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0103 MOCO ROAD - Health
Lco Rd.W.Baranstable 021•'-+► I �1 J TOWN OF BARNSTABLE "'1LOCATION 6 03 i l e,-6 O 6Z ts SEWAGE# —1O1 q — AJN4, VILLAGE W, Q,,iw rf3/z ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. �— SEPTIC TANK CAPACITY LQX I rI-Q a c,F, `am '-4--t y/o + a t LEACHING FACILITY:(type) (size) -Af,K(� �3 eCJ- NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: 11 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) 100 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHEDBY Aly%/ roc y, 344 3'' LE No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OP BARNSTABLE, MASSACHUSETTS Yes Applifation for Disposal Opstem Construction i3ermit Application for a Permit to Construct( ) Repair F'i) Upgrade( ) Abandon( ) ❑Complete System P<Individual Components Location Address or Lot No. /03 N pGO n� Owner's Name,Address,and Tel.No.S O�- W.'QM&YVOt� j4( M*AOn i c,-3 Assessor's Map/Parcel If s-/q 1 { Ldjj hnS-+a Installer's Name,Address,and Tel.No. 6 016- 701 4 3?7 Designer's Name,Address,and Tel.No. �p( (a" Cv5 ra�'1.ti,C��t'o� LnC �t5ix�Dcash �vto�1 ip2 ice+ it ar3`4 64aj Sf- ffit i I g a dr A oL062,e� Type of Building: 13 Dwelling No.of Bedrooms Lot Size /J�,07a — sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) SW gpd Design flow provided 9 gpd Plan Date)%lf/q� o�a/ Number of sheets Revision Date Title i ! S,k Pte n d-1- /03 M06C�I R04J Size of Septic Tank P_Y,1. 62i i r C�c�s C�-tQwf�C Type of S.A.S. Description of Soil 6u /p Z ) 44 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and mainte ance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environm Code of to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt Signe J~ Date / l Application Approved by Date / Application Disapproved by Date for the following reasons Permit No. ( � Date Issued ------------------------------------------------ - ----- --- v No- ., Fee Iwo THE COMMONWEALTH-'OF MASSACHUSETTS Entered in computer: 60, PUBLIC HEALTH DIVISION - TOIIVNRD-f`;BARNSTABLE, MASSACHUSETTS Yes 4plication.for -Misposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair 0( Upgrade O Abandon( ) ❑Complete System RlIndividual Components Location Address or Lot No. 10?, GGO ( Owner's Name,Address,and Tel.No.Y05-S,45_3GL Assessor's Ma /Parcel W'12nw\6�" ' iot), MCLi Installer's Name,Address,and Tel.No. 5 v55. 90 j - c)3 q •Designer's�Name,�Address,and Tel.No. �j�-36 P-V5v� p��-�,��-� CUt�"a{-�:u.<r�i�,•��.lr,� �l5.ir�e,���.,c� � iJ� i n��U'!v�j �r 3`f ,�-t�cc.n SF Type of Building: Dwelling No.of Bedrooms 13Lot Size /$�U�� _ sq.ft. Garbage Grinder( ) Other' Type of Building No.of Persons Showers( ) Cafeteria( ) Other-Eixtures Design Flow(min.required) .930 gpd Design flow provided gpd Plan Date Yfdp, /9 o7G/ Number of sheets / Revision Date Title ;iie �;;- S,to 210_"J- /03 4jo ,fQ%4rl Size of Septic Tank !o ;S�s nc , � -fit�1( Type of S.A.S. Description of Soil { Nature of Repairs or Alterations(Answer when applicable) Date last inspected: X x Agreement:. The undersigned agrees to ensure the construction and maintenance of the afore des ribed on-site sewage disposal system in accordance with the provisions of Title 5 of the Environme tar an. of to place the system in operation until a Certificate of Compliance has been issued by this Board of HealtZ 'p Signed �,,r' Date Application Approved by Fe Date Application Disapproved by Date for the following reasons Permit No. ;�� °J — (rs Date Issued ] ----------------------------------- --------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by 2br Go vos 1- Y rr,, C at 1—rn? 62C Rj A,rn-,r,g(i Pa has been constructed in accordance " with the provisions of Title 5 and the for Disposal System Construction Permit No. dated o Installer at,t CAL ",l r)4d Ir cn ; nc Designer°.A.. #bedrooms _�%3 Approved desr&unction 'ow. ice--I,— I gpd The issuance of this permit s all not be construed as a guarantee that the system wil. designed. Date Inspector r s - - - - - - --- ---------------------- --------------------------.-- ------------------------------------------------------ No. . Fee l; THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at -10.3 � o { 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. Provided:Construction must be completed within three years of the date of this permit. Date /r 100 1 &A 1 Approved by l AUG-08-2019 05:16 From: To:15087906304 Pa9e:1/1 /9 '1)3 Town of Barnstable Regulatory Services Thomas F.Geiler,Director j a Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA.02601 Of m 50&862.4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: Sewage Permit# — Assessor's MaplParcel 170 2� Designer: ' L-0vj -, i' 1 ruri g Installer: "(n c& Address: / Ma.I Address: f - �b 70 y Onsl ty 11 was issued a permit to install a (date) / /d (ms er) septic system at 1 Q3 moco /�-�J& Q based on design drawn by (address) ' LL3ati..t `a 6� U dated `m I o19' i (desi er) - V 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. I certify that the septic system referenced above was installed with major changes (i.e. w greater than 10' lateral relocation of the SAS or any vertical relocation of say component of the septic hem)but in accordance with State&Local Regulations. Plan.revision or certifie tvlt by designer to follow. OF Mqs� DANIF-I.A. �G OJAIA of Signature.) CIVIL y No.46502IP Q TONAL E - (Designer's Signature) (Affix Designer's Stamp Flere) PLrTASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION, ERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ART RECIYr AX T BARNSTA,BLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Healtd/Scptfc/Desigacr Certification Form 3-26-04.doe � ��„� �e� p ���" ��d ` N�� ��"� � �� ���� power MOW �.Er Tp N F F I Ar �,- - C0 Certified Mail Fee lT $ M Q pp>`�" Extra Services&Fees(check box,adVlPas appro ey N y ❑Return Receipt(ha dcopy) $rq Return Receipt(electronic) O ❑ $ QD Postma O ❑Certified Mail Restricted Delivery $ t;if Her Q ❑Adult Signature Required $ []Adult Signature Restricted Delivery$ t3 Postage m rqTotal Postage and Fees Ln $ MATTON,ALBERT JOSEPH I Sent To,a 103 MOCO ROAD .I I,.M1 StreetandApt.No.,o� c7 WEST BARNSTABLE, MA 02668 City State;ZIP+4� :�� r rr •r••r• Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this.j delivery. .; •✓ USPS®-postmarked Certified Mail receipt to the •A record of delivery[including lii'recipient's JI retail associate. signature)that is retained by the.Fo5ta1 Service- Restricted delivery service,which provides for a specified period. `i delivery to the addressee specked by name,or tq i,•:5' Important Reminders: „`: to the addressee's authorized agent _ Adult signature service;which requires the 0 ■You may purchase Certified Mail sgrvice with' signee to be at least 21 years of age(not _ First-Class Mail®,First-Clam_Package Service®, available at retail). -r_ or Priority Mail®servicet. -- .o Adult signature restricted delivery service,which •Certified Mail service Is notavailable for requires the signee to be at least 21 years of age International mail. and provides delivery to the addressee specified ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent 3 with Certified Mail service.However,the purchase (not available at retaiq. . of Certified Mail service does not change the o To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a' certain Priority Mail items. i PS postmark.If you would like a postmark on rn ■For an additional fee,and with a proper tfiis Certified Mail receipt,please present your ' endorsement on the mailpiece,you may request " Certified Mail item at a Post Office-for the following services: . G t' postmarking.If you don't need a postmark on this -Return receipt service,which provides a jecord-, Certified Mail receipt,detach the barcoded portion u of delivery(including the recipient'ssignattire). of this label,affix it to the mailpiece,apply F-1 You can request a hardcopy retu'm receipt or an,,.appropriate postage,and deposit the mailpiece. p electronic version.Fora hardcopy reiu6receipt; complete PS Form 3811,Domestic Retgrrt, Receipt attach PS Form 3811 to your mailpiece; IMPOUANr Save tads receipt for your records. PS Forth 3800,April 2015(Reverse)PSN7530-02.000.9047 7Preint • • •ms 1,2,and 3. A. Signature me and address on the reverse X ❑Agent an return the card to you. ❑Addressee I if- acscard to the back of the mailpiece, B.'Received by(Printed Name) C. Date of Delivery or on the front if space permits. 1- A f0 1. Arti . Is delivery address different from item 1? ❑Yes i If YES,enter delivery address below: ❑No jMATTON,ALBERT JOSEPH I 103 MOCO ROAD WEST BARNSTABLE, MA 02668 3. Service Type ❑Priority Mail Express®I IIIIII IIII III I II II9I IIQ I I III'II I IIII I I III ❑Adult Signature ❑Registered MailTR ❑�+dult Signature Restricted Delivery ❑Registered Mail Restricted 9590 9402 4798 8344 8568 51 Certified Mail® �:tiiuvrery Certified Mail Restricted Delivery nReceipt for ❑Collect on Delivery erchandise RCnll :t nn Delivery Restricted Delivery ❑Signature ConfirmationTM Ily E ,` i it ❑Signature Confirmation 7 0 jA H17 ' 0 1 0 0 b V 14 9 8 7 ,7 6119 '`£`il Restricted Delivery Restricted Delivery I° PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt k ljlSPSTRACKNG# USPS First-Class Mail Postage&Fees Paid Permit No.G-10 9590 9402 4798 8344 8568 51 United States •Sender:Please print your name,address,and ZIP+4®in this box* Postal Service Town of Barnstable Health Division Main Street -Hyannis,MA 02601 t t Ji �QFVE ram, kzsftd Town of Barnstable Barnstable P Inspectional Services t MRANicacftv as rrSMNEI F� SS b 9 Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 7619 May 1, 2019 MATTON, ALBERT JOSEPH 103 MOCO ROAD WEST BARNSTABLE, MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 103 Moco Road, West Barnstable, MA was inspected on 04/12/2019 by Frank Nunes III, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20h). 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 OF THE BOARD OF HEALTH an, R.S., CH Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\103 Moco Road West Barnstable.doc I Town of Barnstable ♦ r s > BARNsrABLE, + Regulatory Services Department rfA MA'l a Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation o a driveway due to H-10 components, etc) eaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEAD LINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form <,-Subsurface Sewage Disposal System Form-Not for Voluntary Assessments1 103 Moco Rd. cF Property Address t- Matton Sc' Owner information Owner's Name is required for / West Barnstable MA 02688 4/12/19 yrrown every page. State Zip Code Date of Ins ection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 51MW 37:3-50 f 1. Inspector: Frank Nunes III r Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 13010 Telephone Number License Number l" B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority h,5f- i 4/12/19 Inspec rs Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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. t5ins.doc•rev.6/16 — Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' M 103 Moco Rd. Property Address Matton Owner information Owner's Name is required for every page. West Barnstable MA 02688 4/12/19 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. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 Moco Rd. Property Address Matton Owner information Owner's Name is required for every page. West Barnstable MA 02688 4/12/19 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh l5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 103 Moco Rd. Property Address Matton Owner information Owner's Name is required for every page. West Barnstable MA 02688 4/12/19 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 103 Moco Rd. Property Address Matton Owner information Owners Name is required for every page. West Barnstable MA 02688 4/12/19 City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 Moco Rd. Property Address Matton Owner information Owner's Name is required for every page. West Barnstable MA 02688 4/12/19 City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts a u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 103 Moco Rd. Property Address Matton Owner information Owner's Name is required for every page. West Barnstable MA 02688 4/12/19 Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No is laundry on a separate sewage system? (include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Occupied Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments G M 103 Moco Rd. Property Address Matton Owner information Owner's Name is required for every page. West Barnstable MA 02688 4/12/19 City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped post inspection Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): l5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 Moco Rd. Property Address Matton Owner information Owner's Name is required for every page. West Barnstable MA 02688 4/12/19 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Original septic tank per age of home, new d-box and leach pit 1992 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2411 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water suppl well or suction line: >10' feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 20"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) Compartment style H-10 1000g septic tank appears to be structurally sound, inlet cover raised If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000g Sludge depth: 8" t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' M 't 103 Moco Rd. Property Address Matton Owner information Owner's Name is required for every page. West Barnstable MA 02688 4/12/19 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle '12 Scum thickness 1/2 11 Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 103 Moco Rd. Property Address Matton Owner information Owner's Name is required for every page. West Barnstable MA 02688 4/12/19 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.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ,e' 103 Moco Rd. Property Address Matton Owner information Owners Name is required for every page. West Barnstable MA 02688 4/12/19 City[Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box is 3' below grade and in average condition Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,.•�''p 103 Moco Rd. Property Address Matton Owner information Owner's Name is required for every page. West Barnstable MA 02688 4/12/19 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit is in a state of hydraulic failure at this time, effluent level has risen into the riser, pit is approximately 5' below grade, cover raised to 10"of grade 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 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 103 Moco Rd. Property Address Matton Owner information Owner's Name is required for every page. West Barnstable MA 02688 4/12/19 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 103 Moco Rd. Property Address Matton Owner information Owner's Name is required for every page. West Barnstable MA 02688 4/12/19 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately a- a�4 � 306 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 Moco Rd. Property Address Matton Owner information Owner's Name is required for every page. West Barnstable MA 02688 4/12/19 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >15' 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: TOPO mapping shows the sit at 70'msl and nearby surface water at 40'msl You must describe how you established the high ground water elevation: see above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments lug, 103 Moco Rd. Property Address Matton Owner information Owner's Name is required for every page. West Barnstable MA 02688 4/12/19 Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Fee—------7 BOARD OF HEALTH TOWN OF BARNSTAB LE Applicat ion-for Verr Construction Permit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (efian in ividual Well at: Location — Address Assessors Map and Parcel gwner Address — w�ll 011 po. �a©X 96- A,-'eklo— Y? ---- ------ _—_—_---------------- Installer — Driller' Address Type of Building Dwelling ----- -- ---------- Other - Type of Building---- ------- No. of Persons------------------------______ Type of Well Y — Capacity----------.—------ Purpose of Well-®°°"��'` a � 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��-'--N — — /e`a --- date Application Approved By �� — -- - date Application Disapproved for the following reasons: ------- - --------— -__ date Permit No. W ��a � ---- Issued-----— - -= _- ------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired (A- b A Su.-'. e/� ---------- ----- Installer has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.��' — Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-- Inspector-------------____---------_----------- rr --------- -Q n - .� l- W� d�� I �/ Fee-------- ------ BOARD OF HEALTH t y. TOWN OF BARNSTABLE plicatio�i ,forlVell �Con5tructionperm t �_ �a_ Iaj I, Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (✓ran individual Well at: Rd - (" - 4 lc�t-S' 04.k \� 1,' Location — Address Assessors Map and Parcel E cc —___-- owne" Address - --------- ----------- --- ---- Installer — Drille \ Address Type of Building Dwelling Other - Type of Building--- ---- No. of Type of Well y _ -—---- Capacity--- - - ---- -- - ---— tPurpose of Well Agreement: �.o� 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 C � C � \ —_----—— "s /ass 7c�- date Application Disapproved for the following reasons: ------- - ---------- ______—_—_--_____. _ /^— �----date Permit No. ����r " — Issued t` date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of�- Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered { ), or Repaired Installer ---=------- ----- at 16 RAJ . ----------- --------- --___ - ----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. �"o�SDated--5�� (�2— 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 Ivell Con$truct ion Per mit No. W� �aS /)J[)A Se Fee N - Permission is hereby granted to Construct ( ), Alter ( ), or Repair ( man Individual Well at: No. /ofto c� /?c/ _ _ --------------------------------------------------- +; Street — as shown on the application for a Well.Construction Permit / No.- �C»`1-�\� ` -- Dated-- -- g ---- ------ ----- Board of Health DATE— � �C�c�- m el( MO LO Massachusetts Department of Environmental Management Office of Water Resources 10 4 219 TYPE OR PRINT ONLY Well Completion Report 1 WELL LOCATION GPS__(OPTIONAL),,, sa" LATITDE, LONGITUDE m Address at Well Location: 3 . M GO /2 -� Property Owner: l �^°j � Subdivision Name: Mailing Address: /°3 /-22 j-�//' "( ' Cityrrown:W c-S {L, t tt rMlr_ W aaSTu ble City/Town: Assessors Map �S Assessors Lot#: �� NOTE: Assessors Map and Lot# mandatory if no�street•address available Board of Health permit obtained: Yes C( Not Required El Permit Number Date,Issued� 2,..WORK PERFORMED 6; 3 PRQPOSED USE 4. DRILLING METHOD - . ❑ New Well ❑ Abandon Domestic- ❑ Irrigation ❑ Cable .. �aAuger ❑ Deepen El Recondition ❑ Monitoring El Municipal El Air Hammer"❑ Direct Push EXRe lace ❑ Other ❑ Industrial ❑ Other ❑ Mud'Rota " ;❑ Other 5.;WELL.LOG, cr Unconsolidated Consolidated S SITE SKETCH (use permanent landmarks nth distances); W Permeability CO C0 From (ft) To (ft) High Low `� C7 .m Other Rock Type "' l r v`J ff 7°VEIL CONSTRt1C"11101f_ „m 8: CASING tl4 From (ft) To (ft) Casing T' ` a Total Depth Drilled g ype and Material Size O.D. (in) Well Seal Type 1 Date Drilling Complete �l=' 9...:SCREEN From(ft) To (ft) Slot Size Screen-Type and Material Screen Diameter 10. FILTER PACK/GROUT/ABANDONMENT MATERIAL 11. ADDITIONAL WELL INFORMATION r Developed? ❑ Yes ❑ No From (ft) To (ft) Material Description,,. ,. Purpose Fracture Enhancement? ❑ Yes ❑ No a Method Disinfected? O'Yes. ❑ No .12.WELL TEST DATA(PRODUCTION WELLS)e 13. STATIC WATER LEVEL(ALL_WELLS) Yield-`,Time Pumped Drawdown to Time Recovery to Depth Below Date Method (GPM) (hrs&min) . (Ft. B.GS) (hrs & min) (Ft. BGS) Date Measured Ground Surface (FT) ra.�e�loft 3� 3 A/ X 14. PERMANENT PUMP (IF AVAILABLE) „•e 15,NAMEiADDRESS OF PUIIPINSTAL(,ATIQN CPMPANY,_, Pump Description /b 6S oS 4 Horsepower �-' Sr,n,< Pump Intake Depth r'lr� mob§ 9 (ft) Nominal Pump Capacity (gpm) 16 COMMENTS 17. WELL"DRILLER'S STATEMENT.; This well was drilled and/or abandoned under my supervision, according to applicable rules s � , �' and regulations, and this report is co plete,,and correct to.the best of my knowledge. Driller: "%' Supervising Driller Signature: G f``F Registration #:I I d I � I J Firm: ��( co ee t <f>l /��,'I% .. ��� loa Date: Rig Permit#: NOTE:.Well Completion Reports must be filed by the registered well driller within 30 days of well completion. : BOARD OF HEALTH COPY ✓ /7 TOWN OF BARNSTABLE Gl LOCATION fGC' Wee0 SEWAGE # VILLAGE ASSESSOR'S MAP & LOT /;-p5' � INSTALLER'S NAME & PHONE NO.�(//tMC,61'17 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) /�` (size) NO. OF BEDROOMS P VATS WEL R PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No i 371 _ ASSESSORS MAP NO: y PARCEL NO: U No..-1--02=._� Fx$ 7 ............... THE COMMONWEALTH OF MASSACHUSETTS APPROVED BOARD OF HEALTH Rarnstab a Conservation Dc;=?a:= TOWN OF BARNSTABLE Appliration for Dhipmal Works C omarurtio Application is hereby made for a Permit.to Construct ( ) or Repair ('�.4 an Individual Sewage Disposal System at: ........,/..o..�--.----��ca............................................. ....._........�.s�.�.. .�.�..........r.,�c.../------------- �— --------------- .. �. ......Location- ddress �� r $/ ............... .................. 71� ............_...__...� .................../................ Z --- ...... er dress C ......................................................o '� l- tC3 Ad/.[�/:..lG/.../. ...... ' Installer Address Type of Building � Size Low W___U--_�.._:..Sq. feet U Dwelling—No. of Bedrooms................. ..2_.....................Expansion Attic ( ) Garbage.Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures --------------------------------------------------------------•--------•---•--------•----••-•-••---------•....---............--------•.......••••-_.. wDesign Flow........................... ------gallons per person per day. Total daily flow...........�a�6..................gallons. WSeptic Tank—Liquid capacity// B.gallons Length................ Width................ Diameter-_-_____-___-- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................. Total leaching area....................sq. ft. Seepage Pit No.........../.... Diameter......ZQ...... Depth below inlet......6......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water----.................... a -----------------------------------•----••------•...-----------.....----------.......__......_...._.......................................................... 0 Description of Soil................................................................................................. --------------------------------------------------------------.....--- x U ...••----------------•-----------------....---------.....-------•--•.....---•-------•.._.......--••--•-------------------....---•-----------•---•--------.....-----............-----••---•--•---------_.. w VNature of Repairs or Alterations—Answer when ap licable.__.. �Q______l !_ �4�= '. ��� _. ...----? ----- ----.�� f?y- Agreement: The undersigned agrees to install the aforedescribed'Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian�aseensu Xb �boardof lth.Signed ---- - -- ---.......... .-.-. ... "- Dace Application Approved By ................ . . ...... .- Q . . ...... .................................................. .. ................. = to Application Disapproved for the following reasons- ---------- ----- --------------------------------------------------------------------------------------------------------- ----- ------------ -------- ------------------------ ------------------------------ ---------- -------------------------- --------------------------------------------------------------------- .................................... Dare Permit No. ...... t �oZ �� Issued .. .-- ------ Dace r � _ No....��. ..:... / t Mf. Fps`�-�.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' TOWN OF BARNSTABLE y 9 a ApplirFation for UWpoiiFal Works Tonntrnrtinn rrnti# I �- Application;-is hereby made for a Permit to Construct ( ) ,or,Repair an Individual ,Sewage Disposal System at r— ........ /CJC ......I........................................ ........�� � � .....�..........:� y............. Location- ddress or Lot No �-- Owner ? Address -------------------•--•--...--•-•-•--- ••• ---------- ' / :,�................ _------- - Installer Address �. U Type of Building Size Lot,—,.- ...Sq. feet Dwelling—No. of Bedrooms.............. .................... Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ...................................................................................................................................................... Design Flow......................... -------gallons per person per day. Total daily flow............ R,_-36..................gallons. WSeptic Tank—Liquid capacity/04.gallons Length---------------- Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.....................sq. ft. Seepage Pit No-----------.-___- Diameter......Z�2----__ Depth below inlet......1.. .... Total leaching area..................sq. ft. S Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................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........................ a -•--•----•-•----------------••-----•-•--....•--•••-•---------••.....•-••---••........._..-----...............-------•-----•--•-......-•••---•----...•--...... ODescription of Soil........................................................................................................................................................................ w UNature of Repairs or Alterations—Answer when applicable.__ ....... A!)... C' .__L /. ..`'� _.. C ---------- -��--� �j�-•----` S f�`Sl�.- . ��5��1�.....----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance"as een ' su /by�tl , board of he lth. Signed ...../ll.� ! ---------'---------------/t?-----......--- �J L� 5, '6;e Application Approved By --- �� -, =- ...........................................------------------------------- -------Y7 -. te Application Disapproved for the following reasons- ----------................................ ------------....................................................................... ................................................................................................................................................................................................................ ........................................ �/ Dare PermitNo. ✓...v'Z s - ---------------- Issued .........----------- ......---..--...-----------........---- Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE CE.eztiftcttte of C11ampliance THIS IS TO CERTIFY, That the Individual Sewage Disp sal Sy-tem constructed ( ) or;Repaired ( x) by............................................................ .�.J-�L��l�....- 1.--......lD.' �d G�-1a�/ -------------------------------- ------------------------------------------- / Insraller � at f-.- ................ �lJ�C?------�� ---- �'�J�....�l� -... ... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. -------...53_:-j�:.-.9....... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.DATE 41 V. ------------------------------------ Inspector �;� �--------. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �j TOWN OF BARNSTABLE Disposal Works Tunntrnrfuan rnii# Permission is hereby granted................ � Q�.. � �? _.____C G'"� X' ••-----•....•-•.......•--------•--.......---•-•............................ to Construct ( ) or Repair (�>C) an Individual S,wage Disposal S s,em at No.--•••-•-•--•-•-•--------•--•-•......-•--•- l fGL'a ----......1_� �.�, Street q as shown on the application for Disposal Works Construction Permit Dated.......................................... ...................................... .................................................. q oard of Health DATE...............�,�.�_... .. <-•2--•----------•-•.................... FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS 1. 0 CATION 103 �'Io o /��/ SEWAGE PERMIT NO. 17 VILLAGE I N S T A LLER'S NAME 6 ADDRESS B U I L D E R OR OWN ER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED erg \� , °}No.7 ? ,fir F�s..`.!l....Clswl.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH] ............Town.......OF...........B�.YYnSMb..6C........................... Appliration for Uhipaiial Workii Tomitxurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ...... �1. Y1 Qc�....J1 ............ .......................................... ........................................ on-Address or I of No. ...._. a Ma,1Z'c O ner Address Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a p., Other—Type of Building ............................ No. of persons......................... Showers ( ) — Cafeteria ( ) a � Other fixtures ---...-•---------------------------------------------•---------------------------------...._..----------------------........---............----- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.....'............... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ �4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fYA Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ � ........... ---- .. .............-W --c�.- ---------- ------ _Description of Soal-------..•-•..............1 Z - . x U ••---•••---•---•---•••-•-••-•-•-••••••---•••-••-•••-•-......-••••-•................. .........---•--._....._._ ... W •--•••-••-••-•--••------•---•--•---•---•--.....---•-•-•--•---••••••••-••••-----•••••••-•••--••..................... ..•-----••••-••...•--••-•..---..................••---..................---........ UNature of Repairs or Alterations—Answer when applicable.......... _-.)_l]0.O__-qa( ..#1_#1_y------------------------------------- -------------------------------------------•-.....------....----------------.....---........--•---------•-----------------------------------.......------------------------------........_.....-••-••••. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLL 5 of.the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has/bbeen 'sued b the board health. P PYSi d. 3_....Application Approved BY••• -- ......-� �............................� Da Date Application Disapproved f r the following reasons:.................................................................................................................. .........-•-----------------------•-•----••-------...----•---------------....................-•-----------•••-•••..__....•-•--••-•--••-•••--••-•.._.........•-•....•-•-•-••-•-••--•••----•.........•---- Date PermitNo......................................................... Issued........................................................ Date - —Y_,—, --------------------------- No. ..fm.�.�... FE$----•-•D:.. .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH. .... Lt> ......-oF.......... G?Y..1 S - ) --------------------------- Appliration for Ditivotittl Works Tonitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 1 3 .. .co fl-._d-------------------------------- -------------------------------------------------------------------------------------------------- 'o -Address or Lot o. 1rn ' _ 7 ........Gf x'��..ot b)q..................... -- -••-------•. .... ...-•--- O ner Address ...... ........ . n7u1 ----- --------- Installer Address....... Type of Building Size Lot............................Sq. feet U Dwelling— No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) pa-, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures .................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ {a O Description of Soil...........................•Z"' :h.(._7:.� `----------------------------------- -•------------------.._....._..._.. x V -------------------------------------------•.---•--•--------------------------------------•-•------.._...------------------------------------._....------------------...--------------......•••-•------ W --------------------------------------------------------------------------------------•-•------------------------------------------•---------------••------•-----...._......------•-•--•----•---.....•- UNature of Repairs or Alterations—Answer when applicable........... ..................................... ----------------------------------------------------------•----------------------------••---...._........---••••---•-•--••_._...-••-•-••---••--•-•----------------•-•---•-•--•••-•-•-••..........--_.... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been sued by the board Health. Sid....... 4_ ............................ _._. ajV D/ Application Approved B��r:the -----• �" - =Z6----•-t ..._._.. Date Application Disapproved following reasons:.................................................................................................................. ....................................................... ---•-•••-•---•-•--••--••--•-•----•-._..._.....•-- Date PermitNo. .......................... Issued_........................................................ Date THE COMMONWEX0,'v i OF MASSACHUSETTS BOARD OF HEALTH ............ hdr.......OF........ .................................... (Irr#ifirate of To l tt t THI S 0 C TIFY, That the Indivi Sewage_Disposal System ( )L or Repaired . by............. __ ...._ - 0, )ft Z �_�°.-`.'!_... .. . . -------- "- I tgller -- has been installed in accordance with the provisions of TITLE 5 The State Sanitary Cod as d cribed in the application for Disposal Works Construction Permit No �_'"'__19 r!._.__...._. `,dated.. __f0_ .,,r..�r►_ ______________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUAR NTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...............................................................................-. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH y� I? 'Z- ............ :......:...OF........� 0/--�1. ..�... ................... ... &..N ..............p......_ FEE---. !!l� OW11111al orkii Tonotr ion prat' Permission is hereby ranted.... !.. ..._.. 4 �.. .. _± �_ Yg to Construct or�ai§ d' idu l Sewa e isposal�/stetrhs / /j Street as shown /thelicatio or Disposal Works Construction Permit No D ed.......................................... ...-••-•-----• - - " -t- �! f------------------------•----•-•--....-•-•----.. Board of Health DATE--- .... ---...--•-••.....----••--•--•••-•--•••-••--• FORM 1255 A. M. SULKIN, INC.,^BOSTON LUDCAtION SEWAGE PERMIT NO. 1 s VILLAGE IN.ST A LLEROS NAME & A ADDRESS B U I'l D E R OR OWNER DATE PERMIT ISSUED DAT E CO-MPLIANCE ISSUED , � � e 1 Vol 'a F r I 1� N .......... o ' THE COMMONWEALTH OF MASSACHUSETTS F T vs, BOAR® F' HEALTH ..-..-_.... .OF......I ........................................... Applirttttun for -DWposal Works Tonstrur#tun amit NEW Application is hereby made for a Permit to Construct (nel or Repair ( ) an Individu Sewage Disposal, .., System at: JrT C`�tJ �J 4�' �P 1�,.- a s so _ ( A. z •---.........1.__.....�_ ....... ... ...............:.............................. ........••-•----•-•------'t --- - ....... �• ocation- ddress or Lot No. — V C1 ._odapta _ ---.... ------ ------------•------------ ........................................................3-�-� •-••- •---...__� N �/ hh-- Address • 11 Installe Address �.•- QType of Buil ing Size Lot............................Sq. feet �� Ex ansion Attic D Garbage Grinder Dwelling—No. of Bedro ... P W ) g Other—T- e of Building py yp g ____________________________ No. of persons............................ Showers ( f ) — Cafeteria ( ) Other fixtures.,,,s------------------------------------------------------------------------------------•------------•--------------------- -.._....--------- �-W Design Flow .......�___________________ a oy�pr person per day. Total daily flow.......... !1. .__2_Zt___gallons.� x JW 00 Septic Tank Liquid capacitaonPs�'L•ength________________ Width___._.._._._.... Diameter._-______._____. Depth................ x Disposal Trench—No._/_f 9K _____. Width___________ __ ---- ____..._....._._. Tot leaching area..................sq. ft. CO Z Other Distribution box (" Dosing tank ( ) d� • �� �• ��'� •7 7 x �!a Percolation Test Res Performed by.......................................................................... Date................................or...... JU a Test Pit No. 1___ __________minutes per inch Depth of Test Pit.................... Depth to ground water----.f 10..__.__.1 0f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ txJ •--••--•--- 4 ................ �.. s o ,� .-- j '� Description of oil---•-•P-� &%_/�!u�--� Q -• - -----o� -�',- •-�._.. �V Nature of Repairs or Alterations—Answer when appliOle..................................... __.......................... _______ T—I --------------------••------•---.... �, ,��1�.�� R-T s O/c, f�i�l L !,�/St�l►.a c c r- /.�.5`.A� ... . --------------------------------------------------------------- •-r 1 Agreement: % 4'f /q 7 7 0 T The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with�� the provisions of TJ NU 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed- ---------•----••. .. ...... ---•• ;-q Date H! 7 �1� Application Approved By------- /� �.-•- � ���� t-� v Date Application Disapproved for the following reasons:----•-•-------••----------------------------•---.._.....-------------------------------------...---:••- d ....................... ..-.--..-•--•--------------------------------------------------------•---• -:- 71 Daterl itNo................................................... Issued_....................................................... ^C r Date .Wiry - _ __ • �; Viz No................--....... - Fx$...•••-••..................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® F HEALTH .. )� i y� ---... 5...... OF...... -.. . ... .............................................. Apph atiun for Disposal Works Ton. trnrtiun Prrmit Application is hereby made for a. Permit to Construct ( ) or Repair° ( ) an Individual Sewage Disposal System at: '• '�'" �$ ...................... . .................. ........................................... ............••---•----•••-=-•-----------------••-••-------------•-----•....•-•----.._...-•- :..:: gocationA,4kddress or. Lot No. ._... .... ---•----•--•------••-- ..........--..............••---•--.. ...••--.........--•-•............................... wner Address --•----•--•-------------•. ---........ -- W '- ° InOsta 1 �+ __Address...-•-•-••- W Type of Bu>i ding Size Lot----------------------------Sq. feet a Dwelling—No. of Bedrooms__.__ ...............................Expansion Attic �/, ) Garbage Grinder p, Other—Type of Building _________ ________________ No. of persons--------,................... Showers (/t ) — Cafeteria ( ) rfixtures ,* --•-- •-•-••__________________.__---•-- :- •--------._..--._.. --•••-----•-- W Design Flow :__ ::_:._. _____. g lop r person per day. Total daily flow____.__ ...............":___gallons. WSeptic Taal Liquid ca,P 0,0',r gallons Length _. Wid"th___:__:___:_____ Diameter_______________ Depth................ Disposal,Trench—No /a __________ Width... �__ ot�Leri' _____.____.___..__ Total leaching area___________...___._..s ft. x g q• Seepage,Pit No ---------- ....... Iameter .__....__ F ,.Dept11 belw inlet .__. Total leaching area..................sq. ft. Z Other Distribution box ( Dosing tank is « '� .. ~' percolation Test Results Performed by______ _________________________________________________________________ Date...........---- -Test Pit No. L ___..__..minutes per;inch Depth of Test Pit____________________ Depth to ground water.r------------------- Test Pit No. 2..:.............minutes per inch Depth of Test Pit _..____g___.}_,Depth to ground,water..___-y.�_.__._._._____.... . w °"'.' i, _ +m�" ^'. b"j tca� .ADJ'YS ry��r vFi�q'" 4 Description of Soil yt t... w "+ ---•--•. -••�•- -•-•- ------ ---•--- r A $ F AS $f ¢ d � a W •__ _'_- ------- _............................- _.__. ....: ........ .._.:_._...... .__.______...___ V" Nature'of Repairs or Alterations-.Answer when applicable:____________________ Agreement ,. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in,accordance with, <;a the provisions of TITI s. 5:of,the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issuedxby the board of health Signed ••-•-• ---------------- --•- . .. .-- -_.... -•-••-••- Date Application Approved BY .._ - _ ............. Date Application Disapproved for the following reasons:.......................= ----•--••••-•-••-.-�----•••-----•••................................................... _.......--•---••----••--•-•-••-•------------•--------••••••....•--•---•-••-----•••---------•---•---------'•--•---------------............................... ........................................... Date PermitNo.......................................................... Issued....................................................... Date THE,.,COMMONWEALTH OF MASSACHUSETTS BOARD O HEA`LTH C r ifirtt e of Tit , liana T�S IS TCERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) Y bx � . ` ry a° ? �! 3# I Installer # To t has been mstsxlled in accordance with the provisions of T of The State Sanitary Code as described in the application for Disposal Works Construction Permit Noa�_ ___ _ ti.... ............i dated_--.- ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................................•----...........__........---•--....---- Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS ' 1 'y BOARD OF HEALTH k� NO.......... .. FEE............... Disp,Vs l Works T ffs iu rr�ermil i Permission is hereby granted...... ...t ` max .. .......................................•---....••- to Construct (1 or Repai ) an Ind iduO Sewage DIs osal System d at No.__± x V. __.. .. 4_ .}: .. a �� .. .. ..... s 4 Street V,. ' mff ated -- a#-- �----�/.P_._..._ass own on the application or,Disposal Constr I __.x. ..--=•- . Board of Health. DATE ........................................................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS - iinn r: .s _ �f 4S1'k-+�r'J i" •'xc: �: ,1 ram`!i "`ir:'�' '�"r",":�d" f•^ri' ,got •="S ; k� r•c r <, -s. .,w�S sir L ° i f .�"• '°� ',Q e i k�''s,vr 4a ay�. i daent ..'t{PT 'of Y.. �,r r ` n1 r�;eri:#• d,':.r i. 0: •'j, ;:fir a t2 a'Cr` :� �% .gr`Yr».r+r y'"�'r"'4.` ,�.z,t,. r✓; -t.,.�. r; 1'y': t,- 'M•.s,+,.....« „�,L,I.,"'ids:. •g�`r+` '•;., •.{", l::t W,7`,r•.'.'.s,t ,s 4�.. ..r.,:fa 'rf,"•A:t""r � 7"f,.,.•. a. ,,,` „'M r+" 'eF «r s,. 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V. i /yry F` v} to r tru;.r ev " ,� .i r a, n#i�,S.ixr .r S •f",'r's _ " K w i er t'd•rt;- 1- rt S t; '' l t '�' >+ 1 F�:t. t- a'e :t. '�� i �• _ �,. . 'h1 f t r F r,t •':' r,J. 'E•,y "": r.:-� Y ar. r I : * ,E c' r ♦ r - . :. i x ti 1 ``', a 1 *�}^Stf'rDear t,Mr, Macombair~��:1# ;. •«yic4: ri 'et •.^('S.-,s r. „fix r i �•.• r r r�_� �'' •-• a"�4.A �i•'`t $Y., s. ";. t' +. � ,e 0, •st�'ki• < i �'. "tf q. ,i• ,f i "1':` -'r! J3' ri{ r } 1.Ct "�" ,S,t '�'' ` t,$•,�r ' „� 'r t"r'T' •`r^ „� 4 ie s4^ 4r!,>; �• 'Yl RJt�,. •tr u,, •2k'y„_ r '; �� t•R„� ,yRti,•.r'ri ;4 r t�-�':1r •i�¢,.�{ , E:: f;t "You,;are •granted Xa variance for°the"�s iltooez leach h i t ou",,install'ed :,>a: �� r• z r y 'Yt�r y�.r, t'• "[:. k: 'S+a „� G.. 4 {�A1& 7 ;. .•yS,d"' ^;•.•. 9`r r. �"' g t., y°. .w.C'f','p �y� .,✓ r a,y� R� sl. tiV L 4 �r :,� .�rIJWfeet from a we13:,Rand••pfe:e'.t�fromr',the'�ro d at. 103,~�3ocoMad, WesC -Q- ,A- •'` M.: r r v .� ro ,k.lr; {' Amos, Ye' ¢ T' `P°� �. -q r:r tF A 'rr i ^A Je'•.:`r` �t r"f�.�?� r....'S:i f.�i2 '.p.,,q,.y,{✓ 'S', .+ Cea,• rd', r yf(r 31 I•} $ernstable r r[w �ypy+c£4i t� r'ri `i+ s 1• r r 1,,rs► r ;<*y s t:tr3r �,. "r >x .xr.s]�"ri 4*I_ '#.r i?r r� r r 4t.:r 4 u 4. S ' M 'Y r•ti r.,41 y1�„�,- _ r :. r � t • vrEwnr F, F. y '� Y.a ti`^ {• �`R .r �,t ,,+",R i ,A .+ T SS >r f l "S""";`+',i.�!s •`�a. *: .f•r, M "Y t e, 4 (,'rit' Tat.r c`°`,t, w r 1, ;< .r •.^Y T -1� fie'' ..'�,'. i7 .--E!f �'�•,s1. , ",t s I„'�"^r , :,'� g rr '�J• iTT 4'e 4� -.,:' '•,,, ..r tih•,;, . `You are,;retuindd that you"agreei�as a' condition of',your'Disposal �Iistal]eras „ z t�.r t5 r k 5y f F �'. `to`''�instal•1 r." ,r ,t t *' `„a^ a :4:.a+ . Permit allIsystems';in acc.ordance "with Title �, 'of�the 'St`ate t ' X{.>y�,, ry �#-a wr ;:'; '. 1' a..� f+;d{ - ;>; ,xz.-•rya• ... t r; ,t�F{ .y::,�, � t '.i,;: ,-;` 4 , r �ya�t 1 f 'i E Oronmental6Lode,.sand,the,Wowhsof, Barns'tablc_ Health ,Regulatiio�ns+:�` �°A .,> , y �f`�'r r t {d�` i"prr:+r. 7 y r » s; .'• i„y'w,'�..:ref a- ..�� Yx: ... � , ps y. x7 .T.. s i •At!`4 � �' +,s. ,r y ,F` • '$" `,tyf`.rG ;^.,a¢y r. •" r•igy+'} a,t•,� ,AM �, y.,�, "° ,�rY. 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'i..,,. r < s`_ ti,.s; 4xL 46 ;' 4 > SSfi,ta 31 xt r'` syj- ;.k 'i 4, tlr�.1{x'} rr.t r r. "�r F .• a.,�; t' :.. i��+ � t' F,��.r�'.-.( � :^'R:�;" 1,e:,"•. s3 •�r S'F,'• 4 ��.;' t'# t x4• i, ,{r r `p L ,* J' r ;rs r -_ z, ✓.! �` z r ' j•� ti 'r `r -*r';'"` . .4r.;• W '` 9 !� 4; t•'s A r• ir'.,�':4 ..a x 1f r �„.a At° M ur..��;, f-w• � CrrS r i",�• -+ r �r.{xj s rq' r 4- •ttti.. •. fs ' a ,x'L •• •r£F ::' .Yt ",5F" ,tis•.y.,l•*e ay, =,d '.-L arrt�, +,+k,,� l i ,•br ^r ,}:.,Mrn. •..,Y` r°`" .. '�.i. s.. ri �, �„'3r r y" s rn .1"b 1i y •r-JL r: _'` r-.n li',.'ts Ia � •S '� ','k n'{ yr 4 � ro #.r• 'G.:.1y•! -fir. d •;i tF ! h9"d`,',.ice#r' `�'t,'`2~� -•1`s 't'r '� - t 'Y�� ,�t p!�� a�:.f' �r •! S"s^!;«. .•it"»;k y fiy+•3'�kr tt+.. y ,y"'a t >.g r r !r{ _ '�'`, h 9',. r .r ' ,,,`�. !�' '�,.,, eC".r._y,a arla��r7rdy�°r'rik'�':`�l;.r pia Fra.:r,E }�.ut:"wA v.�'a :�C'sk,.�� �^�h'"'� '�F���ty�'r`�t!;�?x�'�''k1'`�'J'ri-•.:�w�!1.�",.t `�'t_�P r n�li!`�J:sr! /rd"6 .',�e� ��::riti,{..k r`'.�"a$r �..;�"'�'? ��ry�P;,•d F JOSEPH P. MACOMBER & SON, INC. BOX 88 - CENTERVILLE, MASS, 02632 - PHONE 775-6412 775-3338 August 25 1983 Town of Barnstable Board of, Health Hyannis Mass . 02601 Dear Board of Health, Regarding property owned by Albert Matton, 103 Moco Road, West Barnstable . In reference to sewerage permit #83 602. The 1000 gallon leaching pit was installed to get the furthest distance from owners well . The old leaching pit is 120' from well and the new leaching pit is 130 from well, 12' off property line and 6' off existing road . The septic system is in the furthest corner from well . Sincerely, G seph P. Macomber & Son Inc Joseph P. Macomber Jr. Vbi cc' (��a6L 'S •, gyp.• � a3 °. �, a .• n July 22, 197T . r Mr+ 'Wi.11jam Weller D6%-m ,: ape Eng veer .ng r. Pi,acadilly Square. - Red. `.'Xarmouth Mass4c3 ueetts • � Res Dot 17, Moco,Road,; West Barnstable :j You. are granted a conditions* l,, variance',. to install; 'a sewage Ieaching pit 135 feet' from a, wdll on Lot i7 M©w Road, 'hest 'Barnstable,. with• tie -reserve area being 120 Feet from the proposed ;well. ... This: variance ,is contingent: upon approval -of sewaige engineeririgr P. -"fans ercolatic�n"Teets, and'deep 'obser'vation pi.ts.. r P _ ln'rtaddit on,•;the .wdl.l` must be installed and ehemi:ca1 and bacteriological, testing =of the water performed by an :approved laboratory prier to , issuance of a building permit, The .water ' must comply with all. standards .of the Safe.. Drink ng A� and ` ' D State regulations« R: J. • •ill other State and Tgwn Environmental and Health ,Regul ti.ons must, be .met* ;` • , . V147iW.Manc ex +biL��7 Gi..M t �, �.�(7iJ. ` M1 a Vqu er' trt13 . furs a Robert L„ `Childs, Chaixx►an o- V ' t rJ Ahn :Jane' shbaugh _. A« W - Mandelstam, M« D« ' BOARD OF HEALTH 4 DOWN CAPE ENGINEERING ���/® Piccadilly Square -Route 6A YARMOUTH, MA 02675 LETTER Phone 362-4541 Date ..,.......�Tuly_19,1977.. .... .......... ................. To BOARD OF .H.EALTH ......................... ....................... Subject Town of Barnstable................. ................................................................... ..................................I——......................................... .................... ...... 396 Main Street. Hyannis, ,MA P2601 Dear Board Members: ............ ....................................................... ................................................................ .............................................. .................... ............. .................... ...............ROuld...you...please schedule us._at...your Jul 20 meeting for discussion ............. ........ .....I.. . Y., ................. of the attached site plan for Albert Matton. ....................................... ........................................................plan ............................ ....................I................... ........................ ............... Please. note that a variance..is.. ne'e'ded....f.pr the� ai�s.tAPP.e be'tween the ............ ............well and sewage.. ,.,........ L. ........ .Vku.J__ _CL ....... ................... ............ 4 t..k .................T fisj ,.fL.......... 04.1 .. ............+(n...................................................... EC� ........... lzot ........... ........... ........... ...........V o.y\.............Ck vo..vx 6 .10A r 0 eao............... Icli, olk, ............................. ............. ............................................ ....................... ... ... .............. ................. ............. ............................................................................ ............ ... .. ...... [I Please reply E] No reply necessary SIGNED WILL AM G. WELLER FORM 186-2 Available from n a Inc,Townsend,Mass.01469 SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES Railroad MARKED WITH MAGNETIC TAPE OR COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS NAVD 88 (Nor To SCALE) � Q a{e o 0 ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE 2. MUNICIPAL.WATER IS EXISTING Road W Lane \ FILTER FABRIC OVER STONE TOP FOUND. EL. 76.7 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. °rkef MINIMUM .75' OF COVER OVER PRECAST 29 SLOPE REQUIRED OVER SYSTEM 73.0'-74.0' PRECAST H-10 WATERTEST D'BOX FOR LEVELNESS BLOCKS OR 4. DESIGN LOADING FOR ALL PROPOSED PRECAST Cape Cod RISERS (TYP.) MIN. 2" WALL THICKNESS PRECAST RISERS UNITS TO BE AASHO H-1�( Community 7J8' 4"�SCH40 PVC MORTAR ALL Gangtt college PIPES LEVEL 1ST 2' �ENDS 4. COMPONENTS 1�IVERT IN 70.17' 4' 5. PIPE JOINTS TO BE MADE WATERTIGHT.(TMP) SIDES 71.0' ➢,°�°oo�oo. 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE °°°,°°ems : . � o EXISTING E ° ���� ���® ®®®�� ��� a°o°°°°° WITH MO ° Food TEE SEPTIC TANK** TEE 72 4t'* 6" MIN. SUMP >°o °o ���®��®O®�® ®®®®G]E2E2E] \ 3° O ° ° ° ° °°O 0 ° ° ° °°°°°°°°°°°° b '° °°°°o° o 0 0 0 0 0 0 o 0 0 0 o 0 0 0 0 0 0 ° 310 CMR 15.000 TITLE 5. °°°°°o°°°� 12" MIN. INT. DIM. °°°°°°°° oaaacoa�®aa �ao��a000aa ( ) cn Op GAS BAFFLE ;± °" N ;°o°°° :00000aoo 70.44 70.27 E°°°° °°°°°° 68.17' 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND rt Locus NOT TO BE USED FOR LOT LINE STAKING OR ANY \ L H-10 500 GAL. LEACHING CHAMBERS BY ACME PRECAST OR EQUAL. OTHER PURPOSE. 6 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. (2) UNITS REQUIRED d AROUNDALL PRECAST STRUCTURES 6" CRUSHED STONE OR MECHANICAL OVERALL DME SIIONSTOOU SIDE 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. OF STONE: 25.00' X 12.83' Ser Ice j COMPACTION. (15.221 [2]) r_ 9. COMPONENTS NOT TO BE BACKFILLED OR (4.2% SLOPE) ( 1 SLOPE) CONCEALED WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. FOUNDATION- EXIST. SEPTIC TANK 47' D' BOX 12' LEACHING FACILITY 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP CALLING DIGSAFE (1-888-344-7233) AND *THE INSTALLER SHALL VERIFY THE **INSTALLER SHALL CONFIRM MINIMUM 62.0' BOTTOM TH-1 VERIFYING THE LOCATION OF ALL UNDERGROUND & SEPTIC TANK SIZE AT 1 000 GALLONS NO GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF SCALE 1"=2000'f LOCATIONS OF ALL UTILITIES AND ALL AND ITS SUITABILITY FOR RE-USE. WORK. BUILDING SEWER OUTLETS AND REPLACE WITH 1500 GALLON SEPTIC VARIANCES REQUESTED: 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL ASSESSORS MAP 195 PARCEL 21 ELEVATIONS PRIOR TO INSTALLING ANY TANK APPROPRIATE TO SITE APPROVABLE BY HEALTH INSPECTOR OVER THE COUNTER BE REMOVED BENEATH AND 5' AROUND THE PORTION OF SEPTIC SYSTEM CONDITIONS IF NOT SUITABLE (3): FAILED SYSTEMS ONLY - SAS TO PRIVATE WELL SEPARATION DISTANCE PROPOSED LEACHING FACILITY. VARIANCES, IF LOCATED IN THE SAME GENERAL LOCATION AS THE OLD SAS AND MORE THAN 100 FEET SEPARATION IS PROPOSED, BOTH FROM THE 12. EXISTING LEACHING FACILITY SHALL BE PUMPED LEGEND- ON-SITE WELL AND ANY AND ALL WELLS ON ADJACENT AND NEIGHBORING AND REMOVED OR PUMPED AND FILLED WITH CLEAN PARCELS. SAND. 99- EXISTING CONTOUR 63 �60 v SYSTEM DESIGN. ul ftid 61 X 99 f EXIST. SPOT ELEV. -I- GARBAGE DISPOSER IS NOT ALLOWED -[99]- PROPOSED CONTOUR 63 68 f98.4] PROPOSED SPOT EL. EXISTING 3 BEDROOM DWELLING TH1 \ DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 330 GPD TEST HOLE 1�6s USE A 330 GPD DESIGN FLOW 2% SLOPE OF GROUND 68 SEPTIC TANK: 330 GPD (2) = 660 �Q UTILITY POLE I � **RE-USE EXISTING 1000 GAL. SEPTIC TANK A BENCHMARK a r' FIRE HYDRANT MAG NAIL, , G.- NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING R / I EL. = 69.1' M 0 1 " AD PROVIDE 1 OF 40 MIL LINER AT 5' SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD - OFF SAS REA SHOWN. TOP AT BOTTOM 25 x 12.83 (.74) = 237 GPD ELEV. 71.0', TTOM AT EL. 67.0't 8 7�� -- � O TOTAL. 472 S.F. 349 GPD TEST HOLE LOGS S 6 ;2 PAVE �73 70 USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) �, ENGINEER: DANIEL E. GONSALVES, SE #13587 65 DR E � � �TH2 WITH 4' STONE ALL AROUND DAVID STANTON, IRS TH1 WITNESS: DATE: 5/13/19 0 - PERC. RATE < 5 MIN/INCH /66 MA APPROVED DATE BOARD OF HEALTH CLASS I SOILS P# 19-17 61 / 25 77 ELEV. ELEV. w. %, �78 o» Q 72.0' 0„ Q 72.0' - - - - " X v o) �� EXISTING A A � o DWELLING „ LS LS 0 69 0• TOF = 76.7 �� 6" 10YR 3/2 6» 10YR 3/2 � ��� _ TITLE 5 SITE PLAN B B ,10 �_� � _ _ I �o � 100 LS LS DECK SZ 103 MOCO ROAD 24„ 10YR 4/6 70 0' 26" 10YR 4/6 69 8' 1� I I WELL WEST EST BARNSTABLE, MA I- Q PREPARED FOR - �3 ��� BORTOLOTTI CONSTRUCTION/ PERC LOT 17 I FS 15,072± S.F. �`0 ! 85� MATTON M M/FS / �4 ro d -2-3 3 j�"�o4 ., DATE: MAY 13, 2019 2.5Y 6/4 2.5Y 6/4 8 23�pg� >> �' fDANIEL V- �5 1 3 \ K �' �'1slEl-• u,� off 508-362-4541 8' 1�i OJAL,1 l/s�' ��JA,LgA \'�f' fax 508-362-9880 "'': 5 c 1 � No.40980 � �I�✓'iL �, downcape.com 16 - 8 1 18 \ o� /��n1 No 46502 J �. Q5 o� o e 11 0 8 ; I��SS� � ^��r� �k down cape engineering iac 2 .../�Q SU e.., ,` cS�. S� \ lr� ) . 120" 62.0' 120" 62.0' civil engineers NO GROUNDWATER ENCOUNTERED Scale: 1"= 20' 5 1- , _ '� ) land Surveyors 939 Main Street ( R to 6A) �wL, q �_ s�� 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., PiL.S. 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