136004 2_ .. Town zone of contribution:AP (Aquifer Protection Overlay District) State zone of contribution:OUT Owner Info Owner: BESS, JOEL F & KATY M Co-Owner:%CAHILL, JAMES J & MARY C Street1:62 GARDNER STREET Street2: City:HINGHAM State:MA Zip: 02043 Country: Deed date: 1/30/2003 Deed reference: 16321/057 Land Info Acres: 1.04 Use: Single Fam MDL-01 Zoning:RF Neighborhood: 0106 Topography: Road: Utilities: Location: Construction Info Building NoYear Built Gross Area Living Area Bedrooms Bathrooms 1 2006 2760 1456 2 Bedrooms 2 Full + 2H Buildings value:$192,600.00 Extra features: $10,600.00 Land value: $162,800.00 http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=136004 6/21/2011 V V ® C a 10'-4" I CN235 12 L AV ,6 LiNEN - 2 BEDROOM #1 6 (� IgI.: KITCHEN �' DININcl I� a 41) 2 Q 1 30 x72° BATH 2� . Q CATHEDRAL n a © - a /.J CEILING. - I 2S2 2� - . n m. I - D c I o v 2 = --- - in 1tIVINGOPSN m ^, 10°RT eE>.o>v. I 16R orrx To - 6 ro^ eELow _ FOYER BEDROOM #2 _ -- r. � - r i. 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" . _. .. . , . . . . :.., -. ,.. . :.-. . .,: . % ,. . SNEE.T i. :.'. - : : � �'- �' ' ". ,*. .—' '--�'� .'�"'.:�� .. .. y. , 1. % �� I.. . . - — . . : - � . � . .. .. . -. �w .. ..� . I.- � - - . . . . I I . - '.. ,. . . I *:: 1 . I — ��.: ' '-- `—.. . �;; r: . 1, 1''.. .. . � . I. 1 . - . - � .' — '.. � -- .I. d; ...'"- -I.' 1. J y �. . :— .. 1 . � .. % . . I - ��:—: _ _ . � . . .:. , , I :.%., W t .. � . : _ - - . . � . � - .. :.:. I. :t':: .. : ..-.: ". -i.' J06 OAOI . . -- .N. . :. .-I�:':, :: F :, . . Y KIN .... .. "III .. .. .,:..... I. I. .. .. : .. . .. ,:.. ..... '. . :: ...: .5l 4 _. :j 4 ,r- E LEGEND TOP FNDN = 63.5' SYSTEM PROFILE TEST. HOLE_ LOGS SEPTIC NOT ALLOWED (NOT TO SCALE) E C DESIGN: GARBAGE DISPOSER IS I GRADE( ) ACCESS COVER TO WITHIN 6" OF FIN. G D LISA LYONS RS 100.0 PROPOSED SPOT ELEVATION DESIGN FLOW: 3 BEDROOMS ( 110 GPD) = 330 GPD ACCESS COVER (WATERTIGHT) TO ENGINEER: A WITHIN 6" OF FIN. GRADE �'►'r USE A 330 GPD DESIGN FLOW' 60,0 MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM DAVE STANTON, RS Il 100x0 EXISTING SPOT ELEVATION _ 660 54.0 WITNESS: -- � I_ n�cE � SEPTIC TANK: 330 GPD 2 2 12 0 a (-) -`.• RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE DATE: 100 60.0' FOR FIRST 2' °P o- PROPOSED CONTOUR USE A 1500 GALLON SEPTIC TANK PROPOSED 1500 3' MAX. PERC. RATE - 2 MIN/INCH +� LEACHING: GALLON SEPTICq_ z I 10670100 EXISTING CONTOUR �57:.0 jj�EZE ' ? 2(30 + 9.83) 2 ( 74) = 117 57.25 TANK (H- 1O ) GA,S 51.0 CLASS SOILS P# yr eR� SIDES: _ 50.26 LOCUS BAFFLE 50.43 � ED O 0 0 O �8 BOTTOM: 30 x 9.83 (.74) = 218 MIN 50.17' a a a a a 0 0 0 ( 2 % SLOPE) 6" CRUSHED STONE OR MECHANICAL 0 Q 0 0 TOTAL: 452 S.F. 335 GPD _ 4, COMPACTION!. (15.221 [2]) MIN �$g 2' [� O a 0 o O O o� 48.17 Q ELEV. ELEV. USE (3,) 500 GAL. LEACHING CHAMBERS (ACME OR DEPTH of Flow - ( 12 % SLOPE) ( 1 SLOPE) 0" - 54.0' 0" 58.0' EQUAL) WITH 2.5' STONE AT SIDES AND 2.25' AT TEE slzEs: 3/4" TO 1 1/2" DOUBLE :WASHED STONE q q INLET DEPTH = 10 LS LS `• ENDS OUTLET DEPTH = 14" 80t 1OYR 2/2 9" 1OYR 2/1 LOCATION MAP NTS - 29' SEPTIC ' 11 LEACHING 5.67' B B F OUNDATION C TANK 55 D BOX FACILITY ASSESSORS MAP 136 PARCEL 4 LS LS ZONING DISTRICT: RF BOARD OF HEALTH 10YR 5/6 10YR 5/6 YARD SETBACKS: MA' 29" 51.5' 39" 61.25' FRONT = 30' APPROVED DATE BOTTOM TH 1 EL.. 42.5' SIDE = 15' REAR = 15' PERC C C ® FLOOD ZONE: C MS MS i VARIANCES REQUESTED FROM BARNSTABLE BOARD OF HEALTH WELL REGULATION: 2.5Y 6/3 2.5Y 6/3 PROPOSED LEACHING FACILITY AND RESERVE TO BE LESS THAN 150' TO EXISTING WELL (12' AND 32' VARIANCES REQUESTED RESPECTIVELY) WELL TO BE LOCATED ONl LOT WITH LESS THAN 43560 SF 138" 1 142.5' 132.. 47.0' NO GROUNDWATER ENCOUNTERED BENCHMARK: USE TILE AT ELEVATION 44.8' EXIST. L NOTES: 1 . DATUM IS ASSUMED 2. MUNICIPAL WATER IS NOT AVAILABLE \` ` ` \ C 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 2 +39,80 / W 40 .q 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 2 ' V� #4 5. PIPE JOINTS TO BE MADE WATERTIGHT. .61 `+ 0 +36,'77. `, 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. 4¢ q 37.81 ENVIRONMENTAL CODE TITLE V. #3 0 `FocF I \ ( 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE hfi 9 1 '�, VVV s9 A 01 35,92 1+735.81 # +38. 4 '.�1� ti USED FOR LOT LINE STAKING. _o S� .17 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. S .30 ` #i 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT 1tCp�('Tif1►s .. v RhI�C� (1� !lt�ln>'•'t^1 w ' + 6. 1 ,,, +3 �� \ FROM BOARD OF HEALTH. RiNc s`l ��� #7 10. CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE �D 37.4 4,10 #1 LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR „ s xl T. L ` c' 1p0 #6 �, TO COMMENCEMENT OF WORK. .A f ., 9. 4 2 730 SF 5.04 � I S 46, 8 � - �`-� ISO. WE TL ND ���/�ii� f #5 TITLE 5 SITE `61 •- --- I ' + 9.601 WORK LIMIT LINE TO # 61.0 4 #' CONSIST OF STAKED SILT 3 OF + 0. 5 , � FENCE AT THE 100' .OFFSET 19 TILLAGE LANE +4 .60 FROM WETLANDS 2.23 15 ��, �, .76 IN THE TOWN OF: 4 +64.4 ry , s 5 .8 7.1 ` +42.74 (WEST) BARNSTABLE � 62,0 z' EXIST. /7 6 `S PREPARED FOR: KATY M. BESS DWELL. 61. + 2. 4 J �3, +65.95 1s� \v /' + 8. 0 + 5. ACP 30 0 30 60 90 CESSPOOL +63 \ `9 \ PROP. \ 53. 9 EXIST. WELL - DWELL tS +5 .63 cS \ SCALE: 1» = 30' DATE: APRIL 12, 2004 'O, N \ REV. 5/5/04 (ABUT. WELL INFO) .22 61.02 � REV 11/5/04 (SAS) 4 EXISTING c3� \ ISTI REV 1/5/05 (ADD TH 2 'L VAR) 31 -�6 5 .0 \5 4.47 _ +62 9 r.4 ,AA ZHOFRNE HARNE c 59.9 n ��o OJALA .� � TH IVIL g H. OJA rn + .5 1 0 3 792 � v 1 i /� Cc_';' +60.4 52.72 181 �60 0 A, s DATE 3 , SURVE +59.88 S9 3 + 6. LOT AREA + 7 PARCEL 4 S8 36,631 ±SF +55, 1.5 < `APPROX. LO ATION EXIST. LEACHING FACILITY ' SE/ , 169.4' �9 + .45 ti EXISTING WELL fox 508 362-9880 off 508-362-4541 down cape engineering, inc. PARCEL 54-1 CIVIL ENGINEERS (JOEL BESS) LAND SURVEYORS 939 main st. yarmouth, ma 02675 04-022 LEGEND TOP FNDN = 63.5' " SYSTEM PROFILE TEST HOLE LOGS SEPTIC DESIGN: (GARBAGE DISPOSER Is NOT ALLOWED ) ACCESS COVER TO WITHIN 6 OF FIN. GRADE (NOT To SCALE) 100.0 PROPOSED SPOT ELEVATION DESIGN FLOW: 3 BEDROOMS 110 GPD 330 GPD ACCESS COVER (WATERTIGHT) To LISA LYONS, RS ( ) ENGINEER:- 330 WITHIN 6" OF FIN. GRADE USE A 330 GPD DESIGN FLOW 60.0 MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM DAVE STANTON, RS 'ry� 54.0 WITNESS: - 4 100x0 EXISTING SPOT ELEVATION SEPTIC TANK: 330 GPD ( 2 ) 660 nct a 2 12 04 �- CC RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE DATE: / 100 60.0 FOR FIRST 2' o- 0 -� PROPOSED CONTOUR USE A 1500 GALLON SEPTIC TANK ` _ < 2 MIN INCH PROPOSED 1500 � 3 MAX. PERC. RATE - / 100 EXISTING CONTOUR LEACHING: GALLON SEPTIC 57.25' 57.0' 51.0' CLASS I SOILS P# 10670 2(30 + 9.83) 2 (.74) = 117 TANK (H- 10 ) GAS r s qR SIDES: }. 50.2.6' R� BAFFLE AITEE � � � O 0 O O � � 0 LOCUS 50.43 30 x 9.83 (.74) = 218 MINPs o 50.17' a O BOTTOM: O 0 0 ED ( 2 % SLOPE) �6" CRUSHED STONE OR MECHANICAL 0 0 0 = 0 ED 452 335 go ELEV. ELEV. TOTAL: S.F. GPD , COMPACTION. (15.221 [2]) oo� 2 El 0 0 E = 0 0 48.17" 1 2 USE (3) 500 GAL. LEACHING CHAMBERS (ACME OR DEPTH of Flow = 4 ( 12 % SLOPE) ( MIN% SLOPE) $ „ .. 0" Q 54.0' 0" Q 58.0' EQUAL) WITH 2.5 STONE AT SIDES AND 2.25 AT TEE SIZES: 3/4 TO 1 1/2 DOUBLE WASHED STONE A A INLET DEPTH = 10„ OUTLET DEPTH = 14" LS LS ENDS 8" 10YR 2/2 9" 10YR 2/1 LOCATION MAP NTS FOUNDATION- 29' SEPTIC TANK 55' D' BOX 11 LEACHING 5.67' B B FACILITY ASSESSORS MAP 136 PARCEL 4 LS LS BOARD OF HEALTH ZONING DISTRICT: RF 10YR 5/6 1OYR 5/6 YARD SETBACKS: 29 51.5 39 ,. 61.25, APPROVED DATE BOTTOM TH 1 EL. 42.5' FRONT = 30' SIDE = 15' REAR = 15' PERC C C FLOOD ZONE: C MS MS VARIANCES REQUESTED FROM BARNSTABLE BOARD 2.5Y 6/3 2.5Y 6/3 PROPOS DH LEACHING FACILITY AND RESERVE TO BE LESS THAN 150 TO EXISTING WELL (12 AND 32' VARIANCES REQUESTED RESPECTIVELY) WELL TO BE LOCATED ON LOT WITH LESS THAN 43560 SF 138" 42.5 132 47 " , .0 NO GROUNDWATER ENCOUNTERED i BENCHMARK: USE TILE AT ELEVATION 44.8' EXIST. WE-1- NOTES: +43.7 � T 1 . DATUM IS ASSUMED NOT AVAILABLE 2. MUNICIPAL WATER IS Z +39.80 �� �'� 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 10 ° ��/� 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 42 #4 ' Ol 5. PIPE JOINTS TO BE MADE WATERTIGHT. 4 �� , S +X .61 ` 0 36,�7. 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. g 4 37.81 ` ENVIRONMENTAL CODE TITLE V. 9 � ¢ 10 #3 /t, 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE ��92 +35,81 35, I `I USED FOR LOT LINE STAKING. 0.1� 4 ` -`..�q 9 .17 #2 -.,Yp S� + 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 38. a S I 30 ` #1 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT + , +3 40 - INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED i 6. _ C'RQn Rnn.Qn OF HEALTH, tic ,S► #7 _ 10. CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE `s 1 A T. LL � `0 37.a #1 4.10 LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR f 100 #6 \. TO COMMENCEMENT OF WORK. 9. r 46. 8 730 SF 25.04 S '`-� ISO. WETLIND ; Ul 5 _ TITLE 5 SITE PLAN 1 I ' + 9.60 WORK LIMIT LINE TO 1.#4__ -_ #3 61.0 I' \ CONSIST OF STAKED SILT OF 6� + 0. 5 FENCE AT THE 100' OFFSET 19 TILLAGE LANE +4 .60 C\ FROM WETLANDS 2.23 ��,, .76 IN THE TOWN OF: N 47.1 F64.4 , 5 .6 +42.74 (WEST) BARNSTABLE 62.0 EXIST. S PREPARED FOR: KATY M. BESS DWELL <� 61. + 2. 4 �3, +65,95 \� �� + 5. A Goa s 1S + e o 30 0 30 160 90 EXIST. WELL - PROP. j /' S3. S ,- tS 30 +5 .63 \ .; SCALE: = DATE: � 1" ' APRIL 12, 2004 "0. ON S N \ REV. 5/5/04 (ABUT.- WELL INFO) 22 61.02 REV 11/5/04 (SAS) 4 REV 1/5/05 (ADD'L VAR) TH 2 S \ WELL EXISTING -_ S A \5 4,47 +62 9 �-tt{OF IfAS� SSL �ZH OF 44 S 59.9 ,� ko �� ��a ARNE cLo OJAI H o� ARNEc A ,� TH IVIL .53 792 AA 0 N i -61 + /Cl +60.4 52.72 1g1� 0 `� LA, a s DATE +59.88 ` 'O SURVE 3 S 6, i 9 LOT AREA + 7 PARCEL 4 S8 ^ 36,631 ±SF +55. , I 6� �I+ 1.5 < `APPROX. LO AT10N EXIST. LEACHING FACILITY i REs e ti s 169.4' 1 09 + .45 ,"6, i i EXISTING WELL off 508-362-4541 fax 508 362-9880 down cape engineering, inc. PARCEL 54-1 CIVIL ENGINEERS (JOEL BESS) I, LAND SURVEYORS 939 main st. yarmouth, ma 02675 04-022