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0045 SPRUCE STREET - Health
45 Spruce Street ' -v A=216-052 i ll z Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Tess Owner Owner Q e information is ,A required for _ - A@ a ?"Aulp every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. 'rnpon When filling out A. General Information forms on the computer,use 1. Ins I only the tab key ` to move your � / e-MAQ — cursor-do not use tine return Na re ojInspe r key. '/ !A ' M%4 -- " IN Com ny me d `J God ss l `Q 6�p J� L t rN�T: CdyIT '? y ig Sta y�� �� � Zip Code Telephone Number lrcense 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 in tion.Thp osp on was performed based on my training and experience in the proper function andenance iron sewage disposal systems. I am a DEP approved system inspector pursuant to S on 15a340 Title 5(310 CMR 15.000).The system: �- C� )4 Passes ❑ Conditionally Passes ❑ Fails* ❑ Needs Further Evaluation by the Local Approving Authority ry �, • N r�— Inspector's Sig Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board Of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ***"This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. L"M tsins•09/0e e/m Title 5 Official htspection Fam:Subsufiace Sewaa of system.Paige 1 of 17 Commonwealth of Massachusetts Title 5 Official inspection for Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property ress 4 �� Owner Owner's a information is i required for _!aC every page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) 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. 6 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): Mne•OWW Tits 5 Ofttd�5 hspectlon Form:Subswface Sewage Disposal System Page 2 of 17 _J I Commonwealth of Massachusetts Title 5 Official ,inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments W ro CaSt ._ Prope Tess Owner Owner's' e information is (� A required for pt every page. City/Town State Zip Code Date of Inspection 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(1Kb)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 cs;�.OWN • Title 5 OffloW Inspecoa,Form:subauAace sewage Disposal system-Page 3 or I 7 i Commonwealth of Massachusetts Title 5 Official inspection For Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , Prope ddress r Owner owner's me information is required for _ o2 ISA - every page. City/Town 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 functioningin a manner that protects the public health safety and environment: ❑ The system has a septic tank and soil SAS absorptions stem and the SAS is within Y (SAS) 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 weir*. Method used to determine distance: This system passes if the well water analysis, performed at a DEFT certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systims: 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 '/a day flow ' thins' TWO 5 ofrsaW hW9c im Form:Subwface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments -S VC Property res.'r 141_- Owner information is Owner required for r" every page. 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. ❑ s� Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ t11, 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 conform 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 fM fts.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. >&xi•osaa TWO 5 Offi"ftpecuon Form:Subs�Sawage Disposal system•pop 5 0117 i . i i Commonwealth of Massachusettsj Title 5 Official Inspection For - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments J c ft , Propernddress Owner Dane me information is required for every page. City own 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 j FA ❑ 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? ❑ [ j, 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 1,�41 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? i { ❑ Were all system components, excluding the SAS, located on site? i ❑ 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 CHAR 15.302(5)) i i D. System Information , Residential Flow conditions: i Plumber of bedrooms(design): Number of bedrooms(actual): — I DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): • i t5ins•09M TrW 5 Offidal Inspection Form:Subsurface Sewage Disposal System-!?age 8 or tT I Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form-Not for Voluntary Assessments rva Props dress + Owner owner's information is required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 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? 0� 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: . Date Commemialtindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(go) Basis of design flaw(seats/persons/sq.fk, 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: •09108 Tide 5 Ortfaal trmPeaion Form:Subsurrace Swwap Disposal SysWn•rage 7 or 17 i Commonwealth of Massachuseft Title 5 Official Inspection For Subsurface Sewage Disposal System Form-Not for Voluntary Assessments rj T. Pro ddress Owner owne amen information is required for C! every page, CitylT State Zip Code Cate of Inspection D. System Information (cunt.) Last date of occupancy/use: Cate Other(describe below): i General Information Pumping Records: Source of information: � -� I o4, n ° �o Was system pumped as part of the inspection? ❑ Yes No i 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 i ❑ 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 l/A system by system operator under contract ❑ Tight tank.Attach a copy of the,GEP approval. - i ❑ Other(describe): tsins 09W Title 5 Df6ciel Wapectian Form:Subvxfem Sewage Disposed System Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection For kip Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y� pillr y c e _�'T. Property -- Owner O r -- — wne�'s a information is required for CLr _ every page. Cityrrown State Zip Code Date of Inspection s D. System Information (font.) Approximate age of all components, date installed(if known)and source of information: IOc Were sewage odors detected when arriving at the site? [] Yes No Building Sewer(locate on site plan): Depth below grade: feet- Material � of constriction: ❑cast iron 40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tanis(locate on site plan): 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: Sludge depth: d c5ins•09ma TMO 5 Official trtspeatian Farm:SOWtaw Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w -q 5 viroce ,ff0 props � � I Owner (7u►mer' me information is 'T 1 required for Q ✓�� every page. Cityfrown State Zip Coder Date of inspedion D. System Information (cost.) Septic Tank(cont) A� p/ Distance from top of sludge to bottom of outlet tee or baffle Scum thickness i Distance from top of scum to top of outlet tee or baffle -- Distance from bottom of scum to bottom of outlet tee or baffle --- How were dimensions determined? eas-4 n - — Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, li ' vets s related to outlet inve evidence f I akage, etc. f 0 f kamn p A" 1nil re 1_V W L;.IAi rn n . A-V i Q+n A+ ° a e, 19 A4 a lqz Jac 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 t5irw•09M rare a Official In spection Form:Subsurface Sewag®Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Onsp e' dion Foy Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 C Propedd 7t, 'Owner Owne e information is required for �/�•� - G11, '� t g' every page. CRY/Town State Zip Code Date of Inspec Wn D. System Information (coat.) 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 yl El 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 Title 5 Offiaai fmBpedit Forth:Subsuftw Sewage DisposaE System•Page 17 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Far Subsurface Sewage Disposal System Forma-Not for Voluntary Assessments '-S�r V C,-t Prope rasa Owner Owner information is ,�l1L! required for every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert ---- 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.): A A C te V P .A.4— T� -A [ S�00 A of e L Plump 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: t5ins•09= Title 5 ofricial lnspedfon Form:Subsurface Sewage Disposal Sy9tem•Pap 12 of 17 Commonwealth of Massachusetts U07 W Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Prope FL owner ownerinformation isp required for J �. Every page. CitylTovm State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number. ❑ leaching chambers number: 95 leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Typetname of technology- Comments(note condition of s il, signs of hydraulic failure, level of onding damp soil, condition of v tabo , etc,): 9 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 15ins•O WS Title 5 Official W spection form:Subswfaoe Sewep pjS oW SyStem•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal Systern Form-Not for Voluntary Assessments oroev , Props dress 6hr + Owner Owns me information is required for every page. City/Touvn State Zip Code Date of Inspection D. System Information (cunt.) 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•OWS Tits 5 Offidal Inapeow 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 LI ,4-*% VC Property resits V1r Owner Owner's information is ® ��i �grequired fof o� LJ every page. Cityfrown State Zip Code Da 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 T�o V-3 k / V n • a t5ins•09M We 5 of dW m epsilon Form,SutsuAace Sewage pispoaal System-Page 15 at 17 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Prop Ada resl Owner flume ame information is ft S — f requited for I _ every page. cityrrown State Zip Code Date of inspection D. System Information (coot.) Site Exam: (� Check Slope h fk ' 9 Surface water A Q. t9 Check cellar Shallow wens No o+ l 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 A oar- 07 If checked,date of design plan reviewed: Date ( } Observed site(abutting property/observation hole within 150 feet of SAS) Checked with cal Board of H alth-explain: 'le C ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You plust describe how you establis ed the highrourif water vatio a.ra c Before oiling this Inspection Report,please see Report Completeness Checklist on next page. t5ins•0908 Tula 5 official brpechon Farm:Subsurface$map Disposal System•page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property ress — H Owner Owner's e information is required for r — every page. Gty/T 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 Q� $ketch of Sewage Disposal System either drawn on page 15 or,attached in separate file t sins•usroe Title 5 Oftiai Inspection Forth:Substdaoe Sewage Disposal System•Page 17 of 17 f NEW ENGIAND LAND SURVEY CERTIFIED PLOT PLAN Professional Land Surveying NAME CHRTSTOPHER & KAU N, HALL /IK5 Wheelock Street Oxford, MA .- 01540 LOCATION 45 SPRUCE STREET PHONE: (508) 987-0025 WEST BARNSTABLE, MA FAX: (508) 234-7723 SCALE 1H=30' DATE 10/18/2010. REGISTRY BARNSTABLE WE CERTIFY THAT THE BUILDING(S)ARE NOT WITHIN THE LENDER:Bank Of America SPECIAL FLOOD HAZARD AREA,SEE HUD MAP: -`'(� OF 2500010003D am: 07/02/1992 A DEED BOOK/PAGE: 909/306 FLOOD HAZARD ZONE HAS BEEN DETERMINED BY SCALE FA CK PLAN BooK/PLAN: 151/133 AND IS NOT NECESSARILY ACCURATE.UNTIL DEFINITIVE NO, d51 � RS PLANS ARE ISSUED BY HUD ANWOR A VERTICAL CONTROL SURVEY IS PERFORMED,PRECISE ELEVATIONS CANNOT BE C ��. Q � ZONE: DETERMINED. Nat LAND ' I CERTIFY THAT THIS PLAN FULLY AND ACCURATELY DEPICTS THE LOCATION OF THE BUILDING AND DIMENSIONS AS SHOWN. I avl� 6� 0 1� - - aO� l N85°0100^W 164.62' ' U6GtC � II o N UJ ft F LOT 3CV CI; z 8 20,120 SF z 36.4' W w LU #45 WCk- � M Ln 0 114 z 160.40, N85°05'20"W REQUESTED BY: S&K S . DRAWN BY: AID SCALE: 1"=30' CHECKED BY: GES File: IOCPP4608 Town of Barnstable 0 Regulatory Services BARN.TPAME. H� v ZMAss. Thomas F. Geiger, Director l°M - Public Health Division Thomas McKean, Director -200 Main Street, Hyannis, MA 02601, Office: 508-862-4644 Fax: 508-790-6304 February 18, 2009 I, Timothy B. O'Connell, R.S.,Health Inspector for the Town of Barnstable,hereby certify that attached report dated December 12, 2008, is true and accurate copy of the report I prepared as a consequence of an inspection I conducted at the premises located at 45 Spruce Street, West Barnstable, MA on December 12, 2008. Certified under pains and penalties of perjury this 18t" Day of February 2009. Timothy B. O'Connell, R.S. Health Insp or Town of Barnstable Q:\0rder letters\Housing violations\Rental ordinance\45 spruce 11 FORM 30 C,w HOBBSS WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH CITY/TOWN �a F I q�PARTMENT ADDRESS �M ye y`0 TELEPHONE 44-1� Address � — Occupant_. Floor Apartment No. No.of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units No.S 'es Name and address of owner —7 [ Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: _ Lighting: ya/. STRUCTURE INT. Hall,Stairway: Obst'n.: C7 U ffd p) Hall, Floor,Wall,Ceilin : 99 Hall Lighting: Hall Windows: c— MEATING Chimneys: Central ❑ Y ❑ N Equip. Repair L JU TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ` MS ❑ ST ❑ P Waste Line: — H.W.Tanks Safety and Vents ELECTRICAL Panels, Meters,Cir.: 01 3S'( ❑ 110 ❑ 220 Fusing,Grnd.: UAA AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den / Living Room l Bedroom(1). S� Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin, Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTIPN REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTTIIE$OF ER Y. ' INSPECTOR TITLE DATE TIME L l A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health,or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. a (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold,to meet the ordinary needs of the occupant.in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other oests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns,'shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system wnich makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. r Commonwealth of Massachusetts SUMMARY PROCESS (EVICTION) SUMMONS AND COMPLAINT Department BARNSTABLE Residential Docket No. Division (To be added by clerk's otTicc) C1 Commercial _ 1 ✓rJ.C'f+ ss Entry Date: i ! a 0 0 'NOTICE OF A COURT CASE TO EVICT YOU-PLEASE READ IT CAREFULLY ESTA ES UNA NOTIFICACION DE UN CASO EN CORTE PARR DESALO.JARLE - FAVOR DE'LEER EL MISMO CON CUIDADO TO DEFENDA T(S)ITENANT(S)/OCCUPANT(S):_ ADDRESS" CITY/TOWN:� a//1 S' ,�dQLIP: You are hereby summonsed to appear at a hearing before a Judge of the Court at the hme�(nd place listed.below- ATE: J U TIME: 9:00 a.mCOURT,_ ME: COURT ADDRESS: 3/,9579EPORT TO THE CLERKS OFFICE to defend against the complaint of PLAINTIFF/LANDLORD/OWNER: of STREET �/ �i CITY/TOWN:' IP: that you occupy the premises at being within the judicial district of this c unlawfully and against the right of said Plaintiff l-andlord/Owner because: AM and further, that S �- rent is owed according to the following account: � '� WtT�lE35. ACCOUNT ANNEXED (itemizeY trst or usuce W"12et" V nntea, ame TlTa—in—t homey d �i21 6 lac ss � �oGps' J �j' Stgriature?li 11131 it or omey 0 70 a s or atnut or Homey Me of iv tune of atnut or homey r 156 etepnone i umocr of amnt or ttomcy NOTICE TO EACH DEFENDANT/TENAINT/OCCUPANT: At the hearing on you (or your attorney) must appear in person.to present your defense. You (or your attorney) must also file a written answer to this complaint. An answer is your response stating the reason(s) why you should not be evicted and may,.in residential cases, include any claims you have against the Landlord. (An Answer Form is available in the clerk's office whose telephone number is -'61 - �3 G L- Z S! the answer with the court cleric and serve (deliver or mail) a copy on the landlord (oor landlo dl s attorney oat the address shown above. The Answer must be received by the court clerk_ and received by the landlord (or the landlord's attorney) no later than Monday, _/ — U- - Q S which is the first Ntonday after the"entry date listed above. The entry date is the day by which your landlord must file this complaint with the court cleric. Page I of 2 Pages NOTICE TO EACH DEFENDANT/TENANT/OCCUPANT: IF YOU DO NOT FILE AND SERVE AN ANSWER,OR IF YOU DO NOT DEFEND AT THE TIME OF THE HEARING,JUDGMENT MAY BE ENTERED'AGAINST YOU FOR POSSESSION AND THE RENT AS REQUESTED IN THE COMPLAINT. - SI USTED NO REGISTRA O NOTIFICA UNA CONTESTA, 0 SI USTED NO PRESENTA UNA DEFENSA A LA HORA DE LA AUDIENCIA, UNA SENTENCIA PUEDE SER REGISTRADA EN SU CONTRA PARA POSECCION Y POR LA RENTA R.EQUERIDA EN EL RECLAMO. To the Sheriffs of our several counties, or their Deputies, or.any Constable of any City or Town within said Commonwealth, GREETINGS: We command you to summon the within named sofendant(s)/ tenant(s)/occupant(s) to appear as herein ordered. Rcbert E. Powers C�erk Magistrate Officer's Return f d; 3 :. 4kti ss City/Town: U✓egr �/2tifr� ��Date: 2 By virtue of this Writ, I this day served the within-named tenant or occupant, and summonsed him/her as herein directed, by giving in hand to J 11,1'4 � ����k', 'T v or leaving it at the last and usual place of abode. A copy of this summ',o s was Tnailed first class to each teu=t/occup at the address on: Fees for Service: G Signa of Officer Service S Copy/Attest Travel Printed Narn6 of Officer Use of Car Mailing % (12��.(�, hdres's ot Officer TOTAL S-Z( So Z 7�1 Telephone Number of Officer NOTICE TO PLAINTIFF/LANDLORD/OWNER: Have the Officer complete and return above. Service must be made on the defendant(s) no later than the seventh day and not earlier than the thirtieth day before the Monday entry date. This form must be filed in court no later than the close of business on the scheduled Monday entry date. In appropriate.cases, proper evidence of notice to quit must be provided to this court upon the filing of this complaint. See Uniform Summary Process Rule 2(d). According to Uniform Summary Process Rule 2(c),the hearing date is the second Thursday after the entry date. In some courts, the hearing date is the second Monday, third Tuesday, third Wednesday, or second Friday. Amended effective:09/01/05 Page 2 of 2 Pages 1 ff:B-17-2009 15:28 SOUTH COASTAL COUNTIES LS 15087903955 P,O1 SCWT19 COASTAL COUNTIES LEGAL' SERVICE";-; ' o las°`;p®mom-n��n�'6E� �4-ltynnnhi Paw 01fce TEL 508 775.702U o F A(50 Nest Main Street ( ) (800)74'24107 ���`1tyvnnis',MA 02601.3653 �� � /� q �a.X(508)79tb�g�5 f% { �y q �y All I uribe�rs Voice 8nij yTy I ( i '�fi�: ( �ICJ.a�\i°'• �r JQ i c'Y�14 �c ' ky. 'A�c / armed 7 t lea` €' .�R I J�.hl. i 1 St a i iE FE8-17-2009 15.20 SOUTH COASTAL COUNTIES LS 15087903955 P,02 EN 1•> iji 1 I Timothy O'Connell, Health Inspector for the 'own of Barristabl'e;hereby certify that y P a ` ; the attached report dated December 12,2008, is a true and accurate copy, of the report Y prepared F!j 2S a consPqucnce of an inspection I conducted at the premises located at 45 Spruce Street,West E � ' I3ai stable, Ma. oa December 12, 2008. 1 t 'is Certified under pains and penalties of perjury this Day of February 2009. GGi "r c° rr icf i' r a I` IN ' ,a q 33 p r iI�t PigR1 j 3 "15 ' i F lIf t: !r i � 15f TOTAL P.02 � - C� Ak,-� Ceitified Mail#7006 2150 0002 1041 8399 Town of Barnstable Regulatory Services r IMAM �a Thomas F. Geiler,Director $a�MA"� 1� r � Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 1' December 12, 2008 Weston H. Bartlett 270 Head of the Bay Road Buzzards Bay, MA 02532 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II -MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 45 Spruce Street West Barnstable,was inspected on December 12, 2008 by Timothy O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint. The following violations of the State Sanitary Code were observed: 105 CMR 410.501 -Weather tight Elements. During inspection observed multiple windows and sky-lights to be broken, leaking, and lacking the ability to lock. 105 CMR 410.351 -Owner's Installation and Maintenance Responsibilities. Sink on second floor is not properly attached to wall and it does not drain properly. 105 CMR 410.351—Owner's Installation and Maintenance Responsibilities. 1>le flooring within second floor bathroom dislodged. / 05 CMR 410.150-Washbasins, Toilets,Tubs, and Showers. During inspection it was observed that second floor bathroom was lacking door for privacy. / 9 I 105 CMR 410.200-Heating Facilities Required. Thermostat was observed to be / above heating unit Within basement. Due to this fact the heating system is not working as attended to. 105 CMR 410.500-Owner's Responsibility to Maintain Structural Elements. It was observed that railing around loft area to be loose and in need of repair. Also observed many windows lacking interior trim. It was observed that there was a hole in wall behind heating unit on second floor which had open wiring. It was also observed that due to lack of weather tight windows and sky lights there was microbial activity (possible mold) around and near window and sky lights. QAOrder letters\Housing violations\Rental ordinance\145 spruce w barnl.doc The following violations of the Town of Barnstable Code were observed: 170-4—Certificate of Registration. Home is not registered with Town of Barnstable rental program. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by pulling any required building permits(if applicable); by making alf windows;skylights, and all structural elements of home weather tight which will alleviate chronic dampness; by installing a working thermostat on main floor of home five feet off floor and on a wall any point more than five feet from the exterior wall; by securing sink on second floor bathroom; by ensuring that all drains drain freely; by repairing tiling within second floor bathroom; by installing door on second floor bathroom; by fixing loose railing around loft area; by trimming out all windows to exclude draftiness; by repairing hole behind heating unit on second floor so there is not open wiring exposed; by cleaning all microbial growth (potential mold/mildew) with best standard practices; by registering rental with Town of Barnstable Health Division. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations,please contact the Town Health Division and ask to speak with the inspector who performed the inspection. jPER ORDER OF HE BOARD OF HEALTH Mc ean, R.S., CHO ctor of Public Health Town of Barnstable Cc: Timothy O'Connell, Health Inspector Cc: John Nakutis,`Tenant QAOrder letters\Housing viol ations\Rental-ordinance\145 spruce w barnl.doc . Il f--f tyo emsA/0 i,(c5 `�� " YELLi 11 e i` . Ie - vo . ,nf /7e? Floe I r C�v -ej C �L 1 (3 all 3� J Lo OsLT t rS '� cnc�i ✓S �Cv" ( ode . ,'— LY �(--�4- vL in 4-o 0. i\ 1 t i 5 Al,\5 5'I a 04 1 l /l `%, P rs � �� ked Town of Barnstable • BA MASS.L$ MA ' Board of Health 9e- 3$ � v x659. ♦� prE°MAC A, 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul J.Canniff,D.M.D. Susan G.Rask,R.S. April 25, 2007 CORRECTED Weston H. Bartlett 270 Head of the Bay Road Buzzards Bay, MA. 02532 RE: 45 Spruce St. West Barnstable, MA. A= 216-052 Dear Mr. Bartlett, You are granted permission to construct a soil absorption system designed to be connected to an existing three bedroom home located at 45 Spruce Street, West Barnstable MA. The variances granted are as follows: §397-8.E(1)(f): The soil adsorption system (SAS) shall be located 119.3' from the onsite well, a variance of 30.7'. The SAS shall be located 110.7' from the abutters well, a variance of 39.3'. The variance is granted with the following condition: (1) No more than three (3) bedrooms are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed.restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to three-bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. Q:HEALTH/WPBartlett L The septic system shall be constructed in accordance with the submitted revised plans dated January 22, 2007. Sin erely your ayn iller, M.D. Chairman BOARD OF HEALTH TOWN OF BARNSTABLE Q:HEALTH(WPBartlett 0 Town of Barnstable Submitted by: Board of Health Diana Di Gioia&Melody Masi 220 Main St. 33 Spruce St. - , Hyannis,MA 02601 W. Barnstable,MA January 17, 2007 Regarding: variance for proposed location of S.A.S.,by owner at 45 Spruce St. W. Barnstable,MA We oppose the granting of a variance to locate the Soil Absorption System for 45'Spruce E St., 33% closer to the well head at 33 Spruce St. than is permitted by current town zoning. • Barnstable zoning regulations were made to protect the water supply of neighboring homes, which is exactly what we need them to do. Local officials have the greatest familiarity with local conditions, and have made laws to protect our rights, with consideration to those specific conditions. • The proposed system has the potential to adversely affect the use of our property, as well as its resale value. • A leaching system, or soil absorption system, disperses the sewage effluent into the surrounding natural soils. The effectiveness of such a system depends, in part, on the amount of space available. Most distribution piping and leaching systems are "gravity" systems, meaning the flow runs through piping and distribution boxes without the assistance of any mechanical device. The proposed system would be located immediately uphill from our well head. This leads to the next concern: • Age is a cause of absorption field failure of soil absorption systems, and eventually even a well-maintained SAS will clog and have to be replaced. Based on past experience with this owner,I find no reason to be assured that he will properly and appropriately maintain this system. There has been a history of activity on the property that shows disregard for groundwater safety. We have observed demolition derby cars, multiple gasoline cans,bro ens computer monitors,junk cars, and other items, at various times during the years we've lived at 33 Spruce, all of which have the potential to leak toxins into the ground. We are concerned about the impact on our well water quality, if current or future owners did not maintain the system properly, as has been demonstrated by the current owner at 45 Spruce. The current system was allowed to fail so completely that raw sewage flowed down the street, unattended, on several occasions. We are in favor of appropriate repair and location of a septic system, to benefit the health of our neighborhood, within the current town zoning laws. Respectfully submitted, Melody Masi Diana Di Gioia ` TOWN OF BARNSTABLE LOCATION 7-' SEWAGE# VILLAGE ASSESSOR'S MAP L �&PARCE / t �C3 INSTALLERS NAME&PHONE NO. SEPTIC TANK.CAPACITY �CCG. Sa LEACHING FACILITY: (type) S�� (size) NO, OF BEDROOMS OWNER �/ PERMIT DATE: oC a� d COMPLIANCE DATE: fi e /10 7 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /W Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) °� Q Feet Edge of Wetland and Leaching Facility(If any wetlands exist / within 300 feet of leachin ,faci ' ) 'I Feet FURNISHED BY r.' Jam' r r � s Y1 `a .. No. ' .r p s �--. - - . Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipplication f Or �Digogal *pgtem Construction permit a Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Locati Addressf r/L of No. 7 �d ' O ner's N,,n Addy�ss,ajTel o. la Assessor's Map/Parcel �� G j� /,7 &V 3.2 s�llerjs Name ddr� £�1� ��y/ ��No. ��r Designer's e,A reu�� ��o. Type of Building: Dwelling No.of Bedrooms :3 Lot Size sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers (o!) Cafeteria( ) Other Fixtures Design Flow(min.requ' e ) 30 gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date'_ast 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 He • ned Date Application Approved Date Application Disapproved by: Date for the following reasons Permit No. �� ! (P 7 Date Issued 9" • ry �.�..�;�_;.�„�`-evw....--•' a•@".,,sz _�.�•7 ..,s.".k1�.—.�..tw.: '.:f+'. .. �ayarC,'7•+"+e t' ���-`(i ✓�....�... rr:-.�,.4..�.s'•s... . v O. i r j Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1r/ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpprication for �Digogar *pgtem Con.5truction Permit k. t.Application for a Permit to Construct O Repair Upgrade O Abandon_(, ) ❑Complete System ❑Individual Components Location Address or Lot No. . . J 6 0 O ner's Name Address d Tel. c' ��� /� -�,��J��7 Assessor'sMap/Parcel 2�� Installer's Name<Addr ss, 1.No. G���vr`y 75_/. Designer's,Na e,A dress and Teo.No. V1,5Xh / +��/ ire/. S�%��P/i?� 3 �' c%�i'� '� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft.. Garbage Grinder (ICY Other T e of Buildin / yp g /�'Si /�i,yiG No.of Persons Showers Cafeteria( ) Other Fixtures b Design Flow(min.requ'red) 3a �> ..:gpd Design flow provided gPd Plan Date Number of sheets Revision Date Title t Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: i 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 He h S'gned �� Date Application Approved by 4..A Date Application Disapproved by: Date ¢ for the following reasons Permit No. � t Date Issued - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of°Compliance + THIS IS TO CERTIFY that the On-si e'Sewage Disposal System Constructed Repaired Upgraded Abandoned( )by at y 5 S(J�r y�� has been constructed in accordance GG with the pr�visions of Title 5 d the for Dis osal System Construction Permit No. 0 7 C� r7 dated /1'12�11 Installer K1�6PI�b �J' G'/� J/ Designer / —ha //z fyll_1- 114 #bedrooms j Approved design floMa , > gpd The issuance of this permit shall n�/be ccQ strued as a guarantee that the system l functled. Date /,/� �/ 'Inspector [ �?—0� ` /Da No. ' ---- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS lwiqoal *pgtem Construction Permit Permission is hereby gran ed to Construct ( ) Repair ��) Upgrade ( ) Abandon ( ) System located at ,�/l�� I and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date �f this permi. Date Approved by ...: UL _CD%icr.Yl .r-e)i5imbLL CI,II-RL' of rl" N P'own of BaMstable Regulatory Services Thomas F.Geler,MeM r L Public Health Division Thomas N19Kean,Director 200:Vitt,,street,];ovmwis,MA 02601 Fax: 508.750.6304 Office:.508-862-46A • jgstgUer &Nstner CE A Date: E Q De'4gaera +,,, 'NAr1. t,,��+T� �uRt7�1'�) nscaller: Address: o f�Lb YL-oNco t Rv . Address: a &- C . o 2 Ot"-Z- ��was isst:cd g pa it to instals a (date) Installer) septic:iysi at 4 5Q )COIL F� fC.'L" based on a design drzv-m by (address m6dated 6*.1? 6 Zoo6 - -jAf§j 2-04)TXW7 ( csigaoz) �C z ce-tify that-,be septic syel=referzn;ed above was insWled sabstim-nally 6ccordyng to the design, which may include minor approved cb=ges suc14- as lateral Te:ocation of the distributi=box and/or septic tank. I certify that the septic system referenced abovo was installed with major changes (i.e. greater thm 10' lateral relocation of the SAS o- Iany verdoal relocation of any component of the septic system;)but in accordance with State &Lccel Regalatians, Plan re`rsian or ca't eed as-butt by deaigatz to follow. t�.stailer'943i Ie1C ! 3020 CIVILesrg e) x tatup erE E Ai �c y i -� i _ TO- 39t ZOIM3INHDIW 3NNV , � 909ME805� £t:ZT L0®ZIOtlplo -ID y�4 Town of Barnstable Board of Health xb39` 1Rr P.O. Box 534, Hyannis MA 02601 a Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. l Weston H. Bartlett / February 22, 2007 270 Head of the Bay Road Buzzards Bay, MA. 02532 RE: 45 Spruce St. West Barnstable, MA. /A= 216-052 Dear Mr. Bartlett, You are granted permission to c/s�tructt soil absorption system designed to be connected to an existing three bedroom ho e located at 45 Spruce Street, West Barnstable MA. 7 The variances granted areeaag follows: . `1 : The soi'1 adso tion system SAS shall be located 119.3' from the onsite 397-8 E( )(f1 7 rp Y (SAS) well, a variance of 30/7'. The SAS shall be located 110.7' from the abutters well, a variance of 39.3'. The variance is granted with the following condition: The septic stem shall be constructed in accordance with the submitted plans dated January 22,/ 007. Sin ly your a Miller, M.D. Chairman BOARD OF HEALTH TOWN OF BARNSTABLE Q:HEALTH/WPBartlett OFZHB DATE-. l Z / �6 v senivsTABLE HAss. 1639.0 A REC. BY Town of Barnstable SCHED. DATE: .Board of Health 7 200 Main Street,Hyannis MA 02601 Office: 508-8624644 Susan 0.Rask,R.S. FAX: 508-790-6304 Summer Kaufman,M.S.P.H. Wayne A.Miller, . VARIANCE REQUEST FORM (// LOCATION Property Address: Assessor's Map and Parcel Number: 2 i(o Size of Lot: Wetlands Within 300 Ft. Yes Business Name: No '1,� Subdivision`Name: i Al t5 `R/OC-F APPLICANT'S NAME: Y�£ �'�^/-J' 1 1 Phone Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON s Name: 1A1 :5F -1 lti� ° 1-1' A' 'l, T'i—' Name: 'ytl 's. -1 - ✓LTG T7 ✓"' 3lv2 3 62, 70 Address: Address: Phone: Phone: VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed n� E-S S: %/B r E` Is tl L'Z� A 3c' y'AratAL1rE 'I--, R��a�srE� -L b NATURE OF WORK: House Addition ❑00000 House Renovation ❑ Repair of Failed Septic System ❑ Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets 1/ Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) _ Four(4)copies of labbled dimensional floor plans`submiitted(e.g.house plans or restaurant kitchen plans) Signed letter stating tot the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) r . _ Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only], outside dining variance renewals [same owtier/leasee only], and variances to repair failed sewage disposal systems [only if no expansion to the building proposedD 4 Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne A.Miller,M.D.Chairman NOT`APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Susan 0.Rask,R.S. Q:\HEALTH\Application Forms\VARIREQ.DOC r , DATE: �QtNE 12 f J (J h� ��•P l _ FEE: t BAFUNSMBLE, 9 MASS. g REC. BY 'down of Barnstable SCFiED. DATE: C� Board of Health • :j 200 Main Street,Hyannis MA 02601 < Office::508-86Z-4b44 Susan G.Rask,R.S. FAX: =-5,08-79016304 R Sumner Kaufman,M.S.P.H. ` LLJ Wayne A.Miller,M.D. VARIANCE REQUEST FORM C-J i LOCATION I Property Address: ✓ r ` ;;4�L � .� !r ' ` a Assessor's Map and Parcel Number: 2 1 L Size of Lot: Z o i -Z-- %c--- Wetlands Within 300 Ft. Yes Business Name: No e/' Subdivision Name: ,,lv',S R ii7 "rM APPLICANT'S NAME: y j;r t4-/4' `' n'` t c Phone Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON Nam.: H , 1�4 7L C-T1 Name: V ig- Win✓ /�' �"i r s:r;� f 1v . � :J Address: / �€ Y 1A, Address: Phone: <.5- r, Phone: o VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) � C Stir `s A Ailfiiifi+'JG� "` i:% .��rr' ��i i V I T?d F�L C t' 1= � c:i a it 4iL LAC; ti f ` Fr2or,�t C ;1 s'f ' NATURE OF WORK: House Addition ❑00000 House Renovation ❑ Repair of Failed Septic System ❑ Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. /. Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) - _ Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only], outside dining variance renewals [same owner/leasee only), and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne A.Mier,M.D.Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Susan G.Rask,R.S. Q:\HPALTH\Application Forms\VARIREQ.DOC U.S. Postal Service TM CERTIFIED MAILTM RECEIPT (Domestic M-il' lily;No Insurance Coverage.P.rovided) • �F,o�,deIii-ery,informatim visit our website at vww.usps.como 6 _ Ct ' m • •� - , t tl PS Form 3800,August 7;U6 ? See Reverse for Instructions Certified Mail Provides: c A mailing receipt n A unique identifier for your mailpiece n A record of delivery kept by the Postal Service for two years Important Reminders: '.'.f':` ,a i 4" "R o Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. n Certified'Waihls not available for any class of international mail. o N6'AN., RANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,pleg��onsider Insured or,Registered Mail. n iFor an addift of fee,a Return Receipt may be requested to provide proof of delivery. o Qbtain Return Receipt service,please complete and attach a Return �RedepW S Form 3811)to the article'and add applicable postage to cover the fee'Ewrse mailpiece Tetum Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required''-, _. r —/ o For awn,_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". e 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. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 j . U.S. Postal Service TM CERTIFIED Mfi L5 RECEIPT (Domestic MaH.only;No Insurance Coverage: rovided) • �E&,delivery,information,visit our.wel sIW at www.usps.com® m PS Form 3800,August 2006 Wee—Reverse for lnstructions Certified Mail Provides: e A mailing receipt o A unique identifier for your mailplece o A record of delivery kept by the Postal Service for two years Important Reminders: vt t``} :'i .:;ii'v"i ;i 'a` f r %1 o Certified 'r ay` Y be combined with First-Class Mail®or Priority Mail®. a Certi i bla o available for any:ciass of international mail. in NO^NSRANCE.COVERAGE IS PROVIDED with Certified Mail. For valuables,please_aonsider Insured,or'Registered Mail. e 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.Endorseimailpiece".Return Receipt.Requested".To receive a fee waiver for a duplicate return reece�,*ajUSPS®.postmark on your Certified Mail receipt is. required. n For an additio $I 'delivery may,d-be restricted to the addressee or addressee's 0"Irized 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. IMPORTANT-Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 U.S. Postal Service TM RT CEIFIED MAILTM RECEIPT (Domestic MaillOnly;IVo Insurance1Coverage Provided) IEd�,deiivery,information,visit our wwetFsite at www.usps.com� - 1l M ------------------------- or PO Box PS Form 3800,August 2006 See Reverse for Instructions Certified Mail Provides: o A mailing receipt o A unique identifier for your mailpiece n A record of delivery kept by the Postal Service for two years Important Reminders: 13C 3at3 A.6 3_�its t c 11i�"s,c i e") o Certified Mail may'QNLY`be combined with First-Class Maile or Priority Mail®. a Certified Mai ndl;a'vailablefo�any class of international mail. o NO INSURANCE COVERAGE;IS PROVIDED with Certified Mail. For valuables,:please consider I suet or.Registered Mail. n For an add fio a ej et ,Rea ipt may be requested to provide proof of delivery.;,To°okk��a``in €� e t ice,please complete and attach a Return Receipt(PS:1, 811)to the rt� and add applicable postage to cover the fee.Endorse mailpiece"Return Re ipt Requested".To receive a fee waiver for a duplicate,return,receipt,awAUSP9®.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"Restd,tedDelivery". 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. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 U.S. Postal ServiceTM CERTIFIED MAILTM RECEIPT ' (Domestic Mai�Onik,No Insurance Coverage Provided) ' IFo�,delivery,information,visit our,website_at www.usps.com® f .,.i #f PS Form 3800,August 2006 See Reverse for,,I structions Certified Mail Provides: o A mailing receipt o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: $ut � �"? !"?iiT+"`try i s I<<iU o Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. o Certified Mail is riot available for any class of international mail. o NO INSURANCE COVERAGE,IS PROVIDED with Certified Mail. For valuables,please consider Insured'oP;Registered Mail. provide o delivery Tolobt1ill1fR�2tUa R jp —rvpemplease complete and at a Retum Receipt(PS F,pr"' 3811 t���d the a icle and add applicable postage to cover the fee.Endorse i ce"Return Recei t Requested".To receive a fee waiver for a duplicate-ret r eipt,a USP ® ostmark on your Certified Mail recdipt is required. o For an additional ejive <f of _d!� ry,� ay. be restricted to the addressee or addressee's authorize erit•:"Advise the clerk or mark the mailpiece with the endorsement"Restricted elivery". 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 labels with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 x e w art r M • � co C 43 r'Li Postage $ $0.39 05M, O Certified Fee $2.40 u1 y' B t rk . C3 Return Receipt Fee e04 p (Endorsement Required) C3 Restricted Delivery Fee �QO (Endorsement Required) Ln r-I Total Postage&Fees � $2. � 1 � r l a Sent To y� e C3 3`(reef,Apt. � 0 f or PO Sox No-Q --- -�r..tt City,SItste,ZIP+4 /� / Certified Mail Provides: e A mailing receipt , o A unique identifier for your mailpiece 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 Mail®or Priority Mail®. o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional'fee,a'Retum Receipt may be requested to provide proof of delivery.,To obtain'Retum,Receipt service,please complete and attach a ReturnReceipt(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 a res i USPS®postmark on your Certified Mail receipt is o For n addi lonakfee,;delivery may be restricted to the addressee or addrefsee';s,,auttiorizeit agent:Advise the clerk or mark the mailpiece with the endorsement;Restrictedgh1ivery°. 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. IMPORTANT:Save ills receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 IA T-F f (JI- 1 I 1 ' I� _ I - -,Ack I , ,� _.f _ _ . 1_ 1, d 1 oel I I - I 714TIj , - - - - __ , D J i ( 1 - i ` ' - , ,, .� E �#__ I` .+ �_ _-•�. _� -I•u dj-_-�_ � � -I - �_____�- d���---'1 — t -} �� � ._._w�- _�.._...�_ � �i � I'��, 4 Ml ,. 1 I t t � '- � :�•, is� I� IF �'e I i ( �i ti L _ '_ i`• � 1 ;— , �� � �`c —.-�• b ,;;. _ i--- — �� � '_ _ I_ �.. _ _.:"k._,_ ':F-3 �y. '` _ t- � x ` - — �. .4� •-•j -�. .�- `•rn _ 1 `w� �.��1 4 i..,t�„���^ fit. a t_ � I ! - ,_. ' { •t— .♦._ t., i J 15. —1 � � _ .*, r" �el.- �.71 � }• 1 �" _ t ....--.�- � ; I` il�'+�;.:...�........-.�...�..:. � .L' I - �Ii� 4�l``.1�1 1 - , � FFla,l.'�•, t _ 8 1-t •z r _.I�i._ � �4. '� . 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GjL Ana 196006 # 1745 ram'/U G U' —7= i LL•/ /frrAiF.' #145y2 / eX31Y! /Vo 216022 # 1849 j ce-9 4'rr �c5� 1�R e'tii<S 216032 # 1851 57 216053 tl 57 216055 216054 216020 216023 216024 0 39F t # 34 # 74 # 71 #46 # 34 DISCLAIMERS:This map is for planning purposes only. It Is not adequate for legal Map:216 Parcel:052 boundary determination or regulatory Interpretation. Enlargements beyond a scale of Selected Parcel N1 1"=100'may not meat established map accuracy standards. The parcel lines on this map Owner:BARTLETT,WESTON H JR Total Assessed Value:$366900 are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:0.46 acres Abutters "• W ' "E boundaries and do no represent accurate relationships to physical features on the map Location:45 SPRUCE ST W.BARN. r xurh a¢hulldtrur Inratin _ January 18, 2007 Town of Barnstable Board of Health 200 Main Street Hyannis, MA. 02601 Re: 45 Spruce Street, W. Barnstable, MA. To whom it may concern: My daughter, Corinne Savery and I live at 57 Spruce Street, W. Barnstable. We were in attendance at the variance hearing yesterday, January 17th concerning 45 Spruce Street. Our neighbors who live on the other side of 45 Spruce Street brought certain facts to the board concerning unacceptable conditions that have existed at this property. I realize this was not relevant to the meeting but feel you should know that these deplorable conditions existed for over ten years, old cars sitting around the property, heavy equipment, namely a backhoe and trucks, a smashed computer along with other debris. Although some of these things have been removed in the last six months, old lawn mowers, old gas containers and equipment still remain. I want to verify that all the statements made as being fact. These conditions troubled us but we did not realize there was recourse in the Board of Health. We appreciate knowing you are there and that you may be called at any time. Sincerely, G No p GY1M1 .. ,� . M BOQNr Er Postage $ $0.3 ,'�53"'QpN 0 Certified Fee $L C 3 -rp O Return Receipt Fee N0D Pos-� (Endorsement Required) , �Here C:3 Restricted Delivery Fee � (Endorsement Required) � Z fY I Total Postage&Fees $2.79 it/(}$/ ul N t�t LI N PL_ or PO Box Na � ..... Clly Zl Certified Mail Provides: A mailing receipt (asvene� e� aooanr'ooaew+�sd n a A unique identifier for your mailplece e A record of delivery kept by the Postal.Service for two years Important Reminders: n Certified Mail may ONLY be combined with First-Class Mails or,Priority Mello. e Certified Mail is not available for any class of international maic a NO INSURANCE';COVERAGE(IS,PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. U For an additional fee a Return Receipt may be requested to provide proof of delivery.To obtain QUM 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;Restrigted elivery". .';;x 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. 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. U.S. POstal Service TM CERTIFIED MAILTM RECEIPT (Domestic Mal►,Only;IVo_InsurancelCoverage p�r$vided) EF6rT deiivery,iiiformatior±,visit our website'at www.zlsps.com _ .., or •O Box / i s ' ;. PS Form 3800,August 2006 See Reverse.for,lnstructions Certified Mail Provides: o A mailing recept o A ynique identifier for your mailpiece a A record of delivery kept by the Postal Service for two years Important Reminders: L(,, . „ ,, o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail& o Certified Mail Is not available for any class of international mail. o NO INSURANCE"COVERAGE ISPROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a 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 dulicpl to return receipt,a USPS®jposttmark on your Certified Mail receipt is a For an additional fee, delivery may be restricted to the addressee or, addressee's authorized a ent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-Delivery". I 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. IMPORTANT.Save this receipt and present it when making an Inquiry.- PS Forrn.3800,August 2006(Reverse)PSN 7530-02-000-9047 p ll'iir�i�4u1 Q' ru r- C3 a ru OPostage $ i Ib � Certified Fee $"4 } DReturn Recei t Fee [1 Postma \ Here 0 (Endorsement Required) $0.04�\ U Restricted Delivery Fee �d G :0 (Endorsement Required) $0.00 Ln �8 r9 Total Postage&Fees $ c�.7Q 1J12nj /204b Sent O c<" c �ll1✓ -Gate...:+ J.�ls91l� ` M Sft-eef Apt.No.; or PO Box No. p/�y ------------------------------------------------------------ �^ City State, IP+4 /w CertifiedMail Provides: o A mailing receipt •'A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: • t%. = s,!I?,r . a Certified Mail may ONLY be combined with First`-Class Mail®`or Priority Maile. e Certified Mail is not available for any class of international mail. s e NO INSURANCE`COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. n 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 USPSe postmark on your Certified Mail receipt is required. k v.i"; n For an additional fee, delivery may. be restricted to the addressee or addressee's auftriied a ent.Advise the clerk or mark the mailpiece with the endorsement°Restricteditelivery°. 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. IMPORTANT.Save this receipt and present it when making an inquiry. PS Forth 3800,August 2006(Reverse)PSN 7530-02-000-9047 p ,fY,7G1171 . � O ru wE0B#s#4 ru Postage $ $0.39 o � Ill Certified Fee $2.40�`S� 04�, Postmark O Return Receipt Fee Q11 O (Endorsement Required) $0.00`�! Here � p Restricted Delivery Fee (� r3 (Endorsement Required) $0.00 \d► n9 Ln ra Total Postage&Fees � $2.79 12/12I2(}OG ru Sent To a Street,Apt.No. or PO Box N-- ! .V,4 A/ (((///K City,Slate, +4 r •0216" Certified Mail Provides: o A mailing,receipt A unique identifier for your mailpiece a A record of delivery kept by the Postal Service for two years Important Reminders: r•,1 '•.%,, s.t' .4 ca';;;t, ,; ;,I o Certified Mail may ONLY be combined'with First-Class Maile or Priority Maile. a Certified Mail is not available for any class of international mail. o 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 USPSe postmark on your Certified Mail receipt is required. U-xVx n 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. e 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. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 p �1IV11f1 _ .. • rl- 0 WEOAFSf#L4 M020A 0 ru Postage $ $0.39 0 3' o p 02SU Certified Fee $2.40Ln Pos�ark Retum Receipt Fee CC' ere OO (Endorsement Required) $0.00 Restricted Delivery Fee C3 (Endorsement Required) $0.00 Ln r-a Total Postage&Fees $2.79 ru Se To a -` .c d�ef 44p.' .................................... p Street,Apt. o.; or PO Box No. City,State,Z/P+4 Certified Mail Provides: a Atnailing receipt o A unique identifier for your mailpiece n A record of delivery kept by the Postal Service for two years Important Reminders: r, , ,, fir.`;,!. i.->',It o Certified Mail may ONLY be combined with First-Class Maile or Priority Maile. n 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. h.; I,,,,..}p 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 USPSe postmark on your Certified Mail receipt is required: o For an-additional,fee,,delivery may.,be restricted to the addressee or addressee's authCrizetl'agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". I:r , 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. IMPORTANT:Save this receipt and present it,when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-060-9047 ILOLqMURAjg D 0 0 nil o Postage $ $0.39 �ff?5 2, 6' J Certified Fee $2.`0 �,(,) Q4 O G� Return Receipt Fee Here C O (Endorsement Required) $O.QQ Posture CN N Restricted Delivery Fee m V L (Endorsement Required) $0.00 �� lJ"I �1n r-q Total Postage&Fees $ $2.79 ru —0 Sent � /�� ,0 ----+ t/�` ...................•............ `Q S ree,Apt.No.; M1 or PO Box No. ---------. •..... -`.......................... City,Stat � Q OU�CD 6 Certified.11140 Provides: e'A mailing receipt WA unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: :., s . . ,t.i ?`F o Certified Mail may ONLY be combined with First-Class'Mail®or Priority Mail® o Certified Mail is not available for anIs;y class of international mail. a NO INSURANCE'COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. n For an additional fee,{a'Retum Recceipt 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 sutNoried a'ant.Advise the clerk or mark the mailpiece 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. IMPORTANT,Save this receipt.and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530.02-000.9047 o D MMLLM tr O e• • Ir Q .1 Postage $ $0.39 ` /�0� o Certified Fee $2.40�/ 03,7 j u C3 CO Postmark p Return Receipt Fee 0.44��t ti Here (Endorsement Required) O M Restricted Delivery Fee 11-9-9 (Endorsement Required) $0.00 �£9ZOd� m Total Postage&Fees $ $2.79 12/08/2OOb Ln O Sent o ---------------- orPO Box No. �_',� Cl ,State,ZJRf4- �.E!�-.x------------- Certified Mail Provides: (--ad)aooz�,nr,���,�sd n A mailing receipt l e'A unique identifier for your mailpiece e A record of delivery kept by the Postal Service for two years Important Reminders: n Certified Mail may ONLY be combined.with First-.Class Mail®or Priority Mail®.. n Certified Mail is not available for any class of international mail. • NO INSURANCE'COVERAGE.;J&PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. n For an additional fee,-a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt serince,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. r^, ryi, e For an additional fee, delive 'ma w be restricted to the addressee or addressee's authorized agent.dvise the clerk or mark the mailpiece with the endorsement"Restricted Delivery°. 0 If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. O � --- 'oN XO8Od io ------------------------------ C� :'nN'7dV Jea!7 o es o rr seed V eselsod lelol w �°©$ (peilnbeyIuawes,opu3) Octi / p eel tienlle0 PeloalseH p n eieH cd� Q �O$ (paiinbeyluewesiopu3) O 6ej�dleaey wnley Weugsod � 6= O F4 J Jol o$ ee�peyp,a� o $ eftSOd 3I M ... . . VIA . • .� LJ � 3 Mied'Mail Provides: ( ,B�ea�� r �+ oze�� 'ooee �+o�sd g receipt n A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: c Certified Mail may ONLY be combine d.wfth'First-Class Mail®or.Priority Mail®. o Certified Mail is not available for any class of international mail. n NO INSURANCE;:COVERAGE iIS,PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional feel°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 ReceiptRequested".To receive a fee waiver for a duplicate return receipt,a LISPS®postmark on your Certified Mail receipt is required. 1%, (jt e 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'Restridted-DDelivery. " •:z e 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. 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. rn D Er � n Postage $ $0.3 / N p Certified Fees (1 0( 7 p C �7 Postmark p Return Receipt Fee Herea (Endorsement Required) $Q. Restricted Delivery Fee rq rq (Endorsement Required) .0Q� m Total Postage&Fees $ 2.79 12/08/2006 Ln O sent fiTo r' . . S`tieet,Apt No,* or PO Box No. ---------- �--- --------------------- City,state,ZIP+4 =7777 t� Aw Certified'Mail Provides: f�1eA�rizoozeur<r oose-ojsa n A mailing receipt n A unique identifier for your mallpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combinedwith_First-Glass Mail®ot.Rriority Mail& o Certified Mail is not available for any class of international mail. o NO INSURANCE;COVERAGE W,..PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Met. p For an additional fee;a Return Redeipt-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 j required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized.al1ent.Advise-the clerk or mark the mailpiece with the endorsement•.!Restrictddi�elivery."..�?' , 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. 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. (1Jrq Ir p WE T B S: !_ - Postage $ $4.39 O p Certified Fee Q.44 03 p N CO Postmark p Return Receipt Fee Here (Endorsement Required) $4.44 q p Restricted Delivery Fee rq (Endorsement Required) $4.44 M Total Postage&Fees $ $21.79 12/48/t446 Ln f p p Sent o ..... Sheet orPO Box No.................. C ,State,ZI 6 Certified Mail Provides: fa�a�a o A mailing receipt d)aooz eunr'0098-od Sd a A unique identifier for your mailpiece a A record of delivery kept by the Postal Service for two years Important Reminders: a Certified Mail may ONLY be combinedywith First-Class Mail®or Priority Mail®. a 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. a For an additional fee-a Return Retpipt.m%be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Retum 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. Cl) 61 a For an additional fee, delivery may be restricted to the addressee or addressee's authorized,aggent.Advise the clerk or mark the mailpiece with the endorsement"RestrictedDe/ivery"..,.' 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. 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. optM!rti =` DATE: 1. r • t EAMNSTABLE. / FEE: MAss. ycb i639• .`�8, prEo MAC a REC. BY Town wn of Barnstable SCHED. DATE: .Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Susan 0.Rask,R.S. FAX- 508-790-6304 Sumner Kaufman,M.S.P.H. Wayne A.Miller,M.D. VARIANCE REQUEST FORM LOCATION Property Address: -id -S -0`7R Assessor's Map and Parcel Number: 2 1�_; Size of Lot: Wetlands Within 300 Ft. Yes Business Name: No sue' Subdivision Name: ,v; ;; r.a APPLICANT'S NAME: VI -f- • Phone Did the owner of the property authorize you to represent him or her?" Yes No PROPERTY OWNER'S'NAS;bK W CONTACT PERSON, - ,, -- , «•; Name VV r- i `� �i' rt i ":ate"" Name: A/ ;Rh 4-17 4�z ram`— . J FC `j'.;t.'„d;✓.! o-°! lit! ...p 'Pi 'Address. A"; f, dv .``' 'Address: Phone: t Phone VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) /O �� 1tl�i?1a�k� s t �.�� 7 icicv Y rtrYt �ti S'� 1Jd^L t NATURE OF WORK: House Addition❑oCIg0(7 House Renovation ❑ Repair of Failed Septic System CO Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. Four(4)copies of the completed variance request form v Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans siibrmtted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request _-? Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only)" f� _ Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance renewals [same ,_oovner/teasee.only],.outside dining variance renewals [same owaer/leasee'on]yj;and variances to repair failed sewage disposal systems - ` [only if no expansion to the building proposed]) ' Variance request submitted at least 15 days prior to.meeting date VARIANCE APPROVED Wayne A.Miller,M.D.Chairman . NOT 0 APPR VED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL • Susan 0.Rask,R.S. Q:\KEALTH\Application Forms\VARIREQ.DOC, P _ = ❑MOVED,LEFT NO ADDRESS. ❑NOT DELIVERABLE AS ADDRESSED a+ „„„Fo UNABLE TO FORWARD 1$'AMMMD-NOT KNOWN 7006r2150 0005 0202 0729 r. I C�UNCLAIMED ❑REFUSED ❑NO SUCH STREET ' REMOVABLE ❑NO SUCH NUMBER _❑INSUFFICIENT ADDRESS rni • . o��� 3��caG O• 0 3� - i 3 FL•s :sgiii s`•v IitSi: F �? itr. �� "t•e.: i si v' ii! � ii + �:�i w�: ' �:i .[i��'° 40. i s.s i F'iF r� 'i.� i`i r i'i r.N-.F 3'F'5:, i• :• E ,^ " _ _ • .. '1 `, ,`...... + mac. SHE 1p� DATE: h s ,• FEE: MASS. 059. � REC. BY Town-of Barnstable-_4 SCHED. DATE'. Board of`He dth" 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Susan 0.Rask,R-S. FAX: 509-790-6304 Sumner Kaufman,M.S.P.H. Wayne A.Miller,M.D. VARIANCE REQUEST FORM LOCATION Property Address:_ _ < t, + = .._t3 r °✓bra Assessor's Map and Parcel Number: 2 t L-. Z- Size of Lot: Z 0 ! 7-- C I a = Wetlands Within 300 Ft. Yes Business Name: No e.�'' Subdivision`Name: `Ti,v.5 R , Jc' ,E APPLICANT'S NA1vIE: WiE:."� � Phone _ (V� J \,3c0C?, Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S N.41IE "`:* CONTACT PERSON Name .�fia,� , _bti rZ i Name: �. '. f - A/ ��� �� .: ram" Addresss:'' �s Address: 2-70 a-al© Phone: (�SoB� -' �� ®o'�G one: �Z ZZ/ IV dA •® 5`c3�. �— VARIANCE FROM REGULATION q ist Reg.) REASON FOR VARIANCE(May attach if more space needed) • i°jc '�:.� A t/fst�'/fTl�d't`-M`_�� + l.:i L A--S div . f2i- A 3 �.�it i Ci t�C:• -�v r NATURE OF WORK: House Addition ❑00000 House Renovation ❑ R,epair ofFailed Septic System ❑ Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets �/, Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected (no fee for lifeguard modification. renewals, grease trap variance renewals [same owner/leasee only], outside dining variance renewals [same owner/leasee only], and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) F Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED - Wayne A.Miller,M.D.Chairman NOT`APPROVED Sumner Kaufman,M.S.P.H. REASON FOR 6ugsti C,PAO,ILS, -_„ Q,�3iSAitMslAyDiiaatioss Yos�ta�VARI�Q,DOC . THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) im -A DATA -- —`LLHhU t3HY H �y t5U .l"f . 1 7♦J �(/ / _ ��•'// ten. c5'n _ I j JUN i -! GiN _ �'`•,(�('t • �i F u���1 11���A J M-q, d a 5 3 (:119�1 ei! iil l!iNl W f [.Fi^a wL.GC0192-11 nj ru O p c0 co m m Er Er i ❑MOVED,LEFTNOADDRESS o f /�j El NOT DELIVERABLE ASAODRESSED p ��� p} C1 E " P, UNABLE TO FORWARD TTEMPTED-NOT KNOWN o o . 1 UNCLAIMED O:REFUSED i®�9 Y O NOSUCHSTREET`' m m I REMOVABLE ❑NO SUCH NUMBER fg • -- ti -;._,_I�OINSUFFICIENTADDRESS m _ p C3 O C3 O tti f� e ) t ar r rr FF jj ) (rr jj p f y � �.�« �• ,. ,. I17i?:??t?�:??F.{!!..?t#t?�te.!t'!1!�i�??i�ItT::3.�5?!ft!:!i;l?'�'?dif .,. . .. S r' s THIS ENVELOPE.IS RECYCLABLE AND MADE WITH 30% POST CONSUMER CONTENT. 4 •� LOCATION L0-r 3 5EW&C.4E PERMIT UO. VILLAGE IkJSTQLLER5 W&ME ADDRESS BUILDER 5 Q &VAF- ADDRESS DfITE PERMIT -- D ATE COMPLI &MCE ISSUED : `f ,, �Qu� � . ` � '' ,,�,.• D� ��,,�° f �� �_P� �. No. p�fP �" ' �-� — - Fz�$ Id............ THE COMMONWEALTH OF MASSACHUSETTS BOARD WE HEA TH �p�J ... OF ... . Appliration for DiBpmial Workii C otuitrurtion Vrruift Application is hereby made for a Permit to onst uct (v) or Repair ( } an Individual Sewage Disposal system � - • - �... ------. �--•- --............................ ation-Address or Lot No. — �. ------------------•----.....--- er --.--Address _4 a •----------- •-y�-a�•:.a•- ----•-------•- ----------- -----••----•............---•---•---•--- Installe Address 2 0 �^ 0 Type of Building Size Lot------------)..............Sq. feet Dwelling— No. of Bedrooms---- --------------Expansion Attic ( ) Garbage Grinder ( ) aOther—T}pe of Building -_.-.-A�... No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------ - - - W Design Flow-------- 76 ,-------------------------gallons per person per day. Total daily flow--------- 0-0--__-_-.-.--_.._.gallons. WSeptic Tank--/'Liquid capacity._/_X0gallons Length................ Width................ Diameter---------------- Depth_.--.--_.-__. x Disposal Trench—No. .................... V1/idtii----------___---_,_: Total Length. . _____... Total leach' area------------ ft. Seepage Pit No.._....�.._________ Diameter...l� _ Depth below inlet. Total leaching<tre. _._._____._____sq. ft. Z Other Distribution box ( ) Dosing tank ( ) D N- A - �.3d��7� - '� Percolation Test Results Performed by-------- -- -------------------------------------------------------------- Date---------------------------------------- a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water..._-------.--.--_.____. (q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.----`_---.--.---..._. /----- ---/- -- ---- 1� - - Description of Soil----------- Gam.' •---� �?- - A !�--- ------r- /Z- ice" y V --- -- ------- = W U Nature of Repairs or Alterations—Answer whe applicable.__..................................................................:..__.._.._.__.___.___..... --------------------- -------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ Agreement: _ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI 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. Si ed---•--- . .. --•-•- •..... D to Application Approved By.--- j� Application Disapproved for the following reasons:-.-------------- ............................................................. .........�Da..____e...... ------------------------------------------------------ -------------------------------------•------------•--------------------------------••--•---••-----........---------------------••---------------- Date PermitNo......................................................... Issued.. � Date h � l "WAY ,r r , v No L iFi�$::..............!............. j t a No THE COMMONWEALTH OF MASSACHUSETTS <_ BOARD OF H H l -------- .............. . . .......... .................. h: sslr�ifiaan fixintt1 r� Cnl�ntrnrtilanrrn�it r P `Application is hereby made for 'a Perm' to3, ,nstruct ) or Repair ( ) an Individual,Sewage Disposal s. Syst at � ' 3 7j.; -- --------------------- r Location ..... -• ----- ----- -....-•----- -•• -•-- - •---- l --•-------•-----------------------•• r e . p} z C -- aAddressType of Building Size Lot'.............. t Sq. feet " ,' Dwelling.—.No. of Bedrooms______ ____________________________:Expansion'Attic, ( ) Garbage Grinder ( ) Otlier=Type of Building __- __- �� ------ No. of person--________ 1''_`Showers`( ) = Cafeteria ( ) K <. (rr, L Q i a �. Other fi�ctiures f ---- -------------------------- _- Desrgn.,,Flow................ ...............__gallons per person per day. Total daily flow____-• — _gallons. W �.0.............. Septic 1 .nk— 11(J cal�acitv_-_.._..__._gallons Length____ _________ Width- Diamr----- Depth k .xDis•osaT ch No.!...... . Total Length------- _-_ Total leachingarea.......... sq. ft.pl k , Seepage Pit ,No _________________ Diameter...:..... _._ Depth below i t_. �_..•__. . of /lead I npCr_ ----------------sq. ft. r/ Er Z� e Other'Distribution�ox ( ) ntank ( �• a Percolation Test Results Performed by____________________ ...___................._... Date. t �•, Test Pit No: 1.........t.....minutes per inch Depth of Test -Pit__________ ________ Depth to ground water ____ Test Pit No. 2 minutes per`"mc Depth of 1lest Pit�� h to grotid wajeri ''� (t /f p ` t i r Descripf'iori of Soil•-------------- _ '._...---...----- ----•-----------------------------/`__-_a, ---' -------•---------- -,----- --•-• ............. ...•--•-••- - -•--•- -•----•- ---• ------- -- f ..........a --- -._._..._. n ------------ f�s+ ? Nature Repairs or Alte ions—Answer w e applicable __.__-________________- ----- j .. g t. hr ry Agre�emrent: i > e undersigned agrees to install: the aforedescribed Individual Sewage Disposal System in.accordance with th'e proyis of s of Article tI of the State Sanitary Code—The-undersigned further agrees not:to place the system in * . ram ' operation until a Certificate�of Compliance has'been.issued by the board of health. 41 tl '• , Jy r. ___ •P 7 ; Application ApprovegAyy—• .......= -- -------- ................................. Date r .'Application Disapproved for the following reasons -:--__--__• _•________`_- ,� " __ mo t ?49 ..... --••-_. _....... -•-•-------------- --------------------•-- '� x :, Date •mil �erifiit:No.----••...... # - Issued. THE COMMONWEALTH OF MASSACHUSETTS 1 3 ,BOARD O HEALTH ; ; , T• ry r . r < OF. , If rrtifiratr laf f�untpliana :. �; F �+ 1 S TO SER' FY, t:th Individ 1 Sewage Disposal System constructed .( ) or`#Re ired-( ) . , by ----- -- •---- . at---••-. . ......... •-- •-- ............................................................... ........ Life -- pi has been installed'm accordance with the.provisions.of Article XI of The State Sanitary,'Co � 1� the x application for. Disposal Works Construction Permit Igo..._. :,_/•-___-_._•___.__. datedI_ __..' . 'TQE,.'ES5UA1dCE OF TFIIS' ICERTIFlGATE Si"HALL'KOE4CON5TR'UED..AS q CsT�"�'irl:'�T1"TliE' ri zSYSTEM wYr11LL'';FU CTION SATISFACTORY. r7 /t'� fr g DATE: ---------- Inspector r r THE COMMONWEALTH OF MASSACHUSETTS .- BOARD OF ACTH .i'..' N --•--- FEE =..._._:... S , •k � .:} ,•k. . �� •�� �i��g : h,� a�rk� lorn • � 'wat rrntit Permission is h by granted . _...... :. -. '_.. t to Construe ( R . it ( ) an ividu ewa a po,sal S Si `ynlJ� t !•� Ya •Street as shown ori'.the application'for Iisposal.,Works C nstruction'Permit No Dated_: ............ �. _.. L -Zo r ' DATE.. . .......' - --- ....... ._ . ORM -.f2tS OBBS•& WARREN. INC; ,PUBLIS{iER3 .-A" r?."" _� h,, p,:`t' }`"`�• ,Z,�' l.eau' { `f s..s.,:,:i�' .001, 017 pi _. Oft I 'f -mow - - .f f; ------ --- - ---- � -- - - -- ---- --- ----- --- -- - ---- - - --fir -_ ._ - _-,. _ -T - - - - - - - --- - - - - it - N 13 • i I ' I I i � i + I i � I I � .I ! ! C j f I I ! ► I i �.ti • i I I ' � � � I I I I I I I I 1 1 ! } I i 1 f k GENERAL NOTES: DEF 1xl 0i COVER Vt IAINCE(TITLE 5,SECTION 15.221 (7)• 1. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION 'FINISH GRADE OVER S.A.S.VARIES BETWEEN EL.9250 AND 97.00 " A V IANCE OF UP TO aft.IS REQUIRED IN LIEU 99.80 INSTALL A GAS BAFFLE OF 71E aft.MAXaUM COVER OVER THE S.A.S.TO BURY THE S,A.S. OF THE SEWAGE DISPOSAL SYSTEM ONLY. ACCESS COVERS MUS';'BE ' w, IN OUTLET TEE PROPOSED UP TO 6.0 ft.DEEP AT ITS SOUTH END. WITHIN 6" OF FINISH G BADE. 2. ALL CONSTRUCTION METHODS,MATERALS AND MAINTENANCE FOR THE SEPTIC SYSTEM SHALL .' E5IGN CRITERIA: CONFORM TO"TITLE 5 AND LOCAL ' 4" pjpE 92.00 1.83 r UXER �• BOARD OF HEALTH REGULATIONS. ASH iR'S"O T DESIGN FLOW: 90.00 w''$ "� 3 BEDROOM DWELLING @ 110 GAL/DAY PER BEDROOM 3. ALL SEPTIC SYSTEM COMPONENTS SUBJECT TO :: 95.25 -- 95.00 - : _ EQUALS 330 GALS.PER DAY. (NO GARBAGE GRINDER) 3/A'-1 1iV L LI. VEHICLE LOADING(i.e.UNDER DRIVEWAYS.ETC..) 4'MINIMUM E k� r E wagl�n sTr�r SHALL BE DESIGNED TO WIT ISTAND H-20 LOADING, LIQUID `' 2'EFF II SEPTIC;TANK REQUIRED: 330 x 2.0=660 gal. �\ ` �� DEPTH DIS1 I`�tST< t_L g PbZOPC1 RED S A. .(H 20) SEPTIC TANK PROVIDED: 1000 gal. BOX4. ALL SEWER PIPES SHALL BE SCHEDULE 40 OR r' 4 4 A�PROVED EQUAL. 1 10' MINIMUM ( �' 317E OF LEACHING FACILTTY REQUIRED ' DESIGN PERC RAT�< 10min/in. BEFORE STARTING CONSTRUCTION CALL DIG SAirE 1000 GALLON ' 1-800-322-4844 FOR LOCATION OF UNDERGROUND SEPTIC TANK(EXISTING L 33024.per dtZ' / TO RE INVERT ELEVATIONS: UTILITIES. . MAIN) . SIZE OF LEACHING PROVIDED: NOTE: INVERT AT BUILDING f,,��° 500 gal.CAPACITY CONCRFTI,LEACHING 6. DATUM IS ASSUMED. D-BOX TO SET ON A INVERT IN AT SEPTIC TANTK 9.5.25 ± YRI; W!4°OF STONE. 7.`NO DETERMINATION HAS BEEN MADE AS TO 6"BED OF COMPACTED CRUSHED STOP:E. COMPLIANCE WITH DEED RESTRICTIONS OR ZONING CONTRACTOR SHALL WATER TEST INVERT OUT AT SEPTIC TANK 95.00 + BOTTOM: 436 sf,x.60 = 261<<.P.D. REGULATIONS.IT SHALL REMAIN THE OWNER'S RESPONSIBILITY D-BOX TO SHOW LEVELNESS. INVERT IN AT DIST.BOX 92.00 SIDEWALL: 186 sf,x.60 = i 11 G.P.D. TO OBTAIN ALL REQUIRED PERMITS,SPECIAL PERMITS, 3 wi n P.D. ' INVERT OUT AT DIST.BOX 91.83 TOTALS:622 sf.x.bU = a,� .*. `0 q r1 VARIANCES,ETC.FOR T:IIS PROJECT. „� SOIL TEST ?IT DATA INVERT IN AT SA.S. 90.00 TEST _ y DATA NOTE T.P.#1 ' BOTTOM OF S.A.S. 88.00 GROUND ELEV. =94.0 N EXISTING SEPTIC LEACH PIT SHALL BE PUMPED CLAN ADJUSTED GRc�vr�awATER GRrrv.WATER ELEV. = N.A. AND BACKFILLED WITH SAND TO ELIMINATE VOID,. T.P.#2 393 OBSERVED GROUNL DI WATER GROUND ELEV. 97.3 EXISTING �` a GP�1D.`XA,1-nR ELEV. = N.A. .j DATE:��UG. ,�T 17,�,006 WELL C� PROPOSED TEs� . c& rrALL�T� �sti ,�� S . -YTNG&PER��'ITIN x NC. j �' S.A.S. PROPO D - (J.LA.j,TDERS CAULEY-SOIL EVALUATOR) - 1� VENT "EN 'SSED 3Y:DON DESW-.RES(A(7-ENT) 164.62' I0.4ft '�'EI�C RATE,, 10-ndrd INCH INC b�TRAT: ROP wls TES - ? T.. x ,- t ..rt. HOLE S.A.S. ?Hyl'0 L .I ITABLE AIL ENE AT H . w Q 5" T r ;T, . . _ 3. � .� ."�D a'��'+T�;�.�� .�Sir, ��,II:E>.:�ZONE AI"�Ot7?'y�D # 1 z _�. . p x: fir. � %'�YY,' �«w� 1"ti - u I3I; .A.� °DG � N T T, , �.,1 SOIL ST.RATA EL. 94.0 5' -` �X'ITN �>I., '4I�� 'AND PI I` /� TY1' YP 4 ; . - SECTION 'S.�55(3). , . EXIST. I BENCHMARK. x � . LEA CI I t� ` g TOP OF SLAB PIT - r EL. = 100.00 r" r �-- ''' .q EXISTING n ASSUMED ST. �" 18. 'mo i SE TIC 4 ` 11 9 238.8+ WE'LL T TEST HOLE TO EXISTIN # 2 �'+ ? WELL THiE-E CON�:RETE �P�c�c���Ass9c ___--__ o► E LEACHING STRUCTURES(H-20) RicHa nDECK HOOD DECK k A r TEST HOLE# 1 ` No. 35031 - ���' 0"-24" O/A �o 0 24'"-42", B LOAM 10yr 5B ?SJ.4rraD?_ DRI 42'"-168" CISILTLOAM 10yr5/3 DATE PROF � LAND SURVEYOR STING R'AZ'. 1681"-210N C2 SANDY LOAM 10yr 5/3 WELLING 2101"+ FINE TO MED.SAND 10yr 6/4 N U r _ ) . # 45 x C ;� *A 30.7+ V IANCE REQUIRED TEST HOLE# 2 ROGER na 0"-24" O/A �C, WCHIN EW1 t r O�J �O 24"-47' B LOAM 10yr 5/8 too. 2 P M 42" 168 C1 SILT LOAM 10yr 5/3 ! „_ Y LOAM 1 5 DECK 168 210 ,SAND 10yr t3 - ; Q EXISTING WELL tiO ?'0"+ C FINE'1'0 MED.SAND 1 6/4 - ,,,� ^�-- . ' TOP OF PERC�a 42" � DATE PRO, I NAL ENIi+tEER ( IL) .40' ' TEXTURAL CHANGES,THIN BAND r Aft OF RED HUES. ASSESSOR'S MAP 216 PARCEL 052 104 : T PLAN SHOVv I� ; A SEA"'PT IC SYSTEM REPAIR DESIGN # 45 SPRUCE S�` �_EET BARNSTABLE l A © c� . i.(x lJs [ SCALE 1" = 20' SEPTf_•,i:4BER 06,200C REVISED JArr UARY 22,200/ f E CANAL LAND SURVEYING &`PERMITTING INC. p' 20' 40' 60' „� `f 306 OLD PLYMOUTH ROAD, SAGAMORE BEACH, VA �; '\ (508-888-5955 PROJECT;,LTUMBER (��-033-B LOCUS DRAWN BY:PDR/CHECKED BY:RJH T -� _ w GENERAL NOTES: DEPTH GF COVER VARIANCE(TITLE.5,SEC?'ION 15.221 (7). *FINISH GRADE OVER S.A.S.VARIES -' * A VARLkNCE OF UP TO 3ft.IS REQUIRED IN LIEU 1. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION 99.80 INSTALL A GAS BAFFLE BETWEEN EL.92.50 AND 97.00 ----.�. _ OF THE SEWAGE DISPOSAL SYSTEM ONLY. ACCESS COVERS MUS,BE OF THE aft:MAXIUM COVER OVER THE S.A.S.TO BURY THE SAS. S. w IN OUTLET TEE. WITHIN 6" OF FINISH C r7.4.DE, PROPOSED UP TO 6.0 f:.DEEP AT ITS SOUTH END. Z. ALL CONSTRUCTION METHODS,MATERALS AND VENT MAINTENANCE FOR THE SEPTIC SYSTEM SHALL >` DESIGN CRITERIA: CONFORM TO TITLE 5 AND LOCAL 4" plpE 92.00 91.83 r LAYER ,, BOARD OF HEALTH REGULATIONS. e•-v2DLa DE.+IG�I FLOW: 90.00 W ASHED sroh 3 BEDROOM DWELLING @ 110 GAL/DAY PER BEDROOM 3. ALL SEPTIC SYSTEM COMPONENTS SUBJECT TO 95.25 f 95.00 tE EQUALS 330 GALS.PER DAY. (NO GARBAGE GRINDER) VEHICLE LOADING(i.e.UNDER DRIVEWAYS.ETC..) 4'MINIMUM ASHED STONE e EFF. SHALL BE DESIGNED TO WITHSTAND H-20 LOADING. LIQUID DIST. 88.00 2 SEPTIC TANK REQUIRED: 330 x 2.0=660 I. 4. ALL SEWER PIPES SHALL BE SCHEDULE 40 OR J1. • BOX INSTAL 4' PROPO I D S.A. .(H-20) 4' SEPTIC:TANK PROVIDED: 1000 gal. APPROVED EQUAL low 10' MINIMUM (H-20)INLET TEE SIZa:d1 LEACHING FACILITY REQUIRED ,5. BEFORE STARTING CONSTRUCTION CALL DIG SAFE 1000 GALLON DEdIGN PERC RATE< lOmin/in. 1-800-322-4844 FOR LOCATION OF UNDERGROUND SEPTIC TP EXISTING 330;dal.per Jay TO RE INVERT ELEVATIONS: UTILITIES. M� SIZI:OF LEACHING PROVIDED: 6. DATUM IS ASSUMED. NOTE: INVERT AT BUILDING THREE-500 gal.CAPACITY CONCR=: E LEACHING D-BOX TO SET ON A INVERT IN AT SEPTIC TANK 95.25 + STR i JC rURES W/4'OF STONE. 7. NO DETERMINATION HAS BEEN MADE AS TO 6"BED OF COMPACTED CRUSHED STmE. COMPLIANCE WITH DEED RESTRICTIONS OR ZONING CONTRACTOR SHALL WATER TEST INVERT OUT AT SEPTIC TANK 9S.00 -I- SIDEW. LL: 186 sf.x.60 = 111 G.P.D. i'vi:436 sfx.60 = 261 G.P.D. REGULATIONS.IT SHALL REMAIN THE OWNER'S RESPONSIBILITY D-BOX TO SHOW LEVELNESS. INVERT IN AT DIST.BOX 92.00 SIDE'�V TO OBTAIN ALL REQUIRED PERMITS,SPECIAL PERMITS, TOTJ:LS:622 sf.x.60 = 372 G.P.D. VARIANCES,ETC.FOR THIS PROJECT. INVERT OUT AT DIST.BOX 91.83 INVERT IN AT S.A.S. 90.00 SOIL TEST PIT DATA NOTE: I BOTTOM OF S.A.S. 88.00 T.P. it 1 EXISTING SEPTIC LEACH PIT SHALL BE PUMPED CLI;AN GROUND ELEV. =94.0 ADJUSTED GROUNDWATER GRND.WATER ELEV. = N.A. AND BACKFILLED WITH SAND TO ELIMINATE VOIDS . T.P.,=2 393i, OBSERVED GROUNDWATER GROUND ELEV. =97.3 GRN3.WATER ELEV. = N.A. EXISTING ` j DAT S:AUGUST 17,2006 WELL PROPOSED PROPOS D iEv EST BY:CANAL LAND SURVEYING&PERMITTING INC. j jo, QU S.A.S. T(J•LANDERS CAULEY-SOIL EVALUATOR) X VENT WED aEESSED BY:DON DESMARES(AGENT) 164.62' 10.4ft P RC IR 7M, 10min./INCH IN C 1STRATA 11 3/4"- 11/2" D't:.A. PROPOSED WASHED S CNE TES - S.A.S. R M{EVE UNSUITABLE SOIL BENEATH HOLE 43.5 .4 STDdIT'IIiIN A Sft. NAIIDE ZONE AROUND -- EL. 94.0 -I� _ DOWN TO C�i S ;L�S A •, _ . 25. ' ` ",HE SPECIFICATIONS OF TITLE S �Ti-, E_ BENCHMARK: EXIST. O1 F TY P SECTION 15.255(3). o TOP OF SLAB L P '7 o� O1 ' EL. = 100.00 ( ASSUMED) ST. `�' 18.4ft EXISTING .8+ p' SE Tic 238 TEST HOLE �I ' T TO EXISTIN WELL # 2 . Q' WELL THREE CONCRETE _�r �. v�P��N OF r•�A Fcy -'----+® . LEACHING STRUC I�[1RES I r y DECK ? �o RICHARD DECK� � � �,� J� J� 3x TEST HOLE# 1 HOOD 0"-24'" O/A No. 35031 ^ 24"-42" B LOAM 10yr 5/8 Z;&3A'-1 t 7 a. YO ,D.Rj WA 42"-1168" CISILTLOAM 10yr5/3 F57 I� PR0! 'D S�R'VEYdR STING Y 168 -210"C2 SANDY LOAM 10yr 5/3 / a WELLING 210"+ FINE TO MED.SAND 10yr 6/4 # 45 A 30.7+ V IANCE REQUIRED O TEST HOLE# 2 P:,'°L , '" (� 24 -4Z B LOAM 10yr 5/8 '-,� • �', �. 42"-168" Cl SILT LOAM 10yr 5/3 DECK 168"-219'G2 SANDY LOAM 10yr 5/3 i8 Au 01 9' EXISTING WELL 210"•+ C3FINE TO MED.SAND 10yr 6/4 -- �, D kTE PRO SIONAL ENGINEER 'CIVIL)- TOP OF PERC @ 42 .40' TEXTURAL CHANGES,THIN?3 A.I D OF RED HUES. A.SSESSG o.S MAP 216 PARCEL 052 144 PLAN SHOWING A SEFTIC SYSTEM REPAIR DESIGN o # 45 SPRUCE STR'I-. T , BARNSTABLE ,MA BA 7 LOCUS ,� SCALE 1".= 20' SEPTE JEER 06,2006 REVISED JAIvUARY 22,2007 CANAL LAND SL . VEYING & PERMITTING INC. o 20' 40' 60' 306 OLD PLYMOUT -I ROAD, SAGAMORE BEACH, MA w0 888-5955 PROJECT NUMBER 06-033-B LOCUS MAP DRAWN BY:PDR/CHECKED BY:RJH _