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0457 OLD STAGE ROAD - Health
457 Old Stage Road Centerville A = 190 — 064 SMEA® No.2453LOR UPC 12534 smsad.com • Mad*In USA (log � I�IR�MAIilY000RIN � www � 4 �7 No. � l Fee& THE COMMONWEALTH OF MASSACHUSETTS Entered in omputer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitation for -Misposal 6pstent Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) Complete System ❑Individual Components Location Add/��s or Lot No. � co)ID S��� Owner's Name,Address,and Tel.No. f'pg=3��_Zt►/[.j f_4!^TaV)j 9G ANA l Assessor's Map/Parcel d. Installer's Name,Address,and Tel.No. C,G.C_ Designer's Name,Address,and Tel.No. Yew► K Gen - N - Type of Building: C, Dwelling No.of Bedrooms 7 j Lot Size sq.ft. Garbage Grinder( ) Other Type of Building MOW4 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) fSO gpd Design flow provided gpd Plan Date Number of sheets 3 Revision Date T� Title Size of Septic Tank /�f lbb Qir Type of S.A.S. �3 /y/Q CY> / 14e* Description of Soil C 7.- L..k,l/ 3=4&j*jr y., p /3i Nature of Repairs or Alterations(Answer when applicable) Date last inspected: /O�_�!�?i►/7 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe Date 11 Q�� Application Approved by l Date Application Disapproved by Date for the following reasons Permit No. a 2. Q 7 Date Issued No. U :. �.. : Feen� TH5.COMMONWEALTH.OF MASSACHUSETTS Entered in computer: Ye +. PUBLIC HEALTH DIVISION - TOWN OF,BARNSTABLE, MASSACHUSETTS 01pplication for Misposal 6pstem ConBtrUctlonwP mt f vt Application for a Permit to Construct( )` Repair O Upgrade(/-T Abandon( ) EkG mplete Syste ❑Individual Component - € Location Address or Lot No. Y f7 b1 Q ��" Rce Owner's Name,Address,and Tel.No. 4e_ r�rkiItc lWA ' Y� r3. Assessor's Map/Parcel k AD 14Ii !Y 1-4 ,5 SJ 1. A. d,�W_4�k Installer's Name,Address,and Tel.No. C' , C y Designer's Name;Address,and Tel.No. Type of Building: 1 Dwelling No.of Bedrooms 7 _j Lot Size -.7, sq.ft. Garbage Grinder( ) f Other Type of Building Hey'_-, No.of Persons- Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided , a , gpd }} Plan Date 9�/y��v , Number of sheets 3 Revision,A e ,Y Title ++R yn Size of Septic Tank l e 66 ��L /y-/ ' Type of S.A.S. 3 N Description of Soil C 2- L ic� ►r��' Nature of Repairs or Alterations(Answer when applicable) 4 "4 Date last inspected: Agreement: e' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed.:_i , � - - �il.=:�y711 t,: _� _.- Dafe - A 'lication Approved b PP pp YDate application Disapproved by Date .� for the following reasons M1 / Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS, BARNSTABLE,MASSACHUSETTS F Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(f, Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ated Installer }_ Designer -)I E /fdtJd'� #bedrooms l � tl M, n C�d Approved dew ow _ d gpd The issuance of this permit shall)not be/construe as a guarantee that the system wi I function as rgned. Date �� / � J Inspector------------------------- -------.._ No. -0 OS-7 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS � Btrm Disposal p Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade(l) Abandon( ) System located at 'I r-L , t?d y. and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with'`-fi Title 5 and the following local provisions or special conditions. Provided:Construction must 1be completed within three years of the date of this permit. { Date �) / / Approved by t' Town of Barnstable j++E rho Regulatory Services Richard V. Scab,Interim::Director s,►awsrast�. 9 Public Health Division; °i Thomas McKean,Director 200 Main Street,Hyannis,NIA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Sewage Permit## Assessor s MapTarcel Date: � � � Designer: Jar j a't 3 t�'r�c mot') 0* gn l C� �/7aY ���C ,� S Installer: ,�C M P trivetl� Address: Address: ��7/ �ti /0i— Z On ,j ,G�' It ��b' � `was issued a'permit to install a, [(date) (installer) septic system at based on a design drawn by (a dress)` vr I t dated (deslgne I certify that the septic system referenced above was installed substantially according to the design; which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required), was inspected and the soils were found satisfactory: I certify that the septic system referenced above was installed With major changes. (i.e. - greater than IW lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local.Regulations Plan revision or certified as-built by designertol follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed i mpliance with the terms of t>,P r\n .. , -Oappl cable) VOF GUN ERIc a e igna ure HARRINGTMON I�r3.107'0 (Design r"s ignature) (Affix I)F9I0pkV4jWp Here) PLEASE.RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE' WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC.'HEALTH DIVISION.,. THANK YOU: Q:1Septic\Designer Certification Form Rev 8-,1¢13.doc L15-7 TOWN OF BARNSTABLE 7��e1 ()S LOCATION T OLD 57aOe- R D SEWAGE# W21 VILLAGE 6-t"T CU'j�l� ASSESSOR'S MAP&PARCEL /QQ" 06 INSTALLER'S NAME&PHONE NO.� ji �5 �� v.Z-Octe SEPTIC TANK CAPACITY /�Q�ea) •Io F�7"2S lreans enJ LEACHING FACILITY: (type) C (size) a( 33�'+ 3� NO.OF BEDROOMS q D'l Deg l OWNER L.I Q C A, K&6oLKA PERMIT DATE: COMPLIANCE DATE: q 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 led / 0 & 3 31 1 3 O S 30 � 33 S� ,� .� 37 `� S� � B k 33647 Ps 20 8 0?0�2 01—0 5—2 0 21 a 03 m 3 0� 'GRANT OF NITROGEN LOADING RESTRICTION AND EASEMENT ON FACILITY LAND �,,�D #457 OLD STAGE ROAD,(CENTERVILLE) BARNSTABLE, � �S ��� , '� MA 0 CHAPTER 360 ss. 360-45 This GRANT OF Nitrogen Loading Restriction AND EASEMENT on Facility Land made as of this 54, day of 2020, by Aliaksandr A. Kadolka recorded with the Barnstable County Registry of Deeds, Deed Book 31480 Page 350, of 465 Old Stage Road, Centerville, MA 02632 ("Grantor") hereby grants to the Town of Barnstable acting through its Board of Health (Grantee) a nitrogen loading restriction and perpetual easement to ensure maintenance of the facility. WITNESSETH WHEREAS, Aliaksandr A. Kadolka of #465 Old Stage Road, Centerville, MA 02632 recorded with the Barnstable County Registry of Deeds, a quitclaim deed being the owner in fee simple of that certain parcel of land located in Barnstable (Centerville), Barnstable County, Massachusetts, with the buildings and improvements thereon, pursuant to a deed from Michael J. Hayes, Personal Representative of the Estate of Carl F. Sherman to Grantee of the Benefited Property, recorded August 22, 2018 in Barnstable County Registry of Deeds as Deed Book 31480 Page 350, and being shown as Lot 2 on "Plan of Land on Old Stage Road in Barnstable (Centerville), Mass a Plan of Land in Barnstable, Massachusetts, and recorded in the Barnstable County Registry of Deeds in Book 553 Page 65, referred to herein as ("Benefited Property"); and WHEREAS, Grantor desires to restrict the number of bedrooms as defined pursuant to 310 CMR 15.002 and/or the wastewater discharge design flow in any improvements located on the Property through the use of this Nitrogen Loading Restriction and Easement on Facility Land; and WHEREAS, the Facility Land has the benefit of a Nitrogen Loading Restriction and Easement over 11,000 square feet of land, being more particularly bounded and described in Grant of Nitrogen Loading Restriction and Easement on Nitrogen Credit Land, recorded with. the Barnstable County Registry of Deeds as document number and shown on a plan entitled Nitrogen Aggregation Plan prepared for Aliaksandr A. Kadolka at #465 Old Stage Road, Barnstable (Centerville), MA attached hereto as "Exhibit B"; and WHEREAS, the Nitrogen Loading Facilijy Aggregation Plan has been approved by the Barnstable Board of Health in accordance with the Board of Health Regulation Article XV Protection of Saltwater Estuaries, Chapter 360 On-Site Sewgae Dispposal Systems ss. 360-45 Interim Regulation;" and plan entitled Proposed Septic System Upgrade prepared for Aliaksandr A. Kadolka at #457 Old Stage Road, Barnstable (Centerville), MA attached hereto as "Exhibit A"; said approval being based upon the agreement by Grantor to incur certain obligations regarding the number of bedrooms, as defined in 310 CMR 15.002, and/or the wastewater discharge design flow in any improvements located on the Property and maintenance of the Facility Land Restriction and Easement to ensure protection of the nitrogen loading limitation of 5 mg/L nitrate nitrogen discharge standard pursuant to Chapter 360 ss. 36-45 in nitrogen-sensitive areas or in areas serving new construction where the residential use of both on-site systems and contribution to saltwater estuaries exist; and to grant to the municipality acting by and through the Barnstable Board of Health a perpetual easement to ensure maintenance of the Property including, but not limited to, removal of any prohibited uses and in connection herewith a perpetual easement to pass and repass over the Property for purposes of inspecting the Property to ensure compliance with and fulfillment of the terms of the Facility Land Restriction/Easement as hereafter set forth; NOW, THEREFORE, pursuant to the provisions of Chapter 360 ss. 360-45, Grantor does hereby GRANT to the Town of Barnstable, a Massachusetts municipal corporation situated in Barnstable County, having an address at 367 Main Street, Hyannis, Massachusetts, acting by and through its Board of Health ("Local Approving Authority") for nominal, non-monetary consideration, with QUITCLAIM COVENANTS, a NITROGEN LOADING RESTRICTION AND EASEMENT ON FACILITY LAND -("Facility Land Restriction/Easement") in, on, upon, through, over and under the Property, the terms and conditions of which are as follows: PURPOSE: The purpose of this restriction and easement is to protect and preserve the quality and quantity of ground water resources in the area of the saltwater estuaries in the Town of Barnstable, Massachusetts in order to ensure a safe and healthy saltwater estuary for the present and future inhabitants of the area. It shall also be for the specific purpose of limiting the introduction of nitrogen and other pollutants into, and maintaining the natural uptake of pollutants and the recharge of the ground water which takes place on the Property for the said saltwater estuary. OBLIGATIONS AND EASEMENT: 1. Prohibitions. Grantor agrees to restrict the number of bedrooms, as defined pursuant to 310 CMR 15.002, in any improvements on the Property to a total of four (4). 2. Easements. In creating this Facility Land Restriction and Easement, Grantor hereby grants to the Local Approving Authority, its agents, contractors, subcontractors and employees a perpetual EASEMENT to enter upon and the right to bring equipment onto the Property to do any and all acts deemed necessary to maintain the Property in a manner which ensures protection of the nitrogen loading limitation of 5 mg/L nitrate nitro _nitrogen discharge standard pursuant to Chapter 360 ss. 360 45 P , together with a right to pass and repass by foot and by vehicle over the Property for said purposes, and for purposes of inspecting the Property to ensure compliance with and fulfillment of the terms of this Facility Land Restriction/Easement. 3. Severability_. If any court or other tribunal determines that any provision of this instrument is invalid or unenforceable, such provision shall be deemed to have been modified automatically to conform to the requirements for validity and enforceability as determined by such court or tribunal. In the event the provision invalidated is of such a nature that it cannot be so modified, the provision shall be deemed deleted from this instrument as though it had never been included herein. In either case, the remaining provisions of this instrument shall remain in full force and effect. 4. Enforcement. Grantor expressly acknowledges that a violation of the terms of this instrument could result in the following: (i) upon determination by a court of competent jurisdiction, in the issuance of criminal and civil penalties,,and/or equitable remedies, including, but not limited to, injunctive relief, such injunctive relief could include the issuance of an order to modify or remove any improvements constructed upon the Property in violation of the terms of this Facility Land Restriction/Easement; and (ii) in the assessment of penalties and enforcement action by the Local Approving Authority to enforce the terms of this Facility Land Restriction/Easement, pursuant to Chapter 360 ss 360-45. 5. Provisions to Run with the Land. This Facility Land Restriction/Easement sets forth the rights, liabilities, agreements and obligations upon and subject to which the Property or any portion thereof, shall be left unimproved or according to which said Property may be improved, held, used, occupied, leased, sold, hypothecated, encumbered, or conveyed. The rights, liabilities, agreements and obligations herein set forth shall run with the Property, as applicable thereto, and any portion thereof and shall inure to the benefit of and be binding upon Grantor and all parties claiming by, through or under the Local Approving Authority or Grantor. The rights hereby granted to the Local Approving Authority and its successors and assigns constitute their perpetual right to enforce this Facility Land Restriction/Easement. Grantor hereby covenants for himself/herself/itself and his/her/its executors, administrators, heirs, successors and assigns, to stand seized and hold title to the Property, as applicable thereto, and any portion thereof, subject to this Facility Land Restriction/Easement, provided, however, that a violation of this Facility Land Restriction/Easement shall not result in a forfeiture or reversion of Grantor's title to the Property, as applicable thereto. 6. Concurrence Presumed. It being agreed that Grantor and all parties claiming by, through or under Grantor shall be deemed to be in accord with the provisions herein set forth and to agree for and among themselves and any party claiming by, through or under them, and their respective agents, contractors, sub- contractors and employees, that the Facility Land Restriction/Easement herein established shall be adhered to and not violated and that their respective interests in the Property and the Facility Land Restriction and Easement, as applicable thereto, shall be subject to the provisions herein set forth. 7. Incorporation into Deeds, Mortgages, leases and Instruments of Transfer. Grantor hereby agrees to incorporate this Facility Land Restriction/Easement, in full or by reference, into all deeds, easements, mortgages, leases, licenses, occupancy agreements or any other instrument of transfer by which an interest in and/or a right to use the Property, or any portion thereof, is conveyed. 8. Recordation. Grantor shall record and/or register this Facility Land Restriction/Easement with the appropriate Registry of Deeds and/or Land Registration Office within 30 days .of the latter of: receipt from the Local Approving Authority of the approved Facility Land Restriction/Easement. Grantor shall file with the Local Approving Authority a certified Registry copy of this Facility Land Restriction/Easement as recorded and/or registered within 30 days of its date of recordation and/or registration. 9. Amendment and Release. This Facility Land Restriction/Easement may be amended or released only upon approval by the Local Approving Authority. Release of this Facility Land Restriction/Easement shall be granted by the Local Approving Authority in the event the Property is connected to a municipal sewer system and the septic system serving the Property is abandoned in accordance with 310 CMR 15.354 or the Property is no longer located within a nitrogen sensitive area pursuant to Chapter 360 ss. 360-45. Any such amendment or release shall be recorded and/or registered with the appropriate Registry of Deeds and/or Land Registration Office and a certified Registry copy of said amendment or release shall be filed with the Local Approving Authority within 30 days of its date of recordation and/or registration. 10. Term. This Facility Land Restriction/Easement shall run in perpetuity and is intended to conform to M.G.L. c.184, §26, as amended. 11. Rights Reserved. This Facility Land Restriction/Easement is granted to the Local Approving Authority in connection with the approval of a Nitrogen Loading Facility Aggregation Plan pursuant to Chapter 360 ss. 360-45 It is expressly agreed that acceptance of the Facility Land Restriction/Easement by the Local Approving Authority shall not operate to bar, diminish, or in any way affect any legal or equitable right of the Local Approving Authority to.issue any future order with respect to the Property or in any way affect any other claim, action, suit, cause of action, or demand which the Local Approving Authority may have with respect thereto. Nor shall acceptance of the Facility Land Restriction/Easement serve to impose any obligations, liabilities, or any other duties upon the Local Approving Authority. 12. Effective Date. This Facility Land Restriction/Easement shall become effective upon its recordation and/or registration with the appropriate Registry of Deeds and/or Land Registration Office. WITNESS the execution hereof under seal this day of 2020. By Aliaksandr A. Kadolka COMMONWEALTH OF MASSACHUSETTS BARNSTABLEIH 2020 Then personally appeared the above-named (Grantors) Al g w Aztk. K0'&1a , and acknowledged the foregoing instrument to be their free act and deed before me. Notary Public: U�jC ou,'a 8ur'Kp My commission expires: P2a� 020 VIKTORIIA BURKE (SEAL) Notary Public Massachusetts My Commission Expires May 10,2024 APPROVAL BY LOCAL BOARD OF HEALTH We, the Barnstable Board of Health, hereby approve and accept this Grant of Nitrogen Loading Restriction and Easement on Nitrogen Facility Land. BOARD OF HEALTH OF THE TOWN OF BARNSTABLE B Page 1 of 4 Bk 33647 Ps217 W7133 01-05-2021. a 03 m 30gs GRANT OF NITROGEN LOADING RESTRICTION AND EASEMENT ; Q ON NITROGEN CREDIT LAND �� '� b 8 Chapter 360 ss. 360-45 7 OR &j,G4, This GRANT OF Nitrogen Loading Restriction AND EASEMENT on Nitrogen Credit Land made as of this JS1,,, day of 1)Avux,yu , 2020, by Aliaksandr A. Kadolka, located in Barnstable, Barnstable County, Massachusetts ("Grantor") hereby grants .to the Town of Barnstable acting by and through its Board of Health ("Grantee") a nitrogen loading restriction and perpetual easement to ensure maintenance of the facility. WITNESSETH WHEREAS, Grantor being the owner in fee simple of that certain parcel of land located in Barnstable, Barnstable County, Massachusetts, with the buildings and improvements thereon, pursuant to a deed from William E. Robinson, Jr., to Grantor, executed on December 6, 2017, and recorded with Barnstable County Registry of Deeds as Deed Book 30945 page 137, and being shown as Lot 1 containing an area of 71,536 square feet as shown on "Plan of Land on Old Stage Road in Barnstable (Centerville), Mass" a Plan of Land in Barnstable, Massachusetts, and recorded in the Barnstable County Registry of Deeds in Book 553 Page 65, referred to herein as ("the Property"); and WHEREAS, Aliaksandr A. Kadolka of #465 Old Stage Road, Centerville, MA 02632 recorded with the Barnstable County Registry of Deeds, a quitclaim deed being the owner in fee simple of that certain parcel of land located in Barnstable (Centerville), Barnstable County, Massachusetts, with the buildings and improvements thereon, pursuant to a deed from Michael J. Hayes, Personal Representative of the Estate of Carl F. Sherman to Grantee of the Benefited Property, recorded August 22, 2018 in Barnstable County Registry of Deeds as Deed Book 31480 Page 350, and being shown as Lot 2 on "Plan of Land on Old Stage Road in Barnstable (Centerville), Mass" a Plan of Land I in Barnstable, Massachusetts, and recorded in the Barnstable County Registry of Deeds in Book 553 Page 65, referred to herein as ("Benefited Property"); and o¢ WHEREAS, the Benefited Property has the benefit of a 'Nitrogen Loading Restriction and Easement, being more particularly bounded and described in, a Grant of Nitrogen Loading Restriction and Easement on Facility Land, recorded with the Barnstable County Registry of Deeds herewith, and shown on a plan entitled Proposed Septic System Upgrade, Sheet 1 of 3, prepared for Aliaksandr A. Kadolka at #457 Old Stage Road, Barnstable (Centerville), MA attached hereto as Exhibit A; and WHEREAS, the Nitrogen Loading Facility Aggregation Plan has been approved by the Barnstable Board of Health, Barnstable, Massachusetts in accordance with the Board of Health Regulation entitled Article XV Protection of Saltwater Estuaries, Chapter 36130, On-site Sewage Disposal Systems subsection 360- 45 Interim Regulations;" said approval being based upon the agreement by Grantor to incur certain obligations regarding the number of bedrooms, as defined in 310 CMR 15.002, and/or the wastewater discharge design flow in any improvements located on the Property and maintenance of the Facility Land Restriction and Easement to ensure protection of the nitrogen loading limitation of 5 mg/L nitrate nitrogen discharge standard pursuant to Chapter 360, subsection 360-45 Interim Regulation in nitrogen-sensitive areas or in areas serving new construction where the residential use of both on-site systems and contribution to estuaries exist; and to grant to the Grantee of the Benefited Property and to the municipality acting by and through the Barnstable Board of Health, Barnstable, Massachusetts a perpetual easement to ensure maintenance of the Property as nitrogen credit land including, but not limited to, removal of any prohibited uses and in connection herewith a perpetual easement to pass and repass over the Property for purposes of inspection to ensure compliance with and fulfillment of the terms of this Nitrogen Credit Land Restriction/Easement as hereafter set forth; NOW, THEREFORE, pursuant to the provisions of Chapter 360 subsection 360-454, Grantor does hereby GRANT to the Grantee of the Benefited Property and to the Town of Barnstable, a Massachusetts municipal corporation situated in Barnstable County, having an _ address at 367 Main Street, Hyannis, Massachusetts, acting by and through its Board of Health ("Local Approving Authority") for nominal, non-monetary consideration, with QUITCLAIM COVENANTS, a NITROGEN LOADING RESTRICTION AND EASEMENT on NITROGEN CREDIT LAND ("Nitrogen Credit Land Restriction/Easement") in, on, upon, through, over and under a portion of the Property as shown on a plan entitled Nitrogen Aggregation Plan prepared for Aliaksandr A. Kadolka at 4465 Old Stage Road, Barnstable (Centerville), MA attached hereto as Exhibit B; the terms and conditions of which are as follows: PURPOSE: The purpose of this restriction and easement is to protect and preserve the quality and quantity of ground water resources in the area of the saltwater estuaries in the Town of Barnstable, Massachusetts in order to ensure a safe and healthy saltwater estuaries for the present and future inhabitants of the area It shall also be for the specific purpose of limiting the introduction of nitrogen and other pollutants into, and maintaining the natural uptake of pollutants and the recharge of the ground water which takes place on the Property for the said water supply and for the specific benefit of the above referenced Benefited Property. OBLIGATIONS AND EASEMENT: 1. Prohibitions. Grantor agrees to maintain the Property as nitrogen credit land by prohibiting activities which have .a detrimental effect on nitrogen loading on the Property, including but not limited to wastewater discharges, the use of nitrogen fertilizer, the introduction of artificial impervious surfaces, the raising, breeding or keeping of animals, livestock or poultry for commercial purposes, and the creation or introduction of land under water. 2. Easements. In creating this Nitrogen Credit Land Restriction and Easement, Grantor hereby grants to the Grantee of the Benefited Property and to the Local Approving Authority, its agents, contractors, subcontractors and employees a perpetual EASEMENT to enter upon and the right to bring equipment onto the Property to do any and all acts deemed necessary to maintain the Property as nitrogen credit land, together with a right to pass and repass by foot and by vehicle over Property for said purposes, and for purposes of inspecting the Property to ensure compliance with and fulfillment of the terms of this Nitrogen Credit Land Restriction/Easement. 3. S'everabilitv_. If any court or other tribunal determines that any provision of this instrument is invalid or unenforceable, such provision shall be deemed to have been modified automatically to conform to the requirements for validity and enforceability as determined by such court or tribunal. In the event the provision invalidated is of such a nature that it cannot be so modified, the provision shall be deemed deleted from this instrument as though it had never been included herein. In either case, the remaining provisions of this instrument shall remain in full force and effect. 4. Enforcement. Grantor expressly acknowledges that a violation of the terms of this instrument could result in the following: (i) upon determination by a court of competent jurisdiction, in the issuance of criminal and civil penalties, and/or equitable remedies, including, but not limited to, injunctive relief, such injunctive relief could include the issuance of an order to modify or remove any improvements constructed upon the Property in violation of the terms of this Nitrogen Credit Land Restriction/Easement; and (ii) in the assessment of penalties and enforcement action by the Local Approving Authority to enforce the terms of this Nitrogen Credit Land Restriction/Easement, pursuant to Chapter 360 subsection 360-45. 5. Provisions to Run with the Land. This Nitrogen Credit Land Restriction/Easement sets forth the rights, liabilities, agreements and obligations upon and subject to which the Property or any portion thereof, shall be left unimproved or according to which said Property may be improved, held, used, occupied, leased, sold, hypothecated, encumbered, or conveyed. The rights, liabilities, agreements and obligations herein set forth shall run with the Property and the Benefited Property, as applicable thereto, and any portion thereof and shall inure to the benefit of and be binding upon Grantor, Grantee of the Benefited Property, and all parties claiming by, through or under the Local Approving Authority or Grantor. The rights hereby granted to the Grantee of the Benefited Property, the Local Approving Authority, and their respective successors and assigns, constitute their perpetual right to enforce this Nitrogen Credit Land Restriction/Easement. Grantor hereby covenants for himself/herself/itself and his/her/its executors, administrators, heirs, successors and assigns, to stand seized and hold title to the Property, as applicable thereto, and any portion thereof, subject to this Nitrogen Credit Land 'Restriction/Easement, provided, however, that a violation of this Nitrogen Credit Land Restriction/Easement shall not result in a forfeiture or reversion of Grantor's title to the Property, as applicable thereto. 6. Concurrence Presumed. It being agreed that Grantor and all parties claiming by, through or under Grantor shall be deemed to be in accord with the provisions herein set forth and to agree for and among themselves and any party claiming by, through or under them, and their respective agents, contractors, sub- contractors and employees, that the Nitrogen Credit Land Restriction/Easement herein established shall be adhered to and not violated and that their respective interests in the Property and the Nitrogen Credit Land Restriction and Easement, as applicable thereto, shall be subject to the provisions herein set forth. 7. Incorporation into Deeds, Mortgages, leases and Instruments of Transfer. Grantor hereby agrees to incorporate this Nitrogen Credit Land Restriction/Easement, in full or by reference, into all deeds, easements, mortgages, leases, licenses, occupancy agreements or any other instrument of transfer by which an interest in and/or a right to use the Property, or any portion thereof, is conveyed. 8. Recordation. Grantor shall record and/or register this Nitrogen Credit Land Restriction/Easement with the appropriate Registry of Deeds and/or Land Registration Office within 30 days of the latter of. receipt from the Local Approving Authority of the approved Restriction/Easement. Grantor shall file with the Local Approving Authority a certified Registry copy of this Nitrogen Credit Land Restriction/Easement as recorded and/or registered within 30 days of its date of recordation and/or registration. 9. Amendment and Release. This Nitrogen Credit Land Restriction/Easement may be amended or released only upon approval by the Local Approving Authority. Release of this Nitrogen Credit Land Restriction/Easement shall be granted by the Local Approving Authority in the event the Benefited Property is connected to a municipal sewer system and the septic system serving the Benefited Property is abandoned in accordance with 310 CMR 15.354 or the Benefited Property is no longer located within a nitrogen sensitive area pursuant to 310 CMR 15.215. Any such amendment or release shall be recorded and/or registered with the appropriate Registry of Deeds and/or Land Registration Office and a certified Registry copy of said amendment or release shall be filed, with, the Local Approving Authority within 30 days of its date of recordation and/or registration. 10. Term. This Nitrogen Credit Land Restriction/Easement shall run in perpetuity and is intended to conform to M.G.L. c.184, §26, as amended. 11. Rights Reserved. This Nitrogen Credit Land Restriction/Easement is granted to the Grantee of the Benefited Property and the Local Approving Authority in connection with the approval of a Nitrogen Loading Facility Aggregation Plan pursuant to Chapter 360 subsection 360-45 It is expressly agreed that acceptance of the Nitrogen Credit Land Restriction/Easement by the Local Approving Authority shall not operate to bar, diminish, or in any way affect any legal or equitable right of the Local Approving Authority to issue any future order with respect to the Property and the Benefited Property, as applicable thereto, or in any way affect any other claim, action, suit, cause of action, or demand which the Local Approving Authority may have with respect thereto. Nor shall acceptance of Nitrogen Credit Land Restriction/Easement serve to impose any obligations, liabilities, or any other duties upon the Local Approving Authority. 12. Effective Date. This Nitrogen Credit Land Restriction/Easement shall become effective upon its recordation and/or registration with the appropriate Registry of Deeds and/or Land Registration Office. WITNESS the execution hereof under seal this S4v day of NJ , 2020. n By Print Name �\-k pmai- Grantor: (Aliaksandr A. Kadolka) COMMONWEALTH OF MASSACHUSETTS i BARNSTABLE,§§ jaAQ4y SSG, 2020 Then personally appeared the above-named (Grantors) �IQk50,tl d k KID-IK , , and acknowledged the foregoing instrument to be their free act and deed before me. VIKTORIIA BI'lURKE ''� Notary Public J/ / Massachusetts Notary Public: V 1�� 4 o tz/ t Q g u r- V-e My Commission Expires Notary Public: My commission expires: A `d 2092 APPROVAL BY LOCAL BOARD OF HEALTH We, the Barnstable Board of Health, hereby approve and accept this Grant of Nitrogen Loading Restriction and Easement on Nitrogen Credit Land. BOARD OF HEALTH OF THE TOWN OF BARNSTABLE By Page 1 of 4 ' PROPOSED SEPTIC SYSTEM UPGRADE Y' P��N OFRSS9 PREPARED FOR #505 OLD STAGE ROAD ��� `gam ALIAKSANDR A. KADOLKA M/P: 190-067 MATTHEW C. AT town water No..C5 0 282 "' #457 OLD STAGE ROAD ............. ............................................. I::; :::::::;:::::::.: :.::.. 4o a �� STABLE (CENTERVILLE), MA 16 5.9 4"..................................... x..99.59'........................... ,'.::::: ....... ...... :: ::.::.... ::... v EDGE OF LAWN ............................................. ............................................. ' .'...::.:. . .. . 40 .... :::. :::..: :::. ........... 9 PREPARED BY: Glen E. Harrington, R.S. PROPOSED SAS ; 9 Leda Rose Lane 0 02648 Mills, MA 3 H=10 500 al chambers Marstons M s g - _ o. 70 with4 stone all around in 0 �4: : ::: ::', = p Tel: 774-238-1813 LOT 2 33.5 x 13 x 2 leach trench. av' S F�'1SCE��� Email: gharr88®hotmail.com r #4 AREA=31 ,392±SF a � /TAF 49.2a• x 4e.49• • ': SCA : 1'=20' DRAWN. BY: GEH DATE: 14 JUL 2020 f TH #3 ..... N." rr y DATUM: ASSUMED FILE: 4570ldStage SHEET 1 OF' 3 49.41' x O�O\e :` s:: ::: LEGEND ........ ....... e 1 O ;:a:;z.......... G:, N O Test Hole Location w S ....... ........ z6-6S .9 -o 47.96' 'ti a �� Post & Rail Fence ................. �e W:::::. 6, O fi -a i B.M. ° 49.31' O• O 'p Approximate location o ` `pp'.'j:::.:. ::: BLOWER. :'::'::'::'::'::': f� ES p _w— PP water line r C� 5�'..': ENCLOSURE . . . . . . 1 . . . . . . a =' 1� • :� Ig........ Existing contourO cO 0 w W 1?r}r4eeo::. ,\ O Proposed 1,500 al. O 1 . .. . P 9 � O� Z aej2d' z� rH #z O j �. ❑ H-10 FAST tank m O ��SERVE't LAWN O, c };: > ` Existing Cesspools PR, f t......... .. 0 (to be pumped & backfilled) a ............ ` ;an �:: :::::::::::' o �000 48.93' LAWN � .�;. F. :.r: �.,;....... r.:' i \..::::::r:rirrrri 48.60' . N 48.82' N X�S : :::::::::::: ::.:: a SHE E \NG 2 = '.. 9 x yowl P WE ,i Z ;y ,•r, SOLn P '';` �',i• �'�. t{'rrf C1 ................... ................... ---- \... :.GRAVEL::;::•:::::: ; :::::: ....;::: :::: : _.,-- - \``' .' DRIVEWAY: : ::: :"----- .---- :�c 50.36'::::::::::: ---� Z -- - \. '3 r C" 0 0 0 #40 BAYBERRY LANE #30 BAYBERRY LANE C O O M/P: 190-060 M/P: 190-061 Co water town water #22 BAYBERRY LANE SITE PLAN M/P: 190-062 town water SCALE: 1 = 20 B.M.=50.00 ASSUMED ON VARIANCE REQUEST ARTICLE XV CHAPTER0 4 IS REQUESTED TO ALLOW AN INCREASE OF FLOW 36 5. A VARIANCE Q ESTED CORNER OF CONCRETE ON #457 OLD STAGE ROAD BY UTILIZING DENITRIFICATION AND NITROGEN AGGREGATION. TO BULKHEAD. MIICROFIASTE THE MODEL 0.5 TREATMENOTOUN T SF OF LAND SHALL BE IINSTALALL BE DEED INSTALLED ON ETDHE KNEW FOM #SE TIC OLD SYSTEM STAGE ROAD TO #457 OLD STAGE ROAD AND A r w J - ' r 4> b N F BIO—MICROBICS Existing BLOWER TO BE LOCATED Dwelling IN SUBSURFACE ENCLOSURE OBSERVATION - SYSTEM PROFILE VENT PORT Not to Scale PROPOSED 3 HOLE H-20 Existinq Grade = 48.3' DIST. BOX Finished grade over s stem=2% slope away CELLAR 9 Y P Y Existing Grade = 48't WALL D—Box cover shall be within 6" of finished grade 12" MIN. 36" MAX MIN. One chamber cover shall be Min. 2"-1/8"-1 2" Double—Washed Stone S=0.02 or geo—textile tier cloth L=70' within 6" of finished grade S=0.01'/FT Level for 2' S=0.01'/ft _ _ To of SAS= 4.86't Line 1 = 15' 7' Invert Elev.=46.06' 2 47.52' `,;� Line 2 = 42' 46.19' 13' ® ® ® © ® 24" 46. 3' Oo © © © © ® Bottom of Leach Facility Elev.=44.06' 46.68' 46.36' 3�8.5'=25.5' :I 33 5 • 3/4"-1'k" Double-Washed Stone 5' Min. (5.4'f PROVIDED) 1500 GALLON SEPTIC TANK H _ 0 H-10 PRODUCT ACME PRECAST MODEL OR EQUAL ALL CONCRETE COMPONENTS TO LEACHING CHAMBERS Bottom of Test Hole Elev.=37.50' FAST NOTE : BE INSTALLED ON MIN. 6" CRUSHED STONE BASE FAST SYSTEM SHOWN SHALL BE INSTALLED IN STRICT COMPLIANCE WITH THE D.E.P. APPROVAL FOR GENERAL AST 0.5 TREATMENT MODULE USE AND MAINTAINED BY A LICENSED OPERATOR. r „ one c�fiini?ished Min. 2"-1/8"-1/2" Double-Washed Stone '° within or geo-textile filter cloth Top of Peastone Invert I v, Openln wc� 324" mod. fosFA ® ® ® ® ® ® Bottom of each Facility Elev. lenoSwer piping to FAST? may not exceed 100 FT [30.Sm] total S' 4' th and use 4 elbows no For distances greater than qq 1Do FT C30.5m] - consult factory. Blower must be located above 3/4"-1k" Double-Washed Stone 5' Min. AGauon flood/standing water levels on a concrete base, H— O Settling c Zone m 2. Vent to be located above finish grade or hi her to avoid o f t Hole Elev./GW Elev. �I its a _ Infiltration. Cap with vent gratOV i4himtofe n LEACHING CHAMBERS ��J V V�N surface area. Secure with stainless steel screws (see sheet 3 of — I FAST Details.) F . CROSS SECTION 3 "vt See Note4 , 6Ganon Run vent to desired location and cover opening with vent �,�N -- " grate with atVI@smIsbn. of open surface area. Secure with 9 stainless steel screws. Vent piping must not allow excess AA tank moisture build up or back pressure. penetration 3. All appurtenances to FAST? (e,g. tank pump outs, etc.) must ectrlcal condult from blower must be water conform to all country state, province and local plumbing D svztem r bI �blower 1 cryoM Pump tight and electrical codes. The blower control. system is provided b fi° ng.Seeno�e1 ,BG ou��orh Blo-Microbics, Inc. Y P Y , see note 3,5.&6 6^0[151 P rPteNce"wise 4. Either the Influent pipe tee shot[ be fitted with a pipe cap or the noete1 ag baffle separating the two zones shall be extended to the to of �,0 6 V2MNvent the tank. If choosing to use the pipe ca 1 drill a 1/4' C0.6cmJ P s F � �tiR , PROPOSED SEPTIC. SYSTEM UPGRADE . Pipe see Note286 vent hole in the cap and the baffle shall be at least 3'C83 higher than the water level ns shown on the drawing. q�/T/�R�P- PREPARED FOR Jointsmusibe $, All Inspection, ntal and um out ALIAKSANDR A. KADOLKA watertight prevent accidental or unauthorized acceports smust be secured to 6. Tank; anchors, piping, sondult, blower housing pad and vents 7'MIN 0 _. are provided by others. AT 15c MIN] 0 low 7. All piping and ancillary equipment installed after FAST? oust Piping not Impede or restrict free flow of effluent. #457 OLD STAGE ROAD See Notel 8. No more than 4 FT C1.2 mJ of fill maybe laced over unit lid,ALL OUTLET PIPES FROM THE pp DISTRIBUTION BOX SHALL BE C Refer to installation manual for more details, SET LEVEL FOR AT LEAST 2 FT. `- 12 � CONCRETE COVER BARNSTABLE (CENTERVILLE), MA I InWent 3 - 5" OUTLET 3 see KNOCKOUTS — PREPARED BY: t8" + 12" INLET Glen E. Harrington, R.S. Settling DO NOT SCALE OUTLET 9 Leda Rose Lane Zone UNLESS NOTED `'6" g^ .�Y, AREDfCIMgE�Np INCHES I�ON�Sg MA O,5-1,5 ;=' 3" Marstons Mills, MA 02648 See note IDLERANCESSI FAST UNITS — 78" ^ --� Tel: 774-238-1813 ions en �'" Fro Bated [0.02 05cM/CM] 3" Email: gharr88@hotmail.com effluent see note 7 weGHT lb 9RF OnG NVIW2R PLAN—SECTION CROSS SECTION ME MFORMAIION CONTAWEDTN MB DRAWMG6RIE SOIEPROPERtt OF&O�VCROBICSING ANYR@RDDlIC110NIN PARTOR ASA HAKE DNE A FAST®With lid SHEET WHOLE WDXOUTTHE WRRfEN PERN16310N OF BIOMICROBKSINC6PROHIRfI®.DESIGN AND MVENIION RIGXIS ARE RE59iV®.IN IHE DRAwN crc vlfl�n6 l OF4 MI9t6TOFTCC11NOlOGIGIADVANCEM@1T.NLPROWCIS ARE SI1BlECTTO Da1GN AND ORAM7ERLLL CNANGEWIINON NOIKE 3 HOLE H—2 0 DISTRIBUTION B 0 X SCALE: 1"=20' DRAWN BY: GEH DATE: 14 JUL 2020 HEfJ�D R 4192111 REveEp 19R011 REV, MI-04-0 NOT TO SCALE DATUM: ASSUMED FILE: 45701dStage SHEET 2 OF 3 GENERAL 0 1. ADDRESS: 457 OLD STAGE ROAD, CENTERVILLE Design Calculations 2. ASSESSOR'S NUMBER: MAP 190 PARCEL 064 Number of Bedrooms: 4 Equivalent to 440 Gal./Day ?ROUTE 3. DEVELOPER'S LOT: LOT #2 4. TOPOGRAPHIC INFORMATION WAS COMPILED FROM Garbage Disposal: Not allowed with this design Great MAN ON THE GROUND INSTRUMENT SURVEY. Septic Tank Capacity Required: 440 gpd x 200% = 880 gpd.5. TOWN WATER IS PROVIDED TO THE SITE & SURROUNDING PROPERTIES. Septic Tank Capacity Provided: Proposed MicroFast Model 0.5, 1,500-gal H-10 septic Tank6. NO WETLANDS ARE LOCATED WITHIN 200 FEET OF THE PROPOSED SAS. Leachin Ca acit Re wired:, 440 d x LTAR= 595 SF Re 'd Area SIT7. REFERENCE PLAN: PLAN BOOK 553 PAGE 65 g p Y q gP q8. UTILITIES LOCATED BY DIGSAFE. LTAR for Class I soil at <2 min./inch = 0.74 gal/sq. ft. 9. THIS DESIGN PLAN IS TO BE UTILIZED FOR SEPTIC.INSTALLATION PURPOSES ONLY. Proposed Leaching Structure: 1-33.5'x13'x2' Leaching Trench 10. EXISTING SEPTIC COMPONENTS LOCATED IN THE FIELD. Bottom Leaching Area Provided = 435.5 Sq.Ft. 11. THE SUBJECT PROPERTY IS NOT LOCATED WITHIN A STATE REGULATED ZONE II. Sidewall Leaching Area Provided = 186 sq. ft. 12. THE SUBJECT PROPERTY IS LOCATED WITHIN AN ESTUARIES CONTRIBUTION AREA. Total Leaching Area Provided = 621.5 sq. ft. > 595 sq. ft req'd. 28 Leaching Capacity Provided =621.5 sq. ft X 0.74 gal/sq.ft.=460 gpd. CONSTRUCTION NOTES "CENTERVILLE" SOIL EVALUATION 8c PERK TEST 1. Contractor is responsible for Digsafe notification Date of SOIL EVALUATION: DECEMBER 20, 2019 Soil Evaluation Certification LOCUS and protection of all underground utilities and pipes. l certify that on October, 1995, l have passed the soil evaluator 2. The septic tank and distribution box shall be set Evaluation Performed By: Glen E. Harrington, R.S. examination approved by the DEp and that the analysis was performed by NO SCALE Witness: DAVID STANTON R.S., Health Agent me consistent with the required training, expertise and experience described level on 6" of 3/4"-11/2" stone. , in 310 CMR 15.017. Excavator: ERIC KENNEDY, CAPE GOLF CONSTRUCTION E.HARRINGroN,R.S. 3. Backfstone ll should be clean sand or gravel with no Percolation Rate:< 2 m i IN C2 & C3 at TH 1 stones over 3" in size. P� # 4. This system is subject to inspection during installation by Glen E. Harrington, R.S. Test Hole Test Hole Test Hole Test Hole 5. The contractor shall install this system in accordance No. 1 No. 2 No. 3 No. 4 with Title V of the Massachusetts Environmental Code and local Board of Health Rules and Regulations. DEPTH SOILS ELEV. DEPTH SOILS ELEV. DEPTH SOILS ELEV. DEPTH SOILS ELEV. 6. If, during installation the contractor encounters any 0 48.5' 0 48.141 0 49.241 0 49.30 soil conditions or site conditions that are different A A A A PERK TEST 4 from those shown on the soil log or in the design, loamy sand loamy sanc loamy sonc loamy sari the installer shall halt installation and immediately notify 5" 1OYR4/2 47.82 6" 10YR4/2 47.64 6" 1OYR4/2 48.74 5" 10YR4/2 48.88 Depth of Perk: 40-58" Presoak Period: 15 mins Glen E. Harrington, R.S. Bw Bw Bw Bw Time 9"-6": 3 mins 7. No vehicle or heavymachinery shall drive over the loamy sari oamy sari loamy sari loamy sari Y Perk Rate: 1 mpi septic system unless noted as H-20 septic components. 22" 1OYR5/8 46.41 24" 1OYR5/8 46.14 20" 1OYR5/8 47.57 28" 1OYR5/8 46.97 Use 2 mpi for design 8. Install Tuf-Tite gas baffle or equal on septic tank outlet tee. C1 C1 C1 C1 9. All piping shall be SCH 40 PVC. silt Lm silt Lm silt Lm silt Lm P p g 35" 2.5Y7/4 45.32 36" 2.5Y7/4 45.14 34" 2.5Y7/4 46.41 57" 2.5Y7/4 44.55 10. No wells are located within 150' of proposed SAS. C2 C2 C2 C2 11. Provide 1 Micro Fast Model 0.5 treatment unit, 1 H-20 DB-3 distribution box Lmy SAND - Lmy SAND Lmy SAND Lmy SAND and 3 H-10 500-gal. chambers by Wiggin Precast or equal. 85" 1OYR6/6 41.16 80" 1OYR6/6 41.47 132" 1OYR6/6 38.24 130" 1OYR6/6 38.47 12. The contractor shall be responsible for obtaining a trench permit from the C3 C3 C3 C3 coar�e coar�e coarse coarse local municipality in which the work is being performed. son son son son 13. Existing cesspools shall be pumped and removed. Replacement fill shall meet 132" 10YR6/6 37.24 LIRL 10YR6/6 37.14 144" 1OYR6/6 37.24 144" 1OYR6/6 37.30 specifications of 310 CMR 15.255. No Observed. Ground Water No Observed Ground Water 14. Provide magnetic marking tape over components one-foot below grade to facilitate relocation of components. 15. The Micro Fast Model 0.5 treatment unit shall be installed and maintained in accordance with PROPOSED SEPTIC SYSTEM UPGRADE the current DEP Approval Letter and the Barnstable Board of Health Regulations. PREPARED FOR ALIAKSANDR A. KADOLKA NITROGEN LOADING CALCULATIONS c"OF,�' AT 1. WASTEWATER RECHARGE RATE @ 220 GPD DESIGN FLOW: 832 LITERS/DAY (50% REDUCTION WITH DENITRIFICATION UNIT) * �9 #457 OLD STAGE ROAD WASTEWATER NITROGEN LOAD ® 35/MG/L = 29,144 MILLIGRAMS/DAY �: BARNSTABLE (CENTERVILLE), MA 2. IMPERVIOUS ROOF RECHARGE RATE @ 40 INCHES/YEAR & 2,866 SF ROOF AREA = 741 LITERS/DAY IMPERVIOUS ROOF NITROGEN LOAD © 0.75 MG/L = 556 MILLIGRAMS/DAY I} rn 3. IMPERVIOUS PAVEMENT RECHARGE RATE 40 INCHES YEAR & 4,483 SF = 1,159 LITERS/DAY RE BY: IMPERVIOUS PAVEMENT NITROGEN LOAD © 1.5 MG/L = 1,739 MILLIGRAMS/DAY DO Glen E. Harrington, R.S. 4. LAWN & LANDSCAPE NITROGEN LOAD © 3 LBS/1,000/YEAR & 25% LEACHED & 14,839 SF = 13,844 MILLIGRAMS/DAY cSS F'/�TER 9 Leda Rose Lane 5. NATURAL AREAS RECHARGE RATE @ 19 INCHES/YEAR & 9,204 SF AREA = 5,757 LITERS/DAY q�/TAR\P Marstons Mills, MA 02648 6. COMBINED NITROGEN LOAD = 29,144 + 556 + 1,739 + 13,844 = 45,283 MILLIGRAMS/DAY Tel: 774-238-1813 7. COMBINED RECHARGE RATE = 832 + 741 + 1,159 + 5,757 = 8,489 LITERS/DAY Email: gharr88®hotmail.com 8. ESTIMATED TITLE 5 NITROGEN=5.33 PPM 9. ACTUAL NITROGEN LOADING = 3.53 PPM JJ 10. CALCULATED TOTAL RESIDENTIAL NITROGEN LOAD = 4.43 PPM < 5 PPM WITH 42,392 SF LAND AREA &` DENITRIFICATION UNIT SCALE: 1"=20' DRAWN BY: GEH DATE: 14 JUL 2020 DATUM: ASSUMED FILE: 4570ldStage SHEET 3 OF 3 GENERAL NOTES 1 ! 1. ADDRESS: #465 OLD STAGE ROAD, CENTERVILLE o� / ! 2. ASSESSOR'S NUMBER: MAP 190 PARCEL 065 �sT 2cA I 1 3. DEVELOPER'S LOT: LOT #1 9F Great M C"'-' N 4. TOPOGRAPHIC INFORMATION WAS COMPILED FROM. Qo / AN ON THE GROUND INSTRUMENT SURVEY. O C?1°�� 5. TOWN WATER IS PROVIDED TO THE SITE & SURROUNDING PROPERTIES. _ p� P� 0 6: NO WETLANDS ARE LOCATED WITHIN 200 FEET OF THE PROPOSED SAS. SITE N �19 CPC) �` I, 7. REFERENCE PLAN: PLAN BOOK 553 PAGE 65 8. UTILITIES LOCATED BY DIGSAFE. 9. THIS DESIGN PLAN IS TO BE UTILIZED FOR SEPTIC INSTALLATION PURPOSES ONLY. 10. THE SUBJECT PROPERTY IS NOT LOCATED WITHIN A STATE REGULATED ZONE II. 11. THE SUBJECT PROPERTY IS LOCATED WITHIN AN ESTUARIES CONTRIBUTION AREA. 12. LOT A SHALL BE DEEDED TO #457 OLD STAGE ROAD AS SEPTIC CREDIT LAND IN ROUTE 28 ACCORDANCE WITH THE VARIANCE OF CHAPTER 360 SECTION 360-45. CENTERVILLE" / NATURAL � � � / %' �' #471 OLD STAGE ROAD LOCUS M/P: 190-066 NO SCALE 2,224 SF town water O O 9 .3j 0 00 W "45 po.00W \� NATURAL S80° 31' a'o' 101. O 1' 10 nJ / n z NI-VRO NT ARE SF ' = 11,0 I / \ \ I AREA, o. G DW NG \ LAWN AREA / LAWN AREA f S80 45' 00.00 W is 'S 16,721 SF LAWN AREA 'o OS �6 2,600 SF NATURAL LI, f" o/O ss`S 696, / E III TO 6E NATURAL AREA TO I L 0 T 1 .00- Op .O '"/ ` NANRAL AREA tad o i j AREA= 71 ,536±SF \O .(1 01 SNELL&PAVED DRIVEWAY O�e 6 rO�O &216 SE r V/ / 73, � ------------------------------------- ---- --- --------- _ s39 0 F S86• p 41 0.001,E N84° 23 �3.8, ACCESS EASEMENT N 56.60' 79.31' pO�c�01��- - - - -+- - - - - - - - - S75° 32' 45.001,E �ho• y� 186.45' #457 OLD STAGE ROAD oti N86° 13' 1 s.00"E NITROGEN LOADING CALCULATIONS M/P: 190-064 ti NITROGEN AGGREGATION PLAN # town water 22 BAYBERRY LANE #8 BAYBERRY LANE 1. WASTEWATER RECHARGE RATE @ 440 GPD DESIGN FLOW: 1,664 LITERS/DAY M/P: 190-062 M/P: 19 a PREPARED FOR WASTEWATER NITROGEN LOAD @ 35/MG/L = 58,288 MILLIGRAMS/DAY town water town water ater ALIAKSANDR A. KADOLKA 2. IMPERVIOUS ROOF RECHARGE RATE 0 40 INCHES/YEAR & 1,493 SF ROOF AREA = 386 LITERS/DAY AT IMPERVIOUS ROOF NITROGEN LOAD © 0.75 MG/L = 290 MILLIGRAMS/DAY 465 OLD STAGE ROAD 3. IMPERVIOUS PAVEMENT RECHARGE RATE 40 INCHES YEAR & 8,569 SF = 2,216 LITERS/DAY ILIH OF IMPERVIOUS PAVEMENT NITROGEN LOAD @) 1.5 MG L = 3,325 MILLIGRAMS/DAY ��P �qs� Q T LE(CENTERVILLE), MA 4. LAWN & LANDSCAPE NITROGEN LOAD © 3 LBS/1,000/YEAR & 25% LEACHED & 16,721 SF = 15,601 MILLIGRAMS/DAY 5. NATURAL AREAS RECHARGE RATE @ 19 INCHES/YEAR & 44,753 SF AREA = 8,221 LITERS/DAY kANyC s 6. COMBINED NITROGEN LOAD = 58,288 + 290 + 3,325 + 15,601 = 77,504 MILLIGRAMS/DAY NoCo 28� _ 1 PREPARED BY: 7. COMBINED RECHARGE RATE = 1,664 + 386 + 2,216 + 8,221 = 12,487 LITERS/DAY Glen E. Harrington, R.S.9 Leda Rose Lane 8. ESTIMATED TITLE 5. NITROGEN=6.2 PPM J- 10 ►+� O 9. ACTUAL NITROGEN LOADING = 3.77 PPM r F i�'CEP � 9 Led ns Mills, MA 02648 10. CALCULATED TOTAL RESIDENTIAL NITROGEN LOAD = 4.99 PPM WITH 60,536 SF LAND AREA & 2,600 SF LAWN REDUCTION k '9/�1 T A R�P Tel: 774-238-1813 Email: gharr880hctmail.com SCALE: 1W=40' DRAWN BY: GEH DATE: 14 JUL 2020 DATUM: ASSUMED FILENAME: 4570ldStage SHEET 1 OF 1 4 i Old Stage Road Centerville A = 190_ 064 (?File#2) - fI ,I No. 4214 1/3 ORA ESSELTE 10% ® O O O a 9 � t t) / � cc I,.q rn o r U Z 15.71fied Mail Fee I Extra Services&Fees(checkbox,add teeas appropnate),x []Return Receipt(hardcopy) $ ❑Return Receipt(electronic) $ tmark r3 []Certified Mail Restricted Delivery $ 9 1 Here C:3 []Adult Signature Required $ •3 . C ❑Adult Signature Restricted Delivery$ 0 Postage rn Total Postage and Fet rq SHERMAN, CARL F ` $ e"tT° -q 457A OLD STAGE RD 9treetandApENo.,oi CENTERVILLE, MA 02632 City State,ZIP+4� r. r r r rrr•r. 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Service eRestricted Delivery 0 Reg stered Mail Restricted I� 9590 9402 4116 8092 9362 03 Certified Mail® D elivery I Certified Mail Restricted Delivery eturn Receipt for ❑Collect on Delivery erchandise ��n+t le A6.mhcr Trnnefnr frnm_enn r�hen n Gallant fin Delivery Restricted Delivery �. a r tI 0-Signature confirmation 7 01`5 17 3 0 10[!01 j!4:.9 8 7=: 5 318:. c Pal]Restricted Delivery Restricted Delivery PS Form 3811,July'2015 PSN 7530-02-000-9053 Domestic Return Receipt USPS TRACKING# First-Class Mail e Postage&Fees;Paid USPS .. Permit No.G-10 9590 940 11,6" 8092 9362 03 United States •Sender:Please print your name,address,and ZIP+4®in this box• , Postal Service 1 d" Town of Barnstable It q Health Division I f 200 Main Street I Hyannis,MA 02601 I I I I i��ie►��f��ilfl���fe� ,��>>ijj�i� ii1fi1t{1,r)1ipilfl)e1J IJ11, J 'rt . ru SWIM io 0 F F ' — . L U S E--\l c0 Certified Mail Fee Q' $ a Extra Services&Fees(check box,add fee�es app• ❑Return Receipt(hardcopy). $ C` r `I'" ❑Return Receipt(electronic) $ Postmark ❑Certified Mail Restricted Delivery $ Here oO []Adult SignatureRequired i $ ❑Adult Signature Restricted-Delivery$ 0 - m KADOLKAA-,,ALIAKSANDR A p "n 606 OLD STAGE ROAD r o CENTERVILLE, MA 02632 + Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate rs Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service- Restricted delivery service,which provides r., for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders. Adult signature service,which requires the ■You may purchase Certified Mail service with L Y P ry signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority WHO service. �Y ' .• -Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age+ international mail. and provides delivery to the addressee specified 3 ■Insurance coverage Is notavailable for purchase by name,or to the addressee's authorized agent.. with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the is To ensure that your Certified Mail receipt is Insurance coverage automatically included with- - accepted as legal proof of mailing,it should bear a;; certain Priority Mail items. USPS postmark.If you would like a postmark on rr •For an additional fee,and with a proper this.Certified Mail receipt,please present your _ endorsement on the mailpiece,you may iequest Certified Mail item at a Post Office'for the following services: postmarking.If you don't need a postmark on this Return receipt service,which provides a record. Certified Mail receipt,detach the barcoded'pardon,, of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply r� You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.G� electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Retum " Receipt attach PS Form 3811 to your mailpiece; IMPORTANT.Save this receipt for your records. PS Forth 3800,April 2oi5(Reverse)PSN 7530-02-OW-9047 y 1 • 1 • • • I TI A. Signature ■ Cofiipfetd.itemsAt;2,and 3. ❑Agent � ■ Print your a;riarii hd address on the reverse X ST7-7— Addressee so that we can return the card to you. ■ Attach this card to the back of the mailpiece, B. Received by(P d NO' C. f Delivery or on the front if space permits. 1. Addressed to: D. Is delivery address d int front em 1? ess below: %ABOLKA,ALIAKSANDF2 ?Q6==OLD STAGE ROAD-- < RVILLE, MA 02632 fi ❑Priority Mail Expiess® II I�III� II I�) III�I I'I I I I III I'll _o au ro y,m.o� ❑Registered Mailva Re Adult Signature Restricted Delivery Registered Mall Restricted rtifled Mail® elivery ' ' 9590 9402 5357 9189 1905 79 Certified Mail Restricted Delivery etum Receipt for ❑Collect on Delivery Merchandise 9 Article Numher?ransfer_frnm_service_lahelf, ❑Collect on Delivery Restricted Delivery' Signature ConfirmatlonT"' •• ail ❑Signature Confirmation 7 0`15 17 3 01 0 0 01' 418 : '14 2 5 ," ail Restricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 "_ Domestic Return Receipt` USPS TRACK NG# First-Class Mail Postage&Fees Paid USPS Permit No.G-10 9590 9402 fM."489 1905 79 United States •Sender:Please print your name,address,and ZIP+4®in this box* Postal Service Town of Barnstable y � Health Division 200 Main Street Hyannis,MA 02601 I I I I _ i�iij,�;1�►j�i��ij'!"lllj'tllll�l�ljij�,tl,i;l,ll,;jl;,ij��.l�jj;l I I I ! t °p THE T Town of Barnstable Barnstable Regulatory Services Department j miGac j fAftNSWM ' "�: ,�� Public Health Division m `bprF0�,,�e, 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO SECOND NOTICE CERTIFIED MAIL#7015 1730 0001 4987 5318 August 2, 2018 SHERMAN, CARL F 457A OLD STAGE RD CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 457A Old Stage Road, Centerville,MA was inspected on 04/21/2018 by James D. Sears, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Backup of sewage into the house due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER T E BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\457 A Old Stage Road Centerville- SECONG.doc v ?� t Town of Barnstable Inspectional Services Department p DAMETABM 4Public Health Division rfD 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean.CHO FINAL NOTICE CERTIFIED MAIL#7015 1730 0001 4988 1425 February 21, 2020 KADOLKA, ALIAKSANDR A 606 OLD STAGE ROAD CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 457A Old Stage Road, Centerville,MA was inspected on 04/21/2018 by James D. Sears, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: o Backup of sewage into the house due to an overloaded or clogged SAS or cesspool. The original order letter to repair or replace the septic system was mailed on April 30, 2018. A second notice was mailed on August 2, 2018. A third notice was mailed on November 27, 2018. A fourth notice was mailed on August 22, 2019 to the new owner in our records, in which you were ordered to repair or replace the septic system within sixty days from the date you receive this notification. You are ordered to repair or replace the septic system within 6 months from receiving this notification. Failure to repair/replace the septic system within 6 months will result in scheduling this issue before the Board of Health at a public meeting. Please contact the Public Health Division at 508-862-4644, to rectify this issue. PER ORDER OF THE BOARD OF HEALTH T� h- o a McKean, R.S., CHO Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\457 A Old Stage Road Centerville Final Notice.doc w Town of Barnstable- Public OF THE 7p U.S.POSTAGE>>PITNEY BOWES Health Division + aaaNnANLE. ` 200 Main Street NA °'eo MPS P 0� Hyannis,MA 02601 �!� 00, 7015 1730 0001 4987 9422 �' 2 4w o260'1 0 .$ 006.670 0000.3.36455 NOV. 28. 2018. rV e; HERMAN� S , CARL F 606 OLD STAGE ROAD A1T�R\/1.1el^�,RAA (1'�Fi'17 T:a:i Y �e"r:w s c. �,.r.���• a cy. f RETURNJ TO SENDER' , p MOT DELIVERABLE AS ADDRESSEDT. AE, � � m 11TF I E.lbn 02681400290 8369 051339—2 8—4 2 - .- ••�a�..1..� 0:2 . �i�lr��il�i�i'll''���11'��4�1f$'i��'°�99� r't����ioial9�3'�9l��rrio� ■ Complete items 1,2,and 3. 7Receive�d j ® Print your name and address on the reverse ❑Agent so that we can return the card to you. ❑Addressee s Attach this card to the back of the mailpiece, B. y(Printed Name) C. Date of Deliveiv or on the front if space permits. 1. .Ari D. Is delivery address different from item.i? ❑Yes If YES,enter delivery address below: ❑No 1 SHERMAN, CARL F 666 OLD STAGE ROAD C NTERVI LLE, MA 02632' 3. Service Type ❑priority Mail Express® 1 ' �' / j I I Illlil ill)III I I II I i I I I III I I IIII I I I i I III El Adult❑Adult Signature Restricted Delivery ❑Register d Mal Restricted) j 9590 9402 3759 8032 3744 63 5certifid Mal® Delivery ertifid Mail Restricted Delivery `ll'�Retum Receipt for i ❑Collect on Delivery Merchandise ! ?__Artir[A Numher_?ransfer-from-service_label) ❑Collect on Delivery Restricted Delivery El Signature ConfirrriationTm lil O Signature Confirmation 7-015 1730 0001 4987 9422 lil Restricted Delivery Restricted Delivery a 's . PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt Barnstable Town of Barnstable Regulatory Services Department ;'e"aN j BARN5fAB1F. 039. Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO THIRD NOTICE CERTIFIED MAIL#7015 1730 0001 4987 9422 November 27, 2018 SHERMAN, CARL F 1y'5'Y696.OLD STAGE ROAD CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 457A Old Stage Road, Centerville, MA was inspected on 04/21/2018 by James D. Sears, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995-TITLE V (310 CMR 15.00) due to the following: • Backup of sewage into the house due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH �9 Thomas cKean, Agent_of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\457 A Old Stage Road Centerville Third Notice.doc 0 cO Certified Mail Fee ,..•- Er ' $ t Extra Services&Fees(check box,add fee as appropriate) ❑Return Receipt(hardcopy) $ C ❑Return Receipt(electronic) $ {f V Pia C3 ❑Certified Mail Restricted Delivery $ 1 C> p ❑Adult Signature Required $ �( f� []Adult Signature Restricted Delivery$ — r- 9 � 1 s SHERMAN, CARL F Ln a 457A OLD STAGE RD r- ` CENTERVILLE, MA 02632 Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailplece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the.. ■A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service- Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent f-. Important Reminders: Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not -D First-Class Mail®,First-Class Package Service®, available at retail). _ or Priority Mail®service.`` Adult signature restricted delivery service,which •Certified Mail service is notavaiiable for requires the signee to be at least 21 years of age, international mail. and provides delivery to the addressee specified ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent- with Certified Mail service.However,the purchase (not available at retail). 7 of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a "Insurance Priority Mail items. USPS postmark.If you would like-a postmark on For an additional fee,and with a proper this Certified Mail receipt,please present your , endorsement on the mailplece,you may request Certified Mail item at a Post Office'for the following services: postmarking.If you don't need a postmark on this Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix it to the maiipiece,apply 1 You can request a hardcopy return receipt or an appropriate postage,and deposit the maiipiece. electronic version.For a hardcopy return receipt, 1 complete PS Form 3811,Domestic Return Receipt,•attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records. Ps From,3800,April 2o16 fnevww)PSN 7530-02.000•aoa7 Town of Barnstable Barnstable u4mmi ° �ck"Regulatory Services Department saFvsrnst� 1 39. �' Public Health Division i6 �0 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 7404 April 30, 2018 SHERMAN, CARL F 457A OLD STAGE RD CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 457A Old Stage Road, Centerville, MA was inspected on 04/21/2018 by James D. Sears, certified Title V Septic Inspector for the State of Massachusetts. The se inspection of the tics stem showed that the system stem "Fails" under the guidelines p P y of 1995 TITLE V (310 CMR 15.00) due to the following: • Backup of sewage into the house due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. o� PER ORDER OF THE BOARD OF HEALTH ' omas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\457 A Old Stage Road Centerville.doc Town of Barnstable BUMS Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA-02601 Offica: 508-862-4644 Richard SrA Director FAX 508-79D-6304 Thomas A McKean,CHO Feb 6,2007 Rev. 5111116 DEADLINES TO'REPAIR FAILED SYSTEMS (Town Code §36044 and Title V: 310 CMR 15.000) _ 'An`Y'marked in the ❑is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA - ❑Discharge or ponding of effluent to the surface of the ground ❑Pumping more than 4 times during the last year not due to clogged of obstructed pipe. :. ackup of sewage into the house dne to an overloaded or clogged SAS or cesspool ONE(1)YEARDEADLINE CRITERIA• . ❑Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ' ❑Any portion of the-SAS, cesspool, or privy below high groundwater elevation ❑Any portion of the cesspool within a Zone 1 to a public well ❑Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis.(This system passes if the wafer analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA q Single'Cesspool ❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a d-iveway due to H-10 components, etc) - o Leaching pit or cesspool with high liquid level,<12"below inlet(per Town Code §360-9.1) ❑Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHE+R Repair deadline: Q;\SEPTIC\DEADUNES TO REPAIR FAILED SYSTEMS.doc c Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 457 A Old Stage Road •V Property Address Q Estate of Carl F.Sherman ' Cwner Owner's Name irformation is required for every Centerville MA 02632 4-21-18 t : page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When ng out forms A. General Information clnl the computer, ,,,,,,° OFrA4,16. use only the tab 1. Inspector: ��'• • 9�y� key to move your �moo: G cursor-do not ? JAMES James D.Sears use the return Name of Inspector — Qr:-A- Q key. * *r Jim The Inspector Man �,'•;oFT,� °: Company Name rF"� S:IN.... � P.O.Box 784 �n�nnnummta``�`� Company Address West Yarmouth MA 02673 Cityrrown State Zip Code 508-364-4398 S 1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority oaola,j-P,-,ja� 4-28-18 nspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form W Subsurface Sewage Disposal System Form - Not for Voluntary Assessments s 457 A Old Stage Road Property Address Estate of Carl F.Sherman Owner Owner's Name information is required for every Centerville MA 02632 4-21-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Failed system. The system is two old block c pool's w/orange Burge pipeing. Note: Block's old structural not sound. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 457 A Old Stage Road Property Address Estate of Carl F.Sherman Owner Owner's Name information is required for every Centerville MA 02632 4-21-18 page. CityTTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y . ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 457 A Old Stage Road Property Address Estate of Carl F.Sherman Owner Owner's Name information is required for every Centerville MA 02632 4-21-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form u a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 457 A Old Stage Road Property Address Estate of Carl F.Sherman Owner Owner's Name information is required for every Centerville MA 02632 4-21-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection El El Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 457 A Old Stage Road Property Address Estate of Carl F.Sherman Owner Owner's Name information is required for every Centerville MA 02632 4-21-18 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? iiZ ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the manholes uncovered, opened, and the interior inspected for the condition of the AIMMM tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)1 D. System Information Residential Flow Conditions: Number of bedrooms (design): NA Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ,a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 457 A Old Stage Road Property Address Estate of Carl F.Sherman Owner Owner's Name information is Centerville MA 02632 4-21-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: Two Block c pools w/orange burge pipeing. Number of current residents: NA Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d NA 9 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commercial/Industrial Flow Conditions: Type of Establishment: ' Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form l<F' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments F 457 A Old Stage Road v Property Address Estate of Carl F.Sherman Owner Owner's Name information is required for every Centerville MA 02632 4-21-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ® lcesspool ® Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 457 A Old Stage Road Property Address Estate of Carl F.Sherman Owner Owner's Name information is required for every Centerville MA 02632 4-21-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: NA Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2'feet Material of construction: ® cast iron ❑ 40 PVC ® other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipeing is cast iron and orange burge. Note: Orange burge pipeing main pool to over flow ,Blocked line and comeing apart- pipeing no good. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 -- l Commonwealth of Massachusetts Title 5 Official Inspection Form F5 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 457 A Old Stage Road Property Address Estate of Carl F.Sherman Owner Owner's Name information is required for every Centerville MA 02632 4-21-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 457 A Old Stage Road Property Address Estate of Carl F.Sherman Owner Owner's Name information is required for every Centerville MA 02632 4-21-18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 457 A Old Stage Road Property Address Estate of Carl F.Sherman Owner Owner's Name information is-equired for every Centerville MA 02632 4-21-18 oage. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No Box Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: i t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 457 A Old Stage Road Property Address Estate of Carl F.Sherman Owner Owner's Name information is required for every Centerville MA 02632 4-21-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 1 ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is block 10' Deep w/small steel cover at grade. 2'water w/stain line at inlet. Note: Cover not a good fit. Note: Old Block's structural not good. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1 Depth —top of liquid to inlet invert 1' Depth of solids layer 4" Depth of scum layer 311 Dimensions of cesspool 8' Deep Materials of construction Old Block Indication of groundwater inflow ❑ Yes ® No t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 457 A Old Stage Road Property address Estate of Carl F.Sherman Cwner Owner's Name information is required for every Centerville MA 02632 4-21-18 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Main pool 8' deep- 16" below grade w/cover at grade. Pool at outlet level. No in Tee, Brocken outlet sweep. Note: Block's are old structural not good. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts p' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 457 A Old Stage Road Property Address Estate of Carl F.Sherman Owner Owner's Name information is required for every Centerville MA 02632 4-21-18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately I�R s M-f �t o � o I � 54 MA11' 90011- v"" t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 � I c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 457 A Old Stage Road 1_0 9 Property Address Estate of Carl F.Sherman Owner Owner's Name information is required for every Centerville MA 02632 4-21-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 12'+ Estimated depth ti fMigh ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Auger T.H. 12' no G.K. Bottom of over flow at 10' below grade. Bottom of over flow at 2'above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 I c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 457 A Old Stage Road Property Address Estate of Carl F.Sherman Owner Owner's Name information is required for every Centerville MA 02632 4-21-18 page. CityrTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i l5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 �flg ray Town of Barnstable Regulatory Services nnnxrisrna� Thomas F. Geiler, Director MASS Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 11, 2007 Mr. Robert Jordan Department of Social Services 500 Main Street Hyannis, MA 02601 Re: 457A Old Stage Road, Centerville, MA Dear Mr. Jordan: The Barnstable Public Health Department is in receipt of complaints of the above mentioned address concerning property owner, Carl F. Sherman's son, being Keith A. Sherman and his three children residing in a camper on the Sherman property. Health Inspector, Donna Miorandi has been to the property on December 11 and 27 of 2006 and most recently on January 9, 2007. During these site visits it is obvious that people are living in this trailer due to the illegal connection of blackwater waste emanating from the trailer via a PVC pipe ,that terminates somewhere unknown on the property underground. In addition, there is a hose for greywater waste (shower and kitchen sink) discharging directly to a five gallon bucket on the ground which has overflowed to the ground surface. Both of these connections are violations of the State of Massachusetts Title V regulations, 310 CMR 11.00— 17.00. There are additional violations of the State Sanitary Code, 105 CMR 400.000.,one of which includes temporary wiring. There is an extension cord going from the trailer across the ground outside to the main house on the property. The other violation is 105 CMR 410.602 which requires that the land shall be maintained in a safe and sanitary manner. There is much debris on the property including old washing machines, old propane tanks, other scrap metal as well as old toys, carriages and old grill. Mr. Carl F. Sherman, being the owner of the property has been sent a warning notice to have the latter violation cleaned up by January 15, 2007. These above stated conditions pose a concern for the children residing in the trailer on this property. There are concerns of sewage violations, temporary wiring violations and possibly a lack of adequate heat and natural ventilation (windows). The windows are all blocked from ventilation by either sheeting or some form of aluminum covering. Finally, under 105 CMR 410.430 of the State Sanitary Code no temporary housing may be used except with the written permission of the board of health. QAOrder letters\Sewage violations\457A Old Stage Road,Centerville.doc This department is aware of the family's hardships but this letter is expressing our deep concern for the health and safety of the children. Please feel free to contact me directly if you need further assistance. Thank you for your time and attention to this matter. Sincerely, Donna Z. Miorandi, S. Health Inspector Cc: Robin Giangregorio, Zoning Enforcement Officer Lt. Martin McNeely, COMM Fire Department Officer Mark Delaney, Barnstable Police Department QAOrder letters\Sewage violations\457A Old Stage Road,Centerville.doc { I J 010 I Town of Barnstable Regulatory Services DARNSTAa.M Thomas F. Geiler, Director MASS. Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 11, 2007 Mr. Robert Jordan Department of Social Services 500 Main Street Hyannis, MA 02601 Re: 457A Old Stage Road, Centerville,MA Dear Mr. Jordan: The Barnstable Public Health Department is in receipt of complaints of the above mentioned address concerning property owner, Carl F. Sherman's son, being Keith A. Sherman and his three children residing in a camper on the Sherman property. Health Inspector, Donna Miorandi has been to the property on December 11 and 27 of 2006 and most recently on January 9, 2007. During these site visits it is obvious that people are living in this trailer due to the illegal connection of blackwater waste emanating from the trailer via a PVC pipe ,that terminates somewhere unknown on the property underground. In addition, there is a hose for greywater waste (shower and kitchen sink) discharging directly to a five gallon bucket on the ground which has overflowed to the ground surface. Both of these connections are violations of the State of Massachusetts Title V regulations, 310 CMR 11.00— 17.00. There are additional violations of the State Sanitary Code, 105 CMR 400.000.,one of which includes temporary wiring. There is an extension cord going from the trailer across the ground outside to the main house on the property. The other violation is 105 CMR 410.602 which. requires that the land shall be maintained in a safe and sanitary manner. There is much debris on the property including old washing machines, old propane tanks, other scrap metal as well as old toys, carriages and old grill. Mr. Carl F. Sherman, being the owner of the property has been sent a warning notice to have the latter violation cleaned up by January 15, 2007. These above stated conditions pose a concern for the children residing in the trailer on this property. There are concerns of sewage violations, temporary wiring violations and possibly a lack of adequate heat and natural ventilation (windows). The windows are all blocked from ventilation by either sheeting or some form of aluminum covering. Finally, under 105 CMR 410.430 of the State Sanitary Code no temporary housing may be used except with the written permission of the board of health. QAOrder letters\Sewage violations\457A Old Stage Road,Centerville.doc This department is aware of the family's hardships but this letter is expressing our deep concern for the health and safety of the children. Please feel free to contact me directly if you need further assistance. Thank you for your time and attention to this matter. Sincerely, Donna Z. Miorandi, S. Health Inspector Cc: Robin Giangregorio, Zoning Enforcement Officer Lt. Martin McNeely, COMM Fire Department Officer Mark Delaney, Barnstable Police Department QAOrder letters\Sewage violations\457A Old Stage Road,Centerville.doc i �'T l Town of Barnstable HE Regulatory Services Thomas F.Geiler,Director BARNSTABM ' Building Division y MASS. 1639• Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 January 10,2007 Mr.Robert Jordan Cape&Islands Area Office Dept.of Social Services Hyannis,Ma Re: 457A Old Stage Rd,Centerville,Ma Dear Mr. Jordan: This office was recently called to investigate a zoning complaint at the aforementioned address concerning the property owner,Carl Sherman's son,Keith and his three young children residing in a camper on the Sherman homestead. Local Inspector Jeff Lauzon confirmed this arrangement with Keith Sherman sometime in Nov.2006.At that time,the parties were advised to file for a temporary permit which would allow the occupation of the trailer for twenty days under Zoning Code Chapter 240 Section 9(B). Mr. Sherman was to utilize that timeframe to fmd other accommodations for his family. After repeated attempts to get Mr. Sherman to cooperate,he remains noncompliant. Subsequently,a written order was issued and on Jan.9,2007 a coordinated effort was made by the Barnstable Health, &Building Divisions,COM Fire and the Barnstable Police Dept.to personally contact Mr. Sherman and assess the situation.Although,it appeared that someone was home,no one responded to our attempts to communicate. We are very aware of the sad circumstances leading up to this arrangement. Be assured that our staff has afforded the Shermans every opportunity to correct the violation. You must,however recognize that we lack the discretion to permit this use,as clearly the habitation of a trailer by nonpaying guests is limited to twenty days and clearly the occupation far exceeded that limit,with or without a permit.Although we are reluctant to impose an additional hardship on the Sherman family,we have no alternative but to enforce the ordinance.Violations may result in citations of$100.00 per day. Please feel free to contact me directly should you require clarification. erely, Robin C.Giangregorio Zoning Enforcement Officer Cc:Donna Miorandi,Health. er Martin MacNeely,FP Officer,COM Fire Officer Mark Delaney,BPD JAComplaint Inv Reportsk157A Old Stage DSS Letter.doc k °FTME ta,, Town of Barnstable ti Regulatory Services * snxcvsTABLE, * - Musa �, Thomas F.Geiler,Director i6gg. ♦� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 December 11, 2006 Carl Sherman 457A Old Stage Rd. Centerville, MA 02632 RE: 457 Old Stage Rd., Centerville,Map : 190 Parcel : 064 Dear Mr. Sherman: This letter shall serve as notice that you are currently in violation of the Zoning Ordinance of the Town of Barnstable Section 240-9B. As you may recall, last month this office did inform you of the violation and what needed to be done to resolve the problem. To date, this office has seen no attempt on your part to resolve the violation. You are hereby notified that you have until December 18, 2006 to comply or a ticket in the amount of $300.00 will be levied against you for each day the violation continues. Please call (508) 862-4034 with any questions. Thank you for your anticipated cooperation. By Order, de 7auzon Local Inspector Q:zoning5 _..-.w...�- ,arm.--.,.r,;....,t..•.,.,-,...,,,r,,---*r-+S.�Y+.^..s-^Yyr.-�+s-,-,.mow•^-^-�'y-•`•rs;=tr �.,t.�^.... .r;�ss �;rn+�-';-�+.*,xr-mr*�--:.-„-�..n,...-�^-a„r..,.�,..F+�.^^-.-.^.<-e�..n��t_-........-,�. ,-,.,-: TOWN OF BARNSTABLE BAR-W 349 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager , Address of Offender J-7� Vl; My/MB Reg.# Village/State/Zip f' } t .r (, '. - ' Business Name �- j m/pm oar/i/0� 1,4 �204 Business Address ,a, r ✓ ,r� /p t�' r#t./ , Signature o nforcing Officer Village/State/Zip E Location of Offense �Y///ex/ /� �y� 'W �"'Enfor'cfi�ng Dept'/Di/vision Offense ()1A1�1� t' �1 ff G. C_. 'L� t � ! 1IL Facts �� Ldll r r ....h"M r1i 7,4 -P k-7: :r7rk/77 JrIl �f 0L f ' - ( 'Iloollw, v r11k----- This will" serve only as a warning. At this time no' legal" action has been ,taken'. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. ._ „-_....T2--r; -_- �- ^ter.-a- ,m ...«-,. =w�.T'r e*- sa. .e=,..._.......«,r--�-r-'^t----.-.+ems.•+ ,.�.r�-,.:-r+.--.t:..Yr^:--+...-..-�-, s...�..-.:�....-..�:. TOWN OF BARNSTABLE BAR-W4 '- Ordinance or Regulation WARNING NOTICE qraA Name of Offender/Manager +. f # L�f'7 Address of Offender g r Village/State/Zip t �i �� rr� ? ' _.`'' - ' w V Business Name - . /`pm., ono . 0 .14 f Business Address 1 r" Signature of.,`Enforcing Officer Village/State/Zip Location of Offense , Enforcing Dept/Division 0 f f e n s e �.1�t�� '��a ���{,+r�' j j/j@".� .`_j`fJ'• '°• {y�,� � �j{f, (j`�-• ,�, fr frj} � Facts /'`l:. l; `t,I f if •,' j/ ' �+ /..� J � + y / r ivA This will" serve only as a warning. At this time no legal` action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE 4�& Health Division— 200 Main Street - Hyannis, MA 02601 g4HE l �P O Date: -V`AX BARNSTABLE, mass• Number of pages inclu ing cover sheet: a To From: SHARON CROCKER I t (3 Town of Barnstable Health Division Mail to: 200 Main Street Phone: Hyannis,MA 02601 Fax honer ,Fax 1-508-862-4644 Fax phone: 1-508-790-6304 REMARKS: ❑ Urgent ❑ For your review ❑ Reply ASAP ❑ Please comment ' P. 1 COMMUNICATION RESULT REPORT ( DEC. 8.2006 3:38PM ) ` TTI BARNSTABLE BOARD OF HEALTH FILE MODE OPTION ADDRESS (GROUP) RESULT PAGE 755 MEMORY TX 915089476557 OK P. 2/2 ---------------------------------------------------------------------------------------------------- REASON FOR ERROR E-1) HANG UP OR LINE FAIL E-2) BUSY E-3) NO ANSWER E-4) NO FACSIMILE CONNECTION Citizen Web Request t (-S' Page 1 of 3 Citizen Request Management ' Request ID; 20506 Created; 10/27/2006 9:56:56 A Stanton, David Status: Closed Assigned To: Heap Office .�i � o Chapter II : Housing; Anonymous: Yes Category; Substandard E,C. Date: 10/31/2006 j Created By: Fontaine,Tina Health Office Time Worked: 2.00 Response Time: 7.00 Requestor Details: .Email: Request Location: 457 OLD STAGE ROAD Centerville, Ma 02632 Parcel Number: Map: 190 Block: 064 Lot: 000 Citizen Web Request Page 2 of 3 if there is a no trespassing sign present at the property, however anything observed during the visit on the property cannot be used as evidence, unless the owner grants permission to look around the property. The only evidence that may be used is that which can be observed from a location offsite. However, the Police Department said the Town Attorney would have to agree wit his policy for other Town Departments. We still have not heard back from the Town Attorney as t whether or not this policy is acceptable.) We went to the home of camper #1 (471 Old Stage Road) No one appeared to be home at said location. We then went to the home of camper #2 (463 Old Stage Road) and again, no one home. We then looked in the Conservation field, but did not observe any campers there. A truck then pulled onto the dirt road and went to 471 Old Stage Road. We then went and spoke with him. From there, we went to another location, the site of camper #3 (457 Old Stage Road) We went to the home at 457 Old Stage Road and spoke with the owner of the house. We explained we received a complaint about sewage coming out of the trailer onto the ground. He said that it was not true. DS asked if we could take a look, and he agreed. He walked us over to the location and showed us that the trailers waste discharges into his septic system, which DS observed. The owner wanted to know who complained, but we told him we cannot divulge a complainants name by law. Other department will be notified of the complaint that may have violations at said property. Entered on 10/31/2006 10:28:00 AM No further action required by Health. Internal Note History: System entry on 10/27/2006 9:56:06 AM: Assigned to Stanton, David Entered on 10/31/2006 9:19:50 AM Last modified on 10/31/2006 9:59:46 AM System entry on 10/31/2006 10:00:33 AM: -Please Review- email sent to Giangregorio, Robin Entered on 10/31/2006 10:28:00 AM DS called DSS on 10/31/06 @ 10:15 AM and gave as much information on the case as he has DSS's number is (508) 760-0200. System entry on 10/31/2006 10:28:12 AM: -Please Review- email sent to O'Connell, Timothy System entry on 10/31/2006 10:28:26 AM: Request Closed http://issgl/lntemalwrs/WRequestPrint.aspx?ID=20506 12/8/2006 Citizen Web Request Page 1 of 3 57 '7 "S LV,f 3 Citizen Request Management Request ID: 20506 Created: 10/27/2006 9:56:56 A Stanton, David Status: Closed Assigned To: � Health Office Anonymous: Yes Category: Chapter II : Housing Substandard E.C. Date: 10/31/2006 Created By: Fontaine, Tina Health Office Time Worked: 2.00 Response Time: 7.00 e Requestor Details: Ae}- Email: Request Location: 457 OLD STAGE ROAD Centerville, Ma 02632 Parcel Number: Map: 190 Block: 064 Lot: 000 Request: they are living in a camper at this properly and dumping the sewage straight into the ground. Sewage is all over the place. Request Work History: Entered on 10/31/2006 9:19:50 AM DS updated the request location with the correct address. The original location given to the Health Division was 473 Old Stage Road, which does not exist. Entered on 10/31/2006 9:46:14 AM Last modified on 10/31/2006 9:56:35 AM On 10/30/06 @ 10:00 AM DS and TO went to general area of complaint, as there is no property in Town numbered 473 Old Stage Road, Centerville. We drove down the dirt road that said private property, no trespassing. We did pass on to the property even though it may not be approved by the Town Attorney (According to the Police Dept. training a while back, the Police Department feels that it is OK for Town Employees to go onto a property for official business eves http://issgl/intemalwrs/WRequestPn*nt.aspx?ID=20506 12/8/2006 s � � ._ ..�, �. ��� � i ; �,I� � � —/ .� r a / � . L� u i � 1 1 �, �' ci i, , \ � • ' / � / / i � �. � , _ i � � _ `_ /, , - � � 1 � _�. �,, � � '� - - „� / � � �i � � / t _ , .- . � � 0 ` E ' 1 c # R a I L � ,�- r . A , }y � � ���A � � � � • � � r� � � � � � � �