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HomeMy WebLinkAbout0139 HIGHPOINT ROAD - Health 139 Highpoint Road T f Marstons.Mills F/R lP A 027 029 J No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in omputer. .PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for M is�po$a em �ovtr%jionjo, REP xe-,6 & bvy 00a �" o� Ttc " u S ,r/Y%jr e_' ry h- Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ❑Complete System ❑Individual Components Location Address or Lot No.I vq h(10 Owner's Name Address,and Tel.No. �9 � �1, !,/i4t�'z® cJal9.fQ� Assessor's Map/Parcel —0 /YY, /r A/ 0 �W Wlzf Installer's Name, ddre and Tel.No. Og-412 C972 I Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Natu�e of Repairs or Alterations(Answer when ap licable) diG t'�<�i'/!7!° �pQ('j � � S'���yGsf� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe .!�( Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued P;s- .. .�r.,f. :t'y....•..:...-.�,f .n-.-a_�,^'4^w+'......rt'.-.+ ... +r evo-re.-.-.A+^�j,.ir.+N':iT....u. .-. s- ham..�.('+M'-.. ,. �...w..... . -. . . y i 7 1 No. �/ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in omputer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for �Dk j ogar �pgtem Cow6tructton �erntit u.5 4=xlsti&'r 11©0 Cara/, :Yi%ppc Psmk wirh So/j Crag Tay} Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ❑ Complete System ❑Individual Components Location Address or Lot No.IQ ��QL1 �d r�J o Owner's Name Address,and Tel.No. Assessor's Map/Parcelor�j—oAq M. M I ti� p8- Installer's Name,Address,and Tel.No.j 129- y72-2 Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title \ Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) J9i9 6,411 Sr_w1.16 1'?4-�klk � �f C?II�Gr" GUr tGi ,/�dU [��� S"i'r✓/'r� T�lilC rh �r�rN�. Lo�raTly" Date last inspected: , Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of 7 Compliance has been issued by this Board of Health. Sign f Date Application Approved b 92 k Date Application Disapproved by: Date I v for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS 1 BARNSTABLE, MASSACHUSETTS Certif icate.of Compliance _ THIS IS TO CERTIFY,that the On-site Sew ageDisposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )'by ,/O$ �'�l� a ?,o,,0-5 at /3 /��C/h i't r�J r' �V /0 oill5 has been constructed i a ordance with the pro/visions of Title 5aand the for Di§posal System Construction Permit No. � dated Installer sI0,5 i°/ 4 12,go11eUp k�� Designer #bedrooms 1 P Approved design flow / / gpd The issuance of this permit shall not be /constrruueed:As a guarantee that the system will function as deesigned. o {' Date �( t'/�� Inspector /�f'If/ ✓ ,� tF ,��� ld.� C/ NoA �� ��� Fee THE COMMONWEALTH OF MASSACHUSETTS•... n' PUBLIC HEALTH DIVISION SD —BARNSTABLE, MASSACHUSETTS I R1�p14c� r000 6A/, ,}t_ptiG ���/c / r6 /s-46, =igpo al �pgtem Cangtruction permit Permission is hereby e o Construct ( ) epair ) Up ade ( ) Abandon ( ) System located at 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 condition Provided: Constructio must be/comple d within three years of the date of his r J, Date Approved by Town of Barnstable Barnstable moo, Regulatory Services Department AkmesieaCfty sn�rtsrasz.e. K" 039. m Public Health Division � 'A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644_ Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO April 9, 2008 Madeline Wheet P.O. BOX 272 Oxford, MA 01540 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 139 Highpoint Road, Marstons Mills MA was last inspected on March 28, 2008,by John Webby, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Tank is leaking. You are ordered to repair or replace the septic system within Two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER O THE ARD OF HEALTH Th as McKean,R.S., CHO Agent of the Board of Health CERTIFIED MAIL# 7006 2150 0002 1038 7176 :\ P \Q SE TIC Letters Septic Inspection Failures\I39 Highpoint Road.doc Commonwealth of Massachusetts lug `Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 139 Highpoint Rd. Marston Mills ( Property Address Cif( /L2Nataline Wheet owner Owners Name required is 342 Winter St Winter Street Framingham MA 01702 3/28/08 required for every page, Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way- Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not John Webby use the return Name of Inspector key. Belac Shores LLC Q Company Name 199 Rt 28 Company Address a� West Harwich MA 02671 Cityrrown State Zip Code 508-432-1313 S12987 Telephone Number Ucense Number kD B. C .rtification r; 1 cer6fy1that I have personally inspected the sewage disposal system at this address and that the r 4'information reported below is true, accurate and complete as of the time of the inspection.The inspection --4 f.;was performed based on my training and experience in the proper function and maintenance of on site i sewage;disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Titre 5(310 CMR 15.000).The system: f ' ❑ passes ❑ Conditionally Passes ® Fails - ❑ Needs Further Evaluation by the Local Approving Authority 4/1/08 In s Signature Date TheC' stern 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. Tito 5 RReperl(Ww*)'•MRS Title 50rfi W rnspedion form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts `Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 139 Highpoint Rd.Marston Mills Property Address Nataline Wheet Owner Owner's Name (required for eve 342 Winter St Winter Street Framingham MA 01702 3/28/08 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary:Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass.. Answer yes,no or not determined(Y, N, ND)in the[I for the following statements. If"not determined,"please explain. ❑ The septic tank is metal and over 20 years old"or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced obstruction is removed Title 5 Report(Blank) 03108 Title 5 Official inspection Forth:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 139 Highpoint Rd. Marston Mills Property Address Nataline Wheet Owner Owner's Name information is 342 Winter St Winter Street Framingham MA 01702 3128/08 required for every page. Cityrrown State Zip Code Date of Inspedion B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation Is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, . safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system Is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water -supply. PP Y. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Title 5 Report(Blank)t 03W Tftle 5 Official Inspection Form:Subsurface Sewage Disposal System•Pap 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 139 Highpoint Rd. Marston Mills Property Address Nataline Wheet Owner Owner's Name in is requi d for every 342 Winter St Winter Street Framingham MA 01702 3P28/08 page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) C) Further Evaluation is Required by the Board of Health(cunt): ❑ 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". F Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑, Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ❑ Liquid depth in cesspool is less than 6°below invert or available volume is Tess than %day flow ❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Z Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Title 5 Report(BlarN+02M We 5 Official trispedion Form:Subsurface Sewage Disposal System a Page 4 of 15 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 139 Highpoint Rd. Marston Mills Property Address Nataline Wheet Owner Owner's Name r�uireati d for every 342 Winter St Winter Street Framingham MA 01702 3/28108 page. CAyfrown State Zip Code Date of inspection B. Certification (cunt.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No i ❑ ® 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—1WPA)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. Title 5 Report(Blank)•MM Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 139 Highpoint Rd. Marston Mills Property Address Nataline Wheet Owner Owner's Name information is required for every 342 Winter St Winter Street Framingham MA 01702 3128108 ' page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No i N 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 WA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? Z ❑ 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)] Titles Report(Blank)-tXiW Tits 5 Official hspection Foam:Subswface Sewage Disposal System-Pap 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 139 Highpoint Rd. Marston Mills Property Address Nataline Wheet Owner Owner's'Name reouOis n required for every 342 Winter St Winter Street Framingham MA 01702 3/28/08 page. C4rrown State Zip Code Date of Inspection 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 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes 0 No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 16,000 9 ( Y g (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 10/07 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 True 5 system? ❑ Yes ❑ No Water meter readings, if available: - - Last date of occupancy/use: Date Other(describe): -- Title 5 Report(Blardk)-.MW Title 5 Official trtspection Foffrr Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 139 Highpoint Rd. Marston Mills Property Address Nataline Wheet Owner Owner's Name information is 342 Winter St Winter Street Framingham MA 01702 3/28/08 required for every page. cityrrown State Zip Code Date of Inspection D. System Information (cunt.) General Information Pumping Records: f Source of information: None 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/Altemative 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): Approximate age of all components,date installed(if known)and source of information: Leaching and d-box installed in 2002,Tank was installed many years earlier Were sewage odors detected when arriving at the site? ❑ Yes No Title 5 Report(Ster k):•03008 Title 5 Offidal hmpedion Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 139 Highpoint Rd. Marston Mills Property Address Nataline Wheet Owner Owner's Name information Ls required for eve 342 Winter St Winter Street Framingham MA 01702 3/28108 every page. Cityrrown State Zip Code Date of Inspection D. System information (cunt.) Building Sewer(locate on site plan): Depth below grade: 12"feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 6" Depth below grade: 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: Sludge depth: 0 Distance from top of sludge to bottom of outlet tee or baffle - Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 0 - Distance from bottom of scum to bottom of outlet tee or baffle 0 How were dimensions determined? measured Title 5 Report(BhW•-03/08 Title 5 Official tnspec ion form:Subsurface Sewage Disposal System•Page 9 of 16 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 139 Highpoint Rd. Marston Mills Property Address Nataline Wheet Owner Owners'Name information is required for every 342 Winter St Winter Street Framingham MA 01702 3/28/08 page. Cityfrown 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.): Liquided was 14"below outlet,tank was refilled to bottom of outlet and inspected again the next day and liquid was 1 1/2 below outlet, tank was refilled to bottom of outlet and reinspected the next day and liquid was again 1 1/2"below outlet, at this time system failed due to leak in septic tank. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: 0 concrete ❑ metal ❑fiberglass F-1 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 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 Molding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete 0 metal 0 fiberglass ❑ polyethylene ❑other(explain): ritle 5 Report(ate)•0301 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 10 of 15 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 139 Highpoint Rd. Marston Mills Property Address Nataline Wheet Owner Owner's Name information is required for every 342 Winter St Winter Street Framingham MA 01702 3/28108 page. City/rows State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working.order. ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Liquid was level Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No Alarms in working order. ❑ Yes ❑ No Title 5 Report(Blank)-03108 TWO 5 official Inspection Form:Subsuftce Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 139 Highpoint Rd. Marston Mills Property Address Nataline Wheet Owner Owners Name information is required for every 342 Winter St Winter Street Framingham MA 01702 3/28/08 page. City/rown State Zip Code Date of Inspection D. System Information (cunt.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number. ❑ leaching chambers number. ® leaching galleries number. 2 ❑ Teaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Title 5 Report(Blank)•M= Tide 5 Oftal Inspection Forth.Subswface Sawage Disposal System Page 12 of 15 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 139 Highpoint Rd. Marston Mills Property Address Nataline Wheet Owner Owners Name requirefo is 342 Winter St Winter Street Framingham MA 01702 3128/08 required for every page, cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 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 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.): Title 5 Report(Blazdo-03 Tice 5 Official kgxxtion Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 139 Highpoint Rd. Marston Mills Property Address Nataline Wheet Owner Owner's Name information is required for every 342 Winter St Winter Street Framingham MA 01702 3f28108 citylrown page. State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. CLPQkinpl/ TP VJiC. -n I"t 2 3` pi —"e-OUTLer a- ' a o Fy,i61 D- 3gr ZOO -7 I c �1 loot) IAL C.l�aw.6tr Title 5 Repat(Sim*)•MW We 5 Official won Form:SW=Af3w Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 139 Highpoint Rd. Marston Mills Property Address Nataline Wheet Owner Owner's Name ' e required every Winter for ve 342 St Winter Street Framingham MA 01702 3/28/08 City/Town page. State Zip Code Date of Inspection D. System Information (coat.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water. feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked,date of design plan-reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet.of SAS) ❑ Checked with local Board of Health.-explain: Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Did not get this far,tank was leaking and did not complete inspection on ground water,engineer will determine when new tank is designed for approval for installation. Title 5 Report(atar&)-OC= We 5 Offlcud tnspectim Form Wmfff Sewage Disposal System-Page 15 of 15 - V Town of Barnstable �pF THE A yip ti� Regulatory Services nABIM A; Thomas F. Geiler,Director 9^ 1 & 0 "fjp�ED3YA Public Health .Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future not does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. TOWN OF BARNSTABLE LOCATION _. /✓? r/• �?©,%� rd SEWAGE # 6200,12 Of VILLAGE , 0,o2 7'J1-5 ASSESSOR'S MAP & LOT Pa 51 INSTALLER'S NAME&PHONE NO. �� C" Aw llotO SEPTIC TANK CAPACITY /000 LEACHING FACILITY: (type) -7 (size) aa 5-X «•f3 NO. OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: 0'1 COMPLIANCE DATE: RN/0 a Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist .+ on site or within 200 feet of leaching facility) '= Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) yM, Feet Furnished by 1. 13 T 'rf� a 7 vtho _ r /flea TT aka r� D-do X 50 7/ f 113 g 3 • I mar 1�,�.n�rr � � i No. 002- L 17 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:�� Yes PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE,MASSACHUSETTS Z(ppYication for 30iopagal 6potem Congtrurtion i3ermit Application for a Permit to Construct( )Repair(Vflulpgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 341,�.�Pv Owner's Name,Address and Tel.No. .iMlle..5 LG/S°•'1 �ro�� Assessor's Map/Parcel 2 —2 Installer's Name,Address,and Tel.No. Designer's NanTVftf dfel.KYLE A9°CiC /-,10 sv, 42 Canterbury LaFlq -?0./.lox 33-//,aor A4-'As ,wq East Falmouth, MA 62556 T�Peog: - ; CP wellin No.of Bedrooms 3- Lot Size�sq.ft. Garbage Grinder( ) Type of Building No.of Persons, Showers( ) Cafeteria( ) Other Fixtures Design Flow -330 gallons per day. Calculated daily flow � � gallons. Plan Date (aL,- to-oZ Number of sheets L Revision Date Title Sr-in A 1.,r:_ C; X 3s �. A)A°Tr t 1p,—f .0 Size of Septic Tank t QQL� . � ��r ticztz i Type of S.A.S. ca�.A"a 2 n ►u Description of Soil ��t�- ��-I-_ .PIti LAN ZT� (JF w C � r/ 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 w 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 iss by is Board of Health. Signed > Date �3- 0.7, Application Approved by o _ Date -/?-0.2 Application Disapproved for the llowing reasons Permit No. q d0 - 3 Date Issued S-13 -p 2 ---------------------------------------- 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 -r. /7-" In• rr has been construc ed i�accordance with the provisions of Title 5 and the for Disposal System Construction Pemrit No.PQQ� Z 4�� dated k l D Z. Installer Designer 7 The issuance nTf this permit shall not be construed as a guarantee that the system wil function a de iign,,�r/ Date �I�t�i U� Inspectors1� /LY fI JC No. 00, " �7A Fee _5 0 . THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS �Diopooal bpgtem Conotruction 3permit Permission is hereby granted to Construct( )Repair,(')Upgrade( )Abandon( ) System located at ' f ✓1/• />r ��f 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. i Provided:Con ue on must be completed within three years of the date of ermit. Date: �i'/I 3!�JZ Approved by 1 J T° y ,�/� TOWN OF BARNSTABLE LOCATION �✓� n'.r '+ AY®.%► f Y-/ SEWAGE # 020007- 3 W VILLAGE _Af.,1l5 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC'TANK CAPACITY LEACHING FACILITY: (type) -2 (size) X� NO.OF BEDROOMS 3 BUILDER OR OWNER sv-N A,V PERMITDATE: COMPLIANCE DATE: ?� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet _Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by New � of A g3 T4, q 12hc 13 8 3 2 7T i k o I 57 e No. 002-- j Fee THE COMMONWEALTH OF MASSACHUSETTS { Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Z(ppYico.tion for Mi5po5a l 6pgtem Construction Permit Application for a Permit to Construct( )Repair(V�Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. i-set �y R� Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's N d el. 42 q,r�e,�/o•�s M--'�/f�� ®a� Ea Canterbury 1��A.� ?0.13ox 33 East Falmouth, MA. 02559 Telephone: s Type of g: wellin No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) r Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow '30 gallons per day. Calculated daily flow gallons. Plan Date b(n — to— O—L Number of sheets l Revision Date Title Se-_u`)A k r_ V o fte Via 1k��Tt�1I.A 2a Size of Septic Tank t oc7u Ctss:,y4 rs ,1aim Type of S.A.S. cati.4O �� Yam. Description of Soil TW (C, w G14-, 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 is s by s Board of Health. Signed Date /3" 0.7, Application Approved by r Date Application Disapproved for the llowing reasons Permit No. f)tl 2 — 3 y Date Issued S--13 _G f. ,�; d o.,. DMZ- 16 ; Fee � ... Y, r� / `` / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye V '/ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2pplitation for Migpogar *potent Conotrurtion 30ermit Application for a Permit to Construct( )Repair(V Upgrade( )Abandon(, ) El Complete System ❑Individual Components Location Address or Lot No. (-S q Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's NaniSL MUddei.rUOYLE & ASSOC• J C, A 1-to 42 Canterbury Lane East Falmouth, MA 02536 Telephone: T,pe of 'd' g: wellin� No.of Bedrooms Lot Sizesq.ft. Garbage Grinder( ) .. Type of Building No. of Persons/ Showers'( ) Cafeteria( ) .r Other Fixtures Design Flow 330 gallons per day. Calculated daily flow gallons. Plan Date.. 6(a - to- oZ Number of sheets 1 Revision Date Title �t-a ua A �:.�r t7r�.A _x V%. .—`-°�[i! N� Sizeof Septic Tank oeau Type of S.A.S. ua.A�j3� ` r>r►e Description of Soil �r�i� — _ �n�.R c� 2-�N �� Too 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 is s �d by is Board of Health. Signed ,� Date /3' Oo2 Application Approved by N_ Date -/7-D,? Application Disapproved for the ollowing reasons Permit No.�0000, - 3 l/ Date Issued ! --13 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Comphance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by at • has been construe ed in,accordance with the provisions of itle.5 and the.for Disposal System Construction Permit No. h)p? dated {' G ._ _. }" Installer Designer The issuance this permit shall not be construed as a guarantee that the � systmw dnd rDate Inspecto No. �U12' 31�_ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migogat *potent Congtruction Verrnit Permission is hereby granted to Construct( )Repair kA52)Upgrade( )Abandon/ ( ) System located at J ?9 �i-'4 D"..� ! ✓V• />^�l/r 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 t ' ermi;. Date: UZ Approved by _�,' TOWN OF BARNSTABLE BAR-Ws d 3764 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager ;�.-&,4 (-A 9A/(IA/ pn Address of Offender /. ) 7-71 ,�/'t". MV/MB Reg.# Village/State/Zip M A MN 1-c"), MAI Business Name ,, am/pm, on . 2Q 1 Business Address ,. LMV//7 A.,� k� Signature of nfor—ding Officer Village/State/Zip �T�,t /- Location of Offense s � t� / C� .1 c � f t- .n ` , 64L, Enforcing Dept/`biVision Offense 1, (✓ / _ 11 l 1'� t �.7t (, ! 10i j Facts tl Y 1�> f r`,' i t / � i !A rPON, 9,.. Jam_ VA,4?r) 03111 per L'. or -1 -41 �6 )r) ()#4 6/- vc- od This will serve only as a warning. At` this time no legal action has been taken. i, It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices area attempts to gain voluntary compliance. Subsequent violations will result, in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. n^„-.+ +•'trr^. •.s _ ".',�.....'s^+rr"r^F. ^.til:..:.n..s.+.r 4yp,..'o',�x" 'Y�,"K.ti 'ra.."r�r.r^u'. G�':>T '..d `a•++'M:'..v,y:ry..:.. Y }t TOWN OF BARNSTABLE BAR-W' 3764 Ordinance or Regulation WARNING NOTICE w f a /�iVA (,! _ /f/j ff. ¢ f� ( f�� `/' r1' l �l1 ( " l,:l t r I' ° d MV/MB Reg.# Address 'of Of �. ,� r , r ..,Vil'lage/State/Zips; Iw ., f # 1` ll.f� 31 < .,; At' usiriess Name` ,� am%p.m .,one 2010 Business Address signature of,/Enfording Officer. Village/State/Zip : Location of Offense ( F r # ' L 'l!i­r P, t - j Enforcing Dept/Di`visionr {` Offense' .1 Xr,. p✓ 1� + t "? ` f / �'�',.� 1 ;t Facts '; ' `" ..� €- �/ r� ° ' 4 .✓ �'f1 .f,`, II K ti..r l / 01" 47 6�''•'�'' ''al.F This will serve only as a warning. At` this .time no legal action has been taken. It is the goal of Town agencies to achieve, voluntary compliance of Town Ordinances, Rules and Regulations. Education 'efforts and warning notices are attempts to gain voluntary compliance. ,Subsequent violations will result in ' appropriate legal, action by the Town. ) $ WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK;ENS ORCING OFFICER GOLD-ENFORCING DEPT. a a S Health Complaints 01-Oct-01 Time: 12:51:00 PM Date: 4/4/01 Complaint Number: 2772 Referred To: DONNA MIORANDI Taken By: DANIELLE ST. PETER Complaint Type: CHAPTER II HOUSING Article X Detail: UNSANITARY CONDITIONS 1 - i � LOCATION SEWAGE PERMIT NO.Z�xD> VILLAGE ice• A V// INSTA L2E 'S NAME i ADDRESS BUILDER OR OWNER DA T E PERMIT ISSUED DATE C0MPLI.,AN-CE ISSUED 4,`�® �JCC ti 6 ik No........... 1...... Fnim.--... V................ THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH ��✓ �.r�''a t I ' P_ of A9gss �......C41..................OF.................................... ! (` F .._..... y� qo o`er ROBERT yG Appliration fair Bi4#ng�al narks Tomitru.rttvrt .ermff Z 6OR1 a HARRISON Application is hereby made for a Permit to Construct (Y) or Repair ( ) an Individual Sew $'sa14934;; �Q System at• Location- ddress or Lot No / _ ---• -z..!---- •---- /a Own Address ............................. .......................... ...----- Instal er Address d Type of Building Size Lot--- _e' ': ......Sq. feet U Dwelling—No. of Bedrooms___,....%'._.__-------------------------Expansion Attic ( ) Garbage Grinder ( ) I _.... No. of ersons...4_____________________ Showers — Cafeteria pa Other—Type of Building ............. p ( ) ( ) a' Other fixtures ---------------------------- - W Design Flow......... ........................gallons per person per day. Total daily.flow------------- .'j -----------------gallons. WSeptic Tank—Liquid capacity-lb. (_.gallons Length....2'r.1------ Width... Diameter--............... Depth_-_._1X........ x Disposal Trench—No. .................... Width-------------------- Total Length------ �.__.... Total leaching area------------ __._sq. ft. Seepage Pit No------I------------- Diameter.__/( ------- Depth below inlet_............... Total leaching area_.'_ ...sq. ft. Other Distribution box ('X.) Dosing to k��.. ) '`1"7V �� ~" Percolation Test Results Performed by.... ° � - f '�� ------ Date... °' .®~ aTest Pit No. Lam_ ____-minutes per inch Depth of Test Pit---J�___--__--- Depth to ground water.___w.Id' fi Test Pit No. 2................minutes per inch Depth of Test Pit__-_____.--__-__.__. Depth to ground water........................ R+' t ' i a ° .... --•------••----•-• --- Description of Soil y ( .f a -L- ` =° . -----`---- `0 =- "F=A�+°'�!. .'` '� ----- ° c / x .�,` .------.••-- A --•--------------------------------•--.----------------- =::: � � W --------------------------------------- - d UNature of Repairs or Alterations—Answer when applicable----------------------------------- -------------____-_____--___-------------.---_-_---.-------. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with f"1 T f-1�L^ the provisions of -T: - 5 of the State Sanitary Code— The undersigne -further agrees not to place'the system in operation until a Certificate of Compliance has been ids d by the 6laeal Sign d....'.. l = -----•-------- ------- ----- ot t� Date Application Approved BY - ,�= " = C+r "2-1- ----- - Date Application Disapproved for the following reasons:------••----•---------------------•----•----•---------•-----................................................... ---•--•••......--••-----•----•---•-•---•---•--••----•••--••••.......••-•-.....----•----------•••......••---•----•----------•--------------••------•-•---•--------••---------------------------••------- Date Permit No......................................................... Issued_---- _--- - --•--•------------------- Date No............ ..L-...... Fss. ............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH . ..._.....: w4j.............o......... e�!��1..��'"� -" Appliration for Uh4poii al Works Tomuurtion rami �o� ROBERT tiN GORDON rnl Application is hereby made for a.Permit to Construct ( /) or Repair ( ) an Individual Se aT0N ; System at• 1 17 LAI)r ................. • .-• _ rl _....----•--•------------• --• ---------------- - „_ f� ocatio e �14 ale 7, Pe, ]� .6 0 rw or Lot No. t -----.....__... --•--- ._._ ..-V---- ----------. .....................................................•- ! ... ._ �. Own Address W ..r Instal er Address Q Type of Building � ""^ - Size Lot--.0...... .........a.....Sq. feet' U Dwelling—No. of Bedrooms-_ ... .,,;,,.........................Expansipn Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ...............�_____ No. of persons Showers ( ) — Cafeteria ( ) Q' Other fixtures d 55 ------------- -------------------•-.......-------------------•-------------------•-------• ----••---• W Design Flow.........%!: • .% ...........................gallons per person per day. Total daily flow..............s � .................gallons. 0x Septic Tank—Liquid*capacity_��. __gallons Length... ...... Width___ .... Diameter........:....... Depth.... W Disposal Trench—No. .................... Width.:_ .....____._._.. Total Length Total leaching area___.___.______ s ft. �+ P r g a-------- g q Seepage Pit No------I------------- Diameter...!.__.------- Depth below inlet ........... Total leaching area. sq =ft: Z Other.Distribution box ( ) Dosing }k ) 47040 aPercolation`Test Results ul � Performed _-__ � ............... Date... ' 0 7 _.: a Test Pit No. 1...............minutes per inch Depth of .Test Pit___ .._.,..... Depth to ground water---------- Test Pit No. 2.__':.....:......minutes per inch Depth of Test Pit____.:......_..._... Depth to ground water........................ W .�..--- - .. _ _.. . e - Y I t -r--- O Description of Sol �.... :V! ............................... x � '' U ---.._ •• - ........... ---• . -- �-------------------•----------- t � �,,� W � - UNature of Repairs>'or. Alterations—Answer when applicable.________________________________ ____________________________________________________••-_-____. ------------------------------_--•------ -----------------------------------------•--•---•--•-•--••-•-•-•••--------•------------••----••-•---•--•------•--•-••---------•----•-••...........•-- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with rOV1S10I1S Ot lam. , the p T17T E 5 of the State Sanitary Code—The undersigne urtl:er agrees not to place the system in operation until a Certificate of Compliance has been iSs by�tli heal Sig J -_--•------- . _ Date A * 2_Plication Approve . . ...... ........... . .. - f dd BY --- - ~, �. Date Application Disapproved for the following reasons:--•---•••••---•-------•-••-----••-••--•••---• ------------------------- ...:...........•-•••-•--•---•---•--•-•---••--••-••-••----•----•-••-•---•------•---------•--•--•--•-•-----------------•-------•----•--••••-•-......-•-----------•----•---------•-----••---••-•-•--------- Date PermitNo. =------------- --•----•--- Issued....................................................... Date ..r THE COMMONWEALTH OF MASSACHUSETTS I"' BOARD O HEALTH ........ L..........o .......... . ......: :..` .. ........ ..... �. Tr irat of Tomplianrr TH CERTIF T at th :vidu ewzge Disposal System constructed ( or Repaired ( ) by ..!. ... • =....... ..... •--..... = = ' ----------------------- -------------------•-__-_-___-_-_-- inst at--- -- .--- has been installed in accordance with the provisions of ` of The State Sanitar d as described in�j he application for Disposal Works Construction Permit No-__-_ ___--. _f___________________ dated ."______. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEId'MILL FUNCTION SATISFACTORY. DATE... nr �� nspeetor .� ��.. . ............... 'xea'h4'K?t"�7�'e irk""Sz�T�?'�,f�+a'1F3#t'"3v`"`�-tN.RrW.,.�. ,ajEb'ira*S.a;Sp`��,•„5r ?'`+.'�'��dtt"`..�4#,�3+''�tt+�3 'd�;�`'_, '. .. s �p THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH !" ...... .... '1..................OF.::... . .::. .................................................... ? No......../.............. FEE.. . .--••----.... is�roo k� %_1 it ' itmit Permission, �hereby granted'.,z. - ... to Cons r r alr a In I al a 1 sal System .............? treet as shown'on the application for Disposal Works Construction emit. ._. .. Dated_.2'". /.'".. .......... G� --------------------•---- Board of Healt DATE..... ---- .........-•------•----•-•- ................................. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS - r Fee--- BOARD OF OF HEALTH TOWN OF BARNSTABLE Application for lVell Con5tructionpermit Application is hereby made for a permit to Construct ( ), Alter ( ), or R . ( an individual Well at: f —�`�'--= U s�'^'—S —�^" //s_— �`7 j Location — Address Assessors Map and Parcel Owner " Address DI Installer — Driller — Address Type of Building Dwelling_f rib ------------------------------------------- Other - Type of Building-------------------------------- No. of Persons--------------------------------- Type of Well— -------------------- Capacity-------------------------------- Purpose of Well_�s�o�_"eg r L--," ------------------ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until �a�Cerr ficate ff ompliance has been issued by the Board of Health. Signed ---------------------- date Application Approved By---- ��=�- _ ---- - --- date r `.. Application Disapproved for the following reasons: date PermitNo. - -- 1- `- 6 ---------------- Issued--_-------------------------------------------------- —_----- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TOn CERTIFY, That the Individual Wej1 Constructed ( ), Altered ( ), or Repaired (✓j Installer --------------------------------------------------------------------------------- at---- --`—---I--`---pe, --��-M4!S Tow S — AAi //(— — ---------------------------------------------------- —-- --- 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.W '5''= -Dated---------- THE ISSUANCE OF THIS,CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL ,SYSTEM WILL FUNCTION SATISFACTORY. DATE----------------------------- - — ---- --- Inspector----------------------------------------------- ---- __ 4 BOARD OF HEALTH TOWN OF BARNSTABLE lVell Con!9truct ion Permit �v -� �- No. ------- -- -- --- Fee-------- --------- Permission is hereby granted "!=-S CGc NYve J C�- ` �/`_/l``f— -- - - ------------ — - to Construct ( ),�Alter (� ), or Repair (� an Individual Well l� -- ------------------------------------------------------------------ Street --as shown on the application for a Well Construction Permit - r- - - - Dated-------------------------------------—--------------------- -- --- Board of Health DATE------------------------------------------------------------------------ No.--15 _ __---- Fee-- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*r Vell Congtructionpermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair,(r1)an individual Well at: r/ Location — Address, —Assessors Map and Parcel -------------- -------------------------- ----------(------------ ------------------ -----------7-------------------------------------------------------------- Owner Address r --=--------------------------------------------------------------------- -------------------------------- - A4----------------- -- ----- Type of Building Installer — Driller Address Dwelling---L-2-1 I -------------------------------------------- Other - Type of Building---------------------------------- No. of Persons--------------------------------------------------- Typeof Well-=a------------------------------------------------------------ Capacity------------------------------------------- - - --- -- Purpose of Well-LIB"--=T/ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed --------------------------------- ------__------------------------- date Application Approved By------ � !Q - --------- -- -- -'--'--date r `3' — J L Application Disapproved for the following reasons:--------------- -----------------------------=—_______________ ----------------------------------------------------- date Permit No. - =w �' =' ------------- --- Issued---- - - --- ----- - -___-- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of Compliance THIS IS T{OA{ C(`ERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired Installer at- - t has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection t Regulation as described in the application for Well Construction Permit No.11r 9e 3-=lam Dated------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------------------------------- Inspector---------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Yell Con!5truction j)ermit No. 1 9 ?,=�� ---- p ` Fee-- --�'------- l Permission is hereby granted- =J-`-- LC'r-'rU` (� �; �' /l - to Construct ( ), Alter (� ), or Repair (V) an Individual Well at: No. - 1 -1 ' 1 Sao w ,2 J M v . , /' t 8' ----------------------------------------------------------------------- Street as shown on the application for a Well Construction Permit No. - - 4-6---- - -----___- - Dated--------------------------------- --- ---------------------------------------------- t Board of Health DATE - --- -------------------------------- ----------- t63 . 3b s- � V � L11 A � DR VC 0 �! 1 � N �f I(D4 . t8 i 1 6UIL LOG 4 r--- �- ' ' ``'�T (�< tt, �t✓,o Coa.��t - 1 SEWAGE FlC3111 = '> Jo Gt+c /L��ir ( � pp+`} r 2. LEACHING AREA e470,- 4PO) 5 c T c.- 3. SEPTIC TANK o L a G h t•C.o na a 17.2 --4-..It. 17'Z } 4. ALL WORK MUST COMPLY WITH MASS.ENVIRONMENTAL r l,__ 1 CODE-TITLE 8 AND TOKEN BOARD OF HEALTH E T ! REGULATIONS. 5. BRICK TANK, DIST. BOX a PIT COVERS TO WITHIN !?" i Tca i a ; OF GRADE G. THERE APE '41' FELLS WITHIN 300, OF THIS PIT. 7. THERE !S NO SEWAGE LEACHING WITHIN 100' OF THIS I j i WELL. Aob !� RXSERT CO;i E• Aic !11r} f I~:, 89, tvo w'4r K VAs.r1 ONOlt r.� PERC RATE _ t Z MIN�fNGt! MATE: �1 i9 101-5 FINSH GRADE _ - Ic Aw � °• C�7GF{4m� 00 c Ion 4" __.__ Z7 i PIPE 4� --- � 'jtM a i 7yt j _` q8•zr pvc r ,, (A-,TM ✓2° 3"J S _ 4 Pvc PIPE 2" Zo 4' p��� PIPE } ��Z"-i/8'L I/p"WASHEb PITCI.1 i/4'%FT.MIN. PIT'tiH 18'/FT Nti T. PE.A57ONE q$.`�T Si _(� PITCH Ije'%FT.NSIN. � �' ice-- ---- 97.4d , _ ! t _ _�. a -I t/2 WASHED STONE FREE: OF Cl TEE 11tT7 DISC. BOX `��'Z0 � � t F!N ES,DUST,i i?OFf NO.OUTLETS= SEPTIC TANK __ 6'DiAM. PRECAST FOUNDATION / - LENGTH = g' WIDTH = 5. `!x•'t LEACHING PIT r Al d�. S EWERAGE SYSTEM PROFILE - (NOT TO SCALE) WATER TABLE R013ERT G. HARRISON SCALE � �, y zo , _ WITH SEWERAGE AT Lv7' ,3,3 W16-WRv1,-v17 PROFESSIONAL. ENGINEER DATE /-/ -QO LOT PLAN SYSTEM! ti1A&5TdA/S Mi.CL S - 944.{/S7.4451,E FLINT LOCKE DRIVE PLYMOUTH,MASS. OZ360 PROD, 2 FOR {mot'/4 /,A ' 7157-R 4 414 7— f04 s'14 d UThl MA . SH WA C; Z S YS T-EM PH 0 --JFIL-E VI-E W IV" TS<% . 34" t-/\Att. Ga✓�c� t� rcz S�scr�� Co���?oH�'N�-L TOP FOUND. EL. 9Zt�x�c't' 2 of 1/6 — 1/2 Peastone t I A. WATER TIGHT COVER o�°�° IN V. EL. F-2' L£i/EL o nt 0 FLOW LINE --------- - Total Trench .Length ?L' 52 ., IF iD' MIN. INV. EL. 88Ad i Hashed Crushed Stone Trench ;ridth � /// 10' MIN. soup 'rL. 8'T.0 3/4 1 1/2 Washed Crushed Stone „ .; 4' LIQUID DEPTH / 1_� :./_='__�"--T• e fnY �� o �, �, a• �° PROPOSED S. A. S. TRENCH SECTION INV. EL. s a,�r V. _ .. V E o No. of Trenches t PRECAST K=1i\ ORCED CONCRETE No. of 500 Gallon Precast Cbambers PRECAST REINFORCED CONCRETE SEPTIC TA.PIi' DISTRIBUTION BOX � 3/4 _ 1-1/2" Jfasbed Crushed Stone MINIMUM CONSTRUCTION MATERIALS PER 310CMR 15.226(2) INSTALL ON A LEVEL BASE TEES SHALL BE CONSTRUCTED OF SCHEDULE 40 PVC AND MINIMUM WALL TH!CKNESS SHALL EXTEND A MINIMUM OF 6" ABOVE THE FLOW LINE MINIMUM INSIDE DIMENSION = i2' OF THE SEPTIC TANK AND BE ON THE CENTERLINE OF THE SEPTIC TANK LOCATED DIRECTLY UNDER THE CLEAN-OUT -- MANHOLE. OUTLET INVERTS SHALL BE EQUAL TO EACH -_mow R v ROu7E c�°rt modoe ri,.. Ca'e�°ss Rd Wakeby. ¢ - OTHER AND AT 2' MINIMUM BELOW INLET INVERT. � ' THE INLET PIPE ELEVATION SHALL BE NO LESS THAN 2" NOR E I I y° s, Q' e m „A w; MORE THAN 3" ABOVE THE INVERT ELEVATION OF THE I D,STR!Bn-. ON LINES FROM THE DISTRIBUTION BOX �° °, I '��Rd OUTLET PIPE. SHALL A.LL HAVE EQUAL INVERTS AS DETERMINED BY FLOODING Dwelling A THE DISTRIBUTION BOX TO THE HEIGHT OF THE DISTRIBUTION bY1ih LINE INVERT AFTER ALL LINES HAVE BEEN SEALED IN PLACE. 'a, fPa! SEPTIC TANK SHALL BE INSTALLED LEVEL AND TRUE TO GRADE INVERT ADJUSTMENTS SHALL BE MADE BY FILLING WITH DURABLE Municipal wa ter ��, y-s m ON A LEVEL STABLE BASE THAT HAS BEEN MECHANICALLY AND NON-DEFORMABLE MATERIAL PERMANENTLY FASTEND TO THE o �e COMPACTED AND ON TO WHICH SIX INCHES OF CRUSHED STONE LINE OR RECONSTRUCTING THE LINES UNTIL ALL INVERTS ARE OF . Joh � � HAS BEEN PLACED TO ENSURE STABILITY AND TO PREVENT EQUAL ELEVATION. °= t- r �_eHVWay SETTLING. m SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 Proposed SAS" `�s Ra e'�� a � THREE 20" MANHOLES WITH READILY REMOVABLE IMPERMEABLE \ I c I COVERS OF DURABLE MATERIAL SHALL BE PROVIDED WITH ACCESS 1 ants � �, PORTS BEING PLACED AT THE CENTER AND OVER THE INLET AND 3Ck A-P _ ' �� , f°Xo OUTLET TEES. Te Dwlling THE OUTLET TEE SHALL 8E EQUIPPED WITHGAS BAFFLE. �th � , W , z Munzc.z al a ter 1 , , LOCUS MAP s BM. To on _ da ti Pumpa , _ P 0 _. 90 _ - El. 92.22 ii Remove Existing 0 L l i 90 Datum 14 G VD Leach Pit f t General Construction dotes d/b � 1. All the workmanship and materials shall conform to D.E.P. Title 5 and the Town of Dwelling With � 89 Barnstable rules and regulations for the subsurface disposal of sewage. Municipal water 90 Existing 1000 Gallon 2. At least one access port over tank tees shall be accessible within 6 inches of finish grade, Precast Tank with any remaining access ports brought to within 12 inches of finish grade. Proposed Note: To Remain Water service �� TP ¢ , Assessors Map 27 Parcel 29 Should soils be encountered during sewage system installation that are 3. All components of the sanitary system shall be capable of withstanding H-10 loading ,'I not consistent with soil log, contact the designer and/or your local unless they are under or within 10 feet of drives or parking. H-20 loading shall be used 11 ` ' ;' Zoning District: RF Health Department before proceeding. under or within 10 feet of drives or parking unless noted. - Overlay District: RP & IYP 4. The excavator/contractor shall verify the location of all site utilities prior to any J , , excavation. , 1�OT `91, ���,Sy� , A, / �\ ,�ti Qo Reference Plan: Land Court 34846 B 5. Sewer pipes s 20,4 71fsq.ft. 0 /hall be 4-inch Schedule 40 PVC laid at 0.02 slope. Locus is not in a flood hazard zone . ; 6. Any masonry units used to bring covers to grade shall be mortared in place. 90, ` 1 ' , s' 150' No Well ; GRAPHIC SCALE 7. Finish grade shall have a minimum slope of 0.02 feet per foot. �I° a� % % 2 o to 20 ao eo Q Soil Logs ,' ,' �� 0 ( INr ) ' 1 inch 20 it 69 Test Date.• May 30, 2002 `89 Siol Evaluator* Stephen Doyle -'. -top �N� ;r ' I ' " -- Sewage System Repair Plan DESIGN DATA: �I % , 1�st1 88 � Prepared For. Perc Rate: <2 Min/Inch STRUCTURE �IL'k _3 _% - 139 .H1 h oin t Ho d TYPE I NE BEDROOMS GARBAGE DISPOSAL ' in DESIGN FLOW �� ;' Mars tons Mills, Ma ssa ch use t is 0 i Scale: I" — 20' Date. June 10, 2002„A„ SL IOyr 3/2 - __-- SEPTIC TANK % Prepared Br »B" LS I0yr 5/6 t ��s� �oou_ s>t.P�� �t- � __ _ ______ _ ___ ___ Stephen J. Doyle And Associates 36" ___, � '--------LEACHING FACILITY 42 Canterbury Lane, E. Falmouth, MA 02536 H or,ra,�s Telephone: .508/540-2534 6►slta 11Ca �-NOF Re vis3c� � F32oc � ML''LD i � STEPHEN r�ti `�`�r�41�� Miss . SAND 2.5Y 6/4 perc 36 --- --- ' DO LE ' w f,oz�w cpn ��•QL _� tu __� WILLIAM'• �' No.3755n i� u LIfBEflMAN GRA VEL rrs 1 NA\ 120" No Ground Water Encountered IN0. 1 DATE I DESCRIP77ON BY 1 , --- 7— f l —