HomeMy WebLinkAbout0025 CENTERBROOK LANE - Health 25 CENTERBROOK LN, CENTERVILLE
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HASTINGS, MN
Town of Barnstable
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� BAFiNf3TABI.E, ►
Board of Health
200 Main Street, Hyannis MA 02601
Office: 508-862-4644 Susan G.Rask,R.S.
FAX: 508-790-6304 Sumner Kaufman,MSPH
Wayne Miller,M.D.
July 16, 2004
Mr. Daniel Turner
25 Centerbrook Lane
Centerville, MA 02632
RE: \`25 Centerbrook Lane A= 172-39
Dear Mr. Turner,
You are granted a conditional variance to construct an addition to your home in
close proximity to your septic tank at 25 Centerbrook Lane, Centerville.
The variance granted is as follows:
310 CMR 15.211 M The septic tank will be located eight (8) feet away from
the foundation wall, in lieu of the ten (10) feet minimum separation
distance required.
This variance is granted with the following conditions:
• A polyethelene liner shall be properly installed in the ground in
between the septic tank and the new foundation wall.
This variance is granted because the Board is of the opinion that maintaining the
existing septic tank in it's present location along with the installation of a
polyethylene liner should not adversely affect the health or safety of the
occupants in the home.
Sinc ely yours
,ayn Miller, M.D.
Chair an
Turner
DATE
s
FEE:
* ■ARNSTABM «
MASS.
9� 039. REC. BY
Town of Barnstable
SCHED. DATE:
Board of Health
200 Main Street,Hyannis MA 02601
Office: 508-8624644 Susan G.Rask,R.S.
FAX: 508-790-6304 Sumner Kaufman,M.S.P.H.
Wayne A.Miller,M.D.
VARIANCE REQUEST FORM
LOCATION Property Address: �r� _ ('c C � W
Assessor's Map and Parcel Number: �39 Size of Lot: IS- 00A
Wetlands Within 300 Ft. Yes Business Name:
No I/ Subdivision Name: ('
APPLICANT'S NAME: --bw�(, Phone2--
Did the owner of the property authorize you to represent him or her? Yes No
PROPERTY OWNER'S NAME CONTACT PERSON
Name:-b0Aj fC L L_ I Ur(-h� Name: 1.) utc,
Address: Address:XC(�k',GCCJCX-l-t
Q P 92b-7312 7J Phone:—ZS '-Y26--731z 77c1-83C-70TI
U-
- VARIANC FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed)
1 Q4U
to cli
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r" NA`�`tM OF WORK: House Addition l 00 House Renovation ❑ Repair of Failed Septic System
Checklist (to be completed by office staff-person receiving variance request application)
Please submit copies in 4 separate completed sets.
_ Four(4)copies of the completed variance request form
_ Four(4)copies of engineered plan submitted(e.g.septic system plans) -
_ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans)
Signed letter stating that the property owner authorized you to represent him/her for this request
_ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense
(for Title V and/or local sewage regulation variances only)
_ Full menu submitted(for grease trap variance requests only)
_ Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance renewals [same
owner/leasee only], outside dining variance renewals [same owner/leasee only], and variances to repair failed sewage disposal systems
[only if no expansion to the building proposed])
_ Variance request submitted at least 15 days prior to meeting date
VARIANCE APPROVED Wayne A.Miller,M.D.Chairman
NOT APPROVED Sumner Kaufman,M.S.P.H.
REASON FOR DISAPPROVAL Susan G.Rask,R.S.
Q:\HEALTH\Application Forms\VARIREQ.DOC
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RES. ZONE- 'RF" This MORTGAGE INSPECTION flan is Fo FLOOD ZQNE.
Bank Use Only
TOWN; _ ZV-7'E.�UILLE _------__ REGISTRY OWNER: JOFIlV f & KATHLEEIV L._ FRIEL ____ _
DEED REF: _ CEIZT 4JQZ463-----BUYER: _D_4NM_J _jwfflYE9---DATE: 6,�5
_6 �5/9B ___—_—————_ PLAN REF: _LC 38871 _ SCALE: 1"= 30 ---FT.
i HEREBY CERTIFY TO egNK6o�TON _ _--_---_— YANKEE SURVEY
'['IIA'1 THE BUILDINGrzo C'
SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS p�p�, �1""; CONSULTANTS
SHOWN AND THAT ITS POSITION DOES CONFORM40B (SUITE 1)
TO THE ZONING LAW SETBACI< REQUIREMENTS OF THE N&
TOWN OF I�ARNSTAB�E _--_AND THAT INDUSTRY ROAD
IT DOES_ 1VOT _ LIE WITHIN THE SPECIAL FLOOD HAZARD MARSTONS MILLS, MA. 02648
AREA AS SHOV ON THE H.U.D. MAP DATED_8/19�85 _ TEL: 428-0055
C un -- 1 250001 OOZS. C FAX: 420-5553
THIS PLAN NOT MADE FROM AN-INS I4RC ENT
MF ITrTrI7 cIUPVEY, NOT TO BE USED FOR FEN.CF'S. ETC. ?¢260 CB �
�\ C0ti1M0 "WEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAI 11 �
DEPARTMENT OF EN*VIRONNIENTAL PROT ON
ONE WINTER STREET. BOSTON. NIA 031(b 61?-:9.•S:CMG �
..�' 1998 �
UILL1A"F.WELD . .
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ARGEO PAL1 CELLL CCI S7RL•1=,
v AGE DI
SPOSAL SYSTEM INSPECTION FORM ommissiorre
r SEWAGE Lt.Go emo SURFACE 5
SUB -
{ PART A --- :! -
CERTIFICATION
Property Address; a���C4J� -� b� 6Q, U;1%,kCQWk� 'Address of Owner:
Date of Inspection: I �. of different)
—� � �-
Name of Inspector: lTw�^In a a i� �► E�EC�� ' "�� �
am a DEP ap roved system inspector pursuant to Section115.340 of Title 3 (310 CMR 13.000) i
Company Name:-/t�orr�1•C E/r Y r,-jm A-cP
Mailing Address: � ! o H ASN�2SLH ,9-o e-
Cf-q -
Telephone Number, r5-e 2�.-Z L& Zeo
T
CERTIFICATION STATEMENT -
I certify that I have pe!sonally inspected the sewage disposal system at this address and tha: the information reported below is true. accurate
and comolve as o:the time of rnspec;oo-. The rnspect.on was performed based on my training and experience in the proper_funaron and
maintenance of on-s-te sewage drsposa; systems. The wstenn:
Panes
r �
_ ConcitionaiN Passes
�,eec_ Further Evaluation By the Local Approving Authorrt}
Fa.!s
Inspector's Signature: Date: i G
Tare Svs:e-r Ins.ecm, sha!' submit a cope of this inspection reoor, to the Approving Authorin within than (30) days of completing this
inspection. If the systent is a shared system o, has a design floes• of 10,000 god or greater, the inspector and the system owner shall submit
the repo- to the appropriate regional office of the Depanment or Envrronmenta' Protection.. The orig!na! should be sent to the system owner
and copies E-nt to the buyer. if applicable, and the approving authorin.
INSPECTIO%SUMMARY: Check A, B, C, or D:
A SYSTEM PASSES:
I have not found any information which indicates that the system vioiates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below. .
COM NTS:
61 SYSTEM CONDITIONALLY PASSES:
One or more system components as described in the 'Conditional Pass' section need to be replaced or repaired. The system, upor
completion of the replacement or repair, as approved by the Board of Health, will pass.
Indicate yes, no, or not determined (Y, N. or NDi. Describe basis of determination in all instances. If'not determined-, explain why not.
The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attachedi indicating that the tank was installed within twenty (20) years prior to the date of the. inspection; o
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
(revised 04/15!71) Page 1 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
(C�7Dat
perty Adduos: P
e ospection: i
lv-
YSTEM CONDITIONALLY PASSES tcont,n,�dSewage•backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipets) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the
and of Health). Describe observations:
broken pipe(s) are replaced
-- obstruction is removed -
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipeisl.•The system will pass
inspection if twith approval of the Board of Health): - • - •- - - -
broken pipets) are replaced
obstruction is removed
Cj FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: -
Conditions exist which require furthe•evaluation by the Board of Health in order to determine if the iystem is failing to protect the
public health. safe:)'and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or prn-, is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCT10%I.NG IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT: `
_, The s\•stem has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than•. 100 feet but 50 feet or more from a
private water supply well, uniess a well water analysis for coliform bacteria and volatile organic compounds indicates that
the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method used to determine distance (approximation not valid).
3) _.OTHER
(revised 04:2519-) page 2 of 20
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIOI FORM
PART A
CERTIFICATION (continued)
Property Addrross:
Owner:
Date of Inspection:
DI SYSTEM FAIL5:
You must indicate either 'Yes` or `No' as to each of the folio%wing
have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303 The bans
for this determination is identified below. The Board of Health should be contacted to determine what will be necessar• to correct
the failure.
Yes No
Backup of sewage into facility or system component due to an 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 houid level in the distribition bo> above outlet invert due to an overloaded or clogged SAS or cesspool
liouid depth in cesspool is less than 6- below invert or available volume is less than 1/2 day floe.
Required pumping more than 4 times in the last year NOT due to clogged or obstructea pipes .
~umber of times pumped _.
Any portion o'the Soil Absorption System, cesspool or priv,)• is below the high groundWate• eievanoc
Am por:;on of a cesspool or privy is within. 100 feet of a surface water supoh• or tributar to a surface water suppi}
Any porion of a cesspoo: or privy is w ithir. a Zone I of a public well.
Am pe^,io- e:a cesspool or pmv is within 50 feet of a private water supple well
Am•por,,or. of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceotable water qualm analvsis. It the well has been analyzed to be accectabie. anach cop.- of well water analysis for
cohiorm bacteria volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
You must indicate either -Yes` or "moo- as to each of the following.
The foliow:r,g criteria app;% to large systems in addition to the criteria above:
The system serves a facilir, with a design flow of 10,000 gpd or greater (Large System; and the system is a significant threat to
public health and safer and the environment because one or more of the following conditions exist.
Yes No .
the system is within 400 feet of a surface drinking water supply
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) _.... ...... . ..__.... _ ---
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater:Neatment program - -
requirements.-of 314 CMR3.00 and 6.00. Please consult the local regional office of the Department for-furthe.r.informatiocv:---
(rwis�d Of/75/97i v.... ] a! 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Propert% Address:, —
Owner:
Date of Insp4ctton: �i t L
Check if the following have been done: You must indicate either 'Yes' or 'No` as to each of the following:
Yes No
Pumping information was provided by the owner, occupant, or Board of Health.
None of the system components have been pumped for at least two weeks and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recentl% or
as part of this inspection..
As built plans have been ootatned and e\amined. Note if they are not available with WA.
The fac:li-., or dwelling was inspected for signs o'sewage back-up.
_ The systern does not receive non-sanitan• or industrial waste flow.
_ The site µas inspected for signs of breakout.
_ All systerr: component:, excludine the Soil Adsorption System, have been located on the site.
The septic tank rnanhcies were uncovered. opened. and the interior of the septic tank was inspected for condition of
baffies or tees. materia; o' construction. dimensions, depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption Svstem on the site has been determined based on
The fac.lin oµne• .ano occupants. is difteren: from ow•neri were provided with information on the prope, maintenance of
Sub-Surface Disposal Svstem.
Existing information. Ex Plan at E.O H.
_ Determined in the field of an% of the failure criteria related to Pan C is at issue, approximation of distance is
unacceotabie (15.30131ti!
6 \
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR.m
PART C
SYSTEM INFORMATION
Proper1% Address:
Owner:,�(
Date of Ihspectton: j����rG
b `6 FLOW CONDITION'S
RESIDENTIAL:
Design ilow 3 C p.d..rbedroom for S.4,.S
Number of bearooms
Number o-'current residents
Garbage g•::der (yes or no,: MA
Laundry cor—ected to system (yes or no!
Seasonal use (ves or nwi—Li
Water meter readings. if 2varlabie (last two ;21 year usage (gpdi:
Sump Pump Ives or nor
La<. da;e o;occupant,,—
COMMERC;4L'IN0L'STRIAL:
Type of establishment
Design fio%% ea!ionsida%
Grease trap present (ves or no_
Industna! Waste Holding Tani; present. Ives or no_
',on-sanrta,% Kaste discnarger- to the Trtoe S sys;em ives or no_
\later meter readings if a.a,labie
Las:pa;e o; o -,"P2nc.
OTHER: .De:cube
Last pate of occuoanc.
it GENERAL INFORMATION
PUMPING RECORDS�anjd source of information
System pumped as par, of inspeGron: tees or no.
If yes, volume pumped gallons
Reason for pumping
PE OF SYSTEM
Septic tank/distribution bow'scid absorption system
Singe cesspool
Overflow cesspool
Prn�•
Shared system (yes or no) (if yes, attach previous inspection records, if any)
I/A Technologv etc. Copy of up to date contract?
Other -.-
APPROXIMATE AGE of all components• date installed (if known) and source of information: 1�G�
Sewage odors detected when arriving at the site. (yes or no)� \
(revsaad 04/25/9T) Page 5 of 10
A
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTESA INFORMATION (continued)
Property Address:
Owner: V ci<L
Date of Impection: ����l,(
BUILDING SEWER: 11 7711
(Locate on site plan)
Depth below grade.%
Material of construction. _cast iron _40 PVC _other (explain`
Distance from private water supply well or suction li-t
Diameter
Comments: (condition of joints, venting, evidence of leakage. etc.)
SEPTIC TANK:��
(locate on site play
Depth belo% grade
maierial of construction* Nconcre:e _rne:a _Fiberglass _Polyethylene _othertexplain
if tank is me:al. Ifs: age Is age confirmeC o% Ce^.6ca:e o: Compiiance _('res-No
Dimensions tlf��,1Cf I
Sludge depth t� a�y
Disiance from top o: stuage to bottom o' outie: tee o• ba-;:;e ,3 t
Scum thickness'_ t
Distance from top of scum to top o'outle: tee or ba;;Ie I�L i1
Distance from bottom of scurn to bo-o-t o,outet to e• ban.e 14
How dimensions were determined -4'3.tikA
w
Comments
(recommeridat:on for pumping. rondit on o' inlet rid outlet tees or baffles. depth of liquid leve! to reiatron to outlet inve St
aura
integrity, evidence of le age. e:c t U v' 1 .3
.�-
GREASE TRAP:—Po
(locate on site plan!
Depth below grade:
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:
Comments:
--' Irecommendatron for pumping. condition of i,ilet and outlet tees or baffles, depth of liquid level in relation-te-outlet4nvert7structur-al- -
integrity, evidence of leakage, etc.; -
(r..•t..d 04/25.'971
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Propert. Address:'��
ON ner: .
Date of Inspection:
TIGHT OR HOLDING TANK: --Tank must be pumped prior to, or at time, of inspections
(locate on site plan,
Depth below grade.
Material of construction. _concrete _metal _Fiberglass _Polyethylene —other(explain)
Dimensions:
Capacm• gallons
Desig- floe, galionsda.
Alarm level A:arrn to %korking orde• _ Yes. _ No
Date of previous pumping
Comments
(condition of inlet tee, condition o' a•a'rr. and float switches. etc.)
DISTRIBUTION BOX:W5
(locate on site p-a- _
Dec:h o' liould lee' a00%e oune:
Comments
tnote d ve! and distri _ is ua'_ e��dence of solids c�r ver, e��dence of eak ge into or out of boa, etc.)
PUMP CHAMBER:
(locate on site plan_
Pumps in working order: (Yes or No-
Alarms in working order (les or No
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Prop" Adrir-ss:
Owner: fe l (' l
Date of Inspection:
SOIL ABSORPTION SYSTEM.. (SAS): S
(locate on site_plan, if possible: exca%1tion not required, but may be approximated by non-intrusive methods;
If not determined to be present, explain:
Type:
leaching pits, number.
leaching chambers, number:_
leaching galleries, number.
leaching trenches. number,length:
leaching fields, number, ci,rnensior.s
overflow cesspool, number
Alternative s%,stem
Name.of Tecnnotogy
Comments T t7 S
mote condition of soil. s+gr.s of hydraulic failure leyei of pci ng co ro vegetation, etc.t r l(
CESSPOOLS.
(locate on site play.
Numbe, and conf,g;,ra:.o-
Depth-top of liquid to inlet Inver,
Depth of solids lave-
Depth of scum layer
Dimensions of cesspool
Materials of constructior
Indication of groundwate-
inflow tcesspool must oe pumpeC as par, of inspection.,
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY:
(locate site plan)
Materials of construction: Dimensions:
Depth of solids: ._ _. .-.
Comments
(note condition of soil, signs of hvdraulic failure, level of ponding, condition of vegetation, etc.); -
(r.vi..d 04/25/97) Page ! of 10
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Propert}Address: 'a� �Q•:. �b :
Owner: .IrjLX .,
Date of In3,pection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
LA
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/�...:..J n1 I9(/t� w_�_ a ..• 1n ..
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1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
u A SYSTEM INFORMATION (continued)
Propertv Address• G-'V' q( jmuw'` .0
Owner: 'V
Date of Inspection:�` �G C%S`
Depth to Groundwater�20'feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained irom Design Plans on record
Observation of Site (Abutting property, obsen•ation hole, basement sump etc.)
Determine it from local conditions
Cnec� with loca! Board o• nea'tr
Chec'K FENAA neaps
Check pumping records
Check local excavators ins;allers
L se L SCS Data
r•
a
Describe in vou, o�%-. %,oros no%% % :: es:abhshed the 6-iieh Groundwater Elevation. (Must be completed! b�
rC-ri1L
(rev-sod 04:2s'9'. Page 10 of 10
l
TOWN OF BARNSTABLE Y
-LOCATION Gy'jTta- V- . U"3 SEWAGE #
VILLAGE C AW�Ak-x- ASSESSOR'S MAP& LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY A b Q C,
LEACHING FACILITY: (type) �� TS (size) t OCOO r, _
NO.OF BEDROOMS
BUILDER OR OWNER Q.X..
PERMff DATE: l COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and �'2-0 Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) N ►.e, Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) lw Feet
Furnished by
�-2s
1 tL-7L5'b`' lb2-31°
3-7
f,s
Z '203 499 001
US Postal Service
Receipt for Certified Mail
No Insurance Coverage Provided.
Do not use for International Mail See revs e
n
Street& mb
Post Office,State,&ZIP Code
Postage $
Certified Fee
Special Delivery Fee
Restricted Delivery Fee
LO
rn Return Receipt Showing to
Whom&Date Delivered
Return Receipt Showing to Whom,
Date,&Addressee's Address
0 TOTAL Postage&Fees $
9,0
EPostmark or Date
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rn
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I�
f Stick postage stamps to article to cover First-Class postage,certified mail fee,and
charges for any selected optional services(See front).
1. If you want this receipt postmarked,stick the gummed stub to the right of the return
address leaving the receipt attached, and present the article at a post office service
window or hand it to your rural carrier(no extra charge). m
2. If you do not want this receipt postmarked,stick the gummed stub to the right of the Q)
return address of the article,date,detach,and retain the receipt,and mail the article.
3. If you want a return receipt,write the certified mail number and your name and address rn
on a return receipt card,Form 3811,and attach it to the front of the article by means of the
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6. Save this receipt and present it if you make an inquiry. t o2595-97-B-oi 45 a.
I
oFTti Town of Barnstable
snxxsrnaM Department of Health, Safety, and Environmental Services
9� ' ,.� Public Health Division
�fOiAoYA P.O. Box 534, Hyannis MA 02601
Office: 508-862-4644 Thomas A.McKean,RS,CHO
FAX: 508-790-6304 Director of Public Health
October 1, 1999
Marguerite Surette
c/o Lillian Surette
116 Jefferson Ave.
Everett, MA 02149
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY
CODE H, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE BOARD OF HEALTH NUISANCE
CONTROL REGULATION NUMBER ONE
The property owned by you located at 25 Centerville Ave., Centerville was inspected on
September 28, 1999, by Jerry Dunning, Health Inspector for the Town of Barnstable,
because of a complaint. The following violations of the Nuisance Control Regulation
Number One Regulation and the Sanitary Code H were observed:
410.602: Construction dumpster overflowing with clothing, rubbish and other debris.
The rubbish and debris must be removed.
You are directed to correct violations within forty-eight (48) hours of receipt of this
notice.
You may request a hearing if written petition requesting same is received by the Board of
Health within seven(7) days after the date order is received. However, this violation must
be corrected regardless of any request for a hearing.
Please be advised that failure to comply with an order could result in a fine of not more
than $500. Each separate day's failure to comply with an order shall constitute a separate
violation. You are also subject to non criminal citations of$40.00 for the first violation
and $15.00 for each additional violation. Tickets will be issued daily until the violations
are corrected.
Z
PasA
ER OF THE BOARD OF HEALTH
McKean
Director of Public Health
surette/wp/q/ls
. . ... ....... .. . :...
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NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.06, STATS SANITARY
CODE II MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE BOARD OF HEALTH'S NUISANCE
CONTROL REGULATION NUMBER ONE
The property owned by you located at L5- C', was
inspected on 9.1 -97 by �- � ^'� , Health
Inspector for the Town of Barnstable because of a complaint.
The following violations of the Nuisance Control Regulation
Number One Regulation and the Sanitary Code II were
observed:
I
You are directed to correct this violation within
days/hours of receipt of this notice.
You may request a hearing if written petition requesting
same is received by the Board of Health within seven (7)
days after the date order is received. However, this
violation must be corrected regardless of any request for a
hearing.
Please be advised that failure to comply with an order could
result in a fine of not more than $500. Each separate day's
failure to comply with an order shall constitute a separate
violation.
N PARCEL
/-
THE COMMONWEALTH oFmAssAo*usErra
U����� ���� ���� HEALTH
�� ��_ __ _�� �� ,
TOWN OF/BARNSTABLE
Apph�mtion for D' pwi~� W~ ks To n tirrutit
Application is hereby made for a Permitto [oo ,s� uct ( ) or Repair -�.�
� ) an Individual Sewage Disposal
System at: r
--' -_--_____._-~......... �
i.n ^.u,,. -��
----------------'-----_-_----.--------------'-- ~°-, �--�+----��=�~��' ~
~
.......................................... a�I_'/�---�!��L��^L�-^---_
Installer - ` Axa,^"" �
Type o{ Building �� Size Lo�--__----___80.
Dn,6}�u�-- I�o� "� 8olr000s--~��.�----_------I�zyuoo�ou Attic ( ) Carbu�� Grinder (MjN
Other—Typeof Building --------.- No. of persous---.------. Showers ( ) -- Cafeteria ( )
~~ Other fixtures --------------------------- --------------------------
Design Flow............................................gallons per person per day. Total daily flow--------------------------- .........------v�aDons.
Septic Tank—Liquid cuya6ty-M.gallooa Length---------------- Width---------------- Diameter---------------- Depth................
Disposal Trench--Nn. .................... Wi6t6------- Total Leogdz-------- Total leaching area....................sq. f t.
Seepage Pit lVo-------- Diameter------' � ....................
Depth below ..................lcac6���uroamg. ft.
�� Other D�t�budoobox ( ) Dosing tank ( )
~~ Percolation Test Results Performed by.------- Date............
Test Pit No. l-----.nioutcsyerincb Depth of Test Pit--------------- Depth toground wutec------_'
44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
�4 ---------_-----____----__--__--------_-------^---__--
~~ Description of Soil........................................................................................................................................................................
--.--._-.-_-._.-_-_._--'---.___----_-_-----_---_._—_--_----.----__-----._'
'''-_ -------------
� bLkttjre of
� Repairsapplicable......
]_>.' _____________________________
The undersigned� agrees to install the aforedescrJbed Individual Sewage Disposal System ivaccordance with '
the provisions of TITLE 5 of the State Environmental Code
| � c--'
---------_------ --.....
.'^�~~'-/`�-�
Application. '
-------------------------------------------------
Application.Disapproved for the following reasons: ---------------------------------- -----------------------------------------------------------------------------------------.........
� -------'--_--- ---'_--------_--_---_----' '_---_-----
Permit No '. .' --' l000e6 --------����--� -�
Dme
,
a �
NO� � ��
FEB ,
THE COMMONWEALTH OF MASSACHUSETTS
- BOARD OF HEALTH `w
TOWN OF BARNSTABLE
Appliratinu for Uiinpwi al Workw ,Tputitrnrtinn 11amit
Application is hereby made for a Permit to Construct, �:.9)`or Repair an Individual Sewage Disposal
System at: ^�'
.....---- •.... -
``l ------ -- -- ----
V�. ��"`` capon Address -,, -',:.. - ^--•---o --`............................i�
-: �- . ...t.. ._.......c��c _
-
� ncr dress
---- ----- 1 ? __.C c
1` . . ..k
Installer Address
/ Size ot____________________
Type of Building Si L
Sq. fg�
.-� Dwelling— No. of Bedrooms._________.r-----------------------------Expansion Attic ( ) Garbage Grinder
aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( }
al Other fixtures ___________________
W Design Flow............................................gallons per person per day. Total daily flow_.-----------.. ._,,_....................gallons.
WSeptic Tank—Liquid capacityIA_gallons Length---------------- Width---------------- Diameter________'__-._- Depth................
x Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area.______-_-__._______sq. ft.
Seepage Pit No..............__-___ Diameter----------.--------- Depth below inlet........_........... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by--------------------------------------------------- ...................... Date......................................
Test Pit No I________________minutes per inch Depth of Test Pit__.__....____-_.-_- Depth to ground water------------------------
w Test Pit No. 2................minutes per inch Depth of. Test Pit________.-..______- Depth to ground water_.____-.___-____----___
f� ._...----•----•-------------------------------•-------...•••--..... .........................................................................................
Descriptionof Soil.....................................................................................................------------------------........--------------------•-------••----
U •••••-••••---••--••....•=•••...----•-•••••••-•--•---------•--••-•--•--------••--••-•--•-•••---------•-•••-----•••--------------•---•---••-----••--•-----•-•---------••-----•-•---•-•••--...----•---•••-.
W
U t re of Repairs or Alter ions—Ans er when applicable._.__.+�_ ._. ___.�_____ k�1 .4' SC� Cs_ ____ - ........
.. ..._ - ,... 1 ,f:7 ----------- ----- ---------------------
Agreement.
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions`•of TITLE 5 of the State Environmental Code—T
Jx undersigned further agrees not to place the
system in operation until a Certificate of Com "ante has been 'sued y the bo rd of health.
Signed .. h S
---- --
�13—
- --�?'� Dare
Application.Approved B 'r-------------- .._------------------------------------<•-�' r �--j _
Dare
Application.Disapproved-for the'-,following reasons: -- - - - - - - - ...
-----------------------------------------
---------------- ------------------------ ..
----- --
Permit No. =' -V - Issued -.t�'..._....'�./.:.�. .,��--
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Ciertifi ate of Conylianre
THIS IS,TO VERXIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by -----------------`>C -�-------------------------------------------------------------- - - - -- ------------- -------------- --------------------------------------
1-wile
has been installed in accordance with the provisioon's'95f-TITL 5 of The State Environmental Cgde,as described in ..
the application for Disposal Works Construction Permit N ' •►r � "` datedal.. ' ..
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE '4. ....'....-. - Inspecto °� '"'
----------�----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD' OF HEALTH
TOWN OF BARNSTABLE
No. __�._/ 7 FEE........................
�i��n�tt �r� ��n��vrtilan �rrntit
Permission is hereby granted------------ k_o-iZ-----------. .
to Construct ( ) or Repair ( L4an Individual Sewage Disposal System
at No... c�. ' -- s' � � ------- '
Str t ,,•^�
as shown on the application for Disposal Works Construction Permi ®.__'______ _-__Dated------- '�'"- " �
DATE_ � ^ .. / - ._- Board of Health
------.
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS
TOWN OF BARNSTABLE
i
L<<JCATION SEWAGE # 7
VILLAGE ASSESSOR'S MAP & LOT17,:,:?°°;?Y
INSTALLER'S NAME & PHONE NO.<�)\� clL
SEPTIC TANK CAPACITY
LEACHING FACILITY: ype) (nXk (size) 3 5 .
NO. OF BEDROOMS PRIVATE WELL OR UBLI WATER
BUILDER OR OWNER - (-�,tL
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No �/
A 4-; p
A
io a�
�-b 5�
Q�6 pave go'
t3 ow
e�
.................
No.......................
THE COMMONWEALTH OF MASSACHUSETTS
,--- BOARD _-QF HE/kL7T
/�"_.?.........0 -----------__------------
........ .....................
Appliration for Disposal Works Tonstrurtion Fumit
Application is hereby made for a'Permit to Construct (k,�
or Repair an Individual Sewage Disposal
System t:
-C...rA
........... ........ ... . ............��fll .......M .................
L Adi�pa rIc�No.
C I Iff
-4.............. ----C0192,r...................... .... .........a:2 ... ................
N Owne Address
-----------------_---------- ..........
........... .. J,�-i IC-0 ..I...............................................................
Installer Address
Type of Building Size Lot..4_ 70dd....Sq. feet
U ms......j................................Expansion Attic J�� Garbage Grinder AM
Dwelling—No. of Bedroo
Other—Type of Building ........................... No. of persons............................ Showers Cafeteria
Otherfixtures ......................................................................................................................................................
Design Flow............... ................gallons per person per day. Total daily flow.....:.Y-3 a.........................gallons.
9 Septic Tank—Liquid*capacity�(Z.Ogallons Length_............. Width................ Diameter---------------- Depth................
Disposal Trench—No.................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area...;r--_-------sq. f t.
Z Other Distribution box Dosi 1
�_4 -A �_ W
Percolation Test Results Performed byll.2'e 4... !_!re-1;,?C4.......... Date...
4 �I�V4
Test Pit No. .....minutes per inch Dep�th Test Ptif� /.-.--eepth to ground water
Test Pit N04� 2-minutesper inch Depth of Test Pit.- -------- Depth to ground water.....................
.......... ..................... . ............ ...............................................................................
7, 6 --------
�P 4. ...vVe-7-,Z".0., -
0 Description of Soil....... ---------------- --------------------------------------------
.............................. --- ----6 . ................................................
U ------
------ .... ... . . .. .. ..........................................................................................................
....................................7-'�—A-R-
:V4
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
........................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TH TXI1j 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee i sued by the,�qard of health.
_�ned... . ... .. . . ...
.. .............................. Datel
Application Approved .........C.:..... ...............
....................................... ......... . ..
Date
Application Disapproved for the following reasons:...............................................................................................................
.................................................................................................................I....................................................... .............................
Date
Permit No......................................................... Issued............ ..........
Date �;
----------- ---------------------------
rl
1
THE COMMONWEALTH OF MASSACHUSETTS
------------�C.-�/ ..---.....OF. ............�'�1... ............-=^�` //
Appliration for Disposal Works Tonstratrtion Prrutit
Application is hereby made for a Permit to Construct (k) or Repair ( ) an Individual Sewage Disposal
System at,:. .6
, Location Addyy�6s%s o�
. ............ ........
Owner / Address
a Installer
� Address ,,��;,,+�.
Type of Building Size Lot-..?'�_400....Sq. feet
I—. Dwelling—No. of Bedrooms.....1--------------------------------Expansion Attic Garbage Grinder
Pk
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtu�es --------------- -----------------------------------•-•-----------------------------------------•--------------------------•-----•-
gn ...........................gallons per person per day. Total daily flow.._:-- ----•-----................gallons.
W Design Flow..............
WSeptic Tank—Liquid capacit /40d_gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length........._.......... Total,leaching area....................sq. ft.
Seepage Pit No-_----------------- Diameter.................... Depth below inlet.................... Total leaching area-__ .............sq. ft.
Z Other Distribution box ( ) Dosin t ( �) Q
'-' Percolation Test Results-- Performed by e...... ✓i7t'f'r�,E,7 .......... Date._.
Test Pit No. .........._.__minutes per inch Depth Sf Test P ._.. ...e._—nepth to ground water..... �.
f=, Test Pit N liltrZ._minutes per inch Depth of Test Pit.---.C'�......... Depth to ground water.. .
x ............ �.
Description of Soil. - 4' '"�
UW ---------------------------- ---7, -/ ' �'mot' "'Fr _. �--.�.......------ -------------------- -------------•----....-----------------------------......
Nature of Repairs or Alterations—Answer when applicable...............................................................................................
----------------------------------------'----'-•-------------------......--'--------•-•••-••-•------•-------...•-----. ---•----------------'---------'---------------••-------•-------------.......-----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
-me provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the cyst inin
dperation until a Certificate of Compliance has bee„ 'ssued by the'hand of h h.
. Signed..3�i v- f ----•---------------
` - _..
; .--.....
j Dat APPlication Approved BY:... == .. --
-
Date
Application Disapproved for the following reasons--------------------------------•--------------------'---------------------------•-'---------•-'----"-•--....._
---------------------•----------------------•--....----------......--'---------•--''•--
;=--
PermitNo................................................... _. Issued------•-----•----•-----------•--•---•......au
= -----.
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH /
...........OF. + ;..............................
%lunrtifiratr of TontpliFanrr
- IS TO TIFY, T the Individual Sewage Disposal System constructed ( " or Repred ( )
by..._�oc n� .:5.. -—-----------------t . w --------- •--•-••-----. ..........................................
/�h1�= .... - nstall r/r
at L7�ff - '� ! _ .fit.---. _ ... .*'"(/il/r . .........................................................
has been installed in accordance with the provisions of TITER .5 ofj Mate Sanitary Code as de ribed in the
application for Disposal Works Construction Permit No._' =�_..__. ............. dated_... .�
= ...
THE ISSUAN E OF THIS CERTIFICATE SHALL NOT BE C7..T..UE.1 .. S A GBJARANTEE THAT THE
: •,. SYSTEM WILL FU CTh�OA ISFACTORY.
„t
DATE............... •1--•- .... ............................... Inspector.... .. ----- ---- ...............................................
IU
THE COMMONWEALTH OF MASSACHUSETTS
s
BOARD @ �,HEALT/H
.................OF..----- `.' -.,...-
c� . � ..
No.�:_-...: ......:. FEE.--•-•- ........
nfomodr ' n rrmit
Permission is ereby granted...= .!?' - --"----'-� ............... -----------------------------------------------••'•----.................
to Constr ( or R-Aair ) an I dlvi ual Sewage_ Disposal Syptem
Street
as shown on the application for Disposal Works Construction Permit_NoZ__,=�. ........' `�_ Dated =-------..........................
------------------- ----------'--------'--- ------------......--------...-------•---•.... '
Board of Health
DATE ----- '------••---'--•--•-
FORM 1255 A. M. SULKIN, INC.. BOSTON
N/C,fL.OR/1 ONfINE $r/P.N i '�1'c `NAy ,>�.OVA yb.EN ( rV�F_A�ViYE
N so'14 So
- — IOO.o0
Lp 5
LoT
L oT G
o
,0 �aJ
uxi2 D,R �b� ( .
sp
o Q Lct�cH. �
M GV
1000 4AL
V SEPTIC
� � `�s Tr'�riK .
�"oRn Ear 4� �.�
o 7yS
ZaNC .�G
DRA N
32 � . �QS MENr
' NoTE 'C'NAhrdEp ro
A c 2 /:cad'
a r9gs o .
AssdMO
/°,�orcp i�,y flER
. �au�Nsy ate �.._ 5 5c' iy°oo s OFA44
to�3�r All:Ii, c�c•, ,,
CL:rYTE�?/3RooA LAiv,C
w: fi
($O' �/ f. /�ru✓ .ray) 1`�,p ' ��v��$
�P�SN Uf MAXx �0R G151
LEG END ��h�� ROBERT cyG� oNn� �a
EX1$TINO SPOT ELEVATION OxO B•
BXIf1TINa CONTOUR --- 0 --- 4 ELD€�EDGE � �ERTIFIED PLOT PL AN
a:., he �c
FINISHED SPOT ELEVATION
� � ,L o r $ CENTE''c �Ras>/� SANE
:FINISHED CONTOUR 0AT�to�S� T,� VrLG.E
NOTE: The location of any existing under i out� �s°tFb+ ge, I N
wells, .or other utilities shown on this plan is approx-
imate only as determined from records and/or verbal .
'information. The .contractor is. respon.sible for the
verification of the existing locations in the. field. gCALE� �= 3O� DATE 3/2016-Y
ILD—R—E-DGE ENGINEERING Ca IN NSRC R
CLIENT._..�� i CERTIFY . THAT THE PROPOSED
EGISTERE REOISTEREO Job.No. 81/076- BUILDING SHOWN ON THIS PLAN
'CIVIL LAND ` , CONFORMS TO THE ZONING LAWS
at
X, ENGINEER RV DR.BY� OF BARNSTABLE D MASS:
?12 MAIN STREET CH. BYE
HYANN I S, MASS.` SHEET OF TE REG. LAND SURVEYOR
2D FT. M/N . /YOTF. IF /TNEAT 7We-.SEPT/C:,7A V , DR ., .
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GO.YERS � PP,Q FT.
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04/7tE7r SEPTIC TANK LFT GRQUNo ycwTfR Ti!lfLE
1JVLET D/STi4/Al/T/DN BOX 7/ -ri FT
:SECT��N OF '
OUTLFrDlsTRIBtlT1oN BOX 7/" 2 FTlf4eWAGE 01,T~A J. SYS7'E/y9
INLET LEACtIINlr P/T .ZI -y fT T�l�1JLJ�T/DIV
LEACHING R1 T GIMENst O N /� f'T.
i SCALE : .�f' s / O�
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DJlhENSI�DN C. 4
ER Of BEDROOMS-3
GAAg4 AG,F.D/sPosAl uAr/r NFL- SOIL LOG "SAO TEST
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NUAISE/P 0►F l.L"ACNIMS P/TS i ELEY. 73 9 EL!=Y, .DATE GF SO/L TEST
S/O�L.G`ACHlI�/G PER P/T 1 _Sq. iT. RESULTS #VITNESSED:
. _ _ .
2ACiRCOLATOM RA-rarAt/
OQ7TTOM L6IGH/NG PER P/TL1 AT Logm 4suL `/►11MJy�JINCHH!yl C
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�•i Ei_DREDGE, 0 SE LDR�DEirE f/1+4!'I/1/�R/ 1 '
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INSTALLER'S NAME i ADDRESS
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BUILDER ' OR OWNE
DA T E PERMIT ISSU E D y/0A
DATE COMPLIANCE ISSUED ��
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COTUIT BAY DESIGN
z z ° N m " `� DAN TURNER MASHPEE MA. 026449
�' 25 CENTERBROOK LANE CENTERVILLE, MA (508)539-2699
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