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Home My WebLink About0032 JACKSON AVENUE - Health 32 JACKSON AVE. CENTERVILLE A = 266 079 !J ' Commonwealth of Massachusetts a9v2 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 32 Jackson Ave. Centerville, MA Property Address Kevin Shearer Owner Owner's Name information is Centerville MA 026 6-15-2015 required for every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:when filling out forms A. General Information on the computer, use only the tab 1. Inspector: 41 key to move your cursor-do not Darrell Stone use the return Name of Inspector key. Cape Cod Septic Inspection YQ Company Name P_O. Box 1466 Company Address Harwich MA 02645 Cityrrown State Zip Code 508-240-2500 S14995 Telephone Number License Number B. Certification C2 'I°i 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: ® Pa es ❑ Conditionally Passes ❑ Fails ❑ N Fu her Evaluatio he L al Approving Autho 6-18-2015 I sp o 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 conditions of use. V t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 1 of 17 r. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Jackson Ave. Centerville, MA Property Address Kevin Shearer Owner Owner's Name information is required for every Centerville MA 026 6-15-2015 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 ariy information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 J Commonwealth of Massachusetts f a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 32 Jackson Ave. Centerville, MA Property Address Kevin Shearer Owner Owner's Name information is required for every Centerville MA 026 6-15-2015 page. Cityfrown 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 32 Jackson Ave. Centerville, MA Property Address Kevin Shearer Owner Owner's Name information is required for every Centerville MA 026 6-15-2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: A 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 '/day flow t5ins•3113 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 32 Jackson Ave. Centerville, MA Property Address Kevin Shearer Owner Owner's Name information is required for every Centerville MA 026 6-15-2015 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_ ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. 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 32 Jackson Ave. Centerville, MA Property Address Kevin Shearer Owner Owner's Name information is required for every Centerville MA 026 6-15-2015 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following.- Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been e 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): 5 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 550 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 ..r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Jackson Ave. Centerville, MA Property Address Kevin Shearer Owner Owner's Name information is required for every Centerville MA 026 6-15-2015 page. Citylrown State Zip Code Date of Inspection D. System Information Description: 4 bedroom residential dwelling Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 273.97 gpd 9 ( Y 9 (9P ))� Detail: This property has a lawn irrigation system 2014- 101,000 gallons 2013 99,000 gallons Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Jackson Ave. Centerville, MA Property Address Kevin Shearer Owner Owner's Name information is required for every Centerville MA 026 6-15-2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Unknown 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 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts a r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 32 Jackson Ave. Centerville, MA Property Address Kevin Shearer Owner Owner's Name information is required for every Centerville MA 026 6-15-2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2001 per BoH Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 26"+/- 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.): Apparent good condition Septic Tank(locate on site plan): Depth below grade: 20"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) It tank is metal, list age:g years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallon Sludge depth: 7" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 32 Jackson Ave_ Centerville, MA Property Address Kevin Shearer Owner Owner's Name information is required for every Centerville MA 026 6-15-2015 page. Cityrrown 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 25" Scum thickness 1/2 Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grade to inlet cover 8" Normal liquid level No sign of leakage SCH 40 outlet tee Recommended next pumping within 2 years Recommended maintenance pumping every 2-3 years 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts _ F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Jackson Ave. Centerville, MA Property Address Kevin Shearer Owner Owner's Name information is required for every Centerville MA 026 6-15-2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:,Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments kM 32 Jackson Ave. Centerville, MA Property Address Kevin Shearer Owner Owner's Name information is required for every Centerville MA 026 6-15-2015 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 0 11 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.): Grade to box 40" OK condition 3 outlets with speed levelers No scum Normal liquid level No sign of leakage No sign of failure 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 Fonn:.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 ,M 32 Jackson Ave. Centerville, MA Property Address Kevin Shearer Owner Owner's Name information is required for every Centerville MA 026 6-15-2015 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1 (15x50x0.5) ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 1 (15x504 5') Grade to trench 10" Bottom 20" Clean/Dry No sign of hyfraulic failure 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-3f13 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 32 Jackson Ave. Centerville, MA Property Address Kevin Shearer Owner Owner's Name information is required for every Centerville MA 026 6-15-2015 page. Citylrown 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Jackson Ave. Centerville, MA Property Address Kevin Shearer Owner Owner's Name information is required for every Centerville MA 026 6-15-2015 page. City/Town 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 C)t\ f i 1 r I t I I I i •1 .1 3 ' 0 Q Ho -6 2 zo-v (6- 6 3 ,9 9 { 6 1 !� t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 32 Jackson Ave. Centerville, MA Property Address Kevin Shearer Owner Owner's Name information is required for every Centerville MA 026 6-15-2015 page. Cityfrown 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: >5feet 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: 2000 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Plan on file ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Elevations from design plan Bottom of SAS ELV. 100.9 Adjusted GW ELV. 93.9 Separation >5' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 32 Jackson Ave. Centerville, MA Property Address Kevin Shearer Owner Owner's Name information is required for every Centerville MA 026 6-15-2015 page. Cityfrown 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 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 N. TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE z e k:prK jam/LC e ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 9 2- SEPTIC TANK CAPACTrY I SOo LEACHING FACILITY: (type) L t _ (size) K-0 K I r NO.OF BEDROOMS s� BUILDER OR OWNERc�� PERMITDATE: _COMPLIANCE DATE: I (0. 1 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 ao/'q� ;-nq d rp 13T i 0 '. IY i.y F2 G.'�` - .`r '3'.•y 7 �, 07� CaSx ID51tis .. 0 1 LOT l' tLOCK I .� , DBA J ..�.1 I. - o- r } tl t�'er a 't,) .L%E S(" 'I P' Ct"�N 4. BYL �T,'S �?I /'E,i'�i� �J��I��'�r/ ��—w i�A L j�tug Pf,�r'!.,�I 5" !1''.t )"�,; )..T �, �.� 1�L.I�r N.ri t; .RESIiO tT"��i�''rl.�AL ram. �rA ��•i i. ,... —DECK .E._'.t'.Ii'a2'.'Y CV Department of Health, Safety - Kc-'L.t''�' ' EX ',! :; and Environmental Services OTA11, tiI t 1j�.Va•JJ.'s'.tK.E`�.' ' '`\1 (-tt zC`n5 80 d AI r'A .; x'''}i:lx t.;E`.I,., lxl' i.z. .l �, 'il BARIV 'I'AS BUILM"ING'DIVIS ONry t By 4 `•A, ri T'•i C°�.� i�.:•i} i 12 7 "/ 1 l r rr._r ,rs t .. L nja.r�L,L r' i/:�.�. '. — .� j`):_'1.:..i0�'r .i_—1 I THIS PERMIT CONVEYS NO RIGHT TO.000UPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE'SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK:. APPROVED PLANS MUST BE RETAINED ON JOB AND 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION WHERE APPLICABLE, SEPARATE 2. PRIOR TO COVERING STRUCTURAL.MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- PERMITS ARE REQUIRED FOR (READY TO LATH). PANCY IS REQUIRED, SUCH BUILDING SHALL NOT BE ELECTRICAL, PLUMBING AND MECH- 3.INSULATION. . OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. I 4.FINAL INSPECTION BEFORE OCCUPANCY. ,03 Na i BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 142 fvo � Z3 2Sly 2 f�A ^ � 3 1 HEATINGY SPECTION APPROVALS ENGINEERING DEPARTMENT Ito V v l 2{,� fVP S/ vlc B RD OF HEALTH OT R: SITE PLAN REVIEW AP OVAL ! IL V I F K SHALL NOT PROCEED UNTIL PERMIT ILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS NSPECTOR HAS APPROVED THE STRUC ION WORK IS NOT STARTED WITHIN SIXCARDCAN BE ARRANGED FOR BY OUS STAGES OF CONSTRUC- MONTHS OF DATE THE:PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA., NOTED ABOVE. TION. J rf s x �t�WN OF BA1tNSTABLE s 94 �� 0� LOCATION 7 TA,- FAV SEWAGE # VILLAGE '' L'i~e i r1; j LC �' ASSESSOR'S MAP & LOB u.. `. INSTALLER'S NAME 8c PHONE NO. T/t F e WALk _ / Z j SEPTIC TANK CAPACTIY I.SOd 6-,JLL.6—J LEACHING FACILITY: (type j-- (size) �D ) -' �.CI NO. OF BEDROOMS BUILDER OR OWNER Z.c 113 S%K4e1 —tt— PERMITDATE: 11 ICE 1 COMPLIANCE DATE: IU Separation Between the: ° P _. Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water SupplyVeil and Leaching Facility (If any wells exist on site or within 200 feet of._leact ink facility) Feet . Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet JJ Furnished b}! I... . B O . w LL o q Gti 12 ' 1.1 trJROUJ z X (orrw F�p mPp -I O Ftk 3 � q — ,� i— �� Pow eC-�- Czy,CJZQ C J ' t04LL -" — S-re P�c4 ON if //c/,� ajIzL7vlh�— e �gM. /3 eq�t Cady o f ..�9 N1� ToiS PA�n oN T T�}l� w9L� I ,peA �,��,�� ,✓o '�.�L� z2-z 3 /L w�� Ci' _ —ter — _ _ _ 77 . � z �' - ► I lU� r31,-s',r,T.. i W INCOta� N 9 ►�� C�,ti � _ h_1 + P ----- -- - - -- Zor / / O/NI 66T//{/may ' /Z .r LL =- 1 I '( -: - r 4PR nMz - M _ pl- Q(JC� .adlKo-.-.-=;-., - YT 21 ,eo aN.1 3co' ou-*PL S O�z t L }66 M zI '' 0g� I d II f� 157, Mr I � Ov�rJ �esl< pQy Gas � wal.L I S s 3 r3 i I i o� � `� ' ', ,='1 I I to :i4 j `'� ' `S• Icam. ! hi .4 i( i , g O I �y ' � •I ,, , t I -7/f �rn�nwi it it I i ENT.t y i I —.. ---- 3 L i 2 e _ ' vrdc kZ I r sT N v- x ram_-. ' • l ._ _ t 4� S-vkA )i %�� \ —� �� -54 TT 30 _ F N 1 + m s :j u Ir i „Q C L145'f ;� a 4 I 7 s 2 elLST I ✓2 l�l._ , I i" I� � �GSM.>��'^ I �iv22W 110 t it I I a v . 7VP 09F STANDARD NOTES -- GROITND SURFACE E4- GROUND SURFACE ----� MIN 1) THIS PLAN IS FOR THE INSTALLATION OF A SEPTIC SYSTEM COQ re-aft. (A k 0) - I OUTLET PIPE LEVEL t 2) ALL INSTALLATION PROCEDURES ANI) MATERL4LS SHALL C0IVF0RM TO 310 CMR 15.000, THE STATE ENVIRONMEVTAL CODE -- FIRST TWO FEET C� VENT REQUIRED I O 1.ct TITLE 5, AND THE TOIVN OF � P-.�15 /�� `..C� SUBSURFACE DISPOSAL REGULATIONS: 'TOP EL ' MIN 2' LAYER DOUBLE WASHED LIQUID LEVEL 3) NO DETERWNAI70N HAS BEEN MADE AS TD COMPLIANCE OF AVAILABLE PROPERTY INFORMATION WITH RECORDED DEEDS D-BOX OR ZONING REGULATIONS. •. .:-•':.:•.:•.:•.: 1/8'- 1/2' STONE INVERT EL 10 " r�-� •�c� k . 4 IN 14 .Er:::::::::::� rw _.._ �- �- - ,; 4 TOWN WATER SERVICES T K 'Yl. _ _ r t P`' r �� r +1a l � a . , >n��..r _Y.� ,.-•> , � �ry = � �:� +� PROPERTY otot. •---� ti.: "y „ � -, .-• .,. " .�, .. . �....v-,...,,_.._ C-' .. EFFECTIVE l0 5 t �E s - �,�ty�_ t , .•,�,• at :v� � 5 THERE ARE NO KNOWN PRIVATE TE )!ELLS ON THIS PROPERTY OR WIT.ffIN 100' OF THE PROPOSED SOIL v_ �" r. r t' SIDEA'ALL ) ABSORPTION S �O Z 7 GAS BAFFLE AT,OUT INVERT EL _�L�� • YS?E'M •' (3 A 51E. INVERT EL INVERT EL 6) ALL COVERS OF SYSTEM COMPONENTS SHALL BE BROUGHT TD WITHIN 12" OF FINISHED GRADE, WITH ONE COVER OF THE 102.0 /5 So t-CA � , SEPTIC TANK BROUGHT WITHIN 6" OF GRADE. ' 3/4 1 1/2 DOUBLE INVERT EL g-- (Typical) / WASHED STONE 7) ALL SYSTEM COMPONENTS SHALL REMAIN ACCESSIBLE FOR INSPECTION. NO STRUCTURES SHALL BE LOCATED DIRECTLY 6" STONE BASE INVERT EL UPON OR ABOVE THE COMPONENT ACCESS LOCATIONS,, 1VKICH WOULII INTERFERE WITH THE PERFORMANCE, ACCESS, INSPECTION 1500 Gal. Septic Tank �3iC�t'�f2�'3T` >t..t 110 BOTTOM EL PUMPING OR REPAID (Typical) t 1...)f��1��2 EL �t 8) NO DRIVEWAY, PARKING OR TURNING AREA, OR OTHER rNPERYIOUS AREA SHALL BE LOCATED ABOVE A SOIL ABSORPTION. 5•, ��S i' <N��J41� BOTTOM OF ?EST HOLE SYSTEM, EXCEPT WHEN VENTING HAS BEEN PRO VIDEO. 9) SEPTIC TANKS, GREASE TRAPS, DOSING CHAMBERS AND DISTRMUTI0Y BOXES SHALL BE PLACED ON A 6" ST10NE BASE 1. TO ENSURE STABILITY AND PREVENT SETT7ING. 10) OUTLET DISTRIBUTION LINES SHALL REMAIN LEVEL FOR A NINVIMUM OF THE FIRST TWO FEET OF THEIR LENGTH 11) ALL SYSTEM COMPONENTS SHALL 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 HA VE.AN INNER DIAMETER OF 4" AND SHALL BE CAST-IRON OR SCHEDULE 40 PVC. 13) THE DEPTH OF THE TOP OF ALL SYSTEM COMPONENTS SHALL NOT EXCEED 36" UNLESSS VENTING HAS BEEN PROVIDED. 14) IN THE AREAS OF EXCA VATION, EM STING GRADES SHALL BE REESTABLISHED-UNLESS NOTED AS PROPOSED CONTO URS. 15)_ IF SOILS ARE ENCOUNTERED DURING THE EXCA VATTON OF THE SOIL ABSORPTION SYSTEM, THAT DIFFER NOTABLY FROM THE DEEP OBSERVATION HOLE LOG, CONTACT THE ENGINEER BEFORE PROCEEDING. 00 16) ' CONTRACTOR TO VERIFY LOCATION OF ALL UNDERGROUND UTILITIES. j EXCAVATION ATION NOTES DEEP OBSERVATION 00' 2 6 HOLE LOG 1) ZYG'AVATS' ALL MATERIAL ABOVE SOIL HORIZON C (SEE DEEP OBSERVATION x - Test .Hole \ HOLE NAG) AT APPROXIMATE ELEVATION Ft�R A LATERAL DIJ'TANCE OF 5' # (WME POSSIBLE) IN ALL DIRECTIONS BEYOND 7IiE OUTER PERLi>*ETER OF TINE L"Et�Ca-1 P�2la F\ (EL = 1 b o,l _b) p ev SoII Soil goil 2) FILL MATERIAL SHALL C0IIrS'13T OF CLEAN GRANULAR SAND, FREE FROM ORGANIC �m �tt) Horizon Tezture Color EXIS�. MATTER AND OTHER DELETERIOUS SUBSTANCES, IPHICH 1;f F= THE TEXTURAL (USDA) (Munson) / t \ \ Shut-off CRITERIA;PUT FbRT7 IN SE�C77ON 15.255(3) OF TI ZE 5 0 - 8" 9 c),j 0/E 10 YR5/1 / 0`�' 3) SCARIFY TfIE BOT7VM SURFACE OF THE EXCAVATION PRIOR 7V PLACEMENT ,� ' OF FILL I1V7n TIfE 1?E'TABVVING STRU�'771RE 8" - 26" .y B Loamy Sand 7.5YR6/6 \ _ Pit 4 PLACE FILL ONLY WIMP B0T'7VM SURFACE IS DRY. / �, \ ) j 26 - 133 b ).o C Coarse Sand 2.6YR7/4 57. Cravel -� `SO '' \ TEM EL 102. 70 /S jr ` t \ �� Q �� T�]� of Wa ter Shut Off Deep Obs Hole-Date: NOVEMBER 1, 1998 C Soil Pbwlnw l+r 3'D'ST0NE DESIGN DATA DONNA MIRAND.1 1 I tnessed Perc Rate: " J - ( 2 XIN,/IN A 96 1100• -J /�l `- '.i 1 Soil Survey Description: CARVER �• _ y I t7 Z Geologic Material• 0U77IASH Q� 1 �_ _ = 1 t \ �51 Number of-Bedrooms: ,� Depth to Standing water. 88" tiJ - I r er. to wee ing Water.. 9B / 41 r r~ ` `�. O L- r'o i' a ter'_ Ll.�e I `10� Garbage G ind NO Depth ( .. 1 _ \ I, De th'to Mott ' Color): NA Design Flow. `L h seasonal lgn Gx: 4.x' -Ij USG9 Observation _ (110 Gal/BR./Day = Number of BR) well: IIIII 29 ` •� P j 0 Date of Nast Measurement OCT 1988 ti D� ` Lo 1. '�• Q -Septic Tank: Comments: , _ _ `� , /, Q , - (/ / Gc/ O ! (Minimum = Design Flow z 2007n f 0 0109. ,8 - Sq 't Leachin Area: • 8 DEEP OBSERVATION SidewalL• HOLE LOG (4 81dewalls s _� z.__ `t) + 1 Q (4 l3Yidwnlls z. : m) Test Hole #2 rt Y t ; Bottom; 1 Dppt�h P�ev Soil Soil oil S ) 77 lm/ ln) Horizon Torture _ ,� � - _ j • ¢ _ 6i ' `w•. / / \, �l� I � . .. _�.� x ....._�_f`t (USDA) (Munson) Lon Term Acceptance Rate (LTAR): 0. 74 O�E 10 YR5/1 0 , . o P / �� / Leaching Area Design Capacity S 5 5 Test ,� \ tea® / ._..,.,. G 2z 4 J / (Sidewall Area + Bottom ArealArea}' z.•LTAR -`-�.� 6 �1 S. Loamy Sand 7.5YR6/6 � ! � B Lo m k ti► IV ". o� \ l9 � ./� �' � � � � � � 46 - 126 S9, C Coarse Sand 2.6YR7/4 57 Gravel i Q/ / _ ... Deep Obs Hole Date: N0V1SiVBER 1. 1998 a F Soil Evaluator. ED STONE . 1 �t - / i F y Witnessed By: DONNA XIRANDI g Pere Rate: < 2 JfIN/IN O 78" 1 Soil Survey Description: CARVER Z . WINM.SLOW = St'oF m Geologic Material: 0UTIIASB SP0FF0R0 d• No.23 RD Depth to Standing Rater, f04" b '� a .l ` � � /�i � / �J e� I , p ♦2a.'�3 G r � ,y � � Depth to Weeping Waiter. 104 ,� X ! 2 IC S 3 2 o.9For �' �� r o� Depth to Mottling(Color): NA j 1 co Ou � stE4 �0 au Est Seasonal High G11: " Ol' a t'Uf�� hl / .�✓� , bb C TONAL USGS Observation Hell Mrjr 29 • �� Q (� Q` o Q� Gi/ Date of Iast Measurement: OCT. 1998 F Comments: 4 � •` � �g I � � 0 I 3� /ot ° �" f SS(o G r Yam, �� PROJECT LOCATION Y v` 1 ASSESSORS MAP LOT S~ APPLICANT o AS F , �o o. 0 4{ 3 �l L 3 t(Z pV PREPARED BY. Eatic-- ��.. ,l A & M Land Services (' •D�C� y e 4 y ^i�/ '' od u L_' -\,� s kA- 70H 33 Old Main Street I s _ ( ,, - ..._.�.-:.._.-.._.- .... South Yarmouth, MA 02664 ,�- (508) 398-2121 Fax 394-9642 "D>ara,L\—L W GSM _m. SCALE` \ =10�-� DATE.• 2 3 �1 o Vi pisREV LOCHS MAP / 2 +vIL - -A 4 DWG. NO. �i°I`�'"S SHEET 1 OF 1 f r .rr♦y'r'_.y c 4 T »u' •••'I' `y..r •`' 7i !. . ,J; ' ;. ;� � � ..= 1 fir; 9 l +, "+ ha •«' +nfi F. + r *+rc "1. .1 4 _ r+ }} :j - v +'Y" u. , tF c r i '' r y,f .r '1 ' ' , •r [ + A ' x x 'July 2,:1986 " . Ry • ° ,: 41 ��,.X.h^^. f _e F. r •f ra' '*L«.� r .r .� `cv, i r M'• �•i 3' y 4 `t+« ' - •f" i..r '�st t�«rid ';, . -Mr. Joseph:Stefens ` '1085'Phinney's Lane Centerville, lvl'A 62632 �„ r.«. f . a y ,,, 'Ir k , ♦. ' ..r;K nJ ;� a. ♦ T _ < i 4t , t _ - q j • ! ` Dear Mr:Stefens •« r You are granted a variance,from•,the'� Boa«r`d a of. Health Regulation prohibiting the, installation of ,on'-"site�sewage,dispo al-systems on inarginalr lots',The, variance granted •' '' is for'i'ot 12, .Jackson-and-Centerrville. Avenues, Centerville; and :allows.the. installation- '" of an' on'-site Sewage,disposal sysaem with 3.3 feet of natural, pervious material'beneath ; .. , . . they bottom'of, the'system; in'lieu of'thi i-re.quired fourrfeet, after-making the'adjustment required�byz the.United States`Geological,Survey.High P.robabler Groundwater"calculations. • This;variance`is.contingent upon it 6eting;06,following conditions. ` -? h� .x 4 f x j . (1). The designing engineer must °be.on site and 'supervise construction of the' septic ` 4r ;+ system+and certify in writing to the Board of Health-that his design has'been strictly,f z : � adhered'to pronto the issuance of a'Ceyrtificate of Compliance.. 1rf r� x x ! r t` ,a1 >` .+ T�r''F r '$' �y' .•r'�k �', i •} .." A .,.•. + ,., (2) ,All-unsuitable •material must lbei'removed;,and, replaced .with Mclean, :granular fill a + ten feet in'•ill.directions from the leaching flow-diffusers r, " �(3) AllSothei requirements offi Title-5; and the Town ofkBarnstable 'Health'Regulations r 3 S ,« r {� ,�• i'• T s r ; r « Wit. must be strictly adlierecl,to " 'i` + ,. .k.r ',: r' f . ; _ `f• x ..: .'+.s ', �w Tbis variance.expires•August 1, 1987. , `.t4 ': .. � .c" «,..,. ;f-. K2r,Y.. •�'a' !, .yt � i t_ "T �Tfiis varianceis,grantedRbecause the}surrounding.area+is developed ,''There•are no wetlands J e=` involved:`:The,s61l,,obs6rv&ti6n pitsi-did not show any iron`oxide*layers and:'slightlq.over r:. six feet'>of,,naturdVoccurring material'exists prior to making the United Stat�a Geological'` ' r!' ► 'ro c ti,r. i., Survey adjustment,- d' •,,, r `« A h 1 w1 7 ,`J •y A t 1 ci r s , :.� x."M 4L:. { - # a `�' t '•. r 5 !• 4 xi� r.^. +f"k"r.F• � , .r 'rr "' a `. t c ' r � ., 'rj, c J 't•� - r .. 'cF x+', t7 V`j Y�'r � y l.st `4��t��-r � ��r r r ' ' V T. raj .}a +g. ..r ob ., I.,Inan...S. :a. 7. $ t { ', r •. .w a a * : .; o- J .t f t e, �,,y �•a c , .: f .r` E t'� '� T ! +f y. ,; r '.• ... - 4 F `*.r.:- ,, � / 1 �,i c a. ". •. W,, r,�Jj` _ ,. r 4 n''. - J;i. ...�.i .y_, „ r , Ann Jane,Es baugh «q4 'r ; p . t,•:... r f tr ,w�, ; r f.f a {.. d Grover C.M lFarrish,�M. D z� _BOARD OFM ALTH f •. s . ,4' �, �, ° . �f M TOWN OF, BARNS'TABLB. r f qv rty,` •'.rl ��rt 5 c. � Wr:p?,. ,+. r «c.f. a. .� {,,, „�..� `, �` / .,. W / +. 't'" L t { x.( J t• ?r '„ _ r + =^rat ra r. ,;�_ �•, } 'MK mm �}, �'' ir-.{ ,{, �'�#F. r�J'F'A. f�.•+* n 7 - `' r ♦t r,« « "7 ,r ,l i.� w �,f...'' , r +,x.E 4 !'• ',i. p '!1 . 7 f+Y �6 .•iY. y,, J" , I `' } • Y �+ «- y t,.,1 1 "` v:t ` •ra �'« �• , � 'J„� �.��h,, � r; 3 =•.;... { +, r k:`± 7 � � r,a M1;, r pf Ax .: I ", 'R•4 h, �+ i i3 8 6 NO.- DATE �P�oFiH¢?owf TOWN OF BARNSTABLE FEE 6 SS OFFICE OF . = BAHTSTIBL j yMR BOARD OF HEALTH YAY•k\�� 367 MAIN STREET HYANNIS, MASS. 02601 VARIANCE REQUEST FORM All variance requests must be submitted five (5) days prior to the scheduled Board of Health meeting.; ' NAME OF APPLICANT_ Mt . Joseph Stefens TEL NO 775-004 ADDRESS OF APPLICANT 1085 Phinney ' s Lane = Centerville NAME OF OWNER OF PROPERTY 'Mr . Tadeusz Domansk i SUBDIVISION TAME ' DATE APPROVED LOCATION:OF REQUEST Corner of Jackson Ave and Centerville Ave .-Centerville VARIANCE FROM REGULATION (List regulation) Marginal Lot Bylaw VARIANCE._REQUESTED• (Sp.ecific••request) 0 . 7 ' of removal of subsoil to be replaced. with 'clean coarse sand. REASON FOR VARIANCE :(May attach fetter if more space needed) ,. SEE ATTACHE.MENT "A" I j PLANS - Two copies of ,plan must be submitted clearly outlining variance requested'. VARIANCE APPROVED NOT APPROVED • i REASON FOR DISAPPROVAL -Robert L. Childs, Chaicman Ann Jane Eshbaugh i Grover C.M. Farrish, M. D. BOARD OF HEALTH , �I ATTACHMENT "A" Town of .Barnstable -Board of Health: Please consider the variance of 0 . 7 ' of subsoil removal, at its greatest extent , tapering off to 0 . 3 ' as: .The surrounding area is developed. .A relatively small system is being proposed. .The proposed system meets all other Title 5 and town requirements . .Slightly over 6 ' of naturally occurring suitable material exists above the observed groundwater . 3 . 3 ' above the corrected groundwater elevation. .Not abutting any conservation or wetland areas . .No iron oxide layers or any other evidence of higher groundwater levels in the past . _ 5� s NEB ZoF -L DCS 1 �l �f�T .Fo� �L..� N V IEV�1 �IN6U rkvm .Y - 3(3E��Oot�S tkw-Y VwW = 3 x ►lo = 33v.G'�. . �c P- IL ThN1L- 33o X I so °/o 7. 30' U so 1000 LEAC N FI ELt> - USE 80 1 X 2° . FU�WWTU550� o 30o is 1.0 ` _ -500 (��p TLl T bT k L -Mo. o� Ss . I >ET .1L O1= 171� ySA<L-�;ED i NDT5 REMOVE /�� urlsu}Y1�L� (har�P.l aL I.F GRCOVWEKL-t> ) 10' IN NL-L- S.EE 5>4t:�t 3 EOM bIR�CTIDNS OF LEAM.i1NO PtT. P 0 5 ._ ,V/1 P-1 SUMM RSV t + ; 3 O' PvL_ ._ .. .._.: -�..._ _ _r6Px�E NYE i c..� T'•N�zkr-:Y�'u, HA IaZ.bq moo oz.44'.__! lou 4 TAA, 3-4. XS� FWw1DIFF�S�IRS o��-4a.°e mE Z,g ' 4- 4� -- ,_ WAsNED 9tONE U-AojN4 STOl4L ()r%L.l qP. •o w _ No AWE. �e � E,` ,�' W Att✓iZ.f;1.,_.94:i5� °�'�� 5.15 l LG FJI F Y THAT -Tikes...;Mo?, TzNti1, sNoWN WIL p N LO W\9LYS S1(5T RNLY-- RG00I�Z-AV'y OF TI EC- of LA IN �/,eNl'E V i LLLe ol_ H OF A s PETER y�N1 St.G A' Nzr s> _C SULLIVAN "gip NO. 29733 I BOA, c�sTEaE ��Q FSS/ONE L ��ND SV iZV>✓�0� t C l V I L_ �.Nt�I N lLLC 0 . S PETi R NZ E i Z b� SULLIVAN '� NO. 29133 0 �O,r.9�c�sTFaE ��Q L FSSIONAL ENG�< . FND IDo• 1 tZy FNR ,� EXIST�Nb spL;L d loz-a` l IDA'� 1�3 Z CIS < TiN. �s Z� O v 1 FLOWDI G�� 1 3 � l01•<6 46A L_c7� �2 1 CJIL GAI. O IA 57C>* { r _..— I i QUt;�T11�C� Vf�R� .Nu: I�5 srto��(y RE; =iLLINL b 7 N\NRGINkl_. LorS PRVPOSE� \S G l7 EL. = 1O3.rj _T c IOs ' FILE- I l,L IOZ$, EL•= F Ill3z 5 Tap c SuS50►l F _ ax ,•• F��vv a�C -.�, �5 ex�AVSlvrl A lb c uarov� \ RcA V�o``_ i L ^.^ram w Stork� - -TNVA IINs'J &LE u RERJ+rST✓:b a�' o.o MRTr�,N L J ko l LIE mATE� AL PICTI E Xis 1 N G GRADES 1 t�Pos�1� Ei}C s L s`(5"C"E M , P�Eb�V��k�D V A r- i'�N cc- s ' DN3 51 N Gu FPS P1M1�.Y - 3 C3E`DKoo1�S No C �t3A 1�1 NCB 'tLY I-t�wJ = 3 x lto = 33v.Gtb. -�fN USo 1000 L1=P\CA FIELD - USE SO X Z, = Z00 B PLOWWTI)550�; "o 1.0 300 C�?D TOTkL FU*1 = 33.0 pEP1ALiA�pc�1 .Rt E t" IN lkow. 6f- LcsS, etc ' REMOVE ALL uNSutTh:6U1 Mazt� a�_ IF --I`IC NT GKE--lam ) 10' IN PlL-t- ?P bF* SEG: SDI t,Ef 3 FOP. DIR t✓L.TI D NS OF` LmE CkUk114(, 'PIT, 105.SFl. �/�4�1( NLC SuMM4t�1� ,. .... F,G,T St7 1 S - .� 1. � • \-�r.:..�:n... \A b3.5 't TZ3TP-514k �6PKTL'F n1lEi c T•N\L u, HR )3.0 3 ` _ a 10.00It G L. e -K = 101-DS * }}} U SOX 4- 4' - 1 ,,, � �� ANi> W AsHet> S7'OtAe Au-k1N4 (� g M W, d LU S'rotyL.Y11A�SD PER- U P. ` o• �Uf`l� -5 - WF-u.-TWS-65 'o PR00 1 L7L- WATt✓�Z�.�.q�,s' ' '� � 5.�s i LCF.T1 F Y THAT T* ....pttu�, AND. sNoW N H-EON L0Iy\PLYS W ITk -tlA(E SI.DI -)N>� AIJl oF- T�r- z�\AN 0T �l_ PL A�IJ U _ A iti►1> Y-A %-T U.Z. IN � OF hi SAD � � �o�v\�A r PETER NC1TL JU111E' 1� 6p SULLIVAN ' No. 29733 `� �XCE t�- ►�1'L (t�L ''�SS,orSTE N�\,��tiQ G�ND ��(ZV>::w 0�.; t C I V I L ! .►'�'L�N t�-:L'r�: NqL E b PETER SULLIVAN No. 29733 0 Fss/ONAI E�G�< JS emu; �O FND t FW>, , ' EXISTINb SAGL d ` f IbZS } l03` Z 4 CIS • { 1 ioD ti "gDo T.H. N 00 , I(JfJ t. C I csa uz-,:i 2-) �I` V NLLIA C REQvt3TIN(> Vf'�R��NL� , N-S SaAo\\4N bb 7 N\NP GINNl LOTS 103 FI l t_ 1=L•=1028 F I LL ILL Ct_.: 102.$u T o SUS t_ F = Ex "•�• ` FL�Wl a\F L V ;q2S ex�AVsl�rl AREA Cla��.., tsE i;lano Tr�yk n Pi rrRRt,e v `& _-flac;r- � --Te'b os u.o A,o �s �r MOA•-R o�utf Z'$� RoV k4vw ki= EL• = 2S I KEPI(-TI`>,� 4 EXvsT IN6 GRNDF-S 1 Pt�Lj�C»�1� A IL S�(�TEM , P�EbV�TI�D Vt�i�It�NC 'e ' P�ofTHE to� TOWN OF BARNSTABLE OFFICE OF BAHISTABLL MMl : BOARD OF HEALTH t639.p 'yk. 367 MAIN STREET 'E y�� HYANNIS. MASS. 02601 August 7, 1986 Mr. Joseph Stefens •1085 Phinney's Lane Centerville, MA. 02632 Dear Mr. Stefens: The variance granted to you on July 1, 1986, to expire August 1, 1987, is extended to expire August 1, 1988. The variance reads as follows - "You are granted a variance from the Board of Health Regulation prohibiting the installation of on-site sewage disposal systems on marginal lots. The variance granted is for Lot 12, Jackson and Centerville Avenues, Centerville, and allows the installation of an on-site sewage disposal system with 3.3 feet of natural,, pervious material beneath the bottom of the system, in lieu of the required four feet, after making the adjustment required by the United States Geological Survey High Probable Groundwater 'calculations. This variance is contingent upon meeting the following conditions: (1) The designing engineer must be on, site and supervise construction of the septic system and certify in writing to the Board of Health that his design has been strictly adhered to prior to the issuance of a Certificate of Compliance. (2) All unsuitable material must be removed and replaced with clean, granular fill ten feet in all directions from the leaching flow-diffusers: (3) All other requirements of Title 5, and the Town of Barnstable Health Regulations must be strictly adhered to. This variance expires August 1, 1987. This variance is granted because the surrounding area is developed. There are no wetlands involved. The soil observation pits did not show any iron oxide layers and slightly over six feet. of natural occurring material exists prior to making the United States Geological Sur y adjustment." er t ly y u Ro er L. hilds Chairman BOARD OF HEALTH TOWN OF BARNSTABLE JMK/mm cc: Mr. Tadeusz Domanski TELEPHONE 773.9304 JOSEPH STEFENS ATTORNEY AT LAW 1085 Phinney's lane Centerville. MA 02632 July 17, 1986 Town of Barnstable Office of Board of Health 367 Main Street Hyannis MA 02601 Attention: Robert L. Child, Chairman Variance Committee Installation of on' site sewage disposal Lot 12 Jackson x Centerville Avenues Centerville, Ma. Owner: Tadeusz Domanski Dear Mr. Robert L. Child: This will acknowledge receipt of notice of granting a variance involving subject matter as_s.tated above. Mr.. Domanski is very appreciative of the favorable decision. He has considerable difficulty in expressing and communicating in English and asked me to inquire whether expiration date of August 1, '1937 for personal, and financial reasons could be extended at least until August 1, 1938 in as much also as the building permit runs until 1990. Your consideration in this .matter will be greatly appreciated. Sincerely yours, Job eph Stefens Esq.