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0006 MORGAN WAY - Health
6. MORGAN I#AY, BART Sf ALE, T A= 175-'033 1 t N F No. 4210 1/3 BLU ESSELTE 10%fl 0 o c 0 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t/ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Misposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(ell"Upgrade( ) Abandon( ) ❑Complete System ndividual Components CLocation Address or Lot No. C<90L ) ckm Owner's Name,Address and Tel.No. Assessor's Map/Parcel As Installer's Name,Address,and Tel.No. C� Designer's Name,Address,and Tel..No. WIS 'RA Type of Building: Dwelling No.of Bedrooms N Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) I.�' gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs orAlterations(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 of ni q Sigged V Uf Z •�3��.�--' Q Application Approved by "' y Date Application Disapproved by Date for the following reasons Permit No. 2-,1 o Date Issued -2 - T f�.� "z-.. ram.,. _ <. .. • J _. ' - .. j ^y t No. G _G �.. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes WItatIDYC for -MIspDsaY 6pBtEltt CDIIBtCULtiD1I PPrIICIt Application for a Permit to Construct( ) Repair(0')�Upgrade( ) Abandon( ) ❑Complete System [PlIndividual Components Location Address or Lot No. , czrl oj Owner's Name,Address,and Tel.No. t � Assessor's Map/Parcel Installer's Name,Address,and Tell..No.�. �, �. Designer's Name,Address,and Tel.No. T�pe of Building Dwelling No.of Bedrooms N Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Shower's(l¢)'Cafeteria( ) Other Fixtures - Design Flow(min.required) � /l gpd Design flow provided 1� 1 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 6-V\cj( Q_ IAV ma 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 I l Cotripliancealias been issued by this Board of Healthy/ •' ;� ' Signed ` ," � .�. v / Application Approved by -? Date ` Application Disapproved by Date / I' for the following reasons Permit No. 2.o.2) . o 6 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY;that the On-site Sewage Disposal system Constructed "� Upgraded( )g p y ( ) Repaired( yam) Abandoned( )by �,.,� Q ...• at 1. � .d C,41& been constructed in accordance with the provisions of Tille,S and the for Disposal System Construction Permit No. of o a dated Installer !( �,��r �„ Designer #bedrooms h1/ ] rt i Approved design flow '�( gpd The issuance of this permit shall not be construed as a guarantee that the system will fijtncctio" design Insectored. _ Date n(i I � r�' P ---._ �l -------------- No. Fee 7 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS -Misposal *yet e Construction permit Permission is hereby granted to Construct( ) Repair(p Upgrade( ) Abandon( ) System located at. ` \ / "1.C 1: % 0�. 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 fi Approved byi f � V PERMIT NO: TOWN OF BARNSTABLE ISSUE DATE 1020 � `- January 1, 2016 PERMIT ,RjV HMENT onIn accorda i j dj` t I of Chapter 94, Section 395A a r�.l ec - _ the Gene ".tea rr`h't is he n areby granted to: JULIE RENEE' STEINDEL JUL 5 TE COMPANY � . Whose place of business i fi RGAN STABLe'W 0 Y Type of business and any I d`tri%tio f s: R HEN ESTA LISHI Ell s �= To operate a food establish ,errn he 5`T LE , RESTRICTIONS IF ANY: SEATING: 0 ANNUAL: � SEASONAL: rift-TEMPORAR z` r� `' ' F'. D OF HEALTH RETAIL FOOD STORE: �Qa FOOD SERVICE ESTABLISHMENT: F4 . ne Miller, M.D., Chairperson RESIDENTIAL KITCHEN FOR RETAIL SALE: + 7 . 4 g h aul J. Canniff, D.M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAST MX ,e..a- Junichi Sawavanagi MOBILE FOOD UNIT: � re�`� TOBACCO SALES: D e c e m b e r 31 , 2016 (� FROZEN DESSERT: Thomas A. McKean, RS, CHO CATERER: Director of Public Health f r Town of Barnstable �VE� Regulatory Services g5/ Richard V. Scali, Director �, BARNSTABLE 0 RAMS"LE. • oaxnsne •c>:xremruF.wnrr•rrcFr+xs „ASS. Public Health Division Sb;y ,0� 109.2014 iOjEo�r s Thomas McKean, Director 575 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: _J NAME OF FOOD ESTABLISHMENT: JA) ADDRESS OF FOOD ESTABLISHMENT: E-MAIL ADDRESS: Lar. C TELEPHONE NUMBER OF FOOD ESTABLIS ENT: &I NUMBER OF SEATS*: INSIDE: OUTSIDE: TOTAL:� * Note: If indoor seating provided, see Licensi, g regarding Common Victuallers ]License TOTAL NUMBER OF BATHROOMS: —v� ANNUAL OR SEASONAL OPERATION: TYPICAL HOURS OF OPERATION MON-FRI: TO DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) IF SEASONAL: APPROXIMATE DATES OF OPERATION: /1 TOE= ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE NAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST *IF SEATING: ALSO, MUST OBTAIN _L,,�-RESIDENTIAL KITCHEN A COMMON VICTUALLER'S LICENSE MOBILE FOOD FROM LICENSING DIVISION. TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING •\-- 'J- OUTSIDE DINING (OVER) { ***REMINDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE HEALTH DIVISION AND F LICENSING, AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? Nl� CURTAIN PROVIDED AT WAITSTAFF SERVICE DOORS IS AN AIR CURT ( )/r CONTACT INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: 0/NO t ADDRESS S y PHONE # h IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: i IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE-OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIEDI FOOD PROTECTION MANAGERS. AT LEAST ONE CERTIFIED FOOD PROTECTION MANAGER IS REQUIRED TO BE ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** r' LIST THE NAMES OF YOUR CERTIFIED FOOD PROTECTION MANAGERS (I.E. SERVSAFE.) 1, EXPIRATION DATE: / / i 2, EXPIRATION DATE: EFFECTIVE FEBRUARY 1, 2011 EACH FOOD ESTABLISHMENT THAT COOKS, PREPARES, OR SERVES FOOD INTENDED FOR IMMEDIATE CONSUMPTION EITHER ON OR OFF THE PREMISES SHALL HAVE AT LEAST ONE CERTIFIED FOOD ALLERGEN AWARENESS TRAINED-STAFF MEMBER. *** PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** w LIST THE NAME OF YOUR CERTIFED FOOD ALLERGEN AWARENESS TRAINED STAFF. 1, EXPIRAT ON DATE , i SIGNATURE OF APPLICANT AND DATE Q:\Application Fonns\Foodapp2.doc I J \ J \ J J \ J \ J J \ - - - - - - CERTIFICATE OF ALLERGEN AWARENESS TRAINING 41 Name of Recipient:Julie RSteindel I _ a , Certificate Number: CW79571 - Date of Completion: 03/11/2014 Date of Expiration: 03/10/2019 I � � t Issued By: � Sr r The above-named person is hereby issued this cert�ficate ; ; for completing an allergen awareness training program Compuftrl<s_ ' recognized by the Massachusetts Department of Public Health CompuWorks Systems,Inc. in accordance with 105 CMR 590.009(G)(3)(a). 591 North Avenue,Door 2 Wakefield,MA 01880 ; P:781-224-1113 This certi zcate will be valid for five(5)years from date of completion. F:781-224-0504 I r V0 wwwcompuworks.com ,. " 'mod ,, � 1+it � +1�i !'r � � � 1� � � +�'�! �►'► EXAM FORM NO. 4907 CERTIFICATE NO. 10917782 o � , CERToHCAT ON ....... ...................... TO JULIE R STEINDEL for successfully completing the standards set�forth for the ServSafe Food Protection Manager Certification.Examination, y j,a which is accredited by the American National Standards Institute(ANSI)-Conference for Food Protection(CFP). 09/2014 >x - DATE 'O'>, EXAMINATION 04/09/2019 DATE OF EX IRATION Local laws apply.Ch ck with your local regulatory agency or recertification requirements. St v ' Sherman Brown � SVP,National Restaurant Associa� tions #0655 ©2014 NatL-pal RestauLan ociation Educational Foundation(NRAEF).All rights reserved.ServSafe is a registered. demark of the NRAEF,used under license by National Restaurant Association Solutions,U.C. The logo appearitSgeext to ServSafe is a trademark of the National Restaurant Association. his document cannot be reproduced or altered. 14013002 0401 EXAM FORM NO. 4907 C:E R T I.F:I C A T.E NO. 10917782 C� o CERT� HCAT� ON TO J ULI E R STE I N DE L for successfully completing the standards set,,forth for the ServSafe'Food Protection Manager Certification Examination, ,c which is accredited by the American National Standards Institute(ANSI)-Conference for Food Protection:(CFP). 09/2014 iA DATE WLEXAMINATIO v 04/09/2.019 DATE OF EX �IRATION ` Locale laws apply.Ch ck with your local regulatory agency or recertification requirements. eP Sherman Brown SVp,National Restaurant Association S tions #0655 ©2014 Nati@nal Restapan ociation Educational.Foundation(NRAEF).All rights reserved.ServSafe is a registered demark of the NRAEF,used under license by National Restaurant Association solutions,LM The logo appe g ne)ext to ServSafe is a trademark of the National Restaurant Association. is document cannot be reproduced or altered. 14013002 v.1401 I Town of Barnstable of Regulatory Services Thomas F. Geiler,Director CAB • • Public Health Division MASS. i639 ` Thomas McKean,Director iOTFo�+" 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: O-_.L 13 Sewage Permit# ®l—3-(--) 'Assessor's Map/Parcel Installer &Designer Certification Form Designer: QRv if_� 63 m kO o _) Installer: (w r-l' S , 0 0 e N Address: Address: a,9 6 r-Q_*V ram; On ��� ��1 � C`� �, �� was issued a permit to install a (date) (installer) septic system at 1, o.f q-fao UQCi�1 based on a design drawn by (address) dated O®1►�,�D 1 . (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. Stripout (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 ns. Plan revision or certified as-built by designer to follow. Stripout(if rem'' c ;v� s�1 ; ,c ted and the soils were found satisfactory. 4, DAVI d &MASON '.. jUnstalles Sig rAkl� :, P (Desig 's i ature) (Affix Designer's Stamp 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. gAoffice fomis\designercertification form.doc L e- Fee Q THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: —�� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Mi5po5a1 ,p!50m Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. l fy)o r A N (�f��) Owner's Name,Address and Tel.No. R a-pk 190 f6� Assessor's Map/Parcel S 33 mod I tallej's Name,Address,and Tel.No. �(?� "'f>J3� Designer's Name,Address and Tel. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 1_�3 0 gallons per day. Calculated daily flow gallons. Plan Date ;1 ..d 1 13 Number of sheets Revision Date Title Size of Septic Tank 100o qQ L —CJ-Z ST-i A Type of S.A.S. C kAffi r S Description of Soil /� t 1, Nature of Repairs or Alterations(Answer when applicable) ��S;s'i L_ 7;N tC /A,:5;r- tj e- x l8 -ate Arc 36- yNt rw l No v-no�'t Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Boar f Health. Signe Date M Application Approved by Date 1—5 Application Disapproved for the following reasons Permit No. Date Issued No. Fee THE COMMONWEALTH-O'F MASSACHUSETTS Entered in computer: "rx"a „�• Yes -PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS + 01pprication for Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. m r N (�C�-.J Owner's Name,Address and Tel.No. 1 q a-pk ekd f6r Assessor's Map/rarcel Installer's Name,Address,and Tel.No. S5Z 4 3a1--0530 Designer's Name,Address and Tel.No.(S0-6)"(33 r' C C)'fit. C o.'S'N�- �'r tr G �3.M 0)S0 of S `i Ll G( s rN R� Hpq�t�vlc.� M�. �S �ti,��oNM �'t, ( S1GN ---- Type of Building: Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( ) Other '` Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures i Design Flow 1 3 gallons per day. Calculated daily flow gallons. Plan Date Q U01 1 3 Number of sheets Revision Date t Title Size of Septic Tank- 10oo qQ Z "E:Y�-1 pe of S.A.S. CkAM .r'S Description of Soil m aiI U v►1 s Ao ciP E ' I Nature of Repairs or Alterations(Answer when applicable) (J 7{1 I iJ O o© a(. 'YAIU k A)e.w O--Rn x . I6 y-20 Arc 3(. UNl y L ( N SToN-E i Date last inspected-.- Agreement: ---� The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in,accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance'has been issued by this Boar f Health. s Signed 7 _ Date Application Approved by Date T Sv Application Disapproved for the following reasons r Permit No. I �c ` Date Issued --------- -------------------^ --- ,.- �. 1THE COMMONWEALTH OF MASSACHUSETTS ARNSTABLE, MASSACHUSETTS 4-ettifiTrt�of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) { Abandoned( )by 2 nbe r--'r . 01.) r- C n. ?AI c- at n lY1DC" ,y f1J gt�' ) Co'). RQ?N Tp lC has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �)C/ 3 6( dated i s-ZI 1 Installer rz D_�e,r'S Q .CCU r C.a /N C Designer AW f)R Al kkQAI The issuance of this permit jshall of be construed as a guarantee that t e system wig 1 fu •t o as designed. Date 4 �� / 3 Inspect r I i No.�,/��-.>� �—=��`) � ----=------- -----------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi5po5ar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at 10 man fa rr: Al W q o fa) and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction mus be completed within three years of the date of this p Date: 1 Approved b�y� 4 4 Q 1 TOWN OF BARNSTABLE ,LOCATION �p ft\O r G A.0 LO PtA SEWAGE# �VILLAGECe 9 ,GAR.1O&�A 1f- AnnSSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO.16O OV co c 9�' 3�oST2 SEPTIC TANK CAPACITY 1000 LEACHING FACILITY:(type)At L (size) 3 l,(o'X, 9. D NO.OF BEDROOMS OWNER RaLPk. PERMIT DATE: ��l ►3 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Cs Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) /J Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) /V hq - Feet FURNISHED BY a 9 � e OLC 0 � y ru Qnj Y*. r� m OFF I CA A L USE CO Postage $ ru 0 Certified Fee S O Return Receipt Fee Po da� O (Endorsement Required) {p f�� Her Restricted Delivery Fee p l' p (Endorsement Required) Total Postage&Fees (o . o - � N Mr. Ralph Bedford 6 Morgan Way West Barnstable, MA 02668 Certified Mail Provides: i o A mailing receipt a A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Maile or Priority Mail& o Certified Mail is not available for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. ;For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. I. IMPORTANT:Save this receipt and present it when.makinq,an inquiry' PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 COMPLETETHIS SECTION . . DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. Q ❑Agent ■ Print your name and address on the reverse X Addressee so that we can return the card to you. B.. - eiv d b nn°te a ) C. Da of D livery ■ Attach this card to the back of the mailpiece,. % `,p 3 "j or on the front if space permits. J D. Is elivery address different from item 17 13 Yes ` 1. Article Addressed to: If YES,enter delivery address below: ❑ No, I Mr. Ralph Bedford P 1 6 Morgan Way 3. Service Type West Bamstable, MA 02668 ❑Certified Mail ❑Express Mail _ ❑Registered ❑Return Receipt for Merchandi 1 I ❑Insured Mail ❑C.O.D. ` 4. Restricted Delivery?(Extra Fee) ❑Ye I 2. Article Number( I ;;7 012`11010 0000 2843 210 2 { i 1 transfer from service laben PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 ` �. ..-: ..�:..:- ..._..,. ._.. I UNITED STATES'k-P>(3S*T7fCr`S.tF&—(, _ SPas aia r ,P©sage'&.Fees Paid .. xY . .� �... .. _.. .. _ .�. .... ' -errm No .. .._......_ ... i� • Sender: Please print your name, address, and ZIP+4 in this box • I I Town of Barnstable Public Health Division ` 200 Main Streety Hyannis, MA 02601 I I 6 t Barnstable Town of Barnstable Regulatory Services Department i M ' Public Health Division 1639. A��� Ub 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director 'FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2843 2102 March 11, 2013 Mr. Ralph Bedford 6 Morgan Way West Barnstable, MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 • The septic system located at 6 Morgan Way, West Barnstable, MA was last inspected on 9/22/2012 by James D. Sears, a certified,septic inspector for the State of Massachusetts. i The inspection of the septic system showed that the system "Failed" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: { • Septic system is in hydraulic failure You were ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. However, as of this date March 6, 2013, we have not received any indication that the construction work for replacing/repairing the Title 5 septic system has been done. Therefore you are again ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. You may request a hearing before the Board of Health with a written petition requesting a hearing on the matter within seven (7) days after the day this order was received. PER ORDER 0 THE BOARD OF HEALTH f omas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\6 Morgan Way W Bam Mar 2013.doc r e Town of Barnstable Barnstable ty �°pTHE Tp�y ' Regulatory Services Department A14mericaCi ❑ARNSTABLE, 'it public Health Division MASS. A gyp° i63 q. `gym ArEb MA�a 200 Main Street, Hyannis MA,02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean;CHO CERTIFIED MAIL# 7006 0810 0000 3524 6833 October 10, 2012 Mr. Ralph Bedford 6 Morgan Way West Barnstable, MA 02668 The septic system located at 6 Morgan Way, West Barnstable, MA was last inspected • on 9/22/2012 by James D. Sears, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Septic system is in hydraulic failure You are ordered to repair or replace the septic system within sixty (60) days 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 TH .BOARD OF HEALTH s cKean, R.S. CHO / Agent of the Board of Health Q:\SEPTIC\L.etters Septic Inspection Failures or Future Eval\32 Westminster Rd.,Cent.doc Town ,of Barnstable 4 P# 7;;" o Department of Regulatory Services n BABNSTABM : Public Health Division Date 9 MASS. �639 �e 200 Main Street,Hyannis MA 02601 or fD MA't a f Date Scheduled / j Time / Fee Pd. 10C L k Soil Suitability A s�sessment for S a e Disposal' Performed By: � r'�-�C.J� Witnessed By: U�� N- LOCATION & GENERAL INFORMATION Location Address / �Lr`j_��og�09` l Owner's Name t 'r"'rs(�^ e4eN 6711O , Address Assessor's Map/Parcel: 7,7 0 Engineer's Name NEW CONSTRUCTION REPAIR Telephone# Sce 36,7- /4/7 Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) ry �n -71s - to Vv r Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weepirig`from side of obs:hole: —` T M. 'Groundwater Adjustment Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST _ Date Time Observation Hole# I Time at 9" Depth of Perct Time at 6" (iD Start Pre-soak Time @ /y Time(9"-6") End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole 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 ASEPTIC\PERCFORM.DOC a DEEP OBSERVATION HOLE LOB, Hole# f Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. I f Consistency,%Gravel LI DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel DEEP OBSERVATION HOLE LOG Hole Depth from Soil Horizon _ Soil Texture Soil Color ' _#_ Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Graven S DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency %Graven Flood Insurance Rate May: -Above 500 year flood boundary*No Yes - - ► __ _ _ r ,._ . �- Within 500 year boundary No es Within 100 year flood boundary No ►' Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perv•o s material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pe ious material? Certification I certify that on �� (date)I have passed the soil evaluator examination approved by the Department of Envir ental Protection and that the above analysis was performed by me consistent with the required training,ex rtise d e erience described in 310 CMR 15.01 . Signature Date L ZOI77 Q:\SEPTIC\PERCFORM.DOC EPTIC\PERCFORM.DOC m _ eQ —0 rU £ C U7 M Postage $ C3 O Certifled Fee 00 Return Receipt Fee /J Postmark (Endorsement Required) 'Z!'�Here . O Restricted Delivery Fee 0 r qu l (Endorsement Reg rs` c G O Total Postage&Fees 7 Y tc Mr Ralph Bedford C�4 - 6 Morgan Way, West Barnstable, MA 02668 Certified Mail Provides: r% anab)ZOOZ sunp'oose uuo�id a A mailing receipt `-- ,a: ' a A unique identifier for your mallpiece n A record of delivery kept by the Postal Service for two years Important Reminders: O Certified Mail may ONLY be combined with First-Class Maila or Priority Mail®. `fir CertWed Mail Is not available for any class of international mail. fad NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt seance,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mallpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is kiequired. 0 For an additional fee, delivery may be restricted to the addressee or addressee's authorized aggent.Advise the clerk or mark the mallpiece with the endorsement"Restricted-Delivery. ,a if a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office'for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. 16 -_ IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs:" COMPLETE -MR .N COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature ���z0o , item 4 if Restricted Delivery is desired. X A ent\es ■ Print your name and address on the reverse so that we can return the card to you. B. i e b din N �P of D ' try ■ Attach this card to the back of the maiipiece, MOW ;F/ 4 or on the front If space permits. D. Is delivery address different ito ❑Y 1. Article Addressed to: if YES,enter delivery address o I Mr Ralph Bedford I p . 6 Morgan Way West Barnstable, MA 02668 3. Service Type ❑Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise �- ❑Insured Mail ❑C.O.D. I 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service label) ' t I f 7 670 U 1O'810 0 0 0 0 j 3T5 2 4 6833 Ps Form 3811,February 2004 Domestic Return Receipt 102595-02-WI540; i UNITED STATES PQy� �k'ilSC' S Vaff."' R w aid I` :tY.?I4 t. Sal.: t ...:.an.. .. 'se ! !ii 5� a I, O a� t dingy •li: a. S+�., t- • Sender: Please print your name, address, and ZIP+4 in this box • I Town of Barnstable Public Health Division 200 Main Streety Hyannis, MA 02601 i i ,„ 11�1!!t!l113��!ll !ll1D31�l ll�ll2Pd��3T]!!tl1t1!fill-!!tl1!idt _n+ a Town of Barnstable Barnstable �pF THE AB-America Gty Regulatory Services Department t RARNS-rAQLE, + 1 public Health Division T MASS. �p 1639 a ArFb"'A� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean;CHO CERTIFIED MAIL# 7006 0810 0000 3524 6833 October 10, 2012 Mr. Ralph Bedford 6 Morgan Way West Barnstable, MA 02668 The septic system located at 6 Morgan Way, West Barnstable, MA was last inspected on 9/22/2012 by James D. Sears, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00.) due to the following: • Septic system is in hydraulic failure You are ordered to repair or replace the septic system within sixty (60) days 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 TH BOARD OF HEALTH ✓_v s cKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\32 Westminster Rd.,Cent.doc i dic r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 6 Morgan Way Property Address ——_ Ralph Bedford Owner Owners Name information is required for every west Barnstable. MA 02668 9-22-12 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. ImportantWhen A. General. Information fillingng outout forms ��nruunuruip on the computer, \`O``\���IH Or: S use only the tab 1. ��' -Y Inspector. key to move your p . N cursor-do not James D. Sears = JA M E S use tits return Name of inspector --- _ key. ?*'•• :it Ca ewide Enterprises,LLC •_o o:Q Company Name ''i,, •' G ���� 153 Commercial St. �''��. ,SrI N StP Company Address Mashpee MA 02649 City/Town State Zip Code 508477-8877 S1623 Telephone Number License Number 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 ® F6A ❑ Needs Further Evaluation by the Local Approving Authority 9-22-12 Apector's Signature Date " Q0 The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared•system'or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. """This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. L ire'11r10 jriu-5Tdp-.-nir.rm:SuGsuAeoe Sewage Olaposal System•Page 1 of 17 x r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 6 Morgan Way Property Address Ralph Bedford Owner Owner's Name information is West Barnstable. MA 02668 9-22-12 required for every page. City[Town 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: ❑ l 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): tsins•11110 Titte 5 Official inspection Forth:Subsuffewa Sewage Disposal System•Page 2 of 17 Z-d dCt,:Z l, Z l, 9Z deS Commonwealth of Massachusetts �. FIN Title 5 Official Inspection Form �wSubsurface Sewage Disposal System Form- Not for Voluntary Assessments t�? 6 Morgan Way Property Address Ralph Bedford Owner Owners Name Information is West Barnstable. required for every MA 02668 9_22_12 page. Cit /Town State Zip Code Date of Inspedion B. Certification (cont.) 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 151715• 'l/�O - . Tine 5 Offidet Inspection Form:SuOsuAace Sewage Disposal System•page 3 M 17 r £'d d£t,:Z6 Zl• 8Z deS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 6 Morgan Way Property Address Ralph Bedford Owner Owners Name information is West Barnstable. MA 02668 9-22-12 required for every �____ page. CityfrDwn 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 0 ❑ 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 is less than 6" below invert or available volume is'less than day flow ?" - t5ins•11r10 Title 5 Officie9 Inspection Form:Subsurface Sewage DIsposel System•Page 4 of 17 d dbt,:Z l Z l, 8Z deS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 Mor acann Way Property Address Ralph Bedford Owner Owners Name regtAre fo s West Barnstable. MA 02668 9-22-12 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.)• Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ Any portion.of a cesspool or privy is within a Zone 1 of a public well. ❑ M 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 Il 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. 151ns-11110 Title 5 DKoal Inspedon Form:Subsurface Sewage Disposal System-Page 5 of 17 9-d dtbt,:Z i, Z I. 8Z deS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 Morgan Way Property Address Ralph Bedford Owner Owner's Name requir on is West Barnstable. MA 02668 9-22-12 requiredd for every page. Cityaown 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): NA Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 (Sins•1 f lf0 TBIe 5 official Inspedion Forth Subsurface Sewage Disposal System•Page a of 17 9-d dbt,:ZI, ZI, 9Z deS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 6 Morgan Way Property Address Ralph Bedford Owner Owner's Name informationaire for a West Barnstable. required for eve MA 02668 _ every 9-22-12 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? El Yes ® No Water meter readings, if available(last 2 years usage (gpd)): 2010-99,000Gal 2011-83,000Gal Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commercial/]ndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gait ns per day(gpd) Basis of design flow(seatstpersonslsq.ft, etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes 0 No Water meter readings, if available: 1.5ins-i iti o Title 5 Official Inspection Form Suhsurface Sewage Disposal System page 7 or 17 Commonwealth of Massachusetts P. . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 Morgan Way _ Property Address Ralph Bedford Owner Owner's Name information is required for every West Bamstable. MA 02668 9-22-12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 6-25-10/3-12-12 Capewide Was system pumped as part of the inspection? ❑ lies ® 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 VA system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): l5ins•11l10 11Ua 5 Olruial Inspectlan Forty:Subsurrace Sewage Disposal System-Page 8 or 17 g•d d9ti:Zl, Zl, 8ZdeS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 6 Morgan Way Property Address Ralph Bedford Owner Owners Name information is required for every West Barnstable. MA 02668 9-22-12 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1995 Permit # 95-631 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1' Depth below grade: feet Material of construction: ❑cast iron ® 40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" pvc sch 40 Septic Tank(locate on site plan): 4" Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑. No Dimensions: 1000 Gal Precast 1„ Sludge depth: 15ire•11r10 Title 8 Official bspedon Form:Subsurtam Sewage Mpoeal Syslem•Page 9 of 17 6'd d9ti:7,6 7,6 8Z deS Commonwealth of Massachusetts Title 5 Official Inspection Form R. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t` 6 Morgan Way Property Address Ralph Bedford Owner owners Name information is required for every West Bamstable. _ MA-.-.- 02668 _ 9-22_12 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 1 81' Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt- Tape Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, .liquid levels as related to outlet invert,evidence of leakage, etc.): Tank ank covers at 4" below grade, Tank at working level. w/in and outlet tee's , No sign of leakage 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-11I10 Tithe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 ar 17 06•d d9t,:ZL Z1. 8Zdes Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 6 Morgan Way Property Address Ralph Bedford Owner Owner's Name required nq iredfn e every West Barnstable. re wired for eve MA 02668 9-22-12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 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 15ins•t 1/t0 TkUe S Offidal Vwectlon Form:Su>Lsurrace Sewage DLVasal System•Page 11 of it l l'd d9t,:7,l ZL 87,deS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ¢ 6 Morgan Way Property Address Ralph Bedford Owner owner's Name information is required for every West Barnstable. MA 02668 9-22-12 ._._._._ page. 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 located on site . not opened Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: r5ins•11I10. Ti11e 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 12 of 17 Z_�•d d917:Z 1. Z l• 9Z deS f commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 Morgan Way Property Address —' Ralph Bedford Owner owners Name information is required for every West Barnstable- MA 02668 9-22-12 page. Cityfrown State Zip Code Date of inspection D. System Information (cons) Type: ® leaching pits number: 1 ❑ leaching chambers number: Q 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.): Leaching is one 1000 Gal precast pit w/2'stone per asbuilt Pit at 8' below grade w/cover at 18". Pit is full, not leaching, need to replace leaching- 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 Ohs•11/10 Title 5 OtfidW Inspecfion Form SubsL41ace Sewage MVosd System•Page 13 of 17 £6'd dLti:Zl, 7,6 87,d8S Commonwealth of Massachusetts Title 5 Official Inspection .Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 6 Morgan Way Property Address Ralph Bedford Owner Owners Name infbffnrequire for is West Barnstable. MA 02668 9-22-12 required for every page, Cityrrown state ?p Code Date of Inspection D. System Information (cunt.) Comments(note condition of soil, signs of hydraulic failure, level of pondiing, 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.): 5ns•11110 Title 5 of'frdal Inspection Farm:Subsurface Sawage Disposal System•Page 14 of 17 t,t'd dLti:Z l, Z l, 9Z deS THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) M DATA Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 Morgan Way Property Address !— Ralph Bedford Omer Owner's!Name "e""a4or'is required for every West Barnstable. MA 02668 9-22-12 page. City/Town State Zip Code Date of Inspection D. System Information (cons) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately I . f � I i I 4 v! �log-/� a ����6� - �b o 3 wozQ=� �q_g' 9L'd dLb:ZL ZL 9ZdeS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 6 Morgan Way Property Address Ralph Bedford Owner owrter's Name information is required for every west Barnstable. MA 02668 9-22-12 page. Cityr town State Zip Code Date of Inspection D. System Information (coat.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water. feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: area high no g.w. problem seen Before filing this Inspection Report, please see Report Completeness Checklist on next page. 5m•11110 Title 5 Official Inspection Form.subsurface sewage oispmw system•Page 16 of 17 gt•d d8ti:Zl, 7,6 2Z deS y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 6 Morgan Way Property Address Ralph Bedford Owner Owners Name information is required for every, west Barnstable. _MA 02668 _ 9-22-12 page. Citylrown 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•11110 Trite 5 Official Inspection Form:SMau face Sewege Disposal System-Page 17 of 17 L 6'd d817:Z.L Z 18Z deS :'/fq3 f,! BOUSFIELD SANITARY SERVICE, INC. ?n BRETT ELLIS, PRESIDENT I OWNER `' Y P.O. BOx 669 SANDWICH, MA 02563 508/888-2010 PROPOSAL SUBMITTED T EDPORD PHONE: 508-428-9489 DATE: OCT. 4, 2012 S EET: 6 M _(BAN iNAY- "— JOB NAME: SEPTIC UPGRADE CITY,si W. BARNSTABLE, MA 02668 JOB LOCATION: (5 MORGAN WAY PLANS ACCOMPANYING, OR OBTAINED FOR THIS PROPOSAL ARE FOR THE SOLE USE OF THE SIGNER OF SAID. PROPOSAL AND BOUSFIELD SANITARY SERVICE, INC. WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES SUBJECT TO ALL TERMS AND CONDITIONS AS SET FORTH IN THIS PROPOSAL AS FOLLOWS: '-- 1. INITIAL DEPOSIT IS TO PROVIDE EXCAVATION FOR PERC TEST, AND ENGINEERED PLANS FOR SEPTIC SYSTEM DESIGN FOR A TITLE V SEPTIC SYSTEM FOR EX ISTING,HOUSE ONLY NOT DESIGNED FOR ADDITIONAL SQUARE FOOTAGE. SEPTIC SYSTEM DESIGN WILL NOT ACCOMMODATE GARBAGE GRINDER, IF EXISTING IT MUST BE REMOVED. ADDED COST WILL OCCUR FOR ANY REDESIGN OR RELOCATION REQUESTED AFTER THE TITLE V SPEC PLANS HAVE BEEN COMPLETED. 2. TO OBTAIN PERMITS TO INSTALL SEPTIC SYSTEM, INSTALL SEPTIC SYSTEM AS PER APPROVED DRAWING, TO INCLUDE THE EXISTING SEPTIC TANK, AND NEW ADEQUATE LEACHING FACILITY PER TITLE V SPECS. FOR A 3 BEDROOM HOME. TO PROVIDE PUMPING SERVICES AS NECESSARY TO FACILITATE THE INSTALLATION ONLY. TO OBTAIN INSPECTIONS, 3. TO GRADE WORK AREA, AND PROVIDE QUALITY LOAM AND SEED FOR RESTORATION OF WORK AREA. TO BE MAINTAINED BY THE HOMEOWNER UPON OUR DEPARTURE. ( WATERING ETC.) 4. BOUSFIELD SANITARY WILL REPAIR UNDERGROUND IRRIGATION, IF DAMAGED. 5. BOUSFIELD SANITARY IS NOT RESPONSIBLE FOR ANY DAMAGE TO ASPHALT DRIVEWAY, IF APPLICABLE, DUE TO HEAVY EQUIPMENT ACCESS. 6. SOME TREE OR SHRUB REMOVAL MAY OR MAY NOT BE NECESSARY TO FACILITATE INSTALLATION, THIS IS INCLUDED. WE PROPOSE HEREBY TO FURNISH MATERIAL AND LABOR,COMPLETE IN ACCORDANCE WITH MASS 310 CMR 11.00,FOR THE SUM OF: _SIX THOUSAND DOLLARS(_$_6,000.00 A DEPOSIT OF$2,000.00 IS REQUIRED TO BEGIN THE PERMITTING PROCESS. '*' *A PAYMENT OF$3,000.00 IS DUE UPON EQUIPMENT PLACEMENT ON SITE. BALANCE IS DUE IN FULL UPON COMPLETION, THEN YOU WILL RECEIVE THE CERTIFICATE OF COMPLIANCE.......... ALL MATERIAL IS GUARANTEED TO BE AS SPECIFIED. ALL WORK TO BE COMPLETED IN A WORKMAN LIKE MANNER ACCORDING TO STANDARD PRACTICES.BOUSFIELD SAMjARY_&ERVICE)y.jAXJJLLY INSURED AND OSHA CERTIFIED. AUTHORIZED SIGNATURE: PROPOSAL MAY BE WITHDRA US IF NCfT ACCEPTED WITHIN 30 DAYS. ACCEPTANCE OF PROPOSAL.THE ABOVE PRICES, SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED. PAYMENT WILL BE MADE AS OUTLINED ABOVE. IF THIS PROPERTY IS FOR SALE,PLEASE DO NOT SCHEDULE ANY CLOSINGS OR DEADLINES UNTIL INSTALLATION IS COMPLETE. SIGNATURE DATE SIGNATURE DATE s THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) IMF E DATA r TOWN OF BARNSTABLE LOCATION T 1676/2GMeU/JAASEWAGE # �3 VILLAGE � ' �d�/2�S'TJ�.S�� ASSESSOR'S MAP&LOT 7 INSTALLER'S NAME&PHONE NO. IDV60 SEPTIC TANK CAPACITY �AG i LEACHING FACILITY: (type) �T� (size) IdW 619G 5�1 NO.OF BEDROOMS 3 . BUILDER OR OWNER 6 '151,0f, gV11,h1 6 Cd PERMTTDATE: O " 9—�COMPLJANCE DATE: R r`:Z Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility /�� Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist _ within 300 feet of leaching facility) Feet Furnished by_ 1p W IVC A P 9 g/V� / IL................... oU 3 -,7-9'=6' ` 9 3 -r31 �o r d THE COMMONWEALTH OF-MASSACHUSETTS 7 BOARD OF HEALTH TO. C.v1 ..-......-OF...............���..ARA[57�F C.C._......-.._..-......_. Appliration for Biipnaal Works C�nnitrurtiun -permit Application is hereby made for a Yermit to Construct (/) or Repair ( ) an Individual Sewage Disposal ' System at: (' ................_........_...-L o,7--..... 6 M096 .. c� ... ..... .. ..... Location•!\d s �//� or Lot/ o. /e ........................�..... � .St.. .... J.1. .-•-• •-----.-•-- -1 k�F.!{/f............. ...........- - .... wner. dress Installer Ass Type of Building Size Lot./S_010..Z..Sq. feet ,., Dwelling—No. of Bedrooms........................................:...Expansion Attic ( ) . Garbage Grinder ( ) a Q, Other—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( ) Q' Other fixtures ....................... W Design Flow.............//fD....................gallons perms peer day. Total daily flow................?3-_3 ..............gallon. WSeptic Tank—Liquid capacity/M-gallons Length..&...(a_.. Width+...(.Q.-. Diameter................ Depth.S.._.+... x Disposal Trench—No.................... Width.................... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No........A........... Diameter......I.�..... Depth below inlet...._3..t:.a..... Total leaching area.Z`t.�...sq. ft. Z Other Distribution box (A) Dosing tank ( ) _ '~ Percolation Test Results Performed b ............G,.fL.... Ef ._. C�� ........ Date....19d1� ID.l......_.. ,al Test Pit No. L._C Z......minutes per inch Depth of Test Pit...!. (a .... Depth to ground water......Ntl! 1 44 Test Pit No. 2................minutes per inch ' Depth of Test Pit.................... Depth to ground water........................ 9 �# ••-•----------•--------------•------•-----.......--•-••--•---......---....................................................-........... QDescription of Soil... .....P.�55� .-••................•--------------.......-•-•-----•-•-•-•-•U .............................•--•--•---......---••-.....----_. ........---......--•---•---•---•--.-••- ---._.._-----•.....................----------.................. ----•---............ . 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 I ITL: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b en issu by the board of Signed_ ..... ...--- -- -• ---:........_lY...`...l... �! ,Pat� / Application Approved By.:_......_ ... .......- ....... ........... ._ ( e..........,l r Application Disapproved for the following reasons:...----•----•-•-•.............••-•---------••---••••••--•-•-----------------...................t.............. ••-•---•----•-•--•-•----•---•......................•--------•----•---••---................••---------:....:--------........--•--•-------•----••---•---•-----------................................•--... Date Permit No....... '... . --•-•--•---•.... ....:................... Issued...................................... ... .... . THE COMMONWEALTH OF MASSACHUSETTS 67 � - BOARD OF iH EALTH o w n............O F................ Appliration for Diopoottl Marks ToftWurtion rrrmit -' -.Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal ! System at j r .. •-------. , _..._._.._ -�:.a.T...../6.�, � /I,:t r r� -- _ c . z t��� :, ......................._ ,.... ........... --• - Location-Address �- -�� . ............•------..._.._.__... . /.l)t c, ( ..... r/ � � � j A% v ,... ..................... W �.... ...........a .....wnerf G 6 4 /1 VI� T/•% �t Gt S M Installer 1 Add�ess i— Q7i Type of Building 13:1 Size Lot.l:....�-.0...0...............Sq. feet U DwellingNo. of Bedrooms................................ .__..Ex anion Attic— ---.... p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures .-------•-•-••-•--•-••................ '.7 . WWDesign Flow............../_!-. ....................gallons perwper6Gn.per day. Total daily flow..................L�P.............. WSeptic Tank—Liquid capacity)Q Wgalloils Length..,?...Kea.._ Width. J.6... Diameter................ Depth.5.._.�:... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. -3 Seepage Pit No........I_.._.____.. Diameter......I.Zm..... Depth below inlet.. .t.`fir ..... Total leaching area.Z_'f.-.'�--...sq. ft. Z Other Distribution box ( Dosing tank Percolation Test Results Performed by............ �:.... a T�._.e.. .......... Date....z�fiylg.7.......... Test Pit No. 1.. .�t ......minutes per inch Depth of Test Pit....- 1::....... Depth to ground water......��.!���_. CZ, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 I _ O ' _ Description of Soil----......#:...�. .5. .....................••--•-•-•----•------.........------------------. V ------------------ ----------•------------------------------ -.------------------ ..... --------------•--- - -------------------------- •----------------------------- ----••-------------•----•---.___...--------•--....._.----..._.._....------.......----------------...----.._.................__........ e. ........... ............................................ U Nature of Repairs or Alterations—Answer when applicabl ......................_....'....._.........................._................................. ...----••---••-••-•••-; •-•-•••---•-•...............•••••-••-•-•-•.......•-•----••-••-•--.._........................----••••••.....-•----•-•---••._.....•-•--•••••-•-•-•••......-•.........•........... Agreement: 1 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLZ 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••- � 1 �........................... ... �- ....��.. `✓`. �..- ... .. _....t.. ...... ..... 6 ,,�.�'`� D le Application Approved BY--•tom.._% �.. ...4;;. .. ..'./a....... .. r/ Date Application Disapproved for the following reasons:............................................................................................................ .. •--•-•---•.................•---••---•-------..._........--•--•-----------....------------......-----..................---.....---.......---•-----...---------------........•-•-••........-••--....---..� _ ter_, Date Permit No..... - + --.......... Issued._—:' Date y ova.,------ um,F w�.i.�...a- .. -iXPF+P w-Js �. ®woaru.v..www-r+..r.w vx+Y O+.`w uw,r n..4 a w•••..n.. // �.iRT b c;u...w..w....ww.,® THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............OF....... .. "l•/1 !3G' 77 ................... Cgrrtifiratr of Toutplilturr THIS IS TO CERTIFY hat the Individual Sewage Disposal S-ste constructed,structed,( )Nor Repaired ( ) r by................................ - ...'; , - ......_...._.._.... �'�n.. �...... ._...... �.--._....._"".-."'- n all !1%..+: ...� .. at... � ' "---•�'` Pr '11.. �rv� ` ' .�... .sir`;?............... 7 has been installed in accordance witli the provisions of Ti" ` 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__ �- �"�` dat�e+do�_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® RANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � Inspector: ..DATE.... .......... .. .. ._. .`.... . ....._. .-, ,-...._-r- -T .r._. __w-_r.r. ------ ---- .._ THE . COMMONWEALTH OF MASSACHUSETTS V BOARD OF HEALTH `..�'4t/ � OF..... ....... :.. w ...................... ,yam N ..............-••---••. FEEK .::........ Disposal � �/urk,,,�����-�Tunstrnrtion f rrmit Permission is hereby granted......... r,,� .... ./7v./__, . to Construct ( V) or Repair ( ) an Individual Sewage Disposal System at No...... '� :/-- i2 '?4. 'I✓`._.._.. �, ` ?.... �� a ,. .. .........._.. .....�.. ..._ ... Street � r,,, k as shown on the application for Disposal Works Construction Permit No.f ".. ...... ed.... - _..' ...f ... ...!. .................................. ......t—... .................................................... //_ 1 V Board of Health DATE............•••............./. _.._... ........---•-•......-•••••......-•-•.... t 3 ; i rr a 3tT`s 0 110 1 "Y I , � to ct' `�' i IN, 5. f i . i_.. MAID ""TsQ.TtG-' T. AJpC S TC � Ihd c1�cC>4..}.HMlJ, WiT14 \ � ~— -----.` "'. s', _ ,.x,_,• ~ f ,. i h t�:rid?'�z t�_ G.a G�' `�rr't.�E.l- \ # �-' --... .o g ;�%� ►�b-j-To �G.a.0 4 µ f fin i Ucr 1-4 Z4 1aocAyY o, Ad L—J ( f 4 etc+ X i .� r� _ ! L.i yet {{`> t 1 yam« I ti\ f'� 4 `' f -(�(Z' Wn��r1ED5Tr3� a 1 T G4L Uc #pLr t�r.1 -Ca i ' '' Ey� -- FM..t_ .- � �,) 'rn 4�' �„'�✓ l..[,..P'rv"�.^.��•f rl y-.-'.,R, ._...__.. � � �+.."x°".'4 �._...�__ � ____._._._._.___..._.,._.._..__..�_—.._.^_-... ' T i Clocun Ct e. Grtq iT7 cCr" lr1G , _ �` t,. ' r C v 1 e►�iG,t�EE eS ? LLaP1D�✓'U¢Jtr^(C�s �.F'3+f�# i t �r�� �� �/ 1 c� ��! ��>?AF.'Pf>F HEpI.-TH I DEL "(AeMovT", MAC, AQ�4 µ . Ga. ALA 12.L.C, MATE A QovEGa CAT ASSESSORS MAP : A IM' NOTES: - ----------- -- ----_-----..__ TEST HOLE LOGS - - PARCEL FLOOD ZONE: (�" SO I L EVALUATOR : I� 1) The installation shall comply willr'1'iCle V aiid 'Town of %�13oard of V � - -�-___.__ .__ ���� _-_--- _ _._.___�__..._ _ I leallh Regulations. �-� WITNESS : v b REFERENCE: IFI DATE: � 1 ) y _ - _ ._ _` 2 I lie installer shall vcrif the location of utilities sewer inverts and septic i PERCOLAT 1014 RATE: �. Z.1l�l I components prior to installation and setting; base elevations. �A�_i7 -� ���_ _ _. _ , }2�j!' F � 12 O� 3) All gravity septic piping, to be 4 inch Sch 4O1'VC at 1/8"per foot. The first �r y two leet out of the d box to the leaching shall be level. e TH-2 4) This plan is not to be utilized for property line determination nor any other q � purpose other than the proposed system installation. 1 ,�A 5) All septic components must meet Title V specifications. 0 q� 6) Parking shall not be constructed over 1110 septic components. 7) The property is bounded by property corners acid property lines. _ LOCATION MAP 8) The property owner shall review design considerations to approve of total 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. x 2 ' 9) The existing leaching or cesspools shall be pumped and tilled with material ' per Title V abandonment procedures. 'Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per Title V specs. u (� �� 1 r L b Wma System components to be 10 feet from water line. Sewer lines crossing the 10)Syst P b water line shall be sleeved with 4 inch SCI 14U PVC with ends grouted if applicable. 'Fhe proposed SAS is being installed below the water service ( line. The line is to be sleeved as aforementioned" and maintained in lace. SEPT 1C SYSTEM DESIGN I p 11 if a garbage grinder exists it is to be removed and is the responsibility of the ) g b g� p Y owner to ensure such. i FLOW ESTIMATE 0 12)The installer is to take caution in excavation around the gas line if such exists. i \�D VEDROOMS AT 11D GAL/DAY/BEDROOiA AL/DAY 13)The installer shaffverify.the location,quantity and elevation of the sewer ��� I lines exiting the dwelling prior to the installation. Al�`� \ SEPT C TA1JiC 14)This plan is representative only that a system can fit on a property meeting � L/DAY x 2 DAYS GAL- Title V requirements. � .GA USE DOG) GALLON SEPTIC TANK(9g5 14Cp 0 0 - - 1 !, ABSORPT ON SYSTEM \ ( � _" �►,�"N OFF .<.Q� -9�s M ON x Z <7 nE vd a a --SEPT I C SYSTEM SECTION Ir ID �Aa rf � GAL 11� - SEPT I C TAN ' ill.0D ' SITE AND SEWAGE PLAN LOCA"!' ION UjIF \ PREPARED FOR SCALE . o DAVID B . MASON9J DATE: Z 2� 3 1 O •$1 �� 1 - dull Ei0 !)E3C EIJV I ROrJMEIJ�fAL. DES 1 GIJS SANDW I CH . MA z DATE ~- ; T1 DT ,A EMIT �� j z L �y tail ! SOa ) 833- ! 77 ��I -2�913l• ' ` < I '. ', GIs (� }� l ---- -- - - — -