HomeMy WebLinkAbout0050 BENT TREE DRIVE - Health 50 Bent Tree Drive
Centerville
A = 168 026
No. 4210 1/3 ORA
Pwj%ndaflex
10%
7
TOWN OF BARNSTABLE
LOCATION ri V/�' SEWAGE#
//V�
VILLAGE, 5l^VlIly5 ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NOJ D�-�26-�7 ,�a5��� �� 01 ,-0_5_
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type)��j ��-/' ®O ��/(size)
NO.OF BEDROOMS
OWNER VJ �J/IJ�G��ONGQ�
PERMIT DATE: 2—/�,/ COMPLIANCE DATES--
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
��
I- _.
..
�. . .
;.:
�$ ,.
- ,
� ,
Ll
No. '0j. 1"__ Fee (` y _
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01pphLation for Ne-Yowl 6pstem ConstCULtion Hermit
Application for a Permit to Construct Repair(grade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.�j Q aml 7r.5rI V111 V1 OAner's Nynme,Address,and Tel.No.
Assessor's Map/Parcel ,p
Iu taller's Name Address,and Tel.No._V8_%QG'- ��3-. DDesigner's Name,Address,an Tel.No.
��,S ui2✓may �n%,
r tames /l � 3f e
Type of Building:
Dwelling No.of Bedrooms ,j Lot Size t sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required). � gpd Design flow provided �� gpd
Plan Date Number of sheets Revision Date I }o �)tr{
Title rp
Size of Septic Tank [,j iqa Type of S.A.S. � ��® G l�n Lj /-"il Z
Description of Soil
Nature of Repairs or terations(Answer when Epp icable) �� /(i/—GT/
`
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date
Application Approved by Date
Application Disapproved by Date
1•
for the following reasons
Permit No.�l o Ci— 7 Date Issued T' f!°
-- ----- --- --__------------
' [(�� G AiT."".fin:.•.."`eq��:i.
No. �� Fee
THE,COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
flpYlcatlon for Disposal 6pstem Construction permit
f
Application for a Permit to Construct('Repair(!�I pgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel ,3_ G
In}staller's Name,Address,and Tel. Designer's Name,Address,and Tel.No.
YEN�"/�/^ !/-G�✓�' d S - UYIS ,/0 �' / ,�.,.,� (.f�✓/_�//IUG,
Type of Building: r
Dwelling No.of Bedrooms Lot Size l sq.ft. Garbage Grinder( )
Other Type of Building '} {�,J/ _ No.of Persons Showers( ) Cafeteria( )
x Other Fixtures
Design Flow(min.required) y`j gpd Design flow provided (2rA t gpd
E
Plan Date Number of sheets Revision Date
Title t S�r D° h
Size of Septic Tank �f, f20 Type of S.A.S. L � , {J�� — !(t .n \
Description of Soil �. `� � ',"'")' VA
� 1
Nature of Repairs or Alterations(Answer when applicable) — -aLJ 4n
3
Date last inspected: Y '
i l
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
i
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. r
Signed. r Date o
Application Approved by Date / 7
Application Disapproved by Date
for the following reasons )
Permit No. / 0 `� �� 7 Date Issued Z
--------------------------------------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of (Compliance
THIS IS TO//CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(e Upgraded(CZ
Abandoned( )by,
at���_ , E/ �J,)rl;4;:/n �/j Y(/;�jhas been constructed in accordance
with the provisions of/Title 57 and the for Disposal System Construction Permit No. — 7dated
Installer n<�r"71� �/� i4//yil Designer
#bedrooms / Approved design flow �jlj gpd
�r
The issuance of this permit shall not be construed as a guarantee that the system will n tion designed.
Date J o' d Inspector
v
---------------------------------------------------------------------------------------------------------------------------------------
No. G Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS
Disposal 6pstem Construction Permit
Permission is hereby granted to Construct( ) Repair(Z_),- Upgrade Abandon( )
System located at �'/J /•?j /V � �
and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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_ //)�/� Approved by �,��,�
t
Town of Barnstable
Inspectional Services
Public Health Division
gib ;a39. �a Thomas McKean,Director
ap+ ya 200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date:5-/9- Zb Sewage Permit#141,47— 7 Assessor's Map\Parcel
Designer: Installer: V!5A4z fz-aS
Address: ja i l7?9 Address: 44Al c�-r L IQ
�idtip✓iC.}i � oz�G3 �l25'�/�/S �u-s. �i �zcq�
Vl*'On �E r,0,a.s was issued a permit to install a
(date) (installer)
septic system at based on a design drawn by
(address)
��R, .fin- dated ��u r/ z/, zG1q
(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. Strip out (if required) was inspected and the soils
were found satisfactory.
---- 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 Regulations. Plan revision or
certified as-built by designer to follow. Strip out(if required) was inspected and the soils
were found satisfactory.
I certify that the system referenced above was constructed in com liance with the to rms of
the I1A approval letters (if applicable) or
A,ID
R -4
(I t er s ignature) " FLAHER�'Y, JR.
No. 1211
�T
(Designer's Signature) (Affix Des �l ffinp Here)
PLEASE RETURN TO BARNSTABLE 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.
WoAdeplAHEALTHISEWER connecASEPTICOesigner Certification Form Rev 8.14-I3DOC
No. 3"- / / Fee$5 0 .0 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Zipphratton for Mi5poeal 6pgtem: CowAruttton Permit
Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
50 Bent Tree Lane 420-5562
Assessor'sMap/Parcel Centerville, MA David and Margaret MacDonald
168-26 _ 32 Stowe Road Sandwich MA
Installer's Name,Address,and Tel.No. r5 0 8—77-5--87 7 6 Designer's Name,Address and Tel.No. 5 0 8—3 6 4—0 8 9 4
W.E. Robinson Septic Service Eco-Tech
PO Box 1089 Centerville MA 43 Triangle Circle- Sandwich, MA
Type of Building:
Dwelling No.of Bedrooms 5 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil sand
Nature of Repairs or Alterations(Answer when applicable) install title 5 septic system
to plans of Eco—Tech Plan # ETE1470
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 Environm ntal Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by th' Bo of Heal
Signed Date q�
Application Approved by Date
Application Disapproved for the following reasons
Permit No. =f'f 772 Date Issued 47130103
5 0.0 0
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
< < Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
0[ppricatton for 30tgo.5al *pttem Construction Permit
Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
50 Bent Tree Lane 420-5562
Assessor'sMap/Parcel Centerville, MA David and Margaret .MacDonald
168- , , - 32 Stowe,Road Sandwich, MA
Installer's Name,Address,and Tel.No. M_0 5=919 6 Designer's Name,Address and Tel.No. 5 0 8—3 6 4—0 8 9 4
W$E. Robbinson/ Septic Service Eco-Tech
PO Box 1089 jC4aterville- MA 43 Triangle Circle,Sandwich, MA
Type of Building: �
Dwelling No.of Bedrooms 5 Lot Size sq.ft. Garbage Grinder( )
Other Type of Burling No.of Persons Showers( ) Cafeteria( )
Other Fixtures
E
Design Flow gallons per day. Calculated daily flow gallons.
.- Plan Date Number of sheets Revision Date
Title
Size of Septic Tank$` Type of S.A.S.
Description of Soil sand
Nature of Repairs or Alterations(Answer when applicable) install title 5 septic system
to plaits of Eco-Tech. Plan # ETE1470
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by t ' Bo d'of Heal //jj
Signed Date q
Application Appioved by Date 3(,
Application Disapproved for the following reasons
Permit No. '� ') — L/ � Date Issued .3U 03
MacDoaald THE COMMONWEALTH OF MASSACHUSETTS
' BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(X )Upgraded( )
Abandoned( )by W.E. Robinson Septic Sertiee
at .__50_ Bent Tree Lane Centerville has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.2-003-y7`3 dated 0i - .30-03
Installer Designer
The issuance of thisvperinfit shall not be construed as a guarantee that the syste . flkfano'on as de'gne`d.
Date b 1 Inspector )
--------------------------
No. Fee �50.00
24U3 - 7� THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Macdonald
Iiopozar 6potem (fongtruction Permit
Permission is hereby granted to Construct( )Repair(X)Upgrade( )Abandon( )
Systemlocatedat 50 Bent Tree :Lane Centerville
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 7;:/U,)
st be completed within three years of the date ofC,this
'permit. J
Date:_ � Approved by
^- TOWN OF BARNSTABLE —
a� LOCATION G'® OIXJL fk*6— LAN& SEWAGE #
VILLAGE 6F-J4Jt-P c1 1 t- ASSESSOR'S MAP & LOT 0�
INSTALLER'S NAME&PHONE NO.Qnk ,,jSOW <606 C. S 09,77 S_- 9 776.
SEPTIC TANK CAPACITY 1500
c/.LEACHING FACILITY: (type) � `i7"WC-1( (size)
NO. OF BEDROOMS S
BUILDER OR OWNER 'icf t I17A2c , rrk17OI1A
PERMITDATE: 1? '3at8 COMPLIANCE DATE: Po f t-7 LU 3
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
� � 1
i
®i
Q � J
J a
691
c a a
TOWN OF BARNSTABLE _
SEWAGE #
t3 N r i rrc
LOCATION
LADE `".° `t° =ASSESSOR'S MAP &LOTVIL
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACH]NG FACILITY: (type.)
(size)
NO.OF BEDROOMS
p � t`7o�wl
BUILDER OR OWNER r® /O
PERMIT DATE: 2I*Q 3--COMPLIANCE DATE:
Separation Distance Between the: Feet
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility
Private Water Supply Well and Leaching Facility (If any wells exist Feet
on site or within 200 feet of leaching facility)
exist
Edge of Wetland and Leaching Facility(If any Feet
within 300 feet of leaching facility)
Furnished by —_--_-_-
i �aoN$ a
I
3
ns d
�, r
FORM30 CIW HOBBSS WARREN TM THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITY/TOWN
o DEPARTMENT
'o,M SVOyeW ADDRESS
/ TELEPHONE
Address Occupants-mow
Floor Apartment No. No.of Occupants �o
No.of Habitable Rooms 7 No.Sleeping Rooms_
No.dwelling or rooming units-1 No.Stories Z S �J
Name and address of owner 7-4—t4k 4 c_�� r 3 z S*yw t--.(zcf l
Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish <T - laaIr✓ J I v E�_J
Containers: 0—t-,(,AS"V,--cL
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual E g ress: and 0bst'n.-7,wjA erreS) 'v3 - red T',A-W-SovW4
❑ B ❑ F ❑ M Doors,Windows: �. S
Roof
Gutters, Drains: -%C11' A-J Sl�WW-J
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation: ,U .cam
Dampness:
Stairs:
Li htin :
STRUCTURE INT. Hall,Stairwa cu_(A"
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING 01 L Chimneys:
Central Er'Y Q N Equip. Repair
TYPE: pf(,'/ Stacks, Flues,Vents:
PLUMBING: Supply Line: Tdux,
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks S fety 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
Pantry
Den
Living Room
Bedroom 1 .
Bedroom 2
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas, Oil, ect) e 136c' X ZJ-f0(,
Stacks, Flues,Vents, afeties:
Kitchen Facilities Sink
Stove c- e
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: '( °f►(R5 For"®
Wash Basin,Shower or Tub: 6 cc,.I J i °' '(P
Infestation Rats, Mice, Roaches or Other:
Egress Dual and Obst'n:
General Building Posted i; k: aj ) Ma4v4 kW4Ge#d1
Locks on Doors: 01
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 OF PERJURY."
e;4 INSPECTO 4 TITLE
DATE TIME `�L� P.M.
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
.. ..... ....:..... :.. ,.,�r�,. 1Ac•j sT . .., y J..r... ,� ..�.•:r rW.�.Y7N.4ti}v�^'.r,' ,1Ik'fe.a:7''e rM... P`.�' „r,�:� �„�r '' { :ra. � } .{r.��{,y*�,., .�L'y .� '�'f
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 heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as.a determination that
other violations or conditions may not be found)to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) 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. 4 l
(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 41.0.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 4,10.602 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 410.150(A)(2)and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system 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.
' FORM30 �I�W HOBBS&WARREN'M THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�fatoIle
CITY/TOW N
W �,E�9 lTH
o DEPARTMENT
'a p,u. 4 x s3 g, ?67 _ a,,.-►Sot--,Q1f ),"kZo
ADDRESS ` W IN
TELEPHONE
Address Sd 17e0 Tvee bn _6eA4_*-o6(` Occupant_ t�_r_tv.%,
Floor Apartment No. — ___. No. of Occupants.
No. of Habitable Rooms—.7 No.Sleeping Rooms_ _4__—__
No.dwelling or rooming units__[ _ No.Stories Z-�—
Name and address of owner VQf�.dC 4 C "r4 r 7 Z s-m-z -
Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish r - i3 a et I I I't, 6ce,- v w4v,5 p*0
Containers: CA.-
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress: and Obst'n.:'ZKtA e 91,6) S WV) -XeIJ T,-.k 4040.w d
❑ B ❑ F ❑ M Doors,Windows: V ( Q(,,,S S dir,t4,, �iw�t. Sic„ Wtwavcp
Roof @ ✓t+C✓�
Gutters, Drains: ( aA Al SC✓tA.+,1 4 Sdv✓�S
Walls:
:'#,Foundation:
Chimney: N
BASEMENT Gen. Sanitation: o PtEf C C ,U jE, 1.(ocu Wy
Dampness:
Stairs:
Li htin :
STRUCTURE INT. Hall,Stairway: r- ) c U UAl -S(,JJA c v L_
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING /6((,.. Chimneys:
Central C�3Y ❑ N Equip. Repair
TYPE: f{W Stacks, Flues,Vents:
PLUMBING: Supply Line: lrm ,, V,.V-gA,—
❑ MS ❑ ST ❑ P Waste Line: I
H.W.Tanks Saf ty 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
Pantry
Den
Living Room
Bedroom 1
Bedroom 2
Bedroom 3
Bedroom 4
Hot Water Facil. Su p.Ten.,Gas, Oil, ect) //o j/,,a is i O Ir06c
Stacks, Flues,Vents, afeties:
Kitchen Facilities Sink
Stove fit,,
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n. F( MR S Wua, C(ea.., 'Flan.°oU
Wash Basin,Shower or Tub: Co L4^i JJ r wf
Infestation Rats, Mice, Roaches or Other: er wo 'Z - )f y.•,
Egress Dual and Obst'n:
General Building Posted vrJ du bu ,129 ' i- VLf kl"4 V *eflf
Locks on Doors: k °
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) d�c
"THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIES OF PERJURY."
INSPECTO. r/ TITLE PDT
M
DATE 7//Z/ TIME
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or
impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B)and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other 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 410.150(A)(2)and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system 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
MRVP # z
Assessor's office (1st Floor)
Assessor's Map and Parcel # 169
Building Department (4th Floor)
Zoning
INSPECTION FEE $50.00
RE-INSPECTION FEE $15.00
Request For A Housing Inspection For Certification Under the
MA Rental Voucher Program
Your Name
Affiliation (Circle One) Owne Real Estate Agent Tenant
Your Address Y7,a cv /P 4/-4A
Telephone Number (Day),Vgk.y,Jp-%Zto 2. (Night)�rA&W �o
Address of Property Where Inspect' is_Re uested } ,
Unit/Apt. # .t''���Z — W �/2 J
Name of Owner
Address 5kek, h4o-v-
Mailing Address (if different)
Telephone Number (Day) _r rh e (Night) S'a sre
Will there be any children under the age of six (6) who will
be occupying the rental unit? (circle one) Yes Q!)
Was the dwelling constructed prior to 1979? Yes No
------------------------------------------------------------
FOR OFFICE USE ONLY:
Certification
The dwelling, dwelling unit, or rooming unit located at
SU U_Ao -f-- Z,_ee p caz �o'l� was ins ected on
rrI°Z 7 by G-11�� - a r�'�hg ��. ,� Health
Inspector for the Town of Barnstable and was found to be in
compliance with the provisions contained within 105 CMR
410.00, State Sanitary Code II: Minimum Standards of Fitness
for Human Habitation. However, this certification does not
include a determination as to whether this unit contains any
lead paint because under 760 CMR 49.02 Massachusetts Rental
Voucher Program, a separate lead paint inspection must be
conducted. r /�
Inspector's Signature
Date /Z,
Town of Barnstable
oFt�ray,
Regulatory Services �rrt c
ti s
Thomas F. Geiler, Director ►
Public Health Division
*. BARNSrABLE,
9 MASS. �, Thomas McKean, Director. � 007
�Ar i639' ei`0 200 Main Street
fD MA'S
Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
March 2, 2009
David MacDonald
32 Stowe Road
Sandwich, MA 02563
As of October 1, 2006 a new rental registration ordinance was put into affect requiring
all--property owners of rental units to register their rental units with the Town of Barnstable
Health Division. According to our records, you own the rental property at 50 Bent Tree Drive,
Centerville .
Enclosed is an application. Please use a separate application for each rental unit you
own. Should you need more applications, they are available online at
www.town.bamstable.ma.us. Go to the Health Division page by looking in the Department
Menu. There is a link to the Rental Registration information on the Health Division page. You
may print out as many as you need, and return them.to the Health Division with the appropriate
2009 fees included. This must be completed within (14) fourteen days of your receipt of
this letter.
Failure to comply with this ordinance will result in the issuance of a non-criminal ticket
citation in the amount of$100. Each day of non-compliance is considered a separate offense.
Should you have any questions, please feel free to call 508-862-4644. Thank you in
advance for your cooperation.
' I
Timothy B. O'Connell, R.S.
Health Inspector
Health Division
Direct#508-862-4646
I
TOWN OF BARNSTABLE
LOCATION 3>P,[V SEWAGE #
VILLAGE _ ASSESSOR'S MAP Cz LOT I&I ff �G
INSTALLER'S NAME 6z PHONE NO. Igo&a
SEPTIC TANK CAPACITY `2
:.LEACHING FACILITY:(type) /U& (size) &CD(,-(,
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER ,
DATE PERMIT ISSUED: ' 7 x
DATE COMPLIANCE ISSUED: 3 r ^ �
VARIANCE GRANTED: Yes No
,Xpru-I N�
cvf,
£kScSTi N l9 0 aq
6EPric TNK
�z� PeE0)5Ti>I i
a-
THE COMMONWEALTH OF MASSACHUSETTS
BOAR OF HEALTH
t
��..-'�!.cn./.............OF...........� ........_.................:....
Appl ration for Disposal Works Tonstr diun 1hrmi#
Application is hereby made fora Permit to Construct ( ) or Repair ( --YZan Individual Sewage Disposal
System at:
._........... .....I: c--•- --•- ..................... ........--............
-L-anon-Address - or Lot No.
............................................•• ...................5. :�''�` ..-_...-----__........................_.......
........._.
(n/
S Address
1
�S .-- --•-----•-------------�... c.�l'.!ti .......---•--•--..._....................------
,W,� -----••�-��---=-fir``-==----------------�-�-•-- ,. �_.
Installer Address
�u Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.........a____________________________*Expansion Attic ( ) Garbage Grinder ( )
p,, Other—Type of Building ............................ No. of persons............................ Showers (. ) — Cafeteria ( )
Other fixtures ...............................
----------------------------------------- ----
WW 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.
3
Seepage Pit No........t........... Diameter.....f_.a._...... Depth below inlet....... ......... Total leaching area.................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
~' Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit......._........----
Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a --------•-------------------•--.....----•-------.._._._..---------.....----•---------._....._---------------------
_......-•--•-•••--...............------=•--
0 Description of Soil.....................................................................................................
-------------...._.......------•----------...--...................
W --••-••----------------------------------------------•--------------------------------.....__.......-------•--•-----•----------------....__.....•--•••--•---..._._...........• ._._..:_._.._..
UNature of Repairs or Alterations-Answer when applicable__.____ ........ �___.____q _�0.....1 ....... `.
................................sS --•--�Q----�' Sr'1.!,.%...... �S'Z�'�........................................................................
Agreement: .
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITI.s 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by f healt
v -
Signed--------- --- ----- ---- ................................................ ------�-G---.
Date
ApplicationApproved By.................................................................................................... ........................................
Date
Application Disapproved for the following reasons:..............._.........................................................................................----
----------------------
-----------------•-------_------------------------------
_------
-------
•--•-- ...--••--•----.._.......---......---.......-•---•--...••--•-------•-- -Date............_
Permit No........5r2_`±f Z/...................__.... Issued_.....................................................
Daft
THE COMMONWEALTH OF MASSACHUSETTS
BOARQOF• HEALTH '
.................................OF......���5 ..\'C..r..._...__...._......._....
Applirati n for Disposal Works Tonstru o' rtinn Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair (`�an Individual Sewage Disposal
system at: _
0:n 1 J`_....... ..................... S.!.. .2_ \ ......................................._..
.... .
Location.Address or Lot No.
..._—^ ^. ................ ✓bl
ar' , ^/� //' rOwr\rer ------------------------`............- ----...............--ice`..�---...: :..Address.............................................
_..._.. �L-O-1_ C Y.'i.-------\_ � �� 1 / f t1 f
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms......... �.............................Expansion Attic ( ) Garbage Grinder ( )
134 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q, Other fixtures
• .....................•-•-
WWDesign Flow...........?��............................gallons per person per day. Total daily flow.~...... ...............gallons.
WSeptic Tank—Liquid ca.pacity___......._.gallons Length................ Width................ Diameter............_--- Depth................
x Disposal Trench—No:.................... Width....................Total Length.................... Total leaching area...................sq. ft.
3 Seepage Pit No........i........... Diameter.....I._,?....... Depth below inlet......V........ 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........................
fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water............---.........
x ------------------------
......
-----------------------•------------------------............................
0 Description of Soil.............•----------------..................-----.............--•------•----------------•-----------------------•--.......--•-.------••--••----•-----......._....
� .
V ............... -
••------------------•---•-----------------------•------------••----•----•---•---•-•---------------------•-----•-------------------...---•--------------...........---•------------ •--------
U Nature of Repairs or Alterations—Answer when applicable........6..V.O........2 0.-e........_.1,425.6....1
----•---•-•-•-----•.............t � - rrS '). `............ -�..............................................................I----------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT IL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by th oar& f-health.
'Signed........ ... •• Z=
f Date
ApplicationApproved By................................................................................................- ........................................
Date
Application Disapproved for the following reasons:..........................................................................................................---
_-
.x
•--•-•-•------•-----•-••--••---------••---.... ....•-----......•-------•--•---•------------•-•_.._._....••------------••----_......-••-••--•--•..................._............. . ......--•-•—
Date
Permit No........ !-17/ - --------_---- Issued.. ---......-........_
Date
----------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-.1hw.!�.........OF. .....................................
Ta if iratr of Toutplianr
THIS IS TO CE-R-TZEY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( c.)—
by............. - -`,-='- c..Ly s....----------....._....••----•---••----•------•--••----••--•-•---•--••-......_.
-.....
Installer
at.........................f F k: c 9 n P a�n y t r •---•-------.
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No....... _.7.- .......... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
- - Inspector....: --..
DATE...............................
. :. -----------�1- :...:a- :_...__ ......._......._
—7---------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF s, S ........................................
p
No.... i F$E.... lam.-.--....
Disposal 30orks Tonstrudion f rrutit
Permission is hereby granted..._.._.. ..-_:-------�., ;e- 5------•--------------------------•......----•--•--...............-•-----•---•-•---_ ..
to Construct ( ) or Repair ( t, )_an Individual Sewage Disposal System
at No.:......---- n iz"L., Ate: .�.0��. 10 W_`w� ......
..--..._.._.
- Street ���
as shown on the application for Disposal Works Construction Permit No?. ................. Dated..........................................
U Board of Ffealth
DATE................................................................................
No._._.. _a _ _.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA1,TH
. ..... ..--------
- -------OF . ..
Appliration -for Di-qVviial Worko Tonotrurtion Vrrnift
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
..................... J'V...............................r -e--- P --------------------- .................................................................................................
Location-Address or Lot No.
............................R4!2.rfl.�t!................................................ ..................................................................................................
,401 ;%o ................................. X Pdre-ss
------------------------- 4 .......ae.. _Xj) t ... .............. *- .... ..A.-.."...
66.
Installer Address
Type of Building Size Lot----------------------------Sq. feet
U
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic Garbage Grinder ( )
PL4 Other—Type of Building ---------------------------- No. of persons-_----_-.----_-___--.----.-_ Showers Cafeteria ( )
Otherfixtures ----------------------------------------------------------------------------------------------------------- ---------------------- ..................
Design Flow............................................gallons per person per day. Total daily flow...........................................gallons.
P4 Septic Tank—Liquid capacity------------gallons Length________________ Width_-.-.-._--._.. Diameter___._...-..-_--_ Depth----------
Disposal Trench—No. .................... Width____.-..--__-------- Total Length--_-___-_-__-____--. Total leaching area-------------- -----sq. f t.
Seepage Pit No_____________________ Diameter.........._..._____. Depth below inlet__....._.........._. Total leaching area---_----.-.--__--sq. it.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by----------- --------------------------................................... Date.--------------------- -----
a Test Pit No. I----------------minutes per inch Depth of Test Pit....___..._......... Depth to ground water_---------------------
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
------------------ -- ------------I--------------------------------....................................................................................
0 Description of Soil-------------------540. ......................................................................................... ------------------------------------------
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------- - ------------------------------------------- .-----...I._. ----
U Nature of Repairs or Alterations—Answer when applicable-------- or......
!!?. -----------
-------------------------------------------------4 44-------------------------------------------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bn isped by the board of health.
Si 2 d./-\)j A...............
Date
Application Approved By------------ 14"4_"11,61a—------------------ . .........................._-----------
-—--------------- --------------------------------------- ----------------------*-------
Date
Application Disapproved for the following reasons____________________' ---------------------------------------------------------------------------------------
Date
Permit No. Issued....,,,�
- - -------------------------
Date
' r0. '1 ��9V'�5�;�?•j�4� ry
l No..... -. FEE ....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA _T�H�J�
------------------ -r
Appliratiun -fur Bi_qpuuttl Works Tono#.rur#ion Vrrttit- ;.
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
...................... -----
Location-Address or Lot No.
= '-----------A tin- !1------------------------------•------------------ -•-----•----------------------------
Installer Address
UType of Building Size Lot----------------------------Sq. feet
0-4 Dwelling—No. of Bedrooms.........:.:..::............................Expansion Attic ( ) Garbage Grinder ( )
p.., Other—Type of Building _________________________.._''No. of persons-______.-_-____`___:-____--_ Showers ( ) — Cafeteria ( )
P�
Q Other 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 lNo..................... Diameter.................... Depth below inlet...._-______-__-_-Total leaching area----------------..sq. ft.
z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by------- ---------•------------••-•-•-•--.........••-----•---•----••••---- Date------------------------------------=--
a
Test Pit No. 1................minutes per inch Depth of Test Pit_.-__-_--_-_-_____- Depth to ground water..--_--.__--------__.
rZ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground,water_..__...._.__...____....
a ---•------ ._...
DDescription of Soil---------------------so?r+ .=-----. -• • . -•-•----------------•---••--••-•-•-.....-• ----••... ----------------------------
U
W ----------------•-----------•------•------------------•-------------------------------------------------•------•-
U Nature of Repairs or Alterat/ions—Answer when applicable--------Q.__ .....QY _:��' o '.___.__ +y-e � `+
--------------------------- -/S_�E ------------.-----------------------------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to�place the system in
operation until a Certificate of Compliance has, is ed by the-board of ealth.
Date
Application Approved By----..-... � ------- •;........................ ----•-•-----------------...............
Date
Application Disapproved for the following reasons:..................
.S
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
ti BOARD OF HEA H.
. .y
1,. - Q',C. ........OF....... ...... .. .................
OX
.:...
Orr#ifiratr of Tomplianrr
ATS j 0 CE TIFY That ndividual Sewage Disposal System constructed ( ) or Repaired
by..• � - --- ►-- --- d....................... = ----------------- -_--------
'`' ----I taller r
has been installed in accordance with the provisions of Article XI of The State Sanitary Cod as described in t e
application for Disposal Works Construction Permit No....... _j�.10.............. dated_..._. ~" .._.-r._ ` ._.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS UARANTEE THAT THE
SYSTEM WILL FUNCTIOW SAT1 FAACTORY.
DATE------ `. ............................. Inspector........... .......................... ........................................... .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT
f
� ... OF r
No....�.i!,,, ._..._.. FEE. .......
~'G
Btiplio ork omi toll Vrrutif
Permission is hereby. rant d ' •-•--• --•- ----- --
Dj
at No..-----:-- osal ste
•.
K � �Ey
to Constru�)tor p r� , Individual S e p" + . ...................
•---- -----------•�----
Street
as shown on the application for Disposal Works Construction Permit r'
... ....... -------- --•-•• f
DATE ..
oard of Healt
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
- a
�t_OGAT_1-O-N 5EW-- 0,4_E_P_E:R-M1-F-U-O.'!
r
D l�►T_E—PER—Iv�1T-1_SSU ED �=6—=7,y --
-----
�e"JGvA laiCj/,ey
ho styo 7c.:i4
e-es
9
LOT 12 LOT 13 LOT 14 CENTERVILLE
140.46 3 Rp��E 28
LOT 39 �' LOCUS:
50 BENT vER R
AREA=15,851 t S.F. TREE DR. 8VMP5 R�
"o-
i
moo_ W
vO' p'q TKO
LOCUS MAP
o LOCUS INFORMATION
LOT 40 PLAN REF: LCP 31043-A
�z TITLE REF: CTF#142653
PARCEL ID: MAP 168 PAR. 26
ZONING: "RC"
r
FLOOD ZONE: "X"
COMMUNITY PANEL: 25001CO563J DATED:07/16/14
LOT 38 #50
Cp
W cp
�2 w
33 SEPTIC REPAIR PLAN
GARAGE FLOOR LOCATED AT:
EL- 28.00 \
�2 `OAKS•,,. 32 50 BENT TREE DRIVE
f CENTERVILLE, MA.
.... 3A PREPARED FOR
130 W �........ REMOVE EXISTING OWNERS:
:::g. •0 30 S.A.S. PER TITLE 5 2g^ DAVID & MARGARET
M ACDON ALD
9,3 :..::...:: : : 28 NOVEMBER 21, 2019
> > p REVISED: MAY 21, 2020
30.
- -- -- ---- - - UPOLE -- - - :::; ;t;:22 -
--
_ •,�l00 0 �..0.............. ......... VENT 6 BENCHMARK:
PINES TOP OF CB/DISC
6 EDWARD �, o DAV s
�+ A.
25 _ EL= 23.67 STONE y �
0� FL ti
lk- �� \ 0.28 0
T ��— Po .p o �O
7 7 800 r�7,Q SgHITAfZ�P�O
2g
GRAPHIC SCALE
E. A. S. !
20 0 10 20 40 80 SURVEY, INC.
P.O. BOX 1729
I SANDWICH, MA. 02563
I
( IN FEET ) CELL:(508)527-3600
1 inch = 20 ft.
SHEET 1 OF 2 J 2147
PROFILE OF 2" LAYER OF VENT
-16.5'-�I 4" SCHEDULE 40 P.V.C. SEWAGE DISPOSAL SYSTEM 1/8" - 1/2" .5 FG
MIN. PITCH 1/8" PER FOOT DOUBLE WASHED STONE 29
HOUSE EXISTING (NOT TO SCALE) OR FILTER FABRIC"'�� ...�.,•���;�����;�
CLEAN SAND FILL PER 310 CMR 15.255
29.0 26.5 FG 26.5 FG ,,, �C
iiiiiiiiiiiiiiiiiii�����������iii ... -20 CON RISER
RISER RISER DBASE
20 NG. o vo Il RISER
% Q N 23.5 H
30. ® S=.086 LEVEL �O&t
EXIST�2�6.00
FOR 2' 25' 0 S=.02 2 �O
00 LIQUID LEVEL
10 25.75 C4'
® ® ® ®
MIN. 14" 23.17 s of 23.0 ® ® ® ® ® ® E3 ® EM ®:QL
r000
p 0 ® ® ® ® ® o o°
MECHANICALLY 22.5 ® ® ® ® ® ® ® ® ® ® p p ® ® ® ® ® ® o
COMPACTED SAND DD o p p 0
oft 0251
48" A GAS PROP. (H-20)DB6 4 20.5
BAFFLE DISTRIBUTION 3/4" TO 1&1/2"
BOX W/"T" DOUBLE WASHED STONE 25' 17'
EXISTING I CERTIFY THAT I AM CURRENTLY APPROVED BY THE DEPARTMENT OF
Z
4-500 (H-20)GAL. CHAMBERS o
ENVIRONMENTAL PROTECTION PURSUANT TO 310 CMR 15.017 TO CONDUCT (5'W X 8'-6"L X 3'-O"H) IL
IL
1 ,500 GALLON TANK SOIL EVALUATIONS AND THAT THE ABOVE ANALYSIS HAS BEEN PERFORMED ">
BY ME CONSISTENT WITH THE REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE SOIL ABSORBTION (TRENCH FORMATION) fO
(TO REMAIN) DESCRIBED IN 310 CMR 15.017. 1 FURTHER CERTIFY THAT THE RESULTS OF MY >.
SOIL EVALU N. A NDICATED ON E ATTACHED SOIL EVALUATION FORM, SYSTEM (S.A.S.) W/5> STRIPOUT TO C„ HORIZON EL=23.9
ARE ACC A AN A AN WITH 310 CMR 15.100 THROUGH 15.107.
BOTTOM OF TESTPIT #2 ELEV.= 14.2
EDWARD A. ST E, PL , CER F D SOIL E LUATOR SE#2359
GENERAL NOTES SEPTIC SYSTEM DETAIL PAGE DESIGN NUMBER OF BEDROOMS.........
1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. DATA: GARBAGE DISPOSAL.................
TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS #5 O BENT TREE DRIVE TOTAL ESTIMATED FLOW
FOR SUBSURFACE DISPOSAL OF SEWERAGE.
2. ALL ACCESS PORTS OVER TANK TEES SHALL BE C E N TE R VI LLE, M A. (110 GAL./BR./DAY X 5 BR.) __550
ACCESSIBLE WITHIN 6" OF FINISH GRADE. NOVEMBER 26, 2019 550GPD X 200% = 1100 GAL
3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE
CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE REVISED: MAY 21, 2020 USE EXISTING 1500 GAL. TANK
UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS THEN THEY INSTALL: 4(H-20) 500GAL CHAMBERS (W/4' CRUSHED STONE
MUST WITHSTAND H-20 LOADING. ON THE SIDES AND ON THE ENDS) AND
4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION TEST PIT RESULTS:
OF ALL UTILITIES PRIOR TO ANY EXCAVATION. BACKFILL WITH CLEAN SAND FILL PER 310 CMR 15.255
5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SOIL CLASSIFICATION................__OR WITHIN WITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE. SOIL TEST DATE: NOVEMBER 4, 2019
6. FINISH GRADE SHALL HAVE A MINIMUM OF 2% GRADE DESIGN PERCOLATION RATE..... <2 MININ.
OVER THE S.A.S. AND DISTRIBUTION Box. B.O.H. AGENT: DAVE STANTON EFFLUENT LOADING RATE.........__-74___
7. SEPTIC TANK SANITARY TEES SHALL BE CONSTRUCTED OF SOIL EVALUATOR: EDWARD A. STONE REQUIRED LEACHING CAPACITY.....550 GALZDAY
SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6' ABOVE
THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND BACKHOE: JOEY DEBARROS LEACHING CAPACITY PROVIDED.....566 GAL/DAY
LOCATED DIRECTLY UNDER THE CLEANOUT MANHOLES.
8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN DAY
= 162 GAL/DAY
6 SIDES
2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT SIDEWALL( ) ( _ ) ( ) /
_ELEVATION of THE OUTLET PIPE. _ __ __ - -- _ _ TH#l_ EL. 28.-8 (P ER-C _BOTTOM @ 6.0"_ _<2 _M P I) BOTTOM: (13' x 25')--(17' X 13')(.74)= _404 GAL/DAY___
9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES.
10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS ELEV. DEPTH (IN.) HORIZON TEXTURE COLOR MOTTLING OTHER TOTAL= 566 GAL/DAY
BAFFLE, 4 INCHES IN DIAMETER AND CONTRUCTED OF 4" PVC.
11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND 28.1 0"-8" A LOAMY SAND ' 10YR4/2 N/A 566 GPD PROVIDED - 550 GPD REQUIRED = 16 GPD RESERVE
FIRST TWO FEET OUT OF THE DISTRIBUTION BOX SHALL 26.6 8"-26" B LOAMY SAND 7.5YR5/6 N/A
I BE LEVEL.
12. CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION 16.8 26"-144" C MEDIUM SAND 2.5Y7/4 N/A
TO EAS SURVEY INC. FOR B.O.H. AND DESIGN ENGINEERS REVIEW
AND APPROVAL. NO MOTTLES, NO GROUNDWATER E. n • S.
13. NOT IN STATE ZONE II E. A.
TH#2 EL.- 26.2 �.�" OF "ASS SURVEY, INC.
���P 9cyG 141 ROUTE 6A
CONSTRUCTION NOTES: g DAVID SALT POND BUILDING
ELEV. DEPTH (IN.) HORIZON TEXTURE COLOR MOTTLING OTHER D,
1. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND " t P.O. BOX 1729
ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING 25.4 0'-10 A LOAMY SAND 10YR4/2 N/A FLAN T ,
WORK ON THE SITE. 23.9 10"-28" B LOAMY SAND 7.5YR5/6 N/A SANDWICH, MA. 02563
2. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE 14.2 28"-144" C MEDIUM SAND 2.5Y7/4 N/A �FG TER�o
WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT
IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. T RAP BUS: 508 888-3619 FAX: 508 888-2496
3. ALL SYSTEM COMPONENTS SHALL BE MARKED WITH MAGNETIC MARKING NO MOTTLES, NO GROUNDWATER ( ) ( )
TAPE OR A COMPARABLE MEANS. SHEET 2 OF 2 J#2147
r VENT 0
FLOW PROFILE PIPE
TOP OF FOUNDATION j RAISE COVERS TO WITHIN
6 in OF FINAL GRADE
j EL ' 38.26 +- ONE INSPECTION RISER FOR
LEACHING GALLERY
CAST RON� 2- LAYER OF 1/8-
COVER TO I/2 STONE
OR ADE
3' DROP ��
H-20 .t.
rr_
FLOW LINE TEE
10 14- H-20
- GAS�� PRECAST V4'
48 BAFFLE 6 in DRYWEI.L �"�. STONE BOTTOH OF 7,
27.00 MIN STONE LEACHING SOIL ABSORPTION
L29.00t 26.28 SYSTEM
26.as BASE GALLERY. .
27.2 6 in STONE BASE 26.00
5.06 rt
I500• GALLON
(END VIEW) 24.00
15.5 ft v SEPTIC TANK 56 Ft a) 4.5 Ft 13.0 Ft
K 13.20
USE H-20 TAN b) 28 F r p
ESTIMATED
NOTE: CONTRACTOR MAY SEASONAL HIGH
GRouNownTER
PLACE SPTI TANK AT
EC
A HIGHER ELEVATION TO
MEET EXISTING CONDITIONS
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SOIL - TEST LOG
DATE OF TEST: AUGUST 9. 2003 DESIGN CALCULATIONS
SOIL EVALUATOR: DAVID D. COUGHANOWR. RS
DESIGN FLOW: 5 BEDROOMS X 110 GPD - 550 GPD
NO GROUNDWATER
TEST PIT I PARENT MATERIAL: E ROGLACIALDOUTWASH SEPTIC TANK: 550 GPD X 2 DAYS - 1100 GALLONS
ELEVATION - 30.50 PERC AT 58 in 2 MIN/INCH IN C SOILS
INSTALL 1500 GALLON H-20 SEPT IC,`TANK (MINIMUM ALLOWED)
DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER DISTRIBUTION BOX: USE 3 OUTLET H-20 D-BOX.
(INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING
0-4 FILL SOIL ABSORBTION SYSTEM: THE LEACHING, GALLERY DEPICTED BELOW CAN LEACH
4-7 0 LOAMY SAND 10 YR 2/2 NONE FRIABLE Abot - ( 41.5 x 13 ) - ( 4 x 4 / 2 ) -- 531.9 sf
Asdw - ( 41.5 + 37.5 ; 9 { 13 } x 2 - 213.4 sf
7-12 A LOAMY SAND 10 YR 4/4 NOW FRIABLE A t o t - 744.3 s f
12-40 B LOAMY SAND 10 YR 5/6 NONE LOOSE V t 0.74 x 744.3 - 550.56 G P D
40432 C MEDIUM SAND 10 YR 6/4 NONE LOOSE USE A 41.5 ft x 13 ft x 2 ft GALLERY. Vt - 550.56 GPD > 550 GPD REQUIRED
GROUNDWATER
ADJUSTMENT
EXISTING GROUNDWATER LEVEL
BASED ON BARNSTABLE GIS LEACHING GALLERY
DEPARTMENT RECORDS
OBSERVED GW: 10.00 CONSTRUCTION DETAIL
INDEX WELL: MIW-29
ZONE: D DRYWELL UNIT - USE H-20 UNITS
READING: JULY. 2003 8•-6• x 4• x 2'-9• STONE
LEVEL: 7.6 2 (t EFF. DEPTH
ADJUSTMENT: 3.2 ft 41.5 ft
ADJUSTED GW: 13.2
NOTES � a
M Ln
1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN
2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM.
3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS 4 fr 8.5' 4 fr 8.5' a ft 8.5- a f,
OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) NOT TO
4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES 37.5 ft SCALE
BEFORE EXCAVATING FOR SYSTEM,
5) EXISTING CESSPOOLS TO BE PUMPED AND COLLAPSED. CONTAMINATF Q SOILS
AROUND PROPOSED LEACHING GALLERY ARE TO BE REMOVED AND 14EPLACED WITH
CLEAN MEDIUM SAND.
6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE
7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0" BEFORE PITCHING DOWN SEWAGE DISPOSAL SYSTEM PLAN_ .
8i ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES -TO SERVE EXISTING DWELLING
AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK
9) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK.
DAVID & MARGARET MacDONALD .
10) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND . TRUE TO GRADE ON A LEVEL 50 BENT TREE LANE CENTERVILLE. MA'-
STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH SIX INCHES OF CRUSHED STONE HAS .BEEN PLACED TO MINIMIZE UNEVEN SETTLING ECO-TECH ENVIRONMENTAL . .
11) SEPTIC TANK OUTLET TEE IS TO BE FITTED WITH GAS BAFFLE.
43 TRIANGLE CIRCLE SANDWICH-MA 025634
R ETE-1470 AUG 10. 2003