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HomeMy WebLinkAbout0075 MOCO ROAD - Health 75 Moco Road West Barnstable . A= 195-019 7 i Commonwealth of Massachusetts W Title 5 Official Inspection Form S u e Disposal System Form -Not for Voluntary Assessments i wM >.•'•v 76 Moco Road, W t Barnstable, MA Property Address nne Meyer Owner Owners Name information is required for every West Barnstable MA 02668 12-19-16 page. City/Town 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 j ❑ drawing attached separately A i a C T D I Q-T y 3.9' 37TT i t 3R.0► Cesspoo � 2 \ D # 6 A. 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P � �6� s •• .. ��`x , T�"�•` ..��".-,��gs��'.�~ ''•, ror`r �,� � .r.''�'+i r� a�, �, '�' �a � 'man.. wMl Y - � s�w i /��f�/� 1����r� pf SKIE TOJy, Barnstable M� Town of Barnstable ABAmedcaCI H" MAS& Board of Health MA9S a ArFc►+ '' 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi r r r January 17, 2014 Mr. Jim LeBoeuf 55 Bodick Road Hyannis, MA 02601 RE .75..Moco Road, West Barnstable " A, 195 019 „ Dear Mr. LeBoeuf, You are granted variances, on behalf of your client, Russell Moulaison, to construct a replacement onsite sewage disposal system at 75 Moco Road, West Barnstable. The variances granted are as follows: Section 397-8(E) of the Town of Barnstable Code: To install the proposed soil absorption system 87 feet away from an abutter's well at 89 Moco, in lieu of the minimum 150 feet separation distance required. Section 397-8(E) of the Town of Barnstable Code: To install the proposed soil absorption system 107 feet away from an abutter's well at 63 Moco Road, in lieu of the minimum 150 feet separation distance required. Section 397-8(E) of the Town of Barnstable Code: To install the proposed soil absorption system 80 feet away from an onsite well, in lieu of the minimum 150 feet separation distance required. The variances are granted with the following conditions: (1) No more than two (2) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. Q:\WPFILES\LeboeufN4oulaison75MocoRoadVariances2Ol4.doc � r z —pg ET i i (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to two bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. (3) The well_water shall be sampled prior to the issuance of a disposal works construction permit. The water sample sh II be an lyzed at a c rtified laboratory. �jv1 _ ('S7 C v— ��..� �ar- o'/I iD-/ , (4) The septic system shall be installed in,strict accordance with the submitted plans dated December 20, 2013. I (5) The designing registered sanitarian shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the submitted plans dated December 20, 2013. These variances are granted because physical constraints at the site severely restrict the location of the septic system components due to the locations of the abutter's private well and wetlands adjacent to this property. The proposed new septic system appears to be designed to meet the maximum feasible compliance standards contained within the State Environmental Code, Title V. Sincere-ly yours, ? Wayne Mil�'er, M.D. Chairman Q:\WPFILES\LeboeufMoulaison75M6coRoadVariances2Ol4.doe (emu-,-ci Op IKKE DATE: FEE: HARrig—rAM;, MASS. 1639. REC. BY & Town of Barnstable SCHED. DATE: Board of Health TV1 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul J.,Qa'hniff,P,*.D. VARIANCE REQUEST FORM LOCATION Property Address 000 '90�p , W F,�< 13 1 73 Assessor's Map and Parcel Number: Size of Lot: 0159 1 Wetlands Within 300 Ft. Yes Business Name: No—Z Subdivision Name: i rrp AA"I APPLICANT'S NAME Ayj It"W120 Phone ;E592 Did the owner of the property authorize you to tepresent him or her? Yes No PROPERTY ONVNER'S NAME CONTACT PERSON Name:-gVt�-C, MWGAI�0 Name: Address:76 M060 ' Pi 1�00 ddress: Phone: 606,-;)G2,- 1-477-2- Phone: ��- ��7 VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) or— IZ7- ��10411 '-70 A I I ATURE OF WORK: House Addition ❑ House �j Vjj1jWqCfr pL Renovation M Repair of Failed Septic System Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. — Four(4)copies of the completed variance request form — Four(4)copies of engineered plan submitted(e.g.septic system plans) — Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian — Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) — Full menu submitted(for grease trap variance requests only) — Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) _ Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\BAJ9P9B7\VARIREQ.DOC i BY DATE WRIGHT-PIERCE .� SHEET NO. OF Engineering a Better Environment CHCKD. BY DATE PROJECT NO. PROJECT BOOK NO. 00 1 lb 1 s to � 7 l?lzi XTH Z�fI 17ND <1 L Mao 2 - T-De-;Ee M, 02, iz, �5o Feo�q LMDL � Ccw, L5 �t 0 1 'e-b\ q e� MOLD �6P � SDI BY ..r DATE WRIGHT-PIERCE =;" SHEET NO. OF Engineering a Better Environment CHCKD. BY DATE PROJECT NO. PROJECT BOOK NO. ��FODEL��--7 U�72 Lti)71t, 5FF-VE � December 30, 2013 Dear Abutter, You are in receipt of,.his notification because you own property that abuts 75 Moco Road in West Barnstable. The property owner of 75 Moco Road, Mr. Russell Moulaison is upgrading the cesspools which have failed anc requires continual pumping. You are notified as an abutter because variances are required from the Barnstable Board of Health for the approval of the new septic system for 75 Moco road being designed by this office and will be discussed at a Board of Health meeting on January 14, 2014. Please be aware that the variances are specifically to private wells. Those wells affected are as follows; #63 Moco Road; The proposed Soil Absorption System is proposed to be 107' from the private well servicing this property. #89 Moco Road; The proposed Soil Absorption System is proposed to be 87' from the private well servicing this property. If your property is not listed above then your well is outside the required setback requirement from the proposed Soil Absorption System(septic system) for 75 Moco Road. The proposed septic plans for the upgrade of the failed cesspools can be viewed at the Barnstable Health Department or call the Health Department at 508-864-4644 with any questions. Or, you may contact David Mason, RS, the designer of the proposed septic system at 508-367-1617. Sincerely, David B. Mason, RS 75 Moco Road, West Barnstable It is my opinion that this property's plan that has been presented for a variance is in Maximum Feasible Compliance. The owner had a new well put in last year and the new components of a septic tank, d-box and leaching chamber will be much better than 3 very old cesspools on the property. Groundwater flow is in the direction that it would not adversely impact anyone's private well including the applicant. �OF IME Tp� 15 DATE: 03 ti0 —01 r FEE: r * BARNSTABLE, �• y MASS. s639. `0� 1 REC. BY � AtFON�IA Town of Barnstable SCHED. DATE: Board of Health 7 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 ' Wayne A.Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi " ' r Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION A o Property Address: +"I Assessor's Map and Parcel Number: 1� I Size of Lot: 0.139 l`- Wetlands Within 300 Ft. Yes Business Name: Njo� e� IAA Subdivision Name: I / APPLICANT'S NAME: ( I : ' t" Phone '"3k�7s 6 fD Did the owner of the property authorize you to tepresent him or her? Yes _�/ No PROPERTY OWNER'S NAME 1 f� �"'1 CONTACT PERSON ,R�SON / Name:_ t/�7/ � MDxAP ✓�0 Name: C� Address:—76 M0U) ,0 1%W ddress: m,,-jV 4 t7l Phone: 5Q ?�2to� L��� Phone: jl� ` MANCE OM REGULATION(List Reg.) REASON FOR VARIANCE May attach if more space needed) b °10tVC 5- ' t"FL ATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. Four(4)copies of the completed variance request form our(4)copies of engineered plan submitted(e.g.septic system plans) Completed seven(7)page checklist confinning review of engineered septic system plan by submitting en g 4e p reegistere sdManan .y Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen _/Signed letter stating that the property owner authorized you to represent him/her for this request k - ,,,Four understands that the abutters must be notified by certified mail at least ten days prior to meeting date''af applicant's ex; ense 6 r' Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) `" 4 ,.j -' Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only], outside dining variance renewals[same owner/lessee only],and variances to repair failed sewage disposal sys4ms[only if no;opansi..o the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman ,>•.... NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\BAJ9P9B7\VARIREQ.DOC {ZI31I Zol ✓ WP,- A� -�;Ccgi �, `�cv.>ic� Wawa � �S �vwissio ,,l i BY DATE WRIGHT-PIERCE SHEET NO. OF � Engineering a Better Environment CHCKD. BY DATE PROJECT NO. PROJECT BOOK NO. Moo z0 PD�Tl) s l0 71 l?lz} Z,�2 1 XTH Z'1 1 17&(D M, 02, Fen IZ 15010,10 -Pao P, BY DATE WRIGHT-PIERCE SHEET NO. OF Engineering a Better Environment CHCKD. BY DATE PROJECT NO. PROJECT BOOK NO. �AT`2' 2� � � C) a , December 30, 2013 Dear Abutter, You are in receipt of this notification because you own property that abuts 75 Moco Road in West Barnstable. The property owner of 75 Moco Road, Mr. Russell Moulaison is upgrading the cesspools which have failed and requires continual pumping. You are notified as an abutter because variances are required from the Barnstable Board of Health for the approval of the new septic system for 75 Moco road being designed by this office and will be discussed at a Board of Health meeting on January 14, 2014. Please be aware that the variances are specifically to private wells. Those wells affected are as follows; #63 Moco Road; The proposed Soil Absorption System is proposed to be 107' from the private well servicing this property. #89 Moco Road; The proposed Soil Absorption System is proposed to be 87' from the private well servicing this property. If your property is not listed above then your well is outside the required setback requirement from the proposed Soil Absorption System(septic system) for 75 Moco Road. The proposed septic plans for the upgrade of the failed cesspools can be viewed at the Barnstable Health Department or call the Health Department at 508-864-4644 with any questions. Or, you may contact David Mason,RS, the designer of the proposed septic system at 508-367-1617. Sincerely, David B. Mason, RS TRANS. NO.: CITY/TOWN: APPLICANT: g-�y ADDRESS: 50� DESIGN FLOW: gpd REVIEWED BY: DATE: N/A OK NO GENERAL Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot,tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided [310 CMR 15.2204(t) Plan proper scale?(1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways,parking areas etc.) 01 [310 CMR 15.220(4)(d)] Ao Location all buildings existing and proposed 310 CMR 15.220(4)(c) Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(01 daily flow septic tank capacity(required andprovided) soil absorption system(required andprovided) whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) 310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and(i)] 01 Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? [310 CMR 15.242 Certification statement by Soil Evaluator[310 CMR 15.220(4)0)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n) Address MOGO P-DA 9 Sheet 1 of 7 N/A OK NO Location of every water supply,public and private, [310 CMR 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply —�z within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. / beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15.211 1) 1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate(two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405 1 k) Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? 310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR 15.0001 System components not> 36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405 1 b ] Address �� Mow ' J d/ Sheet 2 of 7 N/A OK NO SEPTIC TANK Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line 310 CMR 15.227(6)] Outlet tee 14" or 14" + 5"per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter 310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees(no less than liquid depth) 310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<I 000gpd, two fors stems>1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211 1) Buoyancy calculation Required/Done 310 CMR 15.221(8)] H-20 Where a ropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] Multi-Compartment Tanks Required when other than single-family dwelling or flow>1000 gpd[310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and 3)] "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] Address �5 no " Sheet 3 of 7 N/A OK NO BUILDING SEWER AND OTHER PIPING Located at least ten feet from any water line? [310 CMR 15.222(2)] Disposal piping at least 18" below water line(when water and sewer cross, see 310 CMR 15.211(1)[1]) Cleanouts required/provided? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphonproblem/(leachfield below pump chamber) Endca s or vent manifoldspecified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) DISTRIBUTION BOX Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sum 6" [310 CMR15.232(3)(e) Watertight cover,if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] PUMP CHAMBERS Capacity(emergency storage above working=design flow)? [310 CMR 231(2)] Proper setbacks 310 CMR 15.211 same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] 1Z Service components accessible (not too deep with piping, disconnects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and(8)] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed ?1Prrovi�deedp? [310 CMR 15.22 1 ) Address —'+ 7J V y lliL.tJ —Oft/ Sheet 4 of 7 N/A OK NO SOIL ABSORPTION SYSTEMS (SAS) GENERAL Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] Inspection ports specified and within 3"final grade? [310 CMR 15.240(13) Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(l)[4] and Guidance Document] GALLERIES,PITS,CHAMBERS 310 CMR 15.253 Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole(if>2000 gpd must be to grade) [310 CMR 15.253(2)] Aggregate I' minimum-4' maximum. [310 CMR 15.253(l)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a) In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)] TRENCHES 310 CMR 15.251 Width T minimum 3'maximum 310 CMR 15.251 1)(b) 100 feet-maximum length [310 CMR 15.251(1)(a) Minimum separation 2x effective depth or width whichever greater(3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? 310 CMR 15.211(1)[4] and Guidance Document] BED SAS (Maximum size of bed or field 5000 gpd) minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' 310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. 310 CMR 15.252(2)( ) Separation between beds 10' minimum. 310 CMR 15.252(2)(0] Bottom area used in calculations only [310 CMR 15.252(2)(i)] Address 1 Now Sheet 5 of 7 N/A OK NO DID THE PLAN INVOLVE Pressure Dosed System ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system- make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year(systems<2000 gpd) or quarterly (>2000gpd) good to note on plan [310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255 3)? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer[310 CMR 15.255(2)(b Retaining wall must be designed by Registered Professional Engineer [310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] Gravelless System[I/A Approval Letters] Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Alternative Septic System[UA Approval Letters] Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance Variances Are the variances listed on the plan? [310 CMR 15.220 4)( ) . RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.414] Address -�15 M060 40V Sheet 6 of 7 I , N/A OK NO Nitrogen Sensitive Areas Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? 310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] Miscellaneous Pumping to septic tank? [ 310 CMR 15.229] Shared System [310 CMR 15.290] Address ?� M06D Sheet 7 of 7 COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature Item 4 If Restricted Delivery Is desired. ❑Agent X ■ Print your name and address on the reverse ❑Addressee so that we can return the card'to you. eceived by(Printed Name) C. D of el' ery ■ Attach this card to the back of the maiiplece, V ' or on the front if space permits. � 1. Article Addressed to: � . D._Is delivery address different from item 1? Ye If YES,enter delivery address below: ❑No 3. Servi e rtifled Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number + ':1 7 010 0 2'9 0 040 0 2 t 1912 10,43� (transfer from service label) i PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 .y UNITED STATES.I?OSTAL-SE N1 G w..�.... , a. S, .., � . .�s�xoe r, e....:k. .:.t:. SS:,. OStElgV SPS i:kOtt it o: =4.9;�z:M;;, .. e.. • Sender: Please print your name, address, and ZIP+4 in this box • I ,n +qD vtnl i �iiiii.l�li+jl�►i»���iJi����i�,lip,�„��ii��,���"��i,�i��ti�11�� COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Si at e item 4 if Restricted Delivery is desired. % ❑Agent ■ Print your name and address on the reverse X Q3 Addre see so that we can return the card to you. B. Received by(Pri ted Name) C. D e of D very ■ Attach this card to the back of the mailpiece, , or on the front if space permits. D. Is delivery address different from item 17 ❑Ye "1. Article Addressed to: If YES,enter delivery address below: ❑ No 10 3. se a Type Certffied Mail ❑Express Mail ❑Registered ❑.Return Receipt for Merchandise El Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 12. Article Number — (Transfer from service label) `.l 7 0;10 2 5 0 +0 2 1;912 1 5 -� LPS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STA E 'IBCMKSWOM ostagr;' F; Paid • Sender: Please print your name, address, and ZIP+4 in this box • I I z4 a,�,��.rl�a�►,,1»:lit ,:}�,�,i��t�l�i�,�,���„�.i�t,�li�f�:1���,�•��,i COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete Items 1,2,and 3.Also complete A. Sigri Item 4 If Restricted Delivery Is desired. �l("`~ [3 Agent ■ Print your name and address on the reverse G-G ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front If space permits. 1. Article Addressed to: f j,D� s delivery a!'re, different from item 1? ❑Yes I l If YES,eelivery address below: ❑No 00 45. �J 1"4 � � 3. Servi e I rtifled Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise v ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Numbert I f 1+7 0+100 j 0 290 6 O`a 2 1912' 1'0 744 (Transfer from service label) PS Form 3811, February 2004 Domestic Return Receipt )�02595-02-M-1546 UNITED STATES POSTAL SERVICE First-Clas&,Mail Postage&Fees Paid LISPS Permit No.G-10 I I • Sender: Please print your name, address, and ZIP+4 in this box • I 9 6"' --•, .«: a k:t0--14 1 ,.illij:,fl!„jl „��1,flJtllllf�Nl�ll�„!,f„i„l��i'Ijif"f111 �, c.:J i•.r COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signatu Item 4 If Restricted Delivery is desired / '/ �� ❑Agent ■ Print your name and address on the reverse �s ❑Addressee so that we can return the card to you. B. Received by(Printed ame) C. Date of Relive ■ Attach this card to the back of the mailpiece, �,� (� C �!, or on the front if space permits. ` D. Is delivery ad different from Item 1 T ❑Yes 1. Article Addressed to: If YES,er , delivery address below: ❑ No QFCertified Mail ❑Express Mail �� ❑Registered ❑Return Receipt for Merchandise til ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number ! f701d 029 91 -l8 0002 14'8 (Transfer from service label) PS Form 3811,February 2004 Domestic Retum Receipt 102595-02-M-1540 l UNITED STATES POSTAL SERVICE EP .Mail Fees PaUSPid G-10 I I I • Sender: Please print your name, address, and ZIP+4 in this box • I I c COMPL&E THIS SECTION • • ON DELIVERY ■ Complete items 1,2,and 3.Also complete A.-signature `item 4 if Restricted Delivery is desired. n,. / ❑Agent ■ Print your name and address on the reverse L('.L' (�'-� ❑Addressee so that we can return the card to you. Received by fin`1) Name) M f Delive . ry ■ Attach this card to the back of the mailpiece, h (/tea A or on the front if space permits. 1. Article Addressed to: D. is deli Very address differen ,1? ❑�& fA If YES,enter delivery addre low: � o � 0, 0A ` 3. Service e rtified Mail [3 Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number'- ,:7010 0290 OUG2- 1912 L110-4 1 (Transfer from service la6e6 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 ..... ..... ...... ..... UNITED STATE!9�P�81tWIM",'Z... 6sta.,gq es Paid -IJ PS P 0-)eft 7-1 • Sender: Please print your name, address, and ZIP+4 in this box • Map ^` Page 1 of 1 Town of Barnstable Geographic Information System New Sear Parcel Viewer F Custom Map Abutters Map Size [3 E❑ Zoom Out a a a n o n a n 1in ® ■• ay Q ..+— _` ® �_3PG Map: 195 Parcel: 019 d•... �, , ,� „j! h 4 ,} t, "' * Owner: MOULAISON,RUSSELL D&ANN F ]q 1014 4 - �� ,� 105015 ff i. r Location Information to t N76if 4 Map&Parcel 195019 Location 75 MOCO ROAD k ! Acreage 0.39 acres 1 Current Owner ��, .� s +• � �� �r _ r or`�l. '{ Mailing Address MOULAISON,RUSSELLD } MOULAISON FAMILY NON 4a`.M �y� 75 MOCO RD . y ,� ,} •i 41 . ,r ''{ } WEST BARNSTABLE,MA I Appraised Value(FY 2014) 1N103 • f' ,, , : t Extra Features $33,500 105020_"t�, p t t t1 Out Buildings $0 0.-1' .l •, Land $165,400 5 •t 3r;7' ! � w s i C! ! E Buildings $99,700 012 215005 ! t Total Appraised $298,600 t+ �y x f . N + +{� Y '+�-.� .� ,� 215004 Assessed Value(FY 2014) Extra Features $33,500 �r tilt t i �? Out Buildings $0 Land $165,400 I ...j. +1q 1; tw t.16 "..,,,`,+„� •y #"i` _ l if1� 1 Buildings $99,700 '> ye Total Assessed $298,600 j '. .. '• t�Iy A Y ao24i t sal f t " Construction Detail Style Ranch _ x� Model Residential 105 x2892 ~T j, ,tl . 195028oG7 ** Grade Average r • �.. 128 ,' Stories 1 Story k A 1 tit 1l, � t}. • t. 2^ - Exterior Wall Wood Shingle Roof Structure Gable/Hip f( •t Roof Cover Asph/F GIs/Cmp Ilk. • "' Interior Wall Typical .'t -55 Feetk - 4 �✓." Interior Floor Typical _ Heat Fuel Electric Heat Type Typical Set Scale 1"=55 j I April 2008 I MAP DISCLAIMER AC Type None Copyright 2005-2010 Town of Barnstable,MA All rights reserved.Send questions or comments to GIS BamstableMA v1.2.5115[Production] I http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=195019 1/8/2014 'Map Page 1 of 1 Town of Barnstable Geographic Information System New sear Parcel Viewer Custom Map Abutters Map Size � 13 El Out D p p p a O fl O 81n �t % I ,.ri N`_ ® Q_3PG Map: 195 Parcel: 019 Location: 75 MOCO ROAD Owner: MOULAISON,RUSSELL D&ANN F 195014 g104 8501/ ,8 +19591e Location Information pM , p73 _ 1500 D s Map&Parcel 195019 2 8 - � .y .' • �'�'�}*�A Location 75 MOCO ROAD Acreage 0.39 acres �� tl ��" �� �`-' `^+*� �• � t Current Owner :_,_ ,r �[t �{, ` Mailing Address MOULAISON,RUSSELL D M -,� �' MOULAISON FAMILY NON 75 MOCO RD WEST BARNSTAB Al LE M APPraised Value(FY 2014) Extra Features $33,500 q 107 �'1t a 1N5029 �• * ,,�-"'^"*' +• ' r Out Buildings $0 f ,e : r - Land $165,400 � ,� 195019 � E Buildings $99,700 _e- a 2��, 4 2p500503 Total Appraised $298,600 3 1 8 t 215M4 ti Assessed Value(FY 2014) k Extra Features $33,500 Out Buildings $0 Land $165,400 Buildings $99,700 Total Assessed $298,600 „ •'it, ' G • 1" Construction Detail ,,�. P � , �. i " :.i ! "X. Style Ranch q 1 t It Model Residential r •,`. 195028042 �J {•,. �. .b a 1030290WR -�R-t Grade Average 4 t i R28 i s�### 121 3> Stories 1 Story Exterior Wall Wood Shingle Roof Structure Gable/Hip r Roof Cover Asph/F GIs/Cmp nC Feet ' Interior Wall Typical K lr Interior Floor Typical 1r Meat Fuel Electric Heat Type Typical Set Scale 1" jAprill 2008 I MAP DISCLAIMER AC Type None Copyright 2005-2010 Town of Barnstable,MA All rights reserved.Send questions or comments to GIS BamstableMA v1,2.5315[Production] i http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=195019 1/8/2014 Map Page 1 of 1 Town of Barnstable Geographic Information System New sear Parcel Viewer Custom Map Abutters Map Size [3 ❑❑ Zoom Out n e n n n e n Gin ® dj 1=IPG Map: 195 Parcel: 019 Location: 75 MOCO ROAD Owner: MOULAISON,RUSSELL D&ANN F 41 M 104 - �•1950/5 /y 16 1 /Ffy • f LOca[iOn IilfOrma[IOn 1 X75 '^ ^ �'„j0y Map&Parcel 195019 cy,' L.b" ,2X507 Location 75 MOCO ROAD .14•r "`iJ 1 Acreage 0.39 acres 'ry 4` • 4^ �'""1(�, �...fit� «... ` Cu(rent Owner MOULAISON,R USSELLD y Mailing Address 1 1 •.. ,.' a • 1.'. MOULAISON FAMILY NON ( f 75 MOCO RD WEST BARNSTABLE,MA I M u.. . \ �i - Appraised Value(FY 2014) Extra Features $33,500 X 103 '19502D s fi 4 ^, ��'"�•'r ,� w , Out Buildings $0 t�, p89 ( ; „fit ,t { Land $165,400 c{1 4 195010 o r, ' E Buildings $99,700 I { r - ( .} a _ �_�. O ,gin • 2 �' ' C I. Total Appraised $298,600 N521500 005 X 45- Assessed Value(FY 2014) Extra Features $33,500 y " •t4 r Out Buildings $0 Land $165,400 Buildings $99,700 i Total Assessed $298,600 Detail Style Ranch ie 7 Model Residential fitt` j 4y t $ 195028942y, Grade Average a, l .• �' .` f4 ,. r Xta ,g Stories 1 Story Exterior Wall Wood Shingle Roof Structure Gable/Hip %c Roof Cover Asph/F GIs/Cmp Interior Wall Typical { I{ t rt S Feet t i 1 t`:ar."" Interior Floor Typical sWh,vv' y�TT 1 � Heat Fuel Electric -•---w Heat Type Typical Set Scale 1"=55 _ I April 08 I MAP DISCLAIMER AC Type None 20 _ Copyright 2005-2010 Town of Barnstable,MA All rights reserved.Send questions or comments to GIS BarnstableMA v1.2.5115[Production] http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=195019 1/8/2014 Map Page 1 of 1 41, Town of Barnstable Geographic Information System New Sear Parcel Viewer stom Map Abutters Map Size [3 ❑ Zoom Out Q L 0 Q �In Cu IPG Map: 195 Parcel: 019 Location: 75 MOCO ROAD i' 4`^r� ki "' Owner: MOULAISON,RUSSELL D&ANN F Ij 9104 - 19 k * •} ':: % w I) 5015 ` 501 h teSYta t - �, f Location Information 'a4 Y1 . A4 Map a Parcel 195019 " .e. Location 75 MOCO ROAD Acreage g 0.39 acres f , `t `"""'x�r Current Owner s Mailing Address MOULAISON,RUSSELL D ` ``4 K'. '�+ t •. 7 't ° ,( MOULAISON FAMILY NON 75 MOCO RD�` N 4!OcO� WEST BARNSTABLE, f' t - 4 o r Appraised Value(FY 2014) Extra Features $33,500 JI �' t850x0 ` 1 *' _• t Out Buildings $0 a* .1. {' fy,' Land $165,400 10�59 r i _. r f @ Buildings $99,700 • t ' 1 ..�- 4 , r. 4 2t5005 ! (' Total Appraised $298,600 ate• aooea Assessed Value(FY 2014) Extra Features $33,500 T ! s.. r. i - '"^' r •, �.: € Out Buildings $0 V- 4, ! -,.., ;,Tc. Y: t~"!'rSvwee ,,. v. ,t Cr, Land $165,400 17 j` Buildings $99,700 t ! Total Assessed $298,600 1e5oxa 4A !rQ R rt Construction Detail at2e t } rr i. ,.,� S Ranch tyle Model Residential • C1• -` L b _ rn . 19502a0a2 r• � 3 1050xa040 .z 'a, ke Grade Average I ;. Y28 � �� y �{ '.� ,. a20 Stories 1 Story Exterior Wall Wood Shingle Roof Structure Gable/Hip > •,' r �,�1,,. h Roof Cover Asph/F GIs/Cmp Interior Wall Typical Interior Floor Typical 1 Heat Fuel Electric —� w•_ Heat Type Typical Set Scale 1"=55 ! I April 2008 I MAP DISCLAIMER AC Type None copyright 2005-2010 Town of Barnstable,MA All rights reserved.Send questions or comments to GIS BarnstableMA v1.2.5115[Production] I http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=195019 1/8/2014 Map " Page 1 of 1 Town of Barnstable Geographic Information System New Sear Parcel Viewer rn,C/u�stom Map Abutters Map Size 0 ❑ Zoom Out l a l O L Q 11 flIn m --+��,�— F[ ® IPG Map: 195 Parcel: 019 Location: 75 MOCO ROAD Owner: MOULAISON,RUSSELL D&ANN F 195014 p.104 195015 p88 195018 ® Location Information a 70 215008 alp Map&Parcel 195019 2t5997 Location 75 MOCO ROAD a 50 Acreage 0.39 acres 4fOCO Ko Current Owner Mailing Address MOULAISON,RUSSELL D MOULAISON FAMILY NON 75 MOCO RD WEST BARNSTABLE,MA I `~�.. 195021 Appraised Value(FY 2014) I 4103 19502 Extra Features $33,500 0 Out Buildings $0 q 99 - 195019 Land $165,400 a75 E Buildings $99,700 215005 I Total Appraised $298,600 963 215004 am Assessed Value(FY 2014) Extra Features $33,500 Out Buildings $0 Land $165,400 Buildings $99,700 Total Assessed $298,600 195024 Construction Detail 9125 _ Style Ranch �j�ZModel Residential 195002880G2 195028043 Grade Average 020 / Stories 15[ory Exterior Wall Wood Shingle Roof Structure Gable/Hip Roof Cover Asph/F GIs/Crop 0 5 Feet Interior Wall Typical Interior Floor Typical Heat Fuel Electric Heat Ty pe Typical Set Scale 1"=55 I Aerial Photos I MAP DISCLAIMER AC Type None Copyright 2005-2010 Town of Barnstable,MA All rights reserved.Send Questions or comments to GIS BarnstableMA v1.2.5115[Production] I http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=195019 1/7/2014 Town of Barnstable P# ' Departiment of.Regulatory Services RAMSAHM : Public Health Division Date f MASS. a6J9 .200 Main Street,Hyannis MA 02601 A�FD MP'I � 1 An'Tinie G�Date Scheduled � — Fee Pd. A Sail Suitability A ssessment,f®r Se e"b" Performed By: Witnessed By: .•• , LOCATION& GENERAL INFORMATION Location Address ,>,&- ® C Owner's Name a 4 O/` Address Assessor's Map/Parcel: 11,9 6­ 37 Engineer's Name / NEW CONSTRUCTION REPAIR _ Telephone# Land Use Sloes 'Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft r Drainage Way ft Property Line ft Other ft SICETCII:(Street name,dimensions of lot,exact locations of test holes& erc tests,locate wetlands in proximity to holes) �Z o Z rn Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Race Estimated Seasonal High Groundwater DETERDRNATION FOR SEASONAL IIIG111 WATER TABLE Method Used: Depth Observed standing in obs.hole: In. Depth to soil mottles: itt. Depth to weeping from side of obs,hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj,factor- Adj.Groundwater Level 'PERCOLATION TEST Date_m � Thee Observation Hole# - Time at 9" Depth of Perc �t uf- Thne at 6" v -� Start Pre-soak Time @ T'tme(9"-6") End Pre-soak ' Rate Min./Inch Site Suitability Assessment: Site Passed Site Failedr Additional Testing Needed(Y/N) Original: Public Health Division Observation IIole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation]Division at least one (1) week prior to beginning. q:\SEPTICU'ERCrORM.DOC r DEEP"OBSERVATION BOLE LOG Bale# — Depth from Soil Horizon Soil Texture .Soil Color Soil" Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. onsistency.%Gravel) 0 - 17 /a 2311 7 DEEP OBSERVATION HOLE LOG Halle# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. .onsistency,%Gravel) DEEP OBSERVATION HOLE LOG Hale# Depth from Soil Horizon Soil Texture Soil Color e Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Con i to c Gravel) ]DEEP OBSERVATION DOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, --Consistency, s� Flood Insurance Irate Map: / Above 500 year flood boundary No_ Yes Within 500 year boundary No y' Yes _ Within 1W year flood boundary No. ✓ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious terial exist in all eas observed throughout the ` area proposed for the soil absorption system? If not,what is the depth of naturally occurring pery ous matertal? Certification I certify that on b (date)I have passed the soil evaluator examination approved by the Department of Environ4lenthl Protection and that the above analysis was performed by me consistent with . the required training,expe end ex erience described in 510 CMR 15.017. Signature Date 1-2bG� Q:\SBPTiCkPERCPORM.DOC Town of Barnstable IKE Regulatory Services Richard V. Scali,Interim Director * snexsene[e, 9�AHAS& ��� Public Health Division rE1639. A Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: �5 vt Sewage Permit# Q/� / Assessor's Map\Parcel Designer: , Installer: ✓AJ �4L Address: �J �11J�( '� Address: tA4_l-(_7 On ZI 2DI4 � 1�/� M., as issued a permit to install a (d te) (installer) septic system at based on a design drawn by ((address) V` ,C�dated ZD 'Z.D designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed ' ance with the terms of the 1\A approval letters(if applicable) F 41 DAVID i (Installer's Signature) o MASON y I7, v ,, No.1066 � r�� STEP' Z: :�:)tD�esig 1 ignature) (Affix Desi p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Designer Certification Form Rev 8-14-13.doc David B. Mason, RS 4 Glacier Path East Sandwich, MA 02537 Location; 75 Moco Road, West Barnstable, MA 02668 Type of Inspection; Installation Installation Date; February 25, 2014 Issued Date; March 14, 2014 The Installation of the Title V septic system at the site referenced above was determined to be in compliance with 310 CMR 15.000 and the Town of Dennis Board of Health Regulations per the design plan prepared by David B. Mason, RS., but in no way shall the issuance of this construction installation compliance be construed as a guarantee that the system will function as designed. David B. Mason, RS, i TOWN OF BARNSTABLE LOCATION � � p d SEWAGE# VILLAGE • 4-T11-�';01r1ASSESSOR'S MAP.&PARCEL AP INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) d-0-404rt C1 W6','r(size) NO.OF BEDROOMS o� OWNER PERMIT DATE: I--�1 J1� COMPLIANCE DATE: a ill Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility O 3 -feet Private Water Supply Well and Leaching Facility(If any wells exist on` site or within 200 feet of leaching facility) ��/I�' Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) �/`� Feet FURNISHED BY �Z iGf1 T S i�g a _ rg - ;I"I 1 - DL s-. s- °� /o Tip A,,e �- l , ` 7 �It 1,0 A`G�� Fee THE COMMONWEALTH OF MASSA HUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS IpYILAtIDtt for ;Disposal 6psteUt CoriBtCU tIOYCPCUtit Application for a Permit to Construct(Repair( ) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No..,>, -- � Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Y o .l� 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 -Or .�' No.of Persons Showers( Cafeteria( ) Other Fixtures Design.Flow(min.required) ��4 gpd Design flow provided 9. gpd Plan Date "'�a �>%' Number of sheets / Revision Date Title Size of Septic Tank Type of S.A.S. _L Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o e lth. Sri )d n Date Application Approved by /L Date Application Disapproved by Date for the following reasons Permit No. ,U Date Issued 2 N �,, -o l o. �. / 7 Fee a THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 4 PUBLIC HEALTH DWISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes. 2ppYication for 33isposal-6pstem Co7Compl'ete ion permit Application for a Permit to Construct //Re air Upgrade( Abandon S stem Individual Com onents PP (�') P ( ) Pg ( ) ( ) Y ❑ P Location Address or Lot No,J j— v A/ Owner's Name,Address,and Tel.No. Assessor's Map/Parcel /� �� /V 0 Gov f f�c°� fllo v��/✓�°i�! Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 7 S"0,07 1 Type of Building: n P v� .. Dwelling No.of Bedrooms Lot=Sze ,�a.,., sq.ft. Garbage g Grinder( ) Other Type of Building 0V 4!P No.of Persons Showers( ) Cafeteria Other Fixtures Design Flow(min.required) -:1D 0 gpd Design flow provided 39, 6 gpd Plan Date -Z "-Z c' -/y Number of sheets /:. ._ Revision Date Title Size of Septic Tank Type of S.A.S. M U u ^ 1 U^ t GM Description of Soil. I i Nature of Repairs or Alterations(Answer when applicable) ) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o e lth. Sig �d G�n r Date Application Approved by / 2 1 Date Y Application Disapproved by Date for the following reasons Permit No. 2 0 U f Date Issued ` '21�' y ------------------------------------------------------------------------------------------------------------------------------------------ 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 hl ��©�`U/� �-�`/C f'y C at r /!7 d G e QG'!> Zfi.�sjw. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.) r) % _U1 dated f f Installer nl �c�$G'C-`�I DesignetS&ff iip OOFs n. #bedrooms c1b P ; re jl- ' Approved design flow a 11A gpd The issuance of this permit sh 11 not be o s ed as a guarantee that the system w'II ncI'on as designed. Date Inspector ' ,� J/ j•� ------------------------- - - No. ��N_ A/-7 Fee ( �G THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction J)ermit Permission is hereby granted to Construct(41"' Repair( ) Upgrade(� Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. j Provided:Construction must be com 1 ted within three years of the date of this permit. Date - f - Approved by ` U v 1. k 27939 IPo l4 o 207`5 a 12 e 28ra s7 , DEED RESTRICTION The Barnstable Board of Health requires that the following notification be placed on the property deed; The Massachusetts Department of Environmental Protection and as interpreted by the Barnstable Board of Health require that the owner'be aware that the leaching facility installed is designed to accommodate two (2) bedrooms and the dwelling shall remain as two bedrooms due to variances to the abutting private wells, at the property at: 75 Moco Road, West Barnstable, Massachusetts, Map 195, Parcel 19, as currently owned by Russell D and Ann A Moulaison, 75 Moco Road, West Barnstable, MA, as property referenced in the Barnstable Registry of Deeds as Book 13339, Page 297. I, ,GkSfeGG r /Va azoi Sod and 111W.,4• /91dVWAe)1V as the owners/executors of the property/trustee referenced above acknowledge the deed restriction(s) being placed on the property. Owners/Executor Signature Date A#.nrr4.L �. u1.9! -W The person named above: -fwW 4. AOU4AISu , acknowledges the foregoing instrument to be his/her free-act and deed, before me. ```````,%S U i IINhi��r�,. is§io �� • MM ro' Q 11-201+ ' of Public 6 P�; N p •.,, My Commission Expires: // d/� `.�y�p ,�� ; :''� •, �i�T I?Y PUS G�.``z:= h• , et (;. .7�J ;;"'•meµ' •` • �► :; V. �s • S'�•h1 t!,'C 8ARNSTABLE REGISTRY OF DEEDS � G1 r1 L✓✓1 g i -------------- muco aar � ',jS5e 1/ 4n" Aug 0511 11:28a Cape and Islands Engineer 508-477-9072 p.1 CAPE & ISLANDS ENGINEERING suMMERFIELD PARK 8o,q FALMOUTH ROAD,SUITE 301 C MASHPEE,MA 02649 1508)477-7272 FAX(508)477-9072 August 5, 2011 Harbor Mortgage Solutions, Inc. FAX 781-843-6661 100 Grandview Road, suite 105 Braintree,MA 02184 RE: Russell Moulaison, 75 Moco Road, W Barnstable, MA To Whom It May Conce=- Cape &Islands Engineering has located the existing well by instrument survey and the existing well is approximately Tinside the southerly property line. if you have any questions please feel to contact our office. Sincerely, Charlene Antrim Project Planner so R ., I No. °� O 3� Fee L� BOARD OF HEALTH TOWN OF BARNSTABLE 01ppYicatiou jFor Vern Con5tructiou Permit Application is hereby made for a permit to Construct( ), Alter( ), or Repair( an individual well at: Location-Address Assessors Map and Parcel C_�__,C gweer I 1 Address Installer-Driller Address 91 Type of Buildingv o Dwelling Other-Type off(Building No. of Persons Type of Well `t 11 Capacity DA Purpose of Well �'����.P , Agreement: The undersigned agrees to install the afore described 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 CertificaVof nc s be is ed y the Board of Health. Signed v"te Application Approved `D/� ),-� Date Application Disapproved for the following reasons: ( / Date q Permit No. 6� j �--� `C Issued Date ---------------------------------------------------- ---- -- ---------------------------- BOARD OF HEALTH P TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed Altered( ), or Repaired( l� by Install at I . _Z� �OUL has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector Fee No. C \ BOARD OF HEALTH TOWN O_F BARNSTABLE r 2pprication _for Yell Con.5truction Permit Application is hereby made for a permit to Construct( ), Alter( ), or Repair( ) an individual well at: S M 0C cj _ Gt1� l�ysser�� Ot .o lsn I�S C) l C Location-Address M aAssesgors Map and Parcel wner ' t Address � o G Installer-Driller / Address 0g �.�� o Type of Building Dwelling Other-Type off(Building No. of Persons Type of Well `-4 Capacity 0 <,7 i f�� Purpose of Well �� Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the L,w 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 t fanc s be is ued y the Board of Health. i Signed � Jate Application Approved Date Application Disapproved for the following reasons: 1 , rr Date Permit No. O '�-� � `t Issued 16 `0 qb 2�' t' Date OF C7 TOWN 0FARD BARTNSTABLE Certificate of Compliance �• THIS IS TO CERTIFY,that the individual well Constructed-Altered( ), or Repaired O by Install r at I S O C L� �C1 �0.V Y�►S�`G // i t has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated .1 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date 2- 1 Inspector BOARD OF HEALTH TOWN OF BARNSTABLE q ,` Vell Congtructton Permit l No. w c��� � � � Fee 1 Permission is hereby granted to .Q_: ' Installer to Construct( Alter'( ), or Repair( an individual well at: No. C "a Street as shown on the application for a Well Construction Permit No. t,38-0 IL —o 3 J�J Dated Date ID ` �' Approved By 3 ,,shy Y s i TOWN OF BARNSTABLE LOCATION SEWAGE VILLAGE I.W F ASSESSOR'S MAP Q LOT 21;� 666 'INSTALLER'S NAME & PHONE NO. C SEPTIC TANK CAPACITY �.e,.�, �'�alJ� (size} 2Xo2al.� d LEACHING FACILITY:(type) �1..� NO. OF BEDROOMS — PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COLiPLIANCE ISSUED: VARIANCE GRANTED: Yes �/ No - i II Ii I ASSESSORS MAP : TEST HOLE LOGS PARCEL : I 1) The installation shall con,i.;, with "hide V and Tow of������3oard of FLOOD ZONE: �' SOIL EVALUATOR : i�{A (Ieallh Regulations. REFERENCE : WITNESS : I QA { D 1, J{ 2) The installer shall verify the location of utilities, sewer inverts and septic I -70 DATE: ��L�?k Z.OI components prior to installation and setting base elevations. 44 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first PERCOLATION RATE: �-. Z �t�ll I I �- two feet out of the d-box to the leaching shall be level. 11 � 5, 4) This plan is not to be utilized for property line determination nor any other —k� -- - ---__- -_ TH- ( T11-2 purpose other than the proposed system installation. AAu � ?/1 5) All septic components must meet Title V specifications. \� 1 1 ._ �� =04 6) Parking shall not be constructed over H10 septic components. 1AriWt I�v-ivy r ) 7) The property is bounded by property corners and property lines. Q� ?, I (� ���� 8) The property owner shall review design considerations to approve of total LOCATION MAP design flow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed approval of the design flow by the owner. Gp � � ( �► "' 61 10 9) The existing leaching or cesspools shall be pumped and filled with material �r per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per _____- ----- �, _ -�-- x 'l I lbk►2�'�� 16�YL'j Title V specs. 10)System components to be 10 feet from water line. Sewer lines crossing the n, water line shall be sleeved with 4 inch SCI140 PVC with ends grouted if --F applicable. The proposed SAS is being installed below the water service - - -- - - ------ --i------ line. The line is to be sleeved as aforementioned and maintained in place. SEPTIC SYSTEM DES ! G N 11 If a arba a rinder exists it is to be removed and is the res onsibilit of the owner to ensure such. ------ FLOW ESTIMATE 0 1'?)The exists�staller is to take caution in excavation around the gas line i['such 110 GAL/DAY/BEDROOM - GAL/DAY 13)The installer shall verify the location, quantity and elevation of the sewer BEDROOMS AT lines exiting the dwelling prior to the installation. 14)This plan is representative only that a system can fit on a property meeting - SEPTIC TANK Title V requirements. U—_03AL/DAY x 2 DAYS - GAL USE GALLON SEPTIC TANK O I L ABSORPT I O SYSTEM `' H r Aqpj)(D) P �F ' r 1 ,— - - r��` J► � (� � i ( �t16 r MASON 5 {3 � r SIDE AREA: / + N P BOTTOM AREA: X (� - t 1' SEPTIC SYSTEM SECTION �y . _ Juv�c � 1 ► ► tom'' ' �W��'vo �", , '� � q,,�►�, C�q��j►gfr`U% _ l51�� LiCJ� � �T�� =t . �G. 36 M (S ,�� toval 7h1 _� ���►1__ D-B_ GAL Of N 7 Er --------- _�D /�Z, �� ------- �_� SEPTIC TANK �D� G�iV��itf1 T, �J 't- I�/; 1 A / OJ 1 SITE AND SEWAGE PLAN r ��? -- • I-tj - LOCAT I ON : �J�C� I V2 �3 wry �� �o� 'oP , N air � _ ,. �l _ . ✓' � e ��� � �v�� ��_ +.-� ►�� � ?, PREPARED FOR : 0. epj Y SCALE : ! G� _ • / ?v.� .. ? -. 7Z?_ ? � w DAV I D B . MASON,RS DATE: _ DBC ENVIRONMENTAL DESIGNS w EAST SANDWICH . MA W DATE I HEALTH AGENT Z ( 508 ) 833- 2177 i ASSESSORS MAP : ���� _ J TEST HOLE LOGS PARCEL: �� 1) The in shall cor>>j. , with Title V and "Town of `"AV&oard oT t�f� FLOOD ZONE: � �` (�Y ' SOIL EVALUATOR: ) "� �' I lealth Regulations. ___._ _.__.__ __.___�i -)( tom' 2 The installer shall verify the location of utilities, sewer inverts and septic WITNESS : t>ha �O 1 ) Y REFERENCE: components prior to installation and setting base elevations. _��'��_.`��� ,.. . ICJ --- 1 DATE: -T��U� ZC�I Q ._. PERCOLATION RATE: ZVl�ll I 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first ���t,.` D ` 3 �� --- .�, � , �'�C. � � two feet out of the d-box to the leaching shall be level. �/ - fi(e,i 5, 4) This plan is not to be utilized for property line determination nor any other TH- I TH-2 purpose other than the proposed system installation. LOA c ,I 5) All septic components must meet Title V specifications. I 1 �' 3/i 6) Parking shall not be constructed over 1­110 septic components. �1 W"& /p Vj Lo 0 2 7) The property is bounded by property corners and property lines. � lib _ �'✓' I Z,Z./ 8) The property owner shall review design considerations to approve of total design flow and number of bedrooms to be considered for design. Receipt LOCATION MAP Ll �p 1 of payment for the plan and installation based on the plan shall be deemed approval of the design flow by the owner. G� �,► (., i Iti 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall { , �y��r. �____,.,.- � : --�--�•-- ��� `b � be removed along with contaminated soil and replaced with clean sand per Title V specs. �4,. 10)System components to be 10 feet from water line. Sewer lines crossing the d with 4 inch SC1140 PVC with ends routed if water line shall be sleeve g / Z� applicable.. The proposed SAS is being installed below the water service , _ c ---- , -- line. The line is to be sleeved as aforementioned and maintained in place. SYSTEM S T M DESIGN 11) if a garbage grinder exists it is to be removed and is the responsibility of the SEPTS E P T I E owner to ensure such. 12)The installer is to take caution in excavation around the gas line if such FLOW ESTIMATE exists. �, I 13)The installer shall verify_the location, quantity and elevation of the sewer BEDROOMS AT I� GAL/DAY/BEDROOM - GAL/DAY lines exiting the dwelling prior to the installation. 14)This plan is representative only that a system can fit on a property meeting SEPTIC TANK Title V requirements. GAL/DAY x 2 DAIS - GAL ��I •� USE GALLON SEPTIC TANK IL ABSORPT 10 SYSTEM P\,�H OF��,q" . T �� DA MASON / /b) SIDE AREA: k 1� + !(1 YC�. X o w ,� Q Q _ q-_M...... BOTTOM AREA: X (� X 01 "Z =� J�!�. S TIC SYSTEM , SECTION � �op C 0 , . ll7 NE DR LDnI_ D�.-B ��,�✓? �, / GAL 10f 3 3P SEPTIC TANK � ..�>JV��� /6, I i OJ --- SITE AND SEWAGE PLAN 7 � V /�61�51 / 7 - --- -- y W - _ ( L� • emu`=E �15 P, 0c) VIZ PREPARED FOR : i IrcA 5 , _ - & SCALE: 1 ,r..__ 3..D.� ' ....__.,,._7_?_ _VZ DAV I D B B . MASON,RS DATE. EZ Zb I� z DBC ENVIRONMENTAL DESIGNS u W EAST SANDWICH . MA Z DATE I HEALTH AGENT ( SOS ) 833- 2 1 77 - I-