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Home My WebLink About0057 HALYARD WAY - Health 57 halyard Way Centerville A = 194 066 , 9 f QrU® NO. 1521/30RA 0%I `�� 10% , a -'f .DEED RESTRIC TION WHEREAS,KEITH ALLAIN and ANN MARI ALLAIN, both of 58 Ric Court, North Branford, Connecticut 06471, are the owners, as tenants by the entirety(herein referred to as the. "Owners"), of 57 Halyard Way, Centerville, Massachusetts.02632 and being shown as LOT 29 on a plan entitled"Highview Hills Plan of Land in Barnstable (West Barnstable), Massachusetts for James K. Smith, Scale 1"=60', October 4, 1983, Rev.Nov. 25, 1983, Bauer and Nye, Inc., Registered at the Barnstable.County Registry of Deeds in Plan Book 379 Page 70. WHEREAS,the Owners of said lot has agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be used in any home upon said lot as a pre- condition for compliance with any potential or observed violations of 105 CMR 410.300 and 310 CMR 15.00 of the State Sanitary Code; WHEREAS,the Town of Barnstable Board of Health, as a pre-condition for finding the said lot is in compliance with 105 CMR 410.300 and 310 CMR 15.00 of the State Sanitary Code, are requiring that a restriction as to the number of bedrooms which can be used in any home upon the said lot be put on record with the Barnstable Registry of Deeds, NOW, THEREFORE, the Owners do hereby place the following restriction on the said lot in accordance with this agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and shall be binding upon all successors in title: . 1. 57 Halyard Way, Centerville, Massachusetts 02632 may have constructed upon the lot a house containing no more than three.(3) bedrooms: The. Owners, Keith Allain and Ann Mari Allain, agree that this shall be a permanent deed restriction affecting the said lot, located at 57 Halyard Way, Centerville, Massachusetts 02632, and being shown on the plan recorded in Plan Book 379 Page 70. For title of the Owners, see the Book 11877 Page 075 PROPERTY ADDRESS: 57 Y� Halyard Wa Centerville, Massachusetts 02632 Y Witness our hands and seals this day of 2011. February KEITH ALLAIN ANN MARI AL AIN STATE OF CONNECTICUT County of New Haven ss. New Haven On this the /U/ day of February , 2011, before me, Kristen E. Sveda the undersigned officer,personally appeared Keith Allain and Ann Mari Allain, known to me or satisfactorily proven to be the persons whose names are subscribed to the within instrument and acknowledged that.they executed the same for the purposes therein contained. In witness whereof I hereunto set my hand. Signature of Notary Public Date Commission Expires: 3/31/14 11/19/2010 FRI 6: 39 FAX 508 775 8683 Report from 1803 Hyannis 2001/001 CN i I Anderson Hardware 20 Camp 0pechee Rd. Cantsrville, MA A2632 80$-771-$616. Transaction#: D108412 ��6a?► "' Associate: ASH `. Date: 11/18/2010 Time: 05:17.1.7 PM **x SALE * FIRST ALERT CARBON MONOXI 9807017 1.00 EACH @ $23.99 T $23,99 02M000699 7.ell — Subtotal: $23.99 � 6,25% - Hass: $1,50 TOTAL: $25.49 CASH: $100.00 CHANGE: $74.51 ---------_----- T _ ------Thank Youl have a great day I WE SELL BENJAMIN MOORE PAINT D 1 0 8 4 1 2 Ii f 1. TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date Time: In Out Owner 6�111A /q LL14 I lJ Tenant S'uSigjJ Address 5g ��(. cou Address S� Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities CoAAE,L7 E�> 4z- OF I2 Z r 0 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities p CO At-4 aN -jrc®N G 10. Curtailment of Service G s D am . 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural cat Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal tt o 3 203 fV 17. Temporary Housing 4 18. Driveway Width V/ eK5a CGPJ1'y JAK T-Ou2 19. Number of Tenants Observed } /" (j-VR*rrWL*a TITLE 6_ PART II 37. Placarding of Condemned Dwelling; 4 3 - � �E3°f��c��cf►D '� lab�,� Removal of Occupants; Demolition 0 C6. of:.106-IrDS Number of Bedrooms 15 Number of Vehicles Allowed (max t" _ Number of Persons Allowed (max) Person(s) Interviewed koti % Inspector If Public Building such as Store or Hotel/Motel specify here Town of Barnstable Barnstable -�snnRtvsrABte, Regulatory Services � ' ;e11caC i Thomas F. Geiler, Director Public Health Division m Thomas McKean, Director 2007 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 November 18, 2010 Keith and Ann Mari Allain 58 Ric Court N. Branford, CT 06471 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION THE STATE ENVIRONMENTAL CODE TITLE 5. The property owned by you located at 57 Halyard Way, Centerville, MA was inspected on November 18, 2010 by Jim Parziale Health Inspector for the Town of Barnstable. This inspection was conducted in accordance with the 2006 Barnstable rental registration ordinance requiring yearly inspections of all rental properties. The following violations of the State Sanitary Code were observed: 105 CMR 410.351: Owner's Installation and Maintenance Res onsibilities Electrical outlets in both bathrooms are not functioning. 105 CMR 410.300 and 310 CMR 15.00: Sanitary Drainage System There were a total of four (4) bedrooms observed in this dwelling;.two (2) were observed on the first floor and two (2) were observed on second floor, however, the existing septic system (permit#2003-203) is not designed for (4) four bedrooms. It is designed for three (3) bedrooms. You are ordered to correct the 105 CMR 410.351 violation listed above within thirty (30) days of your receipt of this notice by repairing electrical outlets in both bathrooms to function as intended. You are ordered to correct the 105 CMR 410.300 and 310 CMR 15.00 violation listed above within six (6) months of your receipt of this notice by pulling the required building permits. You are ordered to remove one bedroom from this dwelling by removing entrance door and by opening the door-wa entrance to a minimum opening of five feet.. This will bring the total bedroom count down from () four to the appropriate (3) three as designated by yourseptic pe m#, . You may request a he ain before the Board of/c@t /writclnpetition ?§us ngsame 6.received within ten (1O days after the date the order isserved. Non-compliance will result inafine o$l0ROO per violation. Each d/S failure to,comply with a order shall constitute aspaateGoalton. PER ORDER Of THE BOARD Of HEALTH � (:5mNasA. �McKe% \:, CHO Director o Public Health :. . r p ` . .: . \{ ; \ - � 2 . . . \\1 % A \ X e Commonwealth of Massachusetts Title 5 O ficial Inspection Form Subsurface Sewag Disposal System Form - Not for Voluntary Assessments t 57 Halyard Way ' Property Address Keith Allain — Owner Owner's Name information is Centerville MA 02632 August 21, 2009 required for every page. City/Town State Zip Code Date of Inspection Inspection results 01,iust be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Inf rmation When filling out J' �# forms on the computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not use the return Name of Inspector key. Septic Inspectio Services Co. Company Name 189 Cammett R q ad _ Company Address Marstons Mills MA Sate 002648 Zip Code Cityrrown 508-428-1779 SI 12855 _ 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 oelow is true, accurate and complete as of the time of the inspection. The inspection VA was performed based on my training and experience in the proper function and maintenance of on site sew4ge disposal sys ems. I am a DEP approved system inspector pursuant to Section 15.340 of ow Title (310 CMR 15 000). The system: L � t .0 Passes ❑ Conditionally Passes ❑ Fails h:%. `,,eeds Furth. r Evaluation by the Local Approving Authority e 3 3 i`M N August 21, 2009 _ Inspe or's Signat r. Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DE )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 app opriate regional office of the DEP. The original should be sent to the system owner and copies sent I o the buyer, if applicable, and the approving authority. ****This report only;describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. I ID 09-173 Allain.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 Commonwealth of Massachusetts Title 5 O ficial Inspection Form ` Subsurface Sewag: Disposal System Form -Not for Voluntary Assessments 57 Halyard Way _ Property Address Keith Allain Owner Owner's Name information is required for Centerville MA 02632 August 21, 2009 - every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Sum ary: Check A,B,C,D or E/always complete all of Section D A) System Passes ® I have not fo ind any information which indicates that any of the failure criteria described in 310 CMR 5.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Tank is not in need of pumping at this time, leaching system shows no signs of saturation or surcharge. B) System Conditi Onally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or t paired. The system, upon completion of the replacement or repair, as approved by, Health, will the Board of. pass. Answer yes, no r not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," ple' se explain. ❑ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally u sound, 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. ND Explain: ❑ Observation f sewage backup or break out or high static water level in the distribution box due to broken or` bstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspect n if(with approval of Board of Health): ❑ brok n pipe(s) are replaced ❑ obst uction is removed 09-173 Allain.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth, of Massachusetts J = Title 5 0 ficial Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 57 Halyard Way — Property Address Keith Allain — Owner Owner's Name information is Centerville MA 02632 August 21, 2009 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distr bution box is leveled or replaced. ND Explain: ❑ The system Irequired 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 ❑ obst uction is removed ND Explain: C) Further Eva uation is Required by the Board of Health: ❑ Conditions d<ist which require further evaluation by the Board of Health in order to determine if the system i§ 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 t e environment: ❑ Ces' pool or privy is within 50 feet of a surface water ❑ Ces pool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety andenvironment: ❑ Thesystem has a septic tank and soil absorption system (SAS) and the SAS is within 100.`eet 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 supp ly. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supp ly well. 09-173 Allain.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 o1 15 Commonwealth of Massachusetts Title 5 O ficial Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 57 Halyard Way _ Property Address Keith Allain Owner Owner's Name information is Centerville MA 02632 August 21, 2009 required for — — every page. Cityrrown State Zip Code Date of Inspection B. Certificatio (cont.) C) Further Evaluat on is Required by the Board of Health (cont.): ❑ The system I ias 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 use e to determine distance: _ ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicate,s 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 riteria 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 El ® 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_day flow ❑ ® 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. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 09-173 Attain doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 O ficial Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 57 Halyard Way _ Property Address Keith Allain _ Owner Owner's Name information is required for Centerville MA 02632 August 21, 2009 - every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure:Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply ❑ ® well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence; of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems; To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large system 3, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Secl ion 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 answ red "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 consider d a significant threat under Section E or failed under Section D shall upgrade the system in accord nce with 310 CMR 15.304. The system owner should contact the appropriate regional office of he Department. 09-173 Allain.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewagie Disposal System Form - Not for Voluntary Assessments 57 Halyard Way _ Property Address Keith Allain Owner Owner's Name information is Centerville MA 02632 August 21, 2009 required for — — every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the follc wing 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)] 09-173 Allain.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewag Disposal System Form -Not for Voluntary Assessments 57 Halyard Way _ Property Address Keith Allain _ Owner Owner's Name information is required for Centerville MA 02632 August 21, 2009 - every page. Cityrrown State Zip Code Date of Inspection D. System Inf Drmation Residential Flow Conditions: Number of bedrooms (design); 4 Number of bedrooms (actual): 4 — DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 — Number of curre t residents: 4 Does residence:iave a garbage grinder? ❑ Yes ® No Is laundry on a s parate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system'inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No Water meter rea dings, if available last 2 ears usage d N/A Irrigation g ( y g (gpd)): system. Sump pump? ❑ Yes ® No Last date of occupancy.- Currently Occupied. Commercial/industrial Flow Conditions: Type of Establis. ment: Design flow(bas d on 310 CMR 15.203): Gallons per day(gpd) Basis of design f ow (seats/persons/sq.ft., etc.): — Grease trap present? ❑ Yes ❑ No Industrial waste lipilding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available.- Last date of occupancy/use: Date Other(describe)` 09-173 Allain.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealt of Massachusetts Title 5 O ficial Inspection Form c Subsurface Sewag Disposal System Form - Not for Voluntary Assessments 57 Halyard Way _ Property Address Keith Allain _ Owner Owner's Name information is Centerville MA 02632 August 21, 2009 required for 9 every page. CityrFown State Zip Code . Date of Inspection D. System Inf Dirmation (cont.) General Information Pumping Reco ds: Source of information: None — Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume p mped: gallons How was quantity pumped determined? — Reason for pumping: — Type of System: ® eptic tank, distribution box, soil absorption system ❑ 3ingle cesspool ❑ Dverflow cesspool ❑ :)rivy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ I nnovative/Alternative technology. Attach a copy of the current operation and aintenance contract (to be obtained from system owner) ❑ 'Fight tank. Attach a copy of the DEP approval. ❑ Other (describe).- Approximate age of all components, date installed (if known) and source of information: Compliance date 5/9/03 Were sewage od rs detected when arriving at the site? ❑ Yes ® No 09-173 Atlain.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 «� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 57 Halyard Way _ Property Address Keith Allain _ Owner Owner's Name information is required for Centerville MA 02632 August 21,2009 — every page. Cityrrown State Zip Code Date of Inspection D. System In rmation (cont.) Building Sewe' (locate on site plan): 2' _ Depth below grade., feet Material of cons ruction: ❑cast iron ® 40 PVC ❑ other(explain): — Distance from p ivate water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): 2- Depth below grade: feet Material of cons ruction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, I st age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No ..--------------------- ---------------------------------------------------------------------------------------------...... Dimensions: 10.5' long x 5.8'wide- 1500 gal..— 2-1Sludge depth: 32" Distance from to of sludge to bottom of outlet tee or baffle — Scum thickness'. Trace Distance from top of scum to top of outlet tee or baffle 6" Distance from b ttom of scum to bottom of outlet tee or baffle 14" — How were dimen sions determined? Measured _ 09-173 Allain.cloc-08/06 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 9 of 15 Commonwealt of Massachusetts Ej Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 57 Halyard Way _ Property Address Keith Allain _ Owner Owner's Name information is g required for Centerville MA 02632 August 21, 2009 every page. Cityfrown 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.): Liquid level at b; ttom of outlet invert, tees are intact and clear. Tank is not in need of pumping at this time. Grease Trap (locate on site plan): Depth below grade: feet Material of cons ruction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: — Scum thickness. — Distance from t9D of scum to top of outlet tee or baffle — Distance from bottom of scum to bottom of outlet tee or baffle — Date of last pum ing: Date 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 Holdin Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: — Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 09.173 Allain.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealt, of Massachusetts `' d Title 5 O ficial Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 57 Halyard Way Property Address Keith Allain Owner Owner's Name information is Centerville MA 02632 August 21, 2009 required for 9 _ every page. Cityrrown State Zip Code Date of Inspection D. System In ; rmation (cont.) Tight or Holdin Tank (cont.) Dimensions.- Capacity: gallons Design Flow: — gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pum ing: Date Comments (con'lition of alarm and float switches, etc.): Attach copy of i urrent pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Bo (if present must be opened) (locate on site plan): 0" Depth of liquid le el 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.): Pump Chamber locate on site plan): Pumps in workin order: ❑ Yes ❑ No Alarms in workin order: El Yes ❑ No 09-173 Allain.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form / o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 57 Halyard Way _ Property Address Keith Allain _ Owner Owner's Name information is Centerville MA 02632 August 21 2009 required for 9 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(not' condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not locat d, explain why: Type: ❑ IE aching pits number: — ® leaching chambers number: Three 500 gal drywells. ❑ leaching galleries number: ❑ I ching trenches number, length: ❑ leaching fields number, dimensions: — ❑ o erflow cesspool number: — ❑ it ovative/alternative system T, pe/name of technology: — Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Stone and soils mere probed with no evidence of saturation found. 09-173 Allain.doc•08/06 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 12 of 15 r Commonwealt i of Massachusetts V - Title 5 Cfficial Inspection Form Subsurface Sewa a Disposal System Form -Not for Voluntary Assessments 57 Halyard Way Property Address Keith Allain Owner Owner's Name information is Centerville MA 02632 August 21, 2009 required for 9 every page. Cityrrown State Zip Code Date of Inspection D. System Information (Cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and co figuration — Depth—top of li juid to inlet invert Depth of solids layer — Depth of scum layer — Dimensions of c sspool — Materials of construction — Indication of gro ndwater inflow ❑ Yes ❑ No Comments (notE condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,, etc.): Privy (locate on, ite plan): Materials of conc truction: — Dimensions — Depth of solids — Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,. etc.): 09-173 Allain.doc-08/06 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts Title 5 C fficial Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 57 Halyard Way Properly Address Keith Allain -- - ---'— ..... ....Owner ........ wnersame information is required for Centerville MA 02632 August 21, 2009 every page, City/-rown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch 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. N N75 */NN/N"""%"*"* / J I / / / I ' 16 Water 13 13 14 Service 19 Halyard Way r Commonwealti of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewa le Disposal System Form - Not for Voluntary Assessments 57 Halyard Way Property Address Keith Allain Owner Owner's Name information is g required for Centerville MA 02632 August 21, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slop e ® Surface water ® Check cell r ® Shallow wells Estimated depth to ground water: 20+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Ob ained from system design plans on record If c ecked, date of design plan reviewed: Date ❑ Ob; erved site (abutting property/observation hole within 150 feet of SAS) ❑ Ch' cked with local Board of Health - explain: ❑ Ch: cked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: US; S topo map and town GIS. _ You must describe how you established the high ground water elevation: Town groundwMer contour-map shows water below el. 35 and topo map shows property at el. 80. 1 �y !O6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 McKean, Thomas From: Weil, Ruth Sent: Monday, May 05, 2003 1:53 PM To: McKean, Thomas Subject: RE: 57 Halyard Way/A= 194-166/ Existing Home As DEP correctly informed you, the permit in the Board of Health records is controlling. The fact that the homeowner is in possession of documents which indicate that a fourth bedroom was added illegally show just that and nothing more. Ruth -----Original Message----- From: McKean,Thomas Sent: Monday, May 05, 2003 1:45 PM To: Weil, Ruth Subject: 57 Halyard Way/A= 194-166/ Existing Home Hi Ruth need your opinion on this matter: This site is located within a nitrogen sensitive area and the lot size is 20, 776. Therefore, according to today's State Environmental Code, only two bedrooms are authorized. There is an existing home on this lot. The homeowner is requesting permission to install a new four bedroom septic system. However, all of the Town Hall records indicate that there are only three bedrooms there( according to the original 1985 disposal works construction permit- 3 bedrooms, the 1998 addition permit discusses adding a bedroom over the garage and deleting one of the existing bedrooms first floor bedrooms-totaling 3 bedrooms, and according to the assessor's records-3 bedrooms total). Several years ago, the Massachusetts Department of Environmental Protection (DEP) informed us that we are to use the bedroom count listed on the disposal works construction permit as the official record. Therefore this morning, we informed the applicant the property is restricted to three bedrooms maximum and the septic system plan should reference the existence of three bedrooms, not four. Later this morning, the homeowner came into the Office with two appraisal reports, one written in 1992 when he purchased the home, and one in 1998 when he refinanced the home. Both reports indicate that there are four bedrooms existing in the home. A sketch shows two bedrooms on the first floor and two bedrooms on the second floor. Please advise. We don't understand how the home ended up with four bedrooms in 1992. Should we continue to restrict the home to three (3) bedrooms? P ' 1 No. d`C o � "-. �O� � � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _y ,'� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprtcation for Mi9;poga1 *potem Congtruction Permit Application for a Permit to Construct 0#<epair Grade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. _T-7 H4 L Yee.?a 64114 y Owner's Name,Address and Tel.No. exo/x rl/i!/�, kr1j'� /r'//Aih Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Design 's ame,Add s d Tel.No. SD8-3Qy'47Z 3 t lti1 Lt4� LrviC�-S .Svtis T D/'r�/4= i )101, as r {vt.� Type of Building: Dwelling No.of Bedrooms — Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) (9IV/ xfzlnv `lC T'14111C Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thi Boaz of H alth. Signe Date Application Approved by Date 5 b lam'3 Application Disapproved for the following reasons Permit No. ` CC) 3 Date Issued 51.6 A �µ ~ No.�O 3 ��3r ;l �.n \dip Fee � � Entered\~compater: THE COMMONWEALTH OF MASSACHUSETTSr- .i A L✓'� /� fit'— Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE MASSACHUSETT'S Zipphratton for htgoml *pgtem,lCon!5truction Permit `s, Application for a Permit to Construct(lam')xepair(I-)upgrade( )Abandon( ) ❑Complete System ElIndividual Compo�erits.� Location Address or Lot No. 7 4 L a/s47 Owner's Name,Address and Tel.No. Assessor's Map/Parcel ~ !� / y - oGG ` Hw ` �v� \ Installer's Name,Address,and Tel.No. .Designer's Name,Address and Tel.No. 5_OE'39 y—27?3 � f9 � �! E,yq✓!�S�I^V�c��S 'J J t be bar ev` Type of Building: Dwelling , .No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria(' ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title f%Size of Septic Tank Type.of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable).T.y.ST /1"-1.S`Uy 1111�,w Z..-,W,i G.A00 "-,."S 11-13a X y 9ra�.h� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thi Boar of Health. Signe _ Date Application Appr6ved by Date Application Disapproved for the following reasons Permit No. Q 3 — �n�i _ Date Issued THE COMMONWEALTH OF MASSACHUSETTS A_. . BARNSTABLE, MASSACHUSETTS Certificate of Comphance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(4-4-Repaired ( )Upgraded( ) Abandoned( )by at 5 7 Hi4 i m,, C.614� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �200 -�u 3 dated s/4 L Z Installer .��s �� ( /�sa.^`'ri S Designer,yjf s lrrarr i-r tic i r t1 4d<y1Je/Th Ala, The issuance of this permit shall not be construed as a guarantee that the syste will,functio destgnefd Date rl °lt(� Inspector , . [�S, --------------------------------------- No. �3 — 3 Fee 5 C THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpo5al *pgtem Congtructton Permit Permission is hereby granted to Construct(Repair(, grade( )Abandon( ) System located at 5�7 HIVIL14,rw 4,yw ev s fi-rrnsrl/r%/i- � and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date o—f this a it. Date:_ S�b/U 3 Approved by\ 1 TOWN OF BARNSTABLE 'LOCA11ON �� -'� � S£-SAG)*#1✓�S VILLAGE (�y�fi-er�.�� ASSESSOR'S MAP&,PARCEL NAME&PHONE NO. �'r - c�/1II,t SEPTIC TANK CAPACITY 15'0d LEACHING FACILITY.(type) SQL hctsib (size) NO.OF BEDROOMS OWNER 14 I 1 IG('O p PERMIT DATE: ATE: 5 • 810110CI Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY > ~!1l 4f 4f�l�r M1f 1l 1l 4/�/4/1 1l1/1f�f 4l yl yfy • \ t • t • • t t • t \ \ • \ \ \ t \ t t ! ! J ! f ! f r ! J f ! t t t t t t t \ \ \ \ \ \ \ t • \ \ \ \ \ t • t \ \ t \ t f 1 f f f J ! f f f ! 1 1 1 ! f f \ \ \ \ t \ \ \ \ \ • • \ t \ \ • • \ t t \ \ \ \ \ • \ f ! f f f ! - \ • • • \ \ \ f J f f ! ! . . . . . . . . 16 Water 13 13 14 Service 1 19 Halyard Way TOWN OF BARNSTABLE L,0CATIQN ��C/ dG1 Gt/!9 SEWAGE # 2003 VILLAGE /A_:er"V_Vill� ASSESSOR'S MAP & LOT/9y- �6 INSTALLER'S NAME&PHONE N0. SD ZO-q72 9- 10-3 3�W_4 a,-/S,ey0-U5 SEPTIC TANK CAPACITY 15-0 0 LEACHING FACILITY: (type) `y s�0 ��/ (./��'/� `,Qsize) NO.OF BEDROOMS 3 BUILDER OR OWNER kf lT/ PERMIT DATE: Y-6-03 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facili ) Feet Furnished by ti Fro nT 0 t!'►oiy,�N�l way TOWN OF BARNSTABLE LOCATION "-7 SEWAGE # 1003 VILLAGE� ASSESSOR'S MAP & LOTI?Y-4 66 INSTALLER'S NAME&PHONE NO. SD 8- �/%O-� � �/o•;� � , s�,�lag SEPTIC TANK CAPACITY /,5 o o LEACHING FACILITY: (type) 5, D 641 12.G NO.OF BEDROOMS 3 l BUILDER OR OWNER lkF 111fl;1 PERMIT DATE: COMPLIANCE DATE: Q"b� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facili ) Feet Furnished by ti f -p--fY11t944 i i o i i i f Town of Barnstame P# t Department of Regulatory Services oFIKE,, Public Health Division Date l2—,�—a�— P� 200 Main Street,Hyannis MA 02601 BAMSTABL& ` - - Y MAN. 039. Dater Scheduled Time Fee Pd. _ Soil Suitability Assessment for Sewage Disposal Performed By: t5 �kwI'/ . Witnessed By: :,..: . ..........._._ _ lr,... �. Location Address or //A� Owner's Name 4 g Address Assessor's Map/Parcel: /% /� 9��2 CO Engineer's NamewloAl11"112 NEW CONSTRUCTION REPAIR yf pN"e 'S.c ?37 �777 j V ,' 7v Land Use ��Ki" � — Slopes(%) ` v D Surface Stones /,D�i tances from: Open Water Body Possible Wet Area �� ft Drinking Water Well-Wft Drainage Way l ft Property Line ft Other l Z ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,loci wetlands,in proximity to holes) W bL4e,* r Parent material(geologic) � � �s'� Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping om Pit Face /! Estimated Seasonal High Groundwater Meth Used: Depth Observed standing in o s.hole: ottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: ex Well vel Adj.factor Adj.Groundwater Level_ ..:r::.r r..... ,�.:;.r: :....::::..:... P.EI�CQ►LA IC.�N EST D>it��;�� x�m� Observation « At Hole# l Time at 9" 7 Depth of Perc Time at 6" Start Pre-soak Time Q O / (9"-6") End Pre-soak `' S 4— Rate MinAnch / Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) ,V Original: Public Health Division Observation Hole Data To Be Completed on Back---------- Q:HEALTH/WP/PERCFORM E P>.. . . .T. L ... . ole.. . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(inJ (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency %Gravel) s 10 Rdo 3 Z ..: :::::.; . :H.. .LE.Lt7�..G Hol #:.><>»'::<> ...:.... ..HEEX. ..... t7► :......:.......... c.. ................:::.:.;::.:.::.;:.;:<.;.......:........:. ..,.,.. .::... .. .....it Texture Solt Colo oil Other Depth from •Soil Horizon�•• �Soil T. r � S Surface(in.) (USDA) (Munsell) Mottling (Structure,Stone oulderes. Con cy,% y Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. cousi&Na Gravel) - Ta':: o o` Hale<': :::::::................,....................................::..:fit:.....:...........:. ...::....::,..:..:.:.::::::::::.....:.:.....:.#....:...... :.:.::::,::..:.:::::.... Depth om Soil Horizon Soil Texture Soil Color Soil Other fr Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Gravel)Consistency,% Flood Insurance Rate Maw Above 500 year(food boundary No� Yes j^t; Within 100 year boundary No— Yes Within 100 year flood boundary No_ Yes 7C��iJdV SF 2 y 'Depth of Naturally Occurring Pervious Material 4. Does at least four feet of naturally occurring perv'o s material exist in all areas observed throughout the area proposed for the soil absorption system? S If not,what is the depth of naturally occurring pervious material? Certification 1 certify that on — S-,(date)I have passed the soil evaluator examination approved by the Department of En ironmental Protection'a d that the above analysis was performed by me consistent with the required traini �Iertise a d e r nce described in 310 CMR 15.017. Signature Date Notice-, Tbislorao is.' n 4e Usd For the kepeir Of FaNd � Septic Symms Only. 4 yEACOLATION TK";,AND S0M EVALUATION VMWZPTION F0TLN1 x, + r�L S�,_ 0 ,hereby c `y that wo cSiu sd pla eigand by we dated rho property looaetod u �� A-� �w aaaate 11U att'hm iaugwio;a:ifaete: + 'Thr teilad system is connected m 1 1eai9e4 itl dwedliM oe.1y. There 0 tto ootemasial or buslaa uses mooiaW wft tho da+eiliap. + The soil to ol"siflod a CLASS I wd to peraaiahott rate to let,tb#A or®quaff to I minutaa Per inch'. The alsgt00� my use hi+w®rloal d"to eoneltitde.lt or�ooaduot peeli�inery teats eat the sltm but a basith egont�Hseat . o There Is to iacroate Inflow sadly obmp in-vim proposed • TWO at no va imoee f9pathd or needed. + The bo%om.ofthe prapoied-leaab s 4+AWY w%be lN04 no Iess to five fo above the miximuna 4ueted-8m'-%dw6ter ttblo etovstift-EMUM the ptoudwaet pia using the Frl�ptor methodvi►l1ee.�liotisle) plews complote the t!obwUll A) TOP of Oround Budget glevRt►oa(using 011 iAtersnetton) 8) C�,W,81ev®tson +s ►s�eet fct bit Ae�V,�, 3 0 `pEA8NC8 8ETWW A And a10 ( `� 8ss upon thr shove is os t3�,a Muir MMIT W1U be iamd b bedtoorae ! modmum. No ed�iansd b*oo=us au*9 t a bti the tl�tesa�thAut eaglaeetvd sepric sy+tsm' ' Q�ao�tthlbtdar ue ' a � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ✓�ap Parcel Q/p O Permit# 6v12 .Aealth Division .�i /G= I" Date Issued ,conservation Division Fee ✓Tax Collectoz� INSTALLED IN Ct �Ll � Treasurer /7' �C� � WITH TI�'L�° � , ENVIRONMENTAL CODE AND Date 6ef� T u'tt R Q L ;` J Project Street Address J Village Cili A� Owner G o A L Aii Address Telephone og> Permit Request �,�.�1/�p,;�' = I.0,—i 10 ?.> 1f /�' Square feet: 1 st floor: existing- proposed=i-- p J 2nd floor: existing /Z ��(av V g proposed �� Total new t ,�. .��. r� v `L�3 Estimated Project Cost dAA Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size /y44 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single FamilyA Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes No On Old King's Highway: ❑Yes No Basement Type: XFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) �� Basement Unfinished Area(sq.ft) N//I Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing_ new _5' !1 Total Room Count(not including baths): existing new-. First Floor Room Count Heat Type and Fuel:*Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes �W No Fireplaces: Existing l/ New Existing wood/coal stove: ❑Yes ❑ No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage existing ❑new size I4�/_�Shed: ❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use ��BU1<LDER INFORMATION Name i� u.� Telephone Number Address License# Home Improvement Contractor# �z= L��- Worker's Compensation# LL O S RUCTION DEBR S,RE LTINP FROM THIS PROJEtT WILL BE TAKEN TO �? SIGNATURE DATE No......................... j. Yzic ...... ............... THE COMMONWEALTH OF MASSACHUSETTS B0ARD ,.,9F HEALTH .......OF,.. --- �" ... ------- .. ------------------------ Appliration for Bispaoal Vorkg Towitrurtion rnmit Application is hereby made for a Permit to Construct ("--or* Repair an Individual Sewage Disposal ................ ..Z�(y. ........6 r... ... ...................................... ..... .. L cation dress or Lot �:... ..................................... . .... . .................................... ......... Owner A re ------- ........ Installer Address Type of Building Size Lot{�,._;7.6.�...Sq. feet U Dwelling—No. of Bedrooms.......... ..............................Expansion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons....._.._.._................ Showers Cafeteria Otherfixtures .................................................................................................. ................................. < 0 W Design Flow._....... t/..........................gallons per person per day. Total daily flow..... -V .....................gallons.04 Septic Tank—Liquid capacity............gallons Length................ Width._............_. Diameter....._....__.___ Depth........___..... W Disposal Trench—No..................... Width-................... Total Length...._............._. Total leaching area....................sq. ft. �4 Seepage Pit No--------------------- Diameter-___--_---__-------- Depth below inlet........._.._._..... Total leaching area..................sq. ft. Other Distribution boxDosing .. �_q /6 Percolation Test Results Performed by . ... ...................... Date---/c —. _-.$;?el ................ Test Pit No. I................minutes per inch Depth of Test Pit.___..._ .......... Depth to ground water-.-----___--_--_--___--. (14 Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water._.___......-........... P4 .......... -----------------*........*---------------"--------------- O Description of Soil---.. .......................................................... .....................................a.— U .... ./....... .......................................................... N -------------------------------------------------------------------- .......................................................... Z U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of L I'�LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Co i ripliance has been issued by the b and of Ith* Signed ....... .......... . .e�. . . ....... 2 igned... ................... Date ... .................. .................. Z-0 Application Approved By.............. . .... ...... ......... ................. Date Application Disapproved for the f I owing reasons:................................................................................................................ ............................................................ ........................................................................................................................................... Date PermitNo..................................................... Issued....................................................... Date No.--••••-•-•--••'».....-- Fizz..........................._ THE COMMONWEALTH OF MASSACHUSETTS BOARD PE HEALTH Appliration for Disposal Works Tontrurtion Vprrtnit Application is hereby made for a Permit to Construct (�r Repair ( ) an Individual Sewage Disposal System at:•yx .. u 7-- C...... i� ••-» - '_!- C i ,.'d Location! ddress ......................................... ( ✓.!ter_ / !r+<. ------------ �.�.... ..�'.� -------•-- ------•-•--------•---•...-•---------- ►Wa 1 t�/' i'!��%.[� Owner ...i----- - �..-� r�------------------------------------ dd Installer � Address Type of Building t ; Size Lot; :�__,�. ....Sq. feet U� Dwelling No. of Bedrooms..........-a .......................-----Expansion Attic e 6) Garbage Grinder/()o) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other ...................... per person per day. Total daily flow----i� ........................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing`;;Lnk ( .) ~' Percolation Test Results Performed by.,.._� -7�=------:=-' '...... ._.%'' "' Date../'" .............................. --- Test Pit No. I................minutes per inch Depth of Test Pit-,_-__-:= ._._-__•• Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ---------------------------------------------------..•.... ....-----.,-------•-------------------------------------------------------------------------- D Description of Soil•• -1 ......... „ .... ......................................j ` <� ` = . /\ ..........................................„..........•.........}_:'� _ �! .- `� l: :.cc_...t:c.__f'w ..... /!.................................--.............__...._...•.._ .. V Nature of Repairs or Alterations—Answer when applicable............................................................................................... ••••••••....••••••••-••••••••••••••••••••-•---•••••-•--•-•-•••••••••••••••-••-•••-••.....-••---•---•--•-•••--•-••-•--•---••--•--••-•....•--•••••••••-••-•••••••-•-•-•-••••••••••••-•-•••----•-•---••••-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Co pliance'has been issued by the board of health. Signed_._./ jn ' �'� ,c% ----------••---- � ... � Application Approved BY Date Application Disapproved for the f to owing reasons----------------•---------= -----•----------•-----•---------•-----------------•••-•-•••-•-•••-••......__....-- ......••........................•--- ............ Date Permit No......................................................... Issued...........•.. . Date THE COMMONWEALTH OF MASSACHUSETTS BOARD Q.F HEALTH ....................... ..................OF..... .,.r'i' _f� ................. Trrtifiratr of Tontpliatta r T XS IS TO CERTIFY,^That the Individual Sewage Disposal System constructed ( or Repaired ( ) bY......(�/::.�� . -` c1 . ✓-f!,x -!....•----------------------------------•--•-----....-•---------••----.......--•---------------...........---•--------•-----. -� . ref d' Installer t 1 Yd at `- 7 _... `= �' - has been installed in accordance, ith the provisions of �fTZE 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 CO 'TRUED... _ AS UARANTEE THAT THE SYSTEM WILL F CT ON SATISFACTORY. DATE................ ........-•.......................••-••... Inspector---...... ------•... . --•• ...._. ........_ . _THE COMMONWEALTH OF MASSAC USETTS BOARD OF HEALTH ..................... No -•••..... ....... FEE.—So Diaposal Workii Tontrt ion rrntit Permissionis hereby granted--.................:.......................................................................................................................... to Construct (r oriRepair (;/)"an Individual Sewage Disposal System at No. :..-----�.I.....11_4ir-r'.! / .-f. i/ ---Street----------••--- as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ...................................................................................................... DATE. _�S Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON i , i NO _�GQ,e, GEC !•�c�E,e r 7 j o ' Usk/aoa 1;41= - r .3? G P;O o M_M _ �.t.EGT►2-� o L°-- 30 OAS/G•r/{ ��cv4, �TaN�s24�'' /v'pQq,a i Ldas�Nt=f �, .~ 1 �-- 1 C!{ARD c t "�' ` PETERa N 1 ' o' SULUVAN { "' ` M 1 �. T. _ ,No 29133 i _ - -�-3 STB r l:S'Pfc - - �Cr I f�G-, � t A�l1a MA u. r t BOX /N✓ GAL; [.Faqir air o I , .frlsyE ¢.z 9'f G',E.2T/F/EO �G OT. .pGAN t ' r • { -I � N t LoG.Q Ai r�7z: a J. �/� -01-SG t - �1f3o 9 70 71,►,4;77- Fo�.us�q� PLg o� 3�1 P,gGC. ; � �I'I�/�G,� x �N U,e�Eya.P� !7"OWO/'-#dF:.. ARNSTq LC i , r L C+�STE.e[i/GGc GDC.Q �; �� i r l z �-� ; ; � f ' : . '� +A,�,�%ca;r'7-:- �-,9/�fE s /L S•y.ry. ` I . 1 e T/�!r — r E ' LOCATION 03 SEW GE PERMIT NO. e VILLAGE C 011,LC- IN ST ALL ER'S NAME ADDRESS L/ 1`f�`2/l�c� /3 S 'X -c U I L D E R OR OWNER Sri DATE PERMIT ISSUED `- `' DAT E COMPLIANCE ISSUED .� �� AA Ff?o r-- oil 0 -q lid �/ Q POP OF FO UjAWATf011 EL P(z C. t f a ,-� _ Ply L''>s% �/O 1 6 3 GROUND SURFACE EIS_ ��'• - GROUND SJRFACE, EI " MIN - 1 Tt�S I'�:4 R f �l5 r 4."CATI??.�S! SEPi"it 5 Y5'ti '1. IS �4R �f�6 L �.. - OUTLET PIPE LEVEL 2, ,44L IIssTALC,AfO,'r P1>'OCL17�J>' S AIVJ F!a1: 4�4LS'-SOAIt G'Of1 OflM Z0 316 Ct�i/1 ..�3avP Tft:L�' ST,42r �/IX�b�ilM n 7A . C'Ct0( FIRST TWO FEET U M O VENT REQUIRED - -- - -- ---- � " ��_. _� 71T1.E 5. AND THE TOWN OF __��_^I.S r-7�4rs t. LIQUID TEL TOP EL _ — _____�_-__ SUBSURFACE DISPOSAL REGU�ATIOA-S. � ~ MIN 2' LAYER DOUBLE WASHED 3) NO DETZRirflVA=;V' N_4S 8LE11' _IIs;DF, _45" m C011fPLRU�1U qF AVA.ILA/3T.L PROPERTY fN�'ORaI�TIf.IrV WITH R.A P R DEERS ' 1 lO a - D-BOX _ 1/91- '1/2• STONE D_z ZOA-ZVG RErULATI011'S "' INVERT EL 14 G `` - 2 4 4) TO,17V WATER SERVICES THIS PROPERTY EFFECTIVE C 5 GAS BAFFLE AT OUTLET �"sTnN� E t ( , ) , IN EL -�, - - SIDEWALL 5 THERE ARE NO KNOWN PRIVATE WELLS 011 THIS PROPERTY OR WITHIII' 100' OF THE PROPOSED SOIL ABSORPTION SYSTEM. INVERT EL INVERT EL 6) ALL CO 17 RS OF SYSTEM COMPOAWAITS SHALL BE BRO UGHT TO WITHIN .2" OF FINISHED GRADE, WITH ONE CO VER OF THE S, c� D - Bo }-o _ ' g'_[� Z�f a*� SEPTIC TANK BROUGHT 19TI-IIN 6" OF GRADE. (7�p�ca1) g L'- 1 1/2' DOUBLE 6" STONE BASE INVERT EL INVERT EL CoN c_ C G�Ar^ ��S C° / 5,M:�� 1ASHED STONE 7) ALL SYSTEM COMPONENTS SHALL REIL41N ACCESSIBLE FOR INSPECTION. NO STRUCTURES SHALL BE LOCATED DIRECTLY s , W I y STv DrJ #(D& 5 UPON OR ABOVE THE COMPONENT ACCESS LOCATIONS, WHICH WOULD INTERFERE WITH THE PERFORMANCE, ACCESS, INSPECTION / SoO Gal Septic Tank BOTTOM EL PUMPING OR REPAID 3 ' (Typical) l ✓a S T "r(,.j u it A-I I T S •0 14 Z o O f" 1 T� E L � L{ a 8) NO DRI VEWA Y, PARKING OR TURNING AREA, OR OTHER IMPER VIO US AREA SHALL BE LOCA TED ABO VE A SOIL ABSORPTION BOTTOM OF TEST HOLE SYSTEM, EXCEPT WHEN VENTING HAS BEEN PROVIDED. 34 ' 9) SEPTIC TANKS, GREASE TRAPS, DOSING CHAMBERS AND DISTRIBUTION BOXES SHALL BE PLACED ON A 6" STONE BASE � — TO ENSURE STABILITY AND PREVENT SETTLING. 10) OUTLET DISTRIBUTION LINES SHALL REMAIN LEVEL FOR A MIMMUM OF .THE FIRST TWO FEET OF THEIR LENGTH. 11) ALL SYSTEM COMPONENTS SfIALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' OF DRIVEWAYS OR PARKING OR TURNING AREAS, IN WHICH CASE H-20 COMPONENTS SHALL BE USED. 12) ALL BUILDING SEWER LINES SHALL HAVE AN INNER DIAMETER OF 4" ANO SHALL BE CAST-IRON OR SCHEDULE 40 PVC. HAL YARD WA Y 13) THE DEPTH OF THE TOP OF ALL SYSTEM COMPONENTS SHALL NOT EXCEED 36" UNLESS VENTING HAS BEEN PROVIDED. 14) IN THE AREAS OF EXCA VATION, EXISTING GRADES SHALL BE REESTABLISHED UNLESS NOTED AS PROPOSED CONTOURS. TBM EL 15) IF SOILS ARE ENCOUNTERED DURING THE EXCA VA13DN OF THE SOIL ABSORPTION SYSTEM, THAT DIFFER NOTABLY FROM _ _ _ _ _ - - - - - - - - ' - - PROPOSED LEA CHING FA CILITY THE DEEP OBSERVATION HOLE LOG, CONTACT THE ENGINEER BEFORE PROCEEDING. Ex. P. K in Pavement _ _ - - -_= - - -- - - - - - ,7�-T-= - - - - - T - - - I 'I I I Fo ur 4 '— '—8 " x 8'—6" x 24 " deep Concrete Chambers 16) CONTRACIFOR TO VERIFY LOCATION OF ALL UNDERGROUND UTILITIES. ` Existing II I U (or Similar) with 4 Stone on sides Gas Line �� (to be relocated) II ; (Total Area = 34 ' x 12. 6 = 35. 14 ' I L = 81. 16 ' R — 1094. 64 R DESIGN DA TA L = 28. 63 I I DEEP OBSERVATION Existing I Prop i �, Note: Water Line ( �P, i V (to be relocated) _r I I O Ne W Front and Side Property Line Number of Bedrooms: 3 HOLE LOGj� Prop ` ; , o Gas to be staked prior to installation Garbage Grinder: NO Test Hole #1 D—.BOX 34 I I Design Flow-, �o (EL eY Soil soil Soli Linepq t} �l f Horizon Texture Color (110 Gal/BR/Day x Number of BR) (USDA) (Munsell) 4 I Septic Tank: I I I eb an '0q _�A ry p (Minimum = Design Flow x 200%) C Co /.) k Leaching Area:Existing G/ Leach Pit & S-Tank - to be pumped & - , I I 10' Min O Sidewall: filled or removed 10 ' I I , I Note.- Z' . -� I � � , (� Sidewalls x 3'"f_Ft x _____Ft) + Dee (as required) 0 7I J I Last two chambers to p oba Hole Data. 1 O I 2 Soil Evaluator. EX1St f U 7 Gn/L' be H-20 Units (2 Endwalls x 12-L._Ft x Ft I — ) I � i Witnessed By: ` Pero Rate: 10 , I m DEW I Bottom: q Z Soil Survey Description: CARVER i Y - �y � 1 Geologic MateriaL• OUTWASH 12.E g _-Ft X — —_Ft •` Depth to Standing Water. NA -4 T7 I I , L — — — — — — _. _ -- ) Depth to Weeping Water: NA [1 o Depth to Mottlin Color NA v.J b p (LTAR): 74 Eat Seasonal High GW: NA ., I � I (,J Lon Term Acceptance Rat,, U�g Observation Weil; NA Proposed Prop ��,_ Slab i ! Prop Leaching Area Design Capacity: S Date of last Mean ement NA p v i, Comments: C► 0. '�, I (�'1"1 `7� Ne W (Sidewall Area + Bottom Area) x LTAR 1. 500 Gal � � � ,; Septic Tank �`� �� Water Se � p Line oc� ( Full Basement qCrawl Space BLDG5 7 , N TOF EEL = ,• cci , �a 3 Bed Ho use Wood Decks�oro�wr 9 PROJECT LOCATION 1A A k_.0 wA y AS> -_ErJ-T�_r,-xj I �_LE oA �SSL5SOR5 M,4P el LOT v to lv -- it G A.PZ'f I CiV17 00' 00 oP � 1 e 1, = /S jlin/5eE 1�1t ✓E i South Y,:1fmu✓tk 04A 014v6�- i wEPQ err" \ (wog) 39q 2723 F I I SEALC- ( = ICr AL 5 7 N A t!i.-A R-O NAY t�l�✓G. M) SW6t-T o F l �