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HomeMy WebLinkAbout4308 MAIN ST./RTE 6A(BARN.) - Health 4306 Main $treetrRte 6A (Barn) Barnstable F�(� A 351 029 d a i o a i i . 0 6 a v p u ASSESSORS MAP NO: Na - � PARCEL NO: — Fimic $.....2.0...0.0_ THE COMMONWEALTH OF MASSACHUSETTS - } --BOARD OE HEALTH Town BarnstableF ............ ..OF.........................----•---......------------.....------------............_...._... ApplirFation for Uiipnsal Works Tonstrnr#iun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair �X ) an Individual Sewage Disposal System at: 4308 Rte 6a Cummaquid .... _ ..----•------------•................................................... ••-•-••----•---•-----.._..............-•--••-•---•----•-•••-----•-••••••-•-••-•-•......._•---•--•- Location-Address or Lot No. . .......—.......................................................................... ..........-----------•--••---•--------------------------------------------......_.. Owner i Address Installer Address Type of Building Size Lot............................Sq. feet U DwellingXXNo. of Bedrooms...............4..........................Expansion Attic ( ) Garbage Grinder, ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ---------------------------•--•. . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity......:.....gallons Length................ Width................ Diameter----------...... Depth................ Disposal Trench—No..................... Width.................... Total Length................_--- Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet_........_........ Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................__ Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' ------------------------------------------ x Description of Soil-- -----E_._..__. aXbd...__.aX410C�_____._._li'--------------- --- J ------------------------------------------------ -•U kj-- - W ......•----•----------------••---•----------•-••......••••. ---•-••-••••......-••--•-•.........•-•-- �i­ -- ------ x Jllc�-✓t �Ol r�x3/b U Nature of Repairs or Alterat o Answer when applicabl _____________________________________________________®.._ ._._.._._..... 1-1500 gall 2- pits dl, 1 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of L I T s E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee iss d b he board of ealth. Signed... .. lZ _.._.. . ........11./25./_.SJ_-. ApplicationApproved BY------••. ---•••................................................. -----------��� ....... Date Application Disapproved for the following reasons-------------•------------------•-----------------------•----......------------------------.........._..---••--•- ................................................•--••--•-•••-i----------•-•------------....------....----------------------------•------------•----------late .......................................... "I � ��D7ate °�, Permit No........ ...... �.--_.._.. Issued_----•--•---•-�-.- -Z......-'�-•=---------= / N ..... ---- F�$.. ....2Q...QQ.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Torn Barnstable ..----- ---- ..........OF........................................... Aplifiratiou fur M-4vi ial Works Towitrurtiun Vamit Application is hereby made for a Permit to Construct ( ) or Repairx(X ) an Individual Sewage Disposal System at: 4308 Rte 6a Cummaquid ...............•-----------.._._.._....-••--.._.....•........-•----.._...--•--•.....•-----•_-••••. •••-•--•----._.._....•--•------••-----........-•------••-••-•----•---•.._....-•••-•............--- Location-Address or Lot No. Kent Owner Address W _I. .f_1$ _SCX}Sl .............................................................. Pq Installer Address UType of Building Size Lot............................Sq. feet �-, DwellingKx No. of Bedrooms..............4............................Expansion Attic ( ) Garbage Grinder ( } �`q Other—Type T e of Building No. of ersons____________________________ Showers — YP g -------•-•---•---------•---- P ---(----)-----•.Cafeteria ( ) A4Other fixtures ------------------------------------------•...--------.-------•-----•---•-----••-•- W Design Flow............................................gallons per person per day. Total daily flow----__.______________________.._._____._.___gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter________________ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter____________________ Depth below inlet.................... Total leaching area..................sq. £t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ W Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ w Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil................ Sa rAi G . x � 1d.- ........�? :...................................U UW -------•----------------------------------•-•-•----•---•--........................................... Nature of Re airs or Alteratio.s—Answer when ap licabl ti. �t Jnr��w.G '� �-(.------� -J�j-__ Cx.4 1 J_�� tqr � -•----- 1-1500 a2 on -a.iiX------2;----piV5----- ----- -- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T .T .E 5 o£ the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board o" `ealth. Signed = `?� f�✓._.:�>$;,:a_...... f•l/25/87 i ,. � .Date Application Approved By '::: y ?:- ,..--•---------------------------•- l ✓ -- / ---.--- Date Application Disapproved for the following reasons-------------•---------•-----•-••----•-------•--------------••-----------------•----------------••••------•---- •--------•----•-----•---•.............•---••-•-----------••-•-------•-----...-•------•---•--•--......_._..-••---•••------------•------•---•••---------•-•-------•--•-•••---•-•-----•-••••----••---------- Date Permit No_____________ `7 .1. Issued._..-•••-•..... 2 C � ------------------------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... Town, Barnstab. e .. ......................O F...................................._............................ .......-...._... �rrtifiratr of &-impfianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired�XX} by...---J-.P.Macomber .............•--•---------....-----------------------------•--------•-•-------------•-----------...._._..---------...------••-••---•----•----... at........4308- Rte 6a Cummaqui Installer • --------------------••--------------- -------- has been installed in accordance with the provisions of T i T IE j of The State Sanitary Code a docribed in the application for Disposal Works Construction Permit No.�_____. __._.'1___01.____. dated.......... _....--�1_-� _._________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA ANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS �C) BOARD OF HEALTH Town Barnstable � 20.00 No' -t� !.�✓� OF....................._.._._.........................___....._-__._......_......._.... ... FEE........................ 0hip ial Works Tonitrnrtion .rrmit Permission is hereby granted.....J' .MaComb.ere to Cons r t ( or ai X a ividual Sewage Disposal System at N0 ,Y9 8 R�e. 0a rCKm ac u� -- street ' l as shown on the application for Disposal Works Construction Permit No. ?_ ._..�_` Dated.'---_ ='1___`'------ .......... ._........-•---•----------................. ................... ................................. Board of Health DATE-• - - ............................................ FORM 125,5 HOBBS & WARREN, INC., PUBLISHERS - j TOWN OF BARNSTABLE v SEWAGE V>?LAGE ek i ASSESSOR'S MAP& LOT • - INSTALLER'S NAME&PHONE NO,49ZI-! eiV s 7- SEPTIC TANK CAPACITY /:-r 0 d LEACHING FACILITY: (typey:5�f6oC)l)A SE�L s (size). -1 13-V NO.OF BEDROOMS 3 BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: 2Lot-l—ey Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Le r- 5 �� �0 tv f C r TOWN OF ARNST LE LOCATION ' �� 41 SEWAGE # VV LAGE dug , ASSESSOR'S MAP & LOLeo 'T�5 U INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) (� 140.OF BEDROOMS 'l R BUILDER OR OWNER �i� PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet. Private Wate.Supply Well and Leaching Facility (If any wells exist on site or, ithin 200 feet of leaching facility) Feet Edge of We and and Leaching Facility(If any wetlands exist within 360 feet yff faci ' ) Feet r by J I �_ SO 4 t ° 7ek Q C� o - r, No. Fee { f 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE} MASSACHUSETTS 2pplitation for ;h9pozat 6pgtem Congtruction Permit Application for a Permit to Construct e )Repair(/Q Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. nn Gfj rsr nj 4 5.v". Owner's Name,Address and Tel.No. 93 OF /9 1 rn/Ej Woz,5-A i Assessor's'Map/Parcel a- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. S b � � 7S' / 36 Z 13 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 S gallons per day. Calculated daily flow 3 a gallons. Plan Date D Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with,the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of ealth. Signed A 9r, �'A Date / 6�e Application Approved by U/� Date Application Disapproved f r the following reaso Permit No—OULT Date Issued No: % y s r ��4 _ Fee THE COMMONWEALTH OF MASSACHUSETTS a� Entered in computer BLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS t Yes 2pphcation for Mtopo$af bpztem (Cow6truction Permit K S:� Application for a Permit to Construct )Repair )Upgrade( ' )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. Gv M S Owner's Name,Address and Tel.No. ivi3 `� l,�/!i i r•�F y GUI; Assessor' ap az el �S Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ` A j i f, QeAl ld.a. s j r0TL t TD -7 - :2 K -, 5— d a Type of Building:' * Dwelling No of Bedrooms 3 Ldt Size sq.ft. Garbage Grinder(` ) Other Type of Building No.of Persons Showers( ) Cafeteria( ); Other Fixtures f Design.Flow •3 gallons per day. Calculated daily flow 3 3!� gallons.-,., Plan Date Z:" Number of sheets Revision Date $ - Title T s Size of Septic Tank Type of S.A.S. Description of Soil: Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: 1 The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signe _ r Date ,Z: al Application Approved by lIl_ !! Date Application Disapproved or the following reasons r Permit No. r ( !J(4Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Comphartce THIS IS TO CERTIFY, that the On-site Sewage Disposal Sysieut Constructed( )Repa;red (y )LTYarsdPd Abandoned( )by�4 /L e 14 at l,/3 n__e__Tr /2 a ^� 14 �' .1. 2 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.a n o q-G G '2 dated 1-� J r J� ,L Installer �4 2 14 Designer L�4), A2 0:' o." � � 4 1 The issuance of this p�.rmit shall not be construed as a guarantee that the yste`m will function as des�'gned. _n Date 1 a '3 lr�e Inspector 1 _____ - - ivo.---�—'-/ --------------------------Fee _;)`"`— V V/hq7 __` THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Miopogaf *pgtem Con5trUctton permit Permission is hereby granted to Construct('Repair( )Upgrade( )Abandon( ) System located at Sir r .1.9 f$ Q, and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date:_� �� 1/ YI Approved by t I TOWN OF BARNSTABLE` LOCATION �30 az-v V rI_ cl.,A SEWAGE# "�f- 0,21 VILLAGE (fee,✓y zeZ ASSESSOR'S MAP&LOT S INSTALLER'S NAME&PHONE NO10 1-z t*av g T C, S-o 1 2 7 S /3 6`)— SEPTIC TANK CAPACITY d . a2 �A A SiF n-s (size-f-x 13-t LEACHING FACILITY: (type T15P4 •• NO.OF BEDROOMS_ \ i BUILDER OR OWNER / 6J' � PERMTTDATE: /6 COMPLIANCE DATE: 2 0 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i i Lz) 5"ob C�aMsr�i _ Log" It� �r-r s,A 10 s'o A B)"' 34 Commonwealth of lM6assach settC01165e— S- /_/ - )e vvi • w e r Title 5 Official Inspection Flan Subsurface Sewage disposal Sy!FAam Form, •Not for VOWntary Ass„ ss;nents a Properly Address V Ow ner Owner's NameLAI e infofmatlon is required f or every V"'I lQ Q`4 , page. Cdylrown n s I� State Zip Code Date o Ins n T►" .. . 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. Imng out When ling f A. General Information q filling out forms on the computer, use ony the tab 1. Inspector. key to move your cursor-do not iLj G V, use the return Name of Inspects �Ikay. -�- D- — Company Address7TIT Lam^ l DL Uty/rown a�o-�,�9� State / ,� Zip Code Telephon rrbe License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 16.3410 of Title 5"10 -16.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Inspect 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 DER The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. * '"'This report only eiescribes 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. I Orr.•3113 title5OfficialInspectionFa msubsafacesewageDisposalsystem•Page1of17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Di46sal System Form -Not for Voluntary Assessments Property Address Our ner Ouv ner's Name e (^-// information is C(i1 l/9VO�QU r C Ql�&30 14116 required for every page. G1tyfrown State Zip Code Date of hispection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E 1 alwayscomplete all of Section D A) =u*nd any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes",."no"or"not determined"(Y,N, ND) for the following statements. If"not determined,"please ex0ain. t. 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 efittration 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):, tyns.313 Title 5 official Ins pecfion F onn Subsurtace Seviage Disposal System•Page 2 of 17 Commonwealth of Massachusetts ti Tide 5 Official Inspection Form Subsurface Sewage Disposal System Form w Not for Voluntary Assessments Y30� 2�-- (0/T Property Address ON eer Ow ner's Name information b J' / �4 3(7 /0 required for every ��� 0' /�/& page, Cityrrown State Zip Code Date of fnsp6etion B. Certification (corn.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CHAR 15.303(1)(b)that the system is not functioning in a mannerwhich 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 Mrs 3n 3 Tifla Mficial impecdon Form Subs rface Se%Me Disposal System.Page 30f 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 930,�? R- Roperty Address 61A Cw ner ON ner's Name inforrnation is required for every C(/L G ( yl t� ya 6 ?J o �b page. Cftyrrown State Zip Code Date of Inspection B. Certification (cost.) , 2 System will fail unless the Board of Health (and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters ue to an overloaded or clogged SAS or cesspool ❑ atic 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 t5ns•3M 3 Titie 5 Orfidal nspeotion Form Subsurface Sevdge Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address ON ner ON noes Name !! ? information is �(j1�✓�Gi Q�! / '/� C/r�`�✓D �0 required for every page, Cityrrown State Zip Code Date dt hipection B. Certification (corn.) Y Yes No ❑ Eff Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ y 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 fleet 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.] ❑ e system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or°no°to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA)or a mapped Zone 11 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. One-3M 3 Titie 50tficial Inspection Form Subsuface Sevmge Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface-Sewage Disposal System Form-Not for Voluntary Assessments 93 o'P /4 614 Property Address ON ner Om ner's Nameinformation is /� / 3-0 /�1 requ'tredfor every page. Cityfrown State _ Zip Code Date of Ins ion C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes NNo/ ping information was provided by the owner, occupant, or Board of Health ❑ any of the system components pumped out in the previous two weeks? ❑ 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? L1 LJ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Existing information. For example, a plan at the Board of Health. ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): �J DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): t5ins•3113 Tile 5Official impaction F om[SubsWace Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Y 3 �� Property Address �I Ow ner Ow nees Name information is G CA►/1'►�I C�C2 required for every page. Caty/Town State Zip Code Date of hsgcWrV D. System Information J Description: . � X-�� �`�� .SP T/� ' o�,. �✓ ( ��N /oV7 Number of current residents: Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system?(Include laundry system inspection Yes No information in this report.) ,_,/� Laundry system inspected? ❑ Yes L� No Seasonal use? ❑ Yes No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM R 15.203): capons 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: 15rs-3M 3 Titles official Inspection Form Subsurface Sewage Disposal System-Page 7 of 17 Commonweafth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 94- 64 Property Address oar rfer ON ner's Name ✓� Q t,1 information's required for every - ate Zip Code We of hasp ctlon page. C yfrown D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: " ,-Ol Lf — p Source of information: Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of S m: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the VA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other (describe). wesomciaiinspectionF arm subsirfacesewage Disposal System•Page 8of17 Mr. &13 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assess ments Property Address / Ow ner ON ner's Name information is / /�,/4 -(030 �0 requa ( ed for every (/L f�`�r VJFr^ 62�I d-page. Cdy/Town State Zip Code Date of Vs bon D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: a OQ5 �?o Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): C� Depth below grade: feet Material of constructi;/40 ❑ cast iron 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 g feet Materi of construction: concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: tans.3M3 Title 5 0ffida1 lnspectian Form Subsuface Sevoge Mspord SyMm•Page 9 of 17 i Commonwealth of Massachusetts mo Title 5 official Inspection Form Subsurface Sewage Disposal System Form m Not for Voluntary Assessments --o� _ , CA Property Address / Ow ner Cw ner's Name information isCA01 &-� requaedfor every page. Cdy/Town State Zip Code Date Ins coon D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 Tole C&' vcC 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.): 6-4V"1 1k7 C ' 00c/ 40� o o d Co.,,)t ` 00 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 bottom of outlet tee or baffle Distance from bottom of scum to Date of last pumping: [me tyre•3M3 Tifie 50ffidal Irepecton Form Sutsurf"SexkgeDisposal System-Page 10 of V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments. kvj Property Address Owner Owners Name (�_ 1 / ? /fit information is IA ✓��Gi (S�vl t 0��7 J l� <V !� required for every page. Cdylrown State Zip Code Date of In D. System Information (cost.) 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): I Dimensions: Capacity: gallons Design Flow Y gallons per day . Alarm present: ❑ Yes ❑ No . Alarm level: Alarm in woridng order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required); Is copy attached? ❑ Yes ❑ No' t5ins•3M3 ritie5Offidal ftpectionForm Subsurface SeeageDisposal System-Page lid 17 i. I , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments V30g �- j G ,4 Property Address Owner Ow ner's Name I(/1 �/� information is �� U i G� op ("?0 /O & required for every y page. CRyfrown State Zip Code Date of ecti n D. System Information (cont.) Distribution Box (f present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence'of solids carryover, any evidence of leakage into or out of box, etc.): r Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No* Alarms in working order. ❑ Yes ❑ No' Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 65ns•3M 3 Title 5 official Inspection Form SubsWace Sewage Disposal System•Page 12 d 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3o_�? 94- C14 Property Address Ow ner ON ner's Name ( A information is required for every �i� Ct C2tn / 6�0 / /& page. City/Town State Zip Code Date of I pee on D. System Information (coat.) Type 0'�P- Soo ❑ leaching pits number. ❑ leaching chambers number. ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovativetaltemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 0 If 7o�pl cJ,Y1 cz Zlb �Zvi QZ� L rz�� 61 C -74;i (Gfre Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth-top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t9rts•3H 3 Title 50ffirial I spectim Form Subsuface Sewage Disposal System•Page 13 d 17 commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address G/;l A 4- O.v ner ON ner's Name iftforniftri is required for every page. CRy/Town State Zip Code Date of Ins do D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): tOns Y13 TIVe50fficlal InspecdcnFo m Subsurface SawageDisposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7-2 ��- 61 Property Address OWN ner Cw ner's Name information is 7O�6 j/1 /Q /� required for every V ► l, J V page. Cdy/Town State Zip Code Date of Ins ee n D. System Information (cunt.) 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 when:public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately (Co � 5-e-- l�S s R�s�s 3 a r . y 93- 50 15ns 3!3 Title 5 Official lrepectimFom Subsuface SexegeDisposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address /l Ow ner Owner's Name 1W/ information is A4 requ'lredforevey u V"�01,7' Qu l 0j 6-50 page. Cily(Town State Zip Code Date of Insp tan D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water. f 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 ❑ bserved site(abutting property/observation hole within 150 feet of SAS) Checked with local Bo of Health-explain: 5- 7L %IEF7 b/04 ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: c You must describe how you established the high ground water elevation: 0 o✓"I 0� C�l vi -Z�s S� � /off/ a► P S V-� /H1-Jlc Ae C ✓ 114G Pl , /S A— avE 5 fig SYtP �► �� Before filing this Inspection Report, please see Report Completeness Checklist on next page. Ons•3H3 Title50ffWI Inspection Form Subsuface Sewage0isposal System•Page 16 of 17 M_t Commonwealth of Massachusetts Title 5 Official Inspection Form i g -� Subsurface Sewage Disposal System Form-Not for Voluntary //Assessments Roperty Address ON ner ON oar's Narre A,, �Jo,G�0 / 6 r(o requ�edforevery page. Wfrown State Zip Code Ume of trvspeg= E. ,R,,ep�ort Completeness Checklist Lf Inspection Summary:A, B, C, D, or E checked M" ftpection Summary D(System Failure Criteria Applicable to All Systems)completed L9'Sy em Information-Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate Ile f ' J t5as•3ff3 ► T-me5of6dal impmdmFam[SubWaoe SW*CeDq)wd System*Page T7 of 17 Assessing As-Built Cards Page 1 of 2 E TOWN OF BARNSTABLE � LOCATION cROrk La, SEWAGE#41 jG.—cJ52 VILLAGE C"A ASSESSOR'S MAP&PARCEL C' INSTALLERS NAME&PHONE NO. 06. C nhS6e� 60cr-7?-/1-434� SEPTIC TANK CAPACITY 1S'd6 aal LEACHING FACILITY.(type) 15 o000 c'"cr3 (size) NO.OF BEDROOMS 5 OWNER PERMIT DATE: \01-k�16L. COMPLIANCE DATE: Ahk 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 CGt1C�� L,cinu SC,�NC.yifKf 1 ' i � I c O r Aj z9' ir.� Z1. l7l J7 13. 14 http://www.townof bamstable.us/Assessing/HMdisplay.asp?mappar=3 51029&seq=4 10/3/2016 Commonwealth of Massachusetts � � �� &�,f e 'Title 5 Official ins :ec i b For S f "? Subsurface Sewage Ds'spesal Sys en Fi rm NM fix'O!IIntanr Asses;;rnents Property Address / ,� �✓)-e '"""'— __..�.. W ,•.— � (n� _ l/) f ON ner Ow ner's Name information is ,,,�1 ."'�_.._T...._.,,�Q,.�....._ / � required for every _ (/1 t/�I/ ct OVt l / / / p�6 3 t7 l 0 to b s w page. Cttylfown State^M Zip Code Date of I s tion ., 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:When A. General Information r Ming out formes on the computer, use only the tab 1. Inspector. key to move your cursor-do not use the return 7 a N Inspector ame of Ins �� 0 /sue key Company Name - Company Address City/Town State Zip Code , o� ) d Telephone Nurnbei License Number !B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(3�10 CM 15.000). The system: , Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority l0 Inspecto 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 good 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. s 'This report only aescribes 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. tyre-3113 Title50fficid IrepectionFomc Subsu'face sewage oisposal a15mm•Page 1 or17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `13a � /� f CA i Property Address Lhl 4 IL ON ner Om ner's Name - / /� information is C �� l Cal Vp2 �O JT/ l0 / required for every l page. Cityfrown State Zip Code Date Ins lion B. Cer#ificadon (corn.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D f i A) System Pa I have not found any information which indicates that any of the failure criteria described i in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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 !I 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 ex0ain. 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 wiU 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): i I t5rs-3M 3 Title 5 official Irepection Form subsurface$avage Disposal System•Page 2 of 17 (Commonwealth of Massachusetts 7ifle 5 Official Inspection Form Subsurface Sewage Disposal System Form w Not for Voluntary Assessments CA Property Address Oar ner ON ner's Name C informations G 01 I�o,, c.t C �p�6 O /0 required for every � page. City/Town State Zip Code Datp ofAhspection Bo Certification (corn.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due E to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): { ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): I { ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The { system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): 4 ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): { t 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 1 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 mannerwhich will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water + J ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ns-373 Title50ffiaal lns pectionForm SubsWece savageoisposal System•Page 3017 { Commonwealth of Massachusetts ti =Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not ibr Voluntary Assessments kvi Property Address ON ner j Ow ner's Name information is /J/J required for every Z7( vt 1, /' "/� Da �� /0 6 , page. ( ylfown State Z10 Code Date of-A—Spea Fion Bo Certification (coat.) 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"*. i Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this fbrm. 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 (� charge or ponding of effluent to the surface of the ground or surface waters d to an overloaded or clogged SAS or cesspool i tatic 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 LSiB•313 Tit)e 5 official Inspection Form Subaaf8M Se# wage Disposal System•Paqe 4 of 17 IL i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `f3'o �- Property Address L1�1 C) O ner Ow ner's Name _ information is required for every iU I V*V'M0t aLA t G /c page. Ctty/rown State Zip Code gate of 1 pe tion B. Certification (cunt.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or fobstructed pipe(s). Number of times pumped: ❑ LJ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or ❑ (� tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Any Portion of a cesspool or pr ivy 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.) ❑ e 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, therefiore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either'yyes"or°no"to each of the following, in addition to the questions in Section D. _ Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered'yes"to any question in Section E the system is considered a significant threat, or answered "yes"in Section D above the large system has failed: The owner or operator of.any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. tsrr-3f13 Tito 5Official Inspection Form SubsurfaceSe%%eDisposol Sim-Page 5of17 �\ Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Forma �N sP Y of for Voluntary Assessments Property Address ��l ON ner Ow ner's r bme information is required for every -- r—'-(A ►/"I 611c, a (it 1 O L fo'?o /0 77;L page- Citylrown State Z�Cie Date of I p tion C. Checklist Check if the following have been done. You roust indicate"yes°or"no"as to each of the following: Yes ❑ mping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? ❑ 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 WA) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system components, excluding the SAS, located on site? ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? �❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Existing information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: l / l T I Number of bedrooms (design): / Number of bedrooms(actual): E t DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): ---v _ j f S66 G- d trim•sn s �- Title50fficial ins pectlonF arm SubsWaceSewageDVOSamSystem•Page 6of17 - l �\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form•Not for Voluntary Assessments 1<4 Property Address information rmner Ow nees Name w m quired-fo is j�j� oa 4 3o required for every (./�V'�I M R �tn,a ! 6 page. Cityfrown State Zip Code [We of brX=Wn D. System information Description: / ot4'-6�f,�,".1 120_-'X/ Soo Number of current residents: Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes L7 No information in this report.) Laundry system inspected? ❑ Yes No Seasonal use? ❑ Yes Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes 0 o Last date of occupancy: C L40,ehT Dratte Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ -No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5�rs•3%3 Title50FfiaailrepectimFom[Subsuface$9 sewage Disposal Sp ystem•Page 7 of 17 �\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 614 Property Address 14 ON ner Cw ner's Name information is required;for every (A'M047 a &'^" -70 page. CRytrown State Zip Code Date of hi(peclion D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: �Vo4- C—J Was system pumped as part of the inspection? ❑ Yes o If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of Sy Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner)and a copy of latest inspection of the VA system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (descri be): tyre-3113 1'ille 50ffiaal Irepeetion F arrc Sutsuface Sewage Disposal S}soBm•Page 8 of 17 �\ commonwealth of Massachusetts Title 5 Official Inspection `Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Ow ner's Name ulformatkm is 6m tM v-1 a (y2 f �a 3c7 /O required for every Me. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components, date installed if7wn)and source of information: �o Were sewage odors detected when arriving at the site? ❑ YeS B No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Materi 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: ca Sludge depth: Cz t5ris•3H3 Title 5 Official Ins pection F orm Sutuufaos Sewage Disposal S)SWM•Page 9 of 17 Commonwfeaith of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 93O'g Property Address Ow ner Ow ner's Name information is 6U uo required for every _ /t 4'� ✓ 1 A p2�f " f ` / �O 6 page. Cltyfrown State Zip Code Date of_htpeMn D. System Information (colt.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle less— / 'i Scum thickness ,6 Distance from top of scum to top of outlet tee or baffle a Distance from bottom of scum to bottom of outlet tee or baffle l ,How were dimensions determined? " Ole, #'2a el4ce' Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): MCI r - 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 19R;•3n 3 Title5Official InspecfionForm Subsulaoe SewaggeDisposel System-Page 10d 17 Commonwealth of Massachusetts T W-W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30-F 2 Property Address OAF ner Cw ner's Narneirdormation is r ,/ required for every Me. Cityfrown State Zip Code Date of Irispedtion D. System Information (cost.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or(Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: galbns Design Flow. allons g per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in worldng order: ❑ Yes ❑ No Date of last pumping: Die Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5U6.Ti3 Titleti Official ftpeotion Fomc Subsurface SeVaGe Disposel System-Page 11 of 17 t, j Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L13 �4- Property Address ON ner ov ner's Name A/1 information is LA vA l Val Gl a� L y�`��l� /� ` b required for every page Q1yNown State Zip Code Date of Wspe6tion ®. System Information (coat.) Distribution Box(f present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): o� 'Zo✓-ei/ SSo//C& Aa LAG Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No* Alarms in working order. ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): i *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located,,explain why: t5r>S•3113 Mile50fficial Inspection Form Subsurface Sew2geDisposal System-Page 12 d 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not fbr Voluntary Assessments V3o� Property Address Cw ner Cw ner's Nameinfo _ on is requ'vredfor every Cl LA V",j p4lG (�(t( page.• City/Town State Zip Code Date of Inspection D. System Information (cont.) Type Sao Gci & "1 �!/t G v`, �I S 7v C� �S Elleaching pits number. ❑ leaching chambers number. ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Cesspools (cesspool must be pumped as part of inspection) pocate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t9ris-3M3 Tine 5Official Inspection Fam SupsW8ce Sevrege Disposal Syslam-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments < , Property Address 30Y R 4- C/ ��f l Cw ner QN ner's Name information is G LA v"1✓ CI 9". � vd�� l0 i!v required for every page. 5 /Town State Zip Code Date of Ins do ®. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 1.9ris.3M 3 Titie50Mdal Inspection Form Subsu-face SeµageDisposal S)GWM-Page 14 of 17 I Commonwealth of Massachuset#s ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address ON net ON ne's Name !� information is 3 p required for every Gc�.w�►�g &41 C/ Al v� l G / page. Qy1rown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sew Isposal System: Provide a view of the sewage disposal system, including ties to at least permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate whe ublic water supply enters the building. Check one of the boxes below. hand-sketch in the area below 4-1 + '�� µme- -'T� � � �•�. '� t i ,,..`°j.�'� L) t5rrs-3(13 Trtle5Official Irspection Form Subsuface Sewage Disposal System-Page 15 d 17 II 'll Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `L?W Ile Property Address Ow ner Ow ner's Name information is r� required for every (A 01 o"'I 00 page. Cdylrown State Zip Code Date of Insp6ction D. System Information (cons.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells f � _ Estimated depth to high ground water. feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ���Checked bserved site(abutting property/observation hole within 150 feet of SAS) with local Board of Health-explain: --// �l C,V1 f f / E S7L `7'0/f ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must dess be o"you established the high and r elevation: II �72 /l Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ns-W3 _rWeSOffieial IrspectionForm Subsurface Sevrageoisposd System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form•Not for Voluntary Assessments co A Property Address W�l � o'"rw owner's Name / hfomefion for �1 ci"I a 2"c J. required for every page. W own State Zip Code DWe of P== E. R.,epport Completeness Checklist LN �in�smectionm Sumary:A, B, C, D, or E checked L� h s. , ectron Summary D(System Failure Criteria Applicable to All Systems)completed L�l S m y Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file f6as•W3 TrUe50ffid9 trspe¢I MForm Suft0aw SnW0iV00d SYWM-Pace fl d 17 ,oFI"E rawti Town of Barnstable Regulatory Services BAENSTABLE, * Thomas F. Geiler, Director MASS. g 1639. Public Health Division tFD MA't A Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 P.J. &L. Tolan C/O JM Keehn Inc. Date: September 21, 2004 15300 Ventura Blvd#315 Sherman Oaks, Ca 914 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. Several months have passed by since you have been ordered to repair your "failed" septic system located at 4308 Main Street, Barnstable Ma. You are reminded that you are ordered to hire a professional engineer to design a replacement septic system and to hire a licensed septic installer to replace the system on or before November 1, 2004. You may request a hearing before the Board of Health if petition requesting same is received within ten days. Non-compliance may.result in a non-criminal ticket citation of 100 dollars. Each day's failure to comply with an order of the Health Agent shall constitute as a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health CC: Board of Health Ino—engineer_plan Town of Barnstable Department of Health, Safety, and Environmental Services BARNSTABM 1mr Public Health Division EDN10YA 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health TO: hs� DATE: J ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at '9309 rz'� (OA Gi„AIr-e,Q' ,cQ N4 was inspected on QcI 6e 11,7[SL& , by `t k n ����-, ��. a Massachuse is licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: L o n 1 u! CJL C1C�jrvo (�Vlo cm-b-fool. gwf ��) You are ordered to bring the septic system into compliance within s of the date of discovery. Therefore, the construction of replacement septic system component(s) must be completed on or before First, you must hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of proposed replacement septic system component(s) to the Town of Barnstable Public Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5. In the meantime, you shall ensure that no raw sewage discharges onto the surface of the ground or into any surface waters. You must maintain the system by hiring a licensed septage hauler to pump the septic system whenever it is necessary. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health gUrcellhl�filaVitle3i.doc L Town. of Barnstable = Department of Health, Safety, and Environmental Services =BAMST"B ' Public Health Division 1659. 1�A FD" 367 Main Street, Hyannis MA 02601 Office: 508-790.6265 Thomas A.McKean,RS,CHO FAX 508-790-6304 Director of Public Health yX ATE November 19, 1998 ' l�)•J�II2ONMENTAL G { The se tic stem owned b ou locat p'' sy `"' `~' A y y ed at 54308 Route 6A, Cummaquid, MA, was inspected on October 16, 1998, by Joseph Macomber, a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to an overloaded cesspool. • Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded cesspool. You are ordered to bring the septic system into compliance within forteen (14) days of the date of discovery. Therefore, the construction of replacement septic system component(s) " must=be com Ieted on:or•.before December3, 1998 f w.. �;7 :..:�,.� a .;• . em install .6 submit a s.'that will �` 0, a State.Environmental ..f =' In the meantune, you shall ensure that no raw sewage discharges onto the surface of the ground or into any surface waters. You must maintain the system by hiring a licensed septage hauler to pump the septic system whenever it is necessary. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OFT BOARD OF HEALTH omas A. MEKeanR.S�., C.00. Agent of the Board of Health ywmmA&eiawuesi.aoo ■ Complete items 1,2,and 3.Also complete A. S)6turr item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C.Pa pe of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? Cf Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No P. J-.& L'Tolan C/O JM Keehn Inc•r 15300 Ventura Blvd#315 Sherman Oaks, Ca 91403 3. Service Type ❑Certified Mall ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service label 7002 1000 0004 6683 2522 PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-1540 7�UN17TE� TATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address,and ZIP+4 in this box• I I Public Health Division Town Of Barnstable 200 Main Street Hyannis,Massachusetts 02601 I I I I I lilt I111111 lilt 11111„lili,ltI lilt 1ll1,11111IIIF,lilt 111i1l1l i I ru na m • . L ru m CO 0 F F I C I A L '\ Postage $ y � aa O Certified Fee `'z. a \aV 0 mDark O Return Receipt Fee OQ� Here (Endorsement Required) I O Restricted Delivery Fee O (Endorsement Required) \3cJQ� O r1 Total Postage S Fees $ i rul Sent O I P.J-%&; I L Tolan C/O JM Keehn Inc r` Strei or 15300 Ventura Blvd#315 , � III "� Sherman Oaks,.Ca 91403 Certified Mail Provides: s� 13 A mailing receipt o A unique identifier for your mailpiece o A signature upon delivery o A record of delivery kept by the Postal Service for two years i T; Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail or Priority Mailf_ o Certified Mail is not available for any class of international mail. F_ o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on,your Certified Mail receipt is required. Io 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". a n 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,April 2002(Reverse) 102595-02-M-1133 �y c voFIMErqy Town of Barnstable Regulatory Services * BARNSTABLE, * Thomas F. Geiler,Director MASS 9p �639 . Public Health Division t�ep-MA.t A Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 P.J.&L. Tolan C/O JM Keehn Inc Date: 4/28/04 15300 Ventura Blvd #315 Sherman Oaks, Ca 91403 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. The septic system owned by you located at 4308 Main St./Rte 6A, Barnstable, was inspected on, 10/23/98 by Joseph Macomber, a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: SAS was in hydraulic failure. Our records show that the system has been in a failed state for more than two years. r You are ordered to hire a professional engineer or registered sanitarian to prepare a plan of proposed replacement septic system component(s). This plan is to be submitted to the Town of Barnstable Public Health Division Office (Regulatory Services, 200 Main Street,Hyannis),within (90) days receipt of this letter. The plan will bring the septic system into compliance with 310 CMR 15.00,The State Environmental Code, Title V. You are also ordered to upgrade or replace the septic system within six months (180) days of your receipt of this letter. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as. provided for by the laws of the Commonwealth. You have the option of requesting an adjudicatory hearing pursuant to 310 CMR 15.422 Failure to comp with this order will automatically result in a public hearing scheduled before the Board of Health. F BOARD OF HEALTH as cKean, R.S., C.H.O. Agent of the Board of Health CC: Board of Health JAWed_septic_letters i T WN OF BA STABLE LOCATION72 SEWAGE# -�-( 3 'ILLAGE C �a;� ASSESSOR'S MAP&PARCEL INSTALLERS NAME k-PHONE NO. Cot--1?(- SEPTIC TANK CAPACITY tg! WW ` I� LEACHING FACILITY:(type) $00o,� [."grs (size) NO.OF BEDROOMS OWNER PERMIT DATE: `017616L COMPLIANCE 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 leaching facility) Feet FURNISHED BY Carc k (_and �c a�V�Yinq s;; a e Oi 3 -� %..�, 01 - ? Y � AN- /7' f 3 - 02- r3` No. � Fee -940f!5THE CGMMOINWEALTH OF MASSACHUSETTS Entered in computer: .PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIppYf cation for T3igpoga1 .pg;tem Construction Permit Application for a Permit to Construct(/Repair( ) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No.y3es Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 3 5-I a. A.P.�7�t /D`A1' 8 � _ ,7&60, Installer's Name,Address,and Tel.No. A� Designer's Name,Address and Tel.No. 7G6 0" P/7so9�14 /d /�=Jl N'II3 sa�'-7�9•"� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers v- yp g ( ) Cafeteria( ) Other Fixtures r Design Flow(min.required) �'S C) gpd Design flow provided 5'6 G gpd Plan Date �td r� /Q� �E GO(© Number o[Lf sheets Revision Date Title q?mAai*E 5~4-le D,j,&c&,,,6 e )5 X 0" Size of Septic Tank /�®>� Type of S.A.S. Z/" 4V0 C4 Z C44,w �. Description of Soil 5".,-e r K Nature of Repairs or Alterations(Answer when applicable) Date last inspected: k�k Vo 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 thiW, a gned Date 41,151 Application Approved;b .Date ® �D Application-Disapproved by: Date for the following-reasons Permit No. _�w(D '"Z�.3 'Date Issued /d 1p CNo. ` '�'%} Fee l Svi THE COM'MONWEALTH gfiA6. ACH•LSETTS Entered in computer. i Yes . PUBLIC HEALTHDIVISION+- TOWN OF BARNSTABLE, MASSACHUSETTS Application for Migozar *pgtem Construction Permit Application fora Permit to Construct 0 Repair O Upgrade O Abandon O Complete System ❑Individual Components-- Location Address or Lot No.7 36/3 A k e 611 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel le-v k'�e''� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. >_ r����N� /'Z i� CF.rrraiL L.ssva Jtir✓r `YLG CAL . /7u-d4 /+ �4 Type of Building: Dwelling No.of Bedrooms Lot Size l�/1 . y sq.ft. Garbage Grinder p.> r Other Type of Building J No.of Persons Showers( ) Cafeteria( ) Other Fixtures .,< 1` Design Flow(min.required). ! f S U gpd Design flow provided 5-6,G gpd Plan Date Number of sheets M !f ,., , Revision Date Title I SJ r�f�v}r G L�pSr��a/s' /f i..c�: c.�i.S'u. rc .�✓�3� l��i!'�c74� �� 5�`e Size of Septic Tank /ill d �� r r t ,Type of S MSS'7IV e d-A4 5-< Description of Soil `J Y f' / �1�� r,�' Ill,• Nature of Repairs o`r°Altera'tions(Answer when applicable) .'�� Ilwt,' I Id 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 oard-of H filth•. 91gne" d % � / Date r p Application Approved b f Date /® 6 6 Application Disapproved by: }; Date for the following reasons - } Permit No:eel-W(b 7 Date Issued c -_. _,-a .. ..•.� ,�- .n- •ate :,. �: _ � , THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( t_<Repaired ( ) Upgraded ( ) Abandoned( )by lja,-klo/A C!UJ j'e"t Afro-,/ A at ( G17 G5 � lwl, volm-f p[/i Z has been constructed in accordance y; �,„ J with the provisions.of Title 5 and the for Disposal System Construction Permit No. _ y 3 dated,4! /�"/b Installer �` � In- Designer M)C61 r,N #bedrooms Approved design flow gpd The issuance of this pe t sh not be construed as a guarantee that the syst m will fu i a sig ed. Date / Inspector ———No. v'"� " -� J 3 Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 1=i.5po!6a[ *pgtem Con6truction Permit Permission is hereby granted to Construct ((!) Repair ( ) Upgrade ( ) Abandon ( ) System located at 4130 XG /uvnryJ f�o c� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction mast be completed within three years of the date of trti this per . / Date �d/�/� Approved by� r r JUL,C CYJYJJ lrJ+11M'I Di"fCItJ iP1L7LL WI'T1L• vi Town of Barnstable Regulatory Services Thomas F.Geiler,Director use Public Health Division Thomas McKean,Director Zoo M. 9n Street,Hyannis,MA 02601 Oflim.508-662-4644 Fax; 508-794-6304 Installer& Destner__C�cs�o_ n rorm Date: Desiper: CM-i fi.= L414V 5t7VkV A Installer:. 3e1�10 � Address: )Orb P&V PLC N1 bV f� _ Address: Zl5_Zh-L; Y)A o Z56 y� I� �roo� On 1 d Ci6 , �/,/ / was iwued a permit to instaL.a e ( er septic system atq 3'qg7 r' G V(D�ed on a design drawn by e. LA-"v wOV W?"Stated I certify tbAv the septic system referenced above was installed substantially accor �nng to the desip,, which may iuclUde, Minor approved ehang@s such as lateral xe:ocsstion of the distribution box and/or septic tank. I certfl� that the septic system referenced above was installed with majar changes*(i,e, greater than 10' lateral relocation of the SAS or any vertical relocation of any cotuponent of the septic srtem)but in accordance with State da Local Regulations. Plan revisien or certified as-butt by designer to follow, i W cam ROGER M Onso-4 SiPAUL $ t1[r0 % MICHNIEtlVtGZ No.30420 CIVIL �Q�, um�p��Ca;3TE� InIdAl r(Desiper'it A x es� ,*SU up ere RVETUILK TO BARNSTABLE PUBLIC HEALTH DM.QION. Q:Hsalth/Sgd& 6jiXMW Catfi adox Forty i r: COMPLETE THIS SECTION • • ON DELIVERY ■ Completeitems 11,2,and 3.Also complete A. Signature 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. S. Re ived by( Tinted am C. D to of Delivery m Attach this card to the back of the mailpiece, or on the front If space permits. D. Is delivery address different from item 11 ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No jC7G�_r1 and W1IVA-Y-L" (�. U . T�)oX IGg5 s Service rtifiedd snail ❑Express Marl ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number ! 7 bb 6 B130 i G 010 2 i 1,i0 4111 9 NA 61 i 1 (Transfer from service label) PS Form 3811,February 2004 Domestic Return Receipt 102595-02W-15'40 UNITED STATES I I • Sender: Please print your name, address, and ZIP+4,in iS box • �` I a I II "Town of Barnstable �, t I Public Health Division , 200 Main Street p "� I Hyannis,MA 02601 �. ���rrrrtlr/r�lrlt�tlrrlr��rlrr��larrJlrrrirl.rll�rrrlll�rt�rlll pf'YV'1ff1 CO rq OFFICIAL USE p Postage $ r-q � hAV 1 Certified Fee ti Postmark O p R Receipt Fee �o Here > p (Endorsement Required) p Restricted Delivery Fee Jt7N 7 D p (Endorsement Required) " rq Total Postage&Fees f1J US' .. Ylt Stree p t Apt No., f- or ----PO Box No. tare, r 0 D b—60 MM IS. Certified Mail Provides: o A mailing receipt • A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: a Certified Mail may ONLY be combined with First-Class Made or Priority Mafia. o Certified Mail is not available for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consideQnsured or Registered Mail. a For an additional fee,a,Retum 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 LISPS®postmark on your Certified Mail receipt is required. e For an additional,feedelivery may be restricted to the addressee or addressee's authorized.agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". a If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 Certified Mail#7006'2150 0002 1041 9846 P��z lati Town of Barnstable 0 ' Regulatory Services * BARNS-TABLE, ` 9 MASS. Thomas F. Geiler,Director Qj i67q. �� Public Health Division Thomas McKean,Director 200 Main.Street, Hyannis, MA 02601 a Office: 508-862-4644 Fax: 508-790-6304 June 16, 2008 Joan and Whitney Wright y t o P.O. Box 1045 t_eVL--t, s Barnstable, MA 02630 J - 1/�.Arti A^AOr._, NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY (o CODE I1 - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 4308 Main Street, Barnstable,was inspected on June 13, 2008 by Jaime Cabot, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. ,The following violations of the State Sanitary Code were observed: 1105 CMR 410.500-Owner's Responsibility to Maintain Structural Elements Door threshold is worn. X1 105 CMR 410.280-Natural and Mechanical Ventilation Bathroom fan not working. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by fixing the door threshold and the bathroom fan. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. 'Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak'with the inspector who performed the inspection. dPERJ,OER OF HE BOARD OF HEALTH cKea , R.S., CHO QAOrder letters\Housing violations\Rental ordinance\4308 Main Street.doc i FORM 30 C&w HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN F N J7 W DEPARTMENT 0 Z.D O fl"g J N SST. I'I v A/V N / S ADDRESA TELEPHO Address /3� M AI /Q S,7, ��-^'S14 9�f_ Occupant—SST A g ds Floor �-Apartment No. No.of Occupants R No.of Habitable Rooms_No.Sleeping Rooms Z No. dwelling or rooming units ! No.Stories Name and address of owner CT pNL\J ".:(Z i c4 G >C 16 q< 17 A raj 5jfa Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers.- Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: t�✓LS(4 r, 2►�$ Roof 0L._j;.jf-2S 8S 0f.�• ,L•Z 'Tv \LlA P-j"C2•k N 1 D� Gutters, Drains: &T y2U c! L;rV^,F Tj - Walls: Foundation.- Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair { TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels,Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen. Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom fl'( L...) p Pantry Den Living Room Bedroom 1 I Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Su Gas, Oil, Elect.: St afeties: Kitchen Facilities Sink l -& Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub.- Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted 0 k 4 T PO 04 . ZQ 'Ps�c Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES O ERJUA% INSPECTOR TITLE DATE 06 TIME �', P.M. r THE NEXT SCHEDULED REINSPECTION �� P.M. 1 t 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation,any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is riot included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR.410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold,to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. t (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 4101150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. i� } :°o(0" QW U0-7 Wright Residence ' S6<ee nokn Arre Owwx�g sneer Deseptnn ARCHITECT . 4308 Main Street / Route 6A t1 Lwdea°° E4nd- 51Ii%°° THE DESIGN INITIATIVE,INC AO Site%en Site Plan Cummaquid, MA 02637 AI weodn Fwr er Ele atiov 99 CTu nySte Sulte9W/Be teq Ma ahu t @lll p 4 Ai Rewmenr dw%an V\VU AO Irt slew Plan/VAndwv&Door khadWar 617.654.1665 phone A4 H.- 2nd flo«PI,,,, 617.C59.1666fra A6 Houw 0.w1%en - Construction Document Set A6 Ho. ¢ttwmmr1CP RC➢ L Ai P ///''��� All I Novw ]d fl PCP /{ May 11 2007 "° Ho..: A9 E E Hours E#ena Elm IANDSCAPE ARCHITECT A10All Heuw WeI15x4wa&Dwails L a•A landsnpe Arch"d' arnnv«.w aawm.,r M Washington SL,2nd Floor East Ala Baru 6hw Irc%ow Pl.nwn Provid¢nce,RI Q.9 ` A14 awnn✓dr a w Rwi%.n 401.331.0347 te1 _ A1s a.rNW«kaw —fi,El«.uma 401.331.1739 tax / O I wMVw w (i An e..«wwka w Al Hovw Irrtadw Elm �•! a/� Hevw A30 House ° Ail Neuw FI dwa - S AEI Heuw I Flmema \(� ' 51 Houw 5 IFramne&Fwndatlm%ena - ' .pn/1/ 53 aarnN✓waw $Wcw1.1iramin9&iwndatlm a V h '- J N K 9 `s \ \ \ _ I 1 1� 1 f tII 111111 ga 1 e z3 f �B i N Iv A' THE DESIGN INITIATIVE,INC - W Cheu^ry Street Sefte 909,HataM1 M wlh eett M111 617.6541665 phone 61I.6541fi66 f L M — sQ THE DESIGN INITIATIVE,INC 99Chawuy Street Suite 504/Baton MasazhuY�01111 617.6541666 phone § 8 o 0 617.6541666 fv- L - F J •1 i ^ L. e �� I � `�` + IIII IIIII IIII 1111 g � O I - 1 11 Lwnr�1 II 1, 11 , > 4 / --- — J 'A CJ l I I q c •a ee — dIiYl �a i t•a a yt aaa I- .iSR c ' 1 11 l_ —11 - Pfli r,rr h'Mrt � .. °� 9 4y2 75 7 S. P CPt Fi:igg - 1 1 ', } r:1f pp it al�gi�•i t T II: n f alto 1 ' . a m ,91 �a£ SI n THE DESIGN INITIATIVE,INC a ?c spcna,a ysme wne sw/i+m'ron lrlessachuxtts U2ul 617.65C1665 phone - 9 617.6511666E . L UL sv+ -- -- d GUEST BEDROOM A I R20 g GUEST PIO .. ..�....« ..A> i .._ STAIR a ..... �-v d a 0" 5 AYO 3 P9 Y .. V i- -- ----- '9 Ala .A20 BRIDGE R 10 \ PORCH HAu AID TERRACE n A9 $e9.00 A9 0?➢ A19 © Construction A10 © KITCHEN me Document Set DINING O ©® P!tlffi x�i - % ° ROOM / MASTER Proiecl Neme: AID -- !! '] ] 40 BEUROO Wright Residents ! / / n.B. P21 6A B l /R Cummenui0MA Oule 02637 NO Crewing RI.: ® O HIM Flom Plan ,e als O ® e ,\ BATHqpOM CIL /// O O ul nao:'I scelB. A21 JBaR's All Wft"' c TM awce.e MAA w cDT O D.I.:w t I.20W GAR MobsRoo Isau.Del.el 0 Q �, eaemBrce,a Imes...] O t. IO.OBa6le.91v Pa°.,ga . A9' IOa]10619.IeIMiOvwreg B Ilm.a tea anpF Ra.ae... P9 / aa..5• � � uroro]lea 6m B,Eni� IQ aRSa]I RBYISla Q Am Frst FlDar Ilan \\ Scale:l/4'_1'-0' A3 J r- n I DES PEA 1 aEsce,u — 1111 Iil ; ' - Z + Yun ,A10 _ 111 �NI 111 W y QD A20 y '. 11 9�aWll 1111 > M 111 1 11 F � — 11 1 1 V �� IL 1 111 W V . © A20 A20 AIO A9 i droom Lofl Plan / 04 ale: _ / / - / 1 A9 / Construction Document Set / / ONfIN19HE0 + I ` Prolecl Neme', / 1 Wright Pestilence I 430e Maln Street I Route 6A DUmmaQUld.MA 02637 /ram ® stunt O I , / 11 11 / 1 1 Dmuirlg ial¢: Second Flom Plan / ® / •� 1 1 Scale: ' SR / ¢ �' /// n• / ® ® 11 1 acmeW MAA Dete:Nby 11,20D7 / I J Issue Delta: I / / ltaznslaal�tnKa.sa„�. p0 aazo7lna..a 0�Lecond Floor Plan A4 Seate:d 1'-0' , J , a ' , , 1 I , 1 L , , , r �_r , r , r r � , r r i r , , 1 1 1 1 1 1 _ 1 1 1 , 1 1 1 l 1 1 1 i 1 1 — m �e THE DESIGN INITIATIVE,INC � = 4 a 6 � _ g n ➢�� m � �cneun<y sheet sane sw/>�emn Maseen�:et�ozul- - . a' v 617.6541665 phone § [n 9 A= 617.6511666 I., L l— r HER ' 1 1 D ova= �- a, I , r r , f 8 r i , / 1 I I T ` ¢ I , 1 is 1 ` 1 1 I , . I r � . r I a g THE DESIGN INITIATIVE,INC - D99chawc7 slmcswl<sa/Bcsron nfaaad—lrs Dial 69.6541fi65 ph.. 617.6541666 f. n L GUe oeooM—, Esc g LII ..._ . '� �- , . ,Aal/w fCA4bt[C :::. .:: ...:. --_.I - ......_...: X 1 STAIR n _V. BATH *' _. LID .. Ce :.... sn' ------------------ ._ w Le V ti --------------- .r. ''.i 1 .. .... 0II (L4b _ L IIq/' P PORCH Lob \ 1 LID 9 P LIZ LS \ construction LevdDsi _„_ i Document Set �( Ls KITCHEN�` / / I / - - L113) -9 . Pmiect Name: - / /L/7f3 // L3/ p `�/ '_j 7 Wright RBSIdaMa. ® L!L7)\ /�/ //L ; /' 13 - \L a 430e Main Straet/Route 6A - MASTER Cummaquid.MA o- �// LIVING 13 - 1 BEDROOM 02637 B1N fl1 I\ /� DININ pb R \�L\ \� LI(Z) 10 Le 0 ,Ll mmmwu' m FIrl Flom Reflected 6 1 LID / 1 __ Calling Plan MUD /Loa - L12 - // O! ��' LP3) . Stele: FM 'L / / 1 Y MASTER \ I /WA KJTN 1/4'=1'-0' \ L2a L5- ® b I \ _� \ Za / L _ LB q 1 FO R / LZb \ I I WALK-IN`\ own SR / / `II 1 GL93EI lJ Lll --by:MAA IL5 6/ dLII DeIa:AAaY II,2007 La Lllq, / s� UPPER 1 Issue Dales: I GARAGE � 6/26MICmtl Isla Tray / /'/ / IOaeIX/gtliv Oer�ps. L6 � 1 Ie1111061�rltlti0virpa 1 - I IRllee ltla 1.0 ft.awe. S u101011 Ba 6tl6�brbsion eD...nereetl / �1 Rrst Roo R'eflecled Ceiling flan - - /� - Scale:v4'=4'0' /1'+� ' J d � 1 . a 9 . o S m I O0.\ ,e le s . - - D • I I d � � 9• I I / i d THE DESIGN INITIATIVE.INC � a S s s am p2 -- aN m �_ spcnawcr sreec wire ax�a«ma nr� ,Y�ozui > a - B 5 g n m ' �� 67.5541665 ph— 6t].65Ul fim warn �;; R .,n-neeyenaiea I v _ 4� a .-- m° — - - - - - _ - -- — M� — w� W � � �b o� S. Eil _ a r W U � � t I I I t I I t I I t • a�r oar n Sectlori-lower /01 Section-Tower n Sedion-Oarape ^Section-Garage , L/�vd•-ra LJ�caie:vd•=r-o' swe:a/4•. -c.. `/��cale:/4•=r-0' Construction Document Set au a v. - Proletl Name: wrldm Reetderms 4309 Main Sueel I Route 6A Cummaeuid,MA 02637 ww Drawing Tdle: SuPtUn8 Sectfone Fiat NOT USED nSecdan-Bathroom .' S ale: wre°o.— _ tl§+l rrougm nnrt�"nis.1 Pe4e. ]4:12. r Im vim` narnerm�r im�no�®ee annn M: SR axctaeh MAA Date:Nby u.2007 / / ' 626N61 Ca�tl lmeeery im�aen,otl 1 �/a7��---�� I 1�— it nwnms. �0"°6ir"el I II' dPw"°°�eM1i ter. lous.arwelm a..we. � I 11 �wma �I I II II earmeam'oreago I I I I I I �I �I nmus me N�ge xd.ea�. i I I I I I I I I I I I ulororr 6e 5•aawslm — Spa9lleereetl i w� - - - = - - - - - - A8 Q5 Sectlon-Kitchen 6 Sedion•Dinlnp Room (1Secdon-LNlnp Ro /1Sectlon-Master Bedroom 10 Section-Bd e sca e:I'-•-0• we:vd',r-0• scelea -. om Ll3we:./',r-0• ra e:vd•_r J r 6 Y 0' >nre aPs PN8-u—O MM1eeM No n e • ee3e y - 1IMN 9 C lm �huR ff, ,ki .kr I d1:�de!IPpI'8l 9e11/W C eC:�ep o1P@II9e90'w C C (ae�V:aIP�Jl9w9tA ,. . . . . . . . . .. .. . . . . . . . ... :selep snail . 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V9 eM.8I I-Is u."Back —.—.— —.—. — _._. eweplsey WBI1pA .weN Pelad 1 I las luawnpoa uoilondlsuoa - z - z . o-.l'.vn:yns n .o-.l wooy ulna 9 eoueilu3-uopenel3 41ooS a ue4P11M 4 e ereo-uonetel3>aeB410o5 L P L C LLi8o ® ® ® P DC � m R ^ L s - _ .J F �ED Om� I �� vo I C 3 I j I i I I " I I I I I I I•- I I I I I j I i j c i I ma b= I � I I j I �gAl "I I j a I i I " I 02 I I j m ®® 64 �® w a 1 ®® I v a s I I 0 a 5 I 3 I I I I j - I I j I I I I y o \g " F a obi �3 = THE DESIGN INITIATIVE,INC D , sus. m o fl � � g s � o > � m. _— 99Chawcy Street Suite SO4/&start Masadoxtti 02lll °1 v m Vfj 617.6641665 phone 61ZOC 66Fex L � r g o a a aEU00 OM N O 6 ' . a THE DESIGN INITIATIVE,INC 99Chauwy StmeL Suite 904/3mtom Ma h—tte 02111 617.ffiC1665 phone V - _ 61I.65U1 f L Y M j I � —s -d o� o m I I I I & I 1 I I I I 6ulr I I I I I I I I I I � I I I I I I a I I it I I 1 I O I I I I I � ---------------------- ----------------------- - rLL_i ---- I lIg I I I I I I I I I I I I I I I I I I I I I I I I I I I I 1 I I I I I I I I I I I r I I I I I L—————-—————--— --——I ---- ---J I I . 7Y7� s. I I � . - 5 THE DESIGN INITIATIVE,INC ci 52 ss'chawcy'stcac swm sa/emron 69.041666 ptn`re N _ — 617.6641666 E. L - 4 � A IS p6 m � 1 F moon I I y . o _ o O--J J I I e---�. 0 ` N r; I O I ..I. I I I I I w I I l I T I m I I I I I I I I I O I I 0 Q O _I _ m 9 p HI a �e f 9 SIP THE DESIGN INITIATIVE,INC - 3 g? 3 a S N eg 99 Ch-7 Sheet suite 904/BW-M—ch—tb 02111 G °� 5 - g a _ as _ W a a o a 6 7.6641665 617.654I6661666 fm L Y a Y APO y (------------- ------------- - r y 9 I I I — I I v I I I I I I ' m I I I I I 1 I 1 1 I I I I - 1111:It lllltl I � I I —► I I I I I I I I I I I 1 1 I I I I I I I I I I i L----------------------- I I I i I I 1 r-L--------------------------1----� I I I I I I I I ala I. I 1 I I 1 I 1 I I I I I I I r I L. I 1 I P I I I I ` L---------------------------------� mm m R THE DESIGN INITIATIVE,INC _ D m a d g a 3 3^ WCha..cy St—t suite RA/B.I.,M—h—m 02111 ,, ' c s m 617.6541665 phone — 6I9.6541666 L I I i i I jo i------------------ q i --- ® j j i � i of o £ j 3i j - j i I i li i j I I M1 j------ - I I o i II i I I I I mI li I I s� - I s I _ - I I al r I j o I � 'aV rs � � o m �,! _ mm � _ � � THE DESIGN INITIATIVE,INC WCM YSt-t Safe B.W.00/ Masa[h..M02Ill MR 617.65CI665 phone 617.65a1666t l L _ EF In I i I jib �I; ® ® FFFHI i _ I I i d fw i I i _ I j ®EM i ®� i 12 iF VA hmi III of ®EEO Mi - - F� a j s --- i S > i ! I A� mif 1 .r3a= 2 c� THE DESIGN INITIATIVE.INC 99Ch,—yStreet Swie904/Berton MesuhtwftO2lll 617.65C1665 phone 611.654.1666f L 3 g f / ---------- rmnlmea -- �L14 LI4 04 L14 1 T L16 T L16 a A_ n 1\ sa,am s5Mn1 scam I \ UPPER / — \�\ OPEN TO .I 1 BARN I - WOODS HOP 1 1 1 § o \ \ \ I \ * z I ^\ GAME ROOM J—I \u Lk - s 'L5 is Construction Document Set aeo�E mnl a q�unpmmo�n------- !� Q L6 M TAL T L6 j —Ho L5 �� o• \ Proleal Name:' WOOD SHOP Wright Residence 430e Main Svael/flouts 6A Cummaeuie,MA �Sonm I 0263] I �1 SFlcrslat'.F1l/o4o'r=R1C'-0 Milano,mP - �a _-- Dra»lag Tale: L5 I - Flral Float Reflected \ Ceiling Plan 1 � Scale: 1 I/4'=l'-0' a , l� L6 L6 L6 awn SR o. by:MAA I Del.:Wy 11,2OW Issue Dales', - .a6llbtlb Per�ps O Isntlos lBontlMlOniryz 11R}g61ptl Knye Ntl.6bn. oror r ea stl aaa� BASEMENT iQ SRSel laeraee �6imalONm-amuln--------— . 2 Basemerd RCP/I'm -Workshop A17 Scale:ll4'=I'-o' J o � 8 = m O ell © I F rl Nolth Eienllon-Dining&Living Roam - 2 Eeal Elonggn-Linn Room araa 1 _ 9tAe�,1?•1'd Construction Document Set �roimcxa Prgetl No— Wright Residence I 4306 Main SD..I7 Route 6A I Cummeg id,MA / \ 02637 D Interior Tlle: 1lnerlor Elevations O South Elevallon-LMn &Dlnln Room Scole. 3 s�,lx,rz•I,o A WeaE Elnatlon-Clain Roam swv lrz-ra- uany: SR a.c4d Ay:MAA Del.:May 11,2007 '- E baua Dal.a: 7 J ( �AI `1 t �"F ae.mu esw�aa..y .psi �' ;} tiFE 11 J• it, • . .. .,. ronrnslmwmlvre.w. .i..Fw k l.0."" Y., nw Ik ,,.� _ xI. �t�t?Hv. i- •..��1 d'tiG-...:xl �,.ilf a I.i �. j�'�� y�x�.�..� tlRaGaltld Knpl Np.Ebn. .I !1�{��"p�'I'y' yl;�l�l-1�:1;�!f { �°h' { ` •i.�;,ri:g � 1.,1�81r r.�!�kn`.`r•�� ;ll. I .rl^i I l�f� °a {�It` �L�H,'. ft / � ri fll f ; / \ it �LkJf N. i� fff ja�l b I t �� � l I, i ikil 1F iif +�itk , � i I✓ I- ( d \�� t d li..-11"�Mt.hoaalE-Plo veon-Porch smm l¢•rc NswONchWeC aEleatllon Pomh R mNvrBleaac EleMlon-Pomh A w R 5 saa,m•r & a ` J 3 9 3 �a9 q7 3 9 'ss v 9 C Sm 3 a� 0 3 3 6 "�. THE DESIGN INITIATIVE,INC v9cn.urcy start suite soe/&stop Ma—d,es•la miu 617.6S43665 phone 617.6541666 fe . s _ V $ ^.West Elevativn-Guasl Betlroom /-1 NorfA Elevatlen-Guest Eleaallon-Bddve , saair.irz.rw - L`/soa e:irz-i.a L°l xalv.trz.r.r sala.ra.rm - � 8oNA Eleoallon-Guest BaNraam West Elmllon-Guest BatAroam Nodh Elmtlon-Gush Ba8lroam East ElnaBon-Gnosl Balh... n Nodh EleeaBon-Resatl's Closet - 10 Easl Elerallan-Resmll's Clonl a 11 Not Used - 8 seas ra-x-o 8 scale.+rr-ry 7 srbv.i¢-i s — 8 suiv:irzor ee:err-ro snare.tn.r.o see.irz-ro - Construction 0 0 0 0 0 0 0 0- 0 '0 0 0 Document Set . a Pmlecl Name. Wright HesIdairee - 4308 Main Strael/Route 6A - - •• Cumm pid,MA 02637 e Drawing Tile: / - Interior Elevations _------- ____ SR w by:MAA Dale N1.It,3007 ' � Issue oaten. Soutll Eleaativn-P—olf.Bedrsvm Nodh Elavatlon•Reseofl's Bedroom 12 saia:i¢.ra 13 srdm.irz.�.o mususraww o:wnsa . mmusrmlam�oa.wa =Ld OD . � - rlmua rae awes nd.swn. \ \ uwro7vea se �� � l sasurrnea,aa a / 14 SsutAEleoallon-Resootl's BalMmm nWest Elevetlan-Resntl's BeUrrom Nodh Elevatlon-R.-tt's Batllrrom Soath;E1.1 ion-Ramoms Bedroom NorlA Elevellon-RattalYS Bedroom - s�as.lrr-r-s l'J smeary-ra' 18 sma.+a-rvo 17 s�lelrz-rr 18 sws.rrz-rr . J i. •. i, �n m yz 3 / a' I 3 \ \ / \ , Ell Ll b eT 3 N O a9 ;� 3 2— Ell on 3 e E a G S � a m i 3 �m s o i a `3 I� 3 3 q3 � 3 II 3 u / '3 on \ 3 � I ym I y� I . o� I I 2 I I a _ I I 3 n I 3 I — I 3 3 I I' I G 3 I 3 I I I THE DESIGN INITIATIVE,INC 990awrcy street suite 4Df/satort Masazhurtfs QLlll 617.65klM5 phone '� 9 � • _ 617.65416fi6 I. . 3 an - a3 H z I I S y 3 m I I m I I � I I I I I I I , ©E= I I I I I am �n q$ 4 0 8 fla s S� -n 3 • am §9 , n 3 - m mm� THE DESIGN INITIATIVE,INC N 9schawcr sccac style son/eacpa uase��nm ozvl >_ � , 6V.65416Bi phone 9 A m 617.5641666 fs, L r!1?Yn11111ii1itill - 111611.111 ll i�1 1 111 ;a�U; Illll�l�l�llllillllliii g K y`u'U 52 Irf ry52 23 c \7 y/ p\ o ; z lijillligii — / ial 1a1i Ilii - 1 1 ! a 5 8—e g2 11yy.gg�� 1ii 1 f 1 1 l 9g�3s = �111 . 11 1 1 1''11 9 2 3. 11111111j�11111.. - 11 01 vk r nlll iiiiE�illl 11i ' 1 1 1 � — 111111 11111 . .. - 111 111 •.. a 11 1 - iiilll.l - 1 1 3 J� 11111 • IL ter"— a' a SI 3; �R THE DESIGN INITIATIVE,INC e d 3 — — cn m o sscheuncy street site ran/Baron�%sed+usem oily 617.6541665 phone � - •� f _ 61f.65416fi6 fax . _J (causpnl 31 ______r �_4- htl9fvl6 gy r �T'rllT rrlT l"1T IF1Ti�—. - _ ?II I I I I I I 1 1 1 Ili I I I I I I I I I I i�� le �I rrn r rl T ri;�Trn Q '�IIIIIIIIIIPIIII ILl-L11 11.L11. 11.LI1.L11. 1. Ll t : � IIII IIIII11111 IIIIIII'�_ - � ' " IIII I III 11 16zl I I I I I I I I I I� n� �' I r nrnirP��rn�r Trnl � v IillIlllliillllilll IIII � ' i Ili I I I I I I I I I�I I I I I I I I I I IIII a - n Y N ._._._._ ------- m -M- 9-1 zz It S 9.♦2 1 S — L ._ Y a � X�t� — a � I l 4r P7"q I I n I I I iry� I Itl I I I I 3 �AYM �s I I S I I IIi I lil 1 IY I I ia'9 y 1 I I I Ie �l ICI I I � q I I _ I I Ise I IYI I Z I 1 1 z14 1 II � �Yr 9 aids a a Se SIR ��d Pt£ 3 � $ m g m 3=� THE DESIGN INITIATIVE,INC - d �_ Wcna�a�arsla�cswlesa mnrao�emngh,seMozly 'N _ g g a '= Q � '$' 617.6541665 phon 9 a o 617.65416666. - L z 348. 659 605 Receipt for Certified Mail e No Insurance Coverage Provided uMTEO STATES Do not use for International Mail OOSTILLSERVICE (See Reverse) M Sent to L Str et nd N m � 2 P State and ZIP Code �a o Co G� _QZ (6Z Q Postage M E Certified Fee O lL Special Delivery Fee CA If{es ride LQe vie Yy I�eF Ifiejyr,.nt„ecelpiy wfr�g to Whom&Date Delivered Return Receipt Showing to Whom, Date,and Addressee's Address TOTAL Postage �t &Fees $ Z Postmark or Date ,,/r1?19� STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, _ CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(no extra charge). a CC 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address of the article,date,detach and retain the receipt,and mail the article. 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. C 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, M endorse RESTRICTED DELIVERY on the front of the article. £ ` 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If ti IM return receipt is requested,check the applicable blocks in item 1 of Form 3811. to I a 6. Save this receipt and present it if you make inquiry. 105603-93-13-0218 d SENDER: .0 ■Complete items 1 and/or 2 for additional services. I also wish to receive the y ■Complete items 3,4a,and 4b. following services(for an d ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. d � ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address 4) permit. d ■Write°Return Receipt Requested'on the mailpiece below the article number. 2, ❑ Restricted Delivery to c ■The Return Receipt will show to whom the article was delivered.and the date « delivered. Consult postmaster for fee. 0 a 3.Article Addressed to: 4a.Article Number 0 7-3lZ y06 S N�1 GC-1 � �y01�1 f 4b.Service Type «' ��// v ❑ Registered Certified W Z 3p, 6f� m ❑ Express ured y cGw�m ,a � /I 02 63 0 ❑ Return R ceOorMerchandise C o a lir /T 7.Date of, alive w ZC , 0 5. ived :(Prin e) 8.Address eWaid' ed W and fee is,6.Sig `ur essee o no �` , tt I Tttlll i 4 Il I t i f i its It N -, PS Form 811, December 1994., .... Domestic Return Receipt T UNITED STATES POSTAL SERVICE �°4 First-C ail >� p. Posfagees Paid i� LISPS Permit No.G710 e Print our name, adr ss,, nd ZIP Code in this box • Y r, P4blic Health Division Town of Bamstabie PO Box 534 Hyannis, Massachusetts 02601 Fax(508) 775-3344 Phone(508) 790-6265 i Iif!'t113111F��F1��l I!!!lI111.33!!I 1111!"!3�!!�l3�1S11Fi�1!�3�� i Zoo Fee--Z/= ---/---- BOARD OF HEALTH TOWN OF BARNSTABLE 0ppCication-*rWell Conotruction Permit , Application is he eby made for a permit,to Construct (�Alter ( ), or Repair ( )an individual Well at: xM&I------------ ----------------------------------- LoQtion — Address— ' sse;ssors Map Parcel O er Address -------- ---- -- - ---- -—--- --------------- Installer — Driller �`` Addre Type of Building Dwelling------ ------------------------------------------------- Other - Type of Building ----------- No. of Persons----------------------------__—__________ Type of of Well- -= - ---- - — Ca acitY---- S 6AA — -- - - - - --- - Purpose of Well------ �-/-------------------— — --- 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 pliance has been issued by the Board of Health. Signedunt' a- ----— - -— ------------- 0_---- date Application Approved By--- --- -�=--- - ------------- date Application Disapproved for the following reasons:---------------------------=---------------------______________—____—_________ -----------— -- ----------_ --_--— ------ ------------------------------------------------------------ date Lv Zoo Permit No. ----------- -- — Issued ---- —= -- - - — — --------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS "1 0? CeERTJFY, T the Individual Well Constructed (G')!Altered ( ), or Repaired ( ) by--------- ------------------------------------------------------------------------------------------ ------- -------- Installer ------- has been installed in accordance with the provision of the Town of Barnstable Board of Health Private Well Protection , Regulation as described in the application for Well Construction Permit No. -------------------------Dated------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------—------—----------------------- — -- Inspector------------------------------------------------------------------------ - r_ No. - - �3 Fee-- BOARD OF HEALTH y " + TOWN OF BARNSTABLE Application,for Melt Construct ion Permit Application is hereby made for a permit to Construct Alter ( ), or Repair ( )an individual Well at: P p o L!S_at �//17A7g3� Assqssors Mapa9d Parcel — -------- - ` Owner � � �Address i. / Installer — Driller Addres� Type of Building 1 Dwelling -—`--------------------------------------------------- Other - Type-of Building ---------- No. of Persons----------------------------- C S2 Capacity Type of Well- -- ------ - ---- -- - -- - ;- - - - - - - --— Purpose of Well ------ i 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 Ce tifi a a f mpliance has been issued by the Board of Health. - - - ----- — -6 Signed -- -------- -,-- -----�- __ date Application Approved By-- --------- date Application Disapproved for the following reasons:------"-------------------------------------------------------__—_-------____-- Permit No. _t/lI 20 0 - --- -�__- Issued------��--- _---2 y _ _ O O_date-____-___ � date --------------------------------------------------------------------------------------------------------s BOARD OF HEALTH TOWN OF BARNSTABLE C ertif irate Of Compliance THIS IS TO�ERT FY, T a the Individu 1 Well Constructed (!. Altered ( ), or Repaired - bY---------- - -- l ciit--`'---------------- - - - ------------- --- ------------------------------------------------------------------------ Installer w at -- ------------------------ - --- --------------------- - -- ---- i has been installed in accordance with the provision/of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -------------------------Dated------------------------ ` THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------- - —------------------------- - -- Inspector------------------------------------ ------------------------------------- -a---------------------_-®_---a---------- -------- BOARD OF HEALTH TOWN OF BARNSTABLE Vell Construct ion Permit 1,%� Zo0S- 43 No. ---------------- Fee----- --- Permission is hereby granted _ C`td_ ---- ----- -''- - ----------------------------- to Construct (L.�Alter ( ), or/Repair ( ) an Individual Well at: r No. - —��- - - -- 1�" .t? lJ� - - -------------------------------------------------------------------------------- Street as shown on the amp lication for a Well Construction Permit Gv boa - -��--------- - Dated -- l® Z - ---- -----_ _-_------ -' a-'_-- - -- - ----------- - ----- - - Board of Health la �2 �J Zang DATE------------------------ -------- l / f` - t1 l v b � C _ S TfEEi COMMON-YEALTII OF MASSA.CHUSETTS d DEPARTN TENT OF ENVIRONMENTAL PROTECTION y; BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualificatigns as required and is hereby authorized to use the title CERT { i D TITLE 5 SYSTEM INSPECTOR as provided ire 310 CMR 15.340 and .Section 13 of Chapter 21 A of the General Laws. Issued by The Department of Environmental Protection. lunc 8- ISMS -- --- A(un}{ (>lrcclor of (tic O c �on �( Watt {'ollulim) Coolrol It� c DATE: 10/•1.5/98 PROPERTY ADDRESS: 430-8- Route. 6A Cummaquid,Mass. Cottage On the above date, I Inspected the &eptic system at the above address. This system consists of the following: 1 . 1 -6 'x6 ' •block ,cesspool . based bn my Inec&ctlon, I certify the following conditions: 2 . This is not a title five septic system: 3 . This ' is sewage system 't•hat is' in hydraulic failure: Waste water is over the in vert P i e P 4 . •The system must be upgraded to a title five septic system.. ( 95 Code ) SIGNATURE: I" , Name _J P Macomber Jr• Company:_`• p_MacoMber & Son 'Ync •---- ttlY. --=---- , Address: • ent1 eLMasgi_02b32 Phone:__�SQ8.�Z7 -5-.3338_______ •, I THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC, Tinki-'CeupoolrLs&chtlelds Pumped 1, Init4IIW ' ' Town Sower Connections P.O. Box 66' Centerville, MA 02632.0066 77.5.33U 775-6412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS > DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617.292.5500 J i W1LL1ANI F.WELD TRUDY CO) Govcmor Sccrcu ARGEO PAUL CELLUCCI DAVID B.STRUI Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissior PART A CERTIFICATION , Property Address: 4308 Route 6A Cummaquid,MasS Address of Owner: Date of Inspection-1 0/15/9 8 (If different) > Name of Inspector: Joseph P.Macomber Jr. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 15j1Q06)J Company Name: J.P.Macomber & Son Inc. 2 2 1998 I b, Mailing Address: BOX 66 Centerville,Mass, 02632 END Telephone Number: c,()R_7 7 S_3'j 3 It CERTIFICATION STATEMENT I cenify that I have personally inspected the sewage disposal system at this address and that the info a ion true, accurate and complete as of the time of inspection. The inspection was performed based on my training and ex n i t per function and maintenance of on-site sewage disposal systems. The system: _ Passes _ Conditionally Passes _Aeeds.Further Evaluation By the Local Approving Authority :/ Fail Inspector's Signature: /• Date: P g The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection. The original should be sent to the system owne and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A) SYSTEM PASSES: A , I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B) SYSTEM CONDITIONALLY PASSES: One or more system components as.described in the 'Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes no, or not d (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The tic tan is metal, unless the owner or operator has provided the system inspector with a copy of a Cenificate of e,. -" Com fiance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; of the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/15/$7) Page 1 of 10 DEP on the World Wide Web: http./t.ww.rnagnet.state.ma.ws/Oep Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) P(opertyAddress: 4308 Route 6A Cummaquid,Mass. Cottage Owner: Nancy Hopkins Date of In tpeet)on: 1 0/1 5/9 8 B) SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in th distribution box s due to broken or obstructed pipets) or due to a broken, scaled or uneven distribution box. The system will pass inspection i((with approval of the Board of Health). Describe observations: broken pipes) are replaced obstruction is removed distribution box Is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken plpe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: d)P Conditions exist which require further evaluation by the Board of Health In order to determine if the system is (ailing to procect IN public health, safety and the environment. t) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENTi a Cesspool or privy is within 50 feet of a surface water dj' Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 1) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THA THE SYSTEM 15 FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. N,�j The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SA5 is Iess than 100 feel but So feet or more from a private water supply well, unless a well water analysis for eoli(orm bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nivogen is equal to or less than 5 ppm. Method used to determine distance _ �� (approximation not valid). )) OTHER SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Propcny Address: 4308 Route 6A Cummaquid,Mass. Cottage owner: Nancy Hopkins Date of Inspection: 10 . 15/98 DI SYSTEM FAILS: Yo must indicate ci;%.er 'Yes' or 'No' as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below, The Board of Health should be contacted to determine what will be necessary to Corr( the failure. Yes No Backup of sewage into facility or system gomponent due to an overloaded or clogged SAS or cess 1 _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS 01 cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SA5 or cesspool. _ Liquid depth in cesspool is less than 6' below invert or available volume is less than 1/2 day flow. Required pumping more than a times in the last year NOT due to clogged or obstructed pipets). Number of limes pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feel of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. .C. Any portion of a cesspool or privy is less than 100 feet but greater than SO feet from a private water supply well wah r acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis fc coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: You must indicate either 'Yes' or 'No' as to each of the following: The following criteria apply to large systems in addition to the criteria above: A . The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and sa(ery and the environment because one or more of the following conditions exist: Yes No, the system is within 400 feet of a surface drinking water supply di Ld 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 Protegion Area • IWPA) or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility Into full compliance with the groundwater treatment p(ograrr requirements of 314 CMR 5.00 and 6.00. Please.consult the local regional office of the Depanment for further information. (revised 0//1S/)7) )e0e 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 4308 Route 6A Cummaquid,Mass. .Cot,tage owner: Nancy Hopkins Date of Inspection: 1 0./1 5/98 Check if the following have been done: You must indicate either `Yes' or 'No' as to each of the following: Yes No ' Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal now rates during that period. Large volumes of water have not been Introduced into the system recently or as part of this inspection. L As built plans have been obtained and examined. Note if they are not available with N/A _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or Industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, 4�luding the Soil Absorption System, have been located on the site. _ 41AVU The tic tank manholes were uncovered, opened;and the interior of the septic tank was inspected for condition of ba es or tees, material of construction, dimensions;depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Pan C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) (s.vl••d 0�/a3/f7) P•0. 1 0l 30 = 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 4308 Route 6A Cummaquid,Mass. Cottage Owner: Nancy Hopkins Date of Inspection:10/15/98 FLOW CONDITIONS RESIDENTIAL: Design flow: p.dJbedroom for S.A.S. Number of bedrooms: at Number of current residents: :a Garbage grinder (yes or no): AM Laundry connected to system (yes or no):k Seasonal use (yes or no):.0 Water meter readings, if available (last two (2) year usage (gpo): Sump Pump (yes or no):�� Last date of occupancy: COMMERCIAUINDUSTRIAL: Type of establishment: 41A Design flow: AM Rallons/day Grease trap present: (yes or no)A Industrial Waste Holding Tank present: (yes or no)A2 Non-sanitary waste discharged to the Title 5 system: (yes or no), Water meter readings, if available: ArA Last date of occupancy: OTHER: (Describe) ,U/4 Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information- n System pumped as part of inspection: (yes or no)A} If yes, volume pumped: 6 gallons Reason for pumping: AV TYPE OF SYSTEM ptic tank/distribution box/soil absorption system Single cesspool N6 Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) VA Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: low Sewage odors detected when arriving at the site: (yes or no)AQ (revised 04/15/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 4308 Route 6a Cummaquid,Mass. Cottage Owner: Nancy Hopkins Date of Inspection: 1 0/1 5/9 8 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: e iron 40 PVC_other (explain) Distance fro rivate water supply e I or suction line 61 7�1 _ Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) Joints appear tiaht•No evidence of leakage; Syst to i s yentp'd thrrnigh the hniigp vani- SEPTIC TANK:�0 (locate on site plan) Depth below grader Material of construct ion:*!4concrete�Y�metal�fJ�Fiberglass��4 PolyethyleneV other(explain) If tank is metal, list age d/4 Is age confirmed by Certificate of Compliance It-4L(Yes/No) Dimensions: AJ,4 Sludge depth: N Distance from top of sludge to bottom of outlet tee or baffler Scum thickness: AM Distance from top of scum to top of outlet tee or baffler Distance from bottom of scum to bottom of outlet tee or baffle:,_ How dimensions were determined: A4 Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Septic tank is not present. GREASE TRAP:1d2d1t (locate-on site plan) Depth below grade: Material of construction:NAconcrete.(!gmetalNft'Fiberglass.1/gPolyethylene,4LObther(explain) Dimensions: AM Scum thickness: Distance from top of scum to top of outlet tee or baffler Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Grease trap is not present. (revised 04/2S/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 4308 Route 6A Cummaquid,Mass. Cottage Owner: Nancy Hopkins Date of Inspection:, 0/1 5/98 TIGHT OR HOLDING TANK:4boe-' (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction:q[gconcrete.44metal, FiberglassfiPolyethylene,�other(explain) 41, Dimensions: AIW Capacity: VA gallons Design flow: gallons/day Alarm level: 43A Alarm in working order*.4 Yes; VA No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) Tiq t or holdinq7tiinks are not present DISTRIBUTION BOX:A/AW- (locate on site plan) Depth of liquid level above outlet inven: A�A Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) Distribution box is not present PUMP CHAMBER: (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) Pump chamhPr is not present (revised 04/25/97) Pego 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , PART C SYSTEM INFORMATION (continued) Property Address: 4308 Route 6A Cummaquid,Mass. Cottage Owner: Nancy Hopkins Date of Inspection: 1 0/1 5/9 8 SOIL ABSORPTION SYSTEM (SAS):Y (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: ' leaching pits, number: leaching chambers,. mbe nur: leaching galleries, number: leaching trenches, number,length:_ leaching fields, number, dimebsions: overflow cesspool, number: y Alternative system: , Name of Technology: Ter Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Waste water is over the invert pipe ThP naggpnnl is in hvr'l,raul_i failure • system must hp ,ipgrarlarl to a title Livia sept ^ system. CESSPOOL J (locate on site plan) Number and configuration: Depth4op of liquid to inlet invert: Depth of solids layer: 7'r Depth of scum layer: Dimensions of cesspool: Materials of construction: r Indication of groundwater: inflow (cesspool must be pumped as pan of inspection) Cesspooi was not pumped Per owner, Cessipool pjimppd many t-; mPG in the past. Th-er:e was no sign of water intrusion then. Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) C-Lay to c ay F-0- sand viens & back Vege ation% is lush. PRIVY:&Ate (locate on site plan) Materials of construction: Dimensions: whl Depth of solids:_ Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) -Privy -is not present (revised 04/IS/)7) Page 1 of 10 ' 1 SUBSURFACE SEWAGE DISPC;>-,L SYSTEM INSPECTION FORM SYSTEM INFO)Z..t ,riON (continued) Property Address: 4308 Route 6A Cottage Owner: Nancy Hopkins Date of Inspectional 0/1 5/98 Depth to Groundwater/15 Feet Please indicate all the methods used to determine High Groundwate{Ovation: Obtained from Design Plans on record Observation of Site (Abusing grope observation hole, basemcn)-sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the.High Grounow,rerElevation. (M--vjl be completed) Water Contours Gahrety & Miller Model 12/16/94 i Y w It a j to WkI •r•Rnr..-n,r�.,-,— .nrr„•r„wI„r'•„I,l�rRrnlfn�+r+�n'11R.+.n.n,Rrwy nnr�Un w7 TOWN OF Barnstable BOARD OF HEALTH l SUDSUftFACF 9F.H�GF DISPOSAL SYSTEM I N9P�CTIOH FORM - PART D '- CERTIFICATION I . ,-TYPE OR PAINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 4308 Route 6A Cummaguid,Mass. ASSESSORS MAP, BLOCK AND PARCEL OWNER' s NAME Nancy Hopkins PART D - CERTIFICATION NAME OF INSPECTOR _ Joseph P.Macomber Jr. , COMPANY NAME J.P.Macomber & Son Inc:` ' COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Town or City State LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 - 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the e time of.-inspection . The inspection was performed and an y Y recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one ; Sys teui PASSED , The inspection which I have conducted has not found any information which indicates that the ails system fails to adequately protect public health or the environment as defined in 310 CMR 16 , 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of his form . System FAILED* The inspection whic)I I have con cted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the 130ARD OF HEALT1I, * It the inspection FAILED, .th's owner or operator shall u d within o•ne year of the date of the inspection, unless allowed ortrequiredm otherwise as provided in 3.10 CMR 16 , 306 , partd .doc e y � a i Town of Barnstable P', I Ir Department of Regulatory Services Public ]Stealth Division Date rrarence. = - "r"� 200 Main Street,Hyannis MA 02601 Fee Pd. Date Scheduled Time — Soil Suitability Assesstaent for S age Dis o s Witnessed By: Performed By: LOCATION& GENERAL INFORMATION Location Address �.4 W� Owner's Name 3� , � c� 7 / I Address Engineer's Name �,¢,v�YL v�svrz y�� Assessor's Map/Parcel: -3-5-1 i NEW CONSTRUE TION � REPAIR Telephone# / _ � - Slopes(40) S v Surface Stones w Land Use v Distances from: Open Water Body�_ft Possible Wei.Area ; E`i ft Drinking Water Well . ft Drainage Way ft. Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of to t holes&pert tests,locate wetlands in proximity to holes) I 47- rct= Depth to Beilroek off?c Parent material(gedlogic) fi , to Groundwater. Standing Water in Hole: F3tU"� Weeping from i Pit Face Depth r,. ce 4a'�" Estimated Seasonal:High Groundwater DV UTIO FORT S ASON L hiIG WAT�''lt TABLE ; Ln i 9, in. ' Method Used: in. Depth to soil mottles: fi ' Depth Cibperved standing in obs.hole: In groundwater Adjustment r-z Depth to weeping from side of obs.hole: A�,POD Adj.Gtundwater Level index Well# Reading Date: index Well level -- 4n RCOLATION TEST Dal t2 i '1C4.n Observation ! Time ut 9" Hole# Time atG" Depth of Perc 1 Time(9"-61 Start Pre-soak Time.@ '-�---- lb � End Pre-soak Rate MinAnch Site Suitability Assessment: Site Passed -- Site Failed; Additional Testing Needed(Y/N) Observation Hole Data To Be Completed on Back original: Public Health Division ---------- of wetland,you must first notify the p ***If ercola'ion testis to be conducted within 100' Barnstable C60servation Division at least one(1}wedk prior to beginning.' 'DEEP OBSERVATION HOLE LOG Hole,# Depth from Soil Horizon Soil Texture Soil Color Soil ! Other Surface(in.) (USDA) (Munsell) Mottling (Strucre,Stones,Boulders. Cons stenc ravel � 7 DEEP OBSERVATION HOLE LOG. Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell Mottling. (Structure,Stones,Boulders. Consistent %Gravel) kj I L t7 -i54 L2. P�a s,', ' tG 'le.- 3 ;DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistent Gravel 1� 'DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten Ora el Flood Insuranhe Rate Map: Above 51D0 year flood boundary No^ Yes Within 500 year boundary No— Yes Within 100 year flood boundary No Yes Depth of Natu6 Occurrin Pervious Material Does at least fbfir feet of naturally occurring pervious material exist in all areas observed throughout the area proposed fbr the soil absorption system? If not,what is the depth of naturally occurring pervi,bus material? Certification I certify that on. (date)I have passed the soil evaluator examination approved by the Department of tnv onme tal Protection and that the above analysis was performed by me consistent with . the required train' g.expertise experience described in 310 CMR 15.017. Signatur r C Date - Q:1SEMCW.ERCF.0RM.DOC I` l; r Town of Barnstable y�P�pF4HE ~C Regulatory Services Thomas F.Geiler,Director IARNSFABLE, Public]health Division ArFO :�a Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-8624644 Fax: 508-790-6304 Installer &Designer Certification Form Date: Designer: Installer: A 6L e_la Kd w 5 Address: , )04 ��( Address: Vy On f la A✓ 5 7' was issued a permit to install a (da e) (installer) septic system at (addre based on a design drawn by ss) A f" ' dated, G (designer) T.certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. -- -- I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Plan revision or certified as-built by designer to follow. IN OF moo`' AR ___z_z_I EY Cn ///i (Installer's.Signature)- 1140 �o /STEED ISANITAR\Pa (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO IBB STABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE.BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form OpIKEt Town of Barnstable Barnstable hoard of Health All-wmer;cacm, + BARNSfABLE, y MASS. 200 Main Street,Hyannis MA 02601 Qj i639' �0 ATED NIA't A 2007 Office: 508-8624644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi July 14, 2008 Mr. Whitney Wright P.O. Box 1045 Barnstable, MA 02630 RE: 4308 Main Street, Barnstable A 351-029 Dear Mr. Wright, You are granted variances to construct an onsite irrigation well at 4308 Main Street, Barnstable. The variances granted are as follows: Section 397-8, Town of Barnstable Code: To construct an irrigation well 130 feet away from a neighbor's leaching field, in lieu of the minimum 150 feet separation distance required. Section 397-8, Town of-Barnstable Code: To construct an irrigation well 138 feet away from a neighbor's leaching pit, in lieu of the minimum 150 feet separation distance required. The variances are granted with the following conditions: (1) The irrigation well shall be marked "for non-potable. use only." (2) There shall be no cross-connections between the public water service and the irrigation well. (3) These variances expire in three (3) years. It is the applicant's responsibility to obtain a well construction permit within three years. These variances are granted because physical.constraints at the site severely restrict the location of a new irrigation well due to the locations of existing septic systems on the neighboring properties and onsite. Sinc ly yours W ne iller, M.D. Q:\WPFILES\Wright43O8MainStreetBamstableVariances.doc - 2 mo e -� o ; OF THE Tp� DATE: /�0 O� FEE: • BARNSTABLE, MASS. v� 1639. ��� REC. BY . Town of Barnstable SCHED. DATE: vo 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 Property Address 1-� �l� /U =�b r cunniwuw c� Assessor's Map and Parcel Number: 009 Size of Lot: ILK-1 Wetlands Within 300 Ft. Yes I/ Business Name: No Subdivision Name: APPLICANT'S NAME: " ty L URI GM r Phone �^Q 3 6 2 Did the owner of the property authorize you to represent him or her? Yes V No PROPERTY OWNER'S NAME CONTACT PERSON TDALU { LJOWA-1 y t+ ' Name: ��(�_� Name: W�i�N� L(,y(Q &-A`r Address:_Q� (.O�15 131�1iNS(� L1�, 6).2" Address: Phone: Phone: VARIANCE FROM REGULATION(List Reg. REASON FOR VARIANCE(Mav attach if more space needed) - n6awtts from too r-c. url, ic: n,ttci�Botc°s �L l $ S- &V Mo✓u SIWU % NATURE OF WORK: House Addition ❑00000 House Renovation ❑ Repair of Failed Septic System❑` Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. i� Four(4)copies of the completed variance request form _✓ Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized.you.to represent,him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Paul J.Canniff,D.M.D. REASON FOR DISAPPROVAL Q:\Application Forms\VARIREQ.DOC MAIL-IN REQUESTS Please mail the completed variance application form to the address below. Also include four . copies of engineering plans, house plans, authorization letter, etc (see.check-list below). In addition, please include the required fee amount (see fees at bottom of this page). Make $85.00 check payable to:.Town of Barnstable. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 Checklist _ Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) _ $85.00 variance request application fee (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, you must mail the required $85.00 fee. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. In addition, please mail four copies of engineered plans, house plans, authorization letter, etc. (see check-list below): Checklist Four(4)copies of engineered plan submitted(e.g.septic system plans) _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) _ $85.00 variance request application fee(no fee for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date For further assistance on any item above, call (508) 862-4644 Back to Main Public Health-Division Page II ` �t11E L/ DATE: Y FEE: ss '* BARMABLE, MASS. C %639• REC. BY C�- �' ' Town of Barnstable .° SCHED. DATE: Board of Heafth 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,RS. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Wayne A.Miller,M.D. VARIANCE REQUEST FORM LOCATION Property Address:_[ 3CB Rte-6A - Cummi =itid.Barnstahle Ma Assessor's Map and Parcel Number: 3 51 /031 Size of Lot: 1 45 , 829Sq .1`t. Wetlands Within 300 Ft. Yes X_ Business Name: No Subdivision Name: APPLICANT'S NAME: Phone Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON _ Name: Whitney P.Wri aht Name: r Address: P.0 Box 1045 ,01d Jail Lane Address: Barnstable ,Ma. 02630 �w Phone: 508-362-7669 Phone: Cn CO ryl VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space neede V8ri—R A—freM 1 591 well: sept B requirement. NATURE OF WORK House Addition 0 ????? House Renovation 0 Repair-of Failed Septic System 0 Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets._ ? Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) C:\Documents and Settings\decollik\Local Settings\Temporary Internet Fi1es\0LK3\VARIREQ.D0C Al In -m--. 1P2.dadSC^'Q +..�4}7£2 .Srcfe✓/c� t=`fi ' . p Whitney P:Wright A P.O. 1045 Barnstable MA 02630 Town of Barnstable Board of Health 3/21/08 200 Main St. Hyannis MA 02601 Dear Sirs, I wish to apologize for not appearing at the meeting scheduled to review the placement of the well at my property that was scheduled for March 11,2008.This issue is very important to me. It is difficult for me to admit that I forgot to come to the meeting. I will contact you soon with the hope of scheduling another meeting with you. Sincerely y urs, a 4Whievy rig t y. .r. �_ LO ,a CC- Cj CIE 01:40p Whitney Wright 5083625889 p,1 Fwc For 111' om.* Whitney Wright J-10me Office Fax # 508 362 5889 Phone # 508 362 7669 ,- a.il whitneywriaht(&,comcast net Number of pages Including cover: 508 C 6 ta Mtj\jv Y od s i I `ir r 08 08 09:11a Whitney Wright 5083625889 p.1 F41 Fax No. � _w 21 To: CO tenU onu J`i From: Whitney WrO.1.1ht at h® +llim. Fax.. 5083625889 Please nat ify me islet a qaX is Coming to Me. Phone,-. 508 3627669 Date No.. of pg.. Uncluding cover® Subject. Apr 08 08 09:1:2a Whitney Wright 5083625889 p.2 Whitney P.Wright g P.O. 1045 E�arnsta'ble MA 02630 Fax: 508 362 S889 Town Of Barnstable Board of Health 200 iMain St. F Hyannis MA02601 Dear Board of Health, 4/8/08 wiH nct be able to participate in the meeting scheduled for this afternoon, (418/08),as I have not sent aut the required letters. I plan to meet with you at the meeting on May 13. I apologize for the delay. ince rely Yours, Whitney P.Wright • • .91 YJ ILI&V I za G1&JI V1401 ROMKOVE ■ Complete items 1,2,and.3.Also complete Mianat e item 4.if Restricted Delivery is desired. X Q Agent ® Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. ec i d Name) C. Date of Delivery a Attach this card to the back of the mailpiece, or on the front if space permits. ' Brent fro item 1? ❑Yes D. Is delivery ddress 1. Article Addressed to: If YES,enter delivery a below: ❑No 0 'K,�EUWY /� / f 3. S ice Type U,37� 413 Certified Mail F]ExpressMail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Ar)icle NumberItt 7 0 D77 14 9 D D®D D ►6 7 0fA f7 7 6 2g t f(( j;(Transfer froRl SENICe�abei).}I ; ! x x v x x x x'b x [:x 8 x N x e x, u e A l E PS Form'3811',February' 20041 k} Domestic Return Receipt 102595-02-M-1540 UNITED STATES`b tidTiS �Y ,,._., M. ,,"a i":;,;::" �;-:r c•, . "Ov RM a, $P� ' ''Permit°'too.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • WRIHP-11- P!0, Box 1045 Barnstable,'MA 0 6 Q ��4tt3li�111��11Si��Filii!!!{Fl�1Fl11111{!1!`F91lF�1�}�t�F�}li * i� ® Complete items 1,2,and 3.Also complete `A. Si nature item 4 if Restricted Delivery is desired.' X' � ,p/ P Agent ® Print your name and-address on the reverse 0 Addressee -so that'we:can return the card to you.' B. Re ' e d by Pnn d Name) C. Dat of De'very ® Attach this card to the back of the mailpiece, c � or on the front if space permits. `►4, D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No St1OM -t K ALA WI �l�- U UWL ROV . ill J l�099 N�. `� 3. Se ce Type Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑,,Yes { 2. Article Number 7 D;p 7 r14;9 0 ;O Il 0 0 67,E 5 ,7 7 4 8 II (Transfer from service label) f l PS Form 3811,February 2004 11 '1 1 1 i Domestic Return Receipt 102595-02-M-1540 UNITED STATEP.UA. P,2.6 A; IRK APRr^a a v 2 �O ..,an„W*r" a u mniM"�' ` 1P� • Sender: Please print your name, address, and ZIP+ in"this box • I I WRIGHT P® . BOX 1045 Barnstable, MA 02630 �ifi�„,�i, ,I�►�„!fi►-II,,��, ,lil�;,,it,�,as��,t�,fi,1�fiJ,1�,1 e Complete items 1,2,and 3.Also complete A. Signat item 4 if Restricted Delivery is desired... X p agent ®t nfit�your name and�address on the reverse 0 Addressee so that we can return the card to you. B. ve y(Printe C.Date f Delivery ® Attachthis card to the back of the mailpiece, U�� Or or onthe front if space permits. s` D. Is delivery ad different fro em 1? Yes 1. Articl Addressed to: If YES,enter delivery address below: 0 No ,b�lW Se Ice Type ArlI Certified Mail 17 Express Mail - ❑Registered 13 Return Receipt for Merchandise / 1� p Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes I 2. ArticteNumber l� fiil '�(i 70D7 1490 1�0'001 67U5 ip 7717����' i ([ransfer-from service label) ; , PS Form 3811,February 2004 1 1' 1 Domestic Return Receipt 102595-02-M-1540 UNITED STATES Po6z'•'qwFt#1" 1`1A �i'�'u. • Sender: Please print your name, address, and ZIP+4 in this box • I I two* I I WRIGM P.O. Box 104 � Barnstable, MA 02630 � `?r S sf?tn. 1 13333i1313 1EE1F i 131i$9� $��fE1�4$ $$`s P$649F�933 3�3 3i1 COMPLETESENDER:� • 13,Complete items 1,2,and I Also complete A. Sig re item 4 if Restricted Delivery is desired. nt • Print your name and address.on the reverse X ❑Addressee so that we can return the Card to you. B. Received by(Printed Name) j C.Date of Delivery ® Attach this card to the back of the maifpiece, or on the front if space permits. 2 ��U D. Is delivery address diffe _ m Yes 1. Article Addressed to: If YES,enter delivery b jjW o CU�I�FL,Sl1S {(�ft(.5��(� RoCt�anu 19 C'0��rrSS '7pp��11AA 2008 �'�f`�URV llt'< Vdva� 3. S ice Type MEl Certified Mail O Express Mail ❑Registered d Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. ArticleNumber� III i 70„07 i149� gp00j 6170�5 ;77�55�s f j (transfer from service label) I PS Form 3811,February 2004 i } Domestic Return Receipt 102595-02-M-1540 UNITED STATE ]? �aid ; 'AQil ` P • Sender: Please print your name, address, an x this ox I O I I WRIGHT fi M P.O. Box 10 Barnstable, MA 02630, �rlt�t1�11ti'��Pllitifaitf'1tti+ltt�tlt�i'��t't+ill�tltltt� 0 Complete items 1,2,and 3.Also complete I 7A- SIgnar Item 4 If Restricted Delivery is desired. R�E Print your name and address on the reverse , � dre. So that we Can return the Card to you. I B. Received by(Printed Name) C. Date of Delivery N Attach this card to the back of the maiipiece, or on the front If space permits. 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: ❑No PI�TRIM C14UM Y�C�6��U�CItPUI�z � 6a67 ] 3. Se cefiype Certified Mall ❑Express Mail ❑Registered O Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. ' t 4. Restricted Delivery?(Extra Fee) ❑Yes 12. Article Number it i 1 i t 4 I (Transfer from service label) 70071t];490i�0000, 6705 177001 it PS Form 3811,February 2004 i'i i `Domestic'Retum Receipt 102595-02-M-1540 UNITED STAES.;,PTA • Is .. v°::;T: F u k tm ; �sr «� 'po�e�� ees Pa p� Permit No G 10 C7':.::?',5..+..w • Sender: Please print your name, address, and ZIP+4 in this box • I I P.O. Box 14 Barnstable, MA 028 0" i i li�FlFi?�i�Ftt?'.FFilBiltFi?F�:11�?i?i�i41F3?1?lliFl?Fii4{il??t �-SEN'61ER-. CO COMPLETETHIS SECTION ON DELIVERY, ® Complete items 1,2,and 3.Also complete A:Signature item 4 if Restricted Delivery is desired. Q _-P O Agent ® Print your name and address on the reverse X ' ""`v'�- �^^"``^-�` -❑Addressee so that we can return the card to you. Received by(Printed Name) a livery ® Attach this card to the back of the mailpiece, �i ��G V �' or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item A? Y s If YES,enter delivery address below: El N MIN DOW9 WOO gJ10 0IM� OA 1v s f, 1 r �1J C"�hh"�� QQ VaD t lh ©/D 3: Se ceType I Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail. U C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number � i + i j ; 70g07f 49 P 10 0 0 Of1i 6705 j773'ju (Transfer from service label) f !!! Ps Form 381 i,February'2004 DomesticYReturri Receipt 102595-02-M-1540 1 UNITED STATE s �AL: tiiZ 1C :< ;x" ,:«;E,;: s 1-14a "l .. d.x, e&Fees Paid' I I • Sender: Please print your name, address, and ZIP+4 in this box • I 'I I I 'WRIGHT I PRO. Box 1045 I Barnstable, MA 02630 � { II M I litRDtiRII't��fi'.131d{1it!!R{t��i414f�i11i1t1i!lii�:lEli�1116� SECTIONCOMPLETE THIS ON DELIVERY ® Complete items 1,2,and 3.Also complete . Signatu item 4 if Restricted Delivery is desired, I s "t 0 Agent ® Print your name and address on the reverse X ` 2 . A resse so that.we can return the card to you. elv d (Printed Nam") a li ® Attach his card to the back of the mailpiece, or on the front if space permits. I e d i l e n from ? Yes 1. Article Addressed to: If YES,enter de ery address below: ❑No C;�2zna�r�� n�L�u� CJJOR40UIO nk - V D G 37 3. .Se ice'Type' El Certified Mail Q Express Mail ❑Registered ❑Return Receipt for Merchandise E3 Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑yes 2. Article Number i 1 i l( (i z ' t i; b i ' ' i ` ffiwsfer from service label) 7 O O 7+ 14 a9 0 0 0 0 0 6 7 5 77 2 4 P6 Form 3811,February 2004 i I ' i 1!Domestic Return Receipt 102595.02-M-15�, UNITED STATES TAI�yc7 r�yp� 1G ;n .�;+r, n,.;4' :a/.r �Yil"v. n r ,v,...u•.'`: y`�: .•Y v 't f� �Ir14!TRM�`�'C��ie.d�` r.�•.ate._^�� Y •t¢ sr. %31 n,•x"�,.jic No.G-10 ';h •.s4tiGro'ci ss�:.>%:':•.ki'ti=bt..a^.si.>.��;. ���sv-:�-�.:+.�r�; j • Sender: Please print your name, address, and ZIP+4 in this boxr• I I I I WRIGHT P.O. Box 1 045 Barnstable, MA 02630 TOWN OF BARNSTABLE- V Ii� UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS V"C, /./ xc ASSESSORS MAP NO. I PARCEL NO. / ®, ADDRESS? 3 / A.) s / VILLAGE' U "4//v,-4 y NAME. , �, � �� Rl >r-. - _ CONTACT PERSON > j"C PHONE NUMBER LOCATION OF TANKS:. CAPACITY: .TYPE OF FUEL. AGE: TYPE: . LEAK OR CHEMICAL: DETECTION ( L SYSTEM! DATE OF PURCHASE OF. EACH: . 1. 2. 3. 4. S. DATE`OF FIRE DEPARTMENT PERMIT: .TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS "PLEASE PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD. l f f - !� c C I s i i f • nA10 1 n 39.00 wn LOWER WIN 1" ...M BN,u ..!mhl _ S xU ni"m i::7M T pt,,-a7C� vxd"r . Y.. M tlNmm A IiY, ..... 4.. .I-'!/8 ,,M In G1 NIIRI _. 't ® ®i a nl Ilpea M i]i/s nl nin frlrvoeA rmlrend, .' © aB-M &dam, A 1 fiN [ Y <)/Y A1uh CCM32mM1 Rmpen-0 L,I yp n1 Imr dnvuntl nl 06U, "D,ahl H fl 2 IJIe' J 8/tl Mvvl CDDII?IIIX 26 1:1 &Baro,,,,,u` c di pi Y -YYvx m m ccnnxJz c Irza Acsc Ikdn .- .. '. 6 IMt B✓,S1w r f '" r, /tl Maid CCM2112 U INt Aup Cwu A-- GUEST Mary CCM1166 '0 N U d EST - opunsla..m.... - f M:XBPI au•" 4YI/P 6i:;rvm ccnlJz'si lUA'_-I( !u 1-i -J i/8 A1nnl CCMIMU BEDROOM 1 IB pm _ ... M /c C x-rr rJ I(s nlarvm CCMJz1U u --1,d. to U N UV d/P Y/Il.lf BaJ l4+f Cn Y•R° 'JJI/P nlnrvl C(1x V A8 1.A10 sl I vsL. a• t Y6 "'z ll/x M'rvm c Miiv " ., Z - 1 A2D 1 'CVIIM 41 wNnPaM YR YJI/A M'mn C WNl22R 4 Ge GUEST 16 Lx�@i'raar &drv,n f% Ydi JJI/X Mam cCTYmd < ,Sim/17 f A10 iT 24 s ni m fn uaw YS]LLL D• )A 4 41hvr Y BNn Pitt 4J 1 111/A' M m CLMIYMM 1 d _ e f @Iliac old A Ip "' YS '1 1 /8 Mom G1 N4N f p rd, a �1 1[ G aIT. 14d "� f Y9 4>i/P Manln «nl'�3 is +34.91 1a N U d � Ln 1 51 x i II tlM 2 11/2 '3 I Af ry CfCIN3rn F "' - rA pl H�¢ 1/tl '9 J�tl 91e CUDiDi 29 •. x LI InP n_ _ _ P .. 6 r - 6 9' Afu.l cc 1P]Bfl STAIR M &dm M YIt/2 6 Z N aJ.. Of&LXt A a4 Pkh .. Y xJl/ AWm G\n.<OF A2O A9 _V 11X�'° PI J V' 1>/r Afervi CAWNISIU . to 6 _ u 'u. "G.,n!H rg i 1 (n "s J/a' n+pry cuoHJmx mod:. 46 „pn 1 1 'Y 11!fl Monl CCTI:bItl • e fl :...It . ...' C WN2lDP - '.". ._ ouf1 N \p ya oD p b• D1 'LntaclNt NXW �.. f C .. A-0' 'JJI/A M,vvl CCn1YW1 ...... ...... • 9' ..1V d.l. ❑�.,... ..'..: f 1 '4 1/8 .-,.,n,rvl ,.lPG1 d16 ._... ._... ... W is +31.41 - +35.00 m 8 A20 8 A9 = 5' r .. A10 A9 .. h 6noudww " .... BRIDGEmam,.wo mwr=,... mXan.;a m 10 I. I 8 ry PORCH i © BAH A19 ® 2e A16 TERRACE - O - 'o _ ocue KITCHEN Dmnt Set. , OUTDOOR 11 a O .4 O 7 - SHOWER 11 a.DWG S/A19 fare & PANTRY DIN / © MASTER ®® 'Project Name: / BEDROOM Wright Residence 1 A19 ---- %�� // i / s� ® e ® 1 +39.00 4308 Main Street/Route BA Built-in i A21 2 ROOM Al— ` a A9 Cummaquid,MA 9 Millwork / 4 © 5 gR° CabinCabinet1 4 A18 2 I M 1` a 02637 A21 - , 2P / +39.00 / ZS UP ' �,Ne / I Drawing Title: M D ' � off +39.00 ROOM /O cow TTI.AWooObo �� 28 A21 w° First floor Plan a 16 A19 wlo © 6 FOYER 30 91� A21WELWINDL 1e 2 . O /// THRO O A21 (BELOW) Scale: O 1/4'=1'-0' 9um�n CL O 7 eml 1 C\\` A21 1 O 9 WALK-IN Drawn by: SR hltn CLOSET A21 ALK-IN Checked by:MAA UPPER o ENTRY O C LOSET Date:May 11,2007 GARAGEOURT a9.00 Issue Dates: 38.50 0 601061 Canal Lend Survey O O � Q 10 ,1oro61o61 Realtor Drawings 6 A9 "6 10117106l aoWithi Drawings 8 3 11221081 Old Kngs Hist.Subm. 28.361 1 P9 r•�� 41101071 aid Set Submission 01.4 0 d.�l 11,6 4f 1 5125071 ReNsed CD a10 first Floor Plan \ ! � w R, ti 1 Scale.1/4'= 1'-0' yry UP In 10 STAIR2 w4 w4 ON rr I I II I 11 II 11 1 1 z 2 - s +4s4o A10 I II1 111 W g A201 111 ALM 1111 ~ 1 I 1 1 Q kn A10 t III 1 I I - ~34 35 CLOSET I111 I --111 z .2 /� I L 1 11 ©s A20 A201 I I SEBH40� 111 p ,c A9 I I IM 1 1 W o one, toas // 2 Bedro1. om Loft Plan / / 0. 19 / / 1 A9 Construction `r Document Set / sJoHAD� r— I Project Name: / / 1 Wright Residence Cm8 Main Street MA/Route 6A —7 ——_ 11 1 02637 4 19 STAIR 1 // / ,1 11 ^ "� Drawing Tits: Second Floor Plan �ee.ao / 4PEN 1 11 ON ® � // / ® � � 1 Scale: 1/4'=1'-0' ON Dmwn by: SR Checked by:MAA 6 L\ / 1 11 Date:May 11,2007 AS / 1 Issue Dates: / OFFICE/LAFf A22 �` _ / I _ ___ 8/28/061 Canal Lend Survey " IoroSloe/Realtor orewings 10 10/17106/BoM1oNDrawings , g 1122/081 OW IGng's Mst Subm. 4110/07/Bid Set Submission / S 51251071 Revised n 1 Second Floor Plan A4 Scale:1/4"= 1'-0" 351 TEST HOLE LOGS ASSESSORS MAP : � NOTES: y god.- �Q'a` y PARCEL: 30 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH SO I L EVALUATOR : 1)• V�6we, Rs,Cst THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF FLOOD ZONE: C $ ^ WITNESS : qm- (ZEE uI�0 � 121�ISTNBI.E BOARD OF HEALTH REGULATIONS. REFERENCE: NI DATE: Moyem P;4•'• 1� Zoo {� 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, o a ST . PERCOLATION RATE k L- ZM►N jrlG!'{- SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO GL SuLy `1�,5 ���I 9�'d� INSTALLATION. F�-P-�N(.�� SSs � L'tl�R= o ,Y CRANBE RY \ `t BIN war 0 TH- 1 tL' 403� TH-2 .3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION < p� ( , a ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE • q �� PLCtrJ 01` (� O Y S. SIq Nby 3 DETERMINATION. �ummaanid Nlp►tit� Jr o , q kM Iv�((Z It q tP Q-4 C- -7, 1'l q 3 N $" 3 1 �O� 4) ALL PIPING TO BE 4" SCHEDULE- 40 @ 1/8 "P FOOT. (UNLESS B LOB 4 1oyRS/g SPECIFIED OTHERWISE) SA o _ ,A,II LOCATION MAP(N.T.S) C "p—lAv4H S// ��s I`+ 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A 1 SR+w IOyR l� GARBAGE DISPOSAL. i SIL.r 2 SY6�6 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) Loh-M 5' MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON Ice ��3 A BASE OF 6"OF CRUSHED STONE. �Al5A V-Ivl 7 - 29.85 7) Xi snNj CE-SS Pood -� pvrAp6o L 1 ovE� TER, TI i t-e v 2E pL r w(Cc.E�! MfOt M No 61 W 0{35E�R�J��O�T Z S�n SEPTIC SYSTEM DESIGN $ ab "ow0 w15tcsw�cn►.tsa' 1) 46 WF.TU41'05_vJl i> 100�o F PR01A• _(,��� FLOW ESTIMATE lo� -. utTYtg(.G SD1L�i JrrR1P1JUN'0 �G 7N Remove tvw v . - ' 3 BEDROOMS AT Iln GAL/DAY/BEDROOM - GAL/DAY ''0�El._31_3S b��jp � G t�hLjtfL- � Y� — _.-. SEPTIC� TANK - � ��--t'.------ �3U GAL/DAY x 2 DAYS - W6 GAL - — - — / 58,46 USE Ir GALLON SEPT 1 C TANK N / N i SOIL ABSORPTION SYSTEM N V 5e (Z) 500 6 A-u,a a Pz45i�ASr iEACR Ctta4.4 l3�S w� ��'�5 +� 01J Au, Si©ES �Z5�LY 13'wx 210� I DE AREA: L(i— t 31 Z J x 2 BOTTOM AREA: 25 -7330 6IP rfyV E� l y vie sri�� �, SEPTi SYSTEM..-SECTION = o c� - �'i080 ((A.((A. / (pTii M - =r- E L 40.940 — — -- —— i 2k o I I 31'so 1 ► �1 1 a •,off rade q'MI 4 L 1 i 3�,7� Gj k3 Bn1=FtE /' 2"-3�g 1, astiul fie 3-7.° / r. _�eon '' UJ► 4 SDO GAL L l� h C1 l� / 3�o,3 � `� �� � / , 11��10� � °��'^�4 � �� SEPTIC TANK , 1 34��- 5 l A2 TU ,b'c ( rw M b r r A100 G O� T7DP 0VTL-tT GocA-Tioa 3 D13 f l 2 ' (nldsGlcc� Sf�ie '� is bF G i-Ay eR, 61"6y/ 1 ` Zoom d f-- 72�7v�-Ivr e &L ZG.SS OFM�ss9c SITE AND SEWAGE PLAN LOCATION : 430 b VDui�-: to / 1dl No. 1140 /' s��STER PREPARED FOR : gAgTAR`PN rl ���-T ✓llIZ7 � j SCALE= : I -� [)ARREN M. MEYER, R.S. Z _ - 3 VINE STREET DATE: 12 7 0¢ 1 v of �� DUXBURY, MA 02332 1 W � � ►�s a DATE HEALTH AGENT (781) 585-0293 � Z i u LOCUS � ! k - --; _ 1 - - EXISTING 1c� LEACH PIT - 1 , ~ STREET 5A �Tv LOCUS ININt 19 222. -----— �'\ 1� E D ..�— � ^;i\-r , `' .••_ W �`'�`�ti i 17 S'V`BRIE REQ(,'IRED 13.5ft -` _ ;; �• `i \ .. pRoPO ^ �, PROPOSED _',3. 7 WELL POND \ iAI i-V T TN1� p l ps j -___.___-.________ J-_---_.___ --__-_ _-_.. --_- -- -_-__ •� \ `�V� \ Cr1IS Li'llJ �O�\11JJ� f -\ lI •^ _'�'t 155.17 y�/ \;11 S_A-S, _ HOp Of •; . `'� = —" EXISTLtiG Q. O j L x ;. COTTAGE •6' `? xG. H-AI�.LETT'S MILL POND AN 54.86 Ns ---a LOT1 104,3•:-tsf(L'Pi��'rD) -1 i OF l rt �`� z TD�IT-•� 1-i5.Q4s: i'OT` �_ p�y • . LEACH PIT P. ` D-BOX ? vE�I 23 .45 � 33.14 62.18 I r 25 52.94 a = SEPTIC CO'�il'ONENfTS SHOWN FROM AS-BUILT CARDS FOU D FILED AT THE TOWN OF BAV NSTABL.E BOARD OF HEALTH OF !!--F. i' ° �z` i� iC C iA:R� yV,. J iT L 9 _G i .4 � �` .. .,1 -'�✓ l _.�.r aa��! ¢ r: L,t'•�,.a... 3 �� l a r T /f 11 D?TE PROFc ova t►1NV -t R�rEYC�R t ry SCAM 1" -- 30' 1 - ,� A T'� S���i �� '``�,'� �•�� ���-� -- 0 39 60, 90' t {.�.. r e_ s . . ram-• -- _. ,...,..r... ,. ,_.. _ .,. >,d. :.: ".._,..+t'cY'.ic..u^.r..<I,•.'_....>9.f.,.. :,.':,.....:__... ti-.. _.. T.i_. Xr -- - ... .S_a'S_ ..>. :.. A. - -. .- .:. .. .. .. .. ... 1�\ �/ / � f'I- 3 a , w Sifd$it54 'MidikfWNRS 4MrY. -mLL'.L:3! T r _.. - -. -.:.,''..-._-..<s,.._ __ - _ - -..: _ - .. .... - •, .. 8a®kT' "' . K9bl.t'6aw i4tiXl.lYnR4 .... . ._ t ........ .: -era,...:•.era..r;,.. -:.... ...,. ... v -r v,...w..-.......s__.. :...,.. _ .Y^ "+ems rar. a..c iL-R211PY3,Y.. (311a1"L.1ClE• _.———"may,_-..Ldiftiiifufbi _ _—a+___^r•Y.Ylfix..C-d61:9 .,...acnr'aa.wv. bk. - .. - _ ,...__,,_. .:. _•- - ' _•,- .'.. .". •'. Si. -. :. _ 4 1 f.f no OL IN VFf, T EL EVA TION.' INSTALL A CAS BAffL£ GENERAL N.0 TES: . - 37 e C d /N OUTLET TEE.. •ACCESS COVERS MUST BE WITHIN 8 �I >,4� ov�-R. 1. THIS PLAN, IS FOR THE. DESIGN AND INVF117 AT BUILDING --- ---- -- --- , 38.ofi_ s" of FINI_ GRADE -_ -� D� SYCIV CRITERIA: • CONSTRUCT/ON OF THE SEWAGE DISPOSAL 3�, �p _� 7.0 - �L 32.E INVEi 'T:.`/N AT SEPTIC TANK ----- ---- �{-'p3US'f M FACILITY ONL � 3 � 2-5 TO NnA-rW 4' PIPE - M �- D_ IGN FLOW: �! 2. ALL ' CONS TRUC INVEST OUT AT SEPTIC TANK - ---- _ RUCTION ME AND Z 4 PIPE __5 BEDROOM DWELL /VG 0 1 /0 GAL DAY PER BEDROOM 2' �.�� �L,�dR O 3N QO _ 4" PIPE ,. ., MAINTENANCE FOR THE 'SEPTIC SYSTEM SHALL /NVE ?T /N AT D/ST. BOX ------- -- i� I 2 I/8 -I/2 DIA. , �$�D CONFORM TO, MA. D.Ew 0.E. TITLE 5 AND LOCAL Q 3 3.�Q 4 M/N/M[/M WASHED STONE EQ.:SAL S ___550 ____ GALS. PER DAY. za--15 Q LIQUID -DEPTH BOARD OF HEALTH REGULATIONS /NVE?T OUT A T D/ST.SOX ---------- 3�-2� EFF , 3�4 -1> 2 D/A 4�iL WASHED STONE SE, "TIC TAN/< - Z . Jr{� J D/ST. DEPTH Z�, � -/ r ; INVE?T IN •A T S. -- ------- O lil6TA•LL f�OUIRED. 1. J- ALL SEPTIC SYSTEM COMPONENTS SUBJECT TO � � R «,.►� -r BOX PROPOSED S.A.S __ ---- l/ -HICLE L OADING /.E UNDER DRI VEWA Y,ETC. BO T.r01V OF S.A.S ��oOR 10 MINIMUM ��"�' H- 10 -3-zo 5.`D---- G.P.r) ,Y 2009' 1100------- GAL: SHALL BE DESIGNED TO WITHSTAND H-20 LOADING. 1500 :GqL : _ ADJL STED GROUNDWA TER ---=----- 29 .a o SEPTIC TANK NOTE.- SEPTIC TANK AND D-BOX TO BE SET ON A 4. ALL SEWER PIPES SHALL SE SCHEDULE 40 OR H_ 1�' SE;�'T/C TANK PROv1DED.'=__ 1500 GAL. APPR0 VED EQUAL: OBSL R VE-D GROUND WA TER -- -_-=- ---- 6 BED OF COMPACTED CRUSHED STONE. 3 CONTRACTOR TO WATER TEST D-BOX TO SI•7E OF LEACHING FA,,"ll._h'�' ,REQUIRED: # j 5. BEFORE STARTING CONSTRUCTION CALL DIG SAFE SHOW LEVELNESS 52' Ot-S/GIV PERC. RATE=_ <5_----- 1'111NUTES/INCHES I 1-800-J22=4844 FOR LOCATION OF �` Dl�P�00.SEftVyTT�f[OfyL� LHob/_1 UNDERGROUND UTILITIES. A - - GALLONS PER DAY 6. DA TUM IS NG VD g j .rl � SOIL TEST PIT DATA 7. NO DETER' TION HAS BEEN MADE TO COMPLIANCE II ��L �Z H t 3 ' Sl?F OF LLACHIIVG fACIL/TY PROVIDED.• FOUR-500 GALLON CAPACITY DEEP c_ Hoi.. L ' LEACHING STRUCTURES W/4'OF STONE WI TH DEED RESTRICTIO/VS OR ZONING REGULA TIONS. �.� >, �-- �Q � T P. / 33.53 r.P 2 .3> 75 4 _+ •.r """ ""`'"" ' GROUND REV. GROUND ELEV�-' ----- TYP /T SHALL REMAIN THE OWNER'S RESPONSIBILITY TO L.'t� - .--- n 220 G.W, REV. ------- G.W. REV.-------- I 34- _ i Sl.,FGIALL _____----S.F. X 0.74_ _--- 162 G.P.D I OB TA IN ALL REQUIRED PERMI TS,SPECIAL PERMITS, t , 12 14 2005 BOTTOM K.-,,, �. w � y� _ 54b __ S.F X_0.74----404 _G.P.D VARIANCES ETC. FOR THIS PROJECT. DATE• /- ✓.E.L.ANDERS-CANAL LANDSAUVEY/NG- ---` !---- 42' 1OTALS _ 766__ -566 G.P.D 8. /T SHALL REMAIN THE OWNER'S RESPONSIBIL TY •`�"+ c � i - --C- LEY,P.E SOIL EM JATOR I DEEP OBSERVATION HOLE LOG tl.i.r ... TEST BY._-----_ _ D.I I TO HA VE THE PROPOSED DWELLING FOUNDA TION °-•- " " ' ° "' """' ' 3 PROPOSED S.A.S. - - DONALD DESMARA6 A-S AGENT — t W/TNESS£D BY.________________ DESIGNED TO ACCOUNT FOR THE EXISTING GRADE _ ------•-------- I AND SOIL CONDITIONS AT THE L OCA T/OiV OF THE <5 _ PERC. RATE___--___ MIN./lN PROPOSED DWELLING - - DBE1 085ERVATION HOLE LOG _ Hd.1__ - i NOTE.'REMOVE UNSUITABLE SOIL BENEATH j AND W/TH/N A 5' W/DE ZONE AROUND A ___-- -- - THE S-A.S. DOWN TO THE C-2 STRATA , t� f I ---- AND REPLACE WITH CLEAN SAND PER THE �' i Q pia+ RJt'ER G REQUIREMENTS OF TITLE 5. - P PAUi ,,,,•,..^rr..r.r •_ ••_- ,_— •iy� h10.3uW;213 `'`' I MICHNIEVVIC non>ta..srrr .•.-_ , _. i V i Dw n Ir Mr v 1+.fh P/v.". _ ____.--_.-- / y a•Tri C�'i` ' y 145-00 • IL.o4 drl Y S1 d w-.rf *v{ ntr.r,.11..—_._ .— � y Y , D:A Ff- F ROfESSI 06 I Y - - 222 23' \ . G TO ROUTE 6A EXIsT. 4 LEACH w` i AREA lam,'L Ex1sr. ., ► _ ,,„ _ / - . .��-+''COTTAGE HOOD { .y No. 35031 1� ' <rr ., E' PR E_Y R v�.. } O D SUR�1 V of V\ S MILL To poNo 00 �. c 91•i8 I let q, ITIG � I Al"LANSH,0�;- ! 23p. OFA 69,UBa3URFA((,'.,Il, SEUVAGE Dlrgj?(0&4L EYETEM 45 �' PROPOSED DESIGN 83 14 ` Q64; CUMMAQUIDMAO !ram y't �CAN,4L LAND PERM=INGINC !0_ • EXISTIN6 GYaNTOGGq x -� ---� DIRECT306 OLD 9OAD SA ORE BEA CH,dfAo t�11 Gl�' I S1 X14 TF.J9 f Li' F I PIC-0 6ri I I I � ACT NUMBER 05-&�° , LOUTION MAP NITS > +Irwrw:awws.,:cws.eL:x, +rsr,.:a .-:•nr.cal+c-';r:- - r.arr..cr z;: xa.c ; s •s,. _ . • - ,W.,..w., . _ ---- _ _,., _, .,_........ .,•..—...,.........,.,.. ,....,d. ._.. .,_............,..•....... ... ..... _ w. _ , _ _, t. .. --_. .... ____- - _ .„...—..._....._.:..::..-.•_,.,.........,.y._„",_..-+wn..'.'`+. .. .-+-+ram-_ ._. ,. _.,,__ - - . n / apiiANn1M / LOCUS � � T fCA 90�F RgMP . H •R49 EXISTING �% n 6 LEACH PIT fkk t 5TgFET`.. 6A i ,y AP LOCUS MAP G �CX�CjC ,lv'� 1 75.12 iP EXISTING LEACH 21633 FIELD �.• • •'' ' ' ' Q132-2+1 ,. ARIENCE REQUIRED 13.5ft 87.0 132.35 `f ppo q PROLQ ` LED b 5 \ \ POND '' EXISTING 155.17 , S.A.S. 4 a(l' N . EXISTING 1� \COTTAGE t r St 1,03.0E •6X 100.m :' X wssrL ` HALLETT S 117.87 MILLL 1500ga1. POND TANK 54.86 •o'�' AS-BUILT \ 42.9ft q SEPTIC SYSTEM \ LOT 2 EXTENT 4 ,8 f 04>29s sf(UPLAND) 1 i. _ -WE TL.AIVD { STRIPOUT 145,829s t' EXISTING \ +. LEACH PIT Q, D-BOX VENT y' I 91.18 23 .45 83.14 62.18 82.25 52.94 F �c = SEPTIC COMPONENTS SHOWN FROM AS-BUILT CARDS FOUND FILED AT THE TOWN OF BARNSTABLE L.�.; °-0 _...a ;. BOARD OF HEALTH OFFICE. CI f PLAN RICHARD HvoD N� SHOWING A PROPOSED WELL 4 ROUTE, A T MMI UID (BARNSTABLE), MA DATE PROF _. VEYOR308 � � �v � � ' SCALE 1 = 30' DECEMBER 20, 2006 „ _ CANAL LAND SURVEYING & PERMITTING INC. SCALE 1 - 30 0 30' 60' 90' 306 OLD PLYMOUTH ROAD, SAGAMORE BEACH, MA (508,)-888-5955 DRAWN BY:PDR/CHECKED BY RJH - r ,.ua - ,♦.'x-6':{ z'.`. .r. r ,e . RSNt•u�.w.s.r«-ram .-.. .wu.. ny...•..w..,......t .a..r. ..-.. f✓"y +NIT .f I � .i 'i dAG4NM•.. .... .elert aeattncpet .�. _ rtrttx.a..yr _ — z. ..—xd -.+;:....,wl.mracnrrWsxeeurumw , _. :•;..... I1101, —■ 1 ,lai r'iY+r 1 v ,�!°�M� h3 '� r i rt ,.�tl°sryimd�r -� r - 3°4 F Ids 15 GENERAL NO TES: IN V1 ; , L FVA TION.• INSTALL A OAS BAFfLE /N OUTLET TEE. . ACCESS COVERS MUST BE WITHIN S FOR THE DES/GN AND 6 of FiNrSHED GRADE /N�'r'_r % A 7� BUILDING ----- ' DESIGN CRITERIA-1. 00 H/ L A *51. sp SAL CONS TRUCT/O FACILITY OIVL Y. OF THE SEWAGE DISPO IN I,�.: :L '7 ,/N A T SEPT/C TANK ---- ------- >l� vTVs'r M 33., 26 -ro MAC 4' PIPE r� , r ' DESIGN FLOW. /N I/' 'T OUT A T SEPTIC TANK -------- 1:1#4154 "� __.5 BEDROOM DWEL LING 6) 110 GAL/DA Y PER BEDROOM 2. `ALL CONSTRUCT/ON METHODS,MA TER/ALS AND 2 �� � � 4 PIPE � �, ' OdR c� n / „ / „ ———— 'F'1.� - 3� �Q I - � 4" PIPE 2 1 8 —1 2 D/A. MAINTENANCE FOR THE SEPT/T SYSTEM. SHALL /N1� _ , ,f IN A T D/ST. BOX ---=-- i� "' 4M/Nrn�uM 2 �p WASHED STONE EQUALS _ __550 GALS. PER DAY. CONFORM TO D LOCAL Q 3 3..m -MA. D.EQ.E T/ LESAN Z.�,��J Q L/QU/D OEPTH;�+.. •• ,. BOARD OF HEALTH REGULATIONS. /N11„ ' �(/T AT D/ST.BOX EFF. 3/4 —11/2 DiA -- _------- DEPTH WASHED STONE m D/ST. 26��0 SEPTIC TANK REQU/RED.• 3. ALL SEPT/C SYSTEM COMPONENTS SUBJECT TO /N►%r'a VAT S.A.S ` ; ,,'��'�L' "" BOX — .5rb ——— ____�'. ::. . __550_____G.P.D X 200�'=_ 1100_------ GAL. VEHICLE LOADING II.E UNDER D1?1 VEWA I- -"r PROPOSED S.A.S Y,ETC. ` B��� �" ,.��, OF S.A.S ——————— F't�ovR -�'�. . H- 10 , 1O MIN/MUM 1500 GAl �. _..._ - . ATE.• n, � DESIGNED TD� WITHSTAND H-20 LOAD/NG. "r A0,r. , /L D GROUNDWA TER ---------- 2� ,0 0 SEPT/C TANk S � ,HALL SE H- 10 SE IC TANK AND D-BOX TO BE SET ON A LE . 40 OR '� SEPTIC T1NK PROVIDED.'=__ 1506 __ GAL. rr i OL 1 ;' rE�D GROUND WA TER ----------- l BED OF COMPACTED CRUSHED STONE. 4. ALL SEWER, PIPES SHALL BE SCHEDULE . EQUAL. CONTRACTOR TO WATER TEST D-BOX TO SIZE OF?'EACH/NG FACILITY REQUIRED: APPROVED 5. BEFORE STARTING CONSTRUCTION CALL DIG SAFE Sh'OW LEVELNESS. �'BOO—322- DEEP OBSL�RVATTON HOLE LOG Eiolt 1=_ I 52 LOCATION TION OF �,,� ,�,,_ a.,..._ ,.� ,. DESIGN f'ERC. RATE-= <5 _____ M/NUTES//NCHES 4B44 FOR, _ UNDERGROUND UT/L/T/ES. ,�-� 1� la... a._t �,.,.......1.. ( 4 6. DA TUM '/S NG VD g .. r — -1 _550--_'___ GALLONS PER DAY SOIL TEST PIT DA TA 7. NO DETERM/NA TERMINATION HAS BEEN MADE TO COMPLIANCE r °1 -��L �Z n . , SIZE. OF LEACH/NG FACILITY PROI//DED.• FOUR-500 GALLON CAPACITY DE"OBSF_RVATTONIIOL6LOG Hok1—L WITH DEED RESTRICTIONS OR ZONING REGULATONS. a,.N.. alUi_ 5.11— >w�. TP#� 3353 TP12 3> >5 ``' 4' LEACHING STRUCTURES W/4 OF STONE __ ,mom GROUND ELEV. GROUND ELEV�' - TYO IT SHALL REMAIN THE OWNERS RESPONSIBILITY TO -,� = _ G.W. ELEV _�___ G.W. ELEV__ w; �i 34. SIDEWALt_ 220 __S.F. X_ 0.74_ 162 GPD - --- 7 CIAL PER�►?,rTS, :; 546 0 4 _ 404 BOTTOM ------ S.F X_____-______G.P.Dy OBTAIN ALL,''�REQUJRED. PERMITS SPE _ VARIANCES,ETC. FOR THIS PROJECT. z A 4�. r_1 J. =— �. �. y� C '" _ DATE.• �211412OO,S CANAL LAND SURVEYING _ - _ 4 766 566 .� TOTALS ------ --- G.P.D S' /T SHALL REMAIN THE °OWNER'S RESPONSIB/L TY F� ✓ELANDERs—cAULEYPE soil EVALUATOR - * sa ,.`` � DEEP OBSERVA�'N ROLELOG molt N TEST BY.---------------,-----------_......_—— j TO HA VE THE PROPOSED O WEL L/NG FOUNDA TION " �° 1»a a ' DONALD DESMARA�S' R.S. AGENT PROPOSED S.A.S. _ WITNESSED BY._--------- — DESIGNED ;TO ACCOUNT FOR THE EX/STING GRADE - ----------=- 'k — — AND SOIL CONDITIONS A T — -THE L OCA T/ON OF THE PERC. RATE_ �5---- M/N/lN PROPOSED DWELLING. _.. DEEP OBSERVATION HOLE LOG Hok 1 4 c.r•.. aa� sw ll.Nr ' l.n♦•IW IU7DA1 ti..+t M.0, C6o...ls tadYa - n - NOTE-REMOVE UNSUITABLE SOIL BENEATH _ AND WITHIN A 5' WIDE ZONE AROUND cw THE S.A.S. DOWN TO THE C-2 STRATA _ _- - -- AND REPLACE WITH CLEAN SAND PER THE ROGER REQUIREMENTS OF TITLE 5. ""`NQa z ', tl..t lnna R.a MNo: CIVi 4��s,,,,; v9 war.lot r w t..'..r IM_11L ' err<1t1 aY 1.t4 r.r oe.r.+ldn+q/+t t" f7q'S�'' ` - 17utt n ItM Ytt1.+rWf Ypp1^M ^11O1t ,.' •a.mo4�a:.y..mNrltdt 7 u at,NoM a.e.rr.r.rott '� (q"I_KJ CfIL \ 91 /Q -- / ------- — ——— --- ---- _—_—. 145 00 _ D,4 TE• P FESSIO' AL ENGINEER [CIVILl - 1 .f 118.06 N C _ 222.23 - --- R\ A 55.34 TO ROUTE 6A .� =-'1 ; 0 1y i . `r - " EXIST. REq1'.l A �O 04 OF h'igSS c EXIST. RICHARD Gs COTTAGE 0 HOOD t" a w„ `9 f/ No. 3503 1 — . 7 -- -- A _ o .--�' \ '� ''� '` `.° f,6tav AL LAND SURI/EYDR ;z i ON A TE D R ry , ,sue / Z 1 'i \ `� '� ` y s MILL TO poND 146. a >� VIP I 7 . FROPOSED •`' ` 26 Y d 230•45 8 DESIGN OF.A 3 UBS URFA L",Li SEW,,, A G F 4 08 7MOUT . ......... D 8 '� y UID 43 cummAQ 9MA0 LEA ' 2006 R&UTTS�Powo CARAL 1.4ND UR=NG &Z ?E"T=.lNGhVC. o.-____ Aw arsrrNs aman . - - 1� - - � �; 5 306 OLD FLYMOE TlY 17r""0AD SAG"ORE BEACH 9 9 MA0 ✓2 CT 1�TiCl10ER 0 UXATION MAP NTS ;m;1ne - ,. .,•.., - tt•"" w.9.i._yS:,N.1'BNYC.i1 :G1a.]*.'Si624r3'.'Mt —x.♦xy., ♦r. .. - .- .._- ..,3t,S♦tr { a. v -_. __--_-. - _ "^r'''RTi'_fMa•^ •epw•...w.r..u..a++nl'R.y 9 T ., _ - . -. 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