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HomeMy WebLinkAbout0025 BRAGG'S LANE - Health 25 Bragg's Lane Barnstable. . P vr. , = L V a IV i w , 7 , • r Y ;, is ., _ • — w , 4 r. v , V �'�.•. tea."w�[i �i_., � .�. '" .. — r , , c � h , , r 1 s � : : , r , a V e K' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal°System Form - Not for Voluntary Assessments , �., 25 Braggs Lane Property Address Ben MacPherson '- Owner Owner's Name _..__' information is MA -026 - R•.Ma r 16 2012- Y' required for Barnstable 30 ' '*' State °-Zip Code- Date of Inspection everypage. City/Town a, y 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. Important: A. General Information When filling out forms on the computer,use 1. Inspector only the tab key - to move y6ur Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name reb 189 Cammett Road Company Address MA 02648 Marstons Mills— `-tZip Code reran CityTTown State:', 508-428-1779 Sl 12855 Telephone Number License Number 'B. Certification r _ - . . ... _ . _.. , _.. _: _ _. ..... .•.. I certify thatTl have personally inspected the sewage disposal system-at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance o on slte� sewage disposal systems. I am a-DEP approved system inspector pursuant togection 15.3r40 of Title 5 (310 CMR•15.000). The system: V Fa Is 11 ® Passes ❑^Conditionally Passes_ ❑ k •, ❑ Needs Further uatiKj Approving Authority May 16, 2012 Job# 12-76 ,r In ector's Sign ture 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 a4 that time. This inspection does not address how the system will perform in the future under the same or different conditions offuse. . t" Title 5 V�necionlorrn:Subsurface Sewage Disp sal System•Page 1 of 17 t5ins•11/10 =• n Commonwealth of Massachusetts r Title 5 Official Inspection Forme Subsurface Sewage Disposal,System Form - Not for Voluntary Assessments 25 Braggs Lane Property Address Ben MacPherson Owner Owner's Name information is Barnstable MA 02630 May 16 2012 required for ° every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) r Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates`that ary of the failure criteria described in 310 CMR 15.303 or in•310 CMR 15.304 exist. Any failure criteria not evaluated are - ncl cated°below. Comments: tanks were pumped as part of inspection, leaching system shows no signs of saturation or failure. '. B) System Conditionally Passes: ❑, One or more system components as described in the"Conditional Pass" section need to beY s replaced,o�repaired. The system, upon completion,of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and„over 20 years old* or the septic tank(whether,metal or not) is . structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced,with a complying septic tank as approved by the Board of Health. - • *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. Y.* ❑ N ❑ ND (Explain below): T - t5ins 11)10 , Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts Title 5 Official • Inspection Form Form:- for Voluntary Assessments Subsurface Sewage Disposal System �M 25 Brag s Lane , Property Address _ Ben MacPherson Owner Owner's Name ' k information is 1e -' MA 02630 May 16 2012 Barnstab n f Ins pection ect to Date o _ for ZI Code p required _ ,, State p q City�fown ' every page. B. Certification (cont.) B)' System Conditionally`Passes (cont.) 3 ❑ 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):, Elb'roker-•pii:(s) Y .are replaced . f❑ N. , ❑ ND (Explain below): ❑ ❑ Y ' N ❑ ND (Explain below): obstruction:is removedFj ❑ distribution box is leveled or replaced ❑• Y ❑ N ❑ ND (Explain below):' Y ❑ The system.required pumping more than 4 times a year due to broken or obstructed pipe(s). The system p stem will ass 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): ` 4 C) Further Evaluation is Required by the Board of Health: r ❑ Conditions exist which require further evaluation'by the Board of Health in order to determine if `- the system is failing to protect public health, safety or the environment. ` 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public•health,' safety and the environment: t ❑ 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 t5ins•11/10 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Braggs Lane Property Address t Ben MacPherson Owner Owner's Name information is required for Barnstable MA 02630 May 16, 2012 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 functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is,less than 100 feet but 50 feet or _ more from a private water supply well". . Method used to determine distance: - *' This system passes if,the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided thafno other failure criteria are triggered. A copy of the analysis must be attached to this form. .f , 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No Backup of'sewage into facility or system component due to overloaded or, clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters El E due to an overloaded or clogged SAS or cesspool 4 Static liquid level in the distribution box above outlet invert due to an overloaded , 0 ® or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available.volume is less ❑ ® than day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Braggs Lane Property Address Ben MacPherson " Owner Owner's Name information is Barnstable MA 02630 May 16 2012 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No Required pumping more than 4 times in the last year NOT due to clogged or El 0 .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 El0' tributary to a surface water supply.. ❑ ® Any portion of'a cesspool or privy is within a Zone 1 of a public well. El ® Any portion of a cesspool or privy is within 50 feet of a private water supply - well. ❑ ® Any portion of a cesspool or privy•is less than•100 feet but greater than 50 feet from-a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.) The system is a cesspool serving a facility with a'design flow of 2000gpd ® 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 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 systemthe system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems; you most indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ' El D 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 iri Section E the system`is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large' system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11I10 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 5 of 17 } Commonwealth of Massachusetts w F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form —Not for Voluntary Assessments <c�* 25 Brag s Lane Property Address Ben MacPherson Owner Owner's Name information is Barnstable MA 02630 May 16,2012 required for State Zip Code Date of Inspection every page. Cityrrown C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ®- ❑ Pumping information was provided by the owner, occupant, or Board of Health Were any of,the system components pumped out in the previous two weeks? ® ❑ _ Has the system received_normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or,as part of ❑ ® this inspection? • . El 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? r ® ❑ Was the site inspected for signs of break out? ® ❑ Were all systemcomponents, excluding the SAS; located on site? R® - ❑ 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, f dimensions, depth of liquid;depth of sludge and depth of scum? ® El information 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: ® ❑ e Existing information. For example, a plan,at the Board of Health: C. Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: �. T , , 5 5 t. Number of bedrooms (design): Number of bedrooms (actual): n DESIGN flow.based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 F Title 5 Official Inspection form Subsurface Sewage Disposal System t5ins•11I10 •Page 6 of 17 4 Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface.Sewage Disposal System Form Not for Voluntary Assessments 25 Braggs Lane I Property Address Ben MacPherson' ' Owner Owner's Name ` information is Barnstable .. -MA 02630 May 16 2012 required for State Zip Code Date of Inspection every page. City/Town k.. D. System Information - t r Description: 2 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? `° ❑ Yes El No Seasonal use? ' El Yes ®, No N/A Irrigation Water meter readings, if available (last 2 years usage (gpd)): system. Detail ti Sump pump? ❑ Yes ® No,. $ ` Currently . Last date of occupancy: . Occupied. Commercial/Industrial Flov%r Conditions: . Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of.design flow (seats/persons/sq.ft., etc.): Grease trap present? i ❑ 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: Page 7 of 17 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System• . Commonwealth of Massachusetts Title 5 Official Inspection .Form - , Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .°" 25 Braggs Lane ' Property Address Ben MacPherson ' Owner Owner's Name ` information is Barnstable MA 02630 May 16 2012 required for every pager" CitylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date. w ' Other(describe below): i I General Information ,. Pumping Records: Source of information:{ Tanks last pumped 5/25/11 Was system pumped as part of the inspection? ® Yes ❑ No , ` 1000/ 1500 ' if yes, volume pumped: gallons r • How was quantity pumped determined? Maint. Reason for pumping:- Type of System: ;y ® Septic tank,-distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy r fi ❑ • Shared system (yes,or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained,from system owner) and a copy of latest. inspection of the I/A system by system operator under,contract• ❑ Tight tank. Attach a copy of theADEP approval. Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Braggs Lane _ Property Address Ben MacPherson Owner Owner's Name information is required for Barnstable MA 02630 May 16, 2012 ' _ - every page. City/Town State Zip Code Date of Inspection D. System Information (cont) r Approximate age of all components, date installed (if known)-and source of information: Compliance date: 2/3/03 Were sewage odors detected when arriving at the site? _ ❑ Yes ® No i Building Sewer (locate on site plan): 2' Depth below grade: Meet Material of construction: 4 ' ❑ cast iron ® 40 PVC ❑ other_(explain): �? . Distance from private water supply well or suction line: - feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): $ 2' Depth below grade: feet w Material of construction: -® concrete ❑ metuiJ , ❑ 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 One 1000 gal &one 1500 gal. •i Dimensions: � , ' 2,. Sludge depth: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts- , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 25 Braggs Lane Property Address Ben MacPherson Owner Owner's Name information is Barnstable MA 02630 May 16 2012 required for State Zip Code Date of Inspection every page. Citylfown , i D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Y 2„ 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, Measured How were dimensions determined? ,. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels.as related to outlet invert, evidence of leakage, etc.): . Liquid levels were at outlet inverts and all tees were intact and clear. Both tanks were pumped at time of inspection. 4 'Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: t 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 t5ins•11/10 Commonwealth of Massachusetts = Title 5 Off icial Inspection Form . p - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Braggs Lane Property Address Ben MacPherson ' Owner Owner's Name information is Barnstable MA '.02630 May 16, 2012. required for every page. City/Town State Zip Code Date of inspection D. System Information.(cont.) . Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): " - Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: El concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity gallons Design Flow: gallons per day , Alarm present: Y { . ❑ Yes ❑ No Alarm level: Alarm.in working order: ❑ Yes ❑-No Date of last pumping: t Date Comments (condition of alarm and float switches, etc.): 9 *Attach copy of current pumping contract (required). Is copy attached? -❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 x 3 1 t . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary.Assessments 25 Braggs Lane - a Property Address Ben MacPherson Owner Owner's Name e information is Barnstable MA 02630 May 16; 2012 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) ' a 4 - Distribution Box (if present must be opened) (locate on site plan): - 011 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.)-,- No solids or high stains present. a .c Pump Charri.ber(locate on site plan): ; Pumps in working order: ❑ Yes ❑ No Alarms in working order: 4 ❑ Yes ❑. No Comments (note condition of pump chamber, condition of pumpsand appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located,.explain why: t5ins•11/10 « Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form _ Not for Voluntary Assessments M 25 Braggs Lane Property Address Ben MacPherson Owner Owner's Name information is required for Barnstable MA- •02630 May 16, 2012 — — every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type. ❑ leaching pits number: - s ® leaching chambers number: Five 500 gal drywells. ❑ leaching galleries number: ❑ leaching.trenches number,.length: ❑ leaching fields number, dimensions: . ❑ q overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, cond n of ' vegetation, etc.): Stone and soils surrounding SAS were probed with'no si Yns of saturation or h draulic..fai ure i.vind. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration a Depth—top of liquid to inlet invert Depth of solids layer • Depth of scum layer, a. Dimensions of cesspool Materials of construction *Indication of groundwater inflow ❑ Yes ❑ No l5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 �.. J' .. 0 , ' Commonwealth of Massachusetts Title 5 Official Inspection form , Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 25 Braggs Lane Property Address Ben MacPherson Owner Owner's Name information is Barnstable .~ r required for MA 02630 May 16, 2012 every page. Cityr town s State Zip Code Date of Inspection D. System Information (cont.) ' Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): z Privy,(locate on site plan): Materials of construction: A Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): a E i i A i- .X ' 15ins-11/10 . Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form m a Subsurface Sewage Disposal System Form -.Not for Voluntary Assessments 25 Bracigs Lane Property Address Ben MacPherson \- Owner Owner's Name information is Barnstable MA 02630 May 16, 2012 required for ......-. _--- . .._ — — -- -- every page. City/Town "State Zip Code Date of Inspection D. System Information '(cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ®• hand-sketch in the area below ❑ drawing attached separately 40 20 . \ \ 17 ., 21 "r .2 g Commonwealth of Massachusetts ' N Title 5 Official Inspection Form~ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w., 25 Braggs Lane Property Address Ben MacPherson Owner Owner's Name information is required for Barnstable MA 02630 May 16, 2012 every page. CityrTown State Zip Code Date of Inspection D. System Information Mnt.) Site Exam: , ® Check Slope { ® Surface water Check cellar " ® Shallow wells • Estimated depth to high ground water: 15+feet Please indicate all methods used to determine the high ground water elevation: -� ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date , - ' ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ . Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: - You must describe how you established the high ground waterelevation: Low point of property with no surface water is considerably lower than SAS. ff r Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11110 't Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 17• . • _ - . � t " rK ,� 7:+'.. •��� �+Has , - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -'Not for Voluntary Assessments wM 25 Braggs Lane Property Address Ben MacPherson ` Owner , Owner's Name information is required for Barnstable MA 02630 May 16, 2012 . every page. City(Town State Zip Code Date of Inspection E. Report Completeness Checklist H ® Inspection Summary: A, B, C,'D, or E checked ; ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ., ® System Information- Estimated-depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15.or attached in`separate file p • } Page 17 of 17 l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System• No.mil" o 3 2. ' .. Fee v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: At Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Mi5pozar *potem Congtruction joermit Application for a Permit to Construct(I/)Repair( )Upgrade( )Abandon( ) ❑Complete System C!rIndividual Components Location Address or Lot No. Q Owner's Name,Address apd Tel.No. Assessor's Map/Parcel Nwrlhe"w ,!% le Installer's Name,Address,and Tel. o. r Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size ,2 . Cld�s�.ft. Garbage Grinder K40 Other Type of Building , � o.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date 0T f5' 204W Number of sheets Revision Date / ZS` Title Size of Septic Tank Type of S.A.S. f dr®QZZ I '_^ Description of Soil Nature of Repairs or Alterations(Answer when applicable) �� S Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by t ' oa�dof He lth. ,J Signed 4 Date Application Approved by 4v. Date Application Disapproved for the following reasons Permit No. D 0 0.3—Oa 3 Date Issued No. ��3 V � ` 1 .c Fee jr Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS - Yes PUBLIC. HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS - Zipprtcation for Mtopogal-6r6tem Conztructiotr Permit ,,) Application for a Permit to Construct(V )Repair( )Upgrad )Abandon( ) EJ Complete System 21 Individual Components Location Address or Lot No. / Owner's Name,Address apd Tel.No. Assessor's Map/Parcel - Installer's Name,Address,and Tel.No. r Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms ,5 Lot Size 3.2 .4 sq.ft. Garbage Grinder(/60 Other Type of Building �0�lNo.of Persons \ Showers(.. ) Cafeteria( ) Other Fixtures _ Design Flow 10 gallons per day. Calculated daily flow gallons. Plan Date I O S' /g' 2 C;®O Number of sheets Revision Date Z Title Size of Septic Tank I k?I Type of S.A.S. 4 � . Description of Soil de l'o P 1, Nature of Repairs or Alterations(Answer when applicable) a ell h /V /A Date last inspected: 4 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by th.'s oard of Health. 'J Signed Date �7 Application Approved by oc Date Application Disapproved for the following reasons Permit No. D U u 3-OR 3 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (tompliance THIS IS TO CER FY, that the On-site Sewag isposal System Constructed(✓ )Repaired( )Upgraded( ) Abandoned )by 061 f O' 6, at e qS 9fO has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.;�Uo 3-0?3 dated411-lju� Installer Designer The issuance of his permit shall not be construed as a guarantee that the syste ftu( n aMegigned. Date 2-r / 3 Inspector 7 I r ——————————————————————————————————————— No. U o-1 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migaal *pgtem Conotruction Permit Permission is hereby granted to Construct( ✓)Repair( )Upgrade( )Abandon System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply wkth Title 5 and the following local provisions or special conditions. \Provided:TqI03 nstruction must be completed within three years of the date of this pe t. Date:_ Approved by D�,�,.f 41j, �� ' l , TOWN OF BARNSTABLE LOCATION SEWAGE # 6V 3 VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. /m� �i���raci�r✓ S/�b°= 3�/ SEPTIC TANK CAPACITY e L /OU o9L LEACHING FACILITY: (type) S' ` L`l S (size) A NO.O OOMS UILDER OWNER U DATE: i��/3 COMPLIANCE DATE: 2— -3 -3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and.Leaching Facility(If any wetlands exist within 300 feet of leaching facility) /O( t Feet Furnished by -D,6 C y- so; f S - or 17 Q . GG 9 I I � 3 a TOWN OF BARNSTABLE LOCATION L5 ZC S Lin S1 E# ✓l SO VILLAGE Mt—n . SESSOR'S MAP&PARCEL LNG NAME&PHONE NO. LJf�O n hl- [,��j� (1� I SEPTIC TANK CAPACITY 600 '1'/ S 0o LEACHING FACILITY:(type) ���t1�Wl (� l5 (size) oaj NO.OF BEDROOMP�rso I OWNER GIG n PERMIT DATE: DATEP �� lG Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY r, T°,:a 40 20 4f\f\I4I4f\r4f4f\ f J f F I F F J f \ \ \ \ 4 \ 4 \ 4 4 \ 4 \ \ 4 4 4 4 f I f•r f f J f f I f f f f f f f •• ` 4 \ \ 4•\ \ \ 4 \ - •!\ \ \ \ \ f f f f f f f f f f 4F4 \f I\F\J\f\J\I\!\ 4!\r\r4f4r\l4r 4F\J\ \ \ 4 \ \ \ \ 4 4 4 f f f f F J J f • f' I' F f 4 4 4 4 \ \ \ \ \ 4 4 4 \ F J F f F J F f \ k 4 \ f F r r r 17 21 � 3 TOWN OF BARNSTABLE. LOCP,-iiON,2 rrro S L S/ SEWAGE # L eV 3 �I'.i.LAGE �a�,�rS�t ASSESSOR'S MAP & LOT a O 4'3 INSTALLER'S NAME&PHONE NO. �J �m �iWJYrreir✓ �/.�8-ti3g1/ SEPTIC TANK CAPACITY - Sa- o� Gr9� l LEACHING FACILITY: (type) (size) �Ka E OOMS OWNERATE: i��/�3 COMPLIANCE DATE: Z 3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and.Leaching Facility(If any wetlands exist �O(J f Feet within 300 feet of leaching facility) Furnished by 1�ocu✓ ��k 1�.�;r ca h _ . CQ b w � CGGn (\ � _ o TOWN OF BARNSTABLE ' LOCATION rt ? C- G ~ , SEWAGE # -00c) S'0ii� VILLAGE r. SSESSOR'S MAP & LOTS — 1� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY )S-�v LEACHING FACILITY: (type) tica,wVIt i(o, (size) S-'OD NO. OF BEDROOMS BUILDER OR OWNER��eon \O. M i`n �a R.,:,t PERMITDATE: Z6 X!OdMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of�le chin f cility) Feet Furnished by ©7 M J ol - 17 UP J87. L7-- C/e7 L s� No.--1►�- ova=d36 Fee--- --------------- BOARD OF HEALTH TOWN OF BARNSTABLE Appricat ion-for V er[ Cootruct ion Permit Application is hereby made for a permit to Construct (Alter ( ), or Repair ( )an individual Well at: . 3 Location — Address Assessors Mal and Parcel Owner p� Addresssss n J ,( Installer — Driller Type of Building Dwelling --- ---- - —- Other - Type of Building--- ---- No. of Persons.-- --- � - ------- - a e Type of Well - L— Capacity— Purpose of Well-- 190VQT_LD� C'ML CmPaice b oe'( P(c iq Al Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signed�`14d<�� — -- Ri date Application Approved By J6� ------- `/2-U--- date Application Disapproved for the following reasons: ------- ----- ------------ - ------ - -----------------date Permit No. Way 0 oL— O3 6 — Issued-- h7loz - ------------- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by--- — ---_ ---- ---— — ---—— --- —_____---- Installer at— 'e ---------- — -_- ------- ------ has been install in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.�2&!3b Dated 6 102- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--- - Inspector — —————— —————————————————————————— ------------------------ -- Fee- BOARD OF HEALTH TOWN OF BARNSTABLE . 2ppricat ion for Vei[ Cootruct ion Permit Application is hereby made for a permit to Construct (V�' Alter ( ), or Repair ( )an individual Well at: Location -:-Address Assessors Ma and Parcel Owner I Address Installer — Driller Address Type of Building Dwelling --- —------- Other - Type of Building-= ----_ No. of Persons---------------.--__ Type of Well Capacity-- &- — Purpose of Well-_ - CmAn�E .30 �'r--44 a�. Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed �� date Application Approved By ' date Application Disapproved for the following reasons:-=- -----------.-- ----_ - — -- ---------_ ----date wauoa a36 V-2 Permit No. Issued ._ �_ -----____-- date BOARD OF HEALTH TOWN OF BARNSTABLE (certificate Of eomprtance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by-- — — --- -------------- — - --- fInstaller has been install din accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No(tQL02 3- Dated-6/-z ---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-- Inspector BOARD OF HEALTH TOWN `OF ' BARNSTABLE Ivell contruct ion Permit UV a.002 R� �"rr h�U� Wkllj Wur - vtH�le Fee—V-_— 17— No. -- Permission is hereby granted � SrAOUI �r^-L?? ----------------------- -_ Ito Construct ), Alter ( ), or Repair ( ) an Individual Well at: No. W a o - street as shown on the application for a Well Construction Permit No.- LJQ OU a Dated / -- — G Board of Health DATE ___ No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 4YL60*`� PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipplication for Miow5al 6potem Cottgt U tion permit Application for a Permit to Construct Repair( )Upgrade(4A Abandon( ) Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel .�. S � e '"(/�e-- 3-3 Installer's Name,Addres ,and Tel.No. Designer's Name, ddress and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 0 gallons per day. Calculated daily flow gallons. Plan Date 6 11d Number of sheets Revision Date Title �1rlZ sa Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been' d b is Bo of alth. Signe A OF Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued TOWN OF BARNSTABLE LOCATION 2 <2Lfo i SEWAGE #.1 ' VILLAGE \ r SSESSOR'S MAP & LOTS' z"'a 1 INSTALLER'S NAME&PHONE NO. -- SEPTIC TANK CAPACITY I S C v LEACHING FACILITY: (type) (size) NO. OF BEDROOMS I BUILDER OR OWNER eorl \Cl Vli i y1 Ur' 6i'�✓ >%�� 6 . /�";�Sa,-? PERMITDATE: �B2q pLLkNCE DATE:1� i ISeparation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet. Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of le hing facility) Feet Furnished by i -t-- r G/c r I r z ' �i . •r .. -.+,�.?'tT '•• r^..- ._. _ �i .- ,,. � _ .ate. ,.�.._. ait:. r` •,.' _ ��No. Fee. ��f�D✓ (((///��' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS -application for Mizpo!gar 6potem Co n�t uction joerrnit Upgrade ( ) Complete System O Individual Components Application for a Permit to Construct(r)Repair( )Upg (54)Abandon p y po • i Location Addressor Lot No. 73- j ryl „—A—.u.A— Owner's Name,Address and Tel.No. Assessor's Mal/Parcelt .ss. Installer's Name;Addre and Tel �NNorr�t Designer's Name Address and Tel.No. Type of Building: .� � �• Dwelling No.of Bedrooms Lot Size '�y �1"1t Garbage Grinder( ) Other Type of BuildingNo.of Persons Showers( ) Cafeteria( ) f ; Other Fures Design Flow gallons per day. Calculated daily flow J gallons. Plan Date Fe Number of sheets ( Revision Date ` Title /7;17t 1' .5ZIk - ' Size of Septic Tank Type of S.A.S. r Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected:Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with'the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- ' e /socate.of Compliance has bee ed Signe l 4 e Date IO/y 4jJ k � f Application Approved.by Date Application Disapproved for the following reasons Permit No. ! Date Issued ~ - --- --------� --.— , THE COMMONWEALTH OF MASSACHUSETTS ' BARNSTABLE; MASSACHUSETTS' Certificate of (Compliance THIS IS TO C�,ithat On-s;te Spvwa a Disposal System Constructed(1 )Repaired( )UpgradedAbandonedZ( by_ iat �a - Qf has onstructed in accordance with the provisions of Title and the for Disposal System Construction Permit N . ated Installer Designer The issua�ce„ f this ermit shall not be construed as a guarantee that the sy tem ill function as designe3. Date /w 70* ,0 3-d Inspector F(5 ----------------- FeeN THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 1 lfgpogal &potem Conotructfon permit Permission is hereby granted to Co struct(✓) pj� Rer( )Upgra ( )Abandon( ) System located at ✓� ��99-> '�� 1�Y�15�`9�/ti' 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. x Provided:Constructi n must be completed within three years of the date of this Date: v v Approved by i t' it X. s i TOWN OF BARNSTABLE LOCATION �� L- ✓ SEWAGE #?0bt) `i 1 VILLAGE 1. SSESSOR'S MAP & LOTS �•"© , INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I S CD LEACHING FACILITY: (type) (size) J NO. OF BEDROOMS j BUILDER OR OWNER71PYZ \n yh i ► , ll pp . Uri /Si`'1✓ �����i���.�".Sa, PERMITDATE: 3VMPLIANCE .DATE: Separation Distance Between the: Maximum Adjusted.Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and.Leaching Facility(If any wetlands exist: - within 300 feet of le ching f cility) Feet Furnished by Qcv r Z-1 013 R 5 _ r .1 VI .Q�'SMr�F `a�SILIdKb /YEsn' /-&,fl' 5 2 M D e pi 6 �a v 3� ,off �� �� _ w -7 Ui ro0`� f a SLI D � C 1— J ul 14 Cr t L C� V x � � rr o � J x ° �- S v Vv 3'6� Y. 08 '1 -d - a x x � � -013 LOCATION SEWAGE PERMIT NO. wti a.- L o T 70 6,(r VILLAGE I N S T A LLER'S NAME S ADDRESS S U I L D E R OR OWN ER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED i F N rn Z 7 Snot ZOa ry�n� is;kj.i -ad ow -0.9 vo) ���, wry, . LG-CATION SEWAGE PERMIT NO. YlLLAGE I N S T A LLER'S NAME & ADDRESS I U I L D E R OR OWNER L141TL DATE PERMIT ISSUEDr `�_ � DATE COMPLIANCE ISSUED ��� r WfA 17.E ��a CoAk e4L MoAr /zo7Y eon, CcogN ea. Npu%C Uj w az 3 Fr `i h elf F Fix THE COMMONWEALTH OF MASSACHUSETTS­" ' « BOARD OF' HEALTH 771 (� .............OF...... .1�.GJ '�R_I:_ ....... Applirtt#inn for Disposal Morks Tonstrixrtion trrutif Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at Location-Addressor ................_Z ... ... ......................................................Lot No. WJ..]1./\ ......:.. v\� � .......... Address ....... ^•.............». .»..... a ................. -----•--........... ............-•-•--•----•---•.......•---•---.......................................... ........... Installer Address - Type of Building Size Lot.I �,,r. ��....Sq. feet a Dwelling—No. of Bedrooms.........a.............................Expansion Attic ( ) Garbage Grinder ( ) a Other:—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) i Otherfixtures ..............................................•---••--.••----•........-----........................_.................................................. Design ow...•-• .... ...................... W gn � ...%��. gallons per person per day. Total daily flow......... ..................gallons. WSeptic Tank—Liquid /capacitygallons Length. ?-,.6 .. Width:--4.1./�J.- Diameter.TtT�... Depth.. 121,.Y x Disposal Trench—No.....................3 Width....................Total Length.................... Total leaching area....................sq. ft.Seepage Pit No..9l�. ..... Diameter......Mal..... Depth below inlet..... ......... '2 ft. :� Total leaching area..............sq. z Other Distribution box (I Dosing tank ( ) / `4 Percolation Test Results Performed by......¢,bl<' i+... -��'-t-/s-- ........ Date 81 ,�a'- a ............ .. . ....... 0.4 Test Pit No. 1__��...minutes per inch Depth of Test Pit....l�. ..:!!.. Depth to ground water.....+ ..Y.... f .-4 44 Test Pit No. 2..%. --...minutes per inch Depth of Test Pit..../-Z j!!n Depth to ground water......?.L./ O •-re p<� iram = =.....1 '. ../ F :r» tg� �7.4-.6eIA ............i�..p..�... ra"�� Description of ��CftU -----�T - dticl�-;v/P/cl� `.......................... L� �-----! -�-. iC�-il'>�T1r f CU,l�s4-✓r..7?.�...�.O�.f�I� GCGY�1G� sum' r,oh?eD. l>..4als ' 3° efl �,a�1t� � �:.. �.................................w :. U Nature of Repairs or Alterations—Answer when applicable.... ... ! �?...y....r`lr .. s � ......................•--...........---......................------.................•..... ..•---.._..............---.............-•- ®! ..... _........_ 2 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisi �s of TIT 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operati nti a ifi o u�liauee-has been ss ed by t board 1 ealth. t neid .fi.� .... ..... .......;1�...j, ... ........... .... . ` ate ` plication Approved By--•................... . . ..... ....... .....-----•--¢ �.....nc Date Application Disapproved for the f ollowi g reasons.............................•--•---•---...--------.......-----........_.....--•........... ...............».. .........................................................................................--.......................................D�..........._ PermitNo..................................................... Issued.............. ........................ —{ _.V. No... �: ` 2� 0 a� --•+ - f- Fas. .................._.... THE COMMONWEALTH OF MASSACHUSETTS;.- BOA RD�O3F HEALTH :1'.................OF.....................................................lr Appfirtt inu for Dhipustt1 Works Toustrudiun jJami# Application is hereby made for a Permit to Construct (/"5-­or Repair ( ) an Individual Sewage Disposal System at: ........� o-r:._#:..7© ,Alf _ •r,�L l ��, r I -r -1' - , Location-Address -- •t +€ or Lot No. W `L o PTO G�'i .. • . . ....Address ...- ....•...•--....».............. a ................ ..... _•--•...... ... ........._....••... -.... .......----...............................-•---..........--•--•---•-••......................... Installer / r Address T of Building .�.................Sq. feet U Type g � Size Lot... .. �� .., Dwelling—No. of Bedrooms..... -5 ._..__.._.._ T�._Expansion Attic'( ) Garbage Grinder ( ) aOther—Type of Building ........ .....::... No �'0Nperson�s_,,`6.................. Showers ( ) — Cafeteria ( ) Other fixtures €. ./ du ----------------.:.......-----..................------......--------------------.............---................ W Design Flow..........��.� r gallons,per person day. Total daily flow......... - ..................gallons. W Septic Tank—Liquid capacit X,-�--�--n- ions{,k-Length. r�f. Width:A/1-� �(Diameter:T:c-' .... Depth--f f./ x Disposal Trench—No. -.�--- .._.. Width .............. Total Length.................... Total leaching area..�� �q. ft. 3 Seepage Pit No..!-_ .. Diameter Z6...... Depth below inlet.....tf-�....... Total leaching area..-.-._....±-.--_sq. ft. Z Other Distribution box 06 Dosing tank ( ) Percolation Test Results Performed by '1��• � -L - Date..... a y....................................................................... Test Pit No. l..G��..minutes per inch Depth of Test Pit....&JFIT. Depth to ground water....- +... V4 Test Pit No. 2..je!5� --••__..minutes per inch Depth of Test -Pit----Z-g T: Depth to ground water..... x -teerP)r•y3.�!1:_ ---u---- --- 2g� :j:t ......../Orr, ,1;:WP7w- eWA roc ,t1�,�.r�? Description of Soil.:t AL..' ..a..I: /5�Ct�; ��T 9-n-o' �.;�AxlP�!!........................................F,el ; 2 �`T"� C:�'*•��,c IZ� ..1. �•-�- -T7r}�7/ ¢ .....- i'•, ...-Y.......-..t•2 `U w, .J�,., '^..y../ '.. .�d < 7 r✓./•iP. *-^' P.. !i�..�` !OF rl i i -e f X«K-S+v 7W, 4641" i.............................................., ' � �'f G( (J .....-... ......................... .................5[cA3f `fir-7.!? ._ ?eZ?_ +IcIC�G�,/ if.......................................................................1 ,t x ii U Nature of Repairs or Alterations—Answer when applicable... ..... ........ . �'....` !_.......... ................................................... .................................. ..............••-•---------.........:_.----_. ......................... pAgreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the prorisi Is of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operati nti a ih a laame-has been issu d by the board Af liealth. ed ��` ... .. r �`✓� `1.............. ...... late-...........�� 4 plication Approved By. . - ..... .................................. Date Application Disapproved for the following` reasons. easons........ .:........... --------- ....... ....................... ....--------.. .................. V ..............•--•--.............................................---.............................................-•-•-•------......-•--•---...----......................................................_ Date Permit No..................................... - ...._...... Issued. - r `te iV ..Dau ........................... t i T�H�E,COMMONWEALTH OF MASSACHUSETTS� i ' -- BOARD OE_ HE;ALTHUt T ... Trit f Irate juf.,f9uutpItitnrit THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.......................................... ........ ..................................................... ................................ Installer at-.....-•-•....... `-?f!-......?.. ................. ......... ...._.� _ ?` 6 v S...: ........ . . .. .. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described to the ; application for Disposal Works Construction Permit No............. ... ...�q .... dated... .7...�.. ..................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEMr'WILL FUNCTION SATISFACTORY. DATE................. �/� � ...... Inspector..._ iY ........ .................................................................. �, ..,,_ ».,«-.. p .--,...,.,. .....,q.........,. ..,... . .... .<.,..,� .X,>„•„,�.�..,.r,,.,_........,«» ..M..a.«-„�,„ .��iF.La,�e�'' �dT{' Ct?"'�«tTtl'J?��'r©u THE COMMONWEALTH OF MASSACHUSETTS ,[ C ,toff N 7 l BOARD OF H �EALTH ---ram � td No........ .....�'g .......................................OF....................................... , ....................................... 2Fi ........................�C r Disposal Norks Tuns r� n._�rrmit io r�tt' Permiss ion n is hereby granted................................•-•--..........---............................................................................................ to Construct ( ;)(or Repair ( ) an-Individual Se Di sal Sys wage spotem at No.:._ � ..._.. - _....... �1� UIu,G� l- ... ....................... ...............---............ ......... ........................._.. ...... Street 46 -zq-77 "} as shoWn.-on the application J r Disposal Works Construction Permit No..................�. Dated..: ................................ ....................................................._..._ _ _�................................ ,u� .. �Q ..._....... ......... ,.. DATE.................!. a�lyd�f Health\J . L t V ` 362.4541 926 main street yarmouth mass. 02675 down Cope en��neer�ng civil engineers& land surveyors structural design Arne H.Ojala P.E.,R.L.S. land court Richard R.Fairbank P.E. surveys site planning Barnstable Town Hall sewage system Board of Health designs South Street Hyannis, MA 02601 inspections Dear Sir: This is to certify that on September 16, 1986 permits I inspected the sewage system installed at Lot #70 Braggs Lane for Luis Lapitz, and find that the system has been installed in accordance with the plan # 84-208B, Title V and the town health regulation except that the leaching pit was lowered to elevation 42.0 . The soil was checked to an elevation of 38.0' and found to be clean dry sand. The,leaching pit was lowered because unsuitable soil was encountered between elevation 48 and the surface. Very truly yours, Arne H. Ojala, P.E.,R.L.S. AHO/amp I �-.r. .,.. .r+s:,S!s,F�°7`v'u�,r.,'a:FYI.•w,...r:..,jt*".r...:'i......F:.,d,{'n..jr-.r ?'n"_'.�'. ,? y.,t. ,.i.... <..y.t a..K�. r-..•..... N+s`.o.�f,. �1:.*f q.7a R. '+:M�'f 4-�"'-^h. ..�.�W:,�..,,,A.4��;.,yr'.'.l _`? TOWN OF BARNSTABLE, —`' UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION OWNER AND INSTALLER INFORMATION ADDRESS: O �. N-E' t4. y` > MAP NO. 9� PARCEL NO®��`C� OWNER NAME: sT m VILLAGE: 1�K%n AJ JT A4 L 6- INSTALLATION DATE: jt4je I.7el, BY: L.A 1 ►—t-- 3WIPrT l3 V1LD F& ADDRESSf�-:��^ :.ljv�j S 'rtaf- =-+ -- -CERT: NO TM TANK INFORMATION LOCATION OF TANK: y t' CARAC 1 TY �( CrY'►1- TYPE -rt—; t- AGE I°_ FUEL/CHEMICAL V�" r)r TESTING CERTIFICATION k: , LEAK' DETECTION C ] CHECK IF N/A TYPE/BRAND �lZONE OF CONTRIBUTION C ] YES C ] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED C ] YES C�] NO DATE CONSERVATION C ] CHECK IF N/A DATE BOARD OF HEALTH TAG NO. C ]C ]C ]C } ] .DATE !4' l / / d.• s PLEASE PROVIDE A SKETCH SHOWING .THE TANK LOCATION ON THE BACK OF THIS CARD iy7i' ��� � �� �. _..__� a o � � � �'� � � -� �- . , .� �� --�-- TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS NAME ADDRESS _ A Q kt- L /I VILLAGE A R S %A IS 1- t LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: OR CHEMICAL A- Ra-L 00Lc r unnii RGRQ fin 6-0 y " Fur z t,L /f ki i r/lL (Give same information for any additional tanks'on reverse side of card) DATE OF PURCHASE OF EACH: 1. 2. 3. 4. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS � A � � . R w o to . \ � ■ . A . . . � � . . 511, Akm i x.T A4 ell 17- 1,�, tj 4 V- w- lov, 6?r 1 Lorl-"It AI I 94 tdi 2-t d t; ,` `ti. \ \ \.,\�;`,�`�`,\ \� ti\�. \'_ '\. �` - -_ ` ice.: - - , .f+a' � - -- ----- _ a�, i..�� t .._, ____ _ G> '.,,' 0162 ` �\ 1'""'`s-�`._-\ �`~�"-__..._. �--1' ! '//..�'/,-'�;�1'�l��I I ,�`�,,```�'`�\�,���, 1� �L'��i "'T-� � 'C 2 ' ;-I C..M i`I �K 0►+^ � /f� - I VJO(�Zi G'O - ��'O© r�rzY Y 4-�P, ALL -eO 112 L) t;.T- __ �) ��6j�1�L���� ��','''�•!{� "'"UJ G3� ,+�C�'�'_'• ,'�•'v(.�• ��LL ���✓''.�'' ;/�`��ti�..%; � �, i.J�,�.�.�i I�,C�. a 1/41 1- LEGEND SEPTIC PROFILE TEST HOLE LOGS 3 •., ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT tO SCALE) SE ROUTE 6A FARIA M.S. , SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED ) ACCESS COVER (WATERTIGHT) TO ENGINEER: I 100.0 PROPOSED SPOT ELEVATION 110 DESIGN FLOW: 5_ BEDROOMS GPD = 550 GPD MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE _I ( ) 2% SLOPE REQUIRED OVER SYSTEM 52.0' WITNESS: DONNA MIORANDI RS 10OX0 EXISTING SPOT ELEVATION USE A 550 GPD DESIGN FLOW ' 100 SEPTIC TANK: 550 pp 2 = 1100 RUN PIPE LEVEL 2" DOUBLE WASHED PEAsroNE DATE: AUGUST 15, 2000 O_ l -p PROPGSED CONTOUR G (--) P �`150b FOR FIRST 2' 3' MAX. PERC. RATE _ 2 MIN/INCH IN MS ET z USE A 1500 GALLON SEPTIC TANK EXISTING LOCUS -� N 100 EXISTING CONTOUR .,( ) 50.70' GALLON sEPrlc 50.45 49.0' CLASS I SOILS P ' 3 AND RETAIN EXISTING 1000 GAL SE- TIC TANK S TANK (H- 20 ) GqS z IN FRONT OF HOUSE - 48.35 z BAFFLE 4.8.52 �� � � 0 0 0 0 0 0 � � RAILROAD TRACKS LEACHING: I oS 48.17' : O 0 I� CO 0 O O IO Cl 0 3' O SIDES _ 2(47.5 + 10.83) 2 (,74) = 172 \52.e �6" CRUSHED STONE OR MECHANICAL O E_I CI 0 O O CJ O O • A ELEV. SIDES: ( M2 % SLOPE) COMPACTION.�(15.221 (21) MIN 8 2' 0 0 0 0 0 0 0 0 0 a 46.17' [1 BOTTOM: 47.5 x 10.83 (.74) = 380 ( 1 % SLOPE) ( 1 7 SLOPE) ,� 0" IT DEPTH of FLOW = 4 3/4 TO "1 1/2 DOUBLE WASHED STONE _ 52 8' TOTAL: 745 S.F. 552 GPD TEE SIZES: Ap LOCATION MAP NO SCALE USE `(5) 500 GAL. ACME OR EQUAL LEACHING INLET DEPTH 10" �Sl CHAMBERS WITH 3' STONE AT SIDES AND 2.5' AT ENDS OUTLET DEFIER a 1_4" 14" 10YR 3/4 GARAGE SLAB -y- 44' :1500 132' -- D' BOX 20' LEACHING 5.37' B. NOTE: (1) 500 GAL. IS REQUIRED TO BE ADDED TO :GAL MAX FACILITY �L ASSESSORS MAP 299 PARCEL 43-3 EXISTING LEACHING FACILITY, ALONG: WITH 3' STONE HOUSE BASEMENT SLAB - 62' SEPTIC TANK 24" 10YR'5/6 ZONING DISTRICT: RF-2 AT ITS SIDES AND 2.5' AT ITS END. �O YARD SETBACKS: 5' REMOVAL OF UNSUITABLE SOIL IS REQUIRED LS w/SILT FRONT = 30' AROUND ITS PERIMETER, DOWN TO aUITABLE SOIL 40.8' UNSUIT: VARIEGATED SIDE LOf 82 �POCKE�S = 15'� (MED. SAND) LAYER. ENGINEER TO INSPECT AND 10YR.� 6 REAR = 15 CERTIFY REMOVAL. 72 10YR /2 46.8 PLAN REF. - LCP 17994 0 Qi - G'� PERC FLOOD ZONE: C 332.88' Ci MS , _EDGE OF ---- ---------- ---__--- WETLAND „ -----•_-------------------- _. 2.5Y I6/3'. 38�� 39�40''�r--•------- - --- __PAVED_DRIVEWAY ` ._ _ _._-- ----- - -._ _ _-_ 144" I 4C►.8' % -y42 209.50 ----------------- 38 f `f .___ - ----- NO WATER ENCOUNTERED - A3 - of ' 4 4 /�o 6 NOTES: NOTE. REGRADING 5 1 . DATUM IS ASSUMED REQUIRED TO MITIGATE �- �' ,' g1 *APPROX WATER LINE EXISTING AGAINST POSSIBLE / LOCATION ONLY (NOT 2. MUNICIPAL WATER IS --. AT BREAKOUT _ _ _ x_ __. _. _._ _ s cj3� MARKED TEST) TIME OF 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 20 WO LIMI -z (STAK x FE E �/ *� 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H-10 & W* `�'S� ` 5. PIPE JOINTS TO BE MADE WATERTIGHT. 57 56� Uj 6. CONSTRUCTION DETA.' S TO BE IN ACCORDANCE WITH MASS. - - 12" E l� � ,- ` ENVIRONMENTAL CODE TITLE V. 5' REMOVAL OF UNSUITA-°.,E SOIL ' �� '"--� 8S`� 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE REQUIRED AROUND 3 SIDES OF NEW S. i;� , / ,• sg - ` -- USE FOR LOT 'LINE STAKING. 500 GAL. LEACHING UNIT, DOWN TO �, ` MF' AN LAYER. "N IN /�` 1 110' , . �..^ 60- 8. PIPE OR SEPTIC YSTEM T H 0- PVC. ..D. SAND I YE E G E£� TO ` .: y _ � S 0 GC ,4 4 4. 4 ,1 CE _ _;,-., ...� ...,61 � 1 � -,; � � j I �'. _y, 1.U l I h'I..I IV t_1� I ,.> t, LP � � IJUT I U LL l,r1l.P'�`-f' (� I S 1FATIV' INSPECTION BY BOAR�I L.1 NEAL I H AND PERMISSION OBTAINED I ADD (1) 500 GAL. LEACHING ^� PLANTI GS FROM BOARD OF HEALTH. ` CHAMBER TO EXISTING SYSTEM. ADD {V PAVED ' 3' STONE AT SIDES AND. 2.5' AT. END. _ � .: 8" DAR DRIVE. `RtT• o , I 10. CONTRACTOR SHALL BE RESPONSIBLE FOR. VERIFYING THE TH I WATER METER LOCATION LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR SWALL TO COMMENCEMENT OF WORK. 2' � EXISTING DWELL. EE UM BENCHMARK: EDGE PAVEMENT AT PROP. MAID'S QUARTERS IN CORNER OF GARAGE = EL. 55.8 j_l EXISTING GARAGE 1 L BRICK EC ,*`WALK � D K ' J \ �o TITLE 5 SITE PLAN BUSH O PROP. INVERT OUT ELEVATION AT 52.0'f. THIS ELEVATION CAN BE RAISED IF NECESSARY (ALLOW FOR PROPER SOIL COVER AS OF � T A w REQUIRED) #25 BRAGG S LANE x SS CLEANouTs As IN THE TOWN OF: S AK PROP. V T b NECESSARY _ BARNSTABLE (VILLAGE) o B H �S;` ,,�- , `Oe" PRE PARES FOR: BENJAMIN & DEBRA MACPHERSON � r 30 0 30 60 '90 LOT 70 39.82' LA AT t E LINE 3.2 ACRES 1" = 30, AUGUST 15, 2000 SCALE: DATE: -----•�` REV. 11/25/02 (ADD 1 LEACH CHAMB. W/STONE) A�of �t'A OF `•-----•-- � H. � o� ARNE H, �E BOARD OF HEALTH i ARNE yGs ��E� G _DGE •-----•------.__- u OJ�►6�348 = p�ALA v -- MA No.2 � CIVIL -- • y O APPROVED DATE °�, Af s1E�`�°J� � •`� �'(LPNO - _ SOU t IAN� / ����� 1 10J�1D 2.--•- ARNE H. OJALA, .S. DATE OLD BOG off %8-362-4541 fox 508 362-9880 Q down cape engineering, inc. ems, CIVIL ENGINEERS 401,62' LAND SURVEYORS 939 main st. yarmouth, ma 02675 00-- 1 42 - - - - - - LEGE�Q SEPTIC PROFILE TEST HOLE LOGS }ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) 3 100.0 PROPOSED SPOT ELEVATION SEPTIC DESIGN: (GARBAGE DISPOSER IS NG ALLOWED ACCESS COVER (WATERTIGHT) TO M.S. FARIA, SE ENGINEER: RouT>: sa DESIGN FLOW: 4_ BEDROOMS ( 110 GPD) = 440 GPD MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE I 2% SLOPE REQUIRED OVER SYSTEM 52.0' WITNESS: DONNA MIORANDI, IRS 10OX0 EXISTING SPOT ELEVATION USE A 440 GPD DESIGN FLOW 100 SEPTIC TANK: 440 GPp ( 2 ) = 880 FRUN PIPE OR FIRST LEVEL 2" DOUBLE WASHED PEASTONE DATE: AUGUST 15, 2000 PROPOSED CONTOUR ra o— —o < 2 MIN/INCH IN MS z USE A 1500_ GALLON SEPTIC TANK PROPOSED 1500 3' MAX. PERC. RATE = Q 100 EXISTING CONTOUR GALLON SEPTIC 50.45' I o Locus -� N AND RETAIN EXISTING 1000 GAL SEPTIC TANK S 50.70 TANK (H- 20 ) GAS 49 0 CLASS SOILS P# N IN FRONT OF HOUSE BAFFLE 48 52' �� 48.35' O O O O 0 !� CJ C� [� Q RAILROAD co TRACKS LEACHING: 48.17' o } � I� O � O OO � C] 3' ® SIDES = 2(39 + 10.83) 2 (.74) = 147.5 \52.e t__.__6" CRUSHED STONE OR MECHANICAL 0 A SIDES: _ 5 M2 % SLOPE) COMPACTION. (15.221 [2]) MIN 2' [� Cl 0 C7 Cl 0 46 39 x 10.83 (.74) 312. .17' 1 ELEV. i - ( 1 BOTTOM: - (_1_ ry SLOPE) ( % SLOPE) DEPTH OF FLOW 4 3/4" TO 1 1/2" DOUBLE WASHED STONE 0" 52.8' TOTAL: 621 S,F. 460 GPD TEE SIzE5: Ap LOCATION MAP NO SCALE USE 4 500 GAL. ACM R EQUAL EI�CHING F/1�YR SL ( ) L E O EQ L L INLET DEPTH = 1�" CHAMBERS WITH 3' STONE AT SIDES ANs 2.5' AT ENDS OUTLET DEPTH = 1_4 14" 3/4� GARAGE SLAB 44 1500 132' - D' BOX 20' LEACHING 5.37' B GAL MAX FACILITY /LS / ASSESSORS MAP 299 PARCEL 43-3 7777 HOUSE BASEMENT SLAB -- 62' SEPT?C TANK 24" 10YR 5/6% ZONING DISTRICT: RF-2 * NOTE: THIS PROPOSED INVERT ELEVATION IS �C1 YARD SETBACKS: TO ALLOW FOR PROPER SOIL COVER OVER FRONT = 30' LOT 81 EXIT PIPING LOT 82 40 8' Ls w/SILT i UNSUIT. POCKETS/ VARIEGATED SIDE = 15' 00 10YR 5/6 REAR = 15' 10 a 72" 10YR 5/2/ 46.8' PLAN REF. - LCP 17994 O � PERC r- C 2 FLOOD ZONE: C 332.88' � Uj MS EDGE OF WETLAND -- - - - - -- - - 2.5Y 6/3 39 �' ter`- --------------- PAVED R - - _ '-- --- 0 38 A13 --- —•_�-V�WAY — ---- — --__ 40.$ _8C_ a2 209.50' - ��38-'"—`� /43 - NO WATER ENCOUNTERED 4A 3 q5 o ' Al NOTES: 1 . DATUM IS ASSUMED •APPROX WATER LINE / LOCATION ONLY (NOT 2. MUNICIPAL WATER IS EXISTING ' �J2 MARKED AT TIME OF 3. MINIMUM PIPE PITCH TO BE 1 8" PER FOOT. PERC TEST) / WO LIMI (STAK FE E) SAS =' 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H-10 & 20 5. PIPE JOINTS TO BE MADE WATERTIGHT. 12' 57 EXISTING SEPTIC SYSTEM � 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WI i'H MASS. f 8S ENVIRONMENTAL CODE TITLE V. 5' REMOVAL OF UNSUITABLE SOIL / , rJ `� RE—USE 1000 GAL. SEPTIC TANK, 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE REQUIRED AROUND PERIti,ETER OF ! , f PUMP AND FILL/REMOVE EXIST. LEACH USED FOR LOT LINE STAKING. • '' O I D X SAND LH'I1R. Li .;iVcc ,.1.�Ih�, ��i C;._.....• _. ... - ._� _ _ �1 A, BO AND CERTIFY RED+OVAL. `— '; `�` -` J B. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. ° ST \PATIO'" ` 9, COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT PATIO INSPECTION BY BOARD OF HEALTH AND PERMISSION ❑BTAINED { PAVED PLANTI Gs ' FROM BOARD OF HEALTH, i5E 1G, l UiV1 KHl I Li'R S�{ALL kt u DL I ar' 1vS1L ui: TH 8" DAR DRIVE LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR W a2 �, ALL WATER METER LOCATION — — TO COMMENCEMENT OF WORK. EXISTING NOTE: PROVIDE MINIMUM 2' COVER � � � \\ J OVER PIPING OR UTILIZE L f DWELL. INSULATING BLANKETS PROP, EE UM \ \\ GAR.. DRIVEWAY ` �' BENCHMARK: EDGE PAVEMENT AT \ \\ MODIFICATIONS _— CORNER OF GARAGE = EL. 55.8' i 5 'i BRICK ��PROP. 1 1, 'VALK DECK J CLEANOUTS AS NECESSARY Q — PROP. INVERT OUT ELEVATION AT 52.0't. THIS ELEVATION CAN BE TITLE 5 .SITE PLAN BUSH PROP. 1500 GAL. H-20 0 RAISED IF NECESSARY (ALLOW FOR PROPER SOIL COVER AS SEPTIC TANK CA REQUIRED') OF #25 BRAGG 'S LANE T AK PROP. S" N x IN THE TOWN OF: cl CLEANTS £ds\ NECESSARY AS B s. BARNSTABLE (VILLAGE) H PREPARED FOR: = c�o ems. BENJAMIN & DEBRA MACPHER� ON 39.82' LA AT T � a LOT 70 30 0 30 60 90 E LINE e� 3.2 ACRES 1" =SCALE: 3 0' DATE: AUGUST 15, 2000 c.� L>J J � 'Of_ _ BOARD OF HEALTH p i GE - -- - -- -- . A. MA u N cf it A" (D -1 .. APPROVED DATE #40 !- J .S. DA TE OLD BOG ) O JSL off 508-362-4541 fax 508 362-9880 down cape engineering, Inc. CIVIL ENGINEERS 401 62' LAND SURVEYORS '�` ► N �36, 939 main st. yarmouth, ma 02675 00-- 142