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0045 LAKE ELIZABETH DRIVE - Health
45 LAKE ELIZABETH DR., CENTERVILL A = `� e t TOWN OF BAlRNS'TABLE LOCATION 5.' / T G YJ SEWAGE # �tJ � L� � � z � t'- VILLAGE Ce 4�. T IA I r.L ASSESSOR'S MAP & LOT s"f!L� INSTALLER'S NAME&PHONE NO.,i�Q� :�� IIz SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 2 (size) z X NO. OF BEDROOMS BUILDER.OR OWNER Se J2 / PERMIT•DATE: COMPLIANCE DATE: f. /AM6> . 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) c;w� G "' Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 2 57 �h$ 6A7 asir- No. l D O � Fee THE COMMONWEALTH OF MAS'SACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Apphrati.on for �Dtgoml *pmem Con0trurtton VCrmtt Application for a Permit to Construct(Repair( ) Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No.y 5 L.Q ke F1 Z �']Pf v` —er's Name,Address,and Tel.No. Assessor's Map/Parcel '?� �/ 7 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 3 G Type of Building: Dwelling No.of Bedrooms s Lot Size 13 sq.ft. Garbage Grinder ( ) Other Type of Building ees, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required gpd Design flow provided gpd Plan Date 4-'J 4-o Number of sheets Revision Date Title Size of Septic Tank 15OD Type of S.A.S. / a/ Description of Soil j7�We' Nature of Repairs or Alterations(Answer when applicable) Date last inspected: J ` Agreement: l The undersigned agrees to ensure the construction and maintenance of the afore describe�d(on-site sewage disposal system in accordance with the provisions of Title 5 of the vironm Code of to place the system in operation until a Certificate of Compliance has been issued by th' o ealth. igned Date Application Approved Date l� Application Disapproved by: Date for the following reasons Permit No. 5,5�q Date Issued I 5 , ►� D O 1 No. � �;, c�'t_..c� x+� y. Fee K f t �"- Entered in computer: THE COMMONWEALTF� OF MAS°SA&WAETTS Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIppYication for �DigpogaY *pgtem Con,5truction Permit Application for a Permit to Construct(✓Repair O Upgrade O Abandon( ) " 0 Complete System ❑Individual Components i Location Address or Lot No.Z &1 4� � Z �Pf J Owner's Name,Address;and Tel.No. l Assessor's Map/Parcel 'Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: I Dwelling No.of Bedrooms S Lot Size ��� sq.ft. Garbage Grinder Other Type of Building e es'. No.of Persons Showers( ) Cafeteria( ) t Other Fixtures _ I Design Flow(min.required) J�S�? gpd Design flow provided gpd Plan Date - eg I Number of sheets Revision Date Title I � . Size of Septic Tank /5a/Q Type of S.A.S. IN/ Description of Soil 1 i y i I Nature of Repairs or Alterations(Answer when applicable) j Date last inspected: Agreement: / Thp 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 ironm a "Code not to place the system in operation until a Certificate of Compliance has been issued by t ' o ealth. igned Date 'r 7 Application Approved Date Application Disapproved by: Date ` for the following reasons a•-ter Permit No. . c;bU' '7 Date Issued -------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( /,< Repaired ( ) Upgraded ( ) r-- Abandoned( )by !/ i- Iat 1I has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer; QJ.y �rr°rsr��c�{ �K r! Designer #bedrooms- Approved design flow gpd; The issuance of this permit sh��l not Ve con$)rued as a guarantee that the system wwfction as desig edDate /�/ Inspector / t t_ j P No.aC�7 T Fee / Ud THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS ligpogal *pgtem Congtruction Vermit I' Permission is hereby granted to Construct ( � Repair /( ) Upgrade ( ) Abandon ( ) System located at �/1 u�L/.p �ZahPf,, '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 c mpleted within three years of the da of this pe tt Date 1 ( 1 O / Approve t i I .may dF TQy. Barnstable Town of Barnstableu4nmri cap Ry .ARMAJS B1.E Board of Health t4iASS. ,1 �r y Ybg9 ' �AT�a+ A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi -October 16, 2007 Mr. Peter McEntee, P.E. Engineering Works 12 West Crossfield Road Forestdale, MA 02644 RE 45 Lake Elizabeth apnve,��Centervllle �- A = 276 154 and 155 ; Dear Mr. McEntee, You are granted variances, on behalf of your client, Joseph Hartigan, to construct an onsite sewage disposal system at 45 Lake Elizabeth Drive, Centerville. The variances granted are as follows: .iSection 360-1: The soil absorption system will be located seventy-eight (78) feet away from a vegetated wetland, in lieu of the one-hundred (100) feet minimum setback required. Section 360-1: The septic tank will be located sixty-six (66) feet away from a vegetated wetland, in lieu of the one-hundred (100)feet minimum setback required. s^Section 360-1: The septic tank will be located eighteen (18) feet away from a coastal bank, in lieu of the one-hundred (100) feet minimum setback required. Section 360-1: The soil absorption system will be partially located in or on a coastal bank, in lieu of the one-hundred (100) feet minimum setback required. 310 CMR 15.211-: The soil absorption system will be located fifteen (15) feet away from the foundation wall, in lieu of the twenty (20) feet minimum setback required. ► 310 CMR 15.211: The septic tank will be located four (4) feet away from the foundation wall, in lieu of the twenty (20) feet minimum setback required. Q:\WPFILESWcEnteeFlartington2OO7.doc 11,',27/2007 10:53 5084775313 ENGINEERING WORKS / PAGE 01 Town ®f Bamstuble Regulatory Services Thomas F. Ceder, Mrector Public H:ORM Division Thomas McKean,Director 20011ea1n Street,HYannb,1MA Qum offift SOS-W-4644 Fax: 309-790.6304 Sew# P6rm#t# Assessor's MapwftreI46�/,5 Y� 15 - Installer: /'Ai?s�Gpt ✓Lo' Address: ]IL was issued a permit to insta u a (it taller) septic (address) based on a design.drawn by - - - . �, dated cl 2! 0 I pea 1"tbm the septic system referenced above was installed substantisiiyy acconr to �e: , p'lrich may include minor approved changes such as latter relocation of the n box and/or septic tank.; --.,.. I. ..t>46t the septic system referenced above was installed with moor �r a pe 1:0+ lattral relocation�off ate the SAS or any vwrtfcal relocation 0;any (Mt sPtem)but in accordilace with St t Local Regulations. �!�>aevision or oas-built by designer to Mow, • ���'�N OF M,t PETER T. McENTEE CIVIL w ,o ,9 No.35109 ss�ONAL ENG f tlst let's S<gnaturc) tamp (Affix Desiglzer s S T D UJADS YQU• Q'natal-&FdGl WiM1W CartiHftdon Fond 3.26-04.d,, •.r 310 CMR 15.221(7): To place six feet of soil cover over the top of the soil absorption system, in lieu of the three feet maximum cover allowed. 310 CMR 15.211: The soil absorption system will be located seven (7) feet away from the property line, in lieu of the ten (10) feet minimum setback required. J310 CMR 15.211: The septic tank will be located eighteen (18) feet away from a coastal bank, in lieu of the fifty (50) feet minimum setback required. y 310 CMR 15.211: The soil absorption system will be partially located in or on a coastal bank, in lieu of the fifty (50) feet minimum setback required. The variances are granted with the following conditions: (1) No more than five (5) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the.property to five (5) bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. 1((3) The septic system shall be installed in strict accordance with the revised engineered plans dated September 21, 2007. ✓(4) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the submitted plans dated September 21, 2007. (5) This is subject to the approval of the MA Department of Environmental Protection and the Town of Barnstable Conservation Division. This variance is granted because physical constraints at the site severely restrict the location of a soil absorption system due to the very small size of the lot. The proposed new septic system -appears to be designed to meet the maximum feasible compliance standards contained within the State Environmental Code, Title V. J ira you s ill , M.D. n 3 Q:\WPFILES\McEnteeHartington2OO7.doc Nov 14 07 02:59p John Vaccaro (508) 888-0564 p.2 i- Massachusetts Department of Environmental Protection oFy Bureau of Resource Protection -Wetlands 1. WPA Form 2 — Determination of Applicability 1= IKA&& Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 ,26:59;.t,�0 and Chapter 237 of the Code of the Town of Barnstable DA- 07079 A. General Information Important: When filling out From: forms on the Barnstable computer, use Conservation Commission only the tab key to move To: Applicant Property Owner(if different from applicant): your cursor- do not use the Joseph Hartigan return key. Name Name 23 Elm Street Ma Mailing Address Mailing Address Brookline MA 02445 City/Town State Zip Code City/Town State Zip Code 1. Title and Date (or Revised Date if applicable)of Final Plans and Other Documents: Proposed Septic System Upgrade Plan,34 Lake Elizabeth Dr.,Centerville 9/21/07 Title Date Title Date TiUe Date 2. Date Request Filed: September 26,2007 B. Determination Pursuant to the authority of M.G.L. c. 131, §40,the Conservation Commission considered your Request for Determination of Applicability, with its supporting documentation,and made the following Determination. Project Description (if applicable): Title-5 Septic System Upgrade Project Location: 45 Lake Elizabeth Drive Centerville Street Address Village 226 154 and 155 Assessors Map Number Assessors Parcel Number Npafcrm2.doe•Oelennination of Applicabirly•rev.f ir15M Page 1 of 5 r Nov 14 07 03:O0p John Vaccaro (508) 888-0564 p.3 LlMassachusetts Department of Environmental Protection „uE Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of ApplicabilityRAJWSTABM Massachusetts Wetlands Protection Act M.G.L. c. 131, §40fo; •`� and Chapter 237 of the Code of the Town of Barnstable DA- 07079 B. Determination (cont.) The following Determination(s)is/are applicable to the proposed site and/or project relative to the Wetlands Protection Act and regulations: Positive Determination Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of Conditions (issued following submittal of a Notice of Intent or Abbreviated Notice of Intent)or Order of Resource Area Delineation(issued following submittal of Simplified Review ANRAD)has been received from the issuing authority (i.e., Conservation Commission or the Department of Environmental Protection). ❑ 1. The area described on the referenced plan(s)is an area subject to protection under the Act. Removing,filling,dredging,or altering of the area requires the filing of a Notice of Intent. ❑ 2a. The boundary delineations of the following resource areas described on the referenced plan(s)are confirmed as accurate. Therefore,the resource area boundaries confirmed in this Determination are binding as to all decisions rendered pursuant to the Wetlands Protection Act and its regulations regarding such boundaries for as long as this Determination is valid. ❑ 2b.The boundaries of resource areas listed below are not confirmed by this Determination, regardless of whether such boundaries are contained on the plans attached to this Determination or to the Request for Determination. ❑ 3. The work described on referenced plan(s)and document(s)is within an area subject to protection under the Act and will remove,fill, dredge, or alter that area. Therefore, said work requires the filing of a Notice of Intent. ❑ 4. The work described on referenced plan(s)and document(s) is within the Buffer Zone and will alter an Area subject to protection under the Act. Therefore,said work requires the filing of a Notice of Intent or ANRAD Simplified Review(if work is limited to the Buffer Zone). ❑ 5.The area and/or work described on referenced plan(s) and document(s) is subject to review and approval by: Name of Municipality Pursuant to the following municipal wetland ordinance or bylaw: Name Ordinance or Bylaw Citation wpafonn2.doc.7etem*,a0cn of Applicability -rev.1015105 Page 2 cf Nov 14 07 03:00p John Vaccaro (508) 888-0564 p.4 Massachusetts Department of Environmental Protection , Bureau of Resource Protection -Wetlandso- 1, WPA Form 2 — Determination of Applicability SABLE. - Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 and Chapter 237 of the Code of the Town of Barnstable DA- 07079 B. Determination (cont.) ❑ 6.The following area and/or work,if any, is subject to a municipal ordinance or bylaw but not subject to the Massachusetts Wetlands Protection Act: ❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s) and document(s), which includes all or part of the work described in the Request,the applicant must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c.for more information about the scope of alternatives requirements): ❑ Alternatives limited to the lot on which the project is located. ❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any adjacent lots formerly or presently owned by the same owner. ❑ Alternatives limited to the original parcel on which the project is located,the subdivided parcels, any adjacent parcels,and any other land which can reasonably be obtained within the municipality. ❑ Alternatives extend to any sites which can reasonably be obtained within the appropriate region of the state. Negative Determination Note: No further action under the Wetlands Protection Act is required by the applicant. However, if the Department is requested to issue a Superseding Determination of Applicability, work may not proceed on this project unless the Department fails to act on such request within 35 days of the date the request is post-marked for certified mail or hand delivered to the Department. Work may then proceed at the owner's risk only upon notice to the Department and to the Conservation Commission. Requirements for requests for Superseding Determinations are listed at the end of this document. ® 1. The area described in the Request is not an area subject to protection under the Act or the Buffer Zone, ® 2. The work described in the Request is within an area subject to protection under the Act, but will not remove, fill, dredge, or alter that area.Therefore, said work does not require the filing of a Notice of Intent. Note below* ❑ 3. The work described in the Request is within the Buffer Zone, as defined in the regulations, but will not alter an Area subject to protection under the Act. Therefore, said work does not require the filing of a Notice of Intent, subject to the following conditions(if any). "Sediment controls shall be deployed along work-limit line; prompt loaming and seeding is required. F] 4. The work described in the Request is not within an Area subject to protection under the Act (including the Buffer Zone), Therefore, said work does not require the filing of a Notice of Intent, unless and until said work alters an Area subject to protection under the Act. wpaform2.doc-Delerminafion of App:icabiity-rev.1015,105 Page 3 of 5 Nov 14 07 03:00p John Vaccaro (508) 888-0564 p.5 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands (�, WPA Form 2 — Determination of Applicability ,, L Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 and Chapter 237 of the Code of the Town of Barnstable DA- 07079 B. Determination (cont.) ❑ 5.The area described in the Request is subject to protection under the Act.Since the work described therein meets the requirements for the following exemption,as specified in the Act and the regulations, no Notice of Intent is required: Exempt Activity(site applicable statuatory/regulatory provisions) ❑ 6. The area and/or work described in the Request is not subject to review and approval by: Name of Municipality Pursuant to a municipal wetlands ordinance or bylaw. Name Ordinance oc Bylaw Citation C. Authorization This Determination is issued to the applicant and delivered as follows: ❑ by hand delivery on Date: by certified mail, return receipt requested on O C T 3 0 2007 Print Name Signature Date This Determination is valid for three years from the date of issuance(except Determinations for Vegetation Management Plans which are valid for the duration of the Plan).This Determination does not relieve the applicant from complying with all other applicable federal, state,or local statutes, ordinances, bylaws, or regulations. This Determination must be signed by a majority of the Conservation Commission.A copy must be sent to the appropriate DEP Regional Office(see Attachment)and the property owner(if different from the applicant). -� Signatures: On this-5yz da f C 2FiD ,before me personally appeared me known to be the person described in and who executed the foregoing instrumen nd acknowledged that he/she executed the same as his/her f act and deed 1 3! otary Public `' NOTARY PUBLIC My commissi n pt.: sOM.MONWEAL r OF-7ATTA71117M MY COMMISSION EXPIRES 111210108 wpaformZdoc•Determination of Appiicabiliry•rev,1015t05 Page 4 of 5 Nov 14 07 03:OOp John Vaccaro (508) 88M564 p.6 Massachusetts Department of Environmental .Protection Bureau of Resource Protection -Wetlands ' W PA Form 2 - . BAR"TABLE O Determination of Applicability ASS $ LI Massachusetts Wetlands Protection Act M.G.L. c, 131, §40 r�� and Chapter 237 of the Code of the Town of Barnstable DA- 07079 D. Appeals The applicant,owner, any person aggrieved by this Determination,any owner of land abutting the land upon which the proposed work is to be done, or any ten residents of the city or town in which such land is located, are hereby notified of their right to request the appropriate Department of Environmental Protection Regional Office (see Attachment)to issue a Superseding Determination of Applicability.The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and Fee Transmittal Form(see Request for Departmental Action Fee Transmittal Form)as provided in 310 CMR 10.03(7)within ten business days from the date of issuance of this Determination.A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant if he/she is not the appellant. The request shall state clearly and concisely the objections to the Determination which is being appealed.To the extent that the Determination is based on a municipal ordinance or bylaw and not on the Massachusetts Wetlands Protection Act or regulations,the Department of Environmental Protection has no appellate jurisdiction. Npaforrn2.doc•Detenrination of Appl cabil.ly•rev.ICraM Page 5 of 5 Bk 22480 Ps 153 0.66231 11-19-2007 a 11 = 19cx DEE_STIWIION WHEREAS, Joseph A Hartigan, Jr. and Mary Ellen Hartigan of 23 Elm Street located in Brookline, MA, are the owners of 45 Lake Elizabeth Drive, Craigville Village, Centerville, MA and being shown as on a plan entitled'Plan of Land in Craigville, Barnstable, Mass. Belonging to Edith G. Howe'duly recorded at the Barnstable County Registry of Deeds in Plan Book 75, Page 23. WHEREAS, Joseph A Hartigan, Jr. and Mary Ellen Hartigan as owners of said lot have agreed with the Town of Barnstable, MA, Board of Health, to a restriction as to the number of bedrooms which can be included on any hone built on said lot as a pre- condition of obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage. WHEREAS, the Torn of Barnstable, MA, Board of Health, as a pre-condition to granting a Disposal Works Constriction Permit for a septic system in compliance with 310 CMR 15.000, State Environmental Code,Title V,'Mminuxn Requirements for the Subsurface Disposal of Sanitary Sewage, is rewiring that the agreement for the restriction on the number of bedrooms in any house constructed on said lot be put on record with the Barnstable County Registry.of.Deeds by recording this document. NOW THEREFORE, Joseph A Hartigan, Jr. and Mary Ellen Hartigan do hereby place the following restriction on the above referenced land in accordance with their agreement with the Town of Barnstable, MA, Board of Health,which restriction shall run with the land and be binding upon all successors in title: 1. 45 Lake Elizabeth Drive may have constructed upon it a house containing no more than five(5) bedrooms. Joseph A Hartigan, Jr. and Mary Ellen Hartigan agree that this shall be a permanent deed restriction affecting the dwelling located at 45 Lake Elizabeth Drive, Craigville Village, Centerville, MA and shown in Plan Book 75 Page 23. For title of Joseph A Hartigan, Jr. and Mary Ellen Hartigan see the following Deed: Book 12948 Page 115. Page 1 J Bk 22480 Pg 154 #66231 Executed as a sealed instrument this day of . 2007. (2/'/� Zer's na-- r e COMMONWEALTH OF MASSACHUSETTS ss f Date t/ �� ,2007 Then personally appeared the above named Joseph A Hartigan, Jr. and Mary Ellen Hartigan, known to me to be the person/s who executed the foltawing instrument and acknowledged the same to be their free ad and deed, before me. o un F Notary Public convrnssion e 2 Z� My xpires. ra.o' '�O° (date) "a. ••r..wuua•'•''' BARNSTABLE COUNTY REGISTRY OF DEEDS A TRUE COPY,ATTEST Page 2 JOHN F,MrZADFM REO ST R BARNSTABLE REGISTRY OF DEEM THE 1p� Barnstable y� Town of Barnstable � UmmicacHy ` A, Board of Health i639• �� 200 Main Street, Hyannis MA 02601 Zoos Office: 508-8624644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi October 16, 2007 Mr. Peter McEntee, P.E. Engineering Works 12 West Crossfield Road Forestdale, MA 02644 RE: 45 Lake-Elizabefh Drive, Centerville A #,276-154 and .155 Dear Mr. McEntee, You are granted variances, on behalf of your client, Joseph Hartigan, to construct an onsite sewage disposal system at 45 Lake Elizabeth Drive, Centerville. The variances granted are as follows: aSection 360-1: The soil absorption system will be located seventy-eight (78) feet away from a vegetated wetland, in lieu of the one-hundred (100) feet minimum setback required. ti Section 360-1: The septic tank will be located sixty-six (66) feet away from a vegetated wetland, in lieu of the one-hundred (100) feet minimum setback required. 'r'Section 360-1: The septic tank will be located eighteen (18) feet away from a coastal bank, in lieu of the one-hundred (100) feet minimum setback required. 4 Section 360-1: The soil absorption system will be partially located in or on a coastal bank, in lieu of the one-hundred (100) feet minimum setback required. 310 CMR 15.211: The soil absorption system will be located fifteen (15) feet away from the foundation wall, in lieu of the twenty (20) feet minimum setback required. d 310 CMR 15.211: The septic tank will be located four (4) feet away from the foundation wall, in lieu of the twenty (20) feet minimum setback required. Q:\WPFILES\McEnteel4artington2OO7.doc f •sr 310 CMR 15.221(7): To place six feet of soil cover over the top of the soil absorption system, in lieu of the three feet maximum cover allowed. �310 CMR 15.211: The soil absorption system will be located seven (7) feet away from the property line, in lieu of the ten (10) feet minimum setback required. 1310 CMR 15.211: The septic tank will be located eighteen (18) feet away from a coastal bank, in lieu of the fifty (50)feet minimum setback required. y 310 CMR 15.211: The soil absorption system will be partially located in or on a coastal bank, in lieu of the fifty (50)feet minimum setback required. The variances are granted with the following conditions: (1) No more than five (5) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to five (5) bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. Y(3) The septic system shall be installed in strict accordance with the revised engineered plans dated September 21, 2007. ✓(4) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that.the system was installed in substantial compliance with the submitted plans dated September 21, 2007. (5) This is subject to the approval of the MA Department of Environmental Protection and the Town of Barnstable Conservation Division. This variance is granted because physical constraints at the site severely restrict the location of a soil absorption system due to the very small size of the lot. The proposed new septic system appears to be designed to meet the maximum feasible compliance standards contained within the State Environmental Code, Title V. Si rely you s yn Mill , M.D. C air an Q:\WPFILES\McEnteeHartington2OO7.doc f DATE: - — FEE: R E)ARNSTAt31E, MASS, 039.���g REC. BY L e� " Town of Barnstable SCHSD. DATE:� Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-862.4644 Wayne A.Miller,M.D. FAX: 508-790-6304 Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM P LOCATION Property Address: �� L�l u( 1 t �c ��� `-� ✓U� 1 Assessor's Map and Parcel Number: 074) 1 SSy 15 S^Size of Lot: 3; V 1 S Wetlands Within 300 Ft. Yes � Business Name: No Subdivision Name: r I APPLICANT'S NAME: QZW -�-\ A-(SV\j-tk eL Phone (-SO `17 O —S-3)-7. Did the owner of the property authorize you to represent him or her? Yes � No PROPERTY OWNER'S NAME CONTACT PERSON �— / r 2ekv-Mc En 1--C f Name: ✓69 Name: f 4 Address: gr ,-zr,�f Z n¢j /"/4- Address: Z �� � ��e i J r.� Phone: Phone: F VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if mo eYs)ace needed)"' rt q fi-CL CKta �r— t`�-"5 rn NATURE OF WORK: House Addition 1300000 House Renovation ❑ Repair of Failed Septic System^ Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. _ Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) — Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (forTitle V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Paul J.Canniff,D.M.D. REASON FOR DISAPPROVAL C:\Documents and Settings\decollik\Local Settings\Temporary Internet Fi1es\0LK1\VARIREQ.DOC 1 t ATTACHMENT - 45 LAKE ELIZABETH DR, CENTERVILLE VARIANCE FROM REASON 310 CMR 15.405(a)(b)&(f)—CONTENTS OF LOCAL UPGRADE APPROVAL SITE LIMITATIONS 1) A 3' variance, S.A.S. to side property line, for a 7' setback. DUE TO TOPOGRAPHY, 2) A 5' variance, S.A.S. to cellar wall, for a 15' setback. WETLANDS AND 3) A 6' variance, Septic TAnk to cellar wall, for a 14' setback. LOT AREA 4) A 3' variance to the maximum cover requirement over an S.A.S. 5) A 7' variance, Septic Tank to top of Coastal Bank, for an 18' setback_ 6) A variance to allow S.A.S. to be partially on a Coastal Bank. LOCAL REGULATION Chapter 360. Article 1 — Setback Requirements 7) A 34' variance, Septic Tank to B.V.W., for a 66' setback. 8) A 22' variance, S.A.S. to B.V.W., for a 78' setback. 9) AN 82' variance, Septic Tank to Top of Coastal Bank, for on 18' setback. 10) A variance to allow S.A.S. to be partially on a Coastal Bank. APPROXIMATE SCALE 500 .. FEET XLAILLU FIRM FLOOD INSURANCE RATE MAP ' TOWN OF iBARNSTABLE OR 7 ` I�Iilllliillli u . tta � . 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Cri 7��`at. ., vn r ,�S r s i-> S �'j Ysr r .+-{ 1',ts'Vt a 1age'a" -�l$ 9 ,+s 7 ,cx�.. Rt1ti:.t �• ro''. �t" 'a• t4 p. s q ;3 •�' 'WsvBUT REPRESENTS _ - v:rhC'z'i�l.,.aa''�3� •'tt'��ait'i�sa� v��.�,��."��".. T. .2�.'��.1�'a.d�i�a�r � �.� rx .�. � � 3'&s � � - - - - Town of Barnstable Geographic Information System I September 20,2007 .Gs .%-: 226015 J y .T d .% F ty #67 .�--,.�:��.'k,:',-.,,,j,�:.r-..A,`-k:.z..,��,,..,.,v I u ,:tFr ' e: '' 2�136 . 9, 226020 #B If k : J' .I 3 z f ' ^�. " ' ill a F r+l k rF es, 226162 �#,. '�ti FI �'�� 1 r 1��Ih9pa k,,1' 1 ap #55 �` Jp j^„ r f 9 h i - t� F 1! - ! :. 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LI b :' -.: F 7'. _ 226162 t asrrts:r'xx ° 33 : : ."aim• xnr x u :i t 6 � nX16163 ' a 72gl o4 1ai r r p alai #45 4 r ,hM1h ,l ;.I L {. r^ 7 I ^ kj ) I IN ,i :� f g pia I� 7, I 1 f; 1•1 I. z ,r 1 yc" ! '. a''•1k t p ° 2,,_I : 1.: q 7 x I .x ' t �•..l 1 I 1�.., { �. ! DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:226 Parcel:154 Adjacent(Please choose abutter list type) r"`"-,- K, boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel 1°=100'may not meet established map accuracy standards. The parcel lines on this map Abutter List Type-Default buffer of parcels adjacent to the selected parcel µ' -1 are ony graphic reproseMationa of Assessor's tax parcels. They are not true property Abutt@B VJ ,,t; " E boundaries and do not represent accurate relationships to physical features on the map �yt such as butting locations. Buffer V `Adjacent (Please choose abutter list type) Abutter List for Map & Parcel(s): 1226154','226155','226139' Default buffer of parcels adjacent to the selected parcel Total Count: 9 Close Map&P reel Own s 1 €5 � v rer2 A tJre s1 Address 2 Mailing CityStateZip i 226138 GAVIfT,JULIA G TR 7GG CRAIGVILLE NOMINEE TRUST it DROWNE PKWY RUMFORD, RI 02916 i i 226139 PENDERGAST, PO BOX 576 CENTERVILLE, SYLVIA J MA 02632 ISENSTADT,ALAN %TRADE WINDS BOSTON, MA 226140001 TR RESIDENCES, LLC 94 ST BOTOLPH ST 02116 226152 KUMAR, SANJAYA& 4 ROCK SPRING LA SOUTHBOROUGH, SHUBJEET MA 01772 226153 KUMAR, SANJAYA& 4 ROCK SPRING LN SOUTHBOROUGH, SHUBJEET MA 01772 226154 HARTIGAN,JOSEPH HARTIGAN,MARY 25 ELM ST BROOKLINE, MA A JR& ELLEN 02445-6813 i 226155 HARTIGAN,JOSEPH HARTIGAN, MARY 25 ELM ST BROOKLINE, MA A JR& ELLEN 02445-6813 i 226163 SCHORTMAN, 72 BROAD BROOK BROAD BROOK, MAXINE R RD CT 06016 PAULA ANN 47 LOPATKA,PAULA %LOPATKA, PAULA CENTERVILLE, i 226164 LOPATKA LIVING SOUTHWINDS ANN ANN TR CIR MA 02632 1 This list by itself does NOT constitute a certified list of abutters and is provided only as an aid to the determination of abutters.If a certified list of abutters is required,contact the Assessing Division to have this list certified.The owner and address data on this list is from the Town of Barnstable Assessor's database as of 9/2O/2007. UNITED STATE P �` `"51' pp w•,Y �+��, n}�•��v���.'(( F�xi4 •�� .,�w,.ny.MM.., a q•� µ �r'aYN S�I� i{QYtua ,. xc�n ti•, • Sender: Please print your name, address, and ZIP+4 in this box • I A I � � Engineering Works 12 West Crossfield Road Forestdale, MA 02644 r I -gIF'iiFllFi:F6?3??#F1F?'I?13#fi �F?133e�Fi�?� SENDER: COMPLETE THIS SECTION COMP.LETF THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete e item 4 if Restricted Delivery is desired. ❑Agent I ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. , eived by rint d ame) C. D e o elivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery d ress d rent from item 1? ❑ s 1. Article Addressed,to: If YES,en delive a dress below: ❑No I PENDERGAST SYLVIA J , PO BOX 576 i CENTERVILLE,MA 02632 ({`C 3. Service Type ,! 14 Certified Mail [3 Express Mail IIf ❑Registered ❑Return Receipt for Merchandise I f ❑Insured Mail ❑C.O.D. — - I 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number < R006 '0100 =0003 3589 9050 (Transfer from service label) a i PS Form 3811,February 2004 Domestic Return Receipt 102595-02.M-1540 UNITED STATERSV O M 4W li � e�Paid c:.,...:}•. . a a 1mw`60�.» - t • Sender: Please print your name, address, and ZIP+4 in this box • Engineering Works r 12 West Crossfield Road Forestdale, MA 02644 111}} ! i lil }T J 7} If 1 111}3! 111t11 1J ! -Illd SENDER: COMPLETETHIS SECTION. COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. nature item 4 if Restricted Delivery is desired. X �,V ❑Agent I ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. celved by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery add * 1? ElYes 1. Article Addressed to: If YES,enter d i dress ❑No 4 A r � --- ..- - '°'Plop ID:226138 GAVITT,JULIA G TR sro O''4y JGG CRAIGVILLE NOMINEE TRUST I 1 DROWNE PKWY s. Service Type RUMFORD,RI 02916 `` IN Certified Mail ❑Express Mail I ❑Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. �J 4. Restricted Delivery?(Extra Fee) ❑Yes 2 Article Numr(Transfer from service lahn, ' 1 710,0 6' 1010 0 0003 i 3 5 8i9 j 19 210 j i PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 M� UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • Engineering Works ' 12 West Crossfield Road Forestdale, MA 02644 III tlil,l,„IIlla,,,,,,li„I,II,J�I i SENDER: DELIVERY ■ Complete items 1,2,'and 3.Also complete A. Si a I item 4 if Restricted Delivery is desired. ❑Agent • Print your name and address on the reverse X ❑Addressee so that we can return the card to you. g. Re ived (Printed Name) C. Date of Delivery ■ Attach this card-to the back of the mailpiece, (�i(,// e1 or on the front if space permits. ` C4 Q/1 1. Article Addressed to: D. Is delivery address different from item 17 ❑Ye If YES,enter delivery address below: ❑No I SCHORTMAN,MARINE R 72 BROAD BROOK RD BROAD BROOK,CT 06016 s. Service Type &Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. �--��— 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7006 0100 0003 3589 9067 (transfer from service labeo PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS . !I Permit No.G-10 I • Sender: Please print your name, address, and ZIP+4 in this box • I I I Engineering Works i I 12 West Crossfield Road i Forestdale, MA 02644 N J SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. gent 11 Print your name and address on the reverse X w� ❑Addressee so that we can return the card to you. B. Received by(Printed Na C. Date of Delivery ■ Attach this card to the back of the mailpiece, I or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: I If YES,enter delivery address=below: ❑No oJOH hNq - r Q KUMAR,SANJAYA&SHUBJEET 4 ROCK SPRING LN 3. Service Type O SOUTHBOROUGH,MA 01772 18 Certified Mail D�xpres_ Mal c;P ❑Registered "Retum Recent for Merchandise II ❑ Insured Mail ❑C.01. — %4. Restricted Delivery?(Extra Fee) ❑Yes 12. Article Number ! 7006 0100 0003 3589 9036 I C (Transfer from service labeo i PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 i UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid I USPS j: Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • Engineering-`-- - -eerin g Works i 12 West Crossfield Road Forestdale, MA 02644 1,A,iI111I,,,111la,s IIIih�i,ll��t,l '. MPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete 95natuLe. item 4 if Restricted Delivery is desired. nt"■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. eived by(Printed C. Date of Delive ■ Attach this card to the back of the mailpiece, G/ r1' or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: 0 No ID.226140001 ' ISENSTADT,ALAN TR %TRADE WINDS RESIDENCES,LLC 3. Service Type 94 ST BOTOLPH ST 6 Certified Mail ❑Express Mail BOSTON,MA 02116 ❑Registered ❑Return Receipt for Merchandise �^ s� ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7006 0100 0003 3589 9098 (Transfer from service label)' PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 Engineering' Works EXISTING FLOOR PLAN 12 W. Crossfield Road 45 Lake Elizabeth Dr, Caenterville, MA Forestdale, MA 02644 Job No. 208-07 Date: 8/31 /07 (508) 477-5313 Page 1 of 1 BEDROOM BEDROOM BEDROOM BEDROOM SECOND FLOOR LIV.RM. KIT/DIN FIRST FLOOR UTILITY/LAUNDRY GARAGE BEDROOM BASEMENT FLOOR NOTE: SKETCH IS FOR SCHEMATIC PURPOSES ONLY — NOT TO SCALE I I el/T5, 200-el 13:09 5084775313 ENGINEERING WORKS PAGE 01 Joseph A. Hartigan Jr. 23 Elm Stet Brookline, MA 02445 October 3, 2007 Sanistobte Ewxwd of health NO Main, Street Hyannis, MA 02601 ,Re: 45 Lake Elizabeth ®rive, Title 5 Septic Upgrade Dear Board members: i hereby authorize Peter McEntee PE of Engineering Works to represent ray intexests for the purpose of septic upgrade at the subject site. Sincer®ly, #JH artigan AI I- Town of Barnstable P# aF� oY Department of Regulatory Services i Public Health Division Date j•b79 A�� 200 M-in Street,Hyannis MA 02§0 Date Scheduled V M:ru. ., t Soil Suitability Assessment for Sewage D tsjposal b Performed By: -Pew,, � � Kc CVl -C-c Witnessed By: 1 LOCATION& GENERAL INFORMATION Location Address (j-5 LA(&C 1=1.zq",+-4. Owner's Name Iv j. ✓,s,,.. ."a, AddressS'r;7Cj�<�..�,f A Assessor's Map/Parcel: 2'Z(c Engineer's Name Qe�l�IM(,€w,� 10T NEW CONSTRUCTION REPAIR Telephone# _go 6��i,-7'`S 3 k 3 Land Use I'"'S� U Slopes Surface Stones Distances from: Open Water Body ' ft Possible Wet Area LOCH ft Drinking Water Well j" t Drainage Way ft Property Line l.� ft Other ft SKETCH:(street name,dimensions of lot,exact locations of test holes&perc'tests,locate we.tlands 1n proximity-to holes):,. ,.. C. rr_.► i /W 0. CD �. Ct•7 / fU r Parent material(geologic) 94cle L Depth to Bedrock �f Depth to Groundwater. Standing Water in Hole: I� Weeping from Pit FACe Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in, Depth to soil mottle: In. Depth to weeping from side of obs.hole: In, Groundwater Adjustment B• Index Well# Reading Date: index weli ievci P- --_ Nye,,wc...c r, T w•�- PERCOLATION TEST "bait: Time -d--- Observation Ti Hole# me at 4" - ro l Depth-of Perc Time at 6" Start Pre-soak Time @. 5=o1 0 Time(9"•6") --- End Pre-soak. 5k 3je`�A-L of �'�Z~- ss�►t�' ' 'icr , Rate MinAnch J' Site Suitability Assessment:. Site Passed V Site:Failed: Additional Testing Needed(Y/N) *11 C= Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1) week prior to beginning. .......,..r.....nooncno►A nnr DEEP.OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in. (USDA) (Mansell), Mottling (Structure,Stones;Boulders. sistencVe ✓es- Ay ZAM:? 1LAv - y' DEEP OBSERVATION HOLE LOG Hole# t ' Depth from. Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. i G on ' e % Sao / A �r _ S, ADA O Z ` ' w o jr ' lG Ali arc ` t �DEEP.OBSERVATION HOLELOG - Hole# _ �P�from Soilnonzoo Soil Texture Soil Color Soil - Other f Surface(in.).- _.. x USDA ( ) Mottling; (Structure,Stones,Boulders. ,. ( )~ Munsell i to 3 e _ I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, o Flood Insurance Rate Man• Above 500 year flood boundary No Yes Within 500 year boundary No_ Yes f i r;f Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ,, If not,what is the depth of naturally occurring pervious material? Ltifleation h"cemfy that on -p- (date)I have passed the soil evaluator examination approved by the O C_ Department of Environmenta Protectioii and-ttiat the above anal sis was rformed b me consistent with ; - t the required traini g,:expertise-and expe`ritnce described in1O CMR YS(17' : Signature w t .. a l ' D b Q:\SEPTICIPBRCF0RM.D0C 1 Irh I COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENERGY & ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617-292-5500 DEVAL L.PATRICK IAN A.BOWLES Governor Secretary TIMOTHY P.MURRAY ARLEEN O'DONNELL Lieutenant Governor Commissioner MODIFIED CERTIFICATION FOR GENERAL USE Pursuant to Title 5,310 CMR 15.000 Name and Address of Applicant: Infiltrator Systems,Inc. P.O.Box 768 6 Business Park Road Old Saybrook,CT 06475, Trade name of technology and model:High Capacity chamber,Quick4 High Capacity chamber, Standard chamber,Quick4 Standard chamber,Infiltrator 3050(Storm Tech SC-740),Equalizer 24 chamber,Quick4 Equalizer 24 chamber,Equalizer 36 chamber,and Quick4 Equalizer 36 chamber (hereinafter the"System"). Schematic drawings of the System and a design and installation manual are attached and made a part of this Certification Transmittal Number: W023699 Date of Issuance: February 21,2003,Revised August 19,2005,December 22,2005,July 24, 2006,July 19,2007 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000, the Department of Environmental Protection hereby issues this Certification to: Infiltrator Systems, Inc., P.O. Box 768, 6 Business Park Road,Old Saybrook,CT 06475(hereinafter"the Company"),for General Use of the System described herein. Sale and use of the System are conditioned on and subject to compliance by the Company and the System owner with the terms and conditions set forth below. Any noncompliance with the terms or conditions of this Certification constitutes a violation of 310 CMR 15.000. July 19,2007 Glenn Haas,Acting Assistant Commissioner Date Bureau of Resource Protection Department of Environmental Protection This Information is available in alternate format.Call Donald M.Gomes,ADA Coordinator at 617-556-1057.TDD Service-1-800-298-2207. MassDEP on the World Wide Web: http://www.mass.gov/dep 0 Printed on Recycled Paper i Infiltrator Modified Certification for General Use Page 2 of 7 I. Purpose 1. The purpose of this Certification is to allow use of the System in Massachusetts, on a General Use basis. 2. With the necessary permits and approvals required by 310 CMR 15.000, this Certification authorizes the use of the System in Massachusetts. 3. The System may be installed on all facilities where a system in compliance with 310 CMR 15.000 exists on site or could be built and for which a site evaluation in compliance with 310 CMR 15.000 has been approved by the local approving authority,or by DEP if DEP approval is required by 310 CMR 15.000. R. Design Standards 1. The models listed in Table 1 are covered under this Certification. Table 1. Chamber Dimensions Dimensions Invert Model W x L x H Height Inches Inches Equalizer 24 15 x 100 x 11 6 ick4 Equalizer 24 16 x 48 x 11 6 Equalizer 36 22 x 100 x 13.5 6 ick4 Equalizer 36 22 x 48 x 12 6 Standard Chamber 34 x 75 x 12 6.5 Quick4 Standard 34 x 48 x 12 8 Infiltrator 3050 or 51 x 85.4 x 30 24 StormTech SC-740 High Capacity Chamber 34 x 75 x 16 11 uick4 High Capacity 34 x 48 x 16 11.5 JI 2. The System is an open-bottom leaching unit molded from polyolefm resin. It can be installed without aggregate or distribution pipe as an absorption trench in accordance with the requirements in 310 CMR 15.251 or as a bed or field in accordance with the requirements in 310 CMR 15.252. 3. The use of aggregate as specified in 310 CMR 15.247 is not necessary with the System when installed as a trench,bed or field. When designed with aggregate in accordance with 310 CMR 15.253, the System shall be designed in accordance with Section II item 10. Infiltrator Modified Certification for General Use Page 3 of 7 4. The minimum separation between any two trenches shall be as specified in 310 CMR 15.251. 5. The requirement that the Chamber installed in trench configuration as specified in 310 CMR 15.253(6)be provided with inlets at intervals not to exceed 20 feet is not applicable to the System. In accordance with 310 CMR 15.240(13)a minimum of one inspection inlet shall be installed per system.The inlet shall be capped with a screw type cap and accessible to within three inches of finish grade. 6. The total effective leaching area for any Chamber Model shall be calculated by multiplying the Effective Leaching Area per square foot of chamber times the total length of chamber from end cap to end cap including end caps. 7. For new construction, the applicant can size the System in a trench configuration without aggregate, using the effective leaching areas presented in Table 2. No System, however, shall be designed and constructed with a soil absorption system area of less than 400 square feet of effective area. Table 2.Effective Leaching Area for New Construction And Remedial Sites' Effective Effective Model Leaching Leaching Area Area SF/LF SF/LF Equalizer 24 3.75 NA ick4 Equalizer 24 3.90 NA Equalizer 36 4.73 NA uick4 Equalizer 36 4.73 NA Standard Chamber 6.53 NA Quick4 Standard 6.96 NA Infiltrator 3050 or NA 7 StormTech SC-740 High Capacity Chamber 7.79 NA uick4 High Capacity 7.93 NA J1 1. Effective April 21,2006,310 CMR 15.251(1)(b)maximum trench width is 3 feet. 2. Effective leaching area is equal to 1.67(bottom width+(2x invert height))for Systems 3 feet or less in width. 3. Effective leaching area is equal to 1.0 (3 +(2x invert Height)) for Systems with a width greater then 3 feet. 4. The maximum trench width allowed to calculate effective leaching area is 3 feet. Infiltrator Modified Certification for General Use Page 4 of 7 8. Systems installed on remedial sites shall be allowed to utilize the effective leaching areas presented in Table 2 above or additional reductions in soil absorption leaching area approved by the approving authority in accordance with 310 CMR 15.284. In no instance shall the reduction in the soil absorption system required in 310 CMR 15.242 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.284. 9. In accordance with 310 CMR 15.240 (6) absorption trenches should be used whenever possible. When the System is installed for new construction without aggregate in a bed or field configuration, as defined in 310 CMR 15.252, the System shall be designed using the effective leaching area for the bottom width presented in Table 3. No system shall be designed and constructed with a leaching area of less than 400 square feet of effective area. Table 3. Effective Leaching Area for Bed or Field Configuration Effective Model Leaching' Area SF/LF Equalizer 24 2.08 Quick4 Equalizer 24 2.23 Equalizer 36 3.05 ick4 Equalizer 36 3.05 Standard Chamber 4.72 uick4 Standard 4.72 Infiltrator 3050 or 7.1 StormTech SC-740 apacity Chamber 1 4.72 ck4 Hi&LaLacity 1 4.72 1. Effective Leaching area is equal to 1.67 times bottom width only. 10. The System, when installed in a bed or field configuration without aggregate on remedial sites, shall utilize the effective leaching areas presented in Table 3 above or additional reductions in soil absorption system area approved by the approving authority in accordance with 310 CMR 15.284. In no instance shall the reduction in the soil absorption system area required in 310 CMR 15.242 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.284. 11. The System, when installed as specified in 310 CMR 15.253: Pits, Galleries, or Chambers, shall have an aggregate base and/or be surrounded by aggregate and shall be sized as specified in 310 CMR 15.253 (1) (a) and(b), effective leaching Infiltrator Modified Certification for General Use ' Page 5 of 7 area is equal to 1.0 times a conventional aggregate system.. Effective depth can be increased up to two feet with the corresponding addition of up to 14 inches of base aggregate. Bottom width can be increased by two to eight SF/LF with the corresponding addition of one to four feet of aggregate per side. 12. When the System is installed as specified in 310 CMR 15.255: Construction in Fill, the finished 15 foot horizontal separation distance, item (2), shall be measured from the from the top of the chamber. III. General Conditions 1. All provisions of 310 CMR 15.000 are applicable to the use of the System,except those that specifically have been varied by the terms of this Certification. 2. The facility served by the System, and the System itself, shall be open to inspection and sampling by the Department and the local approving authority at all reasonable times. 3. In accordance with applicable law, the Department and the local approving authority may require the owner of the System to cease use of the System and/or to take any other action as it deems necessary to protect public health, safety, welfare or the environment. 4. The Department has not determined that the performance of the System will provide a level of protection to the environment that is at least equivalent to that of a sewer.Accordingly,no new System shall be constructed,and no System shall be upgraded or expanded, if it is feasible to connect the facility to a sanitary sewer,unless allowed pursuant to 310 CMR 15.004. 5. Design, installation and use of the System shall be in strict conformance with the Company's DEP approved plans and specifications and 310 CMR 15.000, subject to this Certification. IV. Conditions Applicable to the System Owner 1. The System is approved for the treatment and disposal of sanitary sewage only. Any wastes that are non-sanitary sewage generated or used at the facility served by the System shall not be introduced into the on-site sewage disposal system and shall be lawfully disposed of. 2. For new construction, the owner initially shall size a soil absorption system in accordance with 310 CMR 15.242 to demonstrate that a conventional Title 5 soil adsorption system using aggregate, including a reserve area, can be installed on the site. The owner may than size the soil absorption system for the System. The total area required for the aggregate system, which may include the area designated for the System, and a reserve area shall be preserved and the owner shall ensure that no permanent structures or other structures are constructed on that area and that the area is not disturbed in any manner that will render it unusable for future installation of a conventional Title 5 soil absorption system. Infiltrator Modified Certification for General Use Page 6 of 7 3. The owner of the System shall at all times properly operate and maintain the on- site sewage disposal system. 4. The owner shall furnish the Department any information that the Department requests regarding the operation and performance of the System, within 21 days of the date of receipt of that request. 5. No owner shall authorize or allow the installation of the System other than by a person trained by the Company to install the System. V. Conditions Applicable to the Company 1. By January 31 st of each year, the Company shall submit to the Department a report, signed by a corporate officer, general partner, or Company owner that contains information on the System for the previous calendar year. The report shall state known failures, malfunctions, and corrective actions taken for the System as well as the date and address of each event. 2. The Company shall notify the Department's Director of Watershed Permitting at least 30 days in advance of any proposed transfer of ownership of the technology for which this Certification is issued. Said notification shall include the name and address of the proposed new owner and a written agreement between the existing and proposed new owner containing a specific date for transfer of ownership, responsibility, coverage and liability between them. All provisions of this Certification applicable to the Company shall be applicable to successors and assigns of the Company,unless the Department determines otherwise. 3. The Company shall furnish the Department any information that the Department requests regarding the System, within 21 days of the date of receipt of that request. 4. Prior to any sale of the System, the Company shall provide the purchaser with a copy of this Certification. In any contract for distribution or sale of the System, the Company shall require the distributor or seller to provide the purchaser of the System,prior to any sale of the System,with a copy of this Certification. 5. The Company shall prepare an installation manual specifically detailing procedures for installation of its System. The Company shall institute and maintain a training program in the proper installation of its System in accordance with the manual and provide a training course at least annually for prospective installers. The Company shall certify that installers have passed the Company's training qualifications, maintain a list of certified installers, submit a copy to the Department, and update the list annually. Updated lists shall be forwarded to the Department. Infiltrator Modified Certification for General Use Page 7 of 7 6. The Company shall not sell the System to installers unless they are trained to install these Systems by the Company. VI. Conditions Applicable to Installers of the System 1. Each Installer shall install the System in accordance with Company training on the installation of the System and the conditions of this Certification. 2. No Installer shall install the System unless the Installer has been trained by the Company on installation of the System. VII. Reporting 1. All submittals of notices and documents to the Department required by this Certification shall be submitted to: Director Wastewater Permitting Program Department of Environmental Protection One Winter Street-5th floor Boston,Massachusetts 02108 VUL Rights of the Department 1. The Department may suspend, modify or revoke this Certification for cause, including,but not limited to, non-compliance with the terms of this Certification, non-payment of an annual compliance assurance fee, for obtaining the Certification by misrepresentation or failure to disclose fully all relevant facts or any change in or discovery of conditions that would constitute grounds for discontinuance of the Certification, or as necessary for the protection of public health, safety, welfare or the environment, and as authorized by applicable law. The Department reserves its rights to take any enforcement action authorized by law with respect to this Certification, the System, the owner, or operator of the System and the Company. No. ✓ I 1 �Q Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zipptication for Mig og Y *pgtem Con.5tructfon Permit Application for a Permit to Construct( . )Repair Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. s i � Owner's Name,Address and Tel.No. Assessor's Map/Parcel ���"��� J i/►T(�_ aa- &.- 1 5y Installer's FNe, ddress,and Tel.No. Designer's Name,Address and Tel.No. SSA U1rt� 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 applic le) 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 d and ealt , S gned Date �,"2_Z-6;S Application Approved b Date " Application Disapproved for the following reasons Permit No. 5 H Date Issued E. . 1 No. �./ 5 �( + _ Fee CIO THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1 Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS application for Mig�l0 *p$tem Con5truttion Permit Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. { Owner's Name,Address and Tel.No. Assessor's Map/Parcel J �l�n'���`11�a-F� J�• itt�_ aa � � 5 Installer's N e,Address,and Tel.No. Designer's Name,Address and Tel''No. v . SSG s 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 r Nature of Repairs or Alterations(Answer when applic ble) \V`'L_ 9a --✓iuy\ `]�-[-r �J—T C- er i s C Date last inspected: r :r 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,.bee _is ued".is Board f ealth. gned Date ".ZZ s Application Approved Date i 'rJ`(.- Application Disapproved for the following reasons Permit No. �Dp0'j 4-1 I I Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY t=eOn-s ite Sew a e Disposal System Constructed( )Repaired (upgraded( ) Abandoned( )by 5 f L at 4 C-e-o--rr has been constructed in accordance with the provisions of Title and the for Disposal System Construction Permit No. dated � . Installer �Sir Designer The issuance of this permit sh 11 not be construed as a guarantee that �t ction as designed. Date V�'a � Inspect _ No. �CJ�� Lsl T/ --------------------------Fee .,. . . . . THE COMMONWEALTH OF MASSACHUSETTS yPUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS LIN Xh5po5ar 6p5tem Cong;truction Permit Permission is hereby granted to Construct( )Repair 6t.�_( `�ride( )Abandon( ) System located at `� '� C I c , ( r �-` 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 da flhispe, it. ja Date:_ `� _ Approve . TOVt'i�d OF BARNSTABLE I..i�r� ±fiON �1.5� I�rC.a C G :Z Q 12e SEWAGE # ,tt 1 V L V LAGE -a/l�`'e-- 'eX�c ASSESSOR'S MAP & LOT1b?G �✓ li'4STALLER S NAME&PHONE NO. SEPTIC TANK CAPACITY t LEACHING FACILITY: (type) (size) ` NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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 facility) Feet Furnished by 1 1(/ Cc wjo:j Auedwoo'jadu#nd iadwnd 10 ainleu6ig 'Ainfiad;o sa!lleued ayi japun spew s! pue';allaq pue 90polmou4 Aw;o iseq ap of iz)ajjoo pue anti st iajo!l slyi uo pouleiuoo uo!lewo;ui ayi leyi/4!va3 Agajaq I 6uip)(n8 olu) do 6uireg ❑ 6uinno)P9n0 ❑ •luleyy pa)npeg3sun ❑ •luieyy pa)npayog ❑ :uoseaa deal aseaig ❑ juel oildag ❑ )oodssao ❑ :az)jnog padwnd aleQ padwnd suo(ieD (lsel) (isill) al.ueN Vaunnp (oBell!A) (jeans) (jagwnu) ssajppy laaJlS 13)1311 JNIdwnd 39VId3S sjaoM :)ilqnd ;o -idea WPM �o paeog ON Hino0 v:j d r NMOl J 77- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 1 PART C •o SYSTEM INFORMATION (continued) r [� Iroperry Add s: 751t1°C�i2`VJ�i�" Jwncr: Date of ILO/ ,o47-Qy SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmar�s o lr comes into house) locate all wells within 100' (Locate where public water s Y I t 1 Z 203 499 146 US Postal Service Receipt for Certified Mail' No Insurance Coverage Provided. Do not use for Intemational Mail See reverse Street,& uu perr P °/i uJ p //State,&ZIP Code !yiJ ge $ Certified Fee Spada]Delivery Fee Restricted Delivery Fee rn Retum Receipt Showing to Whom&Date Delivered n Return Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees $ c) Postmark or Date 0 a Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). y 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the QQ) return address of the article,date,detach,and retain the receipt,and mail the article. 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the r gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article C a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee,endorse RESTRICTED DELIVERY on the front of the article. Goo co 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. t 6. Save this receipt and present it if you make an inquiry. 102595-97-B-0145 a .� ,.� Town of Barnstable • Department of Health, Safety, and Environmental Services 3AFtN3[Affi,E, 9NAM �� Public Health Division �A 367 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Heahh TO: KAREN M. KELLY DATE: JAN. 20, 2000 P0 BOX 144 HYANNISPORT , MA. 02647 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 45 LAKE ELIZABETH DRIVE was inspected on 12/15/97 by JOSEPH MACOM 3ER a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: �cSTATIC LIQUID LEVEL IN THE DISTRIBUTION BOX IS ABOVE INVERT DUE TO AN OVERLOADED SAS CESSPOOL. The above system, according to our records has been in a failed state for more than two years. Therefore, you are directed to hire a licensed Town of Barnstable septic system installer to sketch a proposed system that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within(14) fourteen days of receipt of this notice. The septic system must be brought into compliance within (30) thirty days of your receipt of this directive. You are also directed to maintain the system by hiring a licensed.septage hauler to pump the septic system to prevent discharge of sewage or effluent into buildings, onto the surface of the ground, or into surface waters'. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH PomaVs A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable ghWth%&M.ViW2y.dx UNITED STATES POSTAL SERVICE n i First-Class Mail ,�O Postage&Fees Paid V � uSPS " ` Uj PM `;� Permit No.G-10 a A Print your n�am4, ad'Ifegs;and ZIP Code in this box 2�pC Board of Wealth 'Gown of Barnstable � P.O. Box 534 Hyannis.,Massachusetts 02601 I I I vComplete SENDER: t andlm21'foi additional services. I also wish to receive the rn :0Complete items 3,4a,rind"47b. following services(for an •Print to Yo ou.ame and address on the reverse of this form so that we can return this extra fee): card ■Attach this form to the front of the mailpiece,or on the bads if space does not 1. ❑ Addressee's Address permit. $ ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N ■The Return Receipt will show to whom the article was delivered and the date a o delivered. Consult postmaster for fee. 0 f d 3.Article Addressed to: 4a.Article Number 4b.S Ice Type d D D �, �G�(' ❑ .egistered ,Certified N J Express Mail ❑insured Re i fo andise QUCOD w Tte of Delivery o f n 5.Received By:7"ame, 8.Adore e's° dres ( ' nested ( W and t ¢ t- - 6.Signature:(Ad ess rael, � X PS Form 3811, December 1 4 tozass-s7-B=ot7s Domestic Return Receipt r CO\I\IONWEALTH OF '-L-,,SSACHUSETTS E.l"ECUTI�'E OFFICE O= E\17R0NA4E\TA1 AF F.L .� ?{!_ ' DEPARTMENT OF E'r�"II�ONIv1ENTAL PROTECTION _S ONE RI\T3rR STREET 02:06 (61;i TRUDY CC Secret DAVID B STRL 1RGEO PALL CELLUCCI Corrsnissic Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION �(C - J� Cen'ern property Address:7 J k&eb'zab yej re_ Name of owner G Address of Owrw- Date of kupection: ' Name of Inspector:(Please Print) Woclgel' ���1'�S ant to beetion 15.:s 1 am a OEP approved aystem yrr{(t of pursu „w of rite 5(310 CMR 15.000) Company Name- d-L !�D µacing Addrass: Telephone Number: CMT1FiCATION STATEMENT I certify that(have personally inspected the sewage disposal system at this address and that the Information reported below is true, accurate and compiate as of the time of Inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _zPasses _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails 01 Date: /d.a 1 6nspectors Signature: The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty (30) days 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 ow shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to ttte system ownor and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page te[it til Pnnud m Recycled►Ape. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A f /,, -�,,, /L 1 nCERTIFICATION/ (continued) Property Addre s:�1 L�xe&lliG belhJe. Cewlet-vi //ei Owner: nG� Gy Date of Insaection: v7'7 1�j 61 SYSTEM CONDITIONALLY PASSES (continued) L� Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C] FURTHER EVALUATION 15 REQUIRED BY TIHE 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 the public health, safety and the environment. t) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy i5 within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. — The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIIFIICC�A/TIO�N�(continued) Property Addres T� e CAI Zw.�T"'�/'� • �� ^�' `r l'C� Owner: &17ey Date of Inspection: 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 failin; to protect the public health, safety and the environment. 11 SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 (1)(b) THAT THE SYS- IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF ANY)DETERMINES THAT THE SYSTEM FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS) and the SAS is within 100 feet of a surface water supply tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates tha well is free from pollution from that facility and the is of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (contirwed) Property Addre 5:S�5�alre f/i7Q�°ui�/Q• �,�r1�QI-v���� owner: e��1°iy Date of Ir� pection D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: _ I have determined that one or more of the following failure conditions exist as described i^ 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine %hat will be necessary to correct the I; Yes No Z Backup of sewage into facility-or system component due to an overloaded or clogged SAS or cesspool. U Discharge or ponding of effluent to the surface of the ground or surface waters oue to an overloaded or clogged SAS c cesspool. Static liquid level in the distribution box above outlet invert due to an overloade: or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less tnan 112 day flow. yRequired 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. / 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 r acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis fc •coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: AThe system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system Is within 200 feet of a tributary to a surface drinking water supply the system Is located In a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA) or a mapped Zone 11 of a pu water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regi office of the Department for further information. revised 9/2/98 Page 4ofII i f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST ?roperty Address:�1 IWGe C.l I ahe/ /�h C•e /tervl 11 L Owner: e. Date of Iruo e,eroo ID;,1�n r 9 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Yes _ Pumping information was provided by the owner, occupant, or Board of Health. K _ None of the system components have been pumped for at least two weeks and-the system has been-receiving normal floe rates during that period. Large volumes of water have not been introduced into the system recently or as part of this /� inspection. V As built plans have been obtained and examined. Note if they are not available with N:A. V The facility or dwelling was inspected for signs of sewage back-up. r _ _ The system does not receive non-sanitary or industrial waste flow. _Y The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. Z The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffl or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ _✓ Existing information. For example, Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable / 115.302(3)(b)I The facility owner (and occupants, if different from owner) were provided with information on the propermaintenanca-0f SubSurface Disposal Systems. revised 9/2/98 PagcSof11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION ' Y : r Address: � �i Owner: ey Date of Insp Cti /b.97-9f RESIDENTIAL: FLOW CONDITIONS Design flow: g.p.d./bedr�i. Number of bedrooms!(.design) Number of bedrooms (actual): Total DESIGN flow Number of current residents: 0 Garbage grinder(yes or no):_s // Laundry(separate system) (yes or no)A ; If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no): J Water meter readings, if av ilable (last two year's usage (gpdi: Sump Pump (yes or no): Last date of occupancy: ✓,)- COMMERCIALANDUSTRIA L: Type of establishment: Design flow: Qpd ( Based on 15.203) Basis of design flow Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER:(Describe) Lest date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: No Ev C H y .,5 /16aV69 System pumped as part of inspection: IYA or no)_ If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM eptic tank/distribution box/soil absorption system Single c�,ss pool _�Overflo'W cesspool Privy Shared system (yes or not (if yes, attach previous Inspection records, If any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known) and source of Information: Sewage odors detected when arriving at the site: (yes or no) revised 9/2/98 Page 6(if II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 'roperty Addre s: yTIa e- 6112a bed , e. 6enMrv/1)c Owner: ���e y Date of Inspection: !D BUILDING SEWER: (Locate on site plan) Depth below grade: �� / 1 Material of construction:_ cast iron_40 PVC V/ other (explain) cl1q', Z 1 LG. 5-f1 Distance from private water supply well or suction line Diameter—� fl Comments: (condition of joints, venting, eviden_ e f leakage, @tc.) t lti SEPTIC TANK: (locate on site plan) Depth below grade:_ Material of construction:_concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance_ (Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: :omments: outlet tees or baffles. depth of liquid level in relation to outlet invert, structure(integrity, frecommendation for pumping, condition of inlet and evidence of leakage, etc.) GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensions Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) revised 9/2/98 Page 7of11 i SUBSURFACE SEWAGE DISPPO R LCSYSTEM INSPECTION FORM SYSTEM INFORMATION (continued) ,rope`" Address:7�s-'�'^'� LTis icvG / !�P el l Owne+: Date of I ion•p 10 7;L7 -95 TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) o Depth below grade:_ a lene _other(explain) Material of construction: _concrete _metal _Fiberglass _Polyethylene Dimensions: gallons Capacity: allonslday Design now:.g Alarm present Alarm in working order: Yes — No_ Alarm level: _ Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc. DISTRIBUTION BOX:1 (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER:. (locate on site plan) Pumps in working order: (Yes or No) Alarms In working order(Yes or No) Comments: appurtenances, etc.) (note condition of pump chamber, condition of pumps and PaFc 8 of 11 revised -9/2/98 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (contirwed) 'roperty Address: ��l.Wt•e f�iZahe 4/Q• /el�✓�1�� Owner: gl/ems/ Date of Insoection:///O SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number:_ leaching trenches, number, length: D leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, )eve of�ondin da p soil, condition of vegetation, etc.) CESSPOOLS: (locate on site plan) Number and configuration: lor, Depth-top of liquid to inlet inv rt: Oepth of solids layer: 4k� )epth of scum layer: U�. Dimensions of cesspool: Materials of construction: 8 Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of ve t ton, et 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.) revised 9/2/98 Page 9of11 + y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �,���v/ �/ �,� 1 SYSTEM INFORMATION (continued) roperty Address: `�L 4ze- C.•�I�`` �/Q• Cen 'cvvd l ei Owner: Ke w Date of Inspeon. io a-7�y NRCS Report name - — --- Soil Type— — ------ — - --- Typical depth to groundwater_____ __ _-- USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells ��.. Estimated Depth to Groundwater fFeet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting property, observation hole. basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) �u5 hf:X.4!�74'b442 %�/ r ��aD A10 ter- revised 9/2/98 Page 11of11 r , NEIL CAMERA P.O. BOX 357 WEST HYANNISPORT, MA 02672 508 790 9300 August 16, 1999 Thomas A McKean Director of Public Health Town of Barnstable Public Health Division P o box 534 Hyannis, MA 02601 RE: 45 Lake Elizabeth Drive Centerville, MA Dear Mr. McKean I received your notice dated August 9, 1999 today and would like to bring you up to date on the status of the items you listed in your letter. I had previously gone over the items with Glen Harrington, R.S. Health Inspector for the town of Barnstable on the day after the inspection. Most items were dealt with by that time. Please be advised that all systems, wiring, plumbing,heating, windows, etc. are brand new and Alice Kelly is the first occupant since the remodeling. My response and action on the specific items is as follows: Item 1) Sliding screen doors were brand new at the time of inspection and have since Been adjusted. Item 2) There does not appear to be any leaks, only condensation, however, our plumber is scheduling a time to make any necessary repairs directly with Ms. Kelly, our summer rental guest and will have any repairs necessary performed this week. Any moldy areas will be sealed and painted right after the repair. Item 3) There is sufficient hot water to the second floor shower, however, if the handle is turned to the extreme right, it reduces the hot water flow. The handle will be adjusted by our plumber. Item 4)The electricity to lighting and ventilating fan was repaired. Item 5) The appliance company that we purchased the washer from scheduled a repair under warrantee. It has already or will be repaired shortly. If for any reason it can not done be repaired within the time period, it will be removed from the premises until it can be repaired, since there is no requirement to provide a cloths washer or dryer in the summer lease. Item 6) The owners name, address and phone number has been posted. Item 7) One smoke detector was not operating at the time of inspection. It was operating properly when it was installed just one month prior to the inspection. A temporary smoke detector was installed and the non-working detector was repaired. Item 8)The permanent screens were on order at the time of inspection. They were delayed because of the hot weather with all the fabrication companies being extremely busy. They were received and installed on the Monday after the inspection and the temporary screens were removed. They will be returned to the supplier as illegal for use in the State. Thank you for our assistance. Please call me if any further information is required. Sincerely, f Neil�C era Managing gent for Karen K ey, Owner 45 Lake Elizabeth Drive Centerville, MA oFIMET ti Town of Barnstable • Department of Health, Safety, and Environmental Services BARNSTABLE, MASS. m Public Health Division i679• �� 39. P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,RS,CI-10 FAX: 508-790-6304 Director of Public Health August 9, 1999 Karen M. Kelley P.O. Box 385 West Hyannisport, MA 02672 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE, ARTICLE 51 The property owned by you located at 45 Lake Elizabeth Drive, Centerville, was inspected on August 4, 1999 by Glen Harrington, R.S. Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code II, Minimum Standards of Fitness for Human Habitation were observed: 410.351: U Sliding screen doors were observed not to operate properly. 410.351:g Lower floor bedroom ceiling is moldy from first floor plumbing. 410.351:(<95) Hot water was not provided to second floor shower. 410.351:U No electricity to lighting or ventilation fan in second floor bath. 410.351:M Clothes washing machine was observed leaking hydraulic oil. V 410.481:lJ No posting of owner's name, address and telephone number. V 410.482:0 Smoke detectors were found to be inoperable. 410.5510 Temporary screens utilized in majority of windows are unacceptable. r y Z L _ 499 004 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do no use for International Mail See T ® e Sent to Office, ZIP I Code Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to Whom&Date Delivered n Return Remo Showing to Whom, Q Date,&Addressee's Address QTOTAL Postage&Fees is M Postmark or Date , 0LL a Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). a� 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address of the article,date,detach,and retain the receipt,and mail the article. uO 3. If you want a return receipt,write the certified mail number and your name and address rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee,endorse RESTRICTED DELIVERY on the front of the article. co 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. li 6. Save this receipt and present 0 if you make an inquiry. 102595-97-B-0145 a oFt► rati Town of Barnstable Bnxivsrne►s Department of Health, Safety, and Environmental Services 9� "�: ,. Public Health Division P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health August 9, 1999 Karen M. Kelley P.O. Box 385 West Hyannisport, MA 02672 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at 45 Lake Elizabeth Drive, Centerville, was inspected on August 4, 1999 by Glen Harrington, R.S. Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code II, Minimum Standards of Fitness for Human Habitation were observed: 410.351: Sliding screen doors were observed not to operate properly. 410.351: Lower floor bedroom ceiling is moldy from first floor plumbing. 410.351: Hot water was not provided to second floor shower. 410.351: No electricity to lighting or ventilation fan in second floor bath. 410.351: Clothes washing machine was observed leaking hydraulic oil. 410.481: No posting of owner's name, address and telephone number. 410.482: Smoke detectors were found to be inoperable. 410.551: Temporary screens utilized in majority of windows are unacceptable. You are also directed to correct the remaining above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH a � . McKean Director of Public Health cc: Alice Kelly cc: C-0-MM Fire Dept. J�o YN�ro,e The Town of Barnstable • -_ Health Department '177Tf" 367 Main Street, Hyannis, MA 02601 rua AY M. Office 508-790-6265 Thomas A. McKean FAX 50t-j7pt3344�5 d- cl 1 Director of Public Health 1 �. G• 6.0x AILIf d 7 z NOTI_C_E TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY l CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property owned by you located at 4S La-1,cp LZaba V was inspected on IkL-S=-j•+- 4 , 1997 by f &L,-, }40. v KSt , (e , S" Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code II, Minimum . Standards of Fitness for Human Habitation were observed: j O SCNlp j y 3 : S (,' "" 7 S C.v`QB� ctry -J ws j &4j JLe ry e J 1_ _ -" �• (°'. 3`� � : L o-t,,,.�.� `�� �d.�-mow. C e�.�,.� r`s � ta�j. �'r-o�-. �c�,�� tL�-- jv C � (`� Y e r these 'olat' OE2 fo r ) �ctedof ei h' You are also directed to correct within ,�„� �� days/hours of receipt of this notice.. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health 9 /0 , 3 s I C tcn y -k j W a j 1.� I c) -14 7-Z- Lvv U-p- "aw S LV'f e(A1 v47` (( UL- jZ �y cc �FORM30 Caw HOBBS&WARREN inn THE COMMONWEALTH OF MASSACHUSETTS 7�'f�- 70fj BOARD OF HEALTH CITY/TOWN47) / G 2 a DEPARTMENT ADDRESS 76 Z—y 4 q y'°ey0 TELEPHONE Address �� ` �`'Za l.eV� �''r Occupant- Cam. A54, Floor Apartment No. No.of Occupants No. of Habitable Rooms'7 No.Sleeping Rooms No.dwelling or rooming units No.Stories Name and address of owner��1 a`/!0 1, �f� SI�1rx. a- �✓ i 7 1�� emarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches-.— Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: -t_ Sc, eeto Roof S" T 'I LIU-" Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceilin a. 6s t;wvl ; 'g / Hall Lighting: �. vrr+lla e Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: dt,i &,avu— El MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vents XrQ+ ELECTRICAL Panels, Meters,Cir.: 110 't220 Fusing,Grnd.: AMP: If Gen. Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT �e0 Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom uww,r Pantry ►` Den Living Room Bedroom M, Bedroom 2 Bedroom 3 Bedroom 4 ➢C , Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: ' 9 / ® J I e` Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted 3 d X✓� Locks on Doors: I �1 ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH ,5�' MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJU A INSPECTO i `�/" TITLE �A �� DATE v TIME I'd`���"' P.M. THE NEXT SCHEDULED REINSPECTION 1 �� {�°�® / �a/`(J P.M. • e.r ti •.aiy;xy Y7e MM;...:4bWr� t� :er::..rY't.++ �...j M.r h lT'1t'.';...t ;r�f;, : ''Q r. •.:Y�'�t'j. L'{�Sdk+t; •eM. ; ,.+n,.xy:. .,M,: :' ' I Y% EWE t , 4)0.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to,xalways have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential tofall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing Failure to include shall in no way be.construed as a determination that other violations or conditions may not bo'found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410:830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom,the order is issued to comply with such order. t (A) Failure to provide a supply of`water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. B Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as ( ) p q prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. ('E) Failuure to provide a\SAfe supply of water. 1 (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (I) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the-creation or spread of disease. (J) The presence of leadbased paint on a'dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or,failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353., ' (N)' Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the'following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: -(1) Lack of'a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. - (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasf`tting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain�a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger.or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered bythe Board of Health. r ' i x II, i t i r � �^ 2-t( COUNTDOWN Feline in a Fedora Dick and • Jane just didn't cut it with the MILLENNIUM doctor. Dr. Seuss, that is, the nom de plume for Theodor Seuss Geisel, who published The 3 Cat in the Hat in 1957. Geisel wanted kids to read, but he TUESDAY wanted them to enjoy the learn- ing experience along the way. Thus, his top-hatted feline came to visit while Mother was.away, and the rhyming antics captured the attention and imaginations of a generation of young book-lovers. F 1 :.::::::::::::::::::::::::::::::::..:.:::::..::::::::::.:.::::::::::::::::.:::::::.::::::::::::::::.::::::.::::::::.:::::.;:.:::..;......... :::::>::::>::::>:::'•s:::1`#ffA:M..:...11ft"$ 226154 < <::.::::::. .-e.,...".,.".............-:%.....,..,......`.....":..0.... :::: ::": ':'::+: ..... ..:.!?.,...i:::}:(::::i':$; .:2:?:'-ii:i{:.i;i::i>i'.''.''' 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EEEEEEEEE #<:: ::. `:..... :cil...........v.. ....ssEEEE::.::::::::::::::::::::::::::::::::. ............................................................... y� "``''i::::::: :............................ ::::::::::::::::::::::::::::::::::::::::.t!� f�#��.•i:•i:•: .1452312 .................................................. :::.AZOY PHILIP:?L::>::>:::: '.. 0000?»> ?>'' `;` :`.."' l3 �i�i te'�-':: , :... : 1452/312't'' ::::>:. : »::>::>::>::>::>::»>::>::>::>::>::>::>::>::>:z: :::67000:::::::i�tkts..... : i.Ei�{5x•::.::::.:...................... ::>::::: 11i1C#ilt 5.. > `?#': rteatises:::: 0000 0 .::::::::::::::::::::::::::::::::::::::::::::::::::. f::::::::::::::::::. :::: 124300 00 000 >>z > :?::<:>EEE:::»:«<:<:«::«<:«««:: ................................ .....................::::::::::::::::::::::::: ......::::::::::::::::::::::::::::::::..........................::::.;;:•::•:;•:;;:-:-::-::;::«zzz::.>:•;:•::•::•::::>::::;:-;:-;:-:.:-:-....... 45�'"'``'' LAKE ELIZABETH DRIVE................:: 43: `::::z:>::>:::fith E#:#rzi#eg::: :::';...44kQ:0090 '?'» >>> # > > > >>> ............;:;.......%::.:::.. ..:3..........: :•i:•::•>:•i:•i:•::•;:.;:::.:::;.::;.;:<.;:.::.:08`6`4�`� ;::•:::........... >:.::.::.::::::.:.-.-.%:.::.::-::.:;-:,....:.::;:.: Unassi ned Road Name :.:::.::.:.a :ftTd #.::.0000 9 ::::: ' ........................................................ ::::::::::•::::::•::.;:.::.:::.::.::.;:;:.: W..>:•............. 4:>::>::»::V....>::»::>::>::>::>::>:<:«<»>:: $.q ': S . ) CENTERVILLE-OSTERVILLE=MARSTONS MILLS FIRE DEPARTMENT INCIDENT REPORT Alarm No•_��- �� ____ Brief Narrative Required on all Calls �i Type of call'. �IE',� egEa,�l.�� '_._-=--- ' m _ Oistrtct: _lj2._ __ Name of eueMess: ___� _ -- Received re oak from Taws health department_ o Location: S_llS _�?�! -- 2=-�� _Date:_ __ -_ -.�____-- y,� - - -- re ardin an ins ection t e co c _tl�__ Called b t.��'�P W� -co�Tel.#!', -aD='a.� Tlms reed .__fi_____E__.-----E--- --- -y_ _ -Dtspatoher:--rc:tar �-�_ �."s� - - this a dyes #�Ithiq repQ:r[.it�ta,a rev�3d Comments:_- - - - - ------------ - 00 �.��.�� �t'2��A77�� � -� -that this reaiidence Call Received On: 911-+- PLT RedloWalkln Other; detectors. _ Total Manpower . POU imestigationLI mound all detectors ao Apparatus response: '3dS�_____ p works sacs t for detector in second f1gLr__ m On the Air:_ /�h�•-on location:_l4St� Ret., / 1�,In Service-lam_ ?�-_._-At:p:Weaiher: PP6.2kZj Tem7� Wind---Q) _ hUa-llway. Thes ten-e-n-�-e-_- d�Bs�eB9r' 4s�- bk_ 1e_ hts In lfv area b tnk and ac=-- n w.rrwarr.rrrrrwrrrrrrarrrrrr+rr.rwra.rar.r.rwarrrr.rarrr rrrrw rr. blow the circuik breaker on a :regular_aeit_ Other Agencies Notified {lhlle_testin smoke detec or �s> Ihak- NamelAgency Tate No. By s------ "tom all detectors do not_seem to. be interconnected. explained co the tenants that I woul4_gUt.ack - --Wa1s�_Realty_�q�,t2t'?E't3_ -.� �-�•a"e._Cheau .rrrrrrrrrrrrrrr.rrrrr.ararrrrw....rrrrrrrrrr..a.rr.a.r.rrw.rraa koda and have electrician e�r$�Uate n0_$ �le Buildings - Type of occupancy; Tole No: - --Y1------------ ised Address: problem with gLCc-U &9i 3�1� �_.�-a1-Q-adY Owner:, - �-•- ----'- _tenant that I would tell Walsh Realty to-1 age - - fore end�f r.rrrrrwwrrwr.rrr.rrrrrrrrrrrr.r...rr rr wv..rr rrsrr..r....rrraane ciCian d0 this eVa Mat�o���'�M� F- mentlType;__ N-_.__ ___.__location:_______r__�_ Equip ktrsh Reahty�e�1ai - Model: Letter was mitten to Wal A Year: __.____Make:,^ -�` - - _ W Serial No. same. I had Walsh ---------_ I 0 U. rrrrrwrrrw...w.r..rr.rrrrrrw+rs.wrrrrrrrrw..rt..rr+eerw.rwa.rrrrwr page the Walsh's tari.ce, but.,no response. Motor Vehicle Year: _ Make/Model: left letter at diSDateh to_�iaye sl_ pafic �3__ Color:_ VIN: yea _letter �9�1st '_���-tbS•p-��-- o to -- - �_ State— Address:------------ - --_` - gL1� = _Uja t w Owner:___._��_.._.�_.. _—r � r_f � 1es � 1ZQQ.�e_I.e�ld JsttAx to_ `-' O orator: -Address:___-^ __ - P him. and owner advised-him that �e would take of tomsrr Ma�� i _ _ - Qt _detector toad_oe= agaiu_aCate}_ a.;3-V"e z _ raw.rnwrr.rrwwrrrriu+rrrrr.rrr.w+warsww.rrr.rwr.wrrwwewrrrarrr.rr. seed hei-_g_.a�v�seSl �t -fBD•t•.-.b�-�-�-�d Q Brush Fire Class: Area/size: take care of this in the morning. m Personnel; Cost: I called_ § Walsh o adise him of sJi�` a ilq� Q1 ` rwrwrrrrrwrrrr.rrrarrwrwrrrrrrwr.wwwrrrrrarrrrr.rrrwro.ovraaa.nr � wi_�,_.�y,� ��ca1;��Tper. an�,.,y�,.�A�.-. m Automatic Alarms - Claselflcatlon/Code; m List Items needing Follow Up: .1 - i Form #r62 left al/with:- _ _A_ m r Report by: ate �.Qa& 449 C•O•MM Form 019A Chlef Reed:_ Date: 08-05-1999 09:20AM CENT OST FIREDEPT 5087902385 P.03 o r i I CENTERViLLE-OSTERVILLE-MARSTONS MILLS FIRE DEPARTMENT NARRATTIVE REPORT ALARM # 581 PAGE P- 2 DATE:{ 8/5/99 } i Dot wil m,n& with order zQ osex-nd ta1L APt c=!rad"-- I requested Ik- W advised of situation- ---- . -- I _-_ - REPORTED BY: DATE: August 5 1999, Form #t 96 TOTAL P.03 'I 08-05-1999 09:19AM CENT OST FIREDEPT 5087902385 P.01 -THE GREAT ESCAPE! NITA IM Fire Pzvmdon Week Theme CENTERYILLE-08TERV1LLF-MARSTONS MILLS ME DEPARTMENT OFFICE OF FIRE FREVENnON 1875 ROUTE 28 CENTERVILLE, MA. 02632 _ (508) 790-2380 ./ FAX ! (508) 790.2385 FAX COMMUNICATION MESSAGE I DATE_ TO: ' "D_. Y64 ATTN: G4,,,�x/ FROM: '�D Gr��N �• G(JI L� � WE ARE SENDING PAGES,INCLUDING THIS COVER LETTER { PLEASE CALL(508)790-2380 IF YOU DO NOT RECEIVE THE TOTAL NUMBED OF DOCUMENTS i i Confidentiality Notice'This fax transmission may contain confidential information belonging to the sender which is legally privileged and which is intended only for the use of the individual or entity named above.Any copying,disclosure,distribution or dissemination of this information or the tak& of any action based on the content of this communication is strictly prohibited.If you have rived t}.�is transmission in error,please notify us immediately by telephone and return the original transmission to us by mail or delivery at our addzess above,the cost of which shall be paid by us.Thank you! FROM WALSH REALTY 775-7330 PHONE NO. : 508 771 1282 Aug. 05 1999 11:48AM P1 IVIAHIE L WALSH, GRI, CRB, CRS ;;m REALTOR-NOTARY Peel-IC; _ !MLS: Wa& Really HEALI'OR of the YEAR 1990 9 610 W.MAIN STREET � OFFICE:(5U8)775-7330 HY/1NNIS, (AA 0?G07 (AX:(,SUB)771-1£$2 FAX COVER SHEET DATE� • N TO• QM(� FAX PHONE; FROM: MARIE T , WALSH, CRS,CRS,GRI FAX PHONE# 508-771 -1282 Total # of pages including cover If you do not receive all pages, please call 508-775-7330 AA SPECIAL INSTRUCTION OR MESSAGE: f7 } � � r7 ;L • • address i Town of Barnstable Department of Health,Safety,and Environmental Services ' -�� ��"� NQ'L ' -�==--• Public Health Division �+ < <° , 1` ��, - •� �. 367 Main Street Z 203 499 004 AUG o'ss "Hyannis;MA 02601' '.J 6138443 KAREN M. KE LEY P.O. OX 3 5 WEST H 6 2 / 3 `soy CZ 45s� At� CyF O3 �aa om i��A�� 9�%seFC b'P�1i'L`aQ I ! I1111IItIIIIIII III III111-1111111111!111111111 111i1111 r � __ �, � � `� f f I i /� , � f � �. [ �`, °� � 1 i � f � `� ��`� S,K� ,,t...:7'��'-�.-^1` h C ti' •.Y,wr.. � ..+'s .. �' .a ..�,y.....t,,,..M•., w...�i"�.C'N'"'"ri".-.( `.�...� „rr,.s•�. .. ,�N.. .+r •* - ��.,�M\ Tm THE COMMONWEALTH OF MASSACHUSETTS �.�� I JQ,© FQRI�"�30—(V HOBBS&WARREN BOARD OF HEALTH �" e� r .� of CITY/TOWN DEPARTMENT 367 t ADDRESS 76 Z - 96yL+ a TELEPHONE I/ Address � ..671�z�L-e� _6k C._�'�Occu ant _ 1( t 1'� (t -. _ -- _ p. - � _ Floor Apartment No.___ -_ No. of Occupants___ •� No. of Habitable Rooms_`'_ No.Sleeping Rooms__.__ No. dwelling or rooming units -,-7I No. Stories -7- p Name and address!of owner !1_�t4__ _,_ � _ _ 4joL SI_ 1r�e I -/�I fi r►-z 77 33 emarks Reg. Vio. YARD Out Bld s.: Fences: k Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress: and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: t Sc,r e e ve 2S' ck Roof (i Z `I 4 t k C,*vre_ S'1 � Gutters, Drains: Walls: Foundation: �,. Chimney: ' BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.-. Hall, Floor,Wall,Ceiling: LL. t,"-/ t i l i 'S a l tam. S Hall Lighting: \. Hall Windows: HEATING' Chimne s: Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: Zatt, t✓a)'u— ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vents *,4-w 1;, 2-4A FJ f0oLW l j 33— ELECTRICAL Panels, Meters,Cir.: _toro Iff H ')Q 110 r 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen Basement Wiring: DWELLING UNIT �� 0 Ventif`' L to Outlets Walls Ceils. Wind. Doors Floors Locks ( ` N 'A Kitchen �\�\ Bathroom Pantry Den Living Room Bedroom(1) Bedroom 2 Bedroom 3 .. Bedroom 4 9C , Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin, Shower or Tub: 6t S ac lv-Ak (era li r` d, k4ej Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted p WeS Al Nm.11 JLF Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH /•AS�' }� MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE G(J��_ AUTHORIZED INSPECTOR.(See Over) �A1V.A/t n'��jDI "THIS INSPECTION SP C PER RRr w�EPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND I 0 PENAINSPECTO '� TITLE . 1114 DATE v TIME ( �'y" P.M. THE NEXT SCHEDULED REINSPECTION �� ����� �d P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. FzWE r Town of Barnstable 0 : Department of Health, Safety, and Environmental Services + IAMSTABI.E, « MASS. 039. Public Health Division ♦0 A'ED1A°�A P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health August 9, 1999 Karen M. Kelley P.O. Box 385 West Hyannisport, MA 02672 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II,MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE, ARTICLE 51 The property owned by you located at 45 Lake Elizabeth Drive, Centerville, was inspected on August 4, 1999 by Glen Harrington, R.S. Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code II, Minimum Standards of Fitness for Human Habitation were observed: 410.351: Sliding screen doors were observed not to operate properly. 410.351: Lower floor bedroom ceiling is moldy from first floor plumbing. 410.351: Hot water was not provided to second floor shower. 410.351: No electricity to lighting or ventilation fan in second floor bath. 410.351: Clothes washing machine was observed leaking hydraulic oil. 410.481: No posting of owner's name, address and telephone number. 410.482: Smoke detectors were found to be inoperable. 410.551: Temporary screens utilized in majority,of windows are unacceptable. 11 't You are also directed to correct the remaining above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH a McKean Director of Public Health cc: Alice Kelly cc: C-O-MM Fire Dept. I DATE : _ 1 /' 2�'21g8 � PROPERTY A DDR E S S • 45 Tsake Elizabeth Drive ✓ , q ��e 0 rie 0�� N 2 T w Mass . FrJ 104,1 99C7 +o On the above date, I inspected the septic system at the -above 8re g" This system consists of the following: 1 . 2-Block Cesspools Based on my Intkc�actlon, I certify the following coridltlons: 2 . This' is not a title five septic system.' 3 . The sewage system is in proper working order.at the present time. 4 . All toilet facilities of lower level have been removed therefore this eliminates failed cesspool at lower level . 5. All area must be capped and sealed off. Which they are not at this time. • 51GNATUR7 : Name : J , P , Hacomber Jr... r Company:�_ P_Macogber &- Son- ,Inc . , __Centerville `Me9s__Q2632 Pn o n e : c,CZ_ J_5._3338-_----- I , THIS CERTIFICATION DOES NOT CONST[TUTE A GUARANTY OR WARRANTY SOSERH P, MACOMBER & SON, INC. T+nki-Ceupooh-L4achfleldi . Pump.d 4 Inttillyd Town Sower Connoctloni P.O. 6oz 60 ' Centerville, MA 02632.0066 17 7 7 5-6412 • �I COMMONWEALTH OF MASSACHUSETTS ID EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS _ DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617-292.5500 WILLIA.Nt F.WELD TRUDY COX Govcmor Sccrcta ARGEO PAUL CELLUCCI DAVID B STRUYI Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commission, PART A CERTIFICATION Property Address: 45 Lake Elizabeth Drive Craig. Address of Owner: Date of Inspection: 1 /22/98 (If different) Name of Inspector: Jc)gt—h P_MAramber- Jr" I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: J.P.Macomber & Son Inc. Mailing Address: Box 66 Telephone Number: Cent-arvi 1 l a*Maac Q2A'A? CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: V Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: __�YA i 41JI— (;Ga�zi.� Date: The System Inspect s I submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to ttie system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AI SYSTEM PASSES: k-S I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303 Any failure criteria not evaluated are indicated below. COMMENTS: B) SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, /'y_no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not ,/= ) The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection, or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revioed 04/25/97) Page 1 of 10 DEP on the World Wide Web: htlp:/rwww.magnet.state.ma.usJdep j Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 45 Lake Elizabeth Drive Craigville Ma Owner: Philip Azoy Date of Inspection: 1 / 22/98 B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: 0 Cesspool or privy is within 50 feet of a surface water LV Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. �'O The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. 1 The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance 4,1A(approximation not valid). 3) OTHE (revised 04/25/97) Page 2 of 10 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property address: 45 Lake Elizabeth Drive Owner: Philip Azoy Date of Inspection: 1 /.22/98 D) SYSTEM FAILS: Yo4 must indicate ewer 'Yes" or "No" as to each of the following: NO I have determined that the system violates one or more of the following failure criteria as defined in 310 CmR 15.303 Tne bass for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to cone the failure. Yes No ✓ Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. •4 i KIAF� _ Static liquid level in the distribution box above outlet inven due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below inven or available volume is less than 112 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe($). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a suriace( ater supplti i�- Any portion of a cesspool or privy is within a Zone I 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 n acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (large System) and the system is a significant inrew to public health and safety and the environment because one or more of the following conditions exist Yes No t2D the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area • IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for funher information E lr•vi••d 0�/15/91) P•y• 3 of 10 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 45 Lake Elizabeth Drive Craigville,Mass. Owner: Phillip Azoy Date of Inspection: 1 /22/98 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components,4luding the Soil Absorption System, have been located on the site. ',The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. / The size and location of the Soil Absorption System on the site has been determined based on: _ The facility owner (and occupants, if djfferent from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System, 1C Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (I5.302(3)(b)) (revised 04/25/97) Peg• 4 of 10 51 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 45 Lake Elizabeth Drive Owner: Philip AzOy Date of Inspection: 1 /2 2/9 8 FLOW CONDITIONS RESIDENTIAL: Design Flow: (,,,W 8.p.d./bedroonn for S.A.S. Number of bedrooms: Number of current residents:0 Garbage gander (yes or no): (7) Laundry connected to system (yes or no4,4L-S, Seasonal use (yes or no):Vj /�S 5 DUO—�ql�(�►�S /3.(09 G.Pv water meter readings, if available (last two (2) year usage (gpd): A' .`l3 C,RQ Sump Pump (yes or no):12D T� Last date of occupancy:VIVLC COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: h/P gallons/day ((�� Grease trap present: (yes or no)-LA industrial Waste Holding Tank present: (yes or no)NA �y Non-sanitary waste discharged to the Title 5 system: (yes or no)/J) Water meter readings, if available: Last date of occupancypp:'' OTHER: (Describe) Vy Last date of occupancy: N GENERAL INFORMATION PUMPING RECORDS and source of information System pumped as part of inspection: (yes or no)/ _ If yes, volume pumped: gallons Reason for pumping: TYPIEOF SYSTEM _ Septic tank./distribution box/soil absorption system Single cesspool Overflow cesspool Privy fV 0 Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Techogy etc. Copy of up to date contract? Oiher r APPR X��MTE AGE of all components, date installed (if known) and source of information: �> ' Vb 4,eGt/r5 0 Sewage odors detected when arriving at the site: (yes or no),LO (revised 04/25/97) Page 5 of 10 0 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 45 Lake Elizabeth Drive Craigville,Mass . Owner: Phillip Azoy Date of Inspection: /22/98 BUILDING SEWER: (Locate on site plan) Depth below grade:L Material of construction: cast iro _ 40 PVC _ other (explain) DlYf1C��%i° 54' Distance from private water supply well or suction line Alt - �a Diameter y ' Comme (condition of joints, venting, evidence of leakage, et .) , r SEPTIC TANKti,�/e (locate on site plan) Depth below grade:,� Material of construction-414oncretel�netal,�iberglass4 Polyethylene42&bther(explain) If tank is metal, list age AJ4 Is age confirmed by Certificate of Compliance-44 (Yes/No) Dimensions: /Q' Sludge depth: Distance from top of sludge to bottom of outlet tee or baffler Scum thickness: I" Distance from top of scum to top of outlet tee or baffle: Distance from bonom of scum to bonom of outlet tee or baffle:.4,W How dimensions were determined: Zo Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) _.z ,e is ,rbT GREASE TRAP:-f (locate on site plan) Depth below grade:lf� Material of construct ionA(JconcretoldmetaL .�¢FiberglassW4Polyethylene4/Aother(explain) ti41� Dimensions: 44!? Scum thickness: Alta Distance from top of scum to top of outlet tee or baffle:14A Distance from bottom of scum to bonom of outlet tee or baffle:A.-V Date of last pumping: 24AL Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 45 Lake Elizabeth Drive Craigville,Mass . ONner: Phillip Azoy Date of Inspection:, /22/98 TIGHT OR HOLDING TANK:�J(STank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grader Material of construct ion:4,14concrete tAmetal,ei fiberglass&Pol yet hylene44other(explain) y4 &AL Dimensions:— ,GA Capaciry: VA gallons Design flow. OVA gallons/day Alarm level,—/1 Alarm in working order4),4 Yes; 1i Nu Date of previous pumping: W-4 Comments. (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:,4)111cJ (locate on site plan) Depth of l,cu,d level above outlet tnven: �Ur Comments. (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHANABER:��-Icl (locate on site plan) Pumps n working order: (Yes or No) Alarms �n .working order (Yes or No) Comments (note condition of pump chamber, condition of pumps and appunenances, etc.) (z•vi••G 0�/15/97) Png• 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 45 Lake Elizabeth Drive Owner: Philip AZOy Date of Inspection: 1 /f2 /98 SOIL ABSORPTION SYSTEM (SAS):V/�a CP DLfI s ;locate on site plan, if possible; excavation not required, but may be approximated by non intrusive methods) If not determined to be present, explain: Type: leaching pits, number: V leaching chambers, number: o leaching galleries, number:= leaching trenches, number,length:�_ leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: /I Comments: (note condition of soil, igns of hydraulic failure,rlevel of ponding, con on of vegetation, etc.) v(V�-,c CESSPOOLS: v (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: (_CCkt� Depth of solids layer: �Q��T�1 V\n n�t1 Depth of scum layer: (� Dimensions of cesspool: Materials of construction: (n.(\C1Z`1p, Fil Fc c Indication of (cesspool DA/d inflo (cesspool must be pumped as part of inspection) Comments: (note conditio of soil, signs of hydraulic failure, level of ponding, ondition o vegetation, et �c--t nu•� o � � s o r PRIVY: {v^ (locate on site plan) Materials of construction: a v t 1 Dimensions: / I Depth of solids:_ Comments: (note condition of soil, signs of-hydraulic f 'lure, level of pond' condition of vegetation, etc.) (revlaed 04/25/97) Page 8 of 10 SUBSURFACE SEVVAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) P,open, A.dress. 45 Lake Elizabeth Drive Craigville,Mass . O—er Phillip L. Azoy Dice of �spect.on. 1 '/22/98 SKEICH OF SEWAGE DISPOSAL SYSTEM: -:wpe I.es 10 at least rwo permanent references landmarks or benchmarks jccate all wells wilhin 100 (locale where public water supply comes into house) 1-3 lavANOA tit s ��q C4/3�� 3 a c SUBSURFACE SEWAGE DISP . I. SYSTEM INSPECTION FORM t . C SYSTEM INFOk :ION (continued) Property Address: 45 Lake Elizabeth Drive Craigville,Mass . Owner: Phillip Azoy Date of Inspection: 1 /22/98 If Depth to Groundwater L Feet Please indicate all the methods used to determine High GroundwatW EI(?.ation: Obtained from Design Plans on record �L�Observation of Site (Abuninr R pri=opeRY, observation hole, baserner*s imp etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps `heck pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater-Elevation. (Must be completed) House is on a knol above the herring run and Red Lilly Pond. Used Ground water contours map. Based on Gahrety & Miller Model 12/16/94 (zovia.d 04/25/97) of 10 . rT.RTr•.{i'R�Tr\Tir�J.R'PTfTRTfSSSR.T.R: iTTITitTR"R'.11'•ITRTT�ST1'QT.7R 9'S 1TTRetr."C'TTTV.TTP'TTT�e� �..., TOWN OF Barnstable WARD OF HEALTH + I Sl1IISURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D '- CENTIFiCATlON ` �.•.�.•..�••. ::t—�.IIT.�.�T.T.T"'el'R.'TTITT.1tT.I1•.T'Tt—•.•1 "'{IRR�1T1Rr T'T'I1TRTil 7LTi moot*nr'r�ssv�rrs�r+r.•.—rrrr•_ —..� —TYPO OR PRINT CI.EARL)'— PROPERTY INSPECTED STREET ADDRESS 45 Lake Elizabeth Drive Craigville,Mass . ASSESSORS MAP , BLOCK AND PARCEL OWNER' s NAME Phillip A'Loy PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P.Macomber Jr. , COMPANY NAME J.P.Macomber & St'n' Inc, COMPANY ADDRESS Box 66 Centerville,Mass . 02632 Street Town or City State flP COMPANY TELEPHONE ( 508 ) 775-3338 FAX ( 508 1 790 - 1 578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time of :inspection , The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : XXXX System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public Health or the environment as defined in 310 CMR 15 , 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA sectioll of this form . System FAILED* The inspection which I have con Meted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CIITERIA of this inspection form . Inspector Signature _ ,✓ ! Date 1 /22'/98 One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF itEAL1.1I. * If the inspection FAILED, the owner or'"'oporator shall upgrade within one year of the date of the inspection , unless allowed ort required he m otherwise as provided in 3.10 CMR 16 . 305 , partd .doc WEST LEGEND 8.77 ti x 5.60 WETLAND FLAG CB/NODH/FND WET/RB-3 --102— — EXISTING CONTOUR /' 8,26 r8 o sot`' x 105.16 EXISTING SPOT GRADE Q N x- 13.15 ' / w EXISTING WATER SERVICE N T c EXISTING GAS SERVICE N �' TOP OF COASTAL BANK 17,79 o.H.w. _ OVERHEAD WIRES •� N u� MADEP POLICY 92-1 (FIG. 2) I I e 8 19 ) CB/DH/FND . . N P /SET ® TEST PIT WORK LIMIT (TYP.) 7.62 5"-5:7 Locus -1 _ rr 81` CB/BRKN/FND Road BENCHMARK � PROPOSED 40 MIL POLY 1 � �or<e Qeach Rd LINER, EL. 11.5-10.0 "' t ` a ' _____ ___ 23 VENT v ' Centerville. Harbor v SANJAYA & SHUBJEET KUMAR x c0,57 ` / / 1 I MAP 226, PARCELS 152 & 153 �, .>• • • �� + o O / LOCUS MAP N.T.S. JULIA G. GAVITT TR Benchmark Set / ' Fj�o +/ J1 '1�� 8'UO JGG CRAIGVILLE NOMINEE TRUST Top of Sonotube MAP 226, PARCEL 138 EL.=15.83 NGVD �o /0 <� i.i,�� �`i 3�i 6,53 � ��• � �'� r i. .? .r�,,� .�• ( WET/RB-5 SEWER CONNECT/ON �0,,•, �`,�,y �G , � ''� O / VARIANCE REQUESTS lNv.=14,60E ., . ' ,' ,Qj( > 1 x 8,01 .►°'' ,. X 10,E?8 p' ! 310 CMR 15.405(a)(b)&(f)-CONTENTS OF LOCAL UPGRADE APPROVAL f- i, ..O.+ REAM /��,/� 9�� 8 ,,r.✓�{,._ w`0� ter— 7.99 1) A 3' variance, S.A.S. to side property line, for a 7' setback. / 2) A 5' variance, S,A.S. to cellar wall, for a 15' setback. ,- - f' 8,2 O,H - 3) A 6' variance, Septic TAnk to cellar wall, for a 4' setback. ��6�, .� 4) A 3' variance to the rnoximum cover requirement over an S.A.S. M"''"~ i 8,22 r for 6' of cover. / �� • �fA' f'' HDU SE 45 5) set7' vai once, Septic Tank to top of Coastal Bank, for on 18' k. PROPOSED SEPTIC TANK ." �� ",.TOF=16.411_,, "~' 7 90 �, 6) A variance to allow S.A.S. to be partially on a Coastal Bank. / •o` r` 1 ,� (NGVD), „, 1 `VNC Co. LOCAL REGULATION Chapter 360. Article 1 — Setback Requirements EX/STING LEACH PIT qj .� 7) A 34' variance, Septic Tank to B.V.W., for a 66' setback. TO BE' PUMPED cYc .' F o / , FILLED WITH SAND �bo'f,,-J x �,r'` y �, �,� �,,. ;;,,", ,,� - I ,� � �-a �/ r�� `SOU 8) A 22' variance, S.A.S. to B.V.W., for a 78' setback: 19. 15.46 ; _ /y �' I I 9) An 82' variance, Septic Tank to Top of Coastal Bonk, for an EX/STING 01/ERFLOW S.A.S. / 15.1 TO BE ABANDONED N •� // . F��� 18' setback. j' ••15.43 _ 10) A variance to allow S.A.S. to be partially on a Coastal Bank. I ,' i/,s•'�1REAM % -4 14 i' ' SYL)6A PENDERGAST TOP OF COASTAL BANK p�rb / ,.. TO S _�' �, •- MAP 226, PARCEL 139 MADEP POLICY 92-1 (FIG. 2) �J' ` I .+►` ' r�� / ovedx Drive o / N� f <: 50 13 14,7 '%/ ` �,��, - \� .�8,25 Q �6 FEMA ZONE A10 (EL.11) s.`yEdc : f lowr' • -JX %iF fzs r�`•�, 7.93 X•1`4:7 3 • ••..•'� 0 ✓ �' / 0 ! / / PETER T. s„ , r,� j� •� + .,� 0 C M CIVIL EE WETLAND DELINEATION FLOOD PLAIN DATA 14.73 - ��i' }' 1 I o / No. 35109 VACCARO FIRM PANEL #250001 0008 D 13,411E S.F. -' ..,. .• / �,� 75 / •�� REGIS E��� `� Environmental Consulting REVISED: JULY 2, 1992 1 0.31E AC. -,.'�- ;Y4,72 /�� �- gyp, P.O. Box 955 ZONE A10 (EL 11) & ZONE C '2 '1/ f t� / e, Sandwich, MA 02563 ap 276 _ , . a°' (5n�> 888-5855 Parcels 154 w - dNE`C— ' ,' 7.96 ' Z� 24N - _-- ,� rdy l Note: Entire site lies within river front area. and 155 E A�o.._(.E��_ll�1 r �EDG£ OF 6 ____FL0!�__ { 5,60 l EuFvert under road w /RB-3 PROPOSED SEPTIC SYSTEM UPGRADE PLAN �" -� l `,,,.•�"'' BROOK (Herrin y Run) ~ ,,,,.•- WEf/R -2 45 LAKE ELIZABETH DRIVE, CENTERVILLE, MA `� •''"' S2 ME Prepared for: Joseph Hartigan, 23 Elm Street, Brookline, MA 02445-6813 I•/RB-1 Note: Front property line P P 9 MAXINE R. SCHORTMAN 5.55 68, is approximate only. Engineering by: Surveying by: SCALE DRAWN JOB. NO. MAP 226, PARCEL 163 CB/SEAL/FND - 8 3 ALAN ISENSTADT TR EngineeringWorka WARNER SURVEYING 1"=20' P.T.M. 208-07 t % TRADE WINDS RESIDENCES, LLf West Crossfield Road 22 Long Road PAULA ANN LOPATKA 8,48 \,� MAP 226,, PARCEL 140 -001 Forestdole, MA 02644 Harwich, MA 02645 DATE CHECKED SHEET NO. MAP 226, 'PARCEL 164 (508) 477-5313 (508) 432-8309 9/21/07 P.T.M. 1 of 2 I � I v ' PROVIDE RISER OVER D-BOX & SET INSPECTION RISER PIPE VENT T.O.F. TO WITHIN 6" OF FINISH GRADE FINISH GRADE: 12.9(MIN.)-17.3(MAX.) (Existing) EXISTING F.G. EL.15.5(MIN.) # F.G. EL.16.Ot � � MAINTAIN 2% MIN SLOPE OVER LEACHING AREA INSTALL RISERS OVER INLET & OUTLET TO WITHIN 6 OF FINISH GRADE NUTS: TO PREVENT BREAKOUT, INSTALL A 40 MIL POLY LINER A5 SHOWN ON PLAN AND SET BETWEEN ELEV.=11.5 TO 10.0 L=9't L = 6' APPROVED FILTER FABRIC • OVER STONE ONLY 4" SCH 40 PVC 4" SCH 40 PVC 4" SCH 40 PVC -EL.=11.5 ® S= 29d (MIN.) ia,. ® S= 1% (MIN.) 0 S= 1% (MIN.) 11"HEFFp. POLY LINER !. �a. as° Lioula DE 1' -EL.=tO.o LEVEL 4 ROWS OF 6 UNITS AT"625'ZUNIT. = 37.5' 3.25' 3/4"-1 1/2" GAS PROPOSED INV.=10.92 BAFFLE DOUBLE WASHED =13.40 INV.=13.15 INV.=11.40 D-BOX INV.=11.23 OVERALL LENGTH = 40.8' STONE INV. W/ INLET TEE SOIL ABSORPTION SYSTEM (PROFILE) PROPOSED 1500 GALLON SEPTIC TANK 4-OUTLET (H-20) e.r.s. ESTABLISH VEGETATIVE COVER TIE IN TO EXISTING 4" SEWER ' BACKFILL WITH CLEAN PERC SAND TO TOP OF CHAMBERS 2't FROM DECK, INV.=14.6t NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INVERTS PRIOR TO CONSTRUCTION. BREAKOUT=TOP 2) SEPTIC TANK AND D-BOX SHALL BE SET LEVEL TOP ELEV.=11.3 AND TRUE TO GRADE ON A MECHANICALLY COMPACTED INV. ELEV.=10.92 SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). BOTTOM ELEV.=10.00 II I IIIII�II 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 2.8' 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEES. 5' MIN. ABOVE BOTTOM OF T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH=11.2' SEPTIC SYSTEM PROFILE EXISTING SUITABLE NO G.W. EL.=4.0 MATERIAL USE 4 ROWS OF 6-HIGH CAPACITY INFILTRATOR CHAMBERS N.T.S. I WITH NO SEPARATION BETWEEN EACH ROW & NO STONE TYPICAL SECTION DESIGN CRITERIA GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH SOIL LOG NUMBER OF BEDROOMS: 5 BEDROOMS AND THE DESIGN ENGINEER, SOIL TEXTURAL CLASS: CLASS 1 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE DATE: SEPTEMBER 7, 2007 (REF# 11,935) DESIGN PERCOLATION RATE: 5 MIN/IN ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS, SOIL EVALUATOR: VERONICA WARDEN CSE DAILY FLOW: 550 G.P.D. EXCEPT AS REQUESTED UNDER "VARIANCE REQUESTS" ON SHEET 1. WITNESS: DONNA MIORANDI-HEALTH AGENT DESIGN FLOW: 550 G.P,D. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND GARBAGE GRINDER: NO APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. Elev. TP-- 1 I Dpt eh Elev. T P-2 Depth PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN 16.1 A 0" 16.0 A 0" LEACHING AREA REQUIRED: 550 = 743.2 S.F. HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. SANDY LOAM SANDY LOAM •74 5. ALL ELEVATIONS BASED ON NGVD. 14,5 2.5Y 3 2 19" 14.7 2.5Y 3/2 16" USE 4 ROWS OF 6 HIGH CAPACITY INFILTRATOR H-20 UNITS WITH 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF CONTRACTOR TO E F E NO STONE AND EXTENED BY 125 FT WITH STONE (1 1.2' x 40.8') NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. SANDY LOAM SANDY LOAM 2.5Y 4/1 " 1 4.3 812.5Y 4/1 SIDEWALL AREA: NOT APPLICABLE 81 22 7, WATER SUPPLY TO BE PROVIDED BY TOWN WATER. 14.3 20" BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.72 SF/LF OF INFILTRATOR) 8. THERE ARE NO PRIVATE WELLS LOCATED WITHIN 150' OF THE S.A.S. LOAMY SAND LOAMY SAND (INFILTRATORS) 24 UNITS x 6.25 LF x 4.72 SF/LF = 708.0 SF 9• ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE LANDSCAPED AS AGREED UPON BY 13.8 10YR 3/4 10YR 3/4 (STONE)28" 14.0 24 3.2 T OOTAL ARE ' x = 36.4 SF � " A = 744.4 SF BY OWNER AND CONTRACTOR OR AS DIRECTED BY THE APPROVING AUTHORITY. BLOAMY SAND BLOAMY SAND DESIGN FLOW PROVIDED: 0,74(744.4 S.F.) = 550.9 G.P.D. 10. LOCATIONS SHOWN OF EXISTING UTILITIES ARE APPROXIMATE ONLY. IT SHALL BE THE 11.6 10YR 4/6 10YR 4/6 RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND C 54 11.7 C 52" POSED SEPTIC SYSTEM UPGRADE PLAN UTILITIES PRIOR TO STARTING CONSTRUCTION AND COORDINATE THE RELOCATION OF ANY PERC UTILITY WITH THE APPROPRIATE UTILITY COMPANY. 66" MED. SAND LAKE ELIZABETH DRIVE, CENTERVILLE, MA 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA MED. SAND 2.5Y 6/4 BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN FILL AS 2.5Y 6/4 [P7repared : Joseph Hartigan, 23 Elm Street, Brookline, MA 02445-681 3 SPECIFIED IN 310 CMR 255(3). Engineering by: Surveying by: SCALE DRAWN ,JOB. NO. 12. THERE ARE NO EXISTING SOIL ABSORPTION SYSTEMS WITHIN 10 FT. OF THE PROPOSED 4.1 144" 4.0 144" Engineering Works WARNER SURVEYING N.T.S. P.T.M. 208-07 SOIL ABSORPTION SYSTEM. 12 West Crossfield Road 22 Long Road DATE CHECKED SHEET NO. NO GROUNDWATER OBSERVED Forestdole, MA 02644 Harwich, MA 02645 PERC RATE <2 MIN/IN. ("C" HORIZON) (508) 477-5313 (508) 432-8309 9�21�07 P.T.M. 2 Of 2