HomeMy WebLinkAbout0152 LAKEVIEW DRIVE - Health 152 LAKEVIEW DRIVE, CENTERVILLE
A=214-042
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No.J�LQ!7-01 —1 �
Fee------ --------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
ApplitationAr'vei[ congtruct ion permit
Application is hereby made for a permit to Construct W , Alter ( ), or Repair ( an individual Well at:
---------------
/� Locatio — Address —Assessors Map and Parcel
O�i—__—_--_— Address
el ----------------------------------------------------------------------------------------------
Installer — Driller Address
Type of Building
DwellingS .o.1, -
Other - Type of Building------------------------------ No. of Persons----------------------------------------
r/ _
Type of Well - ---- - ----— -- - Capacity---— -- — -- -- - - - --—
Purpose of Well -��1_'�� e�-------------------------------
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Certificate .of Compliance has been issued by the Board of Health.
nn a
Signed ---------
date
Application Approved By ----- -- -- ---- —--—— - --
date
Application Disapproved for the following reasons:--------------------------------------------------------------------
------------------------------- ----------
date
PermitNo. --—-- -- - —__— ----- - - Issued---------------------------------------------— -------------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certifitate ®f Compliance
THIS IS TO CERTIFY, That the I ividual Well Constructed j,'Altered ( ), or Repaired (y)/
-------------------------------------------------------------
---------------------
Inst r
at ---------------------------------------------------------------------- --
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. ------------------------Dated------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE- --- — — ------------------—--- — -- Inspector------------------------------------------------------------------------
f
' a
1
�zoG7-6(-7 J
' No:-------------------- Fee------ --------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Application jorVell Con.5tructionpermit
Application is hereby made for a permit to Construct ( k Alter ( ), or Repair ( �a/n individual Well at:
Location — Address Assessors Map and Parcel
----------------�---- —---- — ---- ---— ---
-------------------------------------
Owner Address
4A----a �4 __
---------------------------------------------------------------------------------------
Installer — Driller � Address
Type of Building
Dwelling----— — -.;
Other - Type of Building —------------------ No. of Persons-------------------------____—____________
e of Well—`r�/
T `= -- —---
YP ----------------------- Capacity-----------
------------------------------
Purpose of
Agreement: ,rr
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a/.Certificate .of Compliance has been issued by the Board of Health.
' Signed -------------- ----- -------
date --_---
Application Approved By-----— ------ -- -- -------—--—— --------—-- - -
-- date
Application Disapproved for the following reasons:---------------__—_—-------------__----:_____________ _---—-----
--------------------------------------
-------- ----------------------------------------
date
PermitNo. -----=----- -_— ---—- -- Issued----------------------------------------------------------------------
r"' date 1
------------------------------------------------------------------------------------------------------l—�
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate ®f Compliance
THIS IS TO CERTIFY, That the In ividual Well Constructed (!k'-Altered ( ), or Repaired ( lr- r
Instatle
at-----�a —`- r' ! E�1 � �--- ---------------------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. ------------------_-------Dated------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-------------------—--------—----------------------------- - -- Inspector----------------------------------------------------------------------------
®--------------------------------------------------------------------------------------------------------
— BOARD OF HEALTH
TOWN OF BARNSTABLE
lVell Cootruction Permit
�jj2oa -7— o17
No. ---------------- Fee--- 7-2 -----
Permission is hereby granted— `—_ f� vI---- ���J G�f 1_lL�c_,t- -----------------------------------
to Construct ( t) ''Alter ( ), or Repair (✓)ran Individual Well at:
N o. - 3 ------ 7eL,! t%e4 1 --— -------------
----------------------------------------
--------------------------------------------------------
Street
as shown on the application for a Well Construction Permit
No. ----------------------------- - --------------------------------------- Dated--- - ------- ----------------- - ------------------------
UW
--------7----------------1-._.._..........__
2 -0— - Board of Health
DATE-- - —�-1 - -- -- — -
Bk 21132 Ps 6 -Imr-40719
06-27-2006 a 09 : 00u
DEED RESTRICTION
WHEREAS, Ward W. McLaughlin and Melissa M. McLaughlin of 29 Holly
Circle, Holden, Massachusetts are the owners of property located 152 Lakeview Drive,
Centerville, Barnstable County, Massachusetts and being shown on as Lot 2 on a plan
entitled "Subdivision of Land in Centerville, Massachusetts, belonging to Florence M.
Hayes"duly recorded in Barnstable County Registry of Deeds in Plan Book 298 Page 18.
WHEREAS, Ward W. McLaughlin and Melissa M. McLaughlin, are the
owners of said lot have agreed with the Town of Barnstable Board of Health to a
restriction as to the number of bedrooms which can be included in any home built on said
lot as a pre-condition to obtaining a variance from the 310 CMR 15.214 State
Environmental Code; Title V, Minimum Requirements for the Subsurface Disposal of
Sanitary Sewage and to obtaining a building permit for this lot;
WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to
granting the variance from 310 CMR 15.214, State Environmental Code, Title V,
Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing
the issuance of a building permit for the construction of a single family home on this lot
is requiring that the agreement for the restriction on the number of bedrooms in any house
constructed on the lot be put on record with the Barnstable County Registry of Deeds by
recording this document;
NOW THEREFORE, Ward W. McLaughlin and Melissa M. McLaughlin do
hereby place the following restriction on his above-referenced land in accordance with
this agreement with the Town of Barnstable Board of Health, which restriction shall run
with the land and be binding upon all successors in title:
1. 152 Lakeview Drive, Centerville, Massachusetts may have Gfis't�'t�cta .f',
upon the lot a house containing no more than four(4)bedrooms. 'f I��
Ward W. McLaughlin and Melissa M. McLaughlin agree thati ttus. t P
".
pe g property located on 152 Lakevj rive,-.T
Ce '4sa445' s,. own on plan recorded with Barnstafil0�untyt ;
s��d V�9A C:
Re rind Page 18.
CIDS.'
Farntrtl'e;see-Deed dated ember 16, 2005 and recorded with Barnstable County
Registry of Deeds at Book 20619,Page 169.
I ��
Executed as a sealed instrument this�_day o, (-k
2006.
Ward' V McL'au lire Melissa M. McLaughlin
COMMONWEALTH OF MASSACHUSETTS
Barnstable, ss
On this day of Ll f'L� (�lp before me, the undersigned Notary
Public,personally appeared ) .� �(y�p i,AS�/,� proved tome through
satisfactory evidence of identification being(check whichever applies):
0 other state or federal governmental document bearing a
photograph image; or
0 Oath or affirmation of a credible witness known to me who knows the above
signatory; or
My own personal knowledge of the identity of the signatory to be the person
whose name is listed above
and acknowledges to me that he/she/they signed the foregoing instrument voluntarily of
his/her/their own free act and deed.
�N•'•,p ,..•.•, .�,.i per, r� r
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44
,•J o�,..... I��►'' Pr:4`'+' Notary Public
;`off;.•• ,, ��r.��'•,''�::
• My Commission Expires:
:seal
r '� •..�4
": ' ..•,ir!:•�� NAVREEN MANY 81LOTTA
Notary P&*M
OOIr10lMIFAM OR AVAI 1Mp01ifem
My Commisslon Expires
March t,2013
BARNSTABLE REGISTRY OF DEEDS
`;u,jrC�•1 r� r,,';,. Cl f'.
07/25/2006 09:43 9783456374 BOUTWELL OWENS CO IB PAGE 02
.. f
COMMONWEALTH OF'MASSACHUSETTS.
EXECUTTVE OFFICE OF ENVIRONMENTALAFF.'kIRS.
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUESXJP TrACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address:
E
Owner's Name:
Owner's Address:
Date of Inspection: >
Name of Inspect plea e'p int P��`.1 ' �'T��� •
Company Name:
Mailing Address: Ck�CD�t
Telephone Number:
CERTIFICATION STATEMENT
1 certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
trainin,-and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5'(310 CMR 15:000). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving-Authority
Fails
spector's Sipati re 1 Date:
In '7
The system inspector sKa..11 submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable, and the approving
authority,
Notes and Comments ,
*"**This report only describes conditions at the time of inspection.and.under the conditions of use at that
time.This inspection does not address'how the system will perform in the future under the some or different
conditions of use.
Title.5 Inspection Form 6/15moo page 1
07/25/2006 09:43 9783456374 BOUTWELL OWENS CO IB PAGE 03
t
Page 2 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGEDISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address,fSo� �t-C .Lt_Q
Owner:
Date of Inspection: _
Inspection'Su mmary: Check A,B,C,D or E J ALWAYS complete ail of Section D
A. System Passes;
JI have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist Any failure criteria,not evaluated are indicated below.
Comments:
B. System ConditionaIIy 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.
Answer yes, no or not determined(Y,N;ND)in the for the following statements.If"not determined" please
explain.
The septic;tank is metal arid'over 20 years old* or the septic tank(whether metal or ndt).is structurally
unsound,exhibits substantial infilfation or exfiltratiori or,tank failure is imminent:System will pass inspection if the
existing,tank is replaced with.a.complying septic tank as approved by the Board of Health.
sA metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available. .
ND explain:
Observation of sewage backup-or break out or high static water level in the distribution box due to broken or
obstructed•pipe(s�or due to a broken,settled or uneven distribution box.System will past inspection if(with
approval.of Board of Health):
broken pipe(s)are replaced
obstruction.is-removed
distribution box is leveled or replaced ,
ND explain:
The system required pumping more than'4 times a year due to broken or obstructed pipe(s).The system will
pass inspection if(with,approval-of the Board of Health):
broken pipe(S)are replaced
obstruction is removed .
ND explain:
2
07/25/2006 09:43 9783456374 BOUTWELL OWENS CO IB PAGE 04
Page 3 of 11
OFFICIAL INSPECTION FORM-.NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
-PART A
CERTIFICATION(continued)
Property Address:
Owner:
Date of'lnspection
C. Further.Evaluatiort is equired by She Board.of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or the environment,
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) tb3t the
system is not functioning in a manner which will protect public health,safety and the environment:
Cesspool or privy is within 50.feet of a surface water
Cesspool or privy is within 50 feet of a bordering ve-getated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public.Water Supplier,if any).determines that the
system is functioning in a manner that protects the public health,safety and environment.
_ The system has a septic tank and soil absorption system(SAS)and the SAS is,within 100 feet of
surface'water'supply or tributary' to a surface water.supply.
The system has a septic rank and SAS and the SAS is within a Zone 1 of a public water supply.
The system has aseptic tank and SAS and the SAS is within 50 feet of.a private water supply well.
_ The system.has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply-well". Method used to determine.distance
"This system passes if the well water analysis;performed at a DEP certified laboratory,for 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 tb or less'than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this.form.
3. Other:
3
07/25/2006 09:43 9783456374 BOUTWELL OWENS CO IB PAGE 05
Page 4 of 11.
OFFICIAL INSPECTION FORM—.NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: � �—
Owner-
Date of Inspection:
D. System Failure Crite r22pplicable to all systems:
You must indicate"yes" or"no"to each.of the.following foe all inspections:
Ycs Ng
_ ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
_ Discharge.or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
Static liquid level in the distribution box above outlet invert'due to an.overloaded•or clogged SAS or
cesspool
Liquid depth in cesspool is'less than 6" below invert or available volume is less than'G day flow
Required pumping more than 4 times in,the last year NOT due to clogged or obstructed pipe(s).Number '
Jof times pumped
Any portion of the SAS,cesspool or privy is below high ground water elevation.
Any portion of cesspool or privy is within 1.00 feet of a surface water supply or tributary to a surface
J water supply-
_ Anyportion of a cesspool.or.privy,,is within a Zone 1 of public well.
Any portion of a cesspool or privy is within 50 feet of'a.private water supply well.
Anyportion of:'a cesspool or-privy-is:less than 100 feetbut greater than.50 feet-from a private water
supply well with no acceptable water quality'analysis:[This system pssses'if the well water analysis,
performed at..a DEP certified laboratory,for coliform bacteria and'volatile organic compounds
indicates that the.well is free from 'ollution from th'at.facility and the.presence,of ammonia
P
nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided,that no other failure criteria
are triggered.A copy of the analysis.trust be attached to this forma
(Yes(No)The system fails.I have determindd.that one or more of the above failure criteria exist as
described in 310 CMR 15.303,thErefore-the system fails..The.system.owner should'contact the Board of
14ea6h to determine what will be necessary to correct the failure. '
E. Large Systems:
To be considered a large system the system must serve a facility-with a design flow of 10,000 gpd to 15,000
gpd•
You must indicate either".yes" or"no"rp each of the followitg:
(The following criteria apply to large systems in addition to the criteria above)
yes no
the system is within 400 feet of a.surface drinking water supply
.the system i5 within 200 feet.of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone II of a public water supply well.
If you have answered"yes"to any question in,Section E the system is considered a significant threat,or answered
"yes"'in Section D above the large system has failed.The owtier or operator.of any large system considered a
significant threat'under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304.The system owner should contact the appropriate regional office of the Department.
4
07/25/2006 09:43 9783456374 BOUTWELL OWENS CO IB PAGE 06
Page 5 of 1 1
OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: I
Owner: C LCi' •t,(;��.�
Date of lnspection.=Za / ()„
Check if the followina have been done.You must indicate' es"or"no" as to each of the following:
Yes No
b� Pumping.information was provided by the owner,occupant, or Board of Health
; Were any of the system components pumped out in the previous two weeks?
17/. Has the system received normal flows in the previous two week period
_ ?
`� Have large volumes of water been introduced to the system recently or as part of this inspection?
Were as built plans of the system obtained and examined?(If they were not available note as N/A)
Was the facility or dwelling inspected for signs of sewage back up? '
Was the site inspected for signs of break out?
v _ Were al system components,excluding the SAS,located on site?
Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
____
of the baffles or tees.material of construction, dimensions,depth of IiAuid,.depth of sludge and depth of scum?
C — Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has been determined based on:
Yes no
_ Existing information.For example,a plan at the Board of Health.
_ Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of distance
is unacceptable) [310 CMR 15,302(3)(b)]
5
07/25/2006 09:43 9783456374 BOUTWELL OWENS CO IB PAGE 07
Page 6 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUiti%ARY:ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART.C
SYSTEM.INF,ORMATZON
Property Address:
Owner: X _,JLJ
Date,of Inspection: lit
i' FLOW CONDITIONS1ZESIbENTIAL
Number of bedrooms(design): Number of bedrooms(actual):
DESIGN flow based on 3 10 C R 15.203 (fgf example: 11.0 gpd x 4 bf bedrooms);
Number of current residents:��t.P'
Does residence have a garbage grinder(yes or no),
Is laundry on a!separate sewage system(yef or no): .cif yes separate inspection required]
I;aundry system inspected a .or no):, lAA2
Seasonal use:(yes or no):
Water meter readings, if a i. ble(last 2 years usage(gpd)):
Sump pump(yes or no):
Last date of occupancy:
COMMERCIAVINDUSTRIAL�v
Type of establi'shmenc:.
Design flow(based on 310 CMR 15.203): epd
Basis of-design,flow(seats/persons/sgF,etc.): Y
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):_
Non-sanitary,�aste discharged to the.Title 5 system(yes or no):
Water teeter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source-of infotmation:
Was system pumped as part of the ' spection(yes no):
If yes,volume�umped: _ gall'ons—How was quantity pumped determined?
Reason for pumping:
TYP F SYSTEM
cptic ianl, distribution box,soil abso tion .stem
rP system
Single cesspool
Overflow cesspool.
Privy -
_Shared system(yes or no)(if yes, attach,previous inspection records,if any)
_Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system'owner)
Tight tank; —Attach a copyof the DEP approval
_,Other(describe):
imate ge of all comRpnents,date installed(if kn )and r of-n orm -
/ le
Were sewage odorsAemcmd when arrNina at the ite(yes or no):J�L•6
6
07/25/2006 09: 43 9783456374 BOUTWELL OWENS CO IB PAGE 08
Page 7 of 1 l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOS kL SYSTEM•INSPECTIONFORM
PART C
SYSTEM.INFORMATION(continued)
Property Address: '
Owner: 01
Date of Ins ection:
BUILDING SEWER(locate on site plan)f 0
Depth below Prade:
Materials of construction:_cast iron _40 PVC_other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints, venting,evidence of leakage,etc.):
SEPTIC TANK: zoocate'on siteplan)
grade:
e
b Depth
P g J�
Material of construction: oncretc metal_fiberglass polyethylene
_other(explain)
If tank is metal list age:_ Is age.confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions:
Sludge depth: #
Distance from top o sludge to bottom of outlet tee or,baffle:
Scum thickness: 1ZY�� rr
Distance'fiom top o scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee-or baffle:
How were dimensions determined: -
Comments(on pumping recommend ions, in t and outlet tee or baffle condition,structural integrity, liquid levels
related to outlet invert,ev' nce of leakage,etc.):
4o4a �Ge
GREASE TRAP locate on she plan)
Depth below grade:_
Material.of construction:_concrete—metal_fiberglass polyethylene_other
(explai.n):
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.purnping:
Comments(on' pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
07/25/2006 09:43 9783456374 BOUTWELL OWENS CO IB PAGE 09
Page 8 of I l
''OFFICIAL.INSPECTION FORM—,NOT FORNOLUNTARY ;ASSESSMENTS
SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM-INFORMATION(continued)
Property Address: J�vZ
Owner:
Date of Inspection: ,P Ca
TIGHT or HOLDING TANK: (tank must be pumped at time of inspcction)(locate or.i site plan)
Depth..below grade:
Material of construction: concrete metal fiberglass___polyethyiene other(exptain):.
Dimensions:
Capacity: Gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes'or no):
Date of last pumping:
Comments•(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: V(if present must be'opened)(locate on site plan)
Depth of liquid level above outlet invertagVLXqual,
omments note if box ia.level and distribution to out any evidence of solids carryover,any evidence of
age into or out of box,
PUMP CHAMBER4(locate on siteplan)
Pumps in working order(yes of no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc_):
3
07/25/2006 09:43 9783456374 BOUTWELL OWENS CO IB PAGE 10
Page 9 of l 1
OFFICIAL INSPECTION FORM.—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: ,��• I�LCQ.
Owner:
bate orInspection•
SOIL ABSORPTION SY EM (SAS): r: (locate on site plan,excavation not required)
If SAS not located explain why:
,type _..
�rlchin-pits,number:_
leaching chambers,number:
leachLn_galleries, number:
leaching trenches, number, length:
leaching fields,•number,dimensions:
overflow cesspool,number:
_ innovativelalternative system- Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of pondin„damp soil,condition of vegetation,
etc.
CESSPOOLS- (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth"—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of.groundwater inflow(yes or no): :
Comments(note condition-of sail, signs of hydraulic failure,level of pondin„condition of vegetation, etc'
PRIVY:/Vf l (locate on site plan)
Materials of construction:
Dimensions,
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure, level of pondina, condition of vegetation, etc.):
9 •'
07/25/2006 09:43 9783456374 BOUTWELL OWENS CO IB PAGE 11
P1ee 10 of 11
OFFICIAL INSPECTION.FORM,=.NOT FOR VOLUNI TARP ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM
PART-C.
SYSTEM'INFORMATION(continued)
Property Address:
Owner:
Date of Inspectio - % d
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building.
l.
41
0o a loo
15 �
�°
00
ld
Z5O
if
07/25/2006 09: 43 9783456374 BOUTWELL OWENS CO IB PAGE 12
Pagc,11 of l 1
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner:
Date orInspectionr.� / (p
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells i
Estimated depth to ground water f Z feet
Please indicate(check):all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed'she(abutting'properry/observation hole within 150 feet of SAS)
Checked with local Board of Hcaith-explain:
Checked with.local excavators, installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation: IV/12
' 11
07/25/2006 09:43 9783456374 BOUTWELL OWENS CO IB PAGE 13
Permit Number: Data
Completed by:
HIGH GROUND-WATER LEVEL COMPUTATION
Site Location: rI - Ili� `- Lot No.
Owner: l '` 1 / Address:
Contractor: Address
Notes:
STEP 1 Measure depth to water table 7111161 r' �
to nearest 1I10 ft. """""•'-"-............................................................... ,Gate
menthlday/Year
STEP 2 Using Water-Level Range Zone•
and Index Well Map locate
site and determine' ;'i�;;• /�r�f Z
® Appropriate;index.,.well.:;::.;::; _...................................
....
6 Water-level:ran e"^I zone'..-:;'::....-:.::... . ..
STEP 3 Using monthly report-"-current
Water":Resource's- 6nditibns
••deferrriirie�Cl���pnt,�ep'��-t����'� • /j) � L��
-wate.r1evel for:indexLwe e ;:. :::................ month/year
STEP 4 Using Table,of Water-level Adjustments
for index..well.:(ST_EP-.-:2A),'.current depth
to water-levelf_or index-well (STEP 3),
and water•level zone STEP
determine-water-level adjustment_......................................................................................
STEP 5 Estimate depth to high water
by subtracting the water-
level adjustment (STEP 4)
from measured depth to water
levelat site (STEP 1) ....................•-•-.. ..................................................................................
Figure 13.-Reproducible computation form.
15
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COMMONS`TEALTH OF NLASSACHUSETTS
Y EXECUTIVE OFFICE OF ENVIRONMENT_ALAFFALRS
EPARTNIENT OF.ENVIRQNMENTAL PROTECTIOINT
TITLE 5
OF ICIAI INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
ST--TBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
C3,RTIFICATI
Property Address:, -6 ®� �� 1�•-
Owner's Name: a P .r
Owner's Address: --!-).,;).
eel Q�it "A U®� ���/
Date of Inspection:��.,,t 11 a' B lztx_
Name of Inspect9T-?4p;ease p.rin (']l✓ '`�� f� yl�� �"�
Company Name':., )V�
d
Mailing Address:
Telephone Number
CERTIFICATION STATEMENT
I cer tif� that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and.complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems,.I am a DEP
approved system inspector.pursuant toSection 13.340 of Title 5(3:10 CMR 15.000).."The system:
Passes ,
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Ias ector's.SignatL,-e'� Tate: ����/��
P /
The..systern inspector shall submita copy,of this.inspection report to the Approving Authority(.Board of Health or
DEP)wjr•in 30 days of completir_C this inspection.If he.system is.a shared system or has a design flow of 101000
Cpd or heater,the.inspector and the system owner shall submit the report to the appropriate regional office ofthe
DEP.The original should be sans to the system owner and copies sent to the buyer, if applicable', and he approving
authorit,i- i a
Notes and Cornments
.*, ***This report only describes.conditions at the time of inspection.and:under the conditions:of use at that
time.This inspection does not address how the.syst'em will perform in the future under the same'or different
conditions of use.
Title.5 Inspection Form E%1512000 page 1 _
Page 2-of 11
OFFICIAL INSPECTION FORM.--NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address�•�,`' L �Zt?��.t-�-C?a C �t�/ ��
Owner: Alej,,=
Date of Inspection: ( d. �e. ry(
Inspection Summary: Check A,B,C,D or E:/AI WAYS:completi all of Section D
A.. Svsteffi Tnsses:
r
I have not found any information-which.indicates that anv of the failure criteria:described m i 1 Q`CMR
15.303 or in 310 CIv1R 15.304 exist.Any failure criteria.not-evaluated are indicated below.
Comments: _
B: , System Conditionally Passes:
One or more system components as described in the"Conditional Pass" section need to be replaced or
repaired.The system, upon completion of the replacement or repair;.as approved by the Board of I-IealtlL will pass.
Answer yes,no or not determined(Y,N;ND).in the for the followins statements. If"not determined''please
explain.
The septictank is metal and over 2.0 years old-orthe septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exEltration or.tank failure is imminent:System will pass inspection if the
existing tank is replaced with a complying septic tank.as approved by the Board of Health. .
*A metal septic tank will pass inspection if it is structurally sound. not leaking and if a Certificate of Compliance
ind.icatinQ that the tank is less than 20 years old is available. .
ND explain:
Observation of sewage.backupor break out or high static water level in he distribution box due to broken or
obstructed pipe.(s)or due to a.broken, settled or uneven distribution box. System will pass inspection if(with
approval of Board ofHealth):
broken pipe(s)are replaced
obstruction is removed
distribution.box is..
s leveled or replaced .
ND explain:
The system required pumping more than.4 times a year due to broken or obstructed pipe(s).The system will
pass inspection if(with_appro.val of the Board of Health).:
broken pipe(s)are replaced
obstruction is removed .
.ND explain:
Paee 3 of I 1
OFFICI TltiSPECTION FORM -.NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SkWAGE DISPOS,4L SYSTEM INSPE"CTION'F'ORM
PART A
CERTIFICATION(continued)
Property Address ` iast .R-
Owner:
Date oflnspection<L-)
C. Further Evaluation is Required by the Board.of Health:
Conditions exist which require further evaluation by the:Board of Health in order to determine if the system
is failing to protect public health. safety or the environment.
1. System will pass unless Board of,Health determines in accordance with 310 CMR 15303(1)(b) that-the
system is not functioning in a manner which will protect public health;safety and the environment.
Cesspool or privy is within 50 feet of a surface water
_ Cesspool or pH vy is within 50 feet of a bordering vegetated wetland or a saltmansh
_. . System will fail unless the.Board of Health.(and PublicMater Supplier, if any).determines that the
system is functionina in a manner.that protects the public health,safety and environment: .
The system has a septic tankand soil absorption system(SAS).and the SAS is:within-100 feet of a.
surface water"supply or tributary to a surface water-supply:
The system.has a septic tank and SAS and the SAS is Within a Zone I of`a.public water supply.
The system has a septic tank.and SAS and the SAS is.Within 50 feet of a.private water supply well_
Tree system has a septic tank and SAS and the SAS is less than.100 feet but 50 feet or more-from a
private water supply well**. Method used to determine distance
"This.system passes if the well water anai_ysis;performed at a.DEP certified laboratory, 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, provided that no other
failure criteria are triggered. A copy of the analysis:must be attached to this form.
3. Other:
Page 4 of 11
OFFICIAL;INSPECTIOiV`FORwI-..NOT FOR VO;L;UNTARY--ASSESSMENTS
SUBSURFACE SEWAGE-DISPOSAL SYSTEM INSPECTION FORA
PART A
- CERTIFICATION(continued):
Property..Address:
'Owner: �'°.' =�.. r.� �i..:f�t' �1
Date of Inspection:
D:. System Failure C iterfa.applicable to 211`systems:
You must indicate"yes"or"no"to each-of the fo:Ilowing for all.inspections:
Yes N°/
°. Backup of sewase into facility or systern component due to overloaded or clogged SAS or cesspool
a� Discharge or ponding of effluent to the surface of the ground.or surface waters due to an overloaded or
q clogged SAS or cesspool -
1y Static liquid level-in the distribution box above.outlet invert.due to an overloaded or.clogged SAS or
cesspool
Liquid depthin cesspool is less.than 6"below invert or available volume is less.than %day flow
i� Required pumping more than 4 times in.the last year NOT due to cloaaed or;obstructed pipe(s).Number
or times pumped
_ Any portion of.the.SAS,cesspool or privy is below high ground water elevator.
Any portion of cesspool or privy is within 100:feet of a surface:water supply or tributary,to a.surface
I water supply.
Vi. Any portion of cesspool or.privy is within a.Zone 1 of a,public well
Any portion of a.cesspool.or'privy is within 50 feet of'a.private water,Isupply.well
V Any portion of a cesspool or privy is:less than L00 feet but.greatcr.than:50 feet.from a private water
supply well with no acceptable water quality analysis..[This system passes if the well water analysis,
performed at:.a.DEP certified laboratory, for coliform..bacteria and:volatile organiccompounds
indicates that the.well is free from pollution from that.facility and the:presence`of.ammonia
nitrogen and.nitrate nitrogen is equal.ta or less than 5 ppm,.provided that no:other failure criteria
are triggered.A.copy of the analysis.must be attached to this form.]
1 (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR I5.303,tfierefore the system.fails.The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
F E. Large Systems:
To be considered`a large system the system must serve a, facHitywith a design flow of 10;000 gpd to. 1.5,000 .
gpd
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)
yes n0
_ the system is within 400 feet of a.surface drinking water supply
the system is within20b feet.of a tributary to a surface drinking water supply
_ the system is located in a nitrogen sensitive area(Interim 'Vellhead Protp-ction Area—IWPA)or a mapped
Zone II of a public water supply well.
Ifyou have answered"yes"to any question in Section.E the system is considered a significant threat, or answered
yes"in Section D above the large system has.failed.The owner or operator ofany large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 3.10 CMR
15.304.The system owner should contact the appropriate regional office of the Department.
.4
Page 5 of II
OFFICIAL INSFE:CTIO_N FORM-NOT FOR VOLUNTARY ASSESSMENTS :
SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION ION FORM
PART B
CHECKLIST
Property Address: ' _ ' ?e ./ �-
' .A a1 e44
Lll
Owner:. „ , '.
Date of Inspection: .' _
t�
Check if the following-have been done.You must indicate"yes"or"no" as to each of the following.:-
Yes.: No
Pumping.information was provided by,the owner, occupant, or Board of Health
Were any of the system components,pumped out in the previous two weeks ?
Has the system received normal flows in the previous two week period?
7Havellarge volumes of water been introduced to the system recently or as part of this inspection?
�= Were as built plans ofthe system obtained and examined? (If they were not available note as N/A)
_ Was the facility or dwelling inspected for signs of sewage back up
Was the site inspected for signs of break out?
Were all system components, excluding the SAS;,located on site? >.
j/� _ Were the.septic,tank ma.nhoIes uncovered; opened; and the interior of the tank inspected for the condition
of the baffles or tees; material of construction, dimensions, depth of Liquid,.depth of sludge and depth of scum
Was the facility owner(and occupants if different from owner)provided with information on the proper
.maintenance of subsurface sewage disposal systems
The size and location of the Soil Absorption System(SAS) on the site has been determined based on:
Yes no
a_ Existing information.For example, a plan at the Board of Health.
f _ Determined in the field(if any.of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.3 02(3)(b)I
Page 6 of TI
QFFICIAL INSPECTION,FO.RM.-NOT FOR VOLUNTARY AS
SESS'MENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART.C
SYSTEM-INFORMATION
Property Addressy sVli
e vU ALe70
Owner t A,-,j
Date:of Inspection: -7 . ij
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms.(design): Number of bedrooms(actual).: Az
DESIGN flow based"on 310 5.203 (for example: 11.0 gpd x.R of bedrooms):
Number of current residents:. , C .%, `
Does residence have a garbage grinder(yes or no):
Is laundry on al separate sewage system (yes or no):%' [if ves separate inspection required]
Laundry system inspected es.or no):_A10
Seasonal use: (yes orno):
Water meter readings; if a V(d ble (last 2 years usage(Qpd)): s✓" ��
Sump.pump(yes or no)
Last date of occupancy �, / -
COMMERCIATJINDUSTRIAL��
Type of.establishment:,
Desiar.flow(based on 3 10 CMR 15.203): Qpd
Basis of-design flow(seats/persons/sgft,etc.):
Grease trap present(yes or.no);_
Industrial waste holding tank present(yes or.no):_
Non-sanitary tivaste discharged to the.Title 5 system (yes or no):_
Water meter readings,_ if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL.INFORMATION
Pumping Records
Source of information: �thei
Was system pumped as pan ocfion (yes a'no):
If yes,volume pumped: gallons—How was quantity pumped determined?
Reason for pumping:
TYP - F SYSTEM
Septic tank, distribution box,soil absorption system
Single cesspool
_Overflow cesspool
—.Privy, -
_Shared system (yes or no)(if yes, attach previous inspection records, if any)
Innovative%Alternative technology..Attach a copy of the cur-:ent operation and maintenance contract(to be
obtained from system'owner)
Tight tank _Attach a copy,of the.DEP approval
_.Other(describe):
i p ximate age of all components, date installedi(if know ) and.:ource of informatio-n:.
Were sewage odor&detected when arriving at the si"to(.yes or no)_ .
6
Page 7 of 1 I
OFFICIAL INSPECTION FORM—.NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION FORM
PART C
SYSTEM INFORM ATION (continued)
Property Address: a
Owner: ✓' ,9 A0 l 50/5
Date of Ins ection:
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction:—cast iron _40 PVC_other(explain):
Distance-from private water supply well or suction line:
Comments(on condition lofjoints, venting,evidence of leakage, etc.):
SEPTIC TANK: Z(locatebr, siteplan)
Depth below grade: A0 -
Material of construction:._4zc ncrete_metal=fiberglass polyethylene
—other(explain)
If tank is metal list age:— L age:conf-mmed by a Certificate of Compliance(yes or no)`—(attach z copy of
certificate) ,
Q P !
Dimensions: a '
SIudge depth:
Distance from top of sludge to bottom of outlet tee or.baffle:
Scum thickness:
Distance from top or scum-to top of outlet.tee or baffle`. '. it
Distance from bottom of scum to bottom of outlet tee or baffle:
How were .dimensions.detem,fined: 1 44 A
Comments (on,pumping recommend ions, in1'et and outlet tee or baffle condition, structural integrity, liquid levels
s rebated to et invert evil nce.of leakage, etc.):
.&✓`.��v '���y✓ � "'�,A .gd`w....� �+�.f" �d,��%��' ��^ - n
d i
GREASE TRAP/Y locate on site-plan)
Depth below grade:_
Material.of construction:—concrete—meta! fiberglass polyethylene—other
' (explain):. — .
Dimensions:
Scum thickness,
Distance from top'bf scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or' bafrle:
Date of last.pumping:
Comments (on pumping recommendations; inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc,.);
7
Page 8 of I
OFFICIAL INSPECTION FORM NOT:FORYOLUNTARY.ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C.
SY"STEMINFORMATION(continued)
s
Property Address. fi�
Date of Inspection: /T'-t d
TIGHT or.HOLDING TANK�L/2 (tank-ziust be pumped at time of inspection)(Iocate on..site plan)
Depth,below grade:
Material of construction: concrete metal fiberglass polyethylene other(explain);.
Dimensions`
Capacity: Gallons
Design Flow:. gallons/day
Alain present.(yes or no):.
Alarm level: Alarm in working order(yes or no):
Date.of Iast pumping:
Comments(condition of alarm and-float switches, etc.):
DISTRIBUTION.BOX: '(if present must be opened)(locate on site plan)
y" n
Depth of liquid level above outlet invert (`}0&t'4
Comments(note if box is level and distribution'to outle& qual,,any evidence of solids carryover, any evidence of `
leakage into �r out of box, et
:n.
- ,
PUMP CHAMBERi (locate on site plan):
y
Pumps in working.order(yes or no):
Alarms in working order(yes or no):.
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
3
Page 9 of 11
OFFICIAL INSPECTION FORIM1 .-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM PVSPECTION FORM
PART.C
SYSTEM INFO'RMA:TION(continued)
' Property Address:
Owner:
Date of Inspection
SOIL.ABSORPTION SYSTEM (SAS) (locate on site plan,excavation not required)
If SAS"not located explain-why:
Type
1 'china pits, number:leaching chambers,numb_er.:
leaching:cralleries, n.umber:.,
leaching trenches, number:length:
leaching fields,"number, dimensions:
overflow cesspool;number:
innovative/alternative system" Type/name of technology:
Comments (note condition of soil, signs of hydraulic"failure;level of ponding, damp soil; condition of veQeta�.on
etc
�' Ll-zttlj/)7 Jtkzi 'vLa/ rt,(-(
CESSPOOLS: �'� (cesspool must be pumped as part of inspection)(]ocate on site plan)
Number and configuration:
Depth*--top of liquid to inlet invert:
Depth`of solids laver:
Depth of scum layer:
Dimensions of cesspool:.
Materials of construction:
Indication of groundwater inflow(yes or no)-.__
Comments (note condition-of-soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc:):
PRIVY:/A-.lo (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments (note condition of soil, signs of hydraulic failure, Ievel of ponding, condition of vegetation, etc.):.
9
Page 10 of 11. .
OFFICIAL I3tiSPECTIONTORM=.NOT FOR VOLUTNTARY ASSESSItiIENT.S
SUBSURFACE SEWAGE DISPOSAL SYSTE_M:INSPECTIOIwi FORM
PART
SYSTEMJNFO.RMATION(continued).
Property Address: lJ" /�. ✓
Owner
Date of Inspectio'.:
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewase disposal system including ties to at least two permanent reference landmarks.or
.benchmarks. Locate all wells within 100 feet.Locate.where public water-supply enters the buildin-.
d t✓r
L
IDe
Pea
P
t C71 -
Page. I I of 1 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORA
PART C
SYSTE M INFORMATION (continued)
Property Address: ,/6
Owner:
Date of lnspection�i 1 !
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated.depth to ground water' feet
PIease indicate (check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record -If checked, date of design plan reviewed:
Observed site (abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with.local excavators; installers-(attach docurnertation)
Accessed USES database-e-plain:
You must describe how you established the high ground water elevation:
b' _ '9 � �o J6.i r�lv �i�
11
Permit Number: ,tea Date:
Completed by: t✓ ,�i� i�
HIGH GROUND-WATER LEVEL COMPUTATION
Site location: // Lry ',� !r __ Lot No.
Owner. �1%d lGl Cf/7 Address:
Contractor: Address: �✓-r � 5 '�Y Ai
/
Notes: --...__.._ _ 11_', 141171 51 _
STEP 1 Measure depth to water table
�-
to nearest 1/10 ft. .............................................................................. .Date
month/day/year
STEP 2 , Using Water-Level Range Zone.,
and Index Well Map<Locate
site and determine
O Appropriate;index well
OB Waterdevel range zone ...................................
"STEP 3 Using monthly report"Current
Water:Resources.Conditions
deterna me current depiki to J�[ Z_/'5 .
-water..:level for,:index:vvela_.:.:.....:.:...:..:................ (Ltd
•... month/Year
STEP 4 Using Table:of.Water-level-Adjustments
for index.:well (.STEP.2A),,cur-rent-depth
%to water-le.vel:forlindex=well-(STEP 3),,
and water-level"zone (STEP 2B) .
determine-water-le.v.el'.adjustment ..........................................................................................
STEP. 5 Estimate depth to high water
by subtracting the water-
level adjustment (STEP 4)
from measured depth to watert,
levelat site (STEP 1) .....................................:...:....................................................................
Figure 13.—.Reproducible computation form.
15
lob
n
FROM FAX NO. Jul. 31 2006 11:51RM P1
R&H CONSTRUCTION, INC.
P.O. Box 511
Marstons Mills, MA 02648
Tel. & Fax or 508-540-9074
PROPOSAL
June 15, 2006
Polhemus Savery DaSilva
1.01 Depot Road
Chatham, MA 02633
Attn: Jon Phillips
Fax: 508-945-9803
Proposal for: 152 Lakeview—Centerville
Install hay bales and silt fencing $ 1,080.00
Removal of trees and stumps $ 2,390.00
Demo existing house, garage and foundation $ 15,650.00
Excavate for new foundation $ 3,260.00*
Backfilling of foundation $ 1,540.00*
Tie in existing septic to house(as per plan) $ 350.00
E &B electric trench $450.00
Install new 1"water service main to house
(by C-O-M-M) $ 3,750.00
Clear and cut grade for new driveway
Install Y-4"of recycled material for base $ 3,450.00
a Note: No garage included
Total: $31,920.00
WE PROPOSE hereby to furnish material and labor—complete in accordance with these
specifications,for the sum of Thirty One Thousand Nine Hundred Twenty Dollars
Payable as follows:Deposit to be determined upon signed acceptance of proposal/balance to be billed
All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.
Any alterations or deviation from above specifications involving extra costs will be executed only upon written orders,and will
become an extra charge over and above the estimate. All agreements contingent upon strikes, ccidertts or delays beyond our control.
Owner to carry fire,tornado or other necessary insurane workers arc fully covered by en's Compensate n Insurance.
AUTHORIZED SIGNATURE . ur �Q/!� @i--VC�s.
y
NOTE: This proposal y be withdr wn by us if accept within days.
Polhemus Savery DaSilva
Ovol (D0113 i
July 31, 2006
Barnstable Health
Division
200 Main St.
Hyannis, MA 02601
RE: 152 Lakeview Dr.
To Whom It May Concern:
Please accept this letter as notification that Polhemus Savery DaSilva, Inc. Architects/Builders
will be responsible for marking the existing well "Not Potable". It will be used for irrigation
purposes only. The property will be connected to town water.
Thank you.
Sincerely,
Nancy Conrad
Polhemus Savery DaSilva, Inc. Architects/Builders
101 DEPOT ROAD • CHATHAM, MA 02633 901 MAIN STREET • OSTERVILLE, MA 02655
TEL 508 945-4500 9 FAX 508 945-9803 WWW.PSDAB.COM TEL 508 428-1 800 9 FAX 508 428-1896
Message Page 1 of 3
Miorandi, Donna
From: Nancy Conrad [nconrad@psdab.com]
Sent: Monday, July 31, 2006 8:48 AM
To: Miorandi, Donna
Cc: missy@boutwellowens.com; Peter Polhemus; David Pfeifer; Jerry Durr; Jon Phillips; Len Savery
Subject: RE: 152 Lakeview Dr.....
Donna,
Good morning! Thank you for the information. Just to clarify, we need all of this information before
the Board of Health will sign off on my building permit application? Correct? I'm just trying to keep
the process moving. Thank you.
Nancy Conrad
Polhemus Savery DaSilva,Architects/Builders
(508)945-4500
(508)945-9803 fax
nconrad@psdab.com
-----Original Message-----
From: Miorandi, Donna [mailto:Donna.Miorandi@town.barnstable.ma.us]
Sent: Monday, July 31, 2006 8:19 AM
To: nconrad@psdab.com
Subject: RE: 152 Lakeview Dr.....
We still need the well tested as long as it is still being utilized as potable water. If they are connecting to
town water we need a signed contract from the contractor or water department stating that they are
connecting to town water. Then the well, if to be used for irrigation, shall have to be marked "Non-
potable". Any further questions after noon time today will have to wait until noon on Wednesday when I
shall return to the office. Thanks! Donna Miorandi
-----Original Message-----
From: Nancy Conrad [mailto:nconrad@psdab.com]
Sent: Friday, July 28, 2006 9:07 AM
To: Miorandi, Donna
Subject: RE: 152 Lakeview Dr.....
Good Morning, Donna. There is a possibility that the McLaughlins want to connect to
town water and use the well for irrigation purposes only. Do you need a letter from
them (the owner) stating this? What do you need if this is the case? Thanks.
Nancy Conrad
Polhemus Savery DaSilva,Architects/Builders
(508)945-4500
(508)945-9803 fax
nconrad@psdab.com
-----Original Message-----
From: Miorandi, Donna [ma ilto:Donna.M iora ndi@town.ba rnstable.ma.us]
Sent: Thursday, July 27, 2006 4:24 PM
To: nconrad@psdab.com
7/31/2006
l _
Message Page 2 of 3
Subject: RE: 152 Lakeview Dr.....
Whenever I receive the well test data I shall call you and then I can sign off on the c/o. I'll.
be back in the office on Monday. Donna
-----Original Message-----
From: Nancy Conrad [mailto:nconrad@psdab.com]
Sent: Thursday, July 27, 2006 4:18 PM
To: Miorandi, Donna
Subject: RE: 152 Lakeview Dr.....
That's ok. We are all new at some point. Can I expect to hear from you or
someone in your department when everything is a go on the septic
inspection? or do I continue to call for a status? Thank you for all your
time spent on this. I really appreciate it.
Nancy Conrad
Polhemus Savery DaSilva,Architects/Builders
(508)945-4500
(508)945-9803 fax
nconrad@psdab.com
-----Original Message-----
From: Miorandi, Donna [ma ilto:Donna.M iorand i@town.ba rnsta ble.ma.us]
Sent: Thursday, July 27, 2006 3:58 PM
To: nconrad@psdab.com
Subject: RE: 152 Lakeview Dr.....
Nancy, Tina was wrong, not her fault-she is new, as all our staff up front
are. 1 issued the permit. It does not mean I inspected the septic system
when it was complete. Whatever inspector inspected it should have signed
it if it was inspected. I inspected systems during 1999 and 2000 not during
1997 or 1998. The inspection report will have to take the place of the
certificate of compliance. Donna
-----Original Message-----
From: Nancy Conrad [mailto:nconrad@psdab.com]
Sent: Thursday, July 27, 2006 11:52 AM
To: Miorandi, Donna
Cc: 'Peter Polhemus'; 'Len Savery'; 'Jerry Durr'; Jon Phillips; David
Pfeifer; missy@boutwellowens.com
Subject: RE: 152 Lakeview Dr.....
Donna,
Regarding the inspection report, I spoke with Tina on
Tuesday and she said you would need to review the report and
sign the certificate of compliance because you were the
inspector at the time the permit was issued. Is this correct?
Can you give me an idea when the certificate of compliance
will be issued?
Nancy Conrad
Polhemus Savery DaSilva,Architects/Builders
7/31/2006
Message Page 3 of 3
(508)945-4500
(508)945-9803 fax
nconrad@psdab.com
-----Original Message-----
From: Miorandi, Donna
[mailto:Donna.Miorandi@town.barnstable.ma.us]
Sent: Thursday, July 27, 2006 10:27 AM
To: nconrad@psdab.com
Subject: RE: 152 Lakeview Dr.....
Hi Nancy, We have just received the copy of the inspection report
from Bortolotti. Don't know the status of the inspection from this
department. Certificate of compliance was not signed by any
inspector. In further reviewing your files we will need a copy of a
recent well test or evidence that you are on town water. Call or e-
mail if any further questions.
Donna Z. Miorandi, R.S.
Town of Barntable
Health Inspector
-----Original Message-----
From: Nancy Conrad [mailto:nconrad@psdab.com]
Sent: Tuesday, July 25, 2006 1:13 PM
To: Miorandi, Donna
Cc: 'Jon Phillips'; 'Jerry Durr'; 'Peter Polhemus'
Subject: 152 Lakeview Dr.....
Hi, Donna!
I spoke with you a while ago about 152 Lakeview Dr.,
Centerville. To refresh your memory, this property had
a new septic installed in 1997 but the installer failed to
complete the final inspection and a certificate of
compliance was never issued. The septic report has
been completed and sent to your office from Bortolotti
Construction. It is my understanding that I need the
certificate of compliance before I can get my building
permit application signed off by the Health
Department. If you have the report, is this something
that can be issued fairly quickly? I would appreciate
anything you could do to expedite the process. Please
let me know. Thank you.
Nancy Conrad
Polhemus Savery DaSilva,Architects/Builders
(508)945-4500
(508)945-9803 fax
nconrad@psdab.com
7/31/2006
Fee
J THECOMMONWEALTH OF MASSACHUSETTS Entered in computer:
U PUBLIC HEAR DIVISION'��70WN OF BARNSTABLE., MASSACHUSETTS Ye
T-f
0[ppYication for 3Di5posW *pgtem Construction Permit
Application for a Permit to o ct )Reps f( )Upgrade(V�Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. L� Owner's Name,Address and Tel.No.�a91�i1
Assessor's Map/Parcel
Geis fWvl//�= 5-�s -3v3-- �D�?
Installer's Name,A dress,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( O
Other Type of Buildingb_e_dV,1e_No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 1119 gallons per day. Calculated daily flow. 410 gallons.
Plan Date A9 /"7 QS /Number of sheets Revision Date
Title .5"/-f° d-&_41
Size of Septic Tank I Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) T/ 77le -V-
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issuedo. t is B d o He �
Signe Date �`z3
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued
�pp o.rs "A�%T OMMONWEALTH OF MASSACHUSETTS
� �'� 40 BARNSTABLE MASSACHUSETTS
�, �Y�B�C7/tan
�- o.ke r '� ' �, , rfc of �lCompliance
THIS IS TOCERTIFY, that the On-sie, ge''Disposal System Constructed( )Repaired( )Upgraded(ti)
�jjyl,2A � P Pg Abandoned( )by
at G� iov's°w Dr. e� '��1 /� has b n constructed in accordance
with the provisions of Title 5.apd the for Disposal System Construction Permit No. — dated
Installer XB/�� / ��T Designer
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date Inspector
Fee
r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
J D,YPUBLIC HEALTH� ISION'-,TOWN OF BARNSTABLE., MASSACHUSETTS Ye"
application for Mftgpogat *P!Wm Congtruction Permit
Application for a Permit to, o ct )Repair`( )Upgrade( (<Abandon( . ) ElComplete System El Individual Components
Location Address or Lot No. �� Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. �y Designer's Name,Address and Tel.No.
77
Type of Building:
Dwelling No.of Bedrooms Lot.Wze sq.ft. Garbage Grinder( D
Other Type of Building �'�Si �/�C,,C. N;o. of Persons Showers( ) Cafeteria( )
Other Fixtures ~J
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date l0 /°P /l5 /Number of sheets Revision Date
Title 5/fib- s i 6✓l9P G�/l/'I
1,,.,Size of Septic Tank Type of S.A.S.
Description of Soil 1
i
c
Nature of Repairs or Alterations(Answer when applicable) T/ Tle
Date last inspected:
V: 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 been issued b this o- d o e
Signe " _r Date 11_3/�/
Application Approved by U Date
Application Disapproved for the following reasons �.
Permit No. Date Issued
/love S JS 1C-rpW� ,1 ld$j COMMONWEALTH OF MASSACHUSETTS
l)�Ik_-• BARNSTABLE, MASSACHUSETTS
D.k. r Se rlDA 4iCa Of �OIn trance
,20 THIS IS TO CER FY,that the On-site/Sew�geisposal System Constructed( )Repaired ( )Upgraded(V)
j1V
� Abandoned b
af'+ / / Ile has been constructed in accordance
< .m
with the provisions of Title 5 and the for Disposal System Construction Permit No. 3 dated
Installer liel)`D Designer /t C�
r The issuance of this permit shall not be construed as a-guarantee that the system will function as designed.
k Date "..., tInspector
. — ———— ————— ————————————— ———— '('-j��--
No. 4? Q ,W
T(E ,�MMONWEALTH OF MASSACHUSETTS
— PUBLIC u.0 IV9SION _ BARNSTABLEs MASSACHUSETTS
m gp r%tem Congtruction-PermitPermission is hereby granted to Co��s )Repair( )Upgrade( v)AbandonSystem located at �,
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: Constructio ust (codm leted within three years of the date of th`
Date: / � / Approved by
v
i
oFIMErow Town of Barnstable . .Department of Health, Safety, and Environmental Services
gpAN3CA8�
MA99. Public Health Division
0 9. 367 Main Street,Hyannis MA 02601
Thomas A.McKean,Rs,CHO
Office: 508-790-6265 Director of Public Health
FAX: 508-775-3344
June 25, 1997
Mr.Robert Bortolotti
P.O. Box 704
765 Wakeby Road,
Marstons Mills,MA 02648
RE: 152 Lakeview Drive(a.k.a. 151 Lakeview Drive)Centerville,MA
Dear Mr. Bortolottit:
The disposal works construction permits,#95-1808 and 97-309 are revoked due to non-compliance with
Part XI: Section 2.00 of the Board of Health Regulations. The submitted engineered plans do not show a
minimum separation distance of 150 feet between the proposed soil absorption system and the existing
onsite private well.
You may request a hearing if written petition requesting same is received by the Board of Health within
seven days.
- ` Sincerely yours,
Thomas A.McKean
cc: Arne O'Jala,P.E.
Brian Jansson
1
m SENDER:
p, "3 3 9 5 7 8 7 41 \�✓ � :Complete items 1 and/or 2 for additional services. I also wish t0 receive the
I Complete items 3,4a,and 4b. following services(for an
US Postal Service 4) •Print your name and address on the reverse of this form so that we can return this J E card to u extra fee):
Receipt for Certified Ma ; .Attach this to the rrom or the mail
No Insurance Coverage Provided. permit. Piece,or on the back If space does not 1, ❑ Addressee's Address.
Do not use for intemational Mail See reverse 0 �Write Retum-Reee01-Requested'on the mailpiece below the article number.
The Return Receipt wfii show to whom the article was delivered and the date 2• ❑ Restricted Delivery
Sent to c delivered.
° Consult postmaster for fee.
Siree umber
3.Article Addressed to: _ 4a.Article Number
� t�p ice,State,&21P C E y �
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stage
���('q/� - ❑ Registered Certified
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Special Delivery Fee 7.Date of Delivery
LO Restricted Delivery Fee .Received By:(Print N e)
8.Addressee's Address only if requested ;
rn Return Receipt Showing to I and fee is paid)
Whom&Date Delivered N 6.Signatur ddressee or A t) J
a Return Receipt Showing to Wham, F
X
Q Date,&Addressee's Address =
O TOTAL Postage&Fees $ PS Form 11,Deco r 1994 102595 97-B-0179 Domestic Return Receipt
CO
Cl) Postmark or Date
E 0 /
t
a m SENDER:
■Complete items 1 and/or 2 for additional services. I also wish to receive the
�+ •Complete items 3,4a,and 4b. following services(for an
d a Print your name and address on the reverse of this form so that we can return this extra fee):
card to you.
P 339 578 743 -Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address,
permit.
US Postal Service
4t s Write'Retum Receipt Requested'on the mafipiece below the article number. 2. ❑ Restricted Delivery
■The Return Receipt will show to whom the article was delivered and the date
Receipt for Certified Mail c delivered. Consult postmaster for fee.
No Insurance Coverage Provided. a 3.Article Addressed to: 4a.Article Number
Do not use for Into Tonal Mail See reverse
Sent a
c 4b.Service—Type
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and fee Is paid)
5 7 8 7 4 5 rew- S;ENDER:
Sig?7na dr e�PAgent)
p 339 X —
US Postal Service Fo , December 1994 102595-97-B-0179 Domestic Return Receipt
Receipt for Certified Mail
No Insurance Coverage Provided.
Do not use for International Mail See reverse v ■Complete items 1 and/or 2 for additional services.
u► •Complete items 3,4a,and 4b. I also WISh t0 receive tits
Sent to aPrint your name and address on the reverse of this forth so that we can return this following services(for an
BRIAN JANSS( card to you. extra fee):
a Attach this forth to the front of the mailpisoe,or on the back if space does not -Street&Number permit 1. ❑ Addressee's Address 2
6 BRIDLE PATH
ZIP Code m ■wnte'Retum Receipt Requested-on the mailpiece below the article number.
Post Office,State,& �
.The Return Receipt will show to whom the article was delivered and the date 2. ❑ Restricted Delivery a
MAP, TONS MILLS C delivered.
° Consult postmaster for fee. �
$ 2.7 7 -a 3.Article Addressed to:
Postage 4a.Article Number
Certified Fee o
4b.Service Type
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�_.-. -- --__ _� .,� uu i.uv. „L„ y V„,,J JrJi3`tCtS7J77 ►o:5btiy459803 P.1/1
Ir
�\�' -ram✓"IL
i 1 /
G Z-'ZQ'
G\
TOWN OF BARNSTABLE
LOCATION SEWAGE# ~
VILLAGE GP�IP .r'1/i�/�,•+� ASSESSOR'S MAP& LOT ?& Z 11 W
INSTALLER'S NAME&PHONE NO, Af,'IM4 % i ��`' 77/-�3�� VJ
SEPTIC TANK CAPACITY
LEACHING FACI'LrN: (type) (size)
NO, OF BEDROOMS
BUILDER I, OWNER i
PERMITDATE: COMPLIANCE DATE,
Separation Distance Between the.
Maximum Adjusted°Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (if any wells exist
on site or within 200 feet of leaching facility) Fact
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feat of leaching facility) Feet
Furnished by
NO.
DATE
TOWN OF BARNSTA9LE
Hof z+<e roe` FEE
o OFFICE OF IQf`►` O
RE E�j Y
l�yaoe,►a raBL N
Ms� � E30ARD OF HEALTH 30. 199
�
367 MAIN STREET JN
HYANNIS, MASS. 02601
��THpFp�TgB�F / N�
VARIANCE REQUEST FORM
All variances must be submitted FIFTEEN (15) days prior to the schedu o Health
meeting,
NAriE OF ,APPLICANT `P��-�a� I ar-�'55c TEL. NO.
ADDRESS OF APPLICANT q co +�, ,p,2� �2 ,
I
NAME OF OWNER OF PROPERTY �j,o..� ,��o- ►.� ,.t c
SUBDIVISION NAME p DATE APPROVED GI t S 110
ASSESSORS MAP AND PARCEL NUMBER Z1 y aM2 &°"' 9- z.z --ts
LOCATION OF REQUEST (S'2.. �+'�I�-� �/t w -T3 a-, J am,-r��2V 1"=-c
SIZE OF LO'I 40,-;Ij SQ. FT. WETLANDS WITHIN 200 FT. OF PROPERTY: Yes No
VARIANCE FROM REGULATION(List Regulation) . A-?Zopl-�0 l0_ t" _—l+
\/s4►41 A.r.sC-4—r- o•r SD i✓LEIo ;:w o t-k /��1 rl►EVJ SE�� o�1 d7 F
I Sty 4- S pT S�fS Teti( 01�t tit W a LA f s E i7 G� J
REASON FOR VARIANCE(May attach letter if more space is needed)
S fS-CE kA 1-�104 4A-Y!49 i s A.r. f—AfZ A-s doss A)LC FIB" 60 w+A.j
g.4 T7 I kLc[ w E w;' Anz C- -� l Sx�
PLAN four COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST.
VARIANCE APPROVED
NOT APPROVED
REASON FOR DI:SAPROVAL
'� ,Diers�✓J drJ 1`19 S S —
Susan G. Rask
Chairman
Joseph C. Snow,
Erian Ft. Grady
BOARD OF YIEALTH
,FOWN OF BARNSTABLE
_ TOWN OF BARNSTABLE
OF THE l�
WPy,��v OFFICE OF
6
= BANTSTABL BOARD OF HEALTH
wee.
�p t639. Ao 367 MAIN STREET
�c MAY HYANNIS, MASS.02601
July 11, 1997
Sarah O'Jala
Down Cape Engineering
939 Main Street
Yarmouth, MA 02675
Dear Ms. O'Jala:
You are granted a variance on behalf of your client, Brian Jansson, to construct a
replacement onsite sewage disposal system at 152 Lakeview Drive, Centerville. The
variances are,granted from :
Part XI: Section 2.00 of the Board of Health Re ulg ation: To reduce the separation
distance between the leaching facility and the onsite well to one-hundred (100) feet
in lieu of the required 150 feet.
Part VIII' Section 1.2 Onsite Sewage Disposal Construction: To utilize two feet
of sidewall area as part of the calculation of effluent loading rate for the new soil
absorption system.
The variances are granted with the following conditions:
(1) The engineered plan shall be revised to show a heavy duty septic tank with
H-20 loading.
(2) The designing engineer shall supervise the construction of the septic system
and shall certify in writing to the Board of Health that the system was
installed in substantial compliance with the revised plans.
(3) The existing cesspool must be removed or abandoned in accordance with
the procedures of Title 5, State Environmental Code Regulation.
It is recommended that the owner of the property test the private well water on a regular
basis (once each year).
sarah
r.
The variance is granted because the existing cesspool did not pass during a routine real
estate transfer inspection. The proposed replacement septic system meets all of the State
Environmental Code, Title 5, regulations.
Sincerely yours,
us an G. RaC1.S.
Chairman
Board of Health
Town of Barnstable
SGR/bcs
sarah
�FtHET Town of Barnstable ,
Department of Health, Safety, and Environmental Services
antuvsrnH[.e ,
r Public Health Division
i639' ♦0
AIEp Mai" 367 Main Street, Hyannis MA 02601
Office: 508-790-6265 Thomas A.McKean,RS,CHO
FAX: 508-775-3344 Director of Public Health
June 25, 1997
Mr.Robert Bortolotti
P.O. Box 704
765 Wakeby Road,
Marstons Mills,MA 02648
RE: 152 Lakeview Drive(a.k.a. 151 Lakeview Drive)Centerville,MA
Dear Mr. Bortolottit:
The disposal works construction permits,#95-1808 and 97-309 are revoked due to non-compliance with
Part XI: Section 2.00 of the Board of Health Regulations. The submitted engineered plans do not show a
minimum separation distance of 150 feet between the proposed soil absorption system and the existing
onsite private well.
You may request a hearing if written petition requesting same is received by the Board of Health within
seven days.
Q
rely yours,
Thomas A.McKean
cc: Arne O'Jala,P.E.
Brian Jansson
_.,. tive on October 22, 1974, after publication in the Cape Cod
mes.
TOWN OF BARNSTABLE
E raw
OFFICE OF
Y DnIrSTAn BOARD OF HEALTH
MAM 397 MAIN STREET
1659.
'off OM�Y k�� HYANNIS, MASS. oleo, _4ctst�s_._.].�—.____-1 9_74
LEGAL NOTICE
In accordance with the provisions of Section 31 and Section 127A of
Chapter 111, of the General Laws, Regulation 2, of Article I and
Regulation 3, of Article XI, of the Sanitary Code of the Commonwealth of
Massachusetts, and for the protection of the Public Health, the Town of
Barnstable Board of Health adopts the following regulation:
The installation of a private water supply and a private sewage
disposal system on a lot containing an area less than 40,000 square feet
of buildable land is prohibited and in no case shall a private water
supply and a private sewage disposal system be located within 150 feet
of each other.
9`
Variance to this regulation may be granted by the Board of Health,
i� after a hearing, during which the applicant proves that the installation
Si
of .the private sewage disposal system will not adversely affect surface
or sub-surface public or private water resources of:
1) The lot subject to the application
2) The adjacent land (whether developed or not) or
j 3) A defined aquifer recharge area
In granting variances, the Board will take into consideration
4; population density of the area, the size and shape of the lot, slope,
the suitability of the soil for drainage and percolation, existing and
known future water supplies, depth to ground water and impervious material
and area reserved for expansion of sewage system and relocation of water
supply in case of failure.
This regulation takes effect on the date following publication, but
does not apply to preliminary or definitive sub-division plans filed
prior to publication. After publication this regulation supersedes the
previous 40,000 square foot. regulation whi ent into effect April 12,
1974.
.WA
_Wbide L. Ch ds, airman
Ann Jan6 Esh h
Gerald W. 4fAidrd, M: D.
BOARD OF HEALTH
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SET TIC PROFILE - '
T.O.F. AT E- J TEST HOLE LOGS
—- (NOT TO SCALE)
- ACCESS COVER TO WITHIN Ir OF FIN GRADE
ACCESS COVER (WATERTIGHT) TO
ENGINEER:---___'-_
/ MINIMUM .75' OF COVER OVER PRECAST WfTHW OF FIN. GRADE 13'
--- 2% SLOPE REQUIRED OVER SYSTEM +
_ - --------- -- ---- ------ - - WITNESS
RUN PIPE LEVEL v Z
2'
(DQ ) - U(iliBiF.
__ FOR FIRST 2' WASHED P£ASTONE DATE:.
PROPOSED
SVITXI
45 -r TANKiN(4M_L0H 4< - �� w-: - PERC. RATE
�3 /
lyi;of
- -- - -_��
_ 4-4. f --_� CLASS -- �._ --- SOILS P# ,p� � mot°
Jr.a1 / _ 4'E SONG BY / ' 3 _ t� i
4.3 133�r
(-X SLOPE) 6' CRUSHED STONE OR MECHANICAL r ��
DEPTH OF FLOW COMPACTION. (15.221 [2)) K
--- - — ��� C
`
TEE SIZES: X SLOPE) ( X 3/a' TO 1-1 If DOUBLE WASHED STONE # ^ O ✓
(- SLOPE)
INLET DEPTH
{OUTLET DEPTH SIDES AND BOTTOM OF LEACH INTERFACE TO BE SCAFIFIED
__
CJ9 � . �A,� �,. 34 � " �'' O L LOCATION MAY -.-_'� " �?oU.�
S►~•� wA ` -,.1 '�"'```� 'aa"^ - ASSESSORS MAP �/' PARCEL '�-�- <= �✓
LEACHING r3
FOUNDATION- -- ,., - --- SEPTIC TANK —_ - --- -_ D' -BOX FACILITY ;.'►.r.K FLOOD ZONE C`
EL1.,avt
BUILDING ZONE:
_ _ y0" 19 �t_ � 16 4741
�-�vvCof �R e . - — — � �� s - / ��pL', f s�..� m��� cF.�.� SETBACKS: FRONT
�L 41-4 ----____- - , o►�,0N 1"r: e i e e.re G L SIDE
"- ----_ ._ wn
-'---..__-_,,. �"✓//?fr6 .fit/Q,rw! Gt7 /�� / 1..0AnwN ane ..�
C419�� y
REAR
_ -
,.- So; \
� / PLAN REFERENCE:
ie, �� • r �'9 x/�C :1a.A.�aw. MILT) ►Z44 . {:>iF �.v� Tq�I(f (7i-I�ci.! 19 \rs
� *} tom,
0 t
/ r }
1
-NO_T 0
C •
1 . DATUM IS L7A i,6�
SEPTIC DESIGN: (GAFtt3AGE UtSPosER Is 2. MUNICIPAL WATER IS __ N`7- E x>2Trw'Gr
�- 43w� .�G d ►n ` /\ 1� 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT.
DESIGN FLOW: :"_ BEDROOMS ( GPD) GPD 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO_H-Z
USE A _ � -.,� GPD DESIGN FLOW �
5. PIPE JOINTS TO BE MADE WATERTIGHT.
SEPTIC TANK: I�•(J GPD (�- = �--: � GALLONS
div✓1g- -- ✓� ) 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS.
USE A ��_ GALLON SEPTIC TANK ENVIRONMENTAL CODE TITLE V.
.:EACHI
7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO HE
, ` USED FOR LOT LINE STAKING.
SIDES: 4�-S t1o. Y� 4
\ � � _ � (..��) /..��,:.2 GPD 8. PIPE FOR SEPTIC SYSTEM TO 5CH. 40-4" PVC.
�► �, � �. BOTTOM`_4 h S k �o.3 - ( ) 33 1.1p GPO
9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT
I � � ,� • # TOTAL: S.F. '` � GPD INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED
FROM BOARD OF HEALTH.
10, EXISTING CESSPOOLS TO BE PUMPED AND FILLED WITH CLEAN SAND
OR REMOVED AS NECESSARY.
1�1 (t4E _ 4'�'\ -iA 6.�+t7iiFuSapi rN .--
�_� T 4 .S Te A ..d
,t35
Z-)(L) < 74f-) - 14 n.1,c ' SITE AND SEWAGE PLAN OF
-~- � / - HOARD 0)� HEALTH ��f - Vl Gt �- V
PGL _ — I
Z / Z
IN THE TOWN OF:
�7_06V^/ IX/A% 5-/Z APPROVED DATE MA �� _ �T__ !�^' �L � i4►C%1�'. ' /4",,4;9
?E.E 4 KIA/E P_ PREPARED FOR: -- .4
Feet ,
SCALE: DATE:
n 4" 1 idown ca e engineering, Inc.( � � 719 7
CIVIL ENGINEERS 4��' � r,�' `tilq S
!�� ar��-.� �. APOW ...
LAND SURVEYORSzL
PHONE 5J8 - 362-4541 rw. 31
n
-- 4-. FAX 508-362-9880
e3e main st. yarmout2z.
ma 02e76
- -- - - ------
JOB# OJAM, ': .L.S. DA TE 1