HomeMy WebLinkAbout0264 BAY LANE - Health 264 3.ay Lane
186-022 Centerville
UPC 12543
No. 53LOR
HASTINGS, MN
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Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
a 264 Bay Ln _ c
Property Address
Timothy K f I
of o 0
r
Owner Owner's Name -- Z �-- -- cr)
information is s
required for every Centerville Ma 02632 9/12/16
page. City/Town State Zip Code Date of Inspection IV
.1�
W
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 filling out forms A. General Informationa-
(S!
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Michael DiBuono _
use the return Name of Inspector
key.
DiBuono Sewer and Drain _
Q Company Name
8 Johns path
Company Address
S Yarmouth Ma 02664
City/Town State Zip Code
508-364-9587 _ S103522
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000). The system:
® Passes ❑ Conditionally Passes ❑. Fails
❑ Needs Further Evaluation by the Local Approving Authority
`16/21/16
1 ctor's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�
264 Bay Ln
Property Address
Timothy Kofol
' Owner .Owner's Name
Information is Centerville Ma 02632 9/12/16
required for every
_/i page. City/Town State Zip Code Date of Inspection
t B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
System contains a 1500 GI septic as well as a concrete distribution box and two 500 GI leach
chambers. System is like new condition.
B) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
„M a 264 Bay Ln
Property Address
Timothy Kofol
Owner Owner's Name
information is required for every Centerville Ma 02632 9/12/16
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ 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 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form = Not for Voluntary Assessments
264 Bay Ln
Property Address
Timothy Kofol
Owner Owner's Name
information is required for every Centerville Ma 02632 9/12/16
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
'* This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/2 day flow
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Ma v 264 Bay Ln
Property Address
Timothy Kofol
Owner Owner's Name
information is
required for every Centerville Ma 02632 9/12/16
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area —IWPA) or a mapped Zone 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.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
o 264 Bay Ln
Property Address
Timothy Kofol
Owner Owner's Name
information is required for every Centerville Ma 02632 9/12/16
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ ® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M 264 Bay Ln
Property Address
Timothy Kofol
Owner Owner's Name
information is required for every Centerville Ma 02632 9/12/16
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
System contains a 1500 GI septic as well as a concrete distribution box and two 500 GI leach
chambers. System is like new condition.
Number of current residents: 2
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 ❑ No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
169 GPD
Sump pump? ❑ Yes ® No
Last date of occupancy:
Date
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:
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
_ W Title 5 Official Inspection Form -
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
a
264 Bay Ln
Property Address
Timothy Kofol
Owner Owner's Name
information is required for every Centerville Ma 02632 9/12/16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: None provided
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 System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
i
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
a' 264 Bay Ln
Property Address
Timothy Kofol
Owner Owner's Name
information is required for every Centerville Ma 02632 9/12/16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
10 Years
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 4
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.):
System is vented
Septic Tank (locate on site plan):
Depth below grade: 3feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
1500
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:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
J
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
264 Bay Ln
Property Address
Timothy Kofol
Owner Owner's Name
information is required for every Centerville Ma 02632 9/12/16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank (cont.)
Distance from top of sludge to bottom of outlet tee or baffle 24
Scum thickness
3"
Distance from top of scum to top of outlet tee or baffle 42
Distance from bottom of scum to bottom of outlet tee or baffle 1" Sludge stick
How were dimensions determined? Tape Measure
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
No evidence of Ieaking,Tees and or baffles in place at time of inspection.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
i
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
264 Bay Ln
Property Address
Timothy Kofol
Owner Owner's Name
information is required for every Centerville Ma 02632 9/12/16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tees are in place and levels are normal.
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 El polyethylene El other(explain):
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
`Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
264 Bay Ln
i
Property Address
Timothy Kofol
Owner Owner's Name
information is required for every Centerville Ma 02632 9/12/16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if resent must be opened) locate on site plan):
P p ) ( p )
Depth of liquid level above outlet invert level and at normal level
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.).-
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:
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17
r
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
264 Bay Ln
Property Address
Timothy Kofol
Owner Owner's Name
information is required for every Centerville Ma 02632 9/12/16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number:
2
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Chambers are dry and clean
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
l5ins•3113 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
264 Bay Ln
Property Address
Timothy Kofol
Owner Owner's Name
information is required for every Centerville Ma 02632 9/12/16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.)-.
No ponding no break out
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.)-.
t5ins•3113 Title 5 Official inspection
0 sped on Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M 264 Bay Ln
Property Address
Timothy Kofol
Owner Owner's Name
information is required for every Centerville Ma 02632 9/12/16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
❑ hand-sketch in the area below
® drawing attached separately
� I
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
_ W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
a 264 Bay Ln
Property Address
Timothy Kofol
Owner Owner's Name
information is required for every Centerville Ma 02632 9/12/16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 10+ ft
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: 4/5/10
Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health - explain:
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database -explain:
You must describe how you established the high ground water elevation:
Test hole data on plan
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
9/21/2016 Assessing As-Built Cards
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INSTALLER'S NAME&PHONE NO.f� �. �dnr)>✓iYoisv S/�9G
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LEACHING FACILrrY:(type) CPO C! C4wlw (size) izs
NO.OF BEDROOMS 3
BUILDER Rit�i�
PERMUDATE: .7-7-06 COMPLLANCE 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
I Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
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I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 264 Bay Ln
Property Address
Timothy Kofol
Owner Owner's Name
information is required for every Centerville Ma 02632 9/12/16
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
❑ Inspection Summary: A, B, C, D, or E checked
❑ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
❑ System Information— Estimated depth to high groundwater
❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
DEED RESTRICTION B.1, 2°—'6 8 3 F`:9 158 5 6_14 a
WHEREAS, Amy C.Mayfield,of 19 Tunbridge Walke,East Aurora,New York, 14052,is the owner
of the land together with the buildings and improvements thereon situated at 264 Bay Lane,Centerville, 3
Barnstable County,Massachusetts,02632,and more particularly described as Parcel 22 on Assessor's
Map 186 and shown as Lot E on a plan entitled,"Sub-Division of`Cranberry Hill',formerly known as
Long Hill,Centerville, Barnstable, Massachusetts,March 13, 1946",recorded at the Barnstable County
Registry of Deeds in Plan Book 73,Page 5. Said lot containing 49,920 square feet of land,more or less,
according to said plan;and
WHEREAS, I as owner of said Parcel 22 have agreed with the Town of Barnstable Board of Health to a
restriction on the number of bedrooms that can be included in any home now existing or hereafter
constructed on said lot as a condition to obtaining a disposal works construction permit for the on-site septic
system repair/replacement/installation on said parcel pursuant to State Environmental Code,Title V,310
CMR 15,000 et.seq.;and
WHEREAS,-the Town of Barnstable Board of Health as a condition to granting the disposal works
construction permit is requiring that the agreement to restrict the number of bedrooms in any home now
existing or hereafter constructed on the lot be,put on record with the Barnstable County Registry of Deeds by
recording this document;
NOW, THEREFORE, I do hereby place the following restriction on the above referenced lot in
accordance with the Town of Barnstable Board of Health, which restriction shall run with the land and be
binding upon all successors in title:
1. Any home now existing or hereafter constructed on the above-referenced Parcel 22 shall
contain no more than three(3)bedrooms.
I agree that this shall be a permanent deed restriction affecting the above-referenced Parcel 22 also known as
264 Bay Lane,Centerville,Barnstable County,Massachusetts,02632 as shown on said plan recorded in
the Barnstable County Registry of Deeds. This restriction may be released by the Town of Barnstable's
Board of Health should regulations change or sewer become available.
For my title see Deed recorded at the Barnstable County Registry of Deeds in Book 5846,Page 53.
xec ted as a sealed instrument this J A th day of Jao ,2006
' ! e
Amy C.May field
State of New York
' SS. Date: 10,n ( cl 2006
On this _day of 2006 before me,the undersigned notary public,then
personally appeared before me
Proved to me through satisfactory evidence of identification, which was C h iJ�(-'S
to be the person(s)whose name is signed on the preceding or
ti 3 attached document,and acknowledged to me that they ignediitt volunt rily for its st to purpose.
� Notary Public
BARBARA M. E
NOTARY PUBLIC,State of Ne York
Qualified in Erie County
MY Comm 11 20���
�U
;i 'a' ., M . My Commission Expires: �� -U
k t
� NWo
BARNSTABLE RERlSrpy OF DEED
S
LETTER OF TRANSMITTAL
JC Engineering Inc.
Civil&Environmental Services
2854 Cranberry Highway
U9b Telephone: 508-273-0377
e
E.Wareham,MA 02538 Facsimile: 508-273-0367
TO: Town of Barnstable DATE: 15-Feb-06 JOB NO. 581
Board of Health RE: Proof of Recording of Deed Restriction for
200 Main Street 264 Bay Lane
Hyannis,MA 02601 Centerville,MA
WE ARE SENDING YOU: X Enclosed _ Under separate cover via X the following:
Report Prints Brochures Shop Drawings
Specifications Copy of Letter Change Order Contract Documents
Enclosed,please find a copy of the proof of recording of the Deed Restriction for 264 Bay Lane,
Centerville,MA. It was recorded in the Barnstable County Registry of Deeds on January 25,2006
in Book 20683,Page 158.
THESE ARE TRANSMITTED as checked below:
For Approval _Resubmit Copies for Approval
X For Your Use Approved as Noted Copies for Distribution
As Requested Returned Approved as Submitted
Returned For Review and Comment X For Your Information
REMARKS As always,please feel free to contact the office with any questions or concerns.
COPY TO: File/Client SIGNED: /
_ ebecca R.. Figueroa
TOWN OF BARNSTABLE
1.fJCATION �i� /'al Gk/ SEWAGE # >IM ' 71
VA..LAGE ASSESSOR'S MAP & LOTA -0
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY CaL �-yO
LEACHING FACILITY: (type) s70 E'f L Cl w44,d (size) "X Z
NO. OF BEDROOMS 3
BUILDER 0 R �L �COMPLIANCE
PERMITDATE: 3-7- DATE: fo/—lob
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 �� E'no i%w41-/0
e �+
No. 9M 6 ��� � � • Fee ld
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
- Yes
PUBLIC HEALTH-DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
apphratton for � gpogal *y5tem COtt.5trurtton Vertu
Application for a Permit to Construct( ) Repair(K Upgrade( ) Abandon( ) LJ Complete System ❑Individual Components
Location Address or Lot No. z + Owner's Name,Address,and Tel.�
�-� 6 �Qy ��
AsleMr's Ivlap/p/Farcel
9
Installer's Name,Address,and Tel.No. ,ram /` Designer's Name,Address and el.No.
Type of Building:
Dwelling No.of Bedrooms j, Lot Size I7 7 sq.ft. Garbage Grinder ( �
Other Type of Building r5 r B �i No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 gpd Design flow provided .�3l• gpd
Plan Date /Z Number of sheets Revision Date �a
Title IC S Ll
Size of Septic fank Type of S.A.S.
Description of Soil �il`i� Z�� Z
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 Certificate of
Compliance has been issued by this Board of Health. J
igned Date
Application Approve Date
Application Disapproved by: Date
for the following reasons
Permit No. GL� (4 �� Date Issued 3
No.. lV Fee
THE COMMONWEALTH OF MASdACHUS TS Entered in computer:
PUBLIC HE -H'DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Rpplication for Mi!6pog ar 6p5tem Cougtruction Permit
�. Application for a Permit to Construct( Repair(v Upgrade( ) Abandon( ) [ Complete System ❑Individual Components
p.
1
Location Address or Lot No. Z / Kg /fir Owner's Name,Address,and Tel.No.
�j p� b/� v y � y
Ass,BsPr'sZviPpael Ce,.14
y
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms ,3 Lot Size p T, sq. ft. Garbage Grinder
Other Type of Building �(°rjj �/�C�i No.of Persons Showers( ) Cafeteria( )
Other Fixtures /
Design Flow(min.required) j __gpd Design flow provided 3 3f• —5— gpd
Plan Date a 6 O Number of sheets Revision Date
Title
Size of Septic ank
Description of Soil 7 s ,1/ZA 2 l
1
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected: r
Agreement:.
The undersigned agrees to ensure the construction and maintenance of the afore described on-site seydge disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
J1 /
/S'igned ;, � Date
Application Approve(d-by. Date 1p
Application Disapproved by: Date
for the following reasons
..w"
Permit No. gcxD (0 r Date Issued 3
r T a' !t
_ THE COMMONWEALTH OF MASSACHUSETTS /
BARNSTABLE, MASSACHUSETTS/"C-.
Certificate of Compliance
THIS IS TO CERTIFY,,that the On-site Sewage Di osal System Constructed ( ) Repaired ( ✓) Upgraded ( )
Abandoned( )by / G'!9S
k at , r! 1 C has been constructed in accordance
�W with the provisions of Title 5 and the
for Disposal System Construction Permit No. �� ' dated
Installer ilk'
N � Designer
#bedrooms Approved design flow gpd
The issuance of this permit shall noi'be construed as a guarantee that the system will fu�i9"� esigned.
h
Date �� w Inspector —
--- �:�J ----------- -------------- ---
No. �D '—O7 Cj Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION —BARNSTABLE, MASSACHUSETTS
_ Migo!gar 6p!tem Construction Permit
Permission is hereby granted to Construct ( ) Repair ( K. Upgrade ( Abandon ( )
System located at 7,-X y �a �d �'ee I`G°"!
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: Construc ion ust be completed within three years of the datetbyt
Date 3�/�o Approved _ —
Town of Barnstable
Regulatory Services
eni� >� Thomas F. Geiler,Director
Public Health Division
Thomas McKean,Director
200 Main Street,Dyannis,MA 02601
ME= 508-862-4644 F4x; 508-790-6304
bsta ler& Desienir w0cadqn Form -
Date: 3-13 0l0
Designer: �C 5��nee � 1�(1C, Anstailer: ��c��' i/o��, C. .�t✓cx���
Address: 285`I Gcy l��"g�n�`'o,`� Address-, y� 1ti�✓��.�� rl�
C-. Worenolnn \ �tik 0253$ Ai f f�i1r /� j On 7- -5 ' Z/C�//c� �)/c Ly as issued a permit to install a 7
(date) (installer)
septic system at_2-6 4 3ny t 0K e- , C.ev►Vec Ul t1 e, based on a design drawn by
(address)
dat®d APck 26 2CVY ( Reu i 5-I 8-o y)
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I Certify that the septic system referenced above was installed with major changes i.e.
greater that 10' lateral relocation of the SAS or any vertical relocation,of any component
of the septic system)but in accordance with State&Local Regulations. Plan revision or
certifi -built by designer to follow.
CL
JOHN L. INK,
CHURCHILL
JR. 5
Cr S lisnature C �L
N 41K7
G
estgner's S' tire} (Af 1) Designer's Stamp Here)
L O S C H TH DIVILION. CER
OF CNOT BE ISSUED IMU-JIQTH IHIFI FORM AND A5-
B CARD ARE RECT IO .
TAAAIK YOIU.
Q:HealthlSepticJDcaigae:Cer�icstiom Fors
� 2-500 AL
e
GALLON LEACHING .5 aE RA 2
CHAMBERS(H-20)
DISTRIBUTION BOX
PVC fit° . Gam/ \ WRA 3,
6 1
4
E 53.40' w ` \ C 1500-GALLON
58 ' 6'28"E ; ` 1 SEPTIC TANK
\ 1 AL
N _
b 7.6
Z
6 w
o
a x59 5.5'
0
P K _ + I \ �
G R \ AL
EA oo `\\
w TIC NV.
TA
\ � EXISTING � ,
BEDROODWELLINGM\ \
RA s OF=23.80' I
21.03' 1 ! RA 10
27 , i
\wRA 26 L/T" — 1 < f / 1 1 WRA ,°
64
AL
WRA 25
moop
24
RA 23K� ' "`�✓ 94� RA 3� o 0
AL
AL ✓WRA 21
2 64 2>A y (,A (=- X. \
\ / WRA 14 g(�
C(.:!V i'1= 1'�v 1 LL. WRA 20 �$ ✓fO ik 910
15
wRA'1��� AL
�WRA 19 A lv��
,f \ �/WRA 17 AL \ �AL WRA
,: of
THE DATE:
� BARNi3Pi►BI.E, �
FEE:
/ 039.
�Ephgp�� REC. BY
Town of Barnstable
CHED. DATE:
Board of Health
200 Main Street, Hyannis MA 02601
Office: 508-862-4644
FAX: 508-790-6304 Susan G.Rask,R.S.
Sumner Kaufman,M.S.P.H.
Wayne A.Miller,M.D.
VARIANCE REQUEST FORM
LOCATION
Property Address: (au � �
Assessor's Map and Parcel Number: Size of Lot: (ay yq S +
Wetlands Within 300 Ft. Yes X Business Name:
No Subdivision Name:
APPLICANT'S NAME: �C : � •
roe a: Phone Spa-a-+ -•03,
Did the owner of the }
property rty authorize you o represent him or.her? Yes <- No
PROPERTY OWNER'S NAME CONTACT PERSON
Name: AnnH Name: :30k-j L. Ch rr� 11 Sr P E
Address: 19 Zur,,4_6-A,.¢ '�As} Ai,cora NV INy5D Address: rV�A �a53$
JVARI
Ita— '�to.ti-4lolet a Phone: 5—ow-
w cr,
e t e-) E FROM REGULATION([ist Reg.) REASON FOR VARIANCE(May attach if more space needed)
m<rV2
M• co Iu�
C:i -'
NATURE OF WORK: House Addition ❑ V�lo�lta�y
House Renovation ❑ Repair of Failed Septic Systerr 0 4Cade—
Y
n FCh,,klg be completed by office staff-person receiving variance request application)
our(4)copies of the completed variance request form
our(4)copies ofengineered plan submitted(e.g.septic system plans)
ur(4)copies of labeled dimensional floor plans submitted(e.g.house.plans or restaurant kitchen plans)
gned letter stating that the property owner authorized.you to represent him/her for this request
pplicant 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
NOT APPROVED Susan G.Rask,R.S.,Chairman
REASON FOR DISAPPROVAL Sumner Kaufman,j .S.P.H.
Wayne A.Miller,M.D.
C:\Documents and Settings\decollik\Local Set tings\Temporary Internet Files\OLKFB\VARIREQ.DOC
0
JC ENGINEERING, Inc.
f x Civil & Environmental Engineering
2854 Cranberry Highway
s East Wareham, Massachusetts 02538
f Ph. 508-273-0377—Fax 508-273-0367
June 21, 2004
Thomas A. McKean
Town of Barnstable
Board of Health Agent
200 Main Street
Hyannis, MA 02601
RE: 264 Bay Lane, Centerville, MA
(Project#581)
Dear Mr. McKean:
Please find enclosed the revised sewerage disposal design drawing entitled "Proposed Septic
System Upgrade Located at 264 Bay Lane" dated April 26, 2004 with revision dated 5-18-04, for
your review and approval. This project is a voluntary upgrade of an existing septic system.
Due to site constraints, we are requesting the following variances from the Town of Barnstable
Board of Health Regulations; Part VIII, Section 1.00. Please note that the proposed septic tank
was relocated greater than 100 feet outside the bordering vegetated wetlands thus eliminating the
need for a 24.8' variance for the setback from the bordering vegetated wetland to the proposed
septic tank as previously requested. Also, the following variances below have been reduced from
the previously requested variances.
(1) A 41.6' variance (100' to 58.4') for the setback from the coastal bank to
septic tank.
(2) A 37.2' variance (100' to 62.8') for the setback from the coastal bank to the
leaching facility.
Under maximum feasible compliance, we believe by allowing this waiver, the homeowner will
voluntarily upgrade his system and conform to the current septic system standards. We
appreciate your time and consideration on this matter. Please contact me if you have any
questions or concerns.
Thank you for your assistance on this project.
SincerelyeChJohnL.
III , .E., C.S.E.
President
JC ENGINEERING Inc.
} Civil & Environmental Engineering
2854 Cranberry Highway
:IN'R East Wareham Massachusetts 02
538
Ph. 508-2 73-03 77-Fax 508-273-0367
MEETING NOTICE
Dear Abutter:
You are hereby notified that there will be a public meeting on Tuesday, July 13, 2004 at 7:00 PM
in the NTH Hearing Room in the Barnstable Town Hall, which is located at 367 Main Street,
Hyannis, MA 02601. This meeting is to present a variance request associated with a Septic
System Upgrade at 264 Bay Lane, Centerville, Massachusetts. This project is a voluntary
upgrade of an existing septic system. Due to site constraints, we are requesting the following
variances from the Town of Barnstable.Board of Health Regulations; Part VIII, Section 1.00:
(1) A 41.6' variance (100' to 58.4') for the setback from the coastal bank to septic
tank.
(2) A 37.2' variance (100' to 62.8') for the setback from the coastal bank to the
leaching facility.
The application and plans are available for review at the Barnstable Health Department, 200
Main Street, Hyannis, MA Monday through Friday (excluding holidays) from 8:30 a.m. to 4:30
p.m.
BEDROOM
r,
cc
11'-11" CL,
BEDROOM
M
I; BATHROOM
CL.
15'-8"
FAMILY ROOM CL. BATHROOM
N CL.
CLAIM.
15'-11" 13'-6"
DINING ROOM N BEDROOM �4 29'-6"
L.I:VING ROOM KITCHEN
00
CL. CL.
16'
GARAGE
0
N
Floor Plan of 264 Bay Lane, Barnstable
April 25, 2004 JC Engineering, Inc.
Prepared for Ms. Amy Mayfield Waters 2854 Cranberry Highway
E. Wareham, MA 02538
(508)273-0377
BOARD OF HEALTH ABUTTERS LIST FOR
264 BAY LANE, CENTERVILLE, MA
MAP# LOT# (S) OWNER'S NAME & MAILING ADDRESS
Francis Jones
186 18 Sharon Maingay
356 Bay Lane
Centerville., MA 02632
Jonathan & Rebecca Macdonald
186 21 282 Bay Lane
Centerville, MA 02632
Virginia Carothers
186 23 274 Bay Lane
Centerville, MA 02632
Town of Barnstable (Con)
186 24 367 Main Street
Hyannis, MA 02601
Edward Holtzman
186 25 305 East 86th Street
New York, NY 10028
Elizabeth Miles
186 26 PO Box 435
Centerville, MA 02632
Ms.Amy Mayfield Waiters
19 TUMbridge Welke
Ent Aurork NY 14052
Board of Health
Town of Barnstable
200 Main Sbvo
Hyanni6,MA 02601
RE:l]oclaMdon of Authorization
Dear Members of the Board: March 19,2004
Let it be kmmn that L Amy Mayfield Waters do hereby authorizie IC Engineering,Inc,of
East Warehsm to represent my intomte regardipg ttu upgrade of the sewage disposal
eyetem locatrd at 264 Bay Lane, Centerville,MA ill meetings both public and private.
Si eroly,
Amy Mayfield Waters
I
21a CI Ele Beg 7NI2133N.I�M3�l WV 5@:@T tiH@��.iB�2JdlJ
JC ENGINEERING, Inc.
�,Z� V. Civil & Environmental Engineering
s0 L 2854 Cranberry Highway (� n
East Wareham, Massachusetts 02538
D
Ph. 508-273-0377—Fax 508-273-0367
JUN292004 A
MEETING NOTICE BARNSTAB F_ CONSEMIA7
Dear Abutter:
You are hereby notified that there will be a public meeting on Tuesday, July 13, 2004 at 7:00 PM
in the NTH Hearing Room in the Barnstable Town Hall, which is located at 367 Main Street,
Hyannis, MA 02601. This meeting is to present a variance request associated with a Septic
System Upgrade at 264 Bay Lane, Centerville, Massachusetts. This project is a voluntary
upgrade of an existing septic system. Due to site constraints, we are requesting the following
variances from the Town of Barnstable Board of Health Regulations; Part VIII, Section 1.00:
(1) A 41.6' variance (100' to 58.4') for the setback from the coastal bank to septic
tank.
(2) A 37.2' variance (100' to 62.8') for the setback from the coastal bank to the
leaching facility.
The application and plans are available for review at the Barnstable Health Department, 200
Main Street, Hyannis, MA Monday through Friday (excluding holidays) from 8:30 a.m. to 4:30
p.m.
i
JAN-11-2006 08 :30 AM JCENGINEERING 508 273 0367 P. 02
LX
3 . a Town of Barnstable
�.51 so Board of Health
200 Main Street, Hyannis MA 02601
Office: 503-862-4644
SAX; 508-790-6304 Susan G.Rask,R.S.
Sumner KaufMan,MS
Wayne Miller.M.D.
Mr. John L. Churchill, Jr., P.E, July 29, 2004
JC Engineering, Inc.
2854 Cranberry Highway
East Wareham, MA 02538
RE: 264 Bay Lane, Centerville A= 1867022
Dear Mr. Churchill,
You are granted conditional variances on behalf of your client, Amy Mayfield
Waters, to construct a replacement sewage disposal system at 264 Bay Lane,
Centerville, Massachusetts.
i
The variances granted are as follows:
PART VIII, SECTION 1.00: The soil absorption system will be located 62.8 feet
away from a coastal bank, in lieu of the one-hundred feet minimum
separation distance required,
PART Vill, SECTION 1.00: The septic tank will be located 58.4 feet away from a
coastal bank, in lieu of the one-hundred feet minimum separation
distance required.
These variances are granted with the following conditions:
(1) No more than three (3) bedrooms maximum are authorized at this
property. Dens, study rooms, offices, finished attics, sleeping lofts, and
similar-type rooms are considered "bedrooms" according to the MA
Department of Environmental Protection.
(2) The applicant shall record a properly worded deed restriction, signed by
the owner of the property, at the Barnstable County Registry of Deeds
restricting the property to three (3) bedrooms maximum. A copy of the
recorded deed restriction shall be submitted to the Health Agent prior to
obtaining a disposal works construction permit.
Q:W/Church ill AmyMaylleld Waters
f
JAN-11-2006 08 :31 AM JCENGINEERING 508 273 0367 P. 03
(3) The septic system shall be Installed in substantial compliance with the
engineered plans dated May 18, 2004.
(4) The professional engineer shall supervise the construction of the onsite
sewage disposal system and.shall certify in writing to the Board of Wealth
that the system was installed in substantial compliance with the
engineered plans dated May 18, 2004.
These variances are granted because the physical constraints at the site
severely restrict the location of the soil absorption system due to its close
proximity to the wetlands, adjoining this property on three sides.
Slnc ely yours,
ayne filler, M.D.
hair n
b
Q:WP/ChurchillAmyMayticldWotcr.i
FEB-20-2006 09 :55 AM JCENGINEERING 508 273 0367 P. 01
DEED RESTRICTION ENk 21-if'8:3 PrJ 158
WHEREAS, Amy C.Mayfield,of 19 Tunbridge Walke,East Aurora,New York, 14052,is the owner
of the land together with the buildings and improvements thereon situated at 264 Bay Lane,Centerville,
Barnstable County,Massachusetts,02632,and more particularly described as Parcel 22 on Assessor's
Map 186 and shown as Lot E on a plan entitled,"Sub-Division of'Cranberry Hill',formerly known as
Long Hill,Centerville, Barnstable,Massachusetts, March 13, 1946",recorded at the Barnstable County
Registry of Deeds in Plan Book 73,Page 5. Said lot containing 49,920 square feet of land,more or less,
according to said plan;and
WHEREAS, I as owner of said Parcel 22 have agreed with the Town of Barnstable Board of Health to a
resaiction on the number of bedrooms that can be included in any home now existing or hereafter
constructed on said lot as a condition to obtaining a disposal works construction permit for the on-site septic
system repair/replacement/installation on said parcel pursuant to State Environmental Code,'Title V,310
CMR 15,000 et.seq.;and
WHEREAS,the Town of Barnstable Board of Health as a condition to granting the disposal works
construction permit is requiring that the agreement to restrict the number of bedrooms in any home now
existing or hereafter constructed on the lot be put on record with the Barnstable Cnunty Registry of Deeds by
recording this document;
NOW,THEREFORE, I do hereby place the following restriction on the above referenced lot in
accordance with the Town of Barnstable Board of Health, which restriction shall run with the land and be
binding upon all successors in title:
1. Any home now existing or hereafter constructed on the above-referenced Parcel 22 shall
contain no more than three(3)bedrooms,
I agree that this shall be a permanent deed restriction affecting the above-referenced Parcel 22 also known as
264 Bay Lane,Centerville,Barnstable County,Massachusetts,02632 as shown on said plan recorded in
the Barnstable County Registry of Deeds. 'Phis restriction may be released by the Town of Barnstable's
Board of Health should regulations change or sewer become available.
For my title see Deed recorded at the Barnstable County Registry of Deeds in Book 5846,Page 53.
xecc.ted as a sealed instrument this 6 day of_ �_ ,2006
Amy C.May held
State of New York
,Ss, Date:.,f61./1__.I ei 2006
On this 1 _ day of r ,2006.before me,the undersigned notary public,then
personally appeared before me r � _ L .
Proved to me through satisfactory evidence of identification, which was -
_ _^to be the person(s)whose name is signed on the preceding or
attached document,and acknowledged to me that they, igned it volunt rily or its state purpose.
r �
Notary Public
URBARA III
waity PUBLIC.
In Crle Counl�Q�
• y ��. MV�rmr
M 7
U M My Commission Expires:
W
U
BARNSTABLE REGISTRY OF DEEDS
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
■ Complete items 1,2,and 3.Also complete A. Signature
item 4 if Restricted Delivery is desired.. X �— ❑Agent
■ Print your name and address on the reverse ❑Addressee
so that we can return the card to you. B. R eiv, Printe Name) Date of Delivery
■ Attach this card to the back of the mailpiece, j q
or,on the front if space permits. 121
!/ 0
D. Is a dress different from item 1? ❑Yes
1. Article Addressed to: If nt r delivery address below: ❑No
Francis Jones
Sharon Maingay
356 Bay Lane
3. Service Type
Centerville, MA 02632 '�P Certified Mail ❑Express Mail
❑Registered ❑Return Receipt for Merchandise
❑Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number 7003 3110 0002 0207 6363 Go
(Transfer from service. _ : _+f 1. f 67 t
PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-1e40
! � I
UNITED STATES POSTAL SERVICE•) K1 w�
`O Flrst-Class Mail
it { �S "Postage&Fees Paid
{ , LISPS,
Permit No:G-10
• Sender: Please priryotra ` address, and ZIP+4 in this box •
I
1C Engineering,Inc.
I 2854 Cranberry Highway
East Wareham, Ma 02538-1314
I
I
I
I
I
I
f> >. 1�{3!!!tli�l�!�SS!1141!f111S11141�{!t2?��?�ltlll litfi{t�i�?!�1
I�
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
■ Complete items 1,2,and 3.Also complete A. Si ure
item 4 if Restricted Delivery,is desired. ❑Agent
■ Print your name and address on the reverse X dressee
so that we can return the Card to you. Received by(Printed C. D to of Delivery
■ Attach this card to the back of the mailpiece, 491
sag
or on the front if space permits.
D. Is delivery address different from Rem 1? ❑Yes
1. Article Addressed to: If YES,enter delivery address below: ❑No
Jonathan&Rebecca Macdonald
282 Bay Lane
Centerville, MA 02632 3. service Type
Certified Mail ❑Express Mail
❑Registered ❑Return Receipt for Merchandise
❑Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑YeS
2. Article Number 7003 3110 0002 0207 6370 b%t
(rransfer from service la �7
PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-1540 i
— IA
I �
UNITED STATES POSTAL SERVIC ;`J ;4k* First-Class MailT.�
j it �;;LL _Postage&Fees Paid
` USPS`
-Permit No:G-10
,.. 77 ..,
• Sender: Please prirf..y'b te, address, and ZIP+41n-this box
I
� I
I
� I
1C Engineering,►n,,
2854 Cranberry Highway
East Wareham,Ma 02538-1314
I
I
I
f! I!� y F °i I ( I �t jj �fill IIHIII if IIHII!!IIIIJI!IIIIIi!IIJI!!i}11
!Il!!!!d,Id ill till!i!!l!!!I'll
COMPLETE •N COMPLETE THIS SECTIONON DELIVERY
■ Complete items 1,2,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. B. Received by(Printed Name) C Date of Delivery
■ Attach this card to the back of the mailpiece,
or on the front if space permits. ' R aZ g
D. Is delivery address different from item 1? ❑Yes
1. Article Addressed to: If YES,enter delivery address below: ❑No
Virginia Carothers
274 Bay Lane
Centerville,MA 02632 s. Service Type
�ertified Mail ❑Express Mail
❑Registered ❑Return Receipt for Merchandise
❑Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number A : �- 3112 0 0 0 2�":Q2 7 6 3 8 7.
(Transfer from service,
PS Form 3811.,August 2001 Domestic Return Receipt 102595-02-NI-1540
r�
xr
UNITED STATES POSTAL SERVIC �Jv � .'
First-Class.Mail.
} v Postage&i=ees Paid
' USPS
r n - Permit-No.-G-1�
• Sender: Please priniFyourknaMI6, address, and ZlP+4`in this box • -- -
)C Engineering,Inc.
2854 Cranberry Highway
East Wareham,Ma 02538-1314
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
■ Complete items 1,2,and 3.Also complete . Signature
item 4 if Restricted Delivery is desired. _!aA CJ _�_
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or,on the front if space permits:
D. Is delivery address different from Rem 1? ❑Ye
1. Article Addressed to: If YES,enter delivery address below: ❑No
Town of Banlstable (Con)
i
367 Main Street
Hyannis, MA 02601 3tegistered
ice Type
ertified Mail ❑Express Mail
❑Return Receipt for Merchandise
/.,13 Insured Mail ❑C.O.D.
4_w Rdstl te7d Delivery?(Extra Fee) ❑Yes
2. Article Number 4
(rransfer from se c� �+•: a
102595-02-M-1540
PS Form 3$11 Augusf 2DOi w{�,� ����d as .4�� � ipt rs,C
UNITED STATES POSTAL SERV First-Class Mail
Postag6&.Fees P90"
LISPS
PerryAt N6.G-A 0
• Sender: Please print oan,ame, address, and 2lP44'irf-this-tYo)(4*... ......
II
10 F"Rfneerfrit,life.
7854 Cranberry Highway
East Wareham, Ma 02538-1314
r
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
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item 4 if Restricted Delivery is desired. ❑Agent
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I
Edward Holtzman
305 East 861" Street
3. ervice Type
New York, NY 10028 ertified Mail ❑Express Mail
Registered ❑Return.Receipt for Merchandise
IN ❑Insured Mail, ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Art
a i
PS Fo io2sss o2-M-1540
UNITED STATES POSTAL SERVI first-ems Fv1aFv1 it
P M a Postage&" ees 'arch
02 JUL �--o" R.RenitNo-G40 �.
• Sender: Please print you-Ma-me, address, and ZIP+4 in this box •
I
I
I
1C Engineering,Inc, j
2854 Cranberry Highway
East Wareham, Ma 02538-1314
I
a z 4i4„s,,it4�4,4:+f41�1,,i„a,4i„!i►E:s41�4<<i�4t4,�i��1�43�14
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
■ Complete items 1,2,and 3.Also complete A. Sig ure
item 4 if Restricted Delivery is desired. -❑Agent
■ Print your name and address on the reverse ❑Addressee
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D. Is delivery address different from item 1? ❑Yes
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Elizabeth Miles
P.O. Box 435
3. S ce Type
Centerville, MA 02632 Certified Mail ❑Express Mail
t' ❑Registered ❑Return Receipt for Merchandise
❑ Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number '
(transfer from sery 7,0 0,3 13110"Old � 4]7 t 64 .
PS Form 3811.,August 2001 Domestic Return Receipt 102595-02-M-1540
i
UNITED STATES POSTAL SERVIC
EFirst-Class Mail
Postage&Fees Paid
LISPS
' c p Permit No.G-10
N.
c�
• Sender: Please print yOurmam6, address, and ZIP+4 in t`[is box •
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)C Engineering,Inc, j
2854 Cranberry Highway
East Wareham,Me 02538-1314
I
I
BOARD OF HEALTH ABUTTERS LIST FOR
264 BAY LANE CENT ERVILLE, MA
MAP# LOT#.(S) OWNER'S NAME & MAILING ADDRESS
Francis Jones
186 18 Sharon Maingay
356. Bay Lane
Centerville, MA 02632
Jonathan & Rebecca Macdonald
186 21 282 Bay Lane
Centerville, MA 02632
Virginia Carothers
186 23 274 Bay Lane
Centerville, MA 02632
Town of Barnstable (Con)
186 24 367 Main Street
Hyannis, MA 02601
Edward Holtzman
186 25 305 East 86th Street
New York, NY 10028
Elizabeth Miles
186 26 PO Box 435
Centerville, MA 02632
oF.► ,b,,
Town of Barnstable P# 0210, (o
o Department of Regulatory Services
mwwsrAsre Public Health Division Date c 3
y MASS ..
059. `0� 200 Main Street Hyannis MA 02601.
�`OTfD fAAr A
Date Scheduled o�- D Time 0, .G'v il/I Fee Pd. Zd 0'
Soil Suitability Assessment for Sewage Disposal
Performed By: Witnessed By: �G,�ir,{ W. Syay► /t
LOCATION&GENERAL INFORMATION
Location Address wn
r
Oer's Name M h ,'Q '
4 Address
�. P✓17��v I E�
Assessor's Map/Parcel: i — Engineer's Name
NEW CONSTRUCTION REPAIR Telephone#
Land Use
SI � �am��y 1-h>m[: Slopes(%) � Surface Stones 7✓D'v�=
Distances from: Open Water Body �'O ft Possible Wet Area 0 U ft Drinking Water Well ft
Drainage Way ft Property tine 2 Q ft Other ft
SKETCH:(Street name dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes)
N
I WaA_o1.
GO
-�t3 fyJK
: ,.',: ;: n ..,;. n wK/'i i,.:?t��.� ,a ;a 4 ,�s o-r;�'nar ..1 �S to �_•Jr!.k� tJGMa'°� ..s ..
y
GC.Avl14t_ u � �
Parent material(geologic) 071�ASti PIA;w I o4wAj11 Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: ` I y 7 Weeping from Pit Face
>iyy
Estimated Seasonal High Groundwater y y
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used: 1
Depth Observed standing in obs.hole: / S!Ye in., Depth to soil mottles: �/ � in.
Depth to weeping from side of obs.hole: /,r in. Groundwater Adjustment ft.
Index Well# _- Reading Date: Index Well level"' _ .Adj.factor Adj.Groundwater Level_
PERCOLATION TEST. Date I2 t3° ire! -'Uv
Observation -
Hole# I Time at 9"
Depth of
Perc y " Time at 6
Start Pre-soak Time Qa Q_r 3)
Time(9"-6")
End Pre-soak gyp, yO
Rate Min./Inch: �`;Z�''� /�✓ E
Site Suitability Assessment: Site Passed Site Failed Additional Testing Needed.(Y/N)
Original: Public Health Division .� �,; Observation,Ho.le Data,To Be_Gompleted on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:HEALTH/W P/PERCFORM
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel)
0 -9 A Lowvs . 10VZ72
--/-
9 -27 IAAYnY SAi-',O zoatyy
m�� sra-�o
2 7—l Y C /c pro ,e,a � 2,s Y �� 1 S zo% G��l�z Z
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil•Texture . Soil Color Soil Other
Surface(in.) (USDA) (Munsell) -- Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
DEEFIOBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
Flood Insurance Rate Map:
Above 500 year flood boundary No Yes
Within 500 year boundaryNo_
Yes .
Within 100 year flood boundary No— Yes
Depth of Naturally Occurrint?Pervious Material.
Does at least four feet of naturally occurring pervi u trial exist in all areas observed throughout the
area proposed for the soil absorption system? ��
If not,what is the depth of naturally occurring pervious material? .
Certification I certify that on 097 (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with
the required trainin a pertise and experien described in 310 CM.R 15.017.-
Signature Date 2 �) w
Q:H EA.LTH/W P/PE RC FO RM
TOP OF FOUNDATION = 23.80' FINISH GRADE OVER D-BOX= 22.50' FINISH GRADE OVER CHAMBERS= 22.60' - 23.50'
�- SLOPE @ 2% MIN. OVER SYSTEM
4"SCHEDULE 40 PVC MIN SLOPE 1% 3/4"TO 1-1/2"DOUBLE WASHED STONE TO CROWN OF PIPE GENERAL NOTE S
FINISHED GRADE CAST IRON
FRAME &COVER FINISH GRADE OVER TANK EL.= 22.75 2"OF 1/8"TO 1/2" DOUBLE WASHED STONE
@ FOUNDATION = 23.00 5" DIA. OUTLET(S) 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION
-- - SET FRAME IN FULL - � PLACE CAST IRON FRAME&
BED OF MORTAR CAST IRON SET BED RAM E IN F LL TOP OF SAS= 20t= BR
63� ADJUST TO R IN.12 OR MAXD4 COVER ON ALL CHAMBERS METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE
ADJUST TO REQUIRED GRADE FRAME &COVER 9" MINSET FRAME IN FULL ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES.
PROPOSED 4" W/MIN. 2 OR MAX.4 ' SES OR EQUIVALENT BED OF MORTAR
19.80 36 MAX. N WITH REINFORCED 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD
SCHEDULE 40 PVC BRICK COURSES OR EQUIVALENT ADJUST TO REQUIRED GRADE BREAKOUT EL = 20.3000NCRETE COLLARS. OF HEALTH AND THE DESIGN ENGINEER.
DIMENSION WITH REINFORCED W/MIN. 2 OR MAX. 4
' MIN.sLOPE��% 6" 3" 2" DROP MIN. 3" 9" CONCRETE COLLARS. BRICK COURSES OR EQUIVALENT 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL
3" DROP MAX. DIMENSION WITH REINFORCED BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED.
CONCRETE COLLARS. ��� O ���
22.00� 0 4" PVC IN FROM " � � � O � � � op � 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN
14" 20.50' SEPTIC TANK 4 PVC OUT TO ELEVATION =20.30 FOR A DISTANCE OF 15 AROUND THE PERIMETER OF THE SAS. UNLESS
20.75' LEACHING FACILITY T o00 A 40 MIL GEOMEMBRANE LINER IS PLACED AT LEAST FIVE FEET FROM S.A.S.AND THE TOP
PROVIDE WATERTIGHTOF THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
' 12" JOINTS (TYP.) 2 00 po 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM.
OUTLET TEE 20.17 i MIN.21 .Y "48 00op 1 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
BASEMENT " 20.00 DODO 0 0 0 o
TO BE 48.0' 22 ZABEL FILTER o _ 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO
6" CRUSHED STONE
REPLUMBED MODEL#A1801 HIP(GAS OVER MECHANICALLY 4.0' ( 4.0' 3.55' 3.55' BACK FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR
BAFFLE ON BOTTOM) COMPACTED BASE 8.5 4 9' INSPECTION. SYSTEM IS NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING
6"CRUSHED STONE 5 OUTLET DISTRIBUTION BOX 25 0� (Typ ) APPROVAL FROM BOARD OF HEALTH AND DESIGN ENGINEER.
OVER MECHANICALLY TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= <1 1 .59' V 8. ELEVATIONS BASED ON ASSUMED DATUM OF 25.29' OBTAINED
COMPACTED BASE BASE. FIRST TWO FEET OF OUTLET 17.80 12.0 FROM A NAIL IN A TREE AS SHOWN ON PLAN.
PROPOSED 1500 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 2 - 500 GAL. CHAMBERS 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
LENGTH 10.5' WIDTH 5.67' DEPTH 5.58' CROSS SECTION VIEW 5'MIN. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE
Iwi-20 SEPTIC TANK PROFILE TYPICAL CHAMBER PROFILE CHAMBER DETAILS CHAMBER END VIEW AT1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY
DISTRIBUTION BOX DETAIL I L DISCREPANCIES TO THE DESIGN ENGINEER.
NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE
STRUCTURES SHALL BE MADE WATERTIGHT.
• TEST PIT DATA NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR
•� • • ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH
INSPECTOR: Dave Stanton DETERMINATION FROM APPROPRIATE AUTHORITY.
s • a , •
12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS
' SOIL EVALUATOR: John L. Churchill, Jr. LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE
..>±� • DATE: 12/8/03 THEY SHALL WITHSTAND H-20 LOADING.
I . j _ • . TEST PIT#: 1 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND
Nor ELEV TOP= 23.59' FINES.
MAP 186 I -�-- • ELEV WATER= < 11.59. 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND
/ UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF
\' LOT 21 I r PERC RATE _ <2 MIN/IN LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN
...
\ \` N/F MACDONALD o I COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN
\ f e ) DEPTH OF PERC= 36"-54" ACCORDANCE WITH 310 CMR 15.255(3).
<v� CO MAP 186
• TEXTURAL CLASS: 1 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
�� �� LOT 23 I 50'COASTAL BANK OFFSET I SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
\ 3i I 16. PROPOSED PROJECT IS LOCATED WITHIN:
Q�j v N/F CAROTHERS 0" 2 .
o - Ii- MAP 186 3 59
�`'� r' - Loamy Sand
A ASSESSORS MAP 186 PARCEL 22
O� ` \ \ \, O �n LOT 18 t 1�YR 2/2
�\. 0 N/F JONES _ - 9" 22.84' I OWNER OF RECORD: AMY C. MAYFIELD
CV) �o� \ q • * { • .u. B Loamy Sand ADDRESS: 845 CHESTNUT HILL
� \ W I IIVRA 1 • • • • ytt 27" 10YR 4/4 21 EAST AURORA, NY 14052
q \ \ �NOO \ P$9POSED 2-500 0 " �1� p 36" 20 59, FEMA FLOOD ZONE C&A10 (EL 11)
!\ \ 'ccs, GALLON LEACHING 55 E RA 2 �,:� * Perc �� AS SHOWN ON COMMUNITY PANEL# 250001 0016 D
CHAMBERS \ Ng1° 52 PROPOSED • • �/ 19.09
DISTRIBUTION BOX . • + � • ,
. • + • 4 • 54" 17. PLAN REFERENCE:
• ' • • 1. BOOK 73, PAGE 5
/ \ 4Ct 61 \ WRA 3
O • • Medium Sand
\ _k � 660 �p"E 2 , ' 15-2.0%Gravel
AL\ ` 8 01. • 18. DEED REFERENCE:
-� _k N6 O- ' � • 2.5 Y 6/6 1. BOOK 5846, PAGE 53
/ w 84°54, \ - `" -` 4 PROPOSED 1500-GALLON • . C
L1! o , o m�� E 53.40 - ` ` SEPTIC TANK • • yr 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION.
Z {N{ ��\ 1 7•Q� - 89°46 y' ■ 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY
' ■ /
W \ \ �O / (STING DRI FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
Q �/ WRe36� j LIGHT � \ o l-- __ ..,,,� �r �' 1 1I B.M. FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
m _ �. / �� '`�\ - Z Nail in Tree " 21- THE FOLOWING LOCAL VARIANCES ARE REQUESTED.
0 0 e \ POST \ Q _ 144 11.59 I
co / BRA I // \�`` ~ x59 __` O $4' w 6 Elev. =25.29' LOCUS PLAN ° 1. A 41.6'VARIANCE (100'-58.4') FOR THE SETBACK FROM THE SEPTIC TANK TO
34� / \ _ _ Cp�\ ��� Assumed THE COASTAL BANK.
co / / 2.8 9S ` o .. "_ 2. A 37.2'VARIANCE (100'-62.8') FOR THE SETBACK FROM THE LEACHING FACILITY TO
i' l ► � ;• 12.0' \ �y \ e SCALE: 1 - 1000 THE COASTAL BANK.
WET 8A ) `x�WR 33 \ \ 0 1 /��/ /^ P K ARAG \AL IQ
EXISTING CESSPOOL AND
I AL '� \ �o ,xr / � w ��^ � A � � f� �� I A OVERFLOW TO BE PUMPED
t / ° e �/ / <Fo RE ' �' o
/ ' - A FILLED WITH LEAN SAND
r \�� r DESIGN DATA LEGEND
z► � V�/RA 3'' � � � / _
\\ N �o o z
2 AL w AIL �\ � / 1 / I / � 15 �/ ,\� AL BASEMENT TO BE
QI __WRA 31 �j/ , , #264 ( RA 8 X REPLUMBED EXISTING CONTOURS
ILL 0 \ ` EXISTING ' 1 NUMBER OF BEDROOMS (DESIGN) 3 i^v2 PROPOSED CONTOURS
w ` t 7� e 3-BEDROOM ' t AL DESIGN FLOW 110 GAUDAY/BEDROOM
0 / 9\WRA 30 �.� DWELLING 102 PROPOSED SPOT GRADE
I / \ 330
LU RA 9 TOTAL DESIGN FLOW GAUDAY
\� \� OF =23.$0' I %--EXISTING CESSPOOL AND DESIGN FLOW X 200 % = 660 GAUDAY E/T/C - EXISTING OVERHEAD UTILITIES
I / WRA 29 RA 26_ \\� ��A sue/ fir' I
�, 'iYc. OVERFLOW TO BE PUMPED
�, \ �� \ \ ' ivv. / ' --�`� AND FILLED WITH CLEAN SANG USE PROPOSED 1500-GALLON SEPTIC TANK
WET 2A RA 2� \ \��_cg - \ � 21.03' / I I RA 10 �/ -- -- EXISTING WATERLINE
\ 10_ -- � �\ \ \ / I AL N1 TEST PIT LOCATION
AIL 8-1 WRA 26 LIOT/2 1 / / J / WRA 11 INSTALL 2 - 500 GAL. CHAMBERS H-20 Q Q Q PROPOSED 1500 GALLON SEPTIC TANK
AL WATER GATE � 6 / / �16`_14--, -- -20/
WRA / _ / SIDEWALL CAPACITY 4"SOLID SCHEDULE 40 PVC PIPE
EXISTING WATERLINE 742 ( _ / -
e►� / ) RA 1 ❑ DISTRIBUTION BOX
WET4A 1 v�p �\ \\\ ���.. .► /
(LENGTH +WIDTH)(2)(2' HIGH) (.74 GPD/S.F.) GAUDAY
WR / ( ��� >�\ I-,'
I--,'
/ (25 +12) (2)(2) (0.74 GPD/S.F.)= 109.5 GAUDAY DO 500 GALLON LEACHING CHAMBER
A 24 _ / _
\ ` BRA 23` �4 /ro/ / \ 14-- A 3 / o
` \ / ` \\12� / iGv 1 BOTTOM CAPACITY
AL
WRA 21 \6� \ / ( LENGTH x WIDTH ) (.74 GPD/S.F.) = GAUDAY
\ �'i� / (25'x 12') (.74 GPD/S.F.) = 222.0 GAUDAY 1 5/18/04 MCP JLC DECREASED TO 3 BEDROOMS
MAP 186 \ \ REV. DATE BY APP'D. DESCRIPTION
ox WRA 14
/ LOT24 k WRA20 jai �/ ,� AL SEPTIC SYSTEM UPGRADE
\ _ N/F TOWN OF BARNSTABLE TOTALS:
_ \ WRA 15 PREPARED FOR:
-- --- ----- - -___ _ WRA'1��-'' Ak AL AMY MAYFIELD WATERS
� TOTAL NUMBER OF CHAMBERS: 2
WRA 19 Ak TOTAL LEACHING AREA: 447.9 SQ.FT. LOCATED AT
\ 3p� 8 W 75+RA 17 \ TOTAL LEACHING CAPACITY: 331.5 GAL./DAY
AL WRA 264 BAY LANE
TREES TO BE REMOVED: CENTERVILLE, MA 02632
2-10"OAKS RESERVED FOR BOARD OF HEALTH USE i SCALE: 1 INCH = 30 FT. DATE: APRIL 26, 2004
MAP 186 2-8"OAKS 1 0 15 30 60 120 FEET
LOT 25 1 -8" PINE � �"0"`�s,
N/F HOLTZMAN 1 -12" PINE a`� JOHN L. - ----
1- 6"OAK 0 CHURCHILL PREPARED BY:
JR. JC ENGINEERING INC.
WETLAND FLAGGED BY HORSLEY&WITTEN INC. CML '
N° 411W7 2854 CRANBERRY HIGHWAY
EAST WAREHAM, MA 02538
SITE PLAN 508.273.0377
SCALE: 1"=30' S ��lQ Drawn By: MLP _T Designed By:MLP I Checked By:JLC JOB No.581
'_ I