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Home My WebLink About0026 SHORT BEACH ROAD - Health 26 SHORT BEACH ROAD CENTERVILLE A = ._1 r i C+•lll�® �R�cvclfoc`� llll 3 � UPC 12534 No. 2 53LOR °csT.CONS°`� HASTINGS, MN J i � J y �� W 'rz y f I, Commonwealth of Massachusetts Title '5 Official Inspection Form Subsurface'Sewage-Disposal System Form - Not for Voluntary Assessments_ _ c M 26 Short Beach rd FI Property Address Paul Broyer Owner Owner's Name information is required for every Centerville ✓ ' Ma 02632 12/12/15 ' 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 filling out forms A. General Information 33S_ on the computer, J/ use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono = use the return Name of Inspector key. DiBuono Sewer and Drain k Company Name 8 Johns path Company Address ;, I �+ S.Yarmouth MA ; :02664 ,.,,Qitygown State Zip Code ,; :.5,0,8-364-9587 _ S113522 c Telephone Number License Number ,',j as)c�4 �:�-Certification--! I certify that I have personally,inspected the sewagedisposal system at this address and that the information reported below is Rue', 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(MO CMR 15.000).The system: ®: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local ving Authority 12/14/15 _ 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 is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner,, and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address-how the system will perform in the future under the same or different conditions of use. h 0 �s l5ins•3/13 Title 5 Official Inspection Form:SuC::urface Sewage Disposal System•Paeld7 s Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,. 26 Short Beach rd Property Address Paul Broyer Owner Owner's Name information is required for every Centerville Ma 02632 12/12/15 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: ® 1 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: The system contains a 1000 gallon tank as well as a 1000 gallon pump chamber and concrete Distribution box. All tees and baffles are in place. The Distribution box is level and at normal level. The leaching is made up of several leaching chambers and at time of inspection levels appeared to never have been at abnormal levels. 13) 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): I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Dispcsal System•Page 2 of 17 _ ,1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments LAM 26 Short Beach rd Property Address Paul Broyer Owner Owners Name information is required for every Centerville Ma 02632 12/12/15 page. City/Town 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 regpire 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 15ins•3/13 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 M 26 Short Beach rd Property Address Paul Broyer Owner Owners Name information is required for every Centerville Ma 02632 12/12/15 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System r Page 4 of 17 f Commonwealth of Massachusetts ol Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 26 Short Beach rd Property Address Paul Broyer Owner Owners Name information is required for every Centerville Ma 02632 12/12/15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is.within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd 10,000gpd. El ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200,feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in'a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or°failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate' regional office of the Department. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 26 Short Beach rd Property Address Paul Broyer Owner Owner's Name information is required for every Centerville Ma 02632 12/12/15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ' ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Q ® 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 F t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 3 w S Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Short Beach rd Property Address Paul Broyer Owner Owner's Name information is required for every Centerville Ma 02632 12/12/15 page. City/Town State Zip Code Date of Inspection D. System Information Description:, The system contains a 1000 gallon tank as well as a 1000 gallon pump chamber and concrete Distribution box. All tees and baffles are in place. The Distribution box is level and at normal level. The leaching is made up of several leaching chambers and at time of inspection levels appeared to never have been at abnormal levels. Number of current residents: 2 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 Seasonaluse? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage d 189 GPD ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): canons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? El Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 26 Short Beach rd Property Address Paul Broyer Owner Owners Name information equir for is every Centerville required for eve Ma 02632 12/12/15 page. City(rown 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: Pumped 6/12/14 Was system pumped as part of the inspection? ❑ Yes ❑. No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) S ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page B of'17 ; t Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 26 Short Beach rd Property Address Paul Broyer Owner Owner's Name information is required for every Centerville Ma 02632 12/12/15 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: 24 years New Leaching added 1991 Were sewage odors detected when arriving at the site? 0 Yes ❑ No Building Sewer(locate on site plan): Depth below grade: 18"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.): System is vented throught the roof. Septic Tank(locate on site plan): Depth below grade: 1 ft feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 gallon 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: — — l5ins-3113 Title 5 Official Inspection Form:Subsurface Scwaga Disposal System•Page 9 of 17 ti,a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 26 Short Beach rd Property Address Paul Bro er Owner Owners Name information is required for every Centerville Ma 02632 12/12/15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness Y Distance from top of scum to top of outlet tee or baffle 42" Distance from bottom of scum to bottom of outlet tee or baffle 1" Sludge stick How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): No evidence of leakin Tees and or baffles in place at time of inspection Grease Trap (locate on site plan): Depth below grade: NA feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 26 Short Beach rd Property Address Paul Broyer Owner Owner's Name information is required for every Centerville Ma 02632 12/12/15 page. City/Town 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.): Tees are in place and levels are normal. 'Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day .Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 A e Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 26 Short Beach rd Property Address Paul Broyer Owner Owner's Name information is required for every Centerville Ma 02632 12/12/15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert At normal level 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.): Distribution Box is level and at normal level with no signs of carry over or decay. 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.): Operational * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Short Beach rd Property Address Paul Broyer Owner Owners Name information is required for every Centerville Ma 02632 12/12/15 page. City/Town . State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 flow diffusersadded 1991 ❑ leaching galleries number: 0 leaching trenches number, length: leaching fields number, dimensions: overflow cesspool number: 0 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.): No signs of carry over and no signs of hydraulic failure Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 Short Beach rd Property Address Paul Broyer Owner Owners Name information is Centerville required for every Ma 02632 12/12/15 page. City/Town 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.): No signs of ponding or hydraulic failure. 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.): l5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 Short Beach rd Property Address Paul Broyer Owner Owner's Name information is required for every Centerville Ma 02632 12/12/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.•Page 150f 17 f l , Assessing As-Built Cards Page 1 of 2 Gb TOWN OF BARNSTABLE LOCATI 2•Q(51Uri ocu(� /Id SEWAGE� VILLAGE �n v,II G ASSESSOR'S MAP LOT INSTALLER'S NAME&PHONE NO. J.i7 lhticU�. !c�- moo,, .InC SEPTIC TANK CAPACITY I.UUG 6a.0 LEACHING FAC1LIT�Y:((tyyp�e� Z /µsr r, ( tzel 31 NO.OF BEDROOMS--O�- , I ATE �ATER BUILDER OR OWNER DATE PERMIT ISSUED: io DATE COMPLIANCE ISSUED• VARIANCE GRANTED: Yes No i lSb / �� '•a3� snrM;td'CJ � F Z•'� if http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=206042&seq=1 12/4/2015 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 26 Short Beach rd Property Address Paul Broyer Owner Owner's Name information is required for every Centerville Ma 02632 12/12/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10+ ft 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: Pulled plans ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test hole data on plan dated Y10/7/91 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Sub:.urface Sewage Disposal System.-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -,Not for Voluntary Assessments 4M 26 Short Beach rd Property Address Paul Broyer Owner Owners Name information is required for every Centerville Ma 02632 12/12/15 page. CitylTown 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 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 O � U ['JAN 02004 DEED,_RESTIkl TION WHEREAS, MICHAEL S. SULLIVAN of 333 Quaker Meeting House Road, East Sandwich, Barnstable County, Massachusetts 02537, is the Owner of. 26 Short Beach Road located in Barnstable (Centerville) , Barnstable County, Massachusetts 02632, hereinafter after referred to as LOT 20 on Land Court Plan: 9288-L. WHEREAS, MICHAEL S. SULLIVAN as the owner of said lot has agreed with the Town of _Barnstable .Board of Health to a restriction as to the number of bedrooms which car. be included in any home built on said lot as a pre-condition to obtaining a disposal works construction: permit in compliance with 310 CMR 15 : 000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15 . 200, State Environmental . Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single-family home on this property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document. NOW, THEREFORE, Michael S. Sullivan does hereby place the following restriction on his above-referenced land in accordance with. his agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: 26 Short Beach Road, Barnstable (Centerville) , MA may have constructed upon. the lot a house containing no more than two (2) bedrooms. Michael S. Sullivan agrees. that this shall be a permanent deed restriction affecting Lot 20 located on 26 Short Beach Road, Barnstable (Centerville) , MA and being shown on Land Court Plan: 9288-L, EXCEPT that the Town of Barnstable agrees. that a third bedroom may be added after proper engineering by the Board of Health, in which case this restriction would be amended to a three (3) bedroom restriction with the issuance of such a permit. For title of Michael S. Sullivan, see Certificate of Title No. 153287 . EXECUTED as a sealed instrument this day of 200 O Micha Sullivan THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, SS . , 200 Then personally appeared the above-named Michael S . Sullivan known to me to be the person who executed the foregoing instrument and acknowledged the same to be his free act and deed, before me Notary Public My commission expires : A:\Deed Restriction.Lot 20.doc 4 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM,FORM PART A c� 1 CERTII�FICATION Property Address: Z� U ITT @ lrC� _j r7S-L )� Owner's Name: L ,¢ � V ,✓r/(eJ // Owner's Address: orf- ✓vr Date of Inspection: - - Name of Inspector: (please print) //✓4Q� ��t/� t r Company Name: � ScS'v2 �'� +1 - Mailing Address: /moo �x /7Z9 —�` —T �S4_7 ^ mac Telephone Number; ' CERTIFICATION STATEMENT -' I certify that 1 have personally inspected the sewage disposal system at this address and that the informat�2p re cTted n below is true,accurate and complete as of the time of the inspection. The inspection was perfo ed based'on m}u training and experience in the proper function and maintenance of on site sewage disposal syste ns, 1 an a DEFF_ approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The s stem: ✓oS Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority F s Inspector's Signature, Date: The system inspector shall submit a copy of this Inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. 'votes and Comments ,V/ ""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. Title 5 Inspection Form 6/15!2000 page I I Paoe ?. of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property .address: 2,0; 2 ,a/ Owner Date of Inspection: S= =U Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D >Syse asses: 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: 44 B. Sy Conditionally Passes: One or mor stem components as described in the"Conditional Pass"section need to be replaced or repaired. The system,up completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y, D) in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 ye old* or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltr 'on or tank failure is imminent. P System will ass inspection if the Y existing tank is replaced with a complying septic to s approved by the Board of Health. 'A metal septic tank will pass inspection if it is structur sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water el in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. Sy in will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The tem will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: ��o�f 3�''i � - Owner: _ /f ✓.�.� Date of Inspection: ^/ C. Fu r Evaluation is Required by the Board of Health: 4 Condition ist which require further evaluation by the Board of Health in order to determine if the system is failing to protect pu 'c health, safety or the environment. 1. System will pass un s Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioni in a manner which will protect public health,safety and the environment: Cesspool or privy is with 50 feet of a surface water _ Cesspool or privy is within feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and ublic Water Supplier,if any)determines that the system is functioning in a manner that protects the pu 'c health,safety and environment: _ The system has a septic tank and soil absorption syste (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 Zone I of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 f t of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 fe 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 la ratory, for coliform bacteria and volatile organic*compounds indicates that the well is free from pollute n from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, rovided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No/ v 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 squid depth in cesspool is less than 6"below invert or available volume is less than ''/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Arty 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 I of a public well. _ v Any portion of a cesspool or privy is within 50 feet of a private water supply well. _e4 ✓ 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A.copy of the analysis must be attached to this form.] lyl-9(Yes/No)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 convect the failure. E. bwze Systems: 4 To be consi ed a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either' "or"no"to each of the following: (The following criteria apply to 1 stems in addition to the criteria above) yes no the system is within 400 feet of a surface water supply the system is within 200 feet of a tributary to a surface water supply the system is located in a nitrogen sensitive area()interim Wellhead ction 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 eat,or answered "yes" in Section D above the large system has failed.The owner or operator of any large system co 'dered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 0 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B l� CHECKLIST Property Address: yv/ Owner: orv//i t/�ry Date of Inspection: Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes o Pumping information was provided by the owner,occupant,or Board of Health ere any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? ✓Have large volumes of water been introduced to the system recently or as part of this inspection? ✓/ Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up Was the site inspected for signs of break out? V — Were all system components, excluding the SAS, located on site? Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? —Z— Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no Existing information. For example,a plan at the Board of Health. e- ��vSe' i, c£ s �zvyuy ,T-=2 7-0,0 01 4 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(3)(b)] -17 5 f - Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION c/ )'�k/ 71J ��cZ Property Address: 2G G�Zo✓ rC� I/,Ile Owner: r41 Date of Inspection: ,S FLOW CONDITIONS � � �127SIX6.'�gj,X4ds RESIDENTIAL Number of bedrooms(design): Z- Number of bedrooms(actual): Z "T — DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): ZZO fj 4y�"— Number of current residents: / 6edev-'ndl 3 � Does residence have a garbage grinder(yes or no): a 29/ Is laundry on a separate sewage system(yes or no): [if yes separate inspection requtr d Laundry system inspected(yes or no):y1,� ��°�,�•/hi7 y�,,,r�;�� Seasonal use: (yes or no): Yo G�- Water meter readings, if available(last 2 years usage(gpd)): 7��- z Go,crrTh/ L ` Sump pump(yes or no):_ v✓� Last date of occupancy: �oG = Gy ovv / Q✓-tSe x� I/ N4 CO ERCIAL/INDUSTRIAL �-y� �� ' PST d Type o blishment: D Design flow n 310 CMR 15.203): _gpd j Basis of design flow(se ersons/sqft,etc.): Zj✓ Grease trap present(yes or no ---_. Industrial waste holding tank present o): Non-sanitary waste discharged to the Title 5 syst es or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: /212Zeie /Ao14a t dV- �t��P�d��el�<n i�id. X/ Was system pumped as part of the stne p6ct on(yes or no): �u,,?� If yes, volume pumped: G!/ allons--How was/quantityumped determined? .)r Reason for pumping: -441 Ir , TY<OFSTEMk,distribution box, soil absorption system '� � 6e� _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): .e pprox)mate age of all components,date installed(if own)and source of information: �iW ui fr C`K'�iepy,H. ere sewage odors detected when artiving at th sib(yes or no):�/o -)F-Gf1c-r✓�rv�-I Ici ll Page 7ofII OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: i?l P� e,-tom ,r Owner: �..11�✓a.� Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade: 2 y Materials of construction:_cast iron V40 PVC_other(explain): , Distance from private water supply well or suction line: 'TaauAJ 4J,40 Comments(on condition of joints,venting,evidence of leakage,etc.): v 1A✓/e 14-/B'tili1 �e✓� SEPTIC TANK:_(locate on site plan) gas✓ �e.� '��✓red�.�- /n/e. 9 6' Q�a� Depth below grade: �i ' -�l®� er/G 7¢�GS li✓✓%✓f 73 I/Wf`: zy"¢7 Material of construction:_concrete_metal_fiberglass_polyethylene wJld, �,/t/.�A� z�-�N —other(explain) / '�� "� p,2Gdi!f�,��,f If tank is metal list age:b s age confirmed by a Certificate of Compliance(yes or noWZ (attach a copy or certificate) Dimensions�,e�—/D`?A- "IV 2� ) lbGd Sludge depth: 3.1r Distance from top of sludge to bottom of outlet tee or baffle: Z® Scum thickness: 4'' Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: 2¢" How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee r baffle condition, structural integrity, liquid levels as related to outlet inve evidence of.leakage, etc.): (f6lzloC� �3+�d.-�%f/�,,,�- ►?r G ASE TRAP:_(locate on site plan) 5= � Depth be grade:_ Material of co ction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of ou ee or baffle: Distance from bottom of scum to bottom of ou ee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet to baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8of11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: I'Y Owner: ji, <ti41y Date of Inspection: TI T or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below gra Material of construction: Crete , metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ ( present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 47c�,�� Comments(note if box is level an istrib�d'on to outlets equal,any a 'dence of solids carryover,any evidence of ?akag)into or out of bg�, e ): �f/�� &rt Ca c c — ve Zai v i" •• Gr /¢ 9 e PUMP CHAMBER: ✓ (locate on site plan) Q Pumps in working order(yes or no): Qf GSc,S dd ►H 0 Alarms in working order(yes or no): �� Comments(note condition of pum chamb r,condition of pumps and appurtenances,etc.): / AI�, / / /Z / �1,1-It Cwa�4v,1 7r D" � / ►.erf o,2 5=7-d-,;I, '�/o'G�d�c OQ!/ ties' Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: fC�ary gees lei vc Owner: 121&1✓2^ Date of Inspection: J—?-0� SOIL ABSORPTION SYSTEM(SAS): V (locate on site plan,excavation not required) SAS j[located gKplas j: -I !��{ h✓Tej< 5✓�+a i� I9,93 rAZ I:r/40 = X ZX , Type Isaching pits,number:_ —�� / Z leaching chambers,number: 3 �`� /� �� V3 Z �.ZS leaching galleries,number: 1 z /�G leaching trenches,number,length: /� ¢� 2 leaching fields,number,dimensions: Z r ItE''P overflow cesspool,number: innovative/alternative system Type/name of technology: Comments( ote condition of soil, signs of ydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): 'p/", s.t[) 6p/`ir�re/�1• �' to d c clY•-tL All CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number an tion: Depth-top of liquid to to Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition o v tion, etc.): PR to on site plan) 2 Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of pon t ondition of vegetation,etc.): 9 I • Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ZG S�eu►-� /3ta�1 i�� *1&-� Owner: ✓a Date of Inspection: f 7-4-17 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or �V benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. Wln p 2v� PAL—4 Z 8-9 Z•or= �„ G— S /3- /—Z &=0'0-e, Z-3 3_4- 11 illl I[k �� 4�.s 2a�6" Oc. 7Z F" 6,?- /o O - -- ( C /aoa�y X.�r, 2 � 4 -- - - - - S Alp m P ^1-�-�� J y C 17L 'ci� 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2nG 5W`vJ4 8A--c k ^> Owner: u/i✓d�✓ Date of Inspection: 512-11 Z SITE EXAM Slope l�/ Surface water Check cellar Shallow wells Estimated depth to ground water 7S feet -P y L Ple✓� /. �i>b�w = 7 S v.S6S�itlG!/v�4.77iM,��}sc� Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) U56� NGdl� Checked with local Board of Health-explain: A-egrt/S Checked with local excavators,installers-(attach documentation) P#)m S Z7 q!? V Accessed USGS database-explain: 3� E �Pld 9.ao You must describe how you established the high ground water elevation: X��•1 VV 11 6 TOWN OF BARNSTABLE ) � LOCk'2.- N L.0 Jff or 0 Cac 1 Il d SEWAGE # q1 Y:w VILLAGE Cej j p, yi )j�, ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. • /� Met cum 1 c,-- tSoo-v, sic SEPTIC TANK CAPACITY-] 000 �(, LEACHING FACILITY:(type ;1, �;' �`fi' I v� 5 (size) ,3 I u NO. OF BEDROOMS I ATE WELL lOR 3PUBLdC WATER BUILDER OR OWNER /0,0,0) I v DATE PERMIT ISSUED: Q 7 Iq I DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No !s Argei' cy repair Failed sewage syste t -� No.- ��P� D /2E Q�Z FE$.. 3' :............. Barn^table Conservation Comnissj-pfk COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH � � Signed Date TOWN OF BARNSTABLE g_ 0 Appliration for Ehapviial Workii Tomitrnrtiun omit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal 1 at: 20 ' hortbeach Road Centerville ---.__...-----•---...... ._ .. ------•-------------••••-•••---•------ ••-•...-----..........--•••-•-•-•-••........ ....•••-•-•-----------........--------•-- Richard Topp i °`at`°n-Address or Lot rr°. ......................_.......................................................................... ..........--...................................................................................... W J.P.Macomber Jr owner Address Installer Address d Type of Building Size Lot............................Sq. feet aDwelling-x No. of Bedrooms.......... ___ ________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width................ Diameter----------_..... Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................1 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water........................ a ------------------------------------------------•---------••--------•--------..........-----•---•--.......................................................... 0 Description of Soil....................................................................................................................................................................... v .-------------------Sand..--------....-------------------•---•-•-•----------------------------------•-------------------------------------•----------------------------------•----------•--------- W x ----------------------------------------------------------------------------------------- ------------------------------------------------------------------------------ ......................... U Nature of Repairs or Alterations—Answer when applicable1-1 --a11on-...tank_,..J p.r_p_____________________ °harnb-fir---pump__1J, ht--a��d---alarm-- --•f1Qd -ffussQrs------................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia ce has ee issued by the board of health. Signed *! = _ . L l.r�.�7�91..----...... Dare ApplicationApproved By ----------------- - ------ 1 .............. ........................................................ 1.0.- ---7..-..�..... Date Application Disapproved for the fo lowing reasons: ................... . ...................................... . ...------------.-- ........-- -- -- .......... .................................. ......................................... ........................................... .................... . ... ................................................... ------- . .................. PermitNo. ....... ................ . .... Issued .---------------------------............................Dace Date E aer.�� r p i r F >i 1 d s(:wd�TF� ,ys ', No..... , ..... �! y 2 , FR$............y .................. THE COMMONWEALTH OF MASSACHUSETTS ��{ ' BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Dhiposal WorksChun rttr iun rant# ay' ' Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 20 Short"ieach Road Centerville R° e ha r d TOpp j L i cation-Address or Lot No. - .................................•............. ------•----•------------ -----........•------------------------------------------ ...... -----.--- _--------•............_. W t J.P.Ma •o�nber Jr Owner Address ------------------------------------- Installer Address d Type of Building �w 0 Size Lot............................'Sq. feet Dwelling No. of Bedrooms.._....._. --- ----- Expansion Attic ( ) Garbage Grinder ( ) -- ---- --`----------- aOther—Type of Building ............................ No. of persons...................._------- Showers ( ) — Cafeteria ( ) d Other fixtures ....:.... WDesign Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ IV Disposal Trench—No'................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.•---.--.....1------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) HI Percolation Test Results Performed by...................................................................-...... Date........................................ t- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ---------------•-------------------•-----------•----------------•-•-------------•---•....--•---....•....•.........................................•.......... 0 Description of Soil.............................................................................................................................. U -••-•-•-••-•------•Sand-----------•----•---------------•---•----------------------------------------------------------------------------•-------------.......................................... W x ------------------•---•-----------------••-•----•-•------•-----•--•------------••-•----•---------------•••-•-----•--...-•------------•-••-•----••--•-•----------•-•--------....----•--•-.....--•----•--- U Nature of Repairs or Alterations—Answer when applicable.1.-1�_-..I_..a.11an---ta.nk.......L-..!_a..n................... ha:�hPr•-�umn...li r'h}•--end-•- Jq..rM � f lwt�.�-�f?�SsQ�r's Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli ce has e issued by the board of health. Signed .. t / - --- - P. --- ---- -��/7/91 Date --- :..----- ApplicationApproved By ................. ---- ------------ -...........1'`-"'^ - , ....................................................................... -/a-'..7.' .... llate Application Disapproved for the following reasons- ------------------------------------ .................................................... -------------- --------------------------------------------------------------------------------- ----------------...................... ........................................ Date PermitNo. . ...........................................------ Issued ........--------------- ......--........ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tertifirate of C�umpCianu 11 THIS IS TO CERTIFT, That the Individual Sewage Disposal System constructed ( ) or Repaired (XX ) by............................................................J.P.Maco'lber r. -................................................------- ------------------ Installer 2'` Shor+b�-aeh Road Centt rv; lle at ................................................ has been installed in accordance with the provisions of TITLE 5 4 The}5ta e Environmental Code as described in the application for Disposal Works Construction Permit No. ......................7--.--...(�...... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..- - 114� /------------------------------- Ins ector ... ....... B--N-.J ---!/%.-� ::� L� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.... FEE... .... :... Biupuual Works Tuunu#r ion rruti# Permission is hereby granted JP--------'-- ----------------------•••- Maco^iber Jr. to Construct ( ) or Repair (X ) an Individual Sewage Disposal System 2 ShortbPar• r Street Q� as shown on the application for Disposal Works Construction Permit No._ �_ Dated.......................................... .....----•----------••-•• ---- - ---------------•--•-------•---------------........ .... DATE. Board of Health ? - FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS s COMMONWEALTH OF MASSACHUSETTS WETLANDS PROTECTION ACT AND REGULATIONS, G.L. 131, 540, 310 CMR10.00 FROM: a � �� w X7en\ TO s c�..si—�,c�•,� s� Name of Appliea (Name of Property owner) • (address) (address) DATE: - '1 c''� `\� LOCATION: FIDINGS t 1) The hereby certifies pursuant to 310 CMR 10. o6 that the work described below is necessary for the protection of the health and safety of the Citizens of the Commonwealth and will be performed by or has been ordered to be performed by an agency of the Commonwealth or a subdivision thereof. 2) A sit* inspection was performed on AC S-a2V 0 3) The agency ordering or performing the emergency work is the ..-� 'N — (name of agency) . (Not the commission unless work is on land owned or controlled by them. ) 4) Describe below, the work which is allowed to proceed under this certification. No work beyond that necessary to abate the emergency maybe so certified. YY\ I abiC c.,u err S) The, above described work shall be completed by NQ• '�� (data) . (Work performed under on Emergency certification shall not exceed 30 days from the dati of Certification unless the Commissioner of DEP so approves. ) Issued by signature C o Ail SL ¢� Ned ✓1a -I�JTec/Gn ✓�PW4 4 r � a �s e N � I OWN OF BARNSTAKE w OR s� P 206 E2. SCALE g ':i /'♦ ♦ ,`xa z.%f..' ✓ ~' ..I % 'Dl x y81 � w � :,, o `�, � � IN Fri: ' '--� \?' .� � >., a° t x .. .. g,_ � v .?',., ?' .�2.3 ..rd�'77 ELE •...,."' �. � Via. - _ s`�"./`,;:,.0 �. a , ♦♦ x� Y4. i ti. - ,.-.. ,.:;:. .._ ,. 1. \ \ . : :� Fx., s: , X , : x.a Y ', � ..._.... .... .:::. •:.:.• f` - � .�� '�3 v/ r IMt-ffl' < x .,•. :. -- .. _..a .. --. 1.4 s _' t .,x`�� .,, .,, ." 10 ': -. �• d:.t-»<'- / <,.: -:. ;;atny < •M `- ,' I -� > ,_ �' - � �'�.,: ) bdp.�' �' :B#^, /\ /�"' ems' . .ram- ., - .:. ..- _. :. ,__,..♦ , ..: I F. ,�:<, .�' } J 's; tk. 18 ti r :3ry �r s+..�:, .., _..,: �f .. ♦ ,r�>`- . . 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'••E.Y �r„� ,r• �:�.�s•.° "-- � :a,.... � -a-^max`• ,t, mad. r, XP �,_'_;~....- ------ ,t ,4: a emu- _ I �'::7 ,�. ,.. \... 5 r, -* ..-..._•-- r- ... ..- ... b`Y;:- ...,,� -.� .. .:. . .,. ,.. ..sum �'a= ..'n, y _�D.0 1 bl 9t )t-i- _,_.--•e- ,�,�#a'- �',: -� ».; }� vz... `:„ � � ,,.�� +t'e� ,av i:.,�q§ :�`','; ! l ��:,: .. » -..�.t a:. 7. ,... �'F .,. ..,.,: < - � ?�x ..'�.:: ;. -.�', t,.'; •: :;�:.-.is �.�� m�E �,:519}' .a,n.?°� �:r' ^xra. "In -7 . 3 A6 D SYSTEM PROFILE s Y' S TE E S NOT TO SCALE GROUND ELEVATION 8.2 7 DESIGN FLOW HORIZONTAL 240 DIA MIN. CONCRETE BEDROOMS nAT,jJQ.,GPB/D TEE CENTERVILLE RIVER MANHOLE COVER TO GRADE 18* DIA COVER 12" -MIN 36* MAX. COVER TOP ELEV 7.21 TOP *OF FOUNDATION RIDGE RIM ELEV. 8.31 r r, r" r r r1l" r, r REQUIRED JANK FF=11.0 ELEV. 9.94 �4 T SEPTIC, MIN 1/8--1/4- SHORT EXPANDER 2 LOCUS GRADE ELEV. 7.8 ROAD 8.3 RIM -WASHED PEA STONE '330 X 2 660 (1500 N DOUBLE OAL. �G AL; MI CONTROL BOX SEPIC ,TANK:,PROVIDED 1,-.3/4* DOUBLE GAL, XISPNG),�,,, OSED SLAB TOP 6.74 WASHED STONE, MAINTAIN EXISTING SET LEVEL 5 OUTLET 7.94 PITCH OF 0.05% 2' MIN. D-BOX ' THREE 34*x75"x16" INFILTRATORS SIZE OF LEACHING' FACIUTY,,REOUIRED 2' OF STONE ALL AROUND SCH 40 C AIGVILLE EXISTING PIPE P ATE INV.= 7.12 DESIGN E C NCH 2* PVC 4" PVC SCH 40 k2 BEACH 3- S.A.S. (6.83' X' 22.75') 5.88 INV.= a- DISCHARGE EXISTING TO REMAIN LONG TERM��,APPL D/S.F 71 ILI RATE�� _GIP 73 IN V. INV.- 6.80 18" 22" ;;14 INV.= 6.06 5. NANTUCKET SOUND EXISTING TEE 5.47 INV.= 5.36 .5' StJOR '1 le WEEP HOLE MHW. ELEV 1.5 NGVD SIZE OF LEACH IN G'SYSTEM PROVIDED ALARM ELEV.= 5.00 MAXIMUM EXISITNG HIGH GROUNDWATER ISTING) 4.5" !2" SCH 40 3) INFILIRATORS" (EX BUILT IN PUMP ON EL. 4.64 R PVC THREADED EXISTING SYSTEM PIPE THREE 34"x75" StOkt'�ki,A"Ou -W/2 ND 6 x16' , .5 80 TTOM PUMP OFF EL. 4.11 EFFECTIVE INVERT 1 LEVEL CONTROLS BULB ALARM CONTROL ELEV 1.2 LOCUS MAP 1-.4.0. % 0 0. BOT, INS, - 3.86 -7- NOT TO SCALE: 6" BASE OF CRUSHED STONE BOT, EL 3.61 EXISTING 1/3 HP SEWAGE PUMP RAISE TO WITHIN 6 1,000 GALLON TO REMAIN OF FINIS "950 TITLE 5 CALCULATIONS GROUND ELEVATION 8.2 ON FILE 0 B.O.H. SEPTIC TANK EXISTING PRECAST CONCRETE 46/SF BOTTOM AREA 6.83' x 22.75' :1 55.Z8 X"NOTES: 2= #91-440 ISSUED 10/7/91 EXISTING TO REMAIN PUMP CHAMBER TO REMAIN SIDE REA ((6.83-+22.75)0.92' 5 43 8.F4,7 COMP. 11/6/91 INSTALLATION 12" MIN-36" MAX. COVER V 7.30 55� 1. ELECTRICIAL IN WATERTIGHT CONTROL BOX. INSPECTION BY EAS 5/27/99 2. POWER CABLES TO BE PLACED IN or)oc)o �,000 0 MIN 1/8--1/4- 0 CONDUIT IN ACCORDANCE WITH LOCAL C= 2 0 0 0 0 0 BUILDING AND WIRE CODES. 0 0 0 0 STONE 0 0 0 0 0 00 00 0 0 0 0 0 �o 3/4* DOUBLE 3. PUMP AND ALARM To ON SEPERATE REE 4'-�-Owx8'-O"x1'-6* DIFFUSOR/ ELECTRICAL CIRCUITS. CHAMBERS H-20 R' INV- 6.76 SET' LEVEL 1> DIFFUSOR& AMBE (ERbPOSEDj 4. PUMP ALARM TO BE SET IN A CONVENIENT 0 LOCUS INFORMATION ON 18 C6N6.'W/` 2 �`ST LOCATION IN THE BUILDING AND TO BE S.A.S. (8.00 x 26.00) =5.80 HREE -48 ) -20 'P �§T- E T c96 x BOTH AUDIO AND VISUAL. !NVE ENDS.-�. FPECnvt' -Rtr��`,�Ijt�1/2' AND 1' -STONE MkW. ELEV 1.5 N.G.V.D.WN MICHAEL SULLIVAN AUTHENICS Ot4s ADJUSTED MAXIMUM HIGH GROUNDWATER 95"- ,nTLE 5 �cALWLAh PROPOSED EXTENSION 208S.P-' x 0. 46/$P17 B TTOM. AREA 8. 2 0 333 QUAKER MEETING HOUSE ROAD 20 ET- T -- 1 0 '+26.0- )(44.96)*�65.3S WI SIDE AREA ((8.0 ',.0.xO'.,74G/Sr ' 7 6tA 'T MA 02537 16 �- ISTING B ILDING 12 �- "A-10" ELEV 11.0 AND "B" 8 A.S.COMBINED ASSESSORS MAP 206 4 PARCEL 42 L- - - -DAM211 ELEV - - - - - - - - -- - - - - - - - - 0.00 "g5 095 6,236 S.F. (HISTORIC L.C. PLAN) 155.3 'GAL 180 GAL x�':-335,3 L PROV. >GENERAL NOTES: 335 _,IRESOVE 1. ALL WORKMANSHIP AND MATERIALS SHALL FOR NEW CONSTRUCTION CONFORM TO D.E.P. TITLE 5 AND THE TOWN OF BARNSTABLE CENTERVILLE RIVER RULES AND REGULATI E DISPOSAL OF SEWERAGE. 2. AT LEAST ONE ACCESS POINT OVER TANK TEES SHALL BE ACCESSIBLE WITHIN 6" OF FINISH GRADE. NTH ANY REMAINING L GHT TO WITHIN 12" OF FINISH GRADE. IdOft - 3 3. ALL NEW COMPONENTS OF THE SANITARY SYSTEM SHALL BE REBAR' \SET CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE LA HISTORICAL MHW L.C. PLAN 9288-2 UNDER OR WITHINrjo' OF DRIVES OR PARKING AREAS THEY 0 4 MUST WITHSTAND H-20 LOADING. UdW (171 1.5) 1 a- -- 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION 2- - - OF ALL UTILITIES PRIOR TO ANY EXCAVATION. 5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE 5 3 OR WITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE. REBAR 6. FINISH GRADE SHALL HAVE A MINIMUM OF 0.02 FEET PER SET FOOT OVER THE S.A.S. AND DISTRIBUTION BOX. LOT 19 7. SEP11C TANK SANITARY TEE'S SHALL BE CONSTRUCTED OF SHALL EXTEND A MINIMUM OF 6" ABOVE 52' THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND EXISTING 0 L LOCATED DIRECTLY UNDER THE CLEAN OUT MANHOLES. 0. OT 2 6'xl 1' REGULATORY NOTE: 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN 0. BALCONY 56', �O 2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT L4 VARIANCES FOR THE PROPOSED S.�A' .§.� EXPA14SION 01 EXISTING EXISTING A ARE SIMILAR TO THOSE 'PREVIOUSLY GRANTED FOR ELEVATION OF THE OUTLET PIPE. 6'xl 6' ro-1 9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES .000 SEPTIC SYSTEM. BALCONY A 10. ALL PIPES SH ALL BE SCHEDULE 40 PVC SEWER PIPE. 0 A 40000 0 Yr 4'xl 0' BALCON 0. 0 EXISTING 0. OVER EXISTING 8'x1O' 46 A CONSTRUCTION NOTES: 00*10 PORCH SITE ND SEWAGE PtAN z 15 9' L' UP RADE" 1. CONTRACTORS INSTALLERS SHALL VERIFY GRADES AND EXISTING S. A.S. .. COMPONENT, ., .00 ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING A SHED WORK ON THE SITE. CLAMSHELL T-LE-5"' GULATION 2. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE DRIVEWAY 6 T 6 SHOR B EACH R A NTH DEEDED OR ZONING REGULATIO NS. OWN os .2 IS TO ,OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. LOT 21 'CENTERVILL A 3. VEHICULAR TRAFFIC, PARKING OF VEHICLES AND PLACING E MATERIALS OVER THE SEPTIC TANK AND DISTRIBUTION BOX 1.0 v\_Oo IS PROHIBITED. N REBAR IFL O'D 4. EAS SURVEY TO BE N011FIED AT LEAST 48 HOURS PRIOR TO "o. CONCRETE ET 0 A HUSETTS �AB REQUIRED INSPECTIONS. 7-ONt 0 A A B A 7 =1 ot& A SCALE A. A E A PROPOSED (3) PRECAST NOTE: EXISTING CONCRETE H-20 6ox240 f A DIFFU SOR/CHAMBERS. SITE TOPO & WALL LOCA71ONS BASED ON A PLAN OF LAND BALCONY PREPARED fOR TS, REVISION 1/19/99 M MICHAEL SULLI VAN NG HOUS 0 A D' FOUNDATION AS-BUILT BY EAS SURVEY DATED JULY 31, 2000 EXISTING A 11;� 333* QUAKM � MEET # RIM TO -MA N 13.34 A GRADE A SAND WI C H 02537 TITLE 5 SEPTIC INSPECTION BY EAS SURVEY MAY 27. 1999 > A '5 0 8) 8 3 3�'�'8 8 9 3 A EXIS NG S.A.SA A A A ed REMO\ ABANDON E PkEPAR D;�BY.REBAR D OX AND, PAIPE A SET CONTROL C RD DATUM : 8 0 X., 30 50 EDWAI 0 :EAS -,;SURVEY� 0 �15r 20 "A"TON96' rl In In r!!!!!!l 41'VERTICAL DATUM NGVD 1 K3 K3 K::= -55. 80 X BENCH MARK USED: CONCRETE BOUND AT SOUTHWEST LOT CORNER 5.00 BENCHMARK. TOP OF 9.00 NQ 23,971 'SANDWICH CONCRETE BOUND GRAPHIC SCALE: 1 INCH 10 FEET EL. 9.00 (YANKEE SURVEY DATED 1/19/99) ...��......... ELEV, NGVD EXISTING PROPOSED 'PUMP 3,1 d CLAMSHELL�BE .1,AO R z 2 0 ------------------- V ti N /SF 000 t0 0 00000 E� -PH PROVIDED By PARKING YANKEE :SURVEY CHAMBER 88 2496 " �5008�, '888