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1211 CRAIGVILLE BEACH ROAD - Health
1211 Craipille Bead Road 206-054 Centerville •L ,y T No. 4210 1/3 ORA Pendaflexo 10% 0 . Me—s'sage Pagel of 3 Stanton, David From: Stanton, David Sent: Wednesday, March 29, 2017 2:59 PM To: 'Richard Loder' Subject: RE: 1211 Craigville Beach Rd Centerville Floor Plans Thank you very much, those are great. I will put them in the file. The owners will need to submit an affidavit that the property has been 8 bedrooms July 4th, 2008. Thanks, David -----Original Message----- From: Richard Loder [mailto:Richard.Loder@raveis.com] Sent:Tuesday, March 28, 2017 3:12 PM To: Stanton, David Subject: 1211 Craigville Beach Rd Centerville Floor Plans David: Floor plans attached. Regards, 54� , IHR LDER m e C: 503B.785.5050 0. 5€8.428,3320 rich ard,lode rC&ravelis.com - riehardlo er;raveis com 812 Main Street. Osterville, MA 02655 � °, ro 7 _ -.. _ _ �JI ✓� a � tea. From:Stanton, David <David.Stanton@town.barnstable.ma.us> Sent: Monday, March 27, 2017 7:52 AM To: Richard Loder Subject: RE: 3D Tour of 1211 Craigville Beach Rd Centerville Not necessarily, however, a bedroom must be at least 70 sq ft, so if it is not 70 sq ft, it cannot be a bedroom. Or if a room (i.e. study, den...) has a cased opening to exempt it from counting as a bedroom, we would need to know the width of the cased opening. 3/29/2017 Message Page 2 of 3 Thanks, Dave -----Original Message----- From: Richard Loder [mailto:Richard.Loder@raveis.com] Sent: Friday, March 24, 2017 5:04 PM To: Stanton, David Subject: Re: 3D Tour of 1211 Craigville Beach Rd Centerville David: Do you need room sizes? I'II have to do it by hand. Regards, RICHARDLODER. C: 508.785.5050 ° 0: 508.428.332.0 richlard.lodertF rravei3.com - richardlodenraveis.com 812 Main Street , ostervifte, MA 026SS .. IM From: Stanton, David <David.Stanton@town.barnstab le.ma.us> Sent: Friday, March 24, 2017 4:24 PM To: Richard Loder Subject: RE: 3D Tour of 1211 Craigville Beach Rd Centerville Hi Richard, I looked at the photos, those are great. We will need a floor plan of the house, showing all floors present(i.e. basement, 1st, 2nd, 3rd floor, etc) all rooms labeled to help determine the number of bedrooms. Thanks, David W. Stanton, RS Chief Health Inspector Town of Barnstable 200 Main Street 3/29/2017 Message Page 3 of 3 Hyannis, MA 02601 Direct phone: (508) 862-4647 Health Dept. phone: (508) 862-4644 Health Dept. fax (508) 790-6304 -----Original Message----- From: Richard Loder [mailto:Richard.Loder@raveis.com] Sent: Friday, March 24, 2017 3:58 PM To: Stanton, David Subject: 3D Tour of 1211 Craigville Beach Rd Centerville David: Here's a 31) virtual tour that I had done for 1211 Craigville Beach Rd Centerville. Please let me know as soon as you can about the current septic system capacity. http://tours.retool z.co m/u b/1548 5. rr 1211 Craigville Beach Road � Centerville, MA 02632 Real ... rrt tours.retoolz.com ti y;n ' A Residential Home$1,115,000 1211 Craigville ;u Beach Rd, Barnstable.Walk to Craigville Beach and Centerville Village from this... Thank you. Regards, RICHARDLODER INN I a C: 508,785.5050,O; 508.428.3320 f'ich.ardAoder@ ravels,corn ° richar41loder.rave is..ct3m:: 812 Main Street , OStervllle, MA 0265 3/29/2017 f ` 1211 Craigville Beach Road Centerville, MA 02632 First Floor Craigville Beach Road Master Stair Master Hall 2aY Bath Bedroom Way 15'3 Flr , 10 11 x 8 10 #3 "x Ce liar Car Garage 13'9" x 15'4" 3'1" Stairwa Bath " x 3'8" W x 24' 5'1 r` 7 Family Room Living Room 13'9" x 13'7" 14' x 14'9" Hall Way 15'10" x 3'4" Entry Kitchen 811111 x 81811 room Bedroom 20'8" x 14'1" Dining Room r (r Id � #2 --Stair tair 13'5" x 14'4" 10'8" 12'2" x 107' Way 2"d Flr Richard Loder William Ravei 508.785.505C For illustrative purposes, only. Buyer should verify measurements. Electronic measuring tool used. Page 1 J Craigville Beach Road Hall Way Bedroom #6 15'3" x 5'10" ; „ , „ Bedroom #5 9 8 x 8 9 13'9" x 15'4' stain Way 1st Flr Full Bath 71,09110 x 5,411 iigville Beach Road Ile, MA 02632 Bedroom #4 14'6" v 14'4" Full Bath Bedroom #7 7 4 x 6-1611 13 6 x 10 9 Bedroom #8 1 121411 x 7,911 `i StairWay 151 Flr +I For illustrative purposes, only Buyer should verify measurements. Electronic measuring tool used. Page 2 !l _ 4 . 1211 Craigville Beach Road Centerville Floor Plan Basement Craig ville Beach Rd " Cape Cod Basement Stair Way To 1st Flr 14'8" x 21'4" P 1+ For illustrative purposes, only. Buyer should verify the square footage. Electronic measuring tool used. Page 3 r DATE:._6/3/98 PROPERTY ADDRESS: .1211 --Cr-aigville Beach Road Centerville,Mass. 02632 On the above date, I inspected the septic system at the above address. This system consists of the following: 1 . 1 -Row of five flow diffussors side to side. 26 'x14 'x1 ' 2 . •1 -row of three infiltrators. 25 'x9 'x2 ' 3 . 1 -1500 gallon septic tank. 4 . 1.-Distribution box. eased bn my lns.naction, I certify the following conditions: 5 . This is a title five septic system:' -( 78 Code ) 6 . .The septic system -is in proper working order 7• at the. present time. , The leaching area is 3 ' off the water table. 8 .' The leaching area is fol"off the wetlands. 011V_�t Name: J_P_M_acomber Jr... i COm an J• P•Macomber & Son' 'Inc ., , .• \ ��'1 � r� PY�--------•----------- � ! Address:_-Bs-x—bb-----= ---,-- �. vG� v,,q • e Centerville .Mass__0.2.632 --- --- as; -119, Phone:__ ,`; � l'�9 9� •� r _5Q8.�Z7.5�333a------- , THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY a M_ N� JOSEPH P. MACOMBER & SON, INC. Tanks-Ceupools-Leachf lelds Pumped 4 Installed Town Sewer Connections P.O. Box 66' Centerville, MA 02632-0066 77.5-3338 775-6412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617-292.5500 WILLIA1 F.VELD TRUDY COX Govcmor Sccrctx ARGEO PAUL CELLUCCI DAVID B.STRUH Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commission- PART A CERTIFICATION Property Address: 1211 Craigville Beach Road Address of Owner: Date of Inspection: 6/3/98 Centerville,Mass.(If different) Name of Inspector: Joseph P.Macomber Jr. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: J.P.Macomber & Son Inc. Mailing Address: Box 66 Centerville,Mass_ 02632 Telephone Number: r;0R—Z25i.3338 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: /Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fail I/we Inspector's Signature-, i Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the repon to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: 10) One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate y��o, or not determined (Y, N, or ND). 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 (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or 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 04/25/97) Pegs 1 of 10 DEP on the World Wide Web: http:I/www.mapnet.state.ma.us/oep Printed on Recycled Paper • U SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1 211 Craigville Beach Road Centerville,Mass. Owner: Andrew Downes Date of Inspection: 6/3/9 8 B] SYSTEM CONDITIONALLY PASSES (continued) g& Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board 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 pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed CJ FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _i Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety 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: I& Cesspool or privy is within 50 feet of a surface water ,QD 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 FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: �!0 The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. S[� 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, unless 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 A/A (approximation not valid). 3) OTHER 5L-rT (revised 04/25/97) Dap• 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1 211 Craigville Beach Road Centerville,Mass. Owner: Andrew Downes Date of Inspection: 6/3/9 8 D) SYSTEM FAILS: You must indicate ei;t.er "Yes" or"No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes Now 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 liquid level in t i tribution box above outlet invert due to an overloaded or clogged SAS or cesspool. flaw �Ir�ti S��S -F tti�.CyroTgrf Liquid depth in�eesspeel•is less than..-6t-15elov-invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(0. Number of times pumped 0. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. i� Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: �. The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety 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 treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Yag• 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1211 Craigville Beach Road Centerville,Mass. Owner: Andrew Downes Date of Inspection: 6/3/98 SOIL ABSORPTION SYSTEM (SAS):z (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: T yam' N d(iS leaching pits, number. leaching chambers, number: (- leaching galleries, number: leaching trenches, number,length: leaching fields, number, dime stons.overflow cesspool, number: Alternative system: AA � Name of Technology: LO, - Comments: �ote condition of oil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) oamy sands to fine sand: No signs hydraulic failure nr pnndi.n Systems I—eaching are where the tank is: is normal_ CESSPOOLS: ! (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: AM Dimensions of cesspool: Materials of construction: 424 Indication of groundwater: AN inflow (cesspool must be pumped as part of inspection) Cesspools are not present. Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Cesspools are not present. PRIVY:AJnM. (locate on site plan) Materials of constructs n: /�� Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Privies are not present. (revised 04/25/97) pay• B of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1 21 1 Craigville Beach Road Centerville,Mass. Owner: Andrew Downes Date of Inspection:6/3/9 8 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. x 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 recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, dcluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. —The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) (revi#ed 04/25/97) P&q• 4 o1 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION' FORM PART C i SYSTEM INFORMATION Propeny Address: .1211 Eraigville Beach Road Centerville,Mass. Owner: Andrew Downes Date of inspection: 6/3/98 FLOW CONDITIONS RESIDENTIAL: Design flow d./bedroom for S.A.S. 'umber of bedrooms:, Number of current residents: • Garbage gander (yes Or n0).-432 Laundry connected to system (yes or no).A:� Seasonal use (yes or no).ALP eater meter readings, if available (last two (1) year usage lgpdt: 1996 G ii",ocoJ671�� Sump Pump (yes or no):.120— Last date of occupancy "Z COMM FRCIAUINDUSTRIAL: Type of establish ent: Ui4 Design flow: VA sallons/day Crease trap present: (yes or no)_[$- tndustr,al waste Holding Tank present: (yes or no) *,on•sanitar� waste discharged to the Titlle5 system: (yes or no)v �N ater meter readings, if available. n/!y Las: date of occupancy: OTHER: ;Descr.bei 1,14 Last cite of occupancy' GENERAL INFORMATION PUMPING RECORDS and source of information. System pumped as pan of inspection: (yes or no)_Q If yes, volume pumped: 000i�gallons Reason for pumping TYPE OF SYSTEM Septic tank/distribution box/soil absorption system !4 Single cesspool Overflow cesspool IV6_ Privy V1Shared system (yes or no) (if yes, anach previous inspection records, if any) UA Technology etc. Copy of up to date contraaf Other APPROXIMATE ACE of allncomponents date installed (if kn wn) and source of information: p J� �/' CU >spI/• /9;7 3r, <1e— s v 4r144kc1 94; .48 Sewage odors detected when arriving at the site: (yes or no),& lr•v:••d 0�/JS/97) ➢•y• 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1211 Craigville Beach Road Centerville,Mass . Owner: Andrew Downes Date of Inspection: 6/3/9 8 BUILDING SEWER: (Locate on site plan) /r Depth below grade: Material of construction: I�cast iron _L/40 PVC _other (explain) Distance from private water supply well or suction line a/ 'f Diameter„r Comments: (condition of joints, venting, evidence of leakage, etc.) Joints appear ventedt rou a house ven . SEPTIC TANK: 1 500 gallon tank (locate on site plan) Depth below grader Material of construction:concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: Sludge depth:,_ 1/ Distance from top_q.sludge to bottom of outlet tee or baffle: Scum thickness:_ Distance from top of scum to top of outlet tee or baffler Distance from bottom of scum to bottom of outlet tee or baffle:,�� How dimensions were determined: Z5rziiJ.1.f�'� Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) PUMP tank as a Bed & Bre k Utiet & Iniet -tees are in glace. L-i-q--u-1-crTevel at e outlet invert i s ructurally sound and shows nn c; gns of iegakago. GREASE TRAP:.(6de- (locate-on site plan) Depth below grade: AO Material of constructioniJ/(concreted/Rmetal,p/PFibergl ass AA Polyethylene*VAother(explain) Dimensions: Scum thickness: N Distance from top of scum to top of outlet tee or baffler Distance from bottom of scum to bottom of outlet tee or baffle:_ Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,-etc.) rease trap is not present (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1211 Craigville Beach Road Centerville,Mass . Owner: Andrew Downes Date of Inspection: 613198 TIGHT OR HOLDING TANK: Ode(Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grader Material of construction:VA concreteA Ametal,4ff iberglass 4�-Oolyethylene4Aother(explain) JA VA Dimensions: ,UF1 Capacity: gallons Design flow gallons/day Alarm level: Alarm in working order Yes;4h4 No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) Tight or holdinT tan s are not present DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: A-10 Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) The distribution box has two lateral _ T-- cat up to food—oQQ sfde and then the other_ No evidAnne of snlids carry ever. No eyidpnre of ea age in or out the box. PUMP CHAMBER:214w— (locate on site plan) Pumps in working order: (Yes or No)A/.� Alarms in working order (Yes or No)lz Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) Pump chamber is not present. (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properly Address:1211 Craigville Beach Road Centerville,MaSS. owner: Andrew Downes Date of Inspection: 6/3/98 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) lie cf M (sw�s�C 0t/15/97) P&y• 9 of 10 u - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propeny Address:1 211 Craigville Beach 'Road Centerville,Mass. Owner: Andrew Downes Date of Inspection: 6/3/9 8 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) N t Lp7-v2l tZ� L I qt i � I (revised 04/25/97) Day• 9 or 10 csir. WSJ- 1 . THE COMMONWEALT F MASSACHUSETTS BOARD O ,HEALTH �1=� flu .......................: . Q OF.... ... FEE... l. 33iliv .................................. .G J Permission is hereby granted........ ...�.,�t Re air n Ind' 'dual Se f,%age osal st / to Construct C ) p L`' �� �r%� / u ( y... .. �/��/ �....... at No...��.�.�.... ... 1 -. Street as shown on the application for Disposal Works Constructto ermit No.:......:............ Dated.......................................... �. ""' oard of Health ' DATE.................................. lf .................. . �:.. FORM 1255 A. M. SULKIN, INC., BOSTON 1 Cg THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l� �� TOWN OF BARNSTABLE No............. 30 CCFEa..............:........ �is�rnsttl urk,� �un�t�u.r#iun �Pxnttt Permission is hereby granted..J,P.Macomber Jr. ..... to Construct ( ) or Repair an Individual Sewage Disposal System at No.....211 Craigvlle -..each Road Centerville ..............................---...._.... ..................................................... Street qq as shown on the application for Disposal Works Construction Permit Nolte-21�. Dated.......................................... .................................... .......... ......... DATE.... ........7 ' Board of Health ...'... ........................... FORM 38508 HOBBS 6 WARREN,INC..PUBLISHERS THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (T,ortifiratz of Glom Jlianre Fg AaTpo VFY,rlThat the Individual Sewage Disposal System constructed ( ) or Repaired pX4 by............................................................... .............................................................. ......................................................................................................................... InuAw at .......... 2.11...Cragville....Beac.h....Road....Cente.rv..i.11e......:............................................................ ................................ . has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .......,A-m...:;L.J9Y..... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................ .....-....F...'..�..{—......................................... Inspector ............ ... ............................................................. SUBSURFACE SEWAGE DISP. t. SYSTEM INSPECTION FORM t C SYSTEM INFOI: 'ION (continued) Propeny Address: 1211 Craigville Beach Road Centerville,Mass . Owner: Andrew Downes Date of Inspection: 6/3/9 8 Depth to Groundwater/�! Feet Please indicate all the methods used to determine High Groundwater EIv--a:ion: Obtained from Design Plans on record �se-at,on of Site (Abuning property, bservation hole, basenx.ni-simp etc.) �etermine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records heck local excavators, installers Use USGS Data Describe in your own words how you established the High GrounclwatcrElevation. Must be completed) Used Water Contours Map. Gahrety & Miller Model - 12/16/94 (r•vi••G 0�/]S/97) P•c. 1O�t 10 nrw.—n,rr+•-„—•rnrmt•n,rnev-nn+.*xts+�rrr^+rvntrrn*nm rre+�g*.sss�a„rn *rrsTem¢rra.rmrr-�—..z..r••� 1 TOWN OF Barnstable BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 1211 : Craigvillebeach Road Centerville,Mass . ' ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Andrew Downes PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Som *Inc. COMPANY ADDRESS Box 66 Centerville,Mass. 02632. Street Town or City State LIP COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 ) 790 -1578 A CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system nt this address and that the information reported is true , accurate , and complete as of the time of +inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance opf on- site sewage disposal systems . Check one: XXXX System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or tile environment as defined in 310 CMR 15 , 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection which I hflve con tcted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature IleDate _6/3%98 One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF 11RALZ'ii, * If the inspection FAILED, the owner or.".operator shall upgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 3,10 CHR 16 . 305 , partd .doc C. w 7 - � ti b SS byV -31�l THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE S SYSTEM INSPECTOR as provided in 310 CMR 15 .340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. Julie R- 199S Acting Dirwor of Elie t of Water Pollution Control � 1 i U TOWN OF BARNSTABLE 1 �f LGCATION `l 11 �'4 �� SEWAGE # VILLAGE ASSESSOR'S MAP & LOTQQKDA INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (ty ) 67- '5 (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: 4 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet f le hi f ility) Feet Furnished by Y� i1 ra 4-j 3y� ► U L � �tcw aekUs 21 i cmi(go i lie 3e4 . nd Ce l v"c ft OSESSORS MAP NO: l o � No... PARCEL NO: ®n 1�1 .��,.::.�.Y.B Fxs...�....3�..00� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEP LTH TOWN OF BARNSTABLE -G `gam , ppliratilau for Utupnua1 Works Tontitrurt' mutt "�"' ."~•.�. - •.Application is hereby made.for a Permit to-Construct-'(` ) or`"RepairNXX) an -Individual Sewage Disposal System at: 1211 Craigville Beach Road Centerville The Old One Hundred House ................_- - - .....- ....--------------------------*......... .•---------•------••••••-------•-••------•--•--•---•---------------...................--•---.... - Location-Address or Lot No. Downes W J.P.Macomber Jr.Owner Address Installer Address d Type g Size Lot............................Sq. feet T e of Building U Dwelling X-No. of Bedrooms..........5...............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures .-•-----------•---------•-----------------------------------------•---•-------------------------------------------------.....--------•--............. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity.........---gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length...................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1.4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit---_................ Depth to ground water........................ a' ------------------------------•----•----....--•------------•--.....-----._..........---•••-••............................................ ------------------ 0 Desct)gRof Soil........................................................................................ x U -----•--------------•-••--•-----•-----------•------••-------------------------------•....------------•-----------•------••-------•---------••-------•---•----------•----•----------......---•-••--••---- w x .......-••-•---- U Nature of Repairs or Alterations—Answer when a plicable..Re mov e 5 Flow o w D i f f u s s o r s remove ... eplace _used material. Rese Flow diffusors - - - - - - ---------••-.....---------------------------------------•----••---------••-----------------------•-----------...-••....••---- 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—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n ' sue by the b do health. Signed .- . 7� 92 Dale Application Approved By ................ `...''.-- -- --- -- . ...... .= Dare Application Disapproved for the following reasons: ..... ................................................................... .. ....... .. ................... ... ............................................ . . p. Date PermitNo. ........... p�---------- _--------------- Issued ....................................................... -- Date rw r THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Ilej' Appliratilan for Uwpoaal Works Tonstrnrtiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair Y(XX) an Individual Sewage Disposal System at: 1211 Craigville Beach Road Centerville The Old One Hundred House ................•..........-•----•--••---•---------•----••----•---•------------.......-•----...... ......-•-•-•-•••---•---•--••......----•---•---•.....•-•--.....---•--........-----...............-- Downes Location•Address or Lot No. Owner ��--� W J.P.Macomber Jr. Address Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling X-No. of Bedrooms...........5...............................Expansion Attic ( ) Garbage Grinder ( ) Other a —T e of Building g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 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 No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1-4 Percolation Test Results Performed by.......................................................................... Date........................................ l Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---•--------•-••-•----------•-•---------•--•-••----------•------•-•----------------•......---.•••---......................................................... D Descr pt o. x Uof Soil......................... U ------------------•-----•---••--•--•-•---------•.•-•----------------•-•-----------••-----------------•-------------•------•----------------••--•---••------•-------------.........-------•-._..._...•-- W -------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------•••••- U Nature of Repairs or Alterations—Answer when applicable-_Re move 5 Flow Diffussors remove and replace used material. ResetFlow diffussors . • . . . • -----------------------------••----------------------------------------------------------------------. ...................... 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—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has /beeen,�lissued by the board of/health. Signed .. .. ---- ---.wv !=..� ! /�G/ �f.�I- ................................... ........ /6/92.--..--.-- Date Application Approved By ( �c�ee�•- ------------------------------------------------------------ --------7---- Dare Application Disapproved for the following reasons- ...................................................................................... --- ---------------------- ---------------------------.........................---------------- -- ----------------- ----------------------- ---------- ------------------------------------------------------ .....................................----------- e Permit No. _.-..-- .. Issued Du Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tiez#tttca e of C�omplinure 0HI ISM ��C�E jFjy,That the Individual Sewage Disposal System constructed ( ) or Repaired (Xxx� by---------------------------------------------- Installer at ...........1211---Cra g,ville----Beac.h....Road.--Centervi-lle---------- ----------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. --------?.,.--....;..9 K.... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--- --------------�. �------------------------------------------ Inspector ............. ---,-.1-_J - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH c� c, TOWN OF BARNSTABLE 3� 0o No...../•.per... �.1.� FEE...............'........ gispooat Workv C�nnitrudion motif Permission is hereby granted...J.P.Macomber Jr.. --•---------------------•-------------------------------•--.....----........................ to Construct ( )) or Repair (XX)C an Individual Sewage Disposal System at No...1211...qraigyLl.l.e- t3each Road Centerville .......... -- . Street 1 1�as shown on the application for Disposal Works Construction Permit No.____-___ _ Dated.......................................... .....................................� t / ` D^ _. ._. vBoard of Health DATE................ 36508 HOBBS&WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE � u LOCATION (frc,&e tjlc i3e-4-G� JV SEWAGE # VILLAGE Ced^1 V1)le- ASSESSOR'S MAP & LOT v _ INSTALLER'S NAME & PHONE NO. .C_,..�'J�r� s SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: -:y2 • S DATE COMPLIANCE ISSUED: 7 — - VARIANCE GRANTED: Yes No �_� _ 9 � �� �� � � �� ` \ ' e �- v , � � � � '© - Postal CERTIFIED MAIL,. RECEIPT l7'. (Domestic MaH Only; CO For delivery information visit our website at www.0 rrl �. Ni�v� r9 Ln CO Postage $ ru Certified Fee r � a�(j0 M /' P stm'ark. O Return Receipt Fee `�� ere � OO (Endorsement Required) Restricted Delivery Fee y �h O (Endorsement Required) O Total Postage&Fees rq Christine Thamm Living Trust ' C3' Christine & Conrad Thamm, Trustees 1211 Craigville Beach Road Centerville, MA 02632 Certified Mail Provides: ■ A mailing receipt ■ A unique identifier for your mailpiece ■ A record of delivery kept b�the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be corntined with First-Class Mail®or Priority Mailo. ■ Certified Mail is notavailable for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of. delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 s SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if'Restricted Delivery is desired. -1gent ■ Print your name and address on the reverse X �A❑Addressee so that we can return the card to,you. B. Received by(Printed Name) C. Date o eli ery ■ Attach this card to the back of the mailpiece, or on the.front if space permits. ��S —Article Addressed to: D. is delivery address different from item 11 Yes 1„ If YES,enter delivery address below: ❑No �i Christine Thamm Living Trust [ Christine & Conrad Thamm, Trustees 1211 Craigville Beach Road I Service Type Centerville, MA 02632 ❑Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) 13 Yes 2. Article Number ( , (transfer from service label) i;{7 01`2 ,0101 q`0 0.01!2 65 V, 3894 PS Form 3811. February 2004 Domestic Return Receipt +02595-02-M-1540'i I. UNITED STATESIP R"V'l 1 First-Class Mail Postage&Fees Paid I USPS Permit No.G-10 I I • Sender: Please print your name, address, and ZIP+4 in this box • I I I � - - Town of Barnstable Public Health Division 200 Main Street i Hyannis, MA 02601 I Town ®f Barnstable Barnstable • //OF THE T�� Regulatory Services.Department w;ca0 I,14,nAa:VsranLE.?�I� public wealth Division o�pTfb=A`A,� 200 Main Street, Hyannis MA 02601 200 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7012 1010 0000 2851 3894 Christine Thamm Living Trust November 3, 2014 Christine & Conrad Thamm, Trustees 1211 Craigville Beach Road Centerville, MA 02632 The septic system located at 1211 Craigville Beach Road, Centerville, MA was last inspected on 9/19/2014 by David D. Coughanowr,RS, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" • under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: System components (Flow Diffusers (3) and Infiltrators' (4) are located beneath the driveway. And it is unknown.whether they are constructed of heavy duty loading (13-20) which is designed for vehicular traffic. When it is unknown whether or not a particular system component(s) may be located beneath a parking area or driveway is H710 or H-20 (for example: a leaching pit is located beneath a paved driveway without an accessible steel cover to grade and there are no records on file indicating whether the system component is H-10 or H-20, the system shall also be deemed as a "conditional pass". In this case, the,seller must make potential buyer(s) aware of the "conditional pass" status, the unknown construction of the septic system components(s) and its safety concerns. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER OiMc O THE BOARD OF HEALTH ean, R.S. CHO Agent of the Board of Health Enclosure: Copy of Town of Barnstable Policy: H-10 Components...No 2012-005 Q:\SEPTIC\Conditionally Passes Ltr\1211 Craigville Beach Rd Cent Oct 2014.doc Commonwealth of Massachusetts W Title '5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1211 Craigville Beach Road -Assessor's Map 206 Parcel 54 Property Address Christine Thamm Living Trust-Christine and Conrad Thamm Trustees Owner Owner's Name information is Centerville MA ' 02632 September 19 2014 required for every p page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:Whenfilling out forms A. General Information (� on the computer, !v1 use only the tab 1. Inspector: �l/ key to move your cursor-do not David D. Coughanowr, IRS use the return Name of Inspector key. Eco-Tech Rapid Response r� Company Name 155 George Ryder Road South Company Address Chatham MA 02633 Cltylrown State Zip Code 508 364-0894 1328 Telephone Number License Number 1B. Certification r..I certify that I have personally inspected the sewage disposal system at this address and that the —informatjon:reported below is true, accurate and complete as of the time of the inspection. The inspection cc-)was perkWhed based on my training and experience in the proper function and maintenance of on site sewageNi'4osal systems. I am a DEP approved system inspector,pursuant to Section 15.340 of Q N Title 5 fop CMR 15.000). The system: ❑ Passes ��1HOFk,4 ® Conditionally Passes ❑ Fails boa DAVID y�N ❑ Needs er Eve cation a Local Approving Authority v COUGHANOWIR H i No. S glop O S September 19, 2014 Inspector's Signature Date F' The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:S s ce Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 1211 Craigville Beach Road -Assessor's Map 206 Parcel 54 Property Address Christine Thamm Living Trust-Christine and Conrad Thamm, Trustees Owner Owner's Name information is Centerville MA 02632 September 19, required for every 2014 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ® One or more system components as described in the"Conditional Pass" section needto be , replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. , The septic tank is metal and over 20 years old* or the septic tanks(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltral�iono�tk'fiailureyismminent. System will pass inspection if the existing tank is replaced with a complying septic to ftktas approved by the Board of Health. j I4►'u4�,,}}> taa /` + *A metal septic tank will pass inspection if it is strucfurall,yaouna;!hot leaking and if a Certificate of Compliance indicating that the tank is less than 20 years ol'dtis available:' ❑ Y ® N ❑ ND (Explain below): EXPLANATION OF CONDITIONAL PASS DETERMINATION: This system was deemed a conditional pass based on a Town of Barnstable local regulation which states that system components under a driveway are to be H-20 heavy duty components capable of withstanding vehicular loading. An infiltrator system was added in 1992 without any indication of its load rating indicated on file at the Barnstable Health Department. (see attached policy guideline#2012-005 (copy attached to the end of this report], which states that buyer must be made aware of Conditional Pass status). i l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts - W Title '5 Official Inspection Form ., Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1211 Craigville Beach Road -Assessor's Map 206 Parcel 54 Property Address Christine Thamm Living Trust-Christine and Conrad Thamm Trustees Owner Owner's Name information is Centerville MA 02632 September 19, 2014 required for every p page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System,will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Forma Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 1211 Craigville Beach Road -Assessor's Map 206 Parcel 54 Property Address Christine Thamm Living Trust-Christine and Conrad Thamm, Trustees Owner Owner's Name information is required for every Centerville MA 02632 September 19, 2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 1211 Craigville Beach Road -Assessor's Map 206 Parcel 54 Property Address Christine Thamm Living Trust-Christine and Conrad Thamm Trustees Owner Owner's Name information is Centerville MA 02632 September 19, 2014 required for every p page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. t Yes No -❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E.the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1211 Craigville Beach Road -Assessor's Map 206 Parcel 54 Property Address Christine Thamm Living Trust-Christine and Conrad Thamm, Trustees Owner Owner's Name information is required for every Centerville- MA 02632 September 19, 2014 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑. Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? / ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): n/a Number of bedrooms (actual): 8 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a- no plan t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M 1211 Craigville Beach Road -Assessor's Map 206 Parcel 54 Property Address Christine Thamm Living Trust-Christine and Conrad Thamm Trustees Owner Owner's Name information is Centerville MA 02632 September 19, 2014 required for every p page. Citylrown State Zip Code Date of Inspection D. System Information Description: No design plan or other document indicating calculated leaching capacity was found on file at the Health Department. Assessor's records indicates bedrooms Number of current residents: 2 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): 136 gpd Detail: 2012: 42,000 gallons 2013: 57,000 gallons Sump pump? ® Yes ❑ No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official ,Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 1211 Craigville Beach Road -Assessor's Map 206 Parcel 54 Property Address Christine Thamm Living Trust-Christine and Conrad Thamm, Trustees Owner Owner's Name information is required for every Centerville MA 02632 September 19, 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1211 Craigville Beach Road -Assessor's Map 206 Parcel 54 Property Address Christine Thamm Living Trust-Christine and Conrad Thamm, Trustees Owner Owner's Name information is p Centerville MA 02632 September 19, 2014 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 22+ years. Certificate of Compliance for system repair was issued 7/9/1992 (Permit#92-298). Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer lines appears structurally sound with no evidence of leakage or backup into dwelling. Septic Tank (locate on site plan): Depth below grade: 1feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10.5 x 5 x 6-1500 gallon Sludge depth: 3 in l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1211 Craigville Beach Road -Assessor's Map 206 Parcel 54 Property Address Christine Thamm Living Trust-Christine and Conrad Thamm, Trustees Owner Owner's Name information is p required for every Centerville MA 02632 September 19, 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 31 in Scum thickness trace Distance from top of scum to top of outlet tee or baffle 10 in Distance from bottom of scum to bottom of outlet tee or baffle 14 in How were dimensions determined? previous inspection report Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping is not requires at this time. Maintenance pumping is recommended every 2-4 years with year round occupation. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1211 Craigville Beach Road -Assessor's Map 206 Parcel 54 Property Address Christine Thamm Living Trust-Christine and Conrad Thamm, Trustees Owner Owner's Name information is Centerville MA 02632 September 19 2014 required for every p , page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1211 Craigville Beach Road -Assessor's Map 206 Parcel 54 Property Address Christine Thamm Living Trust-Christine and Conrad Thamm, Trustees Owner Owner's Name information is required for every Centerville MA 02632 September 19, 2014 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert at outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box appears functional with no evidence of leakage in or out. Some solids in sump. Do not park or drive over Distribution box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspectionform Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 1211 Craigville Beach Road -Assessor's Map 206 Parcel 54 Property Address Christine Thamm Living Trust-Christine and Conrad Thamm, Trustees Owner Owner's Name information is Centerville MA 02632 September 19, 2014 required for every p page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 2 sets ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There are two leaching galleries present in the driveway. One consists of flow diffussors, and the other is constructed from infiltrators. No engineered plans were present in Health department files to indicate AASHTO load rating of components. Soils above leaching systems appear unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. A hole was dug surrounding stone and no effluent contact staining was observed in the stone or overlying soils. No standing effluent was observed to a depth of 6 inches below the top of the peastone layer. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5iris-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 1211 Craigville Beach Road -Assessor's Map 206 Parcel 54 Property Address Christine Thamm Living Trust-Christine and Conrad Thamm, Trustees Owner Owner's Name information is Centerville MA 02632 September 19, required for every 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 n i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 1211 Craigville Beach Road-Assessor's Map 206 Parcel 54 Property Address Christine Thamm Living Trust-Christine and Conrad Thamm, Trustees Owner Owner's Name information is Centerville MA 02632 September 19 2014 required for every P , page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at.least two permanent reference landmarks or benchmarks. Locate all wells within 1oo feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately L OCA .VOr'/Vr a7 -OF SEPTIC COMPONENTS -DISTANCES IN DECIMAL FEET A B 2 2 2 3 3 3 4 4 4 THIS SKETCH IS BESTYIEWED IN EXISTING COLOR FORMAT DWELLING E 1211 a B INFILTRARORS o IS00 GALLON SEPTIC TANK 2 STONE FLOW n ❑2 DISTRIBUTION BOX DIFFUSSORS ... 3 DRIVE WAY . . .- CRAIGVILLE BEACH ROAD NOT TO SCALE 508 364-0894 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M s 1211 Craigville Beach Road -Assessor's Map 206 Parcel 54 Property Address Christine Thamm Living Trust-Christine and Conrad Thamm, Trustees Owner Owner's Name information is required for every Centerville MA 02632 September 19, 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 6.5-7.5 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Previous inspection report ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: Previous inspection report indicates leaching system to be 3 feet above the water table. Town of Barnstable GIS Department records indicate that the property is 6.5 feet above adjacent Centerville River. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 i Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 1211 Craigville Beach Road -Assessor's Map 206 Parcel 54 Property Address Christine Thamm Living Trust-Christine and Conrad Thamm, Trustees Owner Owner's Name information is Centerville MA 02632 September 19, 2014 required for every p page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 .Barnstable Town of Barnstable 3ARNSfABLE. * Af ICacily Board of Health i639. iOtFDMA'�a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 FAX: 508-790-6304 October 2,2012 Adopted October 9,2012 Public and Environmental Health Program Policies,Procedures,and Guidelines H-10 Components Discovered Beneath Parking Areas and Driveways During Septic System Inspections Conducted Under 310 CMR 15.301,State Environmental Code,Title 5 No.2012-005 When a DEP certified inspector discovers an H-10 septic system component located beneath a parking area or driveway during a septic system inspection,conducted under 310 CMR 15.301 State Environmental Code Title 5,the system shall be deemed as a"conditional pass." The system owner will then be ordered,by the Board of Health,to correct this problem within two(2) years and will be provided several options to rectify the issue,including by: a.) replacing the septic system component with a new component relocated into another area of land which is not beneath any parking area or driveway,and properly abandoning the discovered H-10 component,or by b.) replacing the septic system component with an H-20 component beneath the parking area or driveway,and properly abandoning the discovered H-10 component,or by c.) relocating the parking area or driveway in such a way that no vehicle will have access or the ability to drive over the existing H-10 septic system component. FI it is unknown whether or not a particular system component which is located beneath a parking ea or driveway, is H-10 or H-20(for example: a leaching pit is located beneath a paved riveway without an accessible steel cover to grade and there are no records on file indicating whether the system component is H-10 or H-20),the system shall also be deemed as a "conditional pass". In this case,the seller must make the potential buyer(s)aware of the "conditional pass" status,the unknown construction of the septic system component(s),and it's safety concerns. Wayne Miller,M.D. Paul Canniff,D.M.D. Junichi Sawayanagi C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\G4VHE07Z\H 1 OComponentsDiscoveredBEneathDrivewaysandPark ingAreas.doc No....��. �:s 4 F� FEa........ u..-LIV... THE COMMONWEALTH OF MASSACHUSETTS 3. - BOARD OF HEALTH ----.. ( ow .)...........OF......1 . .........:... Appliratiun for Eliiipuiittl Works Tow1rnrtiun tirrmit Application is hereby made for a Permit to Construct ( ) or Repair (I.)-an Individual Sewage Disposal System at• _ 0 (� es .1. 1. c _. ..--... ........... anon Address o Lot No. • �'�I t�...'.., 1�1�C1. C . .... .... �C1'�-P•CCU-.1 Am.t............................................... e! - --.----cl . Y�/-S-YL 1 5........................................... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Build\in ........................... No, of ersons...._....................... Showers — a yp g p ( ) Cafeteria ( ) a' 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 No...................... Diameter.:.................. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) . Percolation Test Results Performed by.......................................................................... Date................... aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil - C.L-Z �;f ..-----•------------------------- ----------- ...................................................... x w x ------•--•-------------------------•---••--•-------------......------•-----•---••---•-•---------•---•-----------------------•---- U Nature of Repairs or Alterations-Answer when applicable...___1��vo._.. ............................. ------------"--------------------------------------------------------------------� 1 1 a - c1 t ------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the boa d of health. II Signed- Date Application Approved By------. .- .` -- -- .............................................. •--- . ............... Date Application Disapproved for the following reaso s:---•---••------•........................•-•------•----------------•••---------------•-•-._...--•------.---- ......................................................................................................................................................................................................... Date', PermitNo......................................................... IssuecL........................................................ Date FES- No........................ :.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH tr OF. "" ,� Appliration for Uhipa,ittl Workri Tontitrurtinn Frrutit Application is hereby made for a Permit to Construct ( ) or Repair (.L-4 an Individual Sewage Disposal System at;--.,, ff F f �Vtr .X........ .................... R L�fation-Addressor Lot No. � '� s-r.t r 4._ l ..-Ysx+t� :C':}i.,.['{ rr r, r ........ -• ! r c 3 f. - ..a................................................ . Owner; Address W /L✓'•r'r. r ®• fA..6... '� .-r. . ! f Pam' Installer Address UType of Building Size Lot............................Sq. feet r. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 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 No---_---_---------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) •" Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 -----------------) ..........................I_..... O Description of Soil.................�-rf i2. ,� - sf,e!�z a ._..._.. U ............................... •-•---------••---------•-•--•--•-- --•-----------.....----------•---•--------------------•--------••--------•----•------ x --•-----•--------------•--•---......-----•......-----------------•--•--•--••--......------•-----------•-•--•---•----•------•-•......------. g ------ - ......•-------- ......... U Nature of Repairs or Alterations—Answer when applicable...___.. 1 � - t �� --------------- ----------------------------------------------------------------------------••••------....----_.....��__:.. = .?--...... .................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T ITL- 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 the board of health. Signed r>.`. s� , � �y f` r C. ter Dat -------------- Application Approved B Date Application Disapproved for the following reasons:-----••-----•--------------•-•--------.....-•---------......--•-------------•--•-------••-...........-•---...... .........................-•-•-----------•--•-•-----••-------.....-•----••-•-•--.-----•----•---•---Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f ... ..... F / / Trrtif irtt#r of Toutpliunrr THIS-IS 50 CERTIFY That the Individual Sewage Dj,5posal System constructed ( ) or Repaired (44 ........ . , ....e at I f%A Z"2�r��y has Seen installed in accordance with the provisions of TI �5 � State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... . dated................................................ THE 'SS U N E OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WI 2NCTION SATISFACTORY. DATE..l1 ..... ...�1....................•------•-•••--•-•----------•----•---• Inspector...... . ..... THE COMMONWEALTH OF MASSAC USETTS BOARD OF HEALTH 8 3-�J�S .� ..........OF....- Y: 1 ................... ...... .... No......................... FEE... �i �rrr ttl irk Tnnlitputuart rruti ,,pper�'' Permission is hereby ranted...° >f'61 � .. '.. .._.. -- --_-•- :.!/.� ___...._.._.Y g .......................• to Construct ( ) nr Repair. (t_.-�-- n Indi ual Sewage pD' osal Syste'r at N C)v . ...�V h.j 1Z/,/ile....... Street as shown on the application for Disposal Works Construc ' n � e rm�� of ... Dated.......................................... ..............�.... .... Health�� oar DATE.................................. FORM 1255 A. M. SULKIN, INC., BOSTON . O ` L O CA TJON c S E W A E PERMIT NO. IL .Y I G UA C E' rr 12 il I' Ile I N S T A LLER'S NA E & SADDNESS 6 v d UILOE R OR OWNER w .Rr G 1 DA , X-'' PERMIT ISSYED � d l DAT E COMPLIANC.E- - ISSUED - aiz� 1b 7Z:Z� %�/� �' 1 Bellaire, Dianna From:McKean, Thomas Sent:Wednesday, August 16, 2023 3:10 PM To:Bellaire, Dianna Subject:FW: 1211 Craigville Beach Road/ Documentation of Eight Bedrooms in Existence Please upload the email below into the Laserfiche file for 1211 Craigville Beach Road Centerville. From: McKean, Thomas Sent: Wednesday, August 16, 2023 3:06 PM To: 'srapp@srapplaw.com' Subject: 1211 Craigville Beach Road/ Documentation of Eight Bedrooms in Existence Dear Attorney Rapp, The Health Division Laserfiche files contain an affidavit dated March 20th 2017 signed by Christine Thamm indicating the above referenced property has had eight bedrooms in existence since 1998. Also, a floor plan showing eight (8) bedrooms is contained within this file. This information is sufficient for the purposes of documenting the number of bedrooms at this property. Sincerely, Thomas A. McKean, RS, CHO Director of Public Health 508-862-4640 (telephone) The information contained in this electronic transmission ("e-mail"), including any attachment (the "Information"), may be confidential or otherwise exempt from disclosure. It is for the addressee only.. The Information may also be deliberative and pre-decisional in nature. As such, it is for internal use only. The Information may not be disclosed without the prior written consent of the Director of Public Health and/or the Town Attorney's Office of the Town of Barnstable. If you have received this e-mail by mistake, please notify the sender and delete it from your system. Please do not copy or forward it. Thank you for your cooperation.