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0483 ELLIOTT ROAD - Health
W483 Ellio:Road Centerville --- M E A Cr No.2-153LOR UPC 125U smead com • Made In USA 11 CsMMMIN9iIl VATME lNm E �`IKEE r Barnstable Town of Barnstable 'M►S&LIP, Board of Health t ► 200 Main Street, Hyannis MA 02601 2007 Office: 508-862A644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi May 26, 2015 Mr. Peter McEntee, P.E. 12 West Crossfield Road Forestdale, MA 02644 RE: 483 Elliott Road, Centerville A = 227-116 Dear Mr. McEntee, You are granted variances, on behalf of your clients, Peter and Kathleen Shea, to construct an onsite sewage disposal system at 483 Elliott Road, Centerville. The variances granted are as follows: 310 CMR 15. 405: To install the soil absorption system seven (7) feet away from the front property line, in lieu of the minimum ten feet separation - distance required. 310 CMR 15. 405: To install the soil absorption system thirteen (13) feet away from the foundation wall, in lieu of the minimum twenty feet separation distance required. 310 CMR 15. 405: To install the soil absorption system beneath six feet of soil cover, in lieu of the three feet maximum soil cover allowed. The variances are granted with the following conditions: (1) No more than four (4) bedrooms are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to four bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. Q:\WPFILES\MCEnteeShea2015 V ariance.doc i (3) The septic system shall be installed in strict accordance with the engineered plans dated April 21, 2015. (4) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the submitted plans dated April 21, 2015. These variances are granted because physical constraints at the site severely restrict the location of a septic system due to it's proximity to a coastal bank. The proposed system appears to be designed to meet the maximum feasible compliance standards contained within the State Environmental Code, Title V. Ay yours, III Wayn Miller, M.D. Chair an Q:\WPFILES\McEnteeShea2015 Variance.doe UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.0-10 • Sender: Please print your name, address, and ZIP+4®in this box•: {Engineering works, Inc. j 12 West Crossfield Road ` Forestdale, MA 02644 jff,db)qJgj)fllj1]}laaff ld.il}fl, il,flflriif}���}ffJJ}l}�} e e eN.,,� COMPLETE THIS SECTION • • e Complete items 1,2,and.3.Also complete A. Sig Ur item 4 i",rRestricted Deliveryyis desired. ` ❑Agent ■ Print your name and address on the,reverse X ❑Addressee so t that this can return the card to you. B. Re eived by(P ed me) C. {�o�/�odvery ® Attach t,'�is card to the back of the mailpiece, � I I or on thz front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No ✓ �� 4 3. Service Type 1 M 'Certified Mail® ❑Priority Mail Express- C.� t Wr I_ , ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery V �JtO J 4. Restricted Delivery?(Extra Fee) ❑Yes I 2. Article Number 1 I (Transfer from service labeq �i 7 0 1`4 '212 0 0004 6478 6334 PS Form 3811,July 2013 Domestic Return Receipt UNITED STATES POSTAL SERVICE First-Class Mail Pos a e es Paid USPS. Permit No.G-1 `'� • Sender: Please print your name, address, and ZIP+40.j this box* Engineeri 12 West Crossf 1 RW drks' InC. i Forestdale, MA 02644 G n 1 t fit t I�IF�It3�1111lF'31�l It�IJI#1�Iliittlll llii�l F� f f l tF121r! ' !.COMPLETE,THIS SECTION ON DELIVE�� a ■ Complete items 1,2,and 3.Also complete A. Si item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. R eived by(Printed Name) C. Date of Delivery ■ Attach this card�to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from i Yes 1. Article Addressed to: If YES,enter delivery addret� APR Prop7D:227122 27 FRECHETTE,ELEANOR TR 4r. I ELEANOR F FRECHETTE TRUST 3. Servic Ty �j 1 HEWINS FARM ROAD A certifi il�❑Pri ' fs WELLESLEY,MA 02481 ' -C —$R&W ,Ibercha ndise ❑Insured Mail ❑e'ollect on Delivery I 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number „7014;2120 0004 6478 6303 (transfer from service IabeQ ,� l�r PS Form 3811,July 2013 Domestic Return Receipt { UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid -USPS.> Permit No.G-10 • Sender: Please print your name, address, and ZIP+4®in this box* Engineering works, Inc. ! 12 West Crossfield Road Forestdale, MA 02644 i I j#,j#jj#iljlititlz,ijiij,,iiiijjii##i#►�itjill�#1�I►jiiitllj#ij#! i SEC.T16N. o e e e • Complete items 1,2,and 3.Also complete A. Signat e item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. eceived by P'nted ame) C. D e of Delivery ® Attach this card to the back of the mailpiece, or on the front if space permits. Is delivery ress erent from item i ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No I f Prop ID:227117 1 SPRAGUE,ROBERT&DAWN 495 ELLIOTT ROAD 3. Service Type CENTERVILLE,MA 02632 Certified Mail® ❑Priority Mail Express" ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service labeq 7 014 212 0 0004 6478 6 3 2 7 PS Form 3811,July 2013 Domestic Return Receipt ,�:'?'.�', "?,.,).5.�:"•.�^�.'�::rc i .y. �.,:Q• `'�'+�:�. .,;. m,�'Yie_mnnlu).,'""". .nmsn cw�n��ti.a: UNITED STATES OSTAL ERVICE I • Sender: Please print your name, address, and ZIP+4®in this box* Engineering works, Inc. 12 West Crossfield Road Forestdale, MA 02644 I I�,:liilllilll�Ill'i1�11��1��,�illl�►,I�l�IIhIIIh,1)l:1i#t1,.1Jj,i I • • •N DELIVERY ■ Complete items 1,2,and 3.Also complete A. Si ature item 4 if Restricted Delivery is desired. 'Agent M Print your name and address on the reverse_ X ❑Addressee so that we can return the card to you. Received by(Print Name) C.,Da of eliverci ■ Attach this card to the back of the mailpiece, 7 1[ or on the front if space permits. D. Is delivery address different from item 1? ❑Y s 1. Article Addressed to: If YES,enter delivery address below: ❑No I Prop ID:227115 GINGOLD,ANNE PO BOX 155 WEST HYANNISPORT,MA 02672 1 3. Service Type LT! I Certified Mail® ❑Priority Mail Express" ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery 1 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number �' T (transfer from service label) l•1,I',in7 0�14 2120004, 6 4 7 8, 6 31.E t j PS Form 3811,July 2013 Domestic Return Receipt UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS, Permit No.G-10 I • Sender: Please print your name, address, and ZIP+4®in this box* L ering Works, /nc. rossfield Road , MA 02644 i dk'04LIVERYj ■ Complete items 1,2,and 3.Also complete a?. §994ture j item 4 if Restricted Delivery is desired. a„ ❑Agent j X': ., ;. ■ Print your name and address on the reverse ❑Addressee I so that we can return the card to you. B.'-Received by(Printed Name) C. of D iver�l ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery ad different from item es 1. Article Addressed to: If YES, er !Pe address below: ❑No j Prop ID:227121 +i CARR,MICHAEL .< I j 488 ELLIOTT ROAD j CENTERVILLE,MA 02632 3. Service Type JCertified Mail® ❑Priority Mail Express" ❑Registered ❑Return Receipt for Merchandise —�-- ❑ Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number rfromservice labe 2p14 2120 000N 6478 6297 i (Transfer from l) � 4 PS Form 3811,July 2013 Domestic Return Receipt 1 I' UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid I USPS Permit No.G-10 I • Sender: Please print your name, address, and ZIP+4®in this box• I I Engineering Works, inc. 12 West Crossfield Road Forestdale, MA 02644 I I E r • • 7AS,.gna�t . ■ Complete items 1,2,and 3.Also complete item 4 if Restricted Delivery is desired. Agent ® Print your name and address on the reverse ❑Addressee so that we can return the card to you. ved by(Printed Na C. to of ive ■ Attach this card to the back of the mailpiece, Vir'IL Z or on the front if space permits. 1 Is delivery address differ nt fro item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No'`y Prop ID:227124 BURKE,ANTHONY H 472 ELLIOTT ROAD CENTERVILLE,MA 02632 i 3. Service Type 14 Certified Mail® ❑Priority Mail Express- � _ _ _ ____: ❑Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number l (transfer from service label) 7 214 2120 0004 6478 6280 1 PS Form 3811,July 2013 Domestic Return Receipt I Engineering Works, Inc- 12�oqest Crossfield Road,Forestdale, C*A 02644 TPIIFax(508)477-5313 - April 20, 2015 Barnstable Board of Health 200 Main Street Hyannis, MA 02601 Re-, 483 Elliott Road, Centerville, MA, Title 5 Septic System Upgrade Representation Authorization Dear Board members: I hereby authorize Peter McEntee PE to represent rrly interests for Itie subject project, 4er Shea f f DATE: a 7 l FEE: i639MASS v-� REC. BY l/�cdCJGX� �ED► A Town of Barnsta- le �" �• SCHED. DATE: Board of Health ants 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. F : 508-790-6304 hmichi.Sawayanagi Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION PrgpTerty Address: As essor's�ap and Parcel Number: �7 — [ 1 Cv Size of Lot: 3 � t�" 5;(= I W tlands Within 300 Ft. Yes Business Name: _ No Subdivision Name: --- /�'- 1 v ih C w L,1V+\Jv?j^jC- ARPLICANT'S NAME: T157-C VZ -I-, IM LLZryr-CC Jura Phone .50Z -y -77-5 313 Di�the owner of the property authorize you to represent him or her? Yes _j - No _ PROPERTY OWNER'S NAME CONTACT PERSON V~ 1_C W. A K-A F1 ( LC E:l ry M, .5 PEFCYL i, m c L=of --- F, )P L Najne: Name: E A) (�j IV i52=I /U c- iit,'CI�LK S i Ilf C. c� L 1 U' 12, *J,C_('--cs3 r,L-:�--i.J Address: C v r�I z-,r i t_L Sa'1 U2.6 3 Z Address: Ph I ne: Phone: 0 _It 77-.� M VARIANCE FROM L MY'L OM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) '7' �{•)x c.l,, `��1� &"s SRl �ri .clt S<►t C;,—y . ' c 1r�n e•e 1r l�1��,� •:.,-b� ✓=��n ;� e� � Cs,,.-r— t� hcv^E o S`�-J��- S J (•-c.�.-, NATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System O' 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) Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian 7 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 �d/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) �I Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee 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 i VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. C:\47sers\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\BAJ9P9B7\VARIREQ.DOC 1 I Engineering Works, Inc. 12 West Crossfield Road, Forestdale, MA 02644 � Tel/Fax (508)477-5313 April 23, 2015 Town of Barnstable Board of Health 20�0 Main Street Be�rnstable, MA 02601 Re: 483 Elliott Road, Centerville (Parcel ID: 227-116) DE ar Members of the Board, On behalf of my client, Peter Shea, the following request for variances related to a se tic system upgrade, is being made. A complete septic system is being proposed to replace the failed septic system. Variance Requests are as follows: • 310 CMR 15.405(a)&(b) — CONTENTS OF LOCAL UPGRADE APPROVAL 1. A 3' variance, S.A.S. to property line (front), for a 7' setback. 2. A 7' variance, S.A.S. to cellar wall, for aAS setback. 3. A 3' variance to the maximum cover requirement of 3', for up to 6' of cover. • — LOCAL REGULATION, Chapter 360, Article 1 Setback Requirements 99 1. A 56' variance, S.A.S. to coastal bank, for a 45' setback. Variance requests are being made to maximum feasible compliance. ;,Sill erely, Peter T. McEntee P.E. I It 4/23/2015 AbutterReport ,4i. Board of Health Abutter List for Map & Parcel(s): '227116' Direct abutters (no set distance) and the properties located across the street. Total Count: 6 IIC�II �dto Close Map&Parcel Ownerl Owner2 Addressl Address 2 Marling Country Deed CitystateZip WEST 227115 GINGOLD,ANNE PO BOX 155 HYANNISPORT, 10659/224 MA 02672 BERZ S, %SHEA,PETER A & CENTERVILLE, 227116 A LDS I & 483 ELLIOTT RD 10117/186 ]O NTA Z & KATHLEEN M MA 02632 SPRAGUE,ROBERT 495 ELLIOTT CENTERVILLE, 227117 &DAWN MARIE ROAD MA 02632 26628/267 227121 CARR,MICHAEL 488 ELLIOTT CENTERVILLE, 24517/244 ROAD MA 02632 227122 FRECHETTE, ELEANOR F 1 HEWINS FARM WELLESLEY,MA 28488/200 ELEANORTR FRECHETTE TRUST ROAD 02481 227124 BURKE,ANTHONY 472 ELLIOTT CENTERVILLE, 23739/281 H ROAD MA 02632 This list by itself does NOT constitute a certified list of abutters and is provided only as an aid to the determination of abutters If a certified list of abutters is required,contact the Assessing Division to have this list certified.The owner and address data on this list isfrom the Town of Barnstable Assessors database as of 4/23/2015. httpJ/maps.tow iofbarristable.us/arcims/appgeoapp/AbutterReport.asprC N>.—BOH 1/1 l Town of Barnstable Geographic Information System April 23,2015 ' 227112 #443 < 227134 207091006 r 227114 #10 #463 r.. sFA�''QR�yR 227133 #24 227.115 •#468 s. s. .f 2271 16 - 227125 1 5 3 458 7`22 117 4 "( 10 � ,µ E V r 227126 ! m`= #39 ;�-- : 227119 22 . 4601 227119 #500 226191 226192 227127 #498 227120 #494 #47 ,zy #496 0 45 Feet 2#639 227128 #49 DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:227 Parcel:116 Board of Health Q boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel 1"=100'may not meet established map accuracy standards. The parcel lines on this map Abutter List Type-Direct abutters(no set distance)and the properties located are only graphic representations of Assessor's tax parcels. They are not true property across the street. Abutters boundaries and do not represent accurate relationships to physical features on the map such as building locations. Buffer r/ rfa . i Engineering Works, Inc. 12 West Crossfield Road, Forestdale, MA 02644 C> Tel/Fax (508)477-5313 ` 7 April 23, 2015 R : 483 Elliott Road, Street, Centerville, MA (Assessors Map 227, Parc(:)l 116) Construction Title 5 Septic System Dear Sir/Mam: PI ase be advised that an application for variances from the Massachusetts Department of[Environmental Protection, Title, 5, and Local Regulations have been saabmitted to the Barnstable Health Department for approval. The following varianMs arE;., being requested: 3 • 310 CMR 15.405(a)&(b) — CONTENTS OF LOCAL UPGRADE APPROVAL 1. A 3' variance, S.A., 0. to property line (front), for a 7' setback. 2. A 7' variance, S.A.,3. to cellar w ll, for a 17' setback. 3. A T variance to the maximum c ver requirement of 3', for up to 6' of cover. • LOCAL REGULATION, Chapter 360, Article 1 — Setback Requirements 1. A 55' variance, S.A.S. to coasts bank, for a 45' setback. T e application and plans are available for review at the Barnstable Health Department, 2 0 Main Street, Hyannis, MA, Monday through Friday (excluding holidays) from 8:30 a.m. to 4:30 p.m. A Dublic hearing will be held, to discuss the proposed work, on Tuesday, May 12, 2015, at 3:00 p.m. The hearing will be held at the following location: Town Hall Hearing Room Second Floor 367 Main Street Hyanni,r ,, MA Si cerely, Peter T. McEntee P.E. l z _' -1 615' D 31UU.U� Town of Barnstable P#__ Department of Regulatory Services r' Public Health Division Date_z- �A s63Q 16� 200 Main Sheet,Hyannis MA 02601 vfl�y� Date Scheduled !I / i3 - �--�Ttme Fee Pd. 6 -- Soil Suitability Assessment" S e JDisp n a Performed By: � i "�jczllkjL. Witnessed,By: LOCATION& GENERAL INFORMATION Location Address CI 3 E 11�U 1 ( Owner's Name A v�mot Address 02 3 Assessor's Map/Parcel: Z-Z--7 1) (p Engineer's Name NEW CONSTRUCTION REPAIR Telephone# —cl-i`6—-?3 7-4_7 to Chi Land Use P+z34 ., Slopes(So) � Surface Stones Distances from: Open Water Body Possible Wet Area 11(t Drinking Water Well t`Uft 1 Drainage Way. ft Property Line ��'" ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) t ,• Parent material(geologic) 61 �"��\'_ Depth to Bedrock. /Nd Depth to Groundwater: Standing Water in Hole: Moak. _ Weeping from Pit Face/^%JO n.R Y Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: iu, Depth to soil mottles: _ ok in: -- _ Depth to weeping from ride of obs.hole: Groundkvnter Ad;usttr nc --- Lu.Vr,Wel1ri """ - Iieadmg llatei Index Well"level,, Adj.Gwutidwuw'1 tvul_ PERCOLATION TEST bate Time Observation Hole# �P Z_ I! The atV Depth of Perc G=l - _�� Ciy ��1`�� Time at 6" Start Pre-soak Time @ _ ����(,! Time;(9".6") End Pre-soak Rate Min,/Inch. Site Suitability Assessment: Site Passed ✓ _ ..Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- **',If percolation test is to be conducted within 1.00' of wetland, you must first notify t;he Barnstable Conservation Division at least one (1) week prior to beginning. Q:eSEPTICIPERCFORM.DOC I DEEP-OBSERVATION HOLE LOG— Hole#; Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Consistency,116 Gravel) Cry W P-t L4- �22 63 L 5 l.d r - + DEEP OBSERVATION HOLE LOG Hole# 'Z- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Grave r 2 y'Zi� cs 2 5Y DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface*0n.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C sistency.%Grave . I DEEP OBSERVATION HOLE LOG Hole# Depth frorn Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consist n ' I Flood Insurance Rate Map: M-v Above-500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No_K_ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring parviou material exist in all areas observed throughout the area proposed for the soil absorption system? .... If not, what is the depth of naturally occurring pervious material? ........�...,. Certiggation I certify that on IL ��7 (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required t 'ng,expertise and experience described in 310 CMR 15.017. - s,— Date t Signature , Q:\S,E1MC�PERCFORM.DO C No. Fee l7V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pphration for Misposal Epstein Construction Vmit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Pe-l-eq/— SheqK 418.3 611(0ff- cep Cep v-v,'�r� w►� o.ts,7� Assessor's ap/Parce _ O X53;Z Installer's Name,Address,and Tel.No. D[e,signer's Name,Address,and Tel.No. Type of Building: Jeg 7 7�-E3/,3 �'' ���yy 4 ` Dwelling No.of Bedrooms Z of Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) L7 V gpd Design flow provided �S� gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank x Type of S.A.S. 7 L G C, rkc.M e(b LoA s-101 r— Description of Soil o Nature of Re airs or terations(An er when plicable) � ` Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board ealth. Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. O��S'� Date Issued Ke r r v. No, �O S �1 ' , Fee THE COMMONWEALTH OF MASSACHUSETTS Entered�ncompnter: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS res ZWpliLatiou for Disposal *pstrm Construction Permit Application for a Permit to Construct( ) , Repair( )'Upgrade( ) Abandon( ) ❑Complete System\ ❑Individual Components X Location Address or Lot No. Owner's Name,Address,and Tel.No. PG�-�?� keq X y83 /l/;91 R� �n�`�v-�k �� Y83` 6/h of 0 C,� �� ✓,'�� ��o,tS3 Assessors ap/Parce 1 (�a$3 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 1"ek—r- _ A 7)t� �a8-�IGY� •fi 9 , Z r,c 3 X Type of Building: 150� 4 7 7-.S 3/3 • v�6 yy Dwelling No.of Bedrooms Ll dod,� Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) L( � gpd Design flow provided I/�� (� _ gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 19C�� Type of S.A.S. -7 L( . e-a ('L-iGnbt-05 Wi k� ;io"Ur Description of Soil _ o Nature of Repairs or Iterations(Arifyer when applicable) L Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o-Health. Signed Date Application Approved by Ll Date Application Disapproved by Date u for the following reasons Permit No. �C�S Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate Of Compliance THIS IS TO CEE�RTIFY,that the On-site Sewage Disposal system Constructed f( ) Repaired( ) Upgraded( ) Abandoned( )by X at has been constructed in accordance with the provisions of Title 5 and the for,Disposal System Construction Permit No.a 01 S ( dated Installer t 1,u..io��A ; chA�,.t nJC Designer L1 L( (� ` #bedrooms y Approved design flow, L4 C/A gpd The issuance of this permit shall not be construed as a guarantee that the system will Qtib�as desiAed. Date Inspector No. �G P ( ,« 1 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS ' Bisposa'i 6pstem Constturtlott vermit _.- Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at �l�/a �,� 6tAly 1 ,14" and as described in the above Application-fot Disposal System Construction Permit. The applicant recognized his/herfduty to comply with Title 5 and the``'following local provisions or special conditions. f `. Provided:Construction.must be completed within three years of the date of this permit.- Date CI k Approved by a r s Barnstable INE r �Y AFAm ericaCdlr Town of Barnstable BARNST" M Board of Health 2007 '0rfo �# 200 Main Street,Hyannis MA 02601 Wayne Miller,M.D. Office: 508-862-4644 Paul Canniff,D.M.D. FAX: 508-790-6304 7unichi Sawayanagi z May 26, 2015 Mr. Peter McEntee, P.E. 12 West Crossfield Road Forestdale, MA 02644 } RE: 483 Elliott Road, Centerville A = 227-116 Dear Mr. McEntee, You are granted variances, on behalf of your clients, Peter and Kathleen Shea, to construct an onsite sewage disposal system at 483 Elliott Road, Centerville. The variances granted are as follows: 310 CMR 15. 405: To install the soil absorption system seven (7) feet away from the front property line, in lieu of the minimum ten feet separation distance required. 310 CMR 15. 405: To install the soil absorption system thirteen (13) feet away from the foundation wall, in lieu of the minimum twenty feet separation distance required. 310 CMR 15. 405: To install the soil absorption system beneath six feet of soil cover, in lieu of the three feet maximum soil cover-allowed. The variances are granted with the following conditions: (1) No more than four (4) bedrooms are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" , according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to four bed bmrrted to the Health gepy of the t prior to recorded deed restriction shall be su obtaining a disposal works construction permit. Q:\WPFILES\MCEnteeShea2015Variance.doc �a z (3) The septic system shall be installed in strict accordance with the engineered plans dated April 21, 2015. (4) The designing engineer shall supervise the construction of the onsite sewage no disposal system and shall certify in writing to the Board of Health that the system was installed .in substantial compliance with the submitted plans dated April 21, 2015. These variances are granted because physical constraints at the site severely restrict the location of a septic system due to it's proximity to a coastal,bank. The proposed system appears to be designed to meet the maximum feasible compliance standards contained within the State Environmental Code, Title V. Si cerely you�s, Waynp Miller, M.D. Chair an Q:\WPFILESNeEnteeShea2Ol5Variance.doc Los } R��E\ L' EIPT P,rinted: September 22, 2015 12:01: .. B�ARNSTABLE COUNTY REGISTRY OF DEEDS ,JOHN F. MEADE, REGISTER Trans#: 236321'e Oper:JANICE PETER . Bopk: 29153 Page: 60 Inst#: 45919 C-0#: 813 Rec:9-22-2015 P 11:59:58a i'. BARN 483 ELIOTT RID 1" ! D0 DESCRIPTIf.;PJ"' ' TRANS AMT 1 SHEA. PETER A RE3IRICTION County Fee $ '10;00 10.00 Surcharge CPA $20.00 20.00 State'Fee $40.00 40.00 Surcharge Tech $5.00 5.00 Total fees: 75.00 * * Total charges: 75.00 CHECK PM 1070 75.00 -10-45919 09-22-2015 a 1 1 a 59a. DEED RESTRICTION WHEREAS, Peter A. Shea and Kathleen M. Shea of 483 Elliott Road located in Centerville, MA, are the owners of 483 Elliott Road, Centerville, MA, and being shown as Lot 14 on a plan entitled "Riverview Landing Subdivision Plan of Land in Centerville, Barnstable, Mass., for Daniel C. Hostetter et al dated April 9, 1976, Barnstable Survey Consultants, Inc., 411 Main Street, West Yarmouth, Mass.,", which said plan is recorded at the Barnstable County Registry of Deeds in Plan Book 305, Page 42. WHEREAS, Peter A. Shea and Kathleen M. Shea as owners of said lot have agreed with the Town of Barnstable, Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition of obtaining a disposal works construction permit in compliance with 310 CMR 15.000 vuJ` State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage. WHEREAS, the Town of Barnstable, Board of Health, as a pre-condition to granting a Disposal Works Construction Permit for a septic system in compliance with 310 CMR 15.000, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, is requiring that the agreement for the restriction on the �S number of bedrooms in any house constructed on said lot be put on record with the Barnstable County Registry of Deeds by recording this document. NOW THEREFORE, Peter A. Shea and Kathleen M. Shea do hereby place the following restriction on his above referenced land in accordance with their agreement with the Town of Barnstable, Board of Health and only to be rescinded upon receipt of written permission granted by the Town of Barnstable, Board of Health, which m restriction shall run with the land and be binding upon all successors in title: 1. 483 Elliott Road may have constructed upon it a house containing no more than four (4) bedrooms. Peter A. Shea and Kathleen M. Shea agree that this shall be a permanent deed restriction affecting the dwelling located at 483 Elliott Road, Centerville, MA, and being shown as Lot 14, in Plan Book 305, Page 42. 1 For title of Peter A. Shea and Kathleen M. Shea see the following Deed: Book 28722 Page 201. Executed as a sealed instrument this 14 ay of , 2015. Owner' ignature 6-ce Owner's signature COMMONWEALTH OF MASSACHUSETTS , ss Date 2015 Then personally appeared the above named Shu �- W/ap AK She Q- known to me to be the person/s who executed the following instrument and acknowledged the same to be their free act and deed, before me. (S SHARON D.ROGERS bffi�& Notary Public Notary PLMlic COMMOWNIMTH,OF M"MCH1,W"S � * "on q/a September 12,2016 My commission expires: (date) Page 2 BARNSTABLE REGISTRY OF DEEDS John F. Meade, Register 2 r cm# it, I Town of Barnstable aF�we tom, ti Regulatory Services �* Richard V. Scali, Interim Director UAEtN87'ABLE, 1639. �0� Public Health Division iDTen►�c+A Thomas McKean, Director ZOO Main Street,Hyannis,MA 02601 O"Pee: 508-862-4644 Fax; 508-790-6304 Installer &Desiener Certification Form D,te: 3 1 t Sewage Permit# `-ll Assessor's Map\Parcel D 6signer: Wo r-\A s Installer: A -- A idress: I-L Cc,o sa-Ptp-ka fz-� Address: 6-0 r9-s 0 2 yy �'eri�-e rv�I�,L 4�9a- 02k3 2 i O P y`��( �ff2 ra was issued a permit to install a (date) (installer) r se; tic system at gjFj L'��•o Q e� based on a design drawn by (address) 1� ' lv\\, dated (designer) ;tom I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory, I certify that the septic system referenced above was installed with. major changes (i,e. greater than 1.0' lateral relocation of the SAS or any vertical:r relocation of ally component of fire septic system) but in accordance with State & Local Regulations. Plait revision or certified as-built by designer to follow. Strip out (if required) was inspeoted:find the soils were found satisfactory. _ I certify that the system referenced above was.constructed in col. liance with, the terms of the I\A approval letters (if applicable) Aqss�� o� ti PETER T nstaller's Signature) CDMcENT>nE , CIVIL No. 35109 USA (Designer's Signature) (Affix Desigl.PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CER'DUPICA.TE O ? COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- I3 ILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HIS.AL7'PI j.)MS`.ION, TJ IAN](YOU. Q;1'epticTesigner Certification Form Rev 8-14-13,doc TOWN OF BARNSTABLE LOCATION t4 48 3 SEWAGE# DLO iS-/I 1 VILLAGE Cc -Ai-rr J Ar ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY &Y-iS�`.AA LEACHING FACILITY:(type) /- (size) NO.OF BEDROOMS Lf - dtdrrJ t�f' OWNER 6�I L'Gi PERMIT DATE: -a,C( --J y, COMPLIANCE DATE: 30 -Jr Separation Distance Between the: /W^ Ck k- ?&CC- Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY �� ®� taJ r 12�S L4 8:b I I o C ®uT- IA �� 3 ©�� �� oUT_3® 2-4 -7 I - 2/, S' z - Z-3 3 �I Barnstable �V, Town of Barnstable .�. Regulatory Services Department AIAMWIMj MAM �> 1639. A� Public Health Division 200 Main Street,Hyannis MA 02601 2007 r-a'L Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7014 1200 0001 0358 3780 Apr 6,2015 2015 Mr. &Mrs. Arnold J Berzins % Peter A&Kathleen Shea 483 Elliott Road Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 483 Elliott Road, Centerville, MA was last inspected on 1/02/2015, by Douglas A. Brown, a certified septic inspector for the State of • Massachusetts. The inspection of the septic system showed that the system"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • SAS shows signs of Hydraulic failure with heavy staining at the top of the chambers • Tank was not opened due to it being under the brick walkway; tank needs to be made accessible v • Distribution box showed signs of back up and solid carry over You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF T BOARD OF HEALTH �G � omas McKean, R.S., CHO Agent of the Board of Health is Y Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\483 Elliott Rd Cent Jan 2015.doc c �$. 6a_ m r a 8 ° Parcel Detail 4 c e • Issgl2/intart;'p, �����, ,1P,rCslDe1Jl:as�;?ID=1 , _ ... . .. . Apps `J http•-www,town,barn... Application Center Suggested Sites d Imported From IE ®Parcel lookup New Tab ® Bing Y'Video:5Incredible TinOT ... iI�aurnsrnLIie.��; p . Logged In As: Wednesday,April 12015 s * rz e D` r Parcel Looka�� Parcel Info u' Parcel ID 227.116 DeveloperLot LOT 14 Location 483 ELLIOTT ROAD Pri Frontage 190 Sec Road Sec Frontage village CENTERVILLE Fire District C-O-MM sewer exists at this address No Road Index 0492 Asbuilt Septic Scan; Interactive Map71, 227116 1 ; ; Owner Info' owner BERZINS ARNOLDS J& �0 °/oSHEA PETER A&KA Owner streett 483 ELLIOTT RD Street2 city CENTERVILLE state MA I Zip 02632 country lultiple Ownersl ip Info _ ' 1 i Address 50 BERZINS,ARNOLDS J& %SHEA,PETER A& 483 ELLIOTT RD,CENTERVILLE MA i JOLANTA Z& KATHLEEN M 02632 FBERZINS,GIfS R&MARA 49RIDGEVIEI �AVENJE, a GREENWICHCT06830 Land Info . Use Zoning RC Nghbd 0108� Acres 0 60 ( Single Fam MDL-01 _� ��5tart l Q�SEPTI� Parcel Detail Google Ch : ,5 Q 1SEPT1Clletters Septi 483 Elliott Rd Cent]an 2 , n'® f 11,36 AMr Computer name : HEALTH899JF User name : flvnni Operatinq Svstem : Windows NT (5.1) Postal CERTIFIED �� a Q (Domestic 0^ �2- For delivery Information visit our website at www.usps.coma "' ./`S MA M Postage $ r� C3 Certified Fee r3 _ C O Return Receipt Fee f R i$ a 7 j p (Endorsement Required) 0 Restricted Delivery Fee 0 (Endorsement Required) 0 USES Total Postage&Fees $ p rl c3 �Mr: & Mrs. Arnold S. Berzins 2 Highland Terrace #1 Newton, MA Q2640-1813 Certified Mail Provides: a A mailing receipt �l! ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. ■ Certified Mail is not available for any class of international mail. e 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 LISPS®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 7630-02-000-9047 1L off ' J `" Town of Barnstable Barnstable Regulatory Services Department 1 ' A,� Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7014 1200 0001 0358 0499 March 10, 2015 Mr. &Mrs. Arnold S. Berzins 2 Highland Terrace #1 _ g �. Newton, MA 02460-1813 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 483 Elliott Road, Centerville, MA was last inspected on 1/02/2015, by Douglas A. Brown, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • SAS shows signs of Hydraulic failure with heavy staining at the top of the chambers • Tank was not opened due to it being under the brick walkway; tank needs to be made accessible • Distribution bog showed signs of back up and solid carry over You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH • Z!:o:m2as Pc=, Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\483 Elliott Rd Cent Jan 2015.doc stable Town of Barnstable f3arn3.ii .�, Regulatory Services Department A&AnWftj �1.& I NAM 1639. ��' Public Health Division Ma+" 200 Main Street, Hyannis MA 02601 .e . 2007 ..4 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO j CERTIFIED MAIL#7014 1200 0001 0358 0291 January 19, 2015 Mr. &Mrs. Arnold S. Berzins 483 Elliott Road Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 483 Elliott Road, Centerville,MA was last inspected on 1/02/2015, by Douglas A. Brown, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • SAS shows signs of Hydraulic failure with heavy staining at the top of the chambers • Tank was not opened due to it being under the brick walkway; tank needs to be made accessible • Distribution box showed signs of back up and solid carry over You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE B ARD OF HEALTH omas cKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\483 Elliott Rd Cent Jan 2015.doc - IT m t - r -A tv ®Parcel Detail Y ` V. i i`r " G,�1 ryry i{4.VM1RI`i�CTAtiLL09, ` 111♦ {i.� .t Ikogged in As: Parcel Detail Parcel Lockup Parcel Info o Parcel ID 227.116 Developer Lot LOT14 i Location 483 ELLIOTT ROAD PH Frontage 190 N Sec Road Sec Frontage i village CENTERVILLE Fire District C-O-MM 1 n sewer exists atthis address No Road Index 0492 j i Asbuilt Septic Scan: f Interactive Map 227116_1 _ r f m r VOwner Info m r tj Owner'BERZINS,ARNOLD S&J owner'BERZINS,LINTS&MAR Streetl 483 ELLIOTT RD street2 city CENTERVILLE state MA Zip 02632 Country i�®— i gLand Info -10 x Acres 0.60 use Single Fam MDL-01~y Zoning RC Nghbd .0108 I Topography Level J Road 'Paved utilities iPublic Water,Gas,Septic Location Excel View i ;I ! 9 ,construction Info z �. LJ 5 u . I art V �,15EPTIC1Letters Septa,., 484,Cedar St Harn Oci., oogle Ch. 5t Computer name : HEALTH899JF User name : flvnni Operatinq System : Windows NT (5.1) F('C� I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 483 ELLIOTT RD Property Address BERZINS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-2-15 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be alteredin any way. Please see completeness checklist at the end of the form. Important:When filling out A. General Information forms on the computer,use only the tab key 1. Inspector:. to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. D.A. BROWN INC Company Name P.O.BOX 145 Company Address CENTERVILLE MA 02632 Cityrrown State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 1-2-15 Inspe s Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different co itligns of use. d � t5ins•3/13 Title 5 Official Insp o 0 nn:Subsurface Sewa Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 483 ELLIOTT RD Property Address BERZINS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-2-15 every 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: S.A.S IS 30 YRS OLD AND SHOWS SIGNS OF HYDRAULIC FAILURE WITH HEAVY STAINING AT THE TOP OF THE CHAMBERS B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old'or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 5 483 ELLIOTT RD Property Address BERZINS Owner Owner's Name information is CENTERVILLE MA 02632 1-2-15 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy Is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 483 ELLIOTT RD Property Address BERZINS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-2-15 every page. Cityrrown 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 Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 483 ELLIOTT RD Property Address BERZINS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-2-15 every 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- 1 0,000g pd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M yt 483 ELLIOTT RD Property Address BERZINS Owner Owner's Name information is reequiredquired for CENTERVILLE MA 02632 1-2-15 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ❑ ® Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4DESIGN Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 483 ELLIOTT RD Property Address BERZINS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-2-15 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: ACCORDING TO AS-BUILT SYSTEM CONSISTS OF A 1500 GALLON TANK D-BOX AND 4 FLOW DIFFUSERS Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?(Include laundry systern inspection information in this report.) El Yes- ❑ No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage d HOUSE g ( y g (gp ))' VACANT Detail: HOUSE VACANT Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 0 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 483 ELLIOTT RD Property Address BERZINS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-2-15 every page. CityrFown 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: 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 �M 483 ELLIOTT RD Property Address BERZINS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-2-15 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1985 PER AS-BUILT Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet 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 t Dimensions: Sludge depth: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM , 483 ELLIOTT RD Property Address BERZINS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-2-15 every page. Citylrown 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 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 How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK WAS NOT OPENED DUE TO IT BEING UNDER THE BRICK WALKWAY 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 483 ELLIOTT RD Property Address BERZINS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-2-15 every page. City(rown 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 El 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.): ro� "Attach cppy 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 M 483 ELLIOTT RD Property Address BERZINS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-2-15 every page. Cityrrown 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 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.): BOX SHOWED SIGNS OF BACK UP AND SOLID CARRY OVER Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ 'No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: • t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official, Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM , 483 ELLIOTT RD Property Address BERZINS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-2-15 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 4 flow diffusers ❑ 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;4%contiffidn 6f vegetation, etc.): CHAMBERS WERE VIEWED BY CAMERA AND SHOWED HEAVY STAINING AND-SIGNS OF HYDRAULIC FAILURE THE SYSTEM IS 30 YRS OLD 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form • ; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M , 483 ELLIOTT RD Property Address BERZINS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-2-15 every 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 I _ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 483 ELLIOTT RD Property Address BERZINS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-2-15 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately • . I • t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form • a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 483 ELLIOTT RD Property Address BERZINS Owner Owner's Name information is CENTERVILLE MA 02632 1-2-15 required for every page. Cityrrown 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: 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: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I 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 l Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M s 483 ELLIOTT RD Property Address BERZINS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-2-15 every 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 • Assessing As-Built Cards T, JAM Page 1 of 2 4 • (,J 1, TOWN OF B.ARNSTABLE Awvmw� "1 0 LOCATION J Q�4 ___�. c_ SEWAGE# S- /D 97 VILLAGE P�..Da�r11�r ASSESSOR'S MAPt�Tv INSTALLER'S NAME PHONE NO. A.b SEPTIC TANK CAPACITY LEACHING FACILITY:(tnm)�_ rja (size) NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER A DATE PERMIT ISSUED: DATE ,COMPLIANCE ISSUED; VARIANCE GRANTED: Yes No -✓ • % a http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=227116&seq=1 1/7/2015 IIll 0.00 CWU Z,2 Town of Barnstable P# Department of Regulatory Services s amxar,+,BM Public Health Division Date � MASS. t63Q ,b� 200 Main Street,Hyannis MA 02601 A�Epf Date Scheduled ! ime Fee Pd. ( U d � — Soil Suitability Assessment for S e Disp ,! Performed By: � ��1�to�� S� m .���Z witnessed By: � LOCATION& GENERAL INFORMATION Location Address l O 77,, E„`U Owner's Name A Address .Assessor's Mao/Parcel: ZZ� (P Engineer's Name NEW CONSTRUCTION REPAIR Telephone# -Qe$—C73-2-4"] l0 6- Land Use Slopes(40) �' Surface Stones 1 t � Distances from: Open Water Body ( � +�tf Possible Wet Area . co�'-Tt Drinking Water Well r eft 1 Drainage Way ft Property Line ft Other ft D SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands fn proximity to holes) --------------- t y s 2. Parent material(geologic) 6,j Depth to Bedrock. Nd EvZ Depth to Groundwater. Standing Water in Hole:_NuA . Weeping from Pit Face f*k-b AA Estimated Seasonal High Groundwater > �i Z DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: —hi, Depth to soil mottles; Depth to weeping from side of obs.hole: in, Groundwater Adju.dltrrnt.,._,:...._.,.._ ,_...- ......f'r. "Rcaaing Date: index Weli levei^a Av Ad,1,factor— Adj,Groundwater Ltvel o PERCOLATION TEST bate Thne, �. Observation �- Hole IP� Z Time at9" Depth of Perc ILI� Z� JC 10Hj Time at 6" Start Pre-soak Time @ _ (���[lA Time(9"•6") i End Pre-soak Rate Min./Inch. `Sits:Suitability Assessment: Site Passed y Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- I ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one (1) week prior to beginning. Q:S,EPTICVERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency,%Gravel) ® i to:zz- /� L .S _ I: 12v z .r-- 22-.4Z 6j. 1. S 10.. 12 S DEEP OBSERVATION HOLE LOG . Hole# -Z, Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) FZ� A Ao—13Z G S 2 Y ` DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon -Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) ivlottling (Structure,Stones,Boulders. Con iste o Gravel) i DEEP OBSERVATION HOLE;LOG Hole# Depth from . Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. / Consist ncy.%OraytIV Flood Insurance Rate Map: :b^. year fkMrd boundary No_ Yes , Within 500 year boundary No °�� Yes _K Within 100 year flood boundary No—e!C Yes _ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervlou material exist in all areas observed throughout the area proposed for the soil absorption system? .� If not,what is the depth of naturally occurring pervious material? Certification ��� I certify that on —mil Z�-(date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the.above-analysis was performed by me consistent with, . the required t 'ng,expertise and experience described in 310 CMR 15.017. #; Date Signature Q:GSEVnC\PERCFORM-DOC ,t_ C OG 4 N,:o`.. ............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -.-----� ......OF...........,2Z VA! . J'T. CG.�................. Appliration for Disposal Works Tnnitratrtiun 11trutit _ Application is hereby made for a Permit to Construct ( 7) or Repair ( ) an Individual Sewage Disposal System at: ?._:--.-- ....................�f._'!..'�t---•-•------•------•-• .............er�l�...G'f�!Q,e�l,�er Location C ..............._........ ...14AQ-.�ilr ..0.......6��i*/• �y -f?�•+ ress er Installer Address Q Type of Building Size Lot__Z6S.-4a_.-Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder U `-4 Other—T e of Building No. of persons............................ Show„ers. — Cafeteria QOther fixtures ---------------------------------•-•-----._...--------------------------------------------.. --------------.................................. Design Flow..............4.s....................gallons per person per day. Total daily flow-(...4�.-Q� ........................gallons.t WSeptic Tank—Liquid capacitya4ild>6gallons Length.Zar.4._. Width.{$'�._Q_._'Dia r________________ Depth...r5_..._.Q--_. Di osal Trencl3—No. _._..' ...._..... Width......',rt.-......... Total Length..._.......... Total leaching area__4jKet! c-ft. 5e'�"ge PVfoo-------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (1-*7 Dosing tank ( ) Percolation Test Results Performed by.......... jylf,Xtcd/,j�_....,P-e.......... Date..//:t1-,1-?a1���-......_.. ,.a Test Pit No. I.......A-7 .minutes per inch Depth of Test Pit./-.:f*0.--__-. Depth to ground water._A0,444or._. fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---------------------------------------••-. . •----------------..........•-----............ ......--------------------------------•---....-----....-- D Description of Soil..... ................. .......... -?e~"/yam x W --------•----------------------------•-•-----•-----•----------------------------------------•-•---------------------------------------------•--•-----•-----•-----------•-----•-•----------------------- UNature of Repairs or Alterations—Answer when applicable............................................................................................... ........................................... --------------------------------------•--------------------------._._.....-------------------------------------------------------------•--•-•---...... Agreement: The tinder � grees�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 Nnthe ate of Compliance has been issued by the board of health. �Jad �/Si ned.....)et �" � D CCy..--•----•------- --- --- = �� te"'�d for the f o l wing reasons:. -------------------•........---------•---••--------•-----•-----------------------•----••-•-•--•-•-----------------------•-------••-•------•--•------•-----------•-------•-----------•-----•------------- Date PermitNo......................................................... Issued_....................................................... Date ' THE COMMONWEALTH OF MASSACHUSETTS I� BOARD OF ,HEALTH .............. ......OF.....,,��9 �!'. " 1,5tL.E............................. TrdifirFa#r of fuuutpliFanrr THI Ij�CERTI FYI Tha the Individual Sewage 4Diisrtosal System constructed (a�) or Repaired ( ) by...........................� ------.....-------- °" `�------------....---------------.........------......----..........------------------. Installer at------------------- sJl 'l ....... . !aTl"-- ?Z>.-------_. � .T .(�l�!_1.���E..--------.........-------------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................•................................... Inspector------------------------------------------------------...------.........------....-- No......................... Fps............._............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......OF............ IZ.�Y�f' �- ------------------- Appliration for Uiipnml nr Tomitrurtion ami# Application is hereby made for a Permit to Construct ( �),_or Repair ( ) an Individual Sewage Disposal System at: ..........�.GC1..C1 .. ..� ✓1/.1�. .lf,/.�� ...................... ���---•------------------------------------ __Location-Address or Lot No. ... ........... ciie 11----...<�6-1-/�...-------•---•--•-----.. ¢7 T.l..�%� ......�E/11.�11/ O ner Address ----.. ..... � 1_........ ------------------ -------- �.To�t-,a�a ------------ Installer Address Q Type of Building Size Lot-_.,2_ ,5-r..,s--Sq. feet U Dwelling—No. of Bedrooms.................-��_.......................Expansion Attic ( ) Garbage Grinder '4 Other—Type of Building No. of persons............................ Showers — Cafeteria R-I YP g P ( ) ( ) Q' Other fixtures WDesign Flow.............. .......:.............gallons per person per day. Total daily flow------ .2-,al...........................gallons.¢ W Septic Tank—Liquid ca.pacity!�G..gallons Length/re-.ZC.--. Width.,5":-.6-... Diameter-_______-____- Depth....?. _-_o_. - x Disposal Trench—No...... _...._..... Width...... Total Length....._......... Total leaching area_.4s?,4,x.isq-Pft. 6,4_j ge )PV ..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (w-) Dosing tank ( ) Percolation Test Results Performed by......... Ajri t�.�tt .........P.146i.........._ ......... aTest Pit No. I......�..minutes per inch Depth of Test Pit/,4'y: Depth to ground 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---------_.............. a •-•--••-----••-•---------••.........•-•---•...............••--......-•--•-•••-•-•-•--------•---............--•--•.._.......-----.................----.------ D Description of Soil--- x--_-_-------.�z.. �:�?�:'_-S'��S'fll .-----..... .f;�9�. U W ........................................................................................................................................................................................................ VNature of Repairs or Alterations—Answer when applicable...........................................:................................................... -•---•-•---•----•--•--••••-----••-•......_...--•-•-•--------•-•--•-•----------•--••••.......•••--•-•---------•---••-----••---••----•--••---•-••---------••--•------••-•---------•-•---•----.......-••-- Agreement: The under s-to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of',.T t .2 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. Si ned........... �� --•-• ---1 a, ate Application Approved B ... Application Disapproved for the f l wing reasons:--,-.--••--..--•-•-----••--------•--••-•---•----------••-•-----••-----------•----•--------•....------•........---- ------------------------------------------------•-••-----•-•--•-----------•--••----......_...------•--•-=-•-----•----...••-----•---•••---•-•---.......-•----•--•----------•-------------•-----......_. Date PermitNo......................................................... Issued....................................................... Date ti THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Trrfifirtttr of Toutpliattrr THIS IS TO. CERTIFY, That the Individual Sewage Disposal System constructed (✓) or Repaired ( ) by.............. -•---•-h l 1 f .--•-------------------.......-----------•--------•-••-----....................-----......................----------------•-------•-----•. _ Installer at.................G�....../ '----•- .0 l =_%.... �--------------- T� has been installed in accordance with the provisions of TIT E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Peripit No......................................... dated_---------..................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 'YS DATE............................. -•---- Inspector.................................................................................... 1 0CS/61 IAM 0NQNEER THE COMMONWEALTH OF MASSACHUSETTS 4F c-C ri-Pic,4voN BOARD OF HEALTH w�f2�-s-rCAj V6 A rrvo• .OF..::... �9, /I/I�AJ -i J. L. ...................... FEE..._........r ..... t n �tl nrkv T witrudwew er i Permission is hereby granted.....--- .. --- ---------- .......... to Construct � or Repair ( ) an Individual Sewage Disposal System s at No..........-ems.-%--• -------- ...... ................... .......... ...... Street i as shown on the application for Disposal Works Construction Permit NogS'f• ��Healthh DAT Dtd �Z_ Z1._ .. t 4 Boa................ .................'j� 3 FORM 1255 HC & ARRE INC.. PUBLISHERS �z � t �' f LOC AT;`N1-- L- -E-L I-0T- RGA No VI LLAG r.F�TmFRVILILE DaT E_9�,193 'APPLICANT TEILTURNER_ FEE 25 .00 ADDRESS TELEPHONE NO. (Non-refundable) ENGINEER ARROW ENGTNEERTNG INC . TELEPHONE NO._ 540-0354 DATE SCHEDULED NOV. 10 1983 (Applicant' s signature) • • • • o 0 0 0 0 0 • o • o 0 00 0 . • o . • . • o 0 0 • o o • • . • • . • o • . • • • . • o • • . • o • • . . • • . • e • o • • . • • o • • o • . • • • . SOIL LOG SUB-DIVISION NAME DAT A;rpTIME 11 •00 EXPANSION AREA: YES_x_NO _ ENGINEER TOWN WATER X PRIVATE WELL arnstable Jc�d,Er ,A.C�a BOARD OF HEALTH Alfred Fuller EXCAVATOR SKETCH: (Street.-name;etc.-,dimensi s of lot, exact location of test holes and percolation tests, loca wetlands in proximity to test holes ) NOTES : I r L - ' v® Lar I wI � _ ®® 17. PERCOLATION RATE: ' TEST HOLE NO: ELEVATION: TEST HOLE NOc ELEVATION: 2 1 2 3 3 ' 4 4 5 5 6 6 i T r / 7 g73 8 9 \�- 9 10 k1 10 11 11 0 12 12 13 13 14 l 14 I � 15 � •��� 15 16 16 -SUITABLE FOR SUB-SURFACE SEWAGE : LEACHING FIELD LEACHING PIT LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE : ENGINEERING PLANS MUST SHOW NUMBER ASSI ED 0 ERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P . E . AND RETURNED TO BOARD OF HEALTH ' COPY: RETAINED BY APPLICANT a TOWN OF BARNSTABLE mmwmi� vt � LOCATION �+DQ�. r&A,.`" SEWAG�E� # VILLAGE �dD, .�r1� ASSESSOR'S MAP INSTALLER'S NAME PHONE NO. A a SEPTIC TANK CAPACITY LEACHING FACILITY:(type) t I� ate ., ..�f�..;. (sue) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER A A,,w JA =� •. . DATE PERMIT ISSUED: _ OO DATE .COUPLIANCE ISSUED: VARIANCE GRANTED: Yes No --� c � ® � l 300 � 4. Centerville Rlver , E"Ott.Rd I i / x 4,43 N . Qj LOCUS sep 3 6' e ea 1° 00,, �\ �Yoo LOCUS MAP Lot 1\4/ \ x 5.79 NOT. TO SCALE - --- 26,320± S.F. \\ LEGEND II M B LU 227 116 --20-- EXISTING CONTOUR x 20.12 'EXISTING SPOT GRADE -W--+ EXISTING WATER SERVICE �-� U OVERHEAD WIRES x 3' G UNDERGROUND GAS 1 v 1 7x 1.58 r8,14. WETLAND FLAG ; 206 Al L97 / -� SAL l /Vl/'il\Sl l I WETLAND SYMBOL l TEST PIT �/tV 101` 1.55 ,,� V 105 BENCHMARK. J 3,42• \ / 1001, k4s S I \\ 1I V104 /�/ + 44) x 4,64 =��Q� q�yG 1 o PETER T. ^� X 1.86 --�- 2.40 1 o McENTEE N V.W. � CIVIL I EDGE OFB = x 6,45 No. 35109 V1�.�• 3.25 // F R£�ISTE�F��\�� , d` I 2.29 i 4.2 SIGN 1 I 5.58 / I l /BAR Y/V,55TAE COASTAL BAN?C' - �7T Cn . � + 5.35E - - ��/�j � �, � -� - - 2"^`�/ram - -��.. � ,�•.. :; -.�-k /BANK (MADEP 1 9J zr / t �. STAL 6 . :. rri� P 0F COA _ - 11.78 + 11.13 12.64 _ 12.40 O - x 12,20 DECK _/ 0- (above) PATlO �E2.34+ �95 2 2.98 17,8 '(above).:: o OUT BASEMENT 12.50 ! . EXISTING 13.17 r� PK SET Q HOUSE (#483) 1 \ TOF=21.4t1/ Cellar Floor, EL.=13.7f 1 7 5 • PA I (NA VD88) :.QRIVEWA.Y�'; 75 r . STONE RE WALL ^ 17.78 1 .3 13.59:: 19.46 •i• r� \. \ 9,5E �. _M G \ .• SUFFER `.::s:; I .08 LK 119.7X.- TP-1 TP-2 18.93 �:."-,: BRICK ; . . TO B.V.Wz. L ,:,i Q 2 1- 19.10 18;80 ;.: .. WA �14.76 r ._ _ 4 Ci \v 4,37:-f 8.77 .86 U --- 150 0 _ } x x 113,36. W; - ,5018,7E S 71` 4W VENT W ❑ G ,0CATCHBSIN ' 14,38 WG W 13,0E 13.78 ��, �VI/ - 17 85 14,5E G PA WETLAND DELINEATION Edge of /P G- CB I 15.46 18,5 VACCARO Environmental CoAsulting 41 ove ent 16,54 P.O. Bah 955 A E'LLIOTT 16,87 Sandwich, MA 02563 DO�� 17,17 (508) 888-5855 (j, OWNER OF RECORD _ FLOOD PLAIN DATA BENCHMARK EXISTING SEPTIC TANK EXISTING S.A.S. SHEA,SFIOTT ETER A.& MAP N0. 2500E CJULY CTR./CATCH BASIN TOP OF TANK, EL.=17.20 TO BE REMOVED SHEAATHLEEN M. EFFECTIVE DATE: DULY 16, 2014 EL.=14.38 (NAVD88) /NV.(OUT)=15.87f VERIFY 483 ROAD ZONE AE (EL12) NAVD88 DATUM (VERIFY) (SEE NOTE 11-SHEET 2) CENTERVILLE, MA 02632 Engineering by: SCALE DRAWN JOB. NO. PROPOSED SEPTIC : SYSTEM UPGRADE PLAN orks, Inc. 1�=20' P.T.M. 114-15 Engineering W 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. 483 ELLIOTT ROAD CENTERVILLE MA (508) 477-5313 4/21/15 P.T.M. 1 of 2 Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 , .r� . NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL: 15.5 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL WATERTIGHT RISER INSTALL H-20 WATERTIGHT RISER, FRAME & COVER OVER OUTLET AND SET TO 6" OF FINISH GRADE & COVER TO WITHIN 6" OF ONE CHAMBER(MIN.),AND SET TO FINISH GRADE TO SERVE T.O.F.=21.4t FINISH GRADE TO SERVE AS AN INSPECTION MANHOLE. EXISTING F.G. EL.=19.0 to 20.5f F.G. EL=20.1t F.G. EL.=19.0t CHARCOAL VENT L = 44' L = 17'(MAX) Q S=1% (MIN.) @ S-1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC - s" 2" LAYER OF 1/8" io^1 " 6 ®�® TO 1/2 DOUBLE 14" 12" WASHED STONE EXISTING 48" uQUID INV.=15.87t ;1 (OR APPROVED FILTER FABRIC) LEVEL iNV.=15.20 4' 3' 4' " GAS BAFFLE (VERIFY) PROPOSED 3/4 -1 1/2" INV.=15.37 D-BOX4 EFFECTIVE WIDTH = 11' DOUBLE WAS INV.=15.00 STONE EXISTING SEPTIC TANK USE 7 LC-6 GALLON LEACHING CHAMBERS IN SERIES WITH DOUBLE WASHED STONE-ALL SIDES AS SHOWN NOTES: H-20 RATED 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE TOP CONC. ELEV.=15.83 __ _ -BREAKOUT INVERTS, PRIOR TO INSTALLATION. INV. ELEV.=15.00. ®®®0®®® ELEV.=15.5 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE ON A MECHANICALLY COMPACTED SIX BOTTOM ELEV.=14.00 INCH CRUSHED STONE BASE, AS SPECIFIED IN 2' 7 x 6' = 42' 2' 310 CMR 15.221(2). 4' OF NATURALLY OCCURRING 3) INSTALL INLET & OUTLET TEES AS REQUIRED. PERVIOUS MATERIAL EFFECTIVE LENGTH = *.6' 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 5' (MIN.) ABOVE G.W. AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. NO GROUNDWATER, EL=8.8 - LEACHING SYSTEM SECTION SEPTIC SYSTEM PROFILE N.T.S. GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SOIL LOG OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: -310 CMR 15.405(1)(a)&(b): DATE: MARCH 20, 2015 (REF#14,641) 1) A 3' variance, S.A.S. to property line (front), for a 7' setback. SOIL EVALUATOR: PETER McENTEE PE(SE#1542) 2) A 7' variance, S.A.S. to cellar wall, for a 13' setback. WITNESS: DONNA MIORANDI R.S. HEALTH AGENT 3) A 3' variance to the maximum cover requirement of 3', for ELEv. TP-1 DEPTH ELEv. TP-2 DEPTH a maximum cover of up to 6'. 19.1 0" 18.8 0 -LOCAL REGULATION Chapter 360. Article 1 - Setback Requirements FILL -- -4)-A 56' variance, "S.A S.'to coastal�barik, for a 44' setback. 17.8 A 16" 17.5 A 16" 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR LOAMY SAND LOAMY SAND TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 10YR 4/2 10YR 4/2 DESIGN ENGINEER. 17.2 B �2" 17.1 B 20" 4_ ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING LOAMY SAND LOAMY SAND FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 10YR 5/8 10YR 5/8 > ENGINEER BEFORE CONSTRUCTION CONTINUES. 15.6 42" '15.8 36" IF 5. ALL ELEVATIONS BASED ON NAVD88. C C PERC h "" 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF MED30"/48 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF SAND M .5 SAND 2.5Y HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. .SY 6/6 2Y 6/6 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 8.1 132" 7.8 132" 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS PERC RATE <2 MIN/IN., "C" HORIZON AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE NO GROUNDWATER OBSERVED DIRECTED BY THE APPROVING AUTHORITIES. ESTIMATED HIGH GROUNDWATER, EL.=3.0f 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE __ INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. r 4'KNo= UT 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND I 20"as COVER I IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. a'KNOCKOUT 4"KNOCKOUT DESIGN CRITERIA I l NUMBER OF BEDROOMS: 4 BEDROOMS L------ a-KNOCKOUT SOIL TEXTURAL CLASS: CLASS I DESIGN PERCOLATION RATE: <2 MIN/IN r 72" DAILY FLOW: 440 GPD PLAN VIEW DESIGN FLOW: 440 GPD GARBAGE GRINDER: NO-NOT PERMITTED WITH THIS DESIGN ---- ---- EXISTING SEPTIC TANK: 1500 GALLON CAPACITY ® ® '® ® ® ® ® 22" ® ®'® LEACHING AREA REQUIRED: (440 GPD) = 594.6 SF INVERT I ® ® ® ® ® ® ® I I I .74 GPD/SF 1 USE LC-6 GALLON LEACHING CHAMBERS 1N SERIES r 72" r 36` i WITH 4' OF DOUBLE WASHED STONE-ALL SIDES SIDE VIEW END VIEW SIDEWALL AREA: (11.0' + 46.0') x 2 x 1' = 114.0 SF BOTTOM AREA: 11.0' x 46.0' = 506.0 SF WIGGIN LC-6, H-20 LOADING TOTAL AREA:............................. ............................. 620.0 SF LEACHING CHAMBER DESIGN FLOW PROVIDED: 0.74 GPD/SF(620.0 SF) = 458.8 GPD N.T.S. Engineering by: SCALE DRAWN JOB. Na• PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. 1"=20' P.T.M. 1 14-15 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. 483 ELLIOTT ROAD CENTERVILLE MA (508) 477-5313 4/21/15 P.T.M. 1 of 2 Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 I ■ h: r k r 19` g3 � bo ®4 3;k�ri�r✓i��9e dam. (s dg Patio rnr G. 141 F ^. Do- M a ti ti 53' , F. Bath c. � 1 Sauna .� N i� fir$ Af, 144 6% ilesf� Master Bath Family Room Office (3arage Under Ln �,4� 8 Pant i th (half) Wet ar _... . Kitchen 5 Living to Breakfast Nook �� a rsf � / s Room 1®° i 3' co Entry j First Floor ! 8' r. 191 16 ro*",too e.sa EMI W[raRlr 1 t ,9 n c� C CL Q� l i 19' co Patio CO 8' 53' N: ::heck: .v Finished Space nfmi h U s ed Space Garage Under. . Garage — 14.' o _ Bath (ha ) ;D Finished Space 47' _- ____ _ 9' 10' ao i Entry.. CO rn Basement I 8' 19 1 f� f F / •f_r/f 011101D CentervIlle River I Elliott Rd x 4.43 J I/ N I / x 4,53 / Qj °O,, LOCUS P V \ `,S °°,, 0 �\ LOCUS MAP Lot 1�4/ `\ x 5.79 NOT TO SCALE 26,320f S.F. `\ LEGEND MB LU 227-116 ` --20-- EXISTING CONTOUR 1 + 2.20 x 20.12 EXISTING SPOT GRADE _ � 1 1 -W- EXISTING WATER SERVICE U OVERHEAD WIRES I x 3.4�/ \ I G UNDERGROUND GAS I �x 1,58 \ \ r8.14 WETLAND FLAG I AIL l I V 206 1 / -C p n p �/ } A) WETLAND SYMBOL -6 97 ( V101 5ALT /Vlf' R5 / � ` ' � TEST PIT 1.55 't t V105 BENCHMARK 3.42• 6.50 \ / \ / 1-1 �• \ \� OF MAs •/ + 44� x 4.64 y�`�P` V104 / o PETER T. 2.40 / 1 o McENTEE 1 ' OFgV.�W. CIVIL I EDGE OF x 6.46 No. 35109 . 8• .1. '1 V1�,�• 3.25 4 - �'' / �O,p�F EG/STE�����•�`� 1 , 4.2 I I 2,29 / 5.58 / 1 - - 6. I�1 /BARN5-TAIXE INS - _ C_0A5TAL BAN?C'- __7�7T BANK (MADEP c5 OASTAL _ 1� "i` & .- p OF C -12,64 + \11.78 + 11.13 �� // c3 Y(, '---- 12.40 O - x 12,20 DECK 0- - (above) PATIO �� \12.�+ 51 °.`.I::`DECK W WALK 2.9 8 17 8 ` �:..:'..: .: . ,..,I OUT 12.50 / l ..(above):` z BASEMENT y 13.1 •' . r PK SETS_.••� /EXISTING HOUSE (#483) 1 ` TOF=21.4f// RA'l/ED Cellar Floor, EL.=13.7f 1 7 5 (NA VD88)• •,75 1 y^.l `T4i89' STONE d x 19, 3 1 RET. WALL G 19.46 17.78 1 3 �\ .13.59 .r •�• \ f .:. ..'TO .�•..w.....:.: .' I ' . 0 19.13 18,93SUF 119.72 �O TP- TP-2F LK .08 xBRICK 2 19.1B.V � .80 14J6 \ �.•_ 110 I :.�4 37 STo ),,08.77 O ,.. .; ,86 cv ^ x u9,11 18.71 x 19.50.'13,36.. W -'� 1 G''09 U. G CATCHBASIN S 71.1940" WVENT W ❑ 0 13,01 14.38 WG W A8 13.78 / 14.51 �W -17.85 --- I PA -yD - - CB WETLAND DELINEATION I 15.46 Edge of Pave ent G---- 18,5 VACCARO Environmental Consulting �`� 16.54 P.O. Box 955 j j ]O /]7/7s, 16.87 .Sandwich, MA L/1 02563 L-/ j 1 ROAD O A 7••� 17.17 (508) .888-5855 x L FLOOD PLAIN DATA BENCHMARK OWNER ET RECORD EXISTING SEPTIC TANKHEA, PETER A.& MAP N0. 25001C0564J CTR/CATCH BASIN . EXISTING S.A.S.SAS . SHEA, KATHLEEN M. EFFECTIVE DATE: JULY 16, 2014 TOP OF TANK, EL.=17.20 TO BE REMOVED ZONE AE EL12 NAVD88 DATUM EL.=14.38 (NA INV.(OUT)=15.87t(VERIFY) (SEE NOTE 11-SHEET 2) 483 ELLIOTTRVLLROAD ( � CENTERVILLE, M,4 02632 , Engineering by: SCALE DRAWN Joe. No. PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. 1"=20' P.T.M. 114-15 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET No. 483 ELLIOTT ROAD CENTERVILLE MA (508) 477-5313 4/21/15 P.T.M. 1 of 2 Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL: 15.5 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL WATERTIGHT RISER INSTALL H-20 WATERTIGHT RISER, FRAME & COVER OVER OUTLET AND SET TO 6" OF FINISH GRADE & COVER TO WITHIN 6" OF ONE CHAMBER(MIN.),AND SET TO FINISH GRADE TO SERVE T.O.F.=21.4t FINISH GRADE TO SERVE AS AN INSPECTION MANHOLE. • EXISTING F.G. EL.=19.0 to 20.5t F.G. EL.=20.1 f -F_G. EL=19.Ot CHARCOAL VENT L = 44' *± 7 L = 17'(MAX) S=1% (MI ® S=1% (MIN.) 4"SCH40 PV4"SCH40 PVC 6,. 2" LAYER OF 1/8" io"I ®�® TO 1/2 DOUBLE 74" 12" I! If WASHED STONE EXISTING 48" LIQUID INV.=15.87 (OR APPROVED FILTER FABRIC) LEVEL .=15.20cAs � (VERIFY) 4' 3' 4' 3/4"-1 1/2" INV.=15.3 EFFECTIVE WIDTH = 11' DOUBLE WASHED INV.=15.00 STONE EXISTING SEPTIC TANK USE 7 LC-6 GALLON LEACHING CHAMBERS IN SERIES WITH DOUBLE WASHED STONE-ALL SIDES AS SHOWN NOTES: H-20 RATED 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE- TOP CONC. ELEV.=15.83 • _ INVERTS, PRIOR TO INSTALLATION. -- -- -BREAKOUT 2) D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.=15.00 ®®®E3 EM E3 E3 ELEV.=15.5 GRADE ON A MECHANICALLY. COMPACTED SIX BOTTOM ELEV.=14.00 - mot Im INCH CRUSHED STONE BASE, AS SPECIFIED IN 2' 7 x 6' = 42' 2' 310 CMR 15.221(2). 4' OF NATURALLY OCCURRING 3) INSTALL INLET & OUTLET TEES AS REQUIRED. PERVIOUS MATERIAL EFFECTIVE LENGTH = 46' 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 5' (MIN.) ABOVE G.W. AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. NO GROUNDWATER, EL=8.8 - LEACHING SYSTEM SECTION SEPTIC SYSTEM PROFILE N.T.S. GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST 'BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SOIL LOG OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: -310 CMR 15.405(1)(a)&(b): DATE: MARCH 20, 2015 (REF#14,641) 1) A 3' variance, S.A.S. to property line (front), for a 7' setback. SOIL EVALUATOR: PETER McENTEE PE(SE#1542) ' 2) A 7' variance, S.A.S. to cellar wall, ford 13' setback. WITNESS: DONNA MIORANDI R.S. HEALTH AGENT 3) A 3' variance to the maximum cover requirement of 3% for ELEV. TP-1 DEPTH ELEV. TP-Z DEPTH ' a maximum cover of up to 6'. 19.1 0" 18.8 0 11 -LOCAL REGULATION Chapter 360. Article 1 Setback Requirements FILL ��-- `4) A-56`•"variance,-S"A:S' fo coastal"bank,7for a 44' setback. 17.8 A 16" 17.5 A 16" 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR LOAMY SAND LOAMY SAND TO INSPECTION AND APPROVAL BY'THE BOARD OF 'HEALTH AND THE 10YR 4/2 10YR 4/2 DESIGN ENGINEER, 17.2 B 22" 17.1 B 20" 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING LOAMY SAND LOAMY SAND FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 10YR 5/8 10YR 5/8 ENGINEER BEFORE CONSTRUCTION CONTINUES. 15.6 42" 15.8 36" 5. ALL ELEVATIONS BASED ON NAVD88. C C . PERC 6. THE DESIGN'ENGINEER IS,NOT RESPONSIBLE FOR THE FAILURE OF 30"/48" THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF MED. SAND MED. SAND HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 2.5Y 6/6 2.5Y 6/6 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. _ 8.1 132" 7.8 132" 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS PERC RATE <2 MIN/IN., "C" HORIZON AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE NO GROUNDWATER OBSERVED DIRECTED BY THE APPROVING AUTHORITIES. ESTIMATED HIGH GROUNDWATER, EL-3.0f 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. F -- 4*KNoacou Lj r J 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND I 20'as COVER IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. I j DESIGN CRITERIA l4•""�`°� 4•KNaacaur l _ I i NUMBER OF BEDROOMS: 4 BEDROOMS L------ __7 SOIL TEXTURAL CLASS: CLASS I DESIGN PERCOLATION RATE: <2 MIN/IN 72' DAILY FLOW: 440 GPD PLAN VIEW DESIGN FLOW: 440 GPD GARBAGE GRINDER: NO-NOT PERMITTED WITH THIS DESIGN -- - ---- EXISTING SEPTIC TANK: 1500 GALLON CAPACITY ® ® ® ® ® ® ® 22' TEa � LEACHING AREA REQUIRED: (440 GPD) = 594.6 SF IT ( ® Ea ® ® ® Ea E3I i I .74 GPD/SF USE LC-6 GALLON LEACHING CHAMBERS IN SERIES 72" , 36' WITH 4' OF DOUBLE WASHED STONE-ALL SIDES SIDE VIEW END VIEW SIDEWALL AREA: (11.0' + 46.0') x 2 x 1' = 114.0 SF WIGGIN LC-6, H-20 LOADING BOTTOM AREA: 11.0' x 46.0' = 506.0 SF LEACHING CHAMBER - TOTAL AREA:.................................. ......._. 620.0 SF DESIGN FLOW PROVIDED: 0.74 GPD/SF(620.0 SF) = 458.8 GPD N.T.S. Engineering by: SCALE DRAWN JOB. No. PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. 1"=20' P.T.M. 114-15 . 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET No. 483 ELLIOTT ROAD CENTERVILLE MA (508) 477-5313 4/21/15 P.T.M. 1 of 2. Prepared for: D.A. Brown, Inc., P.O. Box .145, Centerville, MA 02632 F'Hrr.A{T >~Lkc,.,'4U crtArfr,r f; , «x F_r _-��_r'� ! 1 } AAA_ �LE.�/ �.: (r•J/f.t 1w�S4 lw:G A. _"ia `�� ^1 ►.!1 I _ F?i.�Ic a ••-t U C G CA:! ' t .�.-- "1�.1 _.:.___u._.__ -'_ - _ ._ (/!_/ i�1�4•i«I !'atJ- t�lw.l'.^�_ M IP.{twin►'i !;F � 7 11kiL r �- - 1 �1 - Al_l_ t='t>''�:+ "(>;, t.►bi. It._I F t?. ��- � .r- r O .r_,2 . .___.--•�-_._-__-.__ � ' '' a I' -1ii ca '�� _... 1 n,ia. GA'!>d Iiid.�ti.1 C'�: "".'r.4-4w:.J'l..r�-<_ -;y.-.) �`••.j C'. t�"___.�__`--�-'^_^� , � Y_,/.• I i� �i � -_ � '! _;_�"" T� l-'�� F'T,�• '�,�.��":, ::ski � rr.�St•rtr..., r.'•• ;- .y'> LA-AC-WI.l *, r'rt`_. «'�,L* I_ _ -�: ;�_` �=t _�_l! :11 Ii rp — +• >t-i L- __ _ J tltt Jo A4 s r. 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