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0379 BRAGG'S LANE - Health
379 Braggs Lane j Barnstable y A= 298-03 1-005 - Z SNP l r T j,v { 9 2 c-�w` ot 031 - � - U /V Oft •. 10 7" �ftS- �T N OF y3, N ' v, •Ilf p' ED o sr if N /0�"/�L� Q�� } r:. �k db�i t •. `EII10 V7 o ' �� Dr v o� i , Sr/4 o" .��� EZGIVATIDNs __. .. .. _ _PLAN, � ,� ` '- ;, CERT . F1 ED PLOD � of � . MA, �;C3A• ,en/STA. .B.�L`'j• Z3 /IB-3 $ LDca►TION • o 3, DATE r ;�_,¢o ' •M ` .� SCALE BANG' LoT�'s PLAN R.EF.ERENC£ ►N!4 �N �L. Bpi• 3.Sd. . 0.4; �� ,eta'• • � . . . . pG 3� 1 CERTIFY THAT THE •f1ED ON THE WUI SHOWN ON THIS PLAN IS � 1T CONFORMS TO b , AS SHOWN HEREON AN0 THATTOWN OF SETBACK REOOIREIAENTS OF TWH CONSTRUCT DATE R14E ti ND S� LA REpISTERED _-- T ' STAUP: ID. w cows n•..�`ualc...wLL I TiOR SLwB✓ /9—JE iiKUCVS hL P.T.Slll PLwTE/Sr[l ' Cam' _ ...1/Y aw Wtv.w.B.r✓-P O.C. Y'•CtrtPKTED GRAVEL a-y • G i ... I .GROUT I f_ ___—_IL DRIL]-.,DP+ElSr i]'OC. 11 . ii n - 1�� ivPKwC i RODE—T—T.-1 $ • I 1 SHiRGLE50W EX.GARAGE; ° I I �uiopwc pLT y' 9 E ° I • SvriPRSGwT�R.SUCIl*YC 411O.C. f• -___-_-___ —_---i -- - _ REu)i111 j'LVL REwOfR �� wLl T—TO—T- ruLt9 vP. u cfe�rrw Z N _ O"PE NOD SwwD' TvvESK" 5L CwRwP[xPO.uRE W 3 LAB..✓ • I Y�CCn Kt[D G¢v[L Q W n 0_ __ V 010W .. RI K1tl•CPK•i1G.CP{.uKC �vQ 6S i CROSS SECTION_ ' W FOUNDATION PLAN Z w' LLJ Q FIRST FLOOR PLAN U) J - p� moo] ~N Q� mZ w ;m nTLE: FLOOR PLAN LIM DATE ISSUED: ' OJ/13/10 REN90N4: 4 ooar�w REAR ELEVATION L�T— DRAWN By. R16NT SIDE ELEVATION ALL TRI,E'c.'RmE LEFT SIDE ELEVATION BDA[c'"'"' 3CALGv,•.I•-D' - DRAWINC NO.: L ..... _._.. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 379 Braggs Lane rtY P Pro a Address Donald Pires Owner Owner's Name information is required forBarnstable MA 02630 03/09/10 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. Important: When fil ling out.. A. General Information ' forms on the computer,use 1. Inspector: only the tab key_, to move your Michael Kellett cursor-do no€" Name of Inspector use the return key. Aardvark Environmental Inspection Company Name Q P.O. Box 896 Company Address East Dennis MA 02641 City/Town ` State Zip Code 508-385-7608 S13742 _ o Telephone Number License Number wry B. Certification F' I certify that I have personally inspected the sewage disposal system at,this address and that information reported below is true, accurate and complete as of the time of the inspection.The Inspecon was performed based on my training and experience in the proper function and maintenance 4n sits sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 03/10/10 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system 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. . t --- -- - c Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 379 Braggs Lane Property Address Donald Pires Owner Owner's Name information is Barnstable MA 02630 03/09/10 required for v. every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: 1 ❑ 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. Answer yes, no or not determined (Y, N, ND)in the❑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. ND Explain: 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 approV9 of Board of Health): .. broken pipe(s) are replaced obstruct ion.is removed I Commonwealth of Massachusetts Title 5 Official Inspection Form • _ a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 379 Braggs Lane Property Address Donald Pires } Owner Owner's Name information is Barnstable MA 02630 03/09/10 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: , ❑ 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 ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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: a ❑ 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. I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M 379 Braggs Lane Property Address Donald Pires Owner Owner's Name information is required for Barnstable MA U630 03/09/10 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow 0, ® 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. Commonwealth of Massachusetts Title 5 official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 379 Braggs Lane Property Address Donald Pires Owner Owner's Name information is required for Barnstable MA 02630 03/09/10 every page. City/Town State• - Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): l Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) large Systems: To be considered a large system the system must serve a facility withr 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 l ❑ ❑ 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 El 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. Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 379 Braggs Lane Property Address Donald Pires Owner Owner's Name information is required for Barnstable . MA -02630 03/09/10 every page. Citylrown State Zip Code Date of Inspection C. Checklist a Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information•was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system_ obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® information on the proper maintenance of subsurface sewage-disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ®'. ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue -approximation of distance is unacceptable)-[310 CMR 15.302(5)] Commonwealth& Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 379 Braggs Lane Property Address Donald Pires Owner Owner's Name information is required for Barnstable MA 02630 03/09/10 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes '®. 'No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/industrial flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): canons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? _ ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): } f , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 379 Braggs Lane Property Address Donald Pires Owner Owner's Name information is required for Barnstable MA 02630 03/09/10 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: . Source of information: - Was system pumped as part of the inspection? ❑ Yes M No If yes, volume pumped: ' gallons How was quantity pumped determined? Reason for pumping: ` Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ; ❑ Overflow cesspool ❑ . Privy ° ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ® Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 04/18/07 per BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 379 Braggs Lane Property Address Donald Pires Owner Owner's Name information is required for Barnstable MA 02630 03/09/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 3.2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints,venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2.8 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal,list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000 gal 311 ! Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 77 Distance from bottom of scum to bottom of outlet tee or baffle . 16" How were dimensions determined? measured Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments < 379 Braggs Lane N \ Property Address r Donald Pires Owner Owner's Name information is required for Barnstable MA 02630 03/09/10 every page. Cityrrown State Zip Code :Date of Inspection t 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.): The tank was sound and tight with tees in place and liquid at outlet invert. 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 379 Braggs Lane Property Address " Donald Pires Owner Owner's Name information is required for Barnstable MA 02630 03/09/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) . t Tight or Holding Tank(cunt.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ' ❑ Yes ❑ No F 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 - Distribution.Box(if present must be opened) (locate on site,plan): Depth of liquid level above outlet invert even 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.): The box was level and tight with no sign of carryover. ry Pump Chamber(locate"on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments, 379 Braggs Lane Property Address Donald Pires Owner Owner's Name information is required for Barnstable MA 02630 03/09/10 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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: ` Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions. ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation;etc.): The system has a 6'x6' precast pit surrounded by two feet of stone.There was no sign of ponding or failure. F Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 379 Braggs Lane Property Address Donald Pires Owner Owner's Name information is required for Barnstable MA 02630 03/09/10 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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 y Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): - e Privy (locate on site'plan): Materials of construction: ` 1. - .. Dimensions y Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Commonwealth of Massachusetts Uf Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 379 Braggs Lane Property Address Donald Pires Owner Owner's Name information is requued far Barnstable MA 02630 03/09110 every page. Citylrown State Zip Code Date of Inspection D. System Information (cunt.) Sketch Of Sewage Disposal System: Provide a sketch 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. A 15 �ls 31 F -3S F `lq c f t: N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 379 Braggs Lane Property Address Donald Pires Owner Owner's Name information is required far Barnstable MA 02630 03/09/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 20.0 feet Please indicate all methods used to determine the high ground water elevation` ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: , ❑ Checked with local excavators, installers- (attach documentation) ® Accessed USGS database-explain You must describe how you established the high ground water elevation: L USGS maps show an elevation of over 20.0 feet. F 1 UNITED STATES PO S T ? 9'; :Ax. In IF' sa .10 • Sender. Please print your name, address, and ZIP+4 in this box• PUBLIC HEALTH DEPARTMENT TOWN OF BARNSTABL-E 200 MAIN STREET I HYANNIS, MA 02601 I • • • THIS SECTIOIvqWbELiVERY ■ Complete items 1,2,and 3.Also complete A. Si nature item 4 if Restricted Delivery is desired. ❑3Agent ■ Print your name and address on the reverse X ddressee so that we can return the card to you. B. eived by(Printed Name) C.; ate of Delivery ■ Attach this card to the back of the mailpiece, _ p or on the front if.space permits. D 1. ArtidrAddressed to: D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below; ❑No Ins i ?a a'k- o� h �f.l1,Q� C� 3. Service Type ❑Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Nul r mibe (Transfer from service label) j• 7005 116 0 I i 0 0 0 0 p A 191' 3115 8'' ^;S Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 rl . • M Er . tr r, 1 OFFICIAL USE O ` Postage $ � 3 �' \ 0 O Certified Fee Return Receipt Fee Posner O }2a Q (Endorsement Required) Restricted Delivery Fee (Endorsement Required) ✓�\ ,G Q9Z0 d r9 •'� u1 Total Postage&Fees s �77-- aSent To - ri jf-•-••- . lax-.��� .Pa�,� Street Apt No �} or PO Box Z City Stele,zl -. Certified Mail Provides: A mailing receipt asjanay)ZOOZ eun�'008E wjo�Sd e a 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 Maile. o Certified Mail is not available for any class of international mail. n NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ® 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. in For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available, n, mail addressed to APOs and FPOs. Town of Barnstable OFTME TOE Regulatory Services snxS1AB Thomas F. Geiler,Director F1639. � Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 11, 2007 Ms Jane Leech 1212 .19th Avenue East Seattle, WA 98112 ORDER TO.COMPLY WITH STATE.ENVIRONMENTAL CODE, TITLE 5 - The septic system owned by you located at 379 Braggs Lane,Barnstable, MA was last inspected April 41h, 2007,by Michael A. Burnie, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system"Conditionally Passed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: The D-Box is.corroded and leaking. It needs to be replaced. �- You have 2 years from the date of the system failure to bring the system into.compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. EH ., H DEPARTMENT Thomas A. McKean,R.S., C.H.O. Agent of the Board of Health I P Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments 'GM SVO e Subsurface Sewage Disposal System Form G; — Q�f Inspection results must be submitted on this form. Inspection forms may not be altered in any way. / Sf A. General Information Important: When filling out 1. Property Information: forms on the computer,use 379 BRAGGS LANE only the tab key Property Address to move your j JANE LEECH cursor-do not use the return Owners Name i key. 1212 19'AVENUE EAST Owner's Address i SEATTLE WA 98112 City/Town State Zip Code 4-3-07 Date of Inspection: Date i 2. Inspector: MICHAEL A. BURNIE! Name of Inspector DAVID J. BURNIE&SONS SEPTIC SERVICES blue water holding corp. Company Name i 105 FERNDOC ST UNIT A Company Address HYANNIS MA 02601 City/Town State Zip Code 408-775-0139 j telephone Number B. Certification i I Ice that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection -- 0was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems~I am a DEP approved system inspector pursuant to Section 15.340 of r-` Titles(310 CMR 15.000)1 The system: i❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority _ 4-3-07 Inspector's Sign re Date The system inspector lisha11 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. title5_2006_blan_k.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 1 ) Commonwealth of Massachusetts Title 5 Official Inspection Form x Not for Voluntary Assessments Subsurface Sewage Disposal System Form M B. Certification (cont) 379 BRAGGS LANE Property Address i BARNSTABLE MA 02630 Citylrown State Zip Code JANE LEECH ! 3-4-07 Owner's Name Date of Inspection Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: R ❑ 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: j i 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. i Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not s 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. i *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. ND Explain: i I i i i i i i P title5_2006_blank.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System r ,�A� Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments 4M Subsurface Sewage Disposal System Form B. Certification (cunt.) 379 BRAGGS LANE Property Address BARNSTABLE MA _ 02630 City/Town State Zip Code JANE LEECH E 3-4-07 Owner's Name Date of Inspection 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 pipes)are replaced I ❑ obstruction is removed z i ® distribution box is leveled or replaced z ND Explain: ? s ❑ 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' I I Elobstructio i n is removed ND Explain: f 1 r ! C) Further Evaluation is Required by the Board of Health: i ❑ 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)thatthe system is not functioning in a manner which will protect public health, safety and the environment: i ❑ Cesspoollor 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 i b title5_2006_blank.doc•03/2006 45 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 f i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary As., Subsurface Sewage Disposal System Form M I r B. Certification (co'nt.) 379 BRAGGS LANE Property Address BARNSTABLE ? MA 02630 Cityrrown State Zip Code JANE LEECH 3-4-07 Owner's Name i Date of Inspection r i , I C) Further Evaluation is Required by the Board of Health (cont.): i 1 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: f ❑ 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. P ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. 7 { t ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. c r ❑ 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: i i **This system passes!if the well water analysis, performed at a DEP 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. i 3. Other: s 1 9 I i title5_2006_blank.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 i t ' 1 Commonwealth of Massachusetts Title 5 Official Inspection Form - Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 379 BRAGGS LANE Property Address i BARNSTABLE MA 02630 Citylrown State ZipCode JANE LEECH 3-4-07 Owner's Name Date of Inspection I f D)System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: a Yes No j ❑ ® 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 %day flow ❑ ® 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. a ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. i ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet #rom 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 of 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. Yes No ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be I ecessary to correct the failure. i I I title5_2006_blank.doc•03/2006 I Title 5 Official Inspection Form:Subsurface Sewage Disposal System ! Page 5 of 16 f E Commonwealth of Massachusetts UTitle 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M Sy0 0e B. Certification (cont.) 379 BRAGGS LANE Property Address BARNSTABLE MA 02630 Cityrrown State Zip Code JANE LEECH 34-07 Owner's Name Date of Inspection i i 3 E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,006 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 i ❑ ® 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 i 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 accordancelwith 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. f i E 4 j i i t { i i i 1 I i I 1 i t I title5_2006_blank.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 • 4 Commonwealth of Massachusetts Title .5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. Checklist 379 BRAGGS LANE Property Address BARNSTABLE ? MA 02630 City/Town State Zip Code JANE LEECH 3-4-07 Owners Name ! Date of Inspection Check if the following Have been done. You must indicate"yes"or"no"as to each of the following: I YES NO a , i ® ❑ 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? 6 ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? I ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, t to 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? E ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? i 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. El ® Dsetern ined 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)] i s E i I title5_2006_blank.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts m Title , 5 Official Inspection Form ° Not for Voluntary Assessments Subsurface Sewage Disposal System Form M D. System Information 379 BRAGGS LANE Property Address BARNSTABLE MA 02630 Cityrrown State Zip Code JANE LEECH a 3-4-07 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms(design): NNKNOW Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): UNKNOWN Number of current residents: UNKNOWN Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No i Seasonal use? ❑ Yes ® No i Water meter readings; if available(last 2 years usage(gpd)): 05-109.6 GPD 06-30.13 GPD Sump pump? ❑ Yes ® No i UNKNOWN Last date of occupancy: Date 1 Commercial/industrial Flow Conditions: i 3 Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) F Basis of design flow(seats/persons/sq.ft., etc.): 3 Grease trap present? ❑ Yes ❑ No t Industrial waste holdi Ag tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings; if available: i Last date of occupancy/use: Date Other(describe): I i title5 2006 I n_ _b a k.doc•0312006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 i /� Commonwealth of Massachusetts . Title 5 Official Inspection Form Not for Voluntary Assessments ` Subsurface Sewage Disposal System Form M y+ay D. System Information (cont.) 379 BRAGGS LANE Property Address BARNSTABLE MA 02630 Cityrrown € State Zip Code JANE LEECH 3-4-07 Owner's Name Date of Inspection General Information Pumping Records: ' Source of information:I12-28-05 NO RECORD ON GALLONS PER BOH Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped- gallons f How was quantity pumped determined? Reason for pumping: Type of System: t i ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy -_ ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. i ❑ Other(describe): i Approximate age of all components, date installed (if known)and source of information: UNKNOWN Were sewage odors detected when arriving at the site? ❑ Yes ® No i i i titles 2006 blank.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System s Page 9 of 16 Commonwealth of Massachusetts .Title 5 Official Inspection Form Not for Voluntary Assessments a Subsurface Sewage Disposal System Form M Spey II Y D. System Information (cont.) 379 BRAGGS LANE I Property Address BARNSTABLE J MA 02630 Cityfrown a State Zip Code JANE LEECH I 3-4-07 Owner's Name J Date of Inspection i Building Sewer(locate on site plan): 37" Depth below grade: feet i Material of construction: i i ❑ cast iron 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet 0 Comments(on condition of joints, venting, evidence of leakage, etc.): l i Septic Tank(locate on site plan): 15"TO 30"THE GROUND IS Depth below grade: k SLOPED OVER THE TANK Material of construction: i ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a'ICertifcate of Compliance? (attach a copy of ❑ Yes ❑ No certificate) - - - - -------------------- I 1,000 GALLONS Dimensions: 2„ Sludge depth: i Distance from top of O udge to bottom of outlet tee or baffle 2„ Scum thickness 1 Distance from top of scum to top of outlet tee or baffle i Distance from bottom)of scum to bottom of outlet tee or baffle SLUDGE JUDGE How were dimensions determined? E title5_2006_blank.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System 1 Page 10 of 16 i Commonwealth of Massachusetts Title 5 Official Inspection Form . Not for Voluntary Assessments M Subsurface Sewage Disposal System Form D. System Information (cont.) i 379 BRAGGS LANE Property Address j BARNSTABLE 3 MA 02630 Citylrown i State Zip Code JANE LEECH 3-4-07 Owner's Name Date of Inspection Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): i t Grease Trap(locate on site plan): i Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): r Dimensions: j Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom bf scum to bottom of outlet tee or baffle I { Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as relatedi to outlet invert, evidence of leakage, etc.): i 3 Tight or Holding Tahk(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: i Material of construction: I ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): i I title5_2006_blank.doc•03/2006 j Title 5 Official Inspection Form:Subsurface Sewage Disposal System- 1 �� Page 11 of 16 '4F i Commonwealth of Massachusetts . Title 5 Official Inspection Form ° Not for Voluntary Assessments 4M Subsurface Sewage Disposal System Form i D. System Information (cont.) f 379 BRAGGS LANE Property Address BARNSTABLE € MA 02630 City/Town j State Zip Code JANE LEECH 3-4-07 Owner's Name Date of Inspection Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: j gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes El No Date of last pumping:s Date Comments(conditionof alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): o„ Depth of liquid level above outlet invert i 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.): THE D-BOX IS CORRODED AND LEAKING AND NEEDS TO BE REPLACED. t 4 Pump Chamber(locate on site plan): ti Pumps in working ord'.er: ❑ Yes ❑ No 4 1 Alarms in working order: ❑ Yes ❑ No title5_2006_blank.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 r ; Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments M 5v e Subsurface Sewage Disposal System Form D. System Information (cont.) 379 BRAGGS LANE Property Address j BARNSTABLE MA 02630 CityfTown State Zip Code i JANE LEECH 3-4-07 Owner's Name Date of Inspection Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): i I i i Soil Absorption System (SAS) (locate on site plan, excavation not required): I If SAS not located, explain why: i i i Ii Type: 1-6' PIT ® leaching pits number: ; ❑ leaching chambers number: ❑ leaching galleries number: I ❑ leaching trenches number, length: i ❑ leaching fields number, dimensions: I ❑ overflow cesspool number: ❑ innovative/alternative system i 1 Type/name of technology: i Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): THE LEACH PIT HAD 6"OF LIQUID IN IT AND DID NOT SHOW ANY SIGNS OF HYDRAULIC FAILURE OR PONDING. I title5.2006 blank.doc•03/2006 j Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 { • I Commonwealth of Massachusetts . Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M D. System Information (cont.) 379 BRAGGS LANE Property Address BARNSTABLE MA 02630 City/Town State Zip Code JANE LEECH i 3-4-07 Owner's Name Date of Inspection i s Cesspools (cesspooh 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 i Dimensions of cesspool i s Materials of construction I Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): f i t i 7 I i { Privy(locate on site plan): k Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i { i i j { title5_2006_blank.doc•03/2006 I Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 i � f Commonwealth of Massachusetts . Title 5 Official Inspection Form ° Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 379 BRAGGS LANE Property Address BARNSTABLE I MA 02630 Cityrrown State Zip Code JANE LEECH 3-4-07 Owner's Name Date of Inspection i Sketch Of Sewage Disposal System: Provide a sketch 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. i s 1 � I 1 I � S Sy i i� 1 t i i i Q i t k i { I }�y t 1 I t i i S{s I title5_2006_blank.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 i I I " o �' Zlv f Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M D. System Information (cont.) 379 BRAGGS LANE Property Address BARNSTABLE MA 02630 City/Town State Zip Code JANE LEECH 3-4-07 Owner's Name i Date of Inspection Site Exam: i i Slope �,��✓ i I Surface water � Q Check cellar ,01-7 } i Shallow wells /�v Estimated depth to ground water: j 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) I ❑ Checked with local Board of Health -explain: I ❑ Checked with local excavators, 'installers-(attach documentation) i Accessed bSGS database-explain: AIW-247 ZONE B 2-3 LEVEL 23.1 ADJUSTMENT=29" i You must describe how you established the high ground water elevation: SEE ATTACHED I i i I i I title5_2006_blank.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 fI/ � .�......®....._. �.. _ r _.. _ ....._..._..e..a. ._.m..e.._..._. ea..a.e.�..� . .e.s_..._. .---._.___.�v... ...__......_.,...__. _....,.-_v__.,._...__...____..-... ______.,__ _.�..___._..._._..,�._ ..... ..._.__ ..__ _ __.... 6,4 g ���� LA-) UNITED STATES ^� w '�.M.F'\ MA y O • Sender: Please print your name, address, and ZIP+4 in this box • q �' ��� � s � �s74(3 6-2c 130 r ljilt?!?Ii1?!t?{!{�!?14?ii!i{S�Ffili�7F?l{{F ?t!??� iiFi i i? ® Complete items 1,2,and 3.Also complete A. Sign ure item 4 if Restricted Delivery is desired. Agent o Print your name and address on the reverse X ddressee so that we can return the card to you. eceived b Printe Name) Dat of D l very 0 Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 17 ❑Yes 1�Article Addressed to: If YES,enter delivery address below: ❑No 3. Se a Type CrOortified Mail 13 Express Mail C]Registered 0 Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7dO7 0220'40003:?1*2] 1245 i (transfer from service labeq r l i .1 J i i:r r r l i i a► t l r ! PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATEKft;Tf4X!LEIVP w• �.Df •Sender: Please print your name, address, and ZIP+4 in this box • JOti4Coo . P(��S 6,1 CR 6A 4-N S 1(A C, a UO r i E.1Hv'1?G 01?:lili12:1 BF11ts:iIII Joh i:'.•.91!!,i+ 3Hi: B:I 7. ,� Y o Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. CI Agent X ® Print your name and address on the reverse ❑AAdressee so that we can return the card to you. eceived by Punted Name) C(tte f Deli o Attach this card to the back of the mailpiece, '"( or on the front if space permits. D. Is delivery address different from item 1? Yes 1, Article Addressed to: If YES,enter delivery address below: ❑No �7114 S 3. Se a Type 1V e7 (f Certified Mall ❑Express Mail ❑Registered Q Return Receipt for Merchandise ❑Insured Mall ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Fransfer from service labeq i r F! ? 071; 2 8O j 0 0 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 M- . rU H P I A 21 lu Postage $ $0.41 ! \ M Certified Fee $2. 03 Postmark . J M RetReturnReceipt Fee $2 �007 Here( t O (Endorsement Required) S, IM Restricted Delivery Fee $0. 0 / 3 (Endorsement Required) ru ru Total Postage&Fees 5•c�L ^^�20C 0 0 CO ent p�j�� (OQ N or PO Box City, a ZIP 4 e �J d I Certified Mail Provides: a A mailing receipt o A.unique identifier for your mailpiece e A record of delivery kept by the Postal Service for two years Important Reminders: f rl NVI AM . a Certified Mail may ONLY be combined with Fiist-Class Mail®or PriorityMail*. s Certified Mail is not available forany�class of international mail. e NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. m For an additional fee a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt.servlce,please complete and attach a Return Receipt(PS Form 3811)to the afticle.and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSO postmark on your Certified Mail receipt is required. V.—* a For an additional.,fee, delivery,may be restricted to the addressee or addressee's authorised 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 artl- cie 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 Foffn 3800,August 2006(Reverse)PSN 7530-02-000-9047 m .. • .•. ti a r-q I H 4IR A ;41 FU Postage $ $0.41 0630-` m• Certified Fee $2e6 03 O Return Reoeipt Fee s Postmark O (Endorsement Required) $t 5 Here O Restricted Delivery Fee 0 (Endorsement Required) $0 00 ti M Total Postage&Fees $ $5. 09/22/2007 :O Sent T� V� / Sfreet,Apt No.; e _ - -- lti or-PO Sox No. Clry, ,ZIP+4 lwll' :IIQIMBOW Certified Mail Provides: a.A mailing receipt a A unique identifier for your mailpiece n A record of delivery kept by the Postal Service for two years Important Reminders: a Certified Mail may ONLY be combined with First-Class Maile or Priority Mails, n Certified Mail is notavailable for,any class of international mail. a NO INSURANCE COVERAGE S"PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a For an additional feea 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 USP%postmark on yourCertified Mail receipt is required. W.Oi is For an additional fee, delivery may be restricted to the addressee or addressee'siautfiori etl agent.Advise,the clerk or mark the mailpiece with the endorsement"Restricted oelivery° 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 rU . • ru a w&FoNFc lodS ,l ru r= Postage $ $0.4y Certified Fee $n J� 03 rY'1 Postmark M Retum Receipt Fee (Endorsement Required) �.15 )OZ / Hale Restricted Delivery Fee U a J :0 (Endorsement Required) $ .00 I U Total Postage&Fees $ $5 09/c/2007 -ate im seer AptT7o.; y // '/ or PO Box No. J0.0Af�iR 1 L! f�'- ----- Certified Mail Provides: e A mailing receipt o A unique identifier for your mailpiece ® A record of delivery kept by the Postal Service for two years Important Reminders: a Certified Mail may ONLY be combined with First-Class Mails or Priority Mail®. o Certified Mail is notavailable for any class of international mail. a NO INSURANCE'COVERAGE''I " ROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ 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 USP,S®postmark on your Certified Mail receipt is required. W-V4 e For an additional fee, delivery may be restricted to the addressee or addressee's adfq'orized;aggent.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- cleat 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 7530-02-0009047 UNITED STATE"} OMRI'- I c54,• • ':. """ "�" �htp w ' •�iN•.••a.Msaytk.. l ..rts�wwn. • E Sender: Please print your name, address, and ZIP+4 i his box• sc I I i LTz(Y a I � I I � I � w r. I � I ® Complete items 1,2,and 3.Also complete A. ignature item 4 if Restricted Delivery is desired. ❑ ent ® Print your name and address on the reverse ®'Addressee so that we can return the card to you. B. Received F�c � C. Date of Delivery o Attach this card to the back of the mailpiece, its oho, R. or on the front if space permits. D. Is d iv`�iy address different fror i i m ,31� ,,P_+es 1. Article Addressed to: L,-® If Y S,ant l d ive addre ow: -No "J41�4- 6DoNo51�U� ��p r " 34egi- 10 - �- 11.,q�ps C 3. Se ' e Type 0 Express Mail CC 4A Registered ail ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 076 30 4. Restricted Delivery?(Extra Fee) ❑Vm---ii 2. Article Number , , p 5�; 4 0 3:5 ;8 4 2 9 I (Ransfer from service label] 0 3 9;� PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 I ru 43 Ln M NOTILFm VC I A Postage $ $0.411A� Ln C3 Certified Fee $2.6 Posture C3 44*4*2 M Return Receipt Fee (Endorsement Required) $2.1 Ifio �Iere C3 Restricted DG'IAr,,.F Ir (Endorsement Required) d) $0.0 M C3 $214 Total Postage&Fees $ $5.21 Ln C3 Sent To 0 lStreet,-Apt No.;. ........ .......... or PO BOX N--o. -------------- -- (j------------------- Certified Mail Provides:o A mailing receipt as,anay m )ZOOZ eunp Does ,oA sd e A unique identifier for your mailpiece 0 A record of delivery kept by the Postal Service for two years Important Reminders: ® Certified Mail may ONLY be combined with First-glass Mail®or Priority Maile. ® Certified Mail is not available for any class of international mail. o NO INSURANCEi`.COVERAGE.tS:'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 argcle,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. i1", Af e For an additional fee, delivery may be restricted to the addressee or addressee's authpdZed.aggent.Advise the clerk or mark the mailpiece with the endorsement"Restricted.Velivet "!. > 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. Internet access to delivery information is not available on mail addressed to APOs and FPOs. I I UNITED.STATEs`h'osTALERVICE a ids. "` • ',_EPA 2 DO.:v.. .:FA. �•� �`e�� Na �. I • Sender. Please print your name, address, and ZIP+4 In this box • BALD �J , ei� CA/- I o Complete items 1,2,and 3.Also complete A. Si nat Item 4,if Restricted Delivery is desired. Agent ® Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B. Rec ' ed rioted Nan4j C D t"f Delivery o Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from ftem 1? ❑Yes If YES,enter delivery address below: ❑No y 9 39S 3. Sep Ae Type r�11 �'y� / Certified Mail ❑Express Mail L_ / I L 2 03 0 ❑Registered O Return Receipt for Merchandise 0 Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number . ; +� `t7 p p 6 215'0 }0 p"p 2 45 3 6 6 2 4 5 (transfer from service Iabe1J � " PS Form 3811,February'2004 Domestic Return Receipt 595-02-M-1540, i &a ( °Ln 1 .,- .. . - .- ru .n BAST BAST4TE F t,661 m Ln Postage $ $0.41 Certified Fee $" 00, 03 Return Receipt Fee Postmark 0 (Endorsement Required) $a 15 00Z CNeredjS Restricted Delivery Fee p (Endorsement Required) so. u7 rq Total Postage&Fees $ 5. �C� Y2007ru .a Sent Tqj^ O Street,Apt.No.; ----------- r- or PO Box No. -- -------------------------------------------------------------- Ciry,State,ZIP+4 Certified Mail-Provides: e 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: f1'`i o Certified Mail may ONLY be combined with First-Class Mail<e or Priority Maile. o Certified Mail is not_available for any;class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured;orRegistered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS ;postmark on your Certified Mail receipt is required. a For an additional,fee, delivery imay,._be restricted to the addressee or addressee's authonze'd a ent.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-'' die 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 zr Barnstable Town of Barnstable , * AlAm efieaC i +. BARNSCABLE• HASS. g Board of Health A �b 200 Main Street, Hyannis MA 02601 zoos Office: 508-8624644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi October 16, 2007 Mr. Donald J. Pires 379 Braggs Lane - Barnstable, MA 02630 RE: Variance,?-Granted/ 379 Braggs Lane; Barnstable A 298° 03'1 005 Dear Mr. Pires, You are granted a variance to construct an addition with a cellar wall foundation within twenty feet from an existing leaching pit at 379 Braggs Lane, Barnstable, Massachusetts. The following variance is granted: 310 CMR 15.211: The new foundation wall will be located 13 feet away from the existing leaching pit in.lieu of the minimum twenty feet setback requirement. The variance is granted with the following condition: • The applicant shall ensure that the new foundation wall will be maintained a minimum of ten feet away from the edge of the existing septic tank. This variance is granted because the applicant demonstrated to the Board that the leaching pit is at a lower elevation than the new foundation wall. Sinc r ly yours, alyne iller, M. Chair n Q:\Piresl3raggsLane2007.doc ZHE T D D DATE: a r r FEE: BARNSTABLF, ; MASS. 9� 1639. ��� REC. BY Town of Barnstable SCHED. DATE:/v — 'U1 Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION q / Property Address: 3� 1 tJ`�A 64.5 . L-/✓ 6 / S liA� �� r +t f�- ® "� bj Assessor's Map and Parcel Number:`ZQ.Ski 43 -60 Size of Lot: l• O 1 t9 e- Wetlands Within 300 Ft. Yes Business Name: No Subdivision Name: APPLICANT'S NAME: �04/Ae-0 J • Pr1IT S Phone ::77 Et d Z R Co Did the owner of the property authorize you to represent him or her? Yes v No ..:, PROPERTY OWNER'S NAME CONTACT PERSON 0 Name: G A/41—D J, PI tee-'S Name: M Fi 4 N Address: Address: Phone: ti— 3 6 — OZ`d 6 Phone: co Co VARIANCE FROM REGULATION(List Reg.)' REASON FOR VARIANCE.(May attach if more space needed) 20` (ZfGlui4c kN?` S/L76146c1 _ i FovMa7�eAr t,✓1-�-�,:,� cw , NATURE OF WORK House Addition ❑000 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 mpresent 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 ownerAeasee only], outside dining variance renewals[same ownerAeasee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Paul I.Canniff,D.M.D. REASON FOR DISAPPROVAL Y Q:\Application Forms\VARIREQ.DOCQ L �iJS iL �JJNDr�7i� r�0 FUAcW,4 aJ7 a f`}7 G�v� C Lip x/CJ ��i d � f�a'i . ��S� � G/z 1/fl�o.c/•J' d ��/' -- — s s� T O� Z Al Lo T 00 0 bpi f64.0 �� o %r !,Y o� ► �/ 61 • B 2p Zy� \ 1��% . LAN `1 CERTIFIED PLOT LOCATION ¢`3A'2NSTAS. MZ3 /9B3 ti o fig, 31 PATE M 7 -S SCAB B�NC pL AN.R W/GG/A iN �L. B��•. -�-�d go 1 CERTIFY' THE TED ON THE SHOWN ON THIS PLAN IS LA T T CONFORtAS Tp A3 SHOWN HERE®N AND TH WN OF SETBACK REOUIF& OF THE TOWHEN STRUCT DATE .�1 •? �B3 s REGISTERED LAND gORV<r 1-77 fIV jJ 6I4 .. TOWN OF BARNSTABLIE LOCATION SEWAGE#c�007 —✓J9 Vf-UAGE! ���-. ASSESSOR'S MAP&PARCEL c9F' 03 ©J` INSTALLERS NAME&PHONE NO.��emu, �� ��rt,� ,a�y�.s ` )5---6/, 9 SEPTIC TANK CAPACITY a, LEACHING FACILITY:(type) Le" (size) NO.OF BEDROOMS OWNER . PERMIT DATE: /l�/O`er COMPLIANCE DATE: 1 II 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 ��, a17 v vb eh z7 9 K. C u .ter , No. /3 Fee J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0ppYication for Digont 4pgtem Congtruction Verna Application for a Permit to Construct O Repairk Upgrade O Abandon O ❑ Complete System X Individual Components Location Address or Lot No � q �t l � Owner's Name,Address and Tel.No. czl� ; ca Assessor's Map/Parcel C=t7 y Installer's Name,A djj'ess,and Tel.No. Designer's Name,Address and Tel.No. =? t �A.'rXic-iLS vwt Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder�( ) Other Type of Building No.of Persons Showers., ) Cafeteria Other Fixtures Design Flow(min.required) 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) & kox Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed �j �' twe,Date Application Approved by Date Application.Disapproved by: Date for the,following;reasons Permit No. Date Issued r No. Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: r' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rolication for Mioonl *_ raem Cowaruction Permit p A lcation for a Permit to Construct Re air Upgrade Abandon A ppi. O p ,�) pgr. O O ❑ Complete System,4 Individual Components Location Address or Lott No. 3 Owner's Name,Addres ,and Tel.No. Assessor's Map/Parcel / ' -D� 3�5'�'iv,yr 4 S/• 7: � �A�� _L 3 )Installer's Name,Address,and Tel.No. Designer's Name,Address-and-Te!.No. 610� ' Type of Building: - w c-: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) {i Other Type of Building No. of Persons Showers,( ) Cadfeteria( ) Other Fixtures Design Flow(min.required) 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) ` 5.c CG- L/X 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 Health.Signed " ' —��p � ` �' r, r u�.,�I;;P r Date Application Approved by 1/v�-� Date Application Disapproved by: Date for the following reasons `a. Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS i;N GIn BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ) Upgraded ( ) Abandoned( )by -1" a , at _�^ t 'k �, 9s*.0 ,-+� has been constructed-in m accordance Uv - 13�1 with the provisions of Title 5 and the for Disposal System Construction Permit No. - dated Installer Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function is,dbsigned. Date ` ! Inspector _ ----No.a---------------------- Fee ---------,_:. lb- �0o THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE, MASSACHUSETTS Btzpo.5al *pgtem Con6truction Permit r Permission is hereb ted t onstruct ( ) /�Re air ) Upgrade ( ) Abandon ( ) System located at Ir---E.i Oe Y�� 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 Co struction must be completed within three years of the date of tf t (pe- it. Date ! O Approved by (II I l! p u LOCATION WAG E PERMIT NO. V f L L A G E ASSESSORS MAP NO: L9 PARCEL NO• 63100� INSTALLER'S NAME A ADDRESS L/El iftL � S R U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �%�� � I Q� HcoE 'r No. :. . 3.. Fps . DD THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �f b ...............OF....... a� Appliration for Uhipoiial Works TIMarurtion rrmit,'. Application is. hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: •- .•-. ca ddre oto� ................•........ "000 &7...• -- ......------. Owness ............................................& ................•-•-..... ..... ............. . .. _ Installer Address QType of Building. Size Lot...............`.... -. V .Ex anion Attic Garbage Grinder Dwelling—No. of Bedrooms--_-••-. p ( ) g ( ) a Other—Type of Building ............................ No. of persons............................. Showers ( ) — Cafeteria ( ) 0., Other fixtures ----------•---- -•----------------------------------•-----•-•---- •. -------------------------•------------------....... -------- W Design Flow.._...._....�30...................gallons per person per day. Total daily flow__._........_......_..._................._..gallons. 04 Septic Tank—Liquid capacity/..gallons Length................ Width................ Diameter................ Depth................ Disposal Trench-No. .................... Width......_............ Total Length ............ Total leaching area............. sq. ft. Seepage Pit No----------I......... Diameter----�.���_...... Depth below inlet---�------------- Total leaching area_.6!_./1 .......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) / Percolation Test Results Performed by------------•--••--•-•......................................................... Date........................................ aTest Pit No. 1 15._.Z-...minutes per inch Depth of Test Pit.../yy..... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' ---•----•-• ------- ---................ •------•---•---••----•------.---.-----------.------------ -... •..... -...... -.................................. ' ODescription of Soil----- _`.7�C�►' ....$!! e....----.Q.` --------------------------------------------------------------------------------------••--- W -----------••--------------------------------------•----------------------------------------------------------------------------------'-----------------------------------------------•-•--•--•------- U. Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iT�s^. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beeennssssu6d by the b d of health. gnedz%'`� ------ . .......................................... ....... D ApplicationApproved By-- -----•. 1�...... ........................................ ----....................-- Date Application Disapprove ,or th following reasons:------•------------------•--•-------•-------------------------•-----------------•-•-......••----........._...--- ................•---•--------•--••-•------•-•------•--------.......................................................................................................................... ................. Date PermitNo......................................................... Issued....................................................... Date f 1- 373 THE COMMONWEALTH OF MASSACHUSETTS BOARD .OF HEALTH 'J� G/ OF.... l�C.!$ ✓' ............................•... Appliration for Dispos al' Yorks C9onstrurtion rnmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ems.. �..- .__ yes "' '... .... -......................................................... .. cats Address or Lot No. ... . :.[... °.. ............................... .,,��, c .,�..? mowt. .............. Own ✓� Address ......... . �` ,5 ........................... ---- ------ ----•--___•-._______-_____--•-----•- -••---- � Installer Address d Type of Building Size Lo .__,..___._ ............................--•-------•=--"--•- -•------• Showers ._.. a Garbage Grinder ( ) a Dwelling Other—Type Building msNo. of persons nsion Attic ( ) ( ) — Cafeteria ( ) 04 Other fixtures .•--.........-• •--•---•---•----•••-••-------•--=-••---•••••--••-••...--••-•---••-•-----••-------•-••-•---•--•---'--••-•................................... Design Flow.........._?30....................gallons per person per day. Total daily flow..............................-_-•-_........gallons. 9 Septic Tank—Liquid capacit 4......gallons Length................ Width................ Diameter-------------:.. Depth................ Disposal Trench—No....................: Width.................... Total Length_.____ ___.__.._._ Total leaching area:___._ ,..�....sq. ft. Seepage Pit No.........I._._.._... Diameter...s(.JP....... Depth below inlet_.___........_. Total leaching area.���._...._.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date.................=...................... 40 a Test Pit No. 1<...�....minutes per inch Depth of Test Pit_. _!�. ...... Depth to ground water.--........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------ R+ ---• --•_- •. _--- •_-- .......................................•----...----...--------............._-----•-••- O Description of Soil---- Gf3-' S. V. ~` x. ----•----------------------------------------------------------------"------------------------------...--------------.._....------------------------------------. ......._....:._------ UNature of Repairs or Alterations—Answer when applicable............................................................................................... --------------"--------------------------------------....--•---•--------•---"--•----•-•--...---....-----...------------•-"------•---------"------------•-••-----...•....--•••-•••--•.._......--•-------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TTL, 5 of the State Sanitary Code— The undersi ned further agrees not to place the system in operation until a Certificate of Compliance has been ii�sue(f by the bo of health. .. gned -- y'" D e Application Approved By.... F tom.y......................................... .......................... ..-- ••-------- Date Application Disapprove or th f ollowing reasons:-------•--------------------------"-•--•---------------------•----------"------------------------••••-••-----••- ......_..--••••-•••-•--•--------•.....•---....•••--•---•.._--•------•-•------••...............•-------•-•-•- Date PermitNo--------------------------------------------------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... (9rdifiratr of Tontplianrr T TIFY, That the Individual Sewage Disposal System constructed I; ) or Repaired ( ) by...:" _... .................. • - - ------- .........-----•-•-•-•-•-----_____------------_-__....._.... ....... ----------------- Installer at.__ .....c?._ ---.....f..-------- �' f has been installed in accordance i the provisions of TTTL; ` of The State Sanitary CX� � escribed in the application for Dis osal Work C struction Permit No. - _ _I. ............. da.ted_ ,,//� ..._.__..._...._________..__.._______. THE ISSU C OF HIS CERTIFICATE SHALL NOT BE CONSTRUED AS _GUARANTEE THAT THE SYSTEM F TION SATISFACTORY. DATE... :. .....: ........................ Inspector_... THE COMMONWEALTH OF MASSACHUSETTS BOA-RD OF HEALTH ... O F................................_................................. .......................... FEE._ . Disposal Works Tongtr ion rrntit Permission is hereby granted...... "_..... _...--.•-•-•----•••••••••••--••----•-•••-•---•••-•-•-•••••-•........-•----••-•......_--•=••....._._.. to Constr ct ( ) or Repair ( ) an Indivi ua ewage Disposal System atNo.. ,?'. '--•---... , �---- -----------------••---------•----••----•--------------------------------•-----••-__-- as shown on the applicat n for Disposal Works Construction Permit No..................... Dated,.,.......................................... !_ �3 b{/� o rd of HealtL DATE •••--•-•-----•-•-...._..--••••----------••-••----•••---•-••-.......... FORM 1255 HOSES & WARREN. INC., PUBLISHERS •rr 1 � 1 9.7 O S" O i,� •gc.�cc'S • �,y �3,1 I N � 53 g 0 rfo -DrsT- �' ���,�,�1A•OFM I •��'� rLy 4r� �� �. �� N LLEY. P 5 � o tr LI,6 , },#1Q25 00 ti 5/ t �� ► R�aa���: of . /JaT&-- eZ I-rV q W o ni s BAls�za a�v - - CERTIFIED PLOT PLAN eg !3.I LOCATION.,BAieN��-ABG MAss . S[:QI . . DATE' MAar Z3 I983 PLAN REFERENCE . .4B Y!: ' 4,77 0' L,�>v� (.B I si D14IN ON .19 CERTIFY THAT THE 49i4rlVa. ,fauvDA�Jv.v i SHOWN ON THIS PLAN 1S LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT.CONFORMS TO THE II SETBACK REQUIREMENTS OF 1 HE TOWN OF d/ tss?•9$t�c�r. . . . . . . . WHEN CONSTRUCTED.. II DATE .IYAy.2�. .1 f 83 � (Ni LL/,9-H F Sw/F?'- 1pE77T/O N&7L EY REGISTERED LAND _SORV . OR 1. :�1.•.c.ca . . TOP OF FOUNDATION t CONCRETE`;COVER ;,. CONCRETE COVERS 4"CAST IRON 12"MAX.mr �nmr�r 12`.MAX. PIPE (OR 4u0RANGEBURG(OR EOUIV.) . - ITCH IQUIV) MIN PIPE.- MIN: EACH ' PITCH i/4"PER: PITCH I/4 PER.ET. PIT PRECAST NVERT .LEACHING-� I�AC G EL..53"30 INVE �u.' • ' PIT OR T !� w SEPTIC TANK A 8 DIST. EQUIV. a INVERT EL, ,.. 5` ,7., BOX INVERT 4. ' o0 0. GAL. INVFLRT e; EL.. . EL ,. �: INVERt . ;.', W e. : 3/4°T6 I'V2' a � ELF... ...• �•: WASHED STONE 7�: PRORLE OF GROUND WATER`TABLE SEWAGE DISPOSAL SYSTEM NO SCALE. SOIL LOG WITNESSED ; BY DATE .. /ZL�83,,, TIME. //% SA!y &A/ C/or;0co . .BOARD-OF HEALTH: TEST HOLE ,I TEST HOLE- 2 ST j►5vsr .P /,/.Q ��,S ENGINEER," ELEV. 7p ELEV. . •30 ®� m p DESIGN DATA o, ` 7op_SoiL. :lapse.L 3 � G NUMBER OF SEDROOMS : . . TOTAL ,ESTIMATED FLOW . . . . . . . . . GALLONS/DAY C �MZsEr BOTTOM LEACHING AREA 7 :�'`_P SQ FT /PIT, s .n SIDE LEACHING AREA r /8*420 'SO.FT:/ PIT GARBAGE„DISP.OSAL: (5O'/vv . . %,AREA INCREASE) TOTAL EACH,N0 AREA .Z-.7 q9. SQ.FT PERCOLATION'`: RATE G4rS lea MIN/'INCH LEACHING AREA PER PERCOLATI®N RATE -S'-�P SQ:FT, No :WINTER ENCOUNTERED NUtwbti+c or•�C'AGNirJu Pi . APPROVEDBOARD OF HEALTH •�'t'��' OF .57Dn/B t'p� ,A-iL' .S/D DATE AGENT OR--INSPECTOR OF Alq - f 1+��tval PETITIONER ' �jS//�- ✓ft�?`? . :Sw/ �1�rrrRt�wa y a x • _ ._ � - - STAMP: r 14, 0, C6NTINUOUS'2xG P.T. SILL PLATE/SILL DRILL 8 GROUT INSUL /I/2" DIA GALv. A B '@ 6'-O" O.C. 7_0„ '� .i•' - 26x46 2-#4 DOWELS @ 12"O.C- - ' - x u -_-_- ' CON'T RI D'o£V£NT r -CONTINUOUS B 4 O':C.ONC .WALL I I - C TYPICAL;ROOF CONSTRUCTION ON IG 10""CONC. FTG: - "� 2x12 RIDGE.BD.! HALT SHINGLES ON .o-' - 5ttPBUIXDING FELT ON - i PROP-A-VENT BAF,fLE t '26x48 t I -- 2x 10 RAFTERS @ IG O.C. / MATCH y t i p 51MP50N H2.5 CLIPS @ I6"wO.C. y EX. 3 i/2 .CONC.-FILLED GARAGE Al,l I - MATCH- GARAGE -- 8 GARAGE LALLY'COLUMN, TYP. - 4' CONC. SCAB a/' j I - EX. Ix5 @ 32" O.G. 6"xG ,10l10 WWM ON P4 I I <'G"COMPACTED GRAVEL p r N _ ALL TRIMTO MATCH EX. a ry,: 4j.. I I 2x8 @ 16" O.C. IW FASCIA B05 _ - I /ALUM. GUTTERS WI2x35 ST BM. Ix SOFFIT / 26x45 O. I r I - - —CON'T VINYL t HATCH ' �:. I 1 NEW G.W:B. ON HALLS 6 SOFFIT VENT - EX. wf I I CLG.-TAPE AND SAND ALL SEAMS (PAINTED) TYPICAL WALL CONSTRUCTION r " z -.n• r r I I ATWONxIDOOR DER GARAGE — Tl I COX PLYWOODPX O E w. o N I P SUR qx7 OH DR ;� DROP WALL `2 '- ° I I - - 4 CONC. SLAB w/ 2.4 STUDS @ 16" O.C. w p . - rr TO MATCH.EX _ -J I _ 6'xb" 10/10 WWM ON z w - . ,`' _ 6" COMPACTED GRAVEL a5 q 6' 2 5 CONTINUOUS 0'x4'-0" CONC. WALL m U n p _ �,..,• T ON 16 x 10 CONC. FTG. �j Q O _- q,_o, 2 a FOUNDATION PLAN k - {• CR055 SECTION 14 Oi< - - _ ADDITION - r iYy, P Lu 5, v - , U d �z . I ter Lij �F R PLAN . � z p FIRST LOO s 4 rarnn SGACEi/4'ml-6'. O W'jV L� t Y Q O N } :ryLu Lu m 7 01 I s I 2 t t - . --- ----- / - ^� — - — — - _ TITLE: ASPHALT.SHINGLES - TO.MATCH EXISTING ON - 15#FELT,'PAPER. -- FLOORLAN . ALL TRIM - --- TO MATCH _ ool .' T. W.C. SHINGLES ATE ISSU -- - '- w/WOVEN'CORNERS 09/1 B/07 ON T7VEK`OR EO REVISIONS: . a .. ..._ -_ ED gg i § - - ADDITION VIA 1 AODR 1oN ELEVATION REAIR•aEo w o DRAWN BY: BD ADDITION RIGHT SIDE ECEVAT.ION PROJECT#: � � � R-20002 FRONT ELEVATION + , . DRAWING NO.: 3 a - m,