Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0090 GREAT HILL DRIVE - Health
)0 Great Hill`-7b Marstons Mills / A = 174 - 039 f I No. Fee J V / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Application for Miopogal *p.5temc Construction Vermit Application for a Permit to Construct( )Repair( )Upgrade(/Abandon( ) ©Complete System U✓Individual Components Ot Location Address or Lot No.,q� �'L'Cl,�"/�/ l Owner's Name,Address and Tel.No. Assessor's Map/Parcel ya^ Installer's Name,Address,and Tel No. •r Designer's Name,Address and Tel.No. 771-11�M/ Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder Other Type of Building T 2$� t�11Ge No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow X/P gallons per day. Calculated daily flow s gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. _ ��� e,111e& e4rG Description of Soil z Nature of Repairs or Alterations(Answer when applicable) r`y-/e 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 Certifi- cate of Compliance has been issued b his Board of alth. - l Signed Date Application Approved by Date A- 9- T 9 Application Disapproved for the llow ng reasons Permit No. ! 5? - N Lei Date Issued N.. 'L ."'.."-''' Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 3ppffcatfon for Df 6pont *pgtem Con!gtructfon Permit Application for a Permit to Construct( )Repair( )Upgrade(!/)Abandon( Complete System L Individual Components Location Add Dr Lot No. Q� �r Owner's Name,Address and Tel.No. Assessor's Map/Parcel / y� jZ _ M Installer's Name,Address,and Te No. — - -.• Designer's Name,Address and Tel.No. '771 — 3 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder Other Type of Building ems' fe-2 No. of Persons Showers( ) Cafeteria( ) Other Fixtures r Design Flow b gallons per day. Calculated daily flow ,34,_-� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ��©�1C4 . �X/% i�� Type of S.A.S. t Description of Soil _ G iaeiel SZqX" Z / 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 Certifi- cate of Compliance has been issued b this Bo d of ealth. Signed Date Application Approved by S44n=n. Date �. 9 �T$ Application Disapproved for the iollowng reasons Permit No. - I L Date Issued THE COMMONWEALTH OF MASSACHUSETTS !-,7G`!-0 39 BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CE IFY,that Ihe On-site jSewage Disposal System Constructed( ) Repaired ( )Upgraded(!/� Abandoned( )by & 4 ,e at �� 1,6711".4 .� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date_ 7 Inspector r ----— =- -----------------------1 --- — -- No. A 7 Fee THE COMMONWEALTH OF MASSACHUSETTS _ PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mtopogar *pztem Con!trurtfon Permit Permission is hereby rante ,to Constryct y )Repair( )Upgrade(Abandon( ) System located at � �� i 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: Approved by V to/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICA TION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) { hereby certify that the application for disposal works cons p g construction permit signed by me dated �s/���� , concerning the property ert located at ® �yL° � ram" meets all of the following criteria: /There are no wetlands located within 100 feet of the proposed leaching facility ere are no private wells within 1. 0 feet of the proposed septic syste n ere is no increase in flow and/or change in use proposed ere are no variances requested or needed. • If the proposed leaching tactitty will .,e to cated within =50 feet of any wetlands, the bottom of:he proposed leaching facility will be located less than fourteen i,ial feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) B)Observed Groundwater Table Elevation(according to Health Division well mat)) SIGNED : DATE: �/� QS LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:kdtb!older.eat r oy ) 'Y 5� JIJ6 Me £'vim-�Tc y z ` 4� T s N ❑ ,3 THE COMMONWEALTH OF MASSACHUSETTS BOARDAl. H E LT- s-�..... oF..... ,�?.�......_�,.. ��'........................ \� Applira#iou for Disposal Works Tono rnr#iun rnmit Application is hereby made for a Permit to Construct (t,-for Repair ( ) an Individual Sewage Disposal System at ......C/4Y----------aa......6z�l..Al t... . ..I.. .... ....... ................. Location-Addre r—,f or Lot�io /® ner --�,'JJ l Installer,� .i. Address �................... �e/\�'�'1, " ,Address---...............-----•--•---•--•--•-----. � Type of Building Size Lot_.___._ �.6_�i'._�Sq. feet Dwelling—No. of Bedrooms.....-. ..............................Expansion Attic (070) Garbage Grinder e7 6 aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) W Other fixtures --------•----------------------• . W Design Flow..........6.: .......................gallons per person per day. Total daily flow........._ ....................gallons. W Septic Tank—Liquid capacity ®V_Ogallons 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. tSl.. -minutes per inch Depth of Test Pit--- f�.,g,"Deppth to ground ound waterer _�_- (i, Test Pit No. (( 9 �� _ _.rnunute�per inch Depth of Test Pit.__.__4._..___�- Depth to round water.--•: I, O Description of Soil..... ;.- .- �. ............. x - - --- ----- U Nature of Repairs or Alterations—Answer when43plicable.______________________......................................................................... ---------------------------------•-••------•--------------...---------------------------...-------•----•-----...------------------------------...---------------------------------------------•-----••-. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the b rd of health. Sined••_` . . --- -- ------ ..................... .--. Application Approved By•-•-•--•-...... :..G..Q..0 . '_-------- ----------- ------- -------------- Date Application Disapproved for the following reasons--------------------------------•-•---------------------------------------------•--------------------...------... .........................................._.--..........................................................I•-•-••-•-----•--•-••-•-•--•--------•---------••-••-•--......----•------••......--•••-•-••--•... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD., F` HE LT�I—I/ ..�_..c .�...............OF....�1 ..ar s.......4._,....•. Appliratinn for Disposal Works Tonstrnr#inn Frrmit Application is hereby made for a fPermiitt to A PT or Repair ( ) an Individual Sewage Disposal Z. System at Coca ion Addr/3s� or ...... v e'? d l ........ 1. t6. ..................... pot_`�-� .-.. t.....................................+ . ..... -•-- ... wner ,+�, 5�M Address f Installer Address d Type of Building Size Lot....111�/.6_5_lSq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic -00) Garbage Grinder 'IC) '4 Other—Type T e of Building No. of persons............................ Showers tL YP g ---------------------------- P ( ) — Cafeteria ( ) Pa Other ores .----•-------------------------• ._.. W Design Flow..........:..... .._......__ ......_..gallons per person per day. Total daily flow-------- . d.....................gallons. W Septic Tank—Liquid*capacit fi dv© _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 .�y minutes per inch Depth of Test� Pit._._.._ /-.Y Depth to ground water.. /� '(s, Test Pit No' �_Q'`_..minutes per inch' Depth of Test Pit._.' __ ._ Depth to ground wate ___ _____________ Description of Soil �04 � .>/ ---- •--------------------------------•--•------------- Ufrr 7S"` f. �iGf cs ................... ---- •------•----- U Nature of Repairs or Alterations—Answer whe pplicable ......... ......... ......... ... ... .......................................... --------•-------------------•---------------------•------------------------.............-----.......---••--•-•------------------------------.....------------.......................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT Li: 5 of the State Sanitary Code— The undersigned further agrees not to place the s stem in operation until a Certificate of Compliance has be issued by the and of health. t _-__. _ Signed •- ---- -----• -••----•- - .--: •-•-- �- Application Approved By......... .............................. .....--=.......................... �..... Date Application Disapproved for the following reasons--------------------------------------------------------------------------------------•-------...----••......-- _........-•---------------••••---•-••--...._.......----------...-•--••------•----•--...:.....-----.....--.---------------------------------------•-------•---------------•------•-----------•-------_.... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT ... l.. ................OF... ! .........�..p................................ (9rdif iratr of TompliFanrr THI,�._L ' TO CERTIFY Th -the Individual Sewage Disposal System constructed ' ) or Repaired ( ) Se"'fa by.........'�jG` ------ •---•.._.. ---------- •••------ ,a,n ry� yes r at... 4 1J *.wC.1 !._!'.. _I................... l 5 � �� ...................................... has been installed in accordance with the provisions of TITLE 5 f The tate Sanitary Code as described ;in the application for Disposal Works Construction Permit"No.._.e _...�..�`-.`..4'--. dated-Sl/(--/_.'? THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL F NCTION SATISFACTORY. DATE................. Inspector Inspector `� --------------•--- a I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL H No FEE6'2,�.............. Dinpn�s 1 Jr k Tnn Uan rrmit Permission is hereby granted...... 11.` co,_ ......................................................... to Constr S�yyss Re air n di ual Se r e Disposal Sysff at No..- C t� t"f i ......- G�j--... t w TK"✓"I 1�! �'-------------------------------------------------•------------- Street .1 as shown on the application for Disposal Works Construction mit-No-----_---_-_----_Dated_.__"-./.:.�.......................... .� �Y ..----�........ ,.. (......fit 0�6... Board of Health DATE............................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON i T,�k�,s • �sf4{i r�µ�/v a � '; � ez r , g � r��'�r v: � 6Y • € ,�5. - - - / 3 v .. y yF 5,1 i'i Y, y -3 x?S& p_ 'S�,� :r 4�-nA, 1 i�ram'-.,jam,s ,t..r. Y ,.� , - r ' f}4 >r`�F ` ••`• r :.Y �•y -.obi i Hdo 3Vb0t3/ bnS ONV1 •o3a 02 1332i1S N. IVW Z!L r�, k ; SVW ' 3IevsSNad8 d0 IZE ONINOZ 3H-. 01 . SABOAN00 f zENV 1d... SINE NO -NMOHS OAIIG'il(18 Z, � ON 00P Q3`�3'1SIJ3a' 8!l31S108 a y t -. b E:' `!03SO, 08d 3H1 1VH1 JlJUS30 i oTIN3i"10 •�.� �/UYN�3NfJHr� ,39CT �CJf7 131 V CI ;off'—,,/ '31 V tb r�. f�/►. �'!+f� [�' �' �p t`ff `"I. 9 t..� 1' < ri N I -40 031 11833 y ,1 y ` K r s. �31SJ� s''B ����•c 11st;� ,t �'Q,,'-�° 8 Z � 'L9EBL 'aPJ' BU0JHQ13• c� •e 3SL'Gi� „�., , ' T/_TY,,� �j b xtkkl 13808 ao ��?�� 12l321 J / fbW i0 N11 � b`t bfVfir, 1- 6 oZ R : 14, '_4 0 . ' Y 7 6 ;p r �' K d; 4y6°1 ^/� 7' rAw Ci I t�' P v r•t y!�� ��p/ J •\.. �l%. � y�, J7 ' \\ : 4 ,;"�'$�`4�1 v+:i tag a � _ •� �. `��g,. .'mil. ' t ;,`r`Hi*� �t�t�a3 of x � � ��eJ� \ ` \ s�, y,��`� s �4`• 'y 1 " # �y ��r�t•�R� �'+kt f� * y Sln�'.:� ;'�i�La,� '.Q\ .....`�� �•__N \. � , ��,y ��7 Y,.v� `� J Ok. s r Ts 47 je C/a N-1 x f `•� e j F:. R �; r , I tn J t. 4 � n p f� „y„r :. r.,.., , La,<,.. t .�. r. .. :� .. ,a..c�” ,..7- _ x.. :�vs• .�� •4 ._ � .d t;s'.. 'n._.,: 1' �,r,��-.�-:_°a, ^ti. s+�: .r� „Yvt ,2 �.:..:..., .,.$', ., _.i+.. :yam_ i •:�'h r•�. ,.;� ,: ,.... .,... � t i', t:'.�r�i!Jt r -=i._•, fir..,.�_a ...�9' ,�; .. xd .,.-a u• Y's7 r.t�`, k ,�•.:.�". �.� .,. <a � .",�- r:�. '�.t� -�h '�J.. i! M +5)a �.' r� - ,3. .. ... .- .. 3w'..RUN-,', ., ..:. .. .>. �,.. .r.a.•... ..,... ....�., `'`7. ... .": y{ ,• �5:� +e'h". ,:.. •K„T�'�-': �.rti,. �y'.r?°?,r,�...��� ,.:�,jre.. -7. ..: ..,? � T4:. a.u,{,- :��.. •�} ...Y, :' '. �.+..t�:..." ,�.t r• ..�jr•'.. -, E. ..k" .s c..�:. ^S'� ..? . �li'• ,:�',,. S ..?? r -,rc -.3 :s'+. ef� .k .,Y� c=.:;. e, .. ,,'.'�• 4G^.;.x,�.. �,..-..re�o jv,�;,t�•= �„ .+,Y'. i.v,.,s :k .3.` a."w �.„:..•r.- b'+; `i:A!.. �:.�.�.•. ..�s:.•FT � a. "�3,.. :.t..u �f>r;,lx.,+: �':..•:.,b•. kaz. .xy.�,.. �',,,,..• �� �".`'�.� #, �v+ �.;,:�,�^"-Y ������;'�`.�",�` •..•-a,�`Sk..,� ,.,.,<".:£,'w r �'"s.,.r'7`e+.>w.• �"+i,�. ,-,•r a"�+�«. .e,.t a'a-#'�` .•n:..a 'k€ .;.;:.'. rr• L� ,`" -.`v.'�r�� :."s:`,:.^r�- 'Y-4tT•;` -�,- .. _ p ..:.,.,:.:. +.s:-.'.,.e ...r-:. Yw eke:: +:a,. _ r� ._...�, �,,,}};.a:.. w.,...L,>a.fix• -L.- ar,r .._-<r �.�e-E.. �... t`'.�..... i<� :^.�)/�y' ,.. �it�i*l�rR:.�... �s .•r 2. .. . •. ?`..t,. '9'F.�. .�..X �..-,1., ,.,��w. w+Jz',. A«. ,n3... *...+'k, wk � a.I=`V/�4 �{ G".F.. t.;:,.. :Y1 "5.5 ..... s.. -,^.,. ,:+ ,• x• ..;s.,a•u" .iy JA" r"-�n�7'. •, ::Z.. G_.,ar :. •,N" -. a 7.> ,. S.�.r.�." ^:r s ''• 6 .r. '' ."'„�`r;'hm ", T . ,v. j.'�,`.. v ..2'^ *. , .?D.F MiN., CH/ vG P1T .4/t /yOR TN ®F1.0 �. .� .r-E ^R TE t-OiiER •.a�RIlOE" 24 /AM FT.ER COiy� _ IO FT• k , BALL �OE, . � . NT, GRACE.. EXTiF'11 GD/VCIBlrYE f /S►E.aYy°:CA`ST IRON C�YER .SHALL !�E VSFO ^ M/N PITGN;• IF DR//N YEivA4 y ' EL` gg 5 COYERS` g'PER FT ,:: ' e — ?2�+J�jrMiM 'V CONCRETE I d1�ADE co►11=5 ;A CB,.gCXF./LL O UQUiD LEYFL ` ?'LAYER _ t SCMEa ULS 4O IL -JAB N za° ° G�lc. ° 0.16 • • . . ;• ,, •. a a.a W,45HFD 57'O YE IJV.o/TC DIST. • i • .�:• • a P.- 10"P&n � � SEPTIC rAA"A v • . . • . •, V B�^ 0.04 • of ✓E • �De 00;0 f �•e o� yYASHED STGiVE . • : /75 '9 z .ov =3.S:Z ; af•� • •; .• ., 40 � .• . op o PRECAST'SEEtAC . j 5.3.°O x a 3 j.Z - . ,•. . • • . • • • •• r ► �•s P/7 OR EVLIIV.. 1.11jYe/CT �'L EYAT/GNS . Pl r cA 3'A r r.Y 9' °1��9 4�ORY a o� • • •. . • • •.+ • ° EL Bo o' AVY.EAT<AT QUlLD/NG BS,o FT 3 C(SEE T�9Bl/L.4 tJON> INLET` SEPTIC 'T.4/VK. .S ^FT- ,FT l7/i4J►'1- OU7LET SEPTIC -rANiC : FT.. INlAET D1ST/41,50TION SO BY Yj FT SECTION GROUND H{�1TEN;Ti�LE . OslT1ETD/STRIB!!T/ BoxSy,�= FT. 8 0" .SrEWASR O/S~A L;3Y.STEM N B /MLET LEACRINlr ImI 7- _fT -r4A&VLATl olV LEA .:PIT i4 3.s 1cALE c Y4" 0I17ENS/ON A fT. D.ESISAt CR/.TE/41/lfT- - R GE DISPOSAL UNIT } NllPlDER GF Li►ED�o p/ys 3 w eN SOIL. LOG. i SOIL TEST TO TAL.:ZVTIAI,4'r o..fLo`t/ 33v G.4c./D�tv 'SO/.L TEST,! SolL 'TEST 2 XUMdE�P Ii,C�ACNINT: PITS': FLE✓. C�:5 EL1�Y�$2 rpATE OF SO/Z TEST S/ADE L:CA CHI NG'PER �75 P1T - • . _�sq, FT ..: r:',p /:',Go fi�'1 D /i L�#"'1 ..�<•/�ESI/LTS IVITNESSED SY R[3 � ' G�i✓1.oI✓ 40TTOh!L64CNlNG PER PIT 753.9- FT s SvSo rt_. �. xg u a35o:��-- AERCOLAT/ON MATElylw,4/INCH TOTiRI.1 i4tH/NG AREA 3Z9 S+n FT r r !`� "I XCOL/�:T/ON Rl4TE 2 Ml1V.//l/VCI�! Z9 1f. 4 l $• * F� ?�. ,� S z 1SlG+'® QCTA'A cE�►Cln.�.G,ptu5'-V5�7>.Z000 GA Srr7� �RESERYELB�iGYtlN6AREA SQ. FT 8R'� '� /✓� D F .:s�!✓D "a!c. lip P y�/ ' • D M ;Trendy °ff LDr `3 .:..(*� 7',,!'� - �A� 14P , s ,Na ��rtrcy -CC/ VI'L..L-L M R o A03ERT o c� ALBERT. G•l� GL ,�; �fa++4iC r r EI�JReQOE `` � (V MORSE cn � , ?boWMAM /Mg- MAIM ,'. ' o.10951,'O � ,+' ��'` sx s �.�:C�L•/� ,:r1 � �LO�� �r. o � :c erii: �,• .�.. £� + �: 1 _� �: � 'lit� •�9T �,'flYII N �. et •-ytan £G'..ST ... .O /S7 �t �+.as, n sr r: :.:i e`• ,, .,a 1 x= . rip �1,y`a�,•;.- ���,�� .: •_ ` .:, :. ..`.! !'�A�-�.L' .,_�• NO GJ�OfINj� YYi4Tt`I� 1'rJVC r +-0 , x?� , ,.�; «. .: ., .' , .- a..,,: p a ..; .a ..":a✓n.�:-, g i. tl�e K`> �'� .,,'tax :y St,.�� fag: �.-, �,.. ..:,: ..;.,•...., ,? ti� ..;.^ a 'm. 4•*�`'�:+,�",:•,.,,cb.,.... r e.>,:��;5.yi!c•.�.�� �f,�"`�i+� � }u '.n-:: ,5"7�. •..�...p.,..�._ :�" g - ''�: _� .. .yw.., Y ,w. rs, ?v •'*4.,.1y., dr3. - n3•r.. 7 f*' h �1'k i'7`' 3:.'' �: , - 'ram:�aai' 3" .:x, s p,^•"sn w L '� `';:.g�C.'' 'a'St'a+l: tk•4i`", �... _ -.._ t ,-h "�^ :ri••Ma. i l �d� r ryJ S"4�i vdl'+• .,. , - _ _. ::-.t.. .,rc�s ,'Ya �..k. ?.'r,,rW�s:^�`ri:«.... a;. e4tisf': ,.`�..•a-e'�'�;:• _., ,p .. •. ..:r;�r'�.+,.a.:: tiFu...., .. xc-•:t.�.�..a :i�s,•as�°�'�:u -- :a President: Member of: ROBERT BRUCE ELDREDGE,R.L.S. CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS ELDREDGE ENGINEERING MASS.ASSOC.OF LAND SURVEYORS Associates: AND CIVIL ENGINEERS ALBERT A.MORSE,P.E.,R.L.S. COMPANY, INC. AMERICAN CONGRESS ON PHILIP WEINBERG.P.E.,R.L.S. SURVEYING AND MAPPING AMERICAN SOCIETY FOR �EQ CSEEZE� GJ\E9 LIEEZEd TESTING AND MATERIALS —Pand tnlviC 712 MAIN STREET 1SU'1VE O'u e ,.� �n inzvu HYANNIS,MASS.02601 TEL.(617)775-2244 July 19, 1985 Board of Health Town Office 267 Main Street Hyannis, Massachusetts 02601 Re: Greenbrier Development Co. LOt 32 Great Hill Drive, Centerville, Ma. Job No. 83209 Gentlemen: A final inspection was made on July 18, 1985 and the results are as follows: DESIGN AS-BUILT Inv, at foundation Elev. 85.0 Elev. 86.7 Inv, at Septic Tank Inlet " 84.8 " 85.9 Inv. at Septic Tank Outlet " 84.6 '.' 85.8 Inv, at Leaching Pit (N/A-Invert pipe is " 85.47 above .pit) Top of Leaching Pit Elev. 84.5 " 84.5 Bottom of Leaching Pit It 80.0 " 80.0 The system appears to have been installed substanitally in conformance'_t6 _ the minimum design standards specified in our sewerage plans dated April 20, 1985. Sincerely, ELDREDGE ENGINEERING COMPANY, INC. Robert B. Eldredge, R. L. S. President RBE/etb Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 90 Great hill T4- Property Address Roopa Freyne Owner Owner's Name { , information is required for every .Barnstable 'V La(�S,I 0 h s IV rnn(�t I k Ma 02668 6/8/2014 page. City/Town 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 filling out forms A. General Information I on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the return Name of Inspector key. DiBuono Sewer and Drain 00 my Company Name Company Address 8 Johns Path ma 02664 City/Town State Zip Code Yarmouth Si13522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and tha�the information reported below is true, accurate and complete as of the time of the insbection. Tie insaction was performed based on my training and experience in the proper function andd,'mamtenange of onNite sewage disposal systems. I am a DEP approved system inspector pursuant'tq Sectiortn1 .346f Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails Y -; ❑ Needs Further Evaluation by the Local Approving Authority ` NO Co rn 6/10/2014 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. Lm�'(j oil l I t5ins•3/13 Title 5 Official Inspect F :Subsurface Sewage Disposal System•Page 1 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments `M s 90 Great hill rd Property Address Owner Roo pa Fre ne information is Owner's Name required for every Barnstable Ma 02668 page. City/I own 6/8/2014 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: This system contains a 2000 gallon tank a Concrete distribution box and two 500 gallon concrete chambers. The sytem was upgraded in 1998 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. *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): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 90 Great hill rd Property Address Roopa Freyne Owner Owner's Name information is required for every Barnstable Ma 02668 6/8/2014 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 pumps/alarms 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 90 Great hill rd Property Address Roopa Freyne Owner Owner's Name information is required for every Barnstable Ma 02668 6/8/2014 page. Cityrrown State Zip Code Date of Inspection 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 cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 90 Great hill rd Property Address Roopa Freyne Owner Owner's Name information is required for every Barnstable Ma 02668 6/8/2014 page. Cityrrown State Zip 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. ❑ ® 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 90 Great hill rd Property Address Roma Freyne Owner Owner's Name information is required for every Barnstable Ma 02668 6/8/2014 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)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 90 Great hill rd Property Address Roopa Freyne Owner Owner's Name information is required for every Barnstable Ma 02668 6/8/2014 page. Citylrown State Zip Code Date of Inspection D. System Information Description: This system contains a 2000 gallon tank a Concrete distribution box and two 500 gallon concrete chambers. The sytem was upgraded in 1998 Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage 2012 40,000 g ( y g (gpd))' 2013 55,000 Detail: average 131 Gpd Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): 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: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,••�'°� 90 Great hill rd Property Address Roopa Freyne Owner Owner's Name information is required for every Barnstable Ma 02668 6/8/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Currently Occupied Date Other(describe below): General Information Pumping Records: Source of information: Home owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 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): 2 500 gallon chambers t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �. 90 Great hill rd Property Address Roopa Freyne Owner Owners Name information is required for every Barnstable Ma 02668 6/8/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 16 years Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ® cast iron ® 40 PVC ® other(explain): Distance from private water supply well or suction line: NA feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1ft 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: 2000 gallon Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 90 Great hill rd Property Address Roo pa Fre ne � Y Owner Owner's Name information is required for every Barnstable Ma 02668 6/8/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 18" Scum thickness 2 Distance from top of scum to top of outlet tee or baffle 3" Distance from bottom of scum to bottom of outlet tee or baffle 28" How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tank was pumped in 2012 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 t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 90 Great hill rd Property Address Roopa Freyne Owner Owner's Name information is required for every Barnstable Ma 02668 6/8/2014 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.): Tank was pumped in 2012 Both tees are in place. Level is normal 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 Row: gallons 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 90 Great hill rd Property Address Roopa Freyne Owner Owners Name information is required for every Barnstable Ma 02668 6/8/2014 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 level, solid and at normal level 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.): no ins of carry over 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•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M ••'� 90 Great hill rd Property Address Roo pa Fre ne Owner information is Owner's Name required for every Barnstable Ma 02668 page. Ciryi I own 6/8/2014 State Zip-Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ 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.): Chambers are dry and there are no signs car over. 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 ElNo t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 90 Great hill rd Property Address Roopa Freyne Owner Owner's Name information is required for every Barnstable Ma 02668 6/8/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): No signs of hydrualic failure 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 90 Great hill rd Property Address Roopa Freyne Owner Owner's Name information is required for every Barnstable Ma 02668 6/8/2014 page. Cityrrown 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: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 3 � I TOWN OF BARNSTABLE p ,LOCATION � �dJ�// �' SEWAGE # VILLAGE �V• ASSESSOR'S MAP & LOT l7e/—Z3r INSTALLER'S AME&PHONE NO. SEPTIC TANK CAPACITY A006 6:4t- LEACHING FACILITY: (type) AdO Go/,l-wel C#44f kI 6t) (size) iX-a �.NO. OF BEDROOMS '`'' BUILDER OR OWNER PERMIT DATE: ;��� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility st Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) /4 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) 14109 Feet Furnished by r. a Y- Y O col R°`g g¢•aV' 07•171 ar.Ito TOWN OF ARN"LE. LOCAPON fP-F0 V11 —:hf SEWAGE .. VII..LAG �, 1 l � _ - !7 - E ASSESSORS MAP&LOT y f�3�l 5 INSTALLER'S NAME&PHONE N0.` SEPTIC;TANK CAPACITY' at'ils GkC-" LEACHING FACILITY. (type) 3W 4 {e , C# �2`Z (size) NO.OF BEDROOMS_ BUILDER OR OWNER PERMITDATE: 9 COMPLIANCE DATE: Separation Distance.Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility st Feet Private.Water Supply Well and Leaching Facility (If any wells exist on"site or within 200 feet of leaching facility) !Y Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300:feet of leaching facility) Feet _ Furnished by 7.1 it•s(► ,IrA-hV ;bi 4V hF'l g' O Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 90 Great hill rd Property Address Roopa Freyne Owner Owner's Name information is required for every Barnstable Ma 02668 6/8/2014 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 15+ ft' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If decked, date of design plan reviewed: 3/5/98 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: You must describe how you established the high ground water elevation: Town Records Bortolloti installed in 1998 test hole shows adjusted ground water is at 15+ft Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 90 Great hill rd Property Address Roo pa Fre ne Owner Owner's Name information is Barnstable Ma 02668 6/8/2014 required for every Ci i Town State Zip Code Date of Inspection page. 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 f 0 `l il--a3f No. q • J Fee V J ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppiication for XDigpogar *pgtem (Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(/Abandon( ) El Complete System 9/individual Components Location Address or Lot No., � Q,�! Jr Owner's Name,Address and Tel.No. Assessor's Map/Parcel in Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 171 Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder W11 Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow //U gallons per day. Calculated daily flow :34:2 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ®�d�P� �iY/5�`/rl9 Type of S.A.S. ��- `/✓�� O D� Description of Soil Z Nature of Repairs or Alterations(Answer when applicable) r)lle 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 Certifi- cate of Compliance has been issued b his Board of alth. Signed Date Jh4pf Application Approved by Date A- `7- T 7 Application Disapproved for the llow ng reasons Permit No. y - Li Date Issued TC. T3•.�� _�-� -'s Lm ai.�i 3��L'�. ---------------------- THE COMMONWEALTH OF MASSACHUSETTS 7Z/ ,0 5 BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CE IFY, that he On-site ewage Disposal System Constructed ( )Repaired ( )Upgraded(4-< Abandoned( )by A at / 540K, �e4) ��'/9 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 76 - I �j S dated TOWN OF BARNSTABLE a _ LOCATION � r�1/�•�� SEWAGE # � �A VILLA/1Gk E ASSESSOR'S MAP & LOT 12V rl.�� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY A666 6k4- LEACHING FACILITY: (type) 3-dO Imo.( 0491-f (4 (size)"' ,.NO. OF BEDROOMS BUILDER OR OWNER F1e-#1V&, PERMIT DATE: _3 Id— COMPLIANCE DATE:��. 17-1 W Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility s'r Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) /4 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 0 ! Y t u.6 Q!-3y l91 R'1' !17•17' C'13 eY-�y, Jv-y�' MeseaFaelnl�s+"°� WR O JIILM Al i ate`& S�Q mf3 � 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD IF HE LT / ..............o F..... :.. . i(.6" �.� .. ....�. L '....................... \ Applirationt for MnVaiial Works Cnowitru.rfltint Permit Application is hereby made for a .Permit to Construct ((✓)'or Repair ( ) an Individual Sewage Disposal System at:LL j d.T. ..t .. .. !.P. T.. ?.r.� 3'........5...� ... ........`........... .... Location.Addre � )) .�/ or � ��._�. ............... il.c .t..�.1...[...� Lo toner V Address W �, 9_t' y� t /� Installer Address Type of Building T Size Lot..`.1_7 feet :.. Dwelling—A o. of Bedrooms....... ..............................Expansion Attic (qp) Garbage Grinder �7 aOther—Type of Building ............................ No. of persons.......7.................... Showers ( ) — Cafeteria ( ) at Other fixtures ............... WDesign Flow.......... �.......................gallons per person per day. Total daily flow.......:. ... ....._......._._...:gallons. � Septic Tank—Liquid.capacit}��CLC)gallons Length................ Width................ Diameter................. Depth................ Disposal Trench—No..................... Width....................Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. it. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed b ............................ ........................................ Date........................................ aTest Pit No. �4el_ ...minutes per inch Depth of Test Pit........ ./ .../Depth to ground water_.y.�.................. Test Pit No.�t�n ..minutes per inch Depth of Test Pit:... _ Depth to ground water...lQ�la .. 94 .......j ........................................................I ... •---------- Description of Soil ..1/. .�.. ....r.�?/. rz7. !Y r --- o U Nature of Repairs or Alterations—Answer when licable Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL L 5 of the State Sanitary Code—The undersigned further agrees not to place the system in j operation until a Certificate of Compliance has beea issued by the b and of health. I I tied... ��.... ............ Application Approved B'y..............—`�..... .. ..`.. n.._:..:..n/I .......................... Date Application Disapproved for the following reasons:................................................................................................................. _........................................._........-•----...-......................--....-..:... -.........---•--....................•••••--•....._.. ....................................... Date PermitNo................. Issued..............................-•-......-----:........... Date i 1 r !' 3 I yl T a l C�� i 11 F .•r +i 9 1 h'.p I _.AJ.. .N O �i SJ� Ilk �:� a.• .':� � CS{'^..' tvT fir- t .. .�.�o �. Vi\ \ Z p NE T•F. \L p T 3 i�` /SO'F2o./TA e� 30 Of ALBERT ROBERT B. E E�DR o. 3DGE 67 79, " ?LOT PLAN ! rt CERTIFIED LB' I N " SCA'LE'./' 40' DATES g U ra.2�EN� L®R�'QGE-ENGINEERING CO.IN CLIENT --=� I CERTIFY THAT HE P OPOS k ; @ 83z d BUILPINO SHOWN ON THIS PLA EGI$TERE REGISTERED JO® NO. CONFORMS TO THE ZONING LA1 rs rr s. CIVIL LAND. - �. , R DR.By ------ OF BARNSTAaLE , :MASP��_zEkGINEER T?.3. / = kk 712-M Ai N ST:REET CH.BY -- 3o e� 1 lr i MYANNIg, MASS., 2 A E RED. LANO_SURVE' SHE�'T--_4 OF LO CAT IQN p SEWAGE PERMIT NO. r' VI L L A G E INSTA LLE"R : NAME s ADDRESS a1 T S coi a llllDE R &?)R, OWNER I DATE PERMIT ISSUED � _� � DATE COMPLIANCE ISSUED Nix,. ' � FEE THE COMMONWEALTH oFwAss*onussrrs N � BOARD OF HEA�LTLJ Application is hereby made for a Permit to Const, (&�'or Repai an Individual Sewage Disposal System at, fol fV1 //4./J�.........C A-4-17,5111---4L 1;rk----------------------- .;:ner Address ~~ - z�*o�- ` Address / � Type ofBuilding Size uo -^ feet Dwelling c6 Be�roonmo---'���--'-------_--- �tt� ��� Garbage Grinder Other--Type of Building ............................ No. c6 persons............................ Showers ( ) -- Cafeteria ( ) '- Other fixtures ----_-_________________________ ______..... _______ < Design '.gallons per person per day. Total daily flow—.. 1:4 Septic Tank—Liquid capacity Z Other Distribution box ( ) D"""e "~~~ ( ) ~~ Percolation Test Results Performed br........... .............................................................. Date........................................ Test P6 per inch Depth of Test Pit .//../Depth to ground water ._.. ~~ Test Pit No. ^��.minutes per inch Depth of Ten Pd—.�������' Depth to ground �atcr'�'�x�*��.��..� , nm ......................................................... ~c � ------------ ---'-.-'_---_-_----.___--.—'---''--_____'---_—._---''--_---'--- ' � - The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of I TU 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of, Compliance b bee issued by thh�eb),ard of health. 4 ..................... -.-- _--� &no1�u��oo Approved �y_----��� '.1'£r������-�~_-�-'�---�-c'���~/-c��=� _'��c'�--.-�---_--- ^^ '' u*° Application Disapproved for the following reasons:....................................................................... ........................................ ..........................................-............................................................................................................................................................ Date Issued I,ero�itI�o-------------------------'-'-' ao ...........................Date ............................ � � � � � ~ r 7�-T- \ s,.: 11 es, sa � ! �o �ova�E'� ti N 43 -J N / 1911 \ Ir 0 Z \yam F:.rr` A. a -71 A) vJ ~ ZONE \ L.0T 3' L /Sv'F2oIV-7 7 > 7 S, OF ROBERT ALBERTB. ELDREDGE N 0,9 19;67 CERTIFIED PLOT PLAN )-OT 3 z :q << ' CEiyT��f//LLB I N / Sc r ,r_40' DATE 4 3 v EMG/NEERlNG CG! 11V CLIENT I CERTIFY THAT YHE 'P1OPOS REGISTERED JOB NO. f? BUILDING SHOWN ON THIS PLA EGISTERE CONFORMS TO THE ZONING l.A' ..7 .: •CIVI1. LAND DR.BY' A ' OF SARwSTASL E MAS ENG NEER R BY� Rom— 30 8� ���° 712 MAIN STREET �H' z may` LAND SURVE E;t HYANNIS, MASS SHE" T�- OF A E REO No. Fee __. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: `/ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Application for Migo5a[ *pgtem Con5tructiun Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �`B r . W i It `72�,r— Owner's Name,Address and Tel.No. Assessor's Map/Parcel I ! y Installer's Name,Address,and Tel.No. 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 gallons per day. Calculated daily flow gallons. 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 Certifi- cate of Compliance has been issued by this Board of Health. Signed .c� Date ®3 0 9 Application Approved by Date CS '3 O 5J. Application Disapproved for th following reasons Permit No. Date Issued ,No. Jr Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ` PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes Zipplication for Di.5pool *p$tem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (� ` l 1 � Owner's Name,Address and Tel.No. Assessor's Map/Parcel 1 -7 03� Installer's Name,Address,and Tel.No. 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 gallons per day. Calculated daily flow, gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil y Nature of Repairs or Alterations(Answer when applicable) `` D Date last inspected: Agreement: r - . 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 Certifi- cate of Compliance has been issued by this Board of Health. Signed Prtl.&JZ0e ail Date Application Approved by Date C5 Application Disapproved for th following reasons Permit No. Ile - S Date Issued 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 at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. rx- — dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date _ 17- 9 V Inspector r N. T5 Fee �5 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lizpoot 6potem Construction Permit Permission is hereby granted to Construct( )Repair(>e)Upgrade( )Abandon( ) System located at 70 a 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: - - Approved by_�