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HomeMy WebLinkAbout0539 MAIN STREET (CENT.) - Health 539 Main St — Capt.David Kelley Centerville House ; A= 207 - 050 � IllnteucQ °a'�`FD�y, UPC 17534 N0.2-15 C0R RASTINGS,UN TOWN OF BARNSTABLE LOCATION `1-W M&IAIL'jT- V1 LL C:. SEWAGE# .VILLAGE��h1 �1 L C—,' ASSESSOR'S MAP&PARCEL �Sp AME&PHONENO.AZ " e4 11 eVee— g2—YOYS SEPTIC TANK CAPACITY 9 14 0-0-t) 6�cl 10-Y%r LEACHING FACILITY:(type) Z— DL�U �0`'l ($ize) c� t � 'NO.OF BEDROOMS / t5 OWNER J�+'DV�Is �L/i n✓l PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: FT' Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Nl� Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or.within 200 feet of leaching facility) AIL Feet Edge of Wetland and Leaching Facility(If any wetlands exist ) within 300 feet of kaching facility) Feet �n FURNISHED BY . �'� C� /"l /' Ne-1 fil r cn -� l DES 40 f-� 3 ,.� Town of Barnstable Inspectional Services BA AS& MA95. Public Health Division y i63p. �'d ArFDMASA Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Fax: 508-790-6304 Office: 508-862-4644 AFFADAVIT FOR A BED AND BREAKFAST PERMIT EXEMPTION FORM Name of Bed and Breakfast: eWVA `j1W19 Kz2tt-z/ f1SL Address: 5 3q AWAI 67- Ct,XW V 111g 4"X 4&L Telephone: �� Name of Owner: how 6A J-9� Telephone Number: As Per 2013 Food Code, State Sanitary Code MA Regulations for Minimum Standards for Food Establishment, Chapter X - 105 CMR 590.001 (C)(1) and can be found on website: https://www.mass.jzov/regulations/105-CMR-59000-state-sanitary-code- chapter-x-minimum-sanitation-standards-for-food I attest I am qualified for a Bed and Breakfast Permit Exemption because I meet the following criteria: X Owner Occupied X Available guest bedrooms does not exceed 6 Number of guests does not exceed 18 Breakfast is the only meal offered The owner/operator is responsible for ensuring all consumers of this establishment are informed by statements contained in the published advertisements, mailed brochures, and placards posted at the registration area that the food is prepared in a kitchen that is NOT REGULATED/NOR INSPECTED by the FC-regulatory authority. Signature of Applicant: Date: 27 V��P T-L�� 1t�-L I o Aqll Q:\Application Forms\Bed and Breakfast Exempt 2019.doc I t I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 539 Main Street Property Address Dennis Quinn Owner Owner's Name infor requir dlon forls Centerville MA 02632 July 19, 2008 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out ! r forms on the computer,use 1. Inspector: iy N only the tab key to move your Darren M. Meyer C" cursor-do not Name of Inspector 1 use the return a, key. n/a Company Name P.O. Box 981 Company Address East Sandwich MA 02537 Cityfrown State Zip Code 508-362-2922 S 1 3920 Telephone Number License Number B. Certification 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 Inspector' gnature Date The system inspector shall submit a cop of his 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. 539 Main Street,CAlle-Title V•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 539 Main Street Property Address Dennis Quinn Owner Owner's Name information formation is Centerville squired for MA 02632 July 19, 2008 every page. City[rown 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: 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. Answer yes, no or not determined (Y, N, ND) in the❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal 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. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed 539 Main Street,CWle-Title V•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 539 Main Street Property Address Dennis Quinn Owner Owner's Name infor requir dlon forls Centerville MA 02632 July 19, 2008 every page. City/Town state Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: 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 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. 539 Main Street,Cville-Title V-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 539 Main Street Property Address Dennis Quinn Owner Owner's Name required information isCenterville MA 02632 July 19, 2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well'. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria 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'/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: ❑ ® 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. 539 Main Street,0Alle-Title V•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 539 Main Street Property Address Dennis Quinn Owner Owner's Name information is required for Centerville MA 02632 July 19, 2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cunt.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 539 Main Street,Cville-Title V-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 c Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ^M 539 Main Street Property Address Dennis Quinn Owner Owner's Name information is required for Centerville MA 02632 July 19, 2008 every page. Cityfrown State Zip Code Date of Inspection C. Checklis t Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board-of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® 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? Z ❑ Was the site inspected for signs of break out? IN ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been 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)] 539 Main Street,Cville-Title V-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 c Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 539 Main Street Property Address Dennis Quinn Owner Owner's Name information is required for Centerville MA 02632 July 19, 2008 every page. Cityfrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 9 Number of bedrooms(actual): 9 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 990 Number of current residents: Variable Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2006: 320gpd 2007: 375gpd Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Bed & Breakfast Design flow(based on 310 CM 15.203): 990 Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): #of bedrooms 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: See above Last date of occupancy/use: Current Date Other(describe): 539 Main Street,CAlle-Title V-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 , a Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM s 539 Main Street Property Address Dennis Quinn Owner Owner's Name information is required for Centerville MA 02632 July 19, 2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: System Installed June 28, 1983, permit#83-444 Were sewage odors detected when arriving at the site? ❑ Yes ® No 539 Main Street,CWle-Title V•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 539 Main Street Property Address Dennis Quinn Owner Owner's Name information required forts Centerville MA 02632 July 19, 2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 18 inches feet Material of construction: Z cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments(on condition of joints, venting, evidence of leakage, etc.): No issues, no signs of leakage Septic Tank(locate on site plan): Depth below grade: .33 or 4" 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: typical 2,000 gallon tank Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle 22" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 8., Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? tapes/rods 539 Main Street,Cville-Title V•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 539 Main Street Property Address Dennis Quinn Owner Owner's Name infor requir dlon forls Centerville MA 02632 July 19, 2008 every page. Cityfrown 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.): tank appears in good condition, inlet and outlet tees are present, liquid levels are even with outlet pipe, no signs of leakage. Recommend pumping every 2 years. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 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): 539 Main Street,Cville-Title V•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 539 Main Street Property Address Dennis Quinn Owner Owner's Name information is required for Centerville MA 02632 July 19, 2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert n/a 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.): D-box was level,flow was not equal, no signs of solids carryover, no signs of leakage, vegetation normal. (recommend installation of flow levelers) Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 539 Main Street,CAlle-Title V•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 539 Main Street Property Address Dennis Quinn Owner Owner's Name information is required for Centerville MA 02632 July 19, 2008 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 2-1,000 gal w/4 ft. of stone ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit#1 had 6"of standing water, Leach Pit#2 had 3 ft of standing water, vegetation normal, soil conditions normal, no signs of complete hydraulic failure. 539 Main Street,Cville-Title V-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 539 Main Street Property Address Dennis Quinn Owner Owner's Name information is Centerville required for MA 02632 July 19, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 539 Main Street,CWle-Title V•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 539 Main Street Property Address Dennis Quinn Owner Owner's Name information is Centerville MA 02632 July 19, 2008 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 53R M,00 t - �*-�-_wa `pL 6rwat!) -� P 5-IEP I pag LE i T �b 0 �01 v EST lL n t,.CAU All� � - � 1� ,�,, $ -2- "• 3513,t PIT 14-- 4 ' 539 Main Street,Cville-Title V•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 539 Main Street Property Address Dennis Quinn Owner Owner's Name information is required for Centerville MA 02632 July 19, 2008 every 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 ground water: >30 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: reviewed former Title V Inspection ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Used data from former Title V Inspection and hand augered to 16 feet and did not find any water. 539 Main Street,CWle-Title V-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 Town of Barnstable y�fTHE Tp�� Regulatory Services ,A,S.,.AB,.E.p; Thomas F. Geiler,Director MASS 9^ 1 ,00 pTED3�a Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector.who conducted the inspection. QASEPTIC\Disclaimer Private Septic Inspections.DOC' i Y��� �\f ��- � � '� ' o MU�I� � �� � � f h �� � Y ._ _ �; 0ATE;_1 1 1 7/00_-__ PROPERTY ADDRESS: �359 M } ,,�,t, p. ______ /�j�( -----4Q44Q--------------- Adams Terrace Gardens In on the above data, I Inspected the septic system at tie above address. This system consists of the following: 1 . 1 -1 500 gallon tank. '9 © p 2 . 1 -Distribution box. 2-1000 gallon precast leaching pits packed in 4:. ' of stone. Based on my Inspection, I certify the following conditions; 3 . This is a title five septic system. ( 78 Code ) 4 . The septic system is in proper working order at the present time. 5. The septic tank was pumped at time of inspection. 0 . One of the leaching pits are dry at this time. 7 . There is 4 ' of 1 '-z" stone around the leaching pits. SIGNATUREt.,/ _ _ N a m e:_,La,--�Ussmktr- ______ Company Son , Inc . Address:_ Box-66----------___ __Centerville L Ha__02632-0066 Phone•___ 508 77S_3338_______ THIS CERTIFICATION ODES NOT CONSTITUTE A CIVARANTY OR WARRANTY ♦ V JOSEPH P. MACOMBER & SON, INC# Tsnks•0911p0014•Loachfloids Pumped & Installed Town sower Connootlons P,o. Box 6775•�338srv4,111 MA 102632-0066 RECEIVE® u E C 0 7 2000 TOWN OF BARmb i HBLE HEALTH DEFT. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENvIRONN=AL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-6600 TRUDY CORE Smrvtary ARGEO PAUL CEL DAVM B. STRUHS Governor Cottunisaioner BSURFACE SEWAGE DIS L SYSTEM INSPECTION FORM PAR A CERTI T10N Address: 539 Main Street ofor,.,Louise Pritchard n r Ii e,MaSS. 02632 Addfia" wrw0 12 N of kt Spector: (Please� 1 e h P. Mac e r Jr. I am a DEP approved system kupector to Section 16.340 of Ttdo 6(310 CMR 15.000) . Joseph P. Mac er & Son Inc. MaawrV Address. e r v i le, Ma. 6 3 2-0 0 6 6 Terephone Number: — — CERTIIt"ICAT10N STATEMENT I certify that I have personally Inspected the sewage disposal system at this address and that the Information reported below is true, accurate and complete as of the time of Inspection. The inspection was performed based on my training and experience In the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ F?.11"',ubmit il A kupector's Signawre: �,opyf / Date: The System Inspector a this Inspection report to the Approving Authority(Board of Health or DEP)whNn thirty (30) days of completing this Inspection. If the system Is a shared system or has a design flow of 10,000 gpd or greater,the Inspector and the system owner shall submit the report to the appropriate regional office of the Department oKinvironmentall Protection. The original should be.sent to'gw system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS **** This report only describes conditions at the time of inspection,and under the condition 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. revised 9/2/98 page iorIi A �) Printed on Recycled Paper Y T SV&SURYACt SEWAGE DISPOSAL SYSTDd W3►£CT$ON FORM PART A CFRT1FW-AT$ON (oond+r+*Cq �,ogayAaa.ea; 539 Main Street Centerville,Mass. o.�...r Pritchard Louise Adams Terrace Gardens Inn µs►eC_ 1 H iVuMAAYI check A4 0, C, a Dt A. Y ST'f]1 ►ASSES• I have not lovnd my lnformadon wNch Mcates that any of the Wurs conddow described In 310 CMR 1,5.303 •:l+t. Any h: rMgnj not svelvated are Indkatsd below. S, SYSTVJ CONDMONALLY PASSES: Ono w mots oystem sompononta oa d000rlbod In the 'CwtddwW►sea' aeodon Rood to be roplaood a repelled. TAW eystam. v �� complodon of tho loplecomenl of repel, aw approved by thW Soud of Hodth, wW peas. v+dcote yq,►,no• °f not Tho eepdc stank I Nmed Ym*W, w+looaD%he owno a opwatw ha.a provtd•d UK@ eey tem Irup otor with o oopy of+a Go+vnul CompUonce (snochod) Indcadng that the tank waa Inatagod wlV%Ln twenty 120) year+ prior to thW dwtW of 0-4 Vtap*c-oc tho sopdc took, whether or not mstel, Is ersokod, ewt<n+r&Wy unwound, ehowe wubetertdeJ InfUVedon w e916Vadon o. lallvre Is InvNnent. The sWom wW pose Uupsotlon If the existing aopdo tank Is repl000d whh a eoer-PWg ewpdc tan epproved by No loud of Hsslth. v Sewage bockvp or broekovt or Ngh static water levol observed In the dlaVlbulJon box 14 due to broken w obsVVCuo P. or due to s broken, sstdsd or uneven d)evlbution box. The ayatsm wW peas InwpooUon If (watt approver of V%4 so-wc < HeslN)• Woken pipe(e) are replwced ob+wcdon le romoved davibudon box Is IovsUed w rsplacod ThW syrtom roQukod pwr%*7Tr-MV tlta+t fvtrr eb^ea 1 eu duw to broKenw obsty atod plpyls). the VTWWm w'vV9xs` InepscUon If (with spp(ovsd of the board of Hoadth)l broken plpele) ue rsplac'sd obewcdon If removed revised 9/2/96 tags 101It I SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART A CERTIFICATION (corrtfrx+ad) 359 Main Street Centerville,Mass . Ownw: Adams Terrace Gardens InW. Louise Pritchard C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Condrdons exist which require further evaluation by the Board of Health In order to datormine If tho 111y410m la ftMnp 10 protect t7a public health, salary and the environment. 1) SySTETA WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CUR 16,303 (1)(b)THAT THE SYSTEW 4 NOT FUNCT1ONW0 IN A MANNER WHJC.R WtLL } .PAOSECT T{E PUBLIC BEA.LTRAND SAFM AUD THE E)1108OkABk(T 4/0 Cesspool or privy It within 60 feat of surface water op cesspool or privy is within 60 loot of a bordering vegetated wedand or a salt marsh. 2) Sy5TDA WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF ANY)D✓:TERUDU!3 THAT THE SYSTE3u CS FUNCT)ONINO IN A IdANNER THAT PROTECTS THE PUBLIC HEALRI AND SAFETY AND THE 9(V1RONMENT: 40 The system has a septic tank and soil absorption system (SAS1 and the SAS Is within 100 toot of a wrface water wpply or tributary to I surtoce water supply, .L The system has a ►optic tank and soil absorption system end the SAS Is within a Zone l o} a puOlJc water supply well. The system has a septic tank and soil absorption system end the 3A3 Is wl%Nn 60 foot of a private water wppWY well. The system has a septic tank and soil absorption system and the 3A3 Is less then 100 feet but 60 feet Or more hom a private water supply well, unless a well water onalysla for colliorm bacteria and voladle orgenlc compounds IAd cats trot tt�+ wall U*it a hom pollution from that facility and the presence of smmonl♦ nJuogen and nJuate rJuogen Is pual to or ia►s than 5 ppm. Method used to determine distance _ (app(oximation not v"d)•- 7) OTHER X.E' revised 9/2/98 P.�alofII f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFVCAnON leortdrx►ed) prapertyAddrss+: 359 Main Street Centerville,Mass. Owner: Adams Terrace Gardens Ina/. Louise Pritchard D@U 94 V 9*C`d : 1 1 /1 7/0 0 0, 3YSTEM FAILS: you/rtusi Indicate either 'Yes' or 'No' to each of the following: exist as �'ert« thils rail I have determined that one of more f the folrd lowing i slthlurg shoconditiould be ntacns led to doterl l minewhatt will be t to corybe nocs arY - determinsdon Is Identified below. yes No / SAs•of•cNi1001• _ Y Backup o4 t+~wage Inw hclAh'a•�'T'e�ootnpone�rttdoeto a�tt ov�tio�b�d ot^c�9g� Discharge or ponding of emuent to the surface of the ground or surface waters due to an overloaded or dogged SAS or —" cesspool. butjyn•box above outlet Invert due to an overloaded or clogged SA3 or ce+apod. Static liquid level In th;distrl _ Liquid depth In Re+'$'pod Is 7ese than 6' below Invert or available volume Is less than 1f2 day flow. Required purnping more than 4 times In the last year�1 due to clogged or obstructed pipe($)• Number of times pumped I—. — Any portion of the Soil Absorption System, ceaapool or privy Is below the high groundwater elevsdon. Any portion of a cesspool or privy Is within 100 fast of s surface water supply or trlbutary to a surface water wpWY -j/ Any portion of a cesspool or privy Is•withln a Zone I of a public well. Any portlon of a cesspool or privy Is within 60 feet of a private water supply well. Any portion of a cesspool or privy Is Usa•than 100 feet but greater then 60 feet from a Privets wets( wppfy weu wiv% .cc.ptable water quality analysis. If the well has been analyzed to be acceptable, sttach copy of w94 wets( anarys" ' colllorm bacteria, volatile orgenlo-compounds, emmonla nitrogen and rtJuste Ntrvgen. E. URGE SYSTEM FAILS: You must Indicate either 'Yes' a 'No' to each of the following: The following criteria apply to large systems In addition to the criteria above: niflcant tt+reat t lot ge ond r gras 1)J The system serve end the environment design b c►u&t one of more pof the followingrcondition System) eal�;the ayatem la s sig health and safety yet No l•/ the system is within 400 feet of a surface drinking water supply �wris.o�•d4•w'aMr-wP�Y ... .. _-- L/ the system IrwlNwt 200 (*at-04-0 ter Y-tv protection Area• IWPA) or a mapped Zo^e ii or the system Is located in a nitrogen sensitive are$ (Interim Wellhead $ water supply well) rslnlormonl.upg(ade the system In accordance with 710 CMR 16.104(2). Pfesse conau►t o1e 1OGar The owner or operator of any such ' oMcs of the Department for furthe fn+tl Pstf 4 of 11 revised 9/2/98 i SUBSURFACE SEWAGE DISPOSAL SYSTDA INSPECTION FORM � PART I ' CHECKUST PropwlyAddrasa:539 Main Street Centerville,Mass. Own—: Adams Terrace Gardens Ine.Louise Pritchard 0" or v,avactson: 1 1 /1 7/0 0 Check If the following have been done: You must Indicate either 'Yes' or 'No' as to each of the following: Yet No Pumping Informadon was provided by the owner, occupant, or Board of Health. .Nona of the system c orryc.nanU 6a64:baan has J ao"wcalaoq.■e.d A rates during that period. Large volumes of water have not been Invdduoed Into the system recently w so pan of urs — inspection. As built plans have been obtained and examined. Note If they are not available with N/A. _ The facility or dwelling was Inspected for signs of sewage backup. The system does not receive non•sarJtary or IndustrlaJ waste flow. _ The ske was Inspected for signs of breakout. All system components,*wcluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the Interior of the septic tank was Inspected for cordtion of oar or tees, material of consvvctJon, dimensions, depth of Liquid, depth of sludge, depth of scum, The size and location of the Soll Absorption System orrthe site has been determined based on: _ Ealsdng Information, For example, Plan at B.O.H. Determined In the field (If any of the failure criteria related to Part C Is at issue, approximation of distance Is vnaccspcao 116.302(7)(b)) The faclUty ownar L+ .—&-"�='.Jf d(tfw&w trozrLosuoari.urua.pccvldaef wUh Latau,,,lomon rr��.,,,,,,,,,. SubSurfece 01sposs.1 Systems, revised 9/2/98 Polls Sorlt I I J � 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION P,w rty Ad&o":539 Main Street Centerville,Mass Ownw: Louise Pritchard Adams Terrace Gardens Inn 0— of Inspection: 1 1 /1 7/0 0 FLOW CONDMONS R ES IDFNTIAL: Design flow:—(jQ_9•p.d./bo om. Number of bedrooms (design):dr Number of bedrooms (actual): Total OESION flow •`xtf ,'ZZ Number of current rssldenw-15f.a.4 Oarbage grinder(Yes or no):_Me Laundry (separate system! es or o ; If yes, sepautalrupectlon•requlred —. laundry system Inspect• as r no) /nJ Seasonal use (Yes or nol: JCf�p� Water meter readings,11 available (last two year's usege(gpd): Sump Pump !yes or nol: '� Last date of occupancy.l�t) MMERMA DUSTRtA Type of establish I. Des gpd ( Basso on 6.20.3) Balls of design Flow =L s Ores&• trap present: (yes or not industrial Waste Molding Tank present: (yes or no)Ao Non•sarOary waste discharged to the Title 6 system: (yes or no)ea Water meter readings,If available: Last date of occupancy:92LY OT}1ER: (Describe) Last date of occupancy: 4,4 GENERAL INFORMATION + PUMPING RM and sou rc 01 Informatl System pumped as part of Inspection: (yes or no) S It yes, volume pumped: , 3 all s Reason for pumping: . Y STEM ptic tank/distribution box/soll absorption system ngle cesspool erflow cesspool vyared system(yes or no) (If yes, attach previous Inspection records.11 any) Technology • c Attach copy of up to date operation and maintenance contract ght Tank Copy of DEP Approval Other ��+ APPR0X1MATE AGE of all components. date Ins tall a($ilf known)-and souse ofJwfer nation: �;r�iPl•3f—.�f � A� � Sewage odors detected when-arriving at the site: (yes or no)" revised 9/2/98 Paee6orII f SUBSURFACE SEWAGE DMPOSACSYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (condrajod) 539 Main Street Centerville Mass. thogerty Ad6rssa. r Owrow: Louise Pritchafd Adams Terrace Gardens Inn. Do" of lnspe,cdon:l 1 /1 7/0 0 BUILDING SEWER: ILocate on site plan) n Depth below grade: Material of constrvction: cast Iron_40 PVC&)other (explain) Oistance hom�rivels water supply well or suction line !' Oiamoist e_ Comments: (condition of Joints, venting, evidence of hsak Be,+tc•) J SEPTIC TANK: Locate on she plan) Depth below grade•_/ Meterisa of constrvctlo concretek LPolysthylene iothar(explain) It tank Is petal, Ilst age 1s.aQ*.confVm*d by Certificate yof Compllance (Yes/No) Dimensions: 1d•6 °�7 d �• a p— Sludge depth:_ Distance from top of 6 dge.to bottom of outlet is$orbaMe�_ Scum thickness: l Distance from top of scum to top of outlet tee or bsMe: ] Distance from bottom of scum to bo m of outlet tee or belle: C) How dimensions were determined: Comments: irecommendation for pumping, condition of inlet and outlet tees or•b&Me&. depth of liquid level In relation to outlet Invert, atructvre►+.�te9rrrY, evidence of laakage, etc.) Inlet & are in place. 'The $ no evi en GREASE TRAP: (locate on site plan) Depth below grade: Jr Mstsrial of constructlon,&concretejl!j�meta�iaFlberglass,4t lPoiyethyieno"other(explaln) 1 Dimensions: Scum thickness: Distance from top of scum to top of out tee or b11 —Aid Distance from bottom of scum to bottom of outlet its or•bafils: 140 Date of lest pumping: Comments: irecommendadon for pumping, condition of Inlet and outlet tees or baffles, depth of liquid level In relation to outlet Invert, structural IntegriTy. evidence of leakage, etc.) rease . revised 9/2/98 hic7of11 SU93URfACE SEWAGE DLSPOSAL SYSTEM WSrECTVON F FUA PART C SYSTDA INFORWAMN (con* *d) P„ , A,a,a,.e:539 Main Street Centerville,Mass. Owrr,•; Louise Pritchard Adams Terrace Gardens Inn 11 /17/00 nOKT 011 MOLDWO TAXK:A&j,(Tank must be pumpod prlo( to, or at Umo of, Inapeadon) Ilocale on Nte plan) Ospth below 9rode MeteAN o1 conswcUvn;✓7concretern•t� .Flberplae�, �dye��lenoNer(�xpl►!nl Olmenslons: Copoclry: gallon► l m llow gallons/day A1# Alarm pre►ent Alorm Iorel: Alarm In/ o(kln9 order:Yea/g No& 0119 of Provlovt pvmpinpl Comment►: lcondaon of INeI tee, oondJtlon of ►:arm and float switches, eta.) Ur n nn t WTRISUTION SOX:Z I10cele on till plonl Oopth of I:Qvld level above owdel Inver: 11d Comment$: Inge 11 lonl and dl►trlbvtlon le saws:, ovidenw of solids carryover, wldanae of leakage Into of ou{ of►oa, etc. No w4denee of sottds D1stri ox. pUWP C14AU@EN! e? hotels on site plan) ►vmp►In worklno order:(Yes or No) Alarm►In wolklnp order IYee or No) Comment$: .) Inoto condlUon of pwmp chamber, condition of pum pa and appurtenances. etc c am roll 1 of 11 revised 9/2/98 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM WFOR"TION (c*n*wd) 539 Main Street Centerville,Ma•ss. owner: Louise Pritchard Adams Terrace Gardens Inn. D4"o+ k%&P*ct*n`1 1 /1 7/0 0 SOIL A.SSORrMN SYSTEM(SAS):, (locals on site plan, If possible:excavation not required,location may be approximated by nominuuslve methods) It not located, explain: Type: leeching pits, number; leaching chambers, number: loathing galleries, number:, leaching trenches,number, length: leaching fields, number, dimenl4ono: overflow cesspool, numl 1. Alternative system: A Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soli, condition of vegetation, etc.) Loamy sand to ranrcc s@pd No signs hyclrattl i C` fai l ii— or CESSPOOLS: (locate on site plan) tidt�- Number and configuration: L) Depth top of liquid to Inist Invert: 1119 Depth of solids layer: -4111 Depth of scum layer: WX Dimensions of cesspool: Materials of construction: Indication of groundwater: Inflow (cesspool must be pumped as pan of Inspection) Cesspools arp nni- prGSQ;4t. Commanu: (note condition of soil, signs of hydraulic failure, level of ponding,condition of-vegetation, etc.) Cesspools are not present (locate on site plan) Msterjais of construction: �,� Dimensions: Depth of solids: Commenu: (note condidon of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Privy revised 9/2/98 Pser9of11 I 3Us3VFt/AC1f SEWAGE DLSPOSAL sYiTVA wsrtcnON FOPJA ►ART C - ' sYiToA WFOF.W.AnON (o*"*-*d) P+pp«ZrAd-d'—;539 Main Street Centerville,Mass. Own-w: Louise Pritchard Adams Terrace Gardens Inn 11 /17/00 SUTCH Of SEWAGE DLSPOSAL SYSTEM: Indudo too to &t 1491t two porm+nont reference Iandmuks or benchmuki loc&t# ul well; within 100' (Locoto where publlo wear wpplY COMO$Into houil) G CV revised 9/2/98 Pago log(II I THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH � ............ OF............ J/) Cl No. ! ....................... /.11 ............. � FEE. ..�... Bi ooul lUvrkB Ton,atri ion errMt.. Permission is hereby granted....... ........... --�C..(� � to Construct ) or e it L--)—a In ividuai e age Dis osal System at No....... -• 1... .'.1.1 ,� ..... �.........� •C `U�,��.................... ....... ...... .�. ��.. Street 7 as shown on the application for Disposal Works Construction Permit No�'... ... Datedl. . ... ........................... .................................... ......................................... DATE... Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /.. �� . . 0F...�,W. 6) .2 .)t........................... Csiertif hate of Tomplianrr THIS--LF T5 CERTIFY, That the Inuividual ewage Di o al ystem constructed ( ) or Repaired by................51 J . ...............................................'...1...................-...... at......... ......... �� .... �....... �J,/ 1.1/1.J ... ............�-........ ... 1/.. r .� has been installed in accordance with the provisions of TITLE [j f T�e State Sanitary Code des tb d in the application for Disposal \V rks Construction Permit No-il ' 7 y, ............. dated,...�i. .... f. . PP THE ISSU CE THIS CERTIFICATE SHALL NOT BE CONSTRU A GUARANTEE THAT THE SYSTEM V/IL FUN N SATISFACTORY. .................... Inspector......... ..... . .......................................---.................... DATE....... ... .. .✓. .. .. n i SU93URFACE SEWAGE"P93AL SY3TVA W3FECMON FORMA PART C 3Y3TOA pFOR"T10N 1..d..d) ►roq✓tyAddraaa: 539 Main Street Centerville,Mass. Ownw: Louise Pritchard Terrace Gardens Inn. Det.a of 4+aDOC6Q#+: 1 1 /1 7/0 0 NRCS Report name Sou Type_ TyplcaJ depth to groundwater uSOS Date webslte vlalled Ooservstlon Walla checked Oroundwetsf depth: Sh&llowModerate Deep SITE EXAM Slope Surface water Chock Cellar Shallow wells I EsOmated Depth to Oroundwater ,Feel vises#Indicate ail the methods used to determine High Oroundweter Elevation: 0otain• �3119 (Ab�uttnq e on record 3 Observedopert obaerv&Uon hole, basement sump Co.) ��/D�fetermined irom local conditions Checked with local losrd of health _ Checked FEMA Maps Checked pumping records Zlocked local eicevetors. Initsllen used U$os Data Descrioe how you established the High Oroundwater ElovoVon. EKES be completed) Installed Septic System. 6/20/83 Permit# 83-444 No water enc.ounted at 141 Used; Water contours map. Gahrety & Miller Model 1 2/1 6/94 reyised 9/2/98 ncelteril • rr•.r rar—lrr.•nnnrr-nr.�•rr.rrr.:•.T++vrr:•nr-er•.rn ns•nttwa•r.�em.a�+ ����_ _. ._.'FOWN OF Barnstable LIOARD OF HEALTH j SUNSURFAU SEWAGE DISPOSAL SYSTF,M INSPECTION - - T N FORM PART D ' CERTIFICATION •.•-••:•r•.••• ��.11).^�-r..r.T.n•n:Trrte�lrTR1T'�'11'rt•t�t'r+r't T'Irmr—'rRRT.eVar/lT.9mt�Tii7 rsrn rt•mrrTrRv:TrTrr.+r.•.:rrrr•�. .....� -TYPO OR PRINT CI,EARLI'- PROPERTY INSPECTED STREET ADDRESS 539 Main Street Centerville,Mass. ASSESSORS MAP , BLOCK AND PARCEL # OWNER' s NAME Louise Pritchard PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber• & Solf Ync. COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Town or City Stat• ilP COMPANY TELEPHONE ( 508 775 - 3338 FAX ( 508 790 _ 1578 n CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and omplete as of the time of .inspection , The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , Checks one : W f System PASSED The inspection tihich I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have con 'acted has found that the system fails to Protect the iltlblic heal0i and the environment in accordance with Title 5 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date �U Ycopy of this rtification must be provided to the OWNER, the BUYER re applicable ) and the BOARD OF HEAL'I'II, IF If the inspection FAILED, the owner or " 'Ierator shall upgrade ' the eyetem within one year of the date of the inspection , unless allowed or required otherwise as provided in 310 CHR 16 . 305 , partd . doc 0 - .r-I V11=-D DATE : 10117/03 - NOV 1 3 2003 PROPERTY ADDRESS: 539MainStreet _ _ _--_-_ TOWN OFBA,RNSTABLE Centerville HEALTH DEPT. _ - - - ----------- Mass 02632 -- - - - ------------------- as On the aoove date, I inspected the septic systerrt-at the above address. Tnis system consists of the loll,owing: 1 . 2000 ga.PPon tank 3. 2- 1000 gaiion /22ecaZi- eeach.ing /2.ita packed in 4 ' o� 1%" ztone. . (6X14 ' 2. 1-Diet2igution Pox. Baseo on my inspection, I certily the following ,condltlons: 4. 7hia i,3 a t.itPe �P-.ive zeptic zyzt/em. ( 78 Code) 5. The aept is zyhtem .ih .in /12o/1e2 wo¢king o zde2 at the /?/ze.aeat time. 6. Rep2aeed 61token dizt2.i.Put ion Sox. 7. lnhta P.Ped one 3/2eed .Peve.Pe z in the d i,6t2 i&ut ion gox. 7h.i.6 w.i e.P equa.P.ize the l.Pow to each /2.it. SIGNATUR Name - _:__ P . _Macomber_Jr ,_ __-- � ompany : ,�4�p�h Son, Inc . 00rE 5 S : ----- - - ----- _QJUSV rY LLL.,- �Ja _ _Q2.6 3 2- 0066 ?^ one 508_•_775_ ) 3 )8 - - -- - --- TmIS CERTIFICATION GOES NOT CONSTITUTE A GUARANTY OR WARRANTY I a L060x P. MACOMBER & SON, INC. ink s•Cesspools•Le+chllelds Pumped & Instilled Town Sewer Connectloni 66 Centerville. MA 02632.0066 115.3338 775-6412 1 i . 0 COMMONWEALTH OF MASSACHUSETTS = EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION r TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 539 Main Street Centerville Ma Owner's Name: Louise Pritchard Owner's Address: same Date of Inspection: 10 17 0 3 Name of Inspector: (please print) J.P. Macomber Jr. , Company Name: Joseph P. Macomber & Son Inc Mailing Address: Box 66 Cpn_tervi 1 1 P Ma 0 632 Telephone Number:508-775-3338 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: s��Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fail D Inspector's Signature: Date: The system inspector shal ubmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner.shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 iPage 2 of I I • OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 539 Main street Centerville Owner: Louise Pritchard Date of Inspection: 10/1 7/03 Inspection Summary: Check A,B,C,D or E/ALWAYS-complete all of Section D A; System Passes: 1 have not any information which indicates that any of the failure criteria described in 310 CMR 5.303 or in 310 MR )5.304 exist. Any failure criteria not evaluated are indicated below. Comments: _7he 6e/2i.ic .6yz.tem 4­6 .in /2/zo/2e2 woakiny oade2 at .the R2eaen1_ time. B. System Conditionally Passes: N� One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in theA4 for the following statements. If"not determined"please explain. tIL 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. ND explain: .440 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): A broken pipe(s)are replaced K� obstruction is removed _ distribution box is leveled or replaced ND explain: VA- 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): L "broken pipe(s)are replaced obstruction is removed ND explain: 2 page 3ofII OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 539 Main Street Centerville Owner: T,c) ii Ge pri tchard Date of Inspection;d1 9 7 1 n 3 < _. C. Further Evaluation is Required by the Board of Health: (VD Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,.safery or the environment. I. 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 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: A 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. 64 The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. V97 The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. NV The system has a septic tank and SAS and the SAS is less than 100 feet but 50 et or more from a private water supple well-. Method used to determine distance 1Oo.dl.-!�. '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. 3. Other: 3 Page 4 of I 1 • OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A `' CERTIFICATION(continued) Property Address: 539 Main Street Centerville Owner: Louise Pritchard r.,. . Date of Inspection: 1 0/17/03 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 jC 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 ii day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped-JJI�,{' 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 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.] _(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 correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no ✓he system is within 400 feet of a surface drinking water supply , _ ,.Z the system is within 200 feet of a tributary to a surface drinking water supply _ 1::-�the system is located in a nitrogen sensitive area(I_nterim Wellhead Protection Area— IWPA)or a mapped Zone 11 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. 4 Page S of I I • OFFICIAL. INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B ' CHECKLIST Property Address:539 Main Street t^_enfRrVi 1 1 a Owner: I nui se Pritchard Date of Inspection: _1_0_.11 7 f0-4 Check if the following have been done. You must indicate "Yes"or"no" as to each of the following: Yes No — Z/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 ? AZ"Have large volumes of water been introduced to the system recently or as part of this inspection ? `SL — Were as built plans of the system obtained and examined?(If they were not available note as N/A) z_, 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, 44�I P he SAS, located on site . .�_ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? \ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no S�/_ xisting inlormati 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 IS.302(3)(b)) 5 . Page 6 of l I • OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C At SYSTEM INFORMATION Property Add ress:539 Main street Cent-Pryi 1 1 P Own er:T.,Ii ca Uri f-rrhgrH Date of Inspection: 1 0/1 7/03 RESIDENTUL FLOW CONDITIONS Number of bedrooms(design):-9— Number of bedrooms(actual): 9 DESIGN flow based on 310 CMR 1 203 (for example: 110 gpd x of bedrooms):1Z 1ef - av Number of current residents: �_ it of '(✓ Does residence have it garbage grinder(yes or no):yU Is laundry on a separate sewage system (ycs or no):ok fir yes separate inspection required) Laundry system inspected (yes or no):4 Seasonal use: (yes or no): AL Z4Xj 1V51 WO Ciil0i'!S 'G.� D " 30q15t1 Water meter readings, if available (last 2 years usage (gpd)): Sump pump(Yes or no): 1�Z Last date of occupancy: COMMERCIAL/INDUSTRI L Type of establishment: Design now(based on 310 CMR 1 S•203): d Basis of design flow(seats/persons/sgft,etc.): C) Greue trap present (yes or no): Industrial waste holding tank present (yes or no):,00 Non-sanitary waste discharged to the Title S system (yes or no): Water meter readings, if available: ) Last date 6f occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: _I) �Q n0►in +-rj(IV jm Wu system pumped as pan of the inspection p (yes or no): If Yes, volume pumped:74b66,gallons •• How was quanti pumped determined? W ,o Si�y'p Reason for pumping: Mri►f)�UA(jr)C P_ TYPE OF SYSTEM T✓Septic tulle, distribution box, soil absorption system .,�Single cesspool /t Overflow cesspool it�:e'';Privy Shared system(yes or no)(if yes, attach previous inspection records, if any) innovative/Altemitive technology, Attach a copy of the current operation and maintenance contract (to be obtained from system owner) )Tight tank <2&Attach a copy of the DEP approval Other(describe): /t/ Approximate age of all components, date Installed (if known) and source of information: �t1SM llPrf b� T P W1U M,A bV r+SdrnS Were sewage odors detected when arriving at the site(yes or no): , Cl 6 Pagi 7 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 539 Main Street Centerville Owner: Louise Pritchard Date of Inspection: 10 f 17 f 03 r- BUILDING SEWER (locate on site plan) ,i Depth below grade: �/ Materials of construction: cast 'iron PVC mother(explain): Asir Distance from private water supply well or suction line: 10'.4, Comments (on condition of joints venting, evidence of leaks e, etc.): ao.int.s a/2/2ea2 t.cgh.:t. No evidence o LtcAage. The zyztem .i.6 vented thorough the aoo� ven .a. ~' SEPTIC TANK: zoocate on site plan) A) Depth below grade: Material of construction: !'concreteA/©metals fiberglass.thJPolyethylene. ,dj&ther(explain) If tank is metal list agc: ) Is age confirmed by a Certificate of Compliance(yes or no)>(A(attach a copy of certificate) J - Dimensions:6i���rre,� t5'�" �. 6 "llli�p> Sludge depth: (2 T Distance !Torn top of sludge to bottom of outlet tee or baffle: Scum thickness: 9 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:Pumped at tame o,P in.6/2ect-ion. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump ze t.ic tank annua2.2 . In.Pe4 & out eet tee.6 ate in /aiace. 7hp tank .i.6 ztauetuaa.2:eu wound and .6 ow.a no evidence o Peakage. GREASE TRAP01004ocate on site plan) Depth below grade: 1 Material of constmction:Aconcreteametal fiberglass,2h�olyethylene.12aother (explain): Dimensions: I\/(+ Scum thickness: _V[+ Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or bathe: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leaks e, etc.): Grer,�e. � /1D�- Ore<c,P1l 7 Page 8 of 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:539 Main G r renteryi 1 1 P Owner:i.n„i Ge Prit.-bn-r� Date of Inspection: 1 0/1 7/0 3 TIGHT or HOLDING TANK:A/O1VL-(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of constmc4ion: concrete V4 metal d1jiberglasse2tpolyethylene�other(explain): Dimensions. Capacity: A/A- gallons Design Flow: K/A gallons/day Alarm present(yes or no): a::- Alarm level: r-W Alarm in working order(yes or no)-' Date of last pumping: N Comments(condition of alarm and float switches, etc.): Ttcth4- or h Idinr, Irs nr-!;e14 DISTRIBUTION BOX:(A&� (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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 or no): Alarms in working order(yes or no): It Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): 8 Page 9 of 1 1 OFFICIAL INSPECTION FORM- NOT FOR VOLIiNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION (continued) Property Address:539 Main Street Centerville Owner: Louise Pritchard Date of Inspection: 1 0 1 7 03 / SOIL ABSORPTION SYSTEM (SAS): t (locate on site plan, excavation not required) 2- 1000 a.P.Pon neca,6.L .Peachin .ita ack d i i" .3 one. 61X141 ) If SAS not located explain why: Loca�-ed: See Rage 10 Ty leaching pits, number:_ � f/Y IY leaching chambers,number: G AILL leaching galleries,number: C) I eaching trenches,number, length: leaching fields,number,dimensions: U overflow cesspool, number: 0 �,,./ l innovative/alternative system Type/name of technology: �iiF9 /•'i�/e, Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Loamy .6and to goney nand to �rr�/_No 34aa.4 uIz D. r)/J ID nr1%nq Cni LA rin0 r/n��. Ve Ge.t a.L.i.on zz no Rm a.Q CESSPOOLV, cesspool must be pumped as part of inspect ion)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: AA Depth of scum laver: i(�A Dimensions of cesspool: Materials of construction: In 1;c....:n of groun:-1`,l .icr inflov, or rri>j: C eae ?o...... o 1 3__ ate_ no _..._.....�_ .._-._.. . .. __. ....__..... ...... ._..._...._.. ...._ _._. ........_._... . ... _ _..... .... t /�!ceerz . Dc}l i Of ol'',ds'' will 1CIi`.', ill. I „1, CI, l�lfi!01' c0ilditicn is oil ! J , . l� Page 10 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C r SYSTEM INFORMATION (continued) Property Address: 539 Main Street Centerville Owner: Louise Pritchard Date of Inspection: 10 f 1 7/03 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 1 J s 0 10 Pagt'I I of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C > SYSTEM INFORMATION (continued) Property Address: 539 Main Street -0-a f.erviiia Owner:Louise Pritchard Date of Inspectional 0/1 7/03 SITE EXAM Slope Surface water Check cellar Shallow wells r Estimated depth to ground water feet Please indicate (check) all methods used to determine the high ground water elevation: q S Obtained from system design plans on record • If checked, date of design plan reviewed:10/17103 y S Observed site(abutting property/observation hole within 150 feet of SAS) NC) Checked with local Board of Health-explain: NA Checked with local excavators, install r • (a cr docume tation) q�Accessed USGSdatabase-explain: h �:// ot�n• ct2nbfu&�e• ma. u�. You must describe how you established the higg�h ground water elevation- /heel: Gahae#y 9 N-igPelz Modee. 1Z/76g/94 Gaourzd wa.i<ea ePevat.iona agove .6ea 2eve . heed: USES: 09ze2va.t<.ion wege da a. u e 7992 LLhed 7eeh cai kuiiai in 92-000- 1 a e #2 4_n_n__ua_Z /zangea o7 gIL01 wate2 e2eva tonz. Leaching �+ . Pit .. cet vxN ' _ Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimptcr Method Therefore,the vertical separation distance between the bonom Of the leaching pit and the adjusted groundwater table is feet. 11 �1 ra•rain r+•—n,•r��•R•,wr me•new nr�.n w•rawwr.�+w�►rwaraRwn�en\y nr-w��wT• .�T--�•-nr•.. .— TOWN OF BARNSTABLE WARD OF HEALTH 0 SUI;SURFACF ,SFWA(;F I)ISI'O,SAL SYSTFM INSPECTION FORM - PART D •- CERTIFICATION •••tn.T••••.'t-T.117:�.�1''4•�tn•1•n.1Tt T1�J�TIiT�1�1•.r'S•1-'1V'M'\RR�rTA��I/R�RR� w11 -TYPE OR PRINT CLEARLY- P1tOPERTY INSPECTED STREET ADDRESS 539 Main Street ' ASSESSORS MAP , BLOCK AND PARCEL OWNER' s NAME Louise Pritchard PART D - CERTIFICATION NAME OF INSPECTORJoseph P.Macomber Jr. COMPANY NAME J P Macomber & Sou Ind. COMPANY ADDRESSBox 66 Centerville Mass . 02632 Street Town or City State t I P COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 -1 578 CERTIFICATION STATEMENT 0r I certify that I have personally inspected the' sewage disposal system nt this nddress and that the i►�formation reported is true , accurate , and omplete as of the time of -inspection . The inspection was performed and any ecoinmendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , Check one : CA/ System PASSED The inspection t+hich I have conducted has not found any information which indicates that the system fails to adequately protect public health or, the environment as defined in 310 CMR 15 , 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA sectio» of this form , System FAILED* The inspection which I have con cted has found that the system fails to protect the })tiblic health and the environment in accordance with Title 5 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signature Date AV'z_/��� ne copy of this c rt.ification must be provided to the OWNER, the BUYER ( where applioable ) and the 130ARD 08' HICALT111a * If the inspection FAILED , the owner or""operator shall upgrade he within one year of the date of the inspection , unless allowed ortrequiredaYstem otherwise as provided in 3.10 CMIR 16a306 , partd • doc • �� ��� `(s-- � i5 pis \:�` ASS LOT 49 y c� ? 0, 00' ` � FWD. r' 1� _ ,•94.0 �b�j raA1 20.3 PORCH 1 ;, 1 31z DECK c:ON\�— --- — - PORCH a=3R O'-_ PAD \ 2p. PORCH ASS LOT {._... _._.. PC 0J. r y r 550 �. SHED r ASS. LOT . 135 ASS LOT J� :'VOTES. PRE'-EA7STING NONC'ONFOR�Itl_NG. SHAPE OF LOT. TA-KEN FROM ASSESSORS MAP A' DEED. MORTGAGE INISPECTION RAn 15 Fit FLOOD zv.vE "c"" This ank tise nl TOWN: L , REGISTRY OWNER: ..J�'FIN P & -,J L._t�ER�iCK�_ — —BUY : _AD9LjlV�L�SF P DEED REF EF: Y — R'LTS H3tiECDA LE: l' fi) _ DATE: PLAN RN �1yZ1p� ._ES -_------ � ofA iZ, I HEREBY CERTIFY 'CO 1C KEELk'1 THAT THE SUILDIrc CONSULTANTS HGwl O�v TNiS FLAN i5 LGCA'1l✓U ON THE GROUND AAUb yo 'SHOW11 AND THAT ITS POSITION DOES .._-___ CONrORM OL �, 40B (SUITE i) TO THE ZONING LAW -ET13ACK REQUIREMENTS OF T14E MElITNEW H iNDUSTRY ROAD TOWN OF jZ'tjF?�V �.� --------------AND THAT 32098 MARSTON.9 *ill.;, 'IiP. ii26an IT DOES- 'VDT _ LIE WiTHIN THE SPECIAL FLOOD HAZARD �f�� �Eoi� TE 428_005;- AREA As SIiOWN- ON THE _H U.D. MAF DATEID_K'ZZZ9z--- ok� Laps 1'�X: 4?t; U �;;=pj i r n _ 20000 CIO D 1. PLAN NO MADE FROM AN * TRUMETtt 16_•-�`i �. --- :�uR�'E`f NOT TO -E E USED FOR Fs NOES ETC p'd ltf Il w C. LOCATION SEWAGE PERMIT NO. r3 s' f✓�% VILLAGE INSTALLER'S NAME & ADDRESS van BUILDER OR �'`OW.NE DATE PERMIT ISSUED DATE C0MILIANCE ISSUED tl 23 r 7 O � No.,9'3 f71;/Jc Fus..........,ly! .. THE COMMONWEALTH OF MASSACHU6ETTS 4 BOAR® F HEAL .......... .--C IV. ..,n.......OF...... . }' Z -------------------_--_ Appliratiou for DhipaaFal Worka Towitrixrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (4-)an Individual Sewage Disposal System at ............ 3 q.---..�.....a...12..-----6_�Vn --------- -------- dj,ej2 ------------------------ ocati i Address or No. W ......•••••' /-•F- Y..6L.Vne .........•.•.• ` -.—. ��fi �........ .. . .. . �•F SS... a Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ............................... .. 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--_____-_____•_---_--_.- �, Test Pit No. 2................minutes per inch Depth of Test Pit___-.__..---___-•... Depth to ground water........................ O Description of Soil....................................` may- ....g Y � --- -- - - - x ------------------- - - -- -••- ..------------------------------------------------------------------------------------------------------------------------•. J U Nature of Repairs or Alterations—Answer when applicable________.___...... n---1\--. _-----••---•--. ........P1.1Z----------------- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance as bee issued by thq boar f health. -J agree {�-/ Cn J� Dat Application Approved By----- •-• ;. ..... - -------------- ate Application Disapprove o e following reasons--------------------------------------------------------------------------------------•-•----•••............••--- ...............................-......................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA 1. No. �?.r:.../ Fes$........:......... ........ THE COMMONWEALTH OF MASSACHU§ETTS BOARD OF HEALTH ..........................................O F..................................._...'-....... :....__. Appliration for Uiipos al Workii Tontratrtion thrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .......... --......_.................................................. ....... _•--- ...................•------ - ' -..:............._•----.......-----•--• Location-Address or Lot No. I !. / Owner Address a Installer Address UType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building No, of ersons____________________________ Showers YP g ---------------------------- P ( )--- Cafeteria ( ) d Other fixtures 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_-___________________--. Grq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ix ----•-------------------------------------------------------•--•-------•-------------------------------•...................••...•••-••••-•---------•--------- 0 Description of Soil........................................................................................................................................................................ x U --•••-•••••••-•-•••••-•....•-•--------•-••••----•----••------••••••••••••--•••-•-•--------------•••--••••--•--••••---•••-•-._---•---•••---•--.....-----•-•--•---._..._.._•--•---•---..._-•-••----•----- W ------------------------------------------------------------------------------------------------------------------------------------------------------•----•----------------•-•-••-•-•-•----••--•-•-•-- U Nature of Repairs or Alterations—Answer when applicable................:..'_______.___..____.___._.'._.___.___..:_...__..___._._._.__________________.. -....................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. r lefollowing ate Application Approved B -------••-•�-•-••••-•---•...•---•-•-••••.._..--•--•--•--•-- �� aApplication Disapproved reasons----------------•-••------------•----..------•----------------------------------�•---••-------•-.....-•---- ••••••••-••------------•-•---•. ••--------•--••-•----•-•-•-•---•••...•-••••••--•-••-------•-------•--••--------•--•--------------•------------•••-•---------------- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................................................................... %TF. rrtifiratr of Tontpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) r , Installer at •-----•----- 1�--•-------------------------------------------•--------•-•--------`-•--------------••--------------------------•-----------------------•--•----__---•-•---•----=------ has been installed in accordance with the provisions of TIT Z 5 of The State Sanitary Code desc ' ed in the application for Disposal Works Construction Permit No.__t�s__ _..__ ' _____________ dated----Z r!.. ', .............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................................OF..----..............._...._........._.._...._..._.._.._....._........__._.._......... No......................... FEE........................ ElioVoottl Workii Tono#rion rrtni# Permission is hereby granted.........................................................-._._.._..---........•---••--------------.....---•-------.._.:-•-••-----•._......._.. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo..................................................---------------------------------------------.-•--•=•-------'---•=•••••-•-•-••••--•-•------------•-••••-••--•- •--•-••---••-- /application for Disposal Street __as shown on the a Works Construction Permit N`2g .1�`' Dated_ __:?'..._''............... r J Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS F, firyh A Mcr nd APPEAL NO. .................................................................. i/ridujC- ' Lei / 100 c TOWN OF BARNSTABLE PETITION FOR Variance UNDER THE ZONING BY-LAW To the Board of Appeals, Town Hall, Hyannis, MA 02601 1Jate ........................1-/22................ 19 a3.......... The undersigned petitions the Board of Appeals to vary, in the manner and for the reasons hereinafter set.forth, the application of the provisions of the zoning by-law to the following described premises. Applicant: Jbba....P.........&.....]wxan.ces.....0........V..aracka.A.......�1.Z.....��.� c�.......k�A...0175 2 (Full Name) (Winter Address) Owner: Elizabeth C.. Parker, 539 „Main St.........,Cente.r..V .�,e.�,,,,,,��,,,,0,�,�i„�,� .......................... .................... ......... .......................... (Full Name) (Winter Address) PriorOwner of record ....................................................................................................................,..................................................................................................... Tenant (if any) : ..................................................................................... (Full Name) (Winter Address) If Applicant other than Owner of property - state nature of interest ......t.Ga....pub:.chesse................................ 1. Assessors map and lot number .......Xap....2.0.2....Lot.....5.f1................................................................................................................._. 2. Loeation of Premises .....5.3.9.....Main.....St....................................................... Village Centexvi.11e......................... (Name of Street) (What section of Town) 3, Dimensions of lot .....:........................................_.................................................................................................................. .2.....acres....................._. (Frontage) (Depth) (Square Feet) 4. Zoning district in which premises are located ........................D1...................................................................................................._........... 5. How long has owner had title to the above premises? .......3.i....y..ears..................................•............................................ 6. How many buildings are now on the lot? ........H. ua.Q.....an.d.....Caa age......................................................: i. Give size of existing buildings .............._ae'!K....aa:IK.tacha.d......................................................................................................._........... Proposed buildings ........................................none............................................................................................................................................ _.._... 3. State present use of premises ................Lodgin.g....HQuse....................................................................................................._.. . ._ 9. State proposed use of premises ....Owner..._ac.c.upie.d.......yeax..-.ro.gun.d.....res.ide.nee.....far.....B. other 10, t iYe extent of proposed construction or alterations: ..........None-................................................................................................ people. ...................................................................................................................................................................................................................................................................._........... IL Number of livi-n _ snits for=-uzhieh- bu�a.cl-ing:is,.i;o-be ar.rang 12. Have you submitted plans for above to the Building Inspecto,r? ......No............................................................................... 13. Has he refused a permit? ..............................................................................................................................................:..................................._....................... 14. What section of zoning by-law do you aslc to be varied? ..............P..—.4.....and....P--5...................................................... ......._............._.,.............................................................................................,............................................................................................................................................................ 15. reasons for s:aria.nc(! or Speeia.l permit: ............Th.e.....pe.ti.ti.one.rs....woul.d....like...._ta._.h,ave 2. .residents live year-round on the -?realises , .along....yi-1Ci,-,11 .'-.-.he.....pet t;?;oners , ................................................ .... .................................................................. .,and.....ser•ire.....them....me.al,s.r...........In:....ox.dex.....fcr....this.....to....be....p.ra.eti.cable.........the....pet.i- ..tioners.....ne.e.d.....the....r..e.-.e.s.tab.I is.bme.n:l".....of...-the.....innkee.pe.rs.....li.cen s.e....wrhi.ch.._h as .not.....been....us.e.d.....sin.ce....1.9.32.....and....the......us.e.....o.f.....the..:..ladga n.g.....haus.e.....li.eenae.....t0 i.n.e.lde...... .... e .an; .,...1s. e. ....Q. .....6..,......................................................................................................................................................... ......................................................................................................................................................__..........................................................................................................._...................... ...................................................................................-.........................................................................................................................................................................................._....... .- Respectfully submitted, Jy n F. Sullivan, Esq. , (Address) •Attorney,....for......,d..-.P...a.....&....E...O........Varacka i Please submit 3 copies of petition form. (Agent) ..Rarr1s.te.rs.....Walk.......Dennis.......MA 02638 Filing fee of .................. required with this petition (Address) ...............................................:......................................................... (OVER) The following are the names and mailing addresses of the abutting owners of property and,the names and addresses of the owners of property abutting the abutting owners of property and the names and addresses of the owners across the street all with their corresponding map and lot num- bers according to the records in the Assessor's Officer at the date of this application: Please type or print only. Map Lot # Name Address Zip Code 207 16 Constance Bearse 582 Main St. , Centerville, MA 02632 " 41 Arthur B. Fair, Jr. 14 Round Wood Rd. , Natick, MA 42 William E. Dacey, III 54.8 Main St. , Centerville, MA 02632 43 Town of Barnstable 44 Clement A. Skalski Off Main St . , Centerville, MA 02632 48 Centerville Historical. Society, Inc. , Box 491, Centerville , TIU " 49 Terrance A. Scott 198A Main St. , . Yarmouthport, NIA 51 Wayne L. LaFlamboy, Jr. , 547 Main St. , Centerville, MP 02632 " 53 South Congregational Church of Barnstable " 61 Stephen P. Hayes 38 Church Hill Rd. , Centerville, 14A 0263. 62 Lawrence Friendson 288 So. Main St. , Centerville, MA 02632 63 Town of Barnstable 108 Jeffrey F. Komenda 508 Main St. , Centerville, MA 02632 109 Bishop of Roman Catholic Church, Fall River, MA 138 The Kimball Co. , Inc. , 247 Buckskin Path, Centerville , hlA 02632 139 The Kimball Co. , Inc. , 247 Buckskin Path , Centerville, 14A 02632 " 149 Richard O' Connor 1211 Craigville Beach Rd. , Centerville, t 4? 208 85 Carmelite Sisters Aged Infirmary, Box 656 , Centerville , t r_ ` 127 William J. Hearn 497 Main St. , .Centerville, Pam. 02632 ' 4 f 1, { t 1 .,There must be submitted with the within application at the time of filing a plan of the k land, in triplicate, (or three prints) showing: 1. The dimensions of the land. 2. The location of existing buildings on the land. 3. The exact location of the improvements sought to be plaee`on the land. Applications filed witliout such plans will 11,e returned without action by the Board of Appeals. � :ip and lot numbei 2C/ C"Gf y�F THE D Q t ermiY number �-•�>�c� .h����. ..� /� w`� o� Z BAHBSTADLE, i (Umber .................................. .............:...................... 9 NABIL ape,1639. � 'FD MAY a• TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATIONFOR PERMIT TO ....:..........:............................................................................................................. L✓.�r� C� Frr:.e�-�-C TYPEOF CONSTRUCTION ................... ............................................................................................................:... ...........!......... ....................19........ TO THE INSPECTOR .OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ............................................................................................. 4...L............................:...................................... Proposed Use .......... EelI �.y:�..Z..... ............. ........................................................................................................................ Zoning District ................ `J /..............................Fire District CtH -tvvi& Name of Owner ....Y!?.��.... �'."....el{-0.............................- Address J Name of Builder ..I .!l� e ��SrU 1'1...........................Address ............................. Nameof Architect ..................................................................Address ............................................:............../......................... Number of Rooms ....I..............................Foundation /� CClGc / ......Roofing ............................... ... ............U. ..... ..�..�... .. Exterior ....... .l."?...:�' e ���JG-v�vi! .�,/T CG ��7: �i Z '�f '. c h Floors ..................Interior .........�I...... ...r'crG ..f:....................................... Heating ru`C Tr�f 17.c� t✓c.� t,. Plumbingk'�iU�c G� t �A- i� ' /3-vr✓a�i"7 o .....................................................�........................... Fireplace ..................................................................................Approximate. Cost .......... ........................................ Definitive Plan Approved by Planning Board -----------_-------------------19____ . Area ...... 43 Diagram of Lot and Building with Dimensions ,J�1 Fee ........!. ...................... ....... SUBJECT TO APPROVAL OF BOARD OF HEALTH r I( BILL CROSTON BUILDING CONTRACTOR BOX 138.OSTERVILLE, MA 02655-428.9657ct �` t , 1 ,f i I r � f N � R i 3' II I `h 1 oZ� I + � ie- 1i ." ram, �% •. y •s l f.'f ; ' •,,�.' y LX, r ,•t r s , rC3. w � ��� J r. �. . *�.1. + .�e$ t` f♦ r':r 4 '" `� �' r � '. dy 4� ,.► f , Sa � t i y F t � r I r. ''�€ .,�. t _ � •/. t.4. t' .".•'t�`'t v,F ^a _+';1, _r`._t,''a�v. • j, -. ' t ',�,} a.r r a t itv, l .., •t y r }` rr •+`,�, �� •d '� ..� + < S.l o +`t r ,..fit Y �,6t:. , ryr. " fr^"` ti 1# ,r �•"d•Jyi "^�S'." tA�, f 131 y, '•. 1. st.- I '-'•' ia'_�{ r � ( ,t q':•i� t�'.f y ' �`v < � `y i t r, �J ,he.j a�4 Sy�F r�� S`+,Y tq' .•r•+�r� - •q4•"*„•t.€`t�a.''x'4-4 f.J y�. ,_�Y r• ' \:t , `+ rt'}`,l i�Ae�� 'y 4" .:'ytA.,'g.t't '"x' ``v + µ y ' �, `s°'+•x +s ' ` :et; , i f ;k a`•+ .t, .,•.,t rt. .. r,�(e "�•++ r�', ' • .J .... ^ l r ,• t � �;,�'' w � ! t i.. Y r � '`' a r } tt k'`d"` ^r,. . - '• r i � ,. } �t trI � r �a q.. s , )+ tir * �, � ,• .: 4 � '�... •. , k� :- i •: ; � y�� �4 "7/ t4 a�t "'t,j'i '� ..,!'+a+.E i. � � '{,C 'i�AFi Via• s ,C��; �4 e.tt z.*i R S�e. `" �� "" ''�. t L. 1 '3'!i WA r�, T ��'P •&.. � •�h d. pb�• � �1 Y L". ��,. _ { �} r+s.. r�rt•� .g :sir yil" .4* ar t, 't;, } � }".>.:.t` g` ,'�+�_ -' �^a..°rr .l fiy t:.. � sxr.a�,, t +.f k' -` • F O 't '�. `4 r yk , .1 r . f, "' A { y >•-r r } FX ,i 1983 „ �r - n tt�r t '', a �. '`S ..- xr".: a+t.. a •� �` ,r ^, .a. + ! t y r C 4r j l'� Fj .F; �.; r ! i.' ..y, �^"is+J + d.t, f g a# A''i a y}Y t, '' r �' � }' [S r t��^e i h�s- ry •. rrt,x,.4 -.'rv. y n ar 'sr 'r�.R t.#( F' A . 1`yjpi ��'',. � F �'b� '?� ���` r b.;, +. F.•: K f ��..N :ir ,f 1J ,7 � .�.��k�e r.,'� F � `�� i ;'. �. rr} f, I � y ��7 4Js s.t t ' j4• Jy4 ��t J \ }..y f�l >t � 1 ;f f F, r .Fs A� ^ q• ♦ s: w .1.M y � r t ..r �r.�'� ."e ry ,fir �{ .r e. r,+ 4 J ,! •� %7w v a F }Ft t ,r�} i'• EtfS: Ili v * i '4p, > - �= A .kor � �� r`; �s `' � • �J�Dn `i.. of � .. Atlupriey far 'Last J , r ti + ,r ' 1 + $arrigteis; Wilds. (of f `Rout1 '6A) 3" rf ti Dennist"M 'l0263 � .fl a-� 'r1 e ti. r t 4 '� .,}`� �Y a�' J f�."f yt:' w,R ���3 My v `' +t } v; �'. w r ; rjtp ... ♦ - 1�' t F IF •3* ` n3s4 <+r� ' e 4Terrace Gardens,='•539 :Main "str eet, ,-,Centeivii .er ` , . 4 ? ,,.�1 _-,,Jr{F Y.Xe ♦ n .:) ... 3r•�+•-' `a ri ?!. y'! '- _ 4 r� ti�' d 2 .F ` t>•i7- J r ry>.! r ±' �'^j, r a^� a d 1''S•` _>v,/ Dear„ •�t SU .i'van:,._••, �' y.r: f t 9t .•?M r + is + '*" ' f. q f. • J.'I, ,r'., a Y. Y.'` , 4'J rF i • '7 }:, - T $f.rr s s '. r{':•a, ^' •, y , r^a• r+`1 ♦ ;. t V� . 'We w il, give 'ynurh'Clf erg:�itotil,, Tavei�Y erg 1.' 1383,- �t+� upgrade' the a ts lap t c .systemj�aezxace , ad> n � 39 Mai; Street, ' eteacv3l ', f ' ,' , • YOU, wad the foll;ot ngt co 'd to ons: Z't �+ w;:t 4+'� �w� f h� s' r �f -sa',�ts+�t+�.,/.ate.r r�, '•. ,._r,. r Cr a• �.� J y� ,a � t r �* + ,4�� e - � -'' •s 4 rc-r •,,, -'•F r'tt n. o � .�5, +. �' ity,cati C?n y be u$1 cd as',aj iodgin4 house•.Jr, meals im not�.authori: d� until' the ,septst w + + systems: .s ipgr ed: a^ t L•; • r , f v "ap r .r t '•Cl t4�' •s i°F r.y I' * ?'.- .r'Jt .t, �-r ?r t r a . .Z I•. ,, f Y extension: s rriva2ct should `proaems F {�}'� c� 1� err ^�yr. er etY �1 �'• � Y+'•� Pr.�C►�is W > .dF�L� �O"yi7tevllla s a r ra t 'i 'C + Yam'.. °^". t • Yi`- ,{ S , - - _ 4 J V(3) %e',facility� must confirm to::ail; of �h� .�+eg�a�l��ions r + "., sr s s ti ;... contained, .fin• 65 �410.©4Q ,,, Minimum, Stand�cids f r"' tness for'� n,3ab3tstiori.�� c lr t.�a ^p x „' .r ^ i - v `,5 i ra. ':"" t �t rr �r � f S s r;'. f • ,t, t ti a� �t , •4 '� ti !' ve h truly 'yout8, A , `' y :`7r awl •a' vt L n v ti.° r r t l +s a is �. - r e� 'ti, 4 S '1•• t .. ^- a �^ .r +!-'t .•' •�{ - ' . s 'r f ?'r .i +f a �" tr a t .r � .' f - fi.''r '` .a � t�, a,+�r1 + .�7,t s �^ •� I'' y � �y�rs /�1'��•� Q� w�•�•��� Jam. ` •+. ...a�� f, '.'S i r�t� � k "Y t.: �' J�;:.+ �� `r i'. '�'.� + r �'r `` :. a,A_ _,F ,.•X `•yy r'.t. y. r Ann. '.. v� �t t 5 �- - ' • 0.�'. r t' l r r`x �", .yam ♦ r=C,Y ;:.� to ,.,, i�a:, r _�+ w. i� ,t+�ti }� '�.d r -. rf � $� +x •�� �`'7l ;..t r `�� P }. �••' � a' ,.i`'Sra it ;`, � .f r viz T � � r'+. r F:. *' d ]. .+r -... ,.`•�- t t o r:. !.. r,`. y.r 4 4.r°� f#- ti 3 t' '� s. s,t - x ^,. ' j� r '^may i�#-ii • rl.ngPr J..F f! t "+•w i +� a."~! x J ',i( �'`' +. �V G .. t BOARD Or KE��LTH.' r .�s�wyw�� 1'i.♦�]'-�. 1.`�yi,�Yy��gy� .rµ���(.a�{��)y3�'�.r 4 : �a 4 '"AN' ^..Y f fi r.Y.` Sa • '�, 1" � Mtn `t„^ ^*r /- t� . R w 6' .i li i•NM.iSTAS=i • fYJ�rYG iTr'�'4 ^nS��4• N ,! �' /A ^. 4 S {~ T. h t {� -� ��� x 1 i l y.J.-tr,tt,I d : + 1'Y. ,, r 1 �,. la • ! ,%�.f �✓ •''4 k f•" t'• 'y f I..,in. Y,. t 3 .. ,,t .a"s# tr r j:'�x7 .r+ h�"i 3 � � i �a• '� s e r'`. .{• ' i- rt' t i ti't r :,,t,.r •x r - r ,�.I _y.l, ,r •4=< r ''; ti."~"., .T� .• +�i. �' '-3ti. '`�".. � x * •_ r &�. • `-: x" * .�i . �� ire - � 1 q:r .j ''S I"f, f.ti� '-� t ♦� s«s -� y t �� a �7 r ��P t� ��wt ti"`a c w .,�. r� a tr. s�. a �y�+: f. r a t �, r y w .• � t.�" t^ �..` � ,J,.: r �,t y ,- i s } ,J' r T �-a F i �,^,.'> v a t_ � � ""� ,r , �_• -wet. � < � ,.,t �'6r� ~k sue.+:,y +, � : ''r � r k" b t..y }s, a '� r .'.. ; rr... c •s � �• }f—r t wy f � Y{t `' t r."tr �ti �„i d J'rr S t a' J4. �-1':k� 7 ,r.y � •f�+• f 4 t M n �` f t i\ ' +'{^` �r.r 3 x jt, �'.; y '•, F'' r ^ '-.,tr er•rt � � +r:tr r+ ''y�A�J � �a y` •��' A :f.. }♦ f k 'Oi 7 s .s h' c y ,.3- .: c + .S 4 ,`, . r+ �,. '^;- ; w+ : J a '••t S , '�r#'S � - G a a4 tJ"�x^., .,t c r'f' X t ;j- } �.. ,-•• �'rA.? kf• - X ;¢ fl' : �,;�� r r t...F ! �,'� f-. 7 '.."r{� �r q_,�,+`"' { t•�J"jur :�r � ✓ ^ f J a ={ ri S + �£ J.. .,t^ Ik \ 4 - it -r A :' r • J a��`+Am �f"� .rrt� k i x•p.r~ t `•�.,,, gtt`t{ , ,. F ` Jy +T- Y+t, ..� .r f ^ � a +',K t� '1 t � L ,-J J. :.`- - b �'�'•`F �' a - + '•-. c r arsw�.'t. FS,J.�'7. ..rd r+ �'a•w i �' It .��� . 1 stir'�'�iis •2 .�tJ' � T,'i„3�r ��'1 �" k}4 r IT ^�'' �. - ��:• t v' 'i` F s y� ,'f }, • t r�j' r+ 4 �t•t r, '�$ -O•r,af * t a y, -r +•'t _ .: ' ,t. ,3�,S4 f�fi T ,r T f +. �f L.J�� `� fry � ,� r � t� sa„'t }i. - �'• `t't`4 s. r°L a w '� y .,k t� t t uw^Yt r � `t`' ,a ��iivratd �'OCaddac .%def/d 016.3'� March 2 , 1983 Mr. Robert L. Childs, Chairman Board of Health New Town Hall Hyannis, MA 02601 Re: Terrace Gardens 539 Main Street, Centerville, MA 02632 Dear Mr. Childs and Members of the Board: Along with the request, please find a plan from our engineer indicating the construction. to be performed in order to bring the sewerage system up to Title V. Since the property will be used for the same purposes as it has been used for the last ten years for the next six months, namely as a guest house serving no meals, T respect--- fully request the Board to allow us until November 1, 1983 to have the work performed, Notwithstanding the above reason, my clients have already received a commitment letter from the bank, not including this outlay of funds, and do not have the necessary funds at this time. They hope to have the funds at the end of the summer season. Respectfully submitted, Jo Sullivan JFS/esr Enc. 4 } rr t }. X y. i t .1'j � h .q t... • a ! r _ f �4r. _ , 3-,t+fit � •, , � x t.� � :x.o , �r�,� �* .v ` l � � . r ., ��� r k •`� ,• t• f_•• C `r t �..,' aP� J�.�+, qrx+`_>,,.to J'�f Y,i `'} �," r •+• ". V.�r+fi f ft 7 "r : + Y+r"$# T•,. J' � �- . , r 1,�, .{A'7T 3 �, At- a' .r ''a r •3 � .►. "Jr }'o ti 'Y' > �` .'x -; e _ ,� t { I;�.-' s �..� 5 .ir ��"�. ; S �}; T r 'J� - �. K`�� �'• 4 rr�`•,': � 4 s44' ti L �,•, ! .. ., ,.,$ w 1 ' 4. ! , t rFt'`� w�� , ,4 r��F..,�! - i �."' � �r_`f •L.. V� t -r�j; �` �f •,�y -.,-i,3q - �� r '• �'`- - , , „�. ,n•.,� .f. •, T c _ .S,..f"` a rh. Y1f`^ 4 � r,.; ti �:�r•r rt:"•` i.t '' ds7e�.Ch` 1�1 .i, �3.4 r '�._�4iY J'.s. 5 •.r ^#.>:i rwr f.�" r 1 •,1 ° �. r 't r�`' �.r j �...,j e.' r `�' tc a- +'wy„M. "{,rt .r4 � � Y" .a� ��rf t +•nf' 2,t� J4r �`4 � i+ i h d,.R � r� .r .. r'�, w+s �- `r•^'K, ti` �; rt a 'fit �w � .,—tr Rt.,` � <k '�a � °�.. - � � t ti,5 ,Lp`*�r�{, t t "r Y� rt •r> 1�r.Y �' ;j'� `� ,r � , �s r 1 v .: F tl'at y 4 T w=. `r .'Ti•y 5 t ,, .'7 y . 'w tiCf:P "� r:.r "ti . � + * ' -s r r t... - � t' t i,f�, t A .r•, { e V "` 'O'i• J ,'' :r •� '� r, '} i. Mr•' John p., V, acka <312' �B,/e�r,13.n:`TZaad ar o, jMs 'oiL /SL:y a j h i! r 1 N 2 t j' yxe *sop 'J .; �R t'� �..%� s ,+t` w 'a S.•;`+,`..'"' rr ' :; Re'z T Gax'de Te racc Guest House ~,539 Shan Strer�t'`-Ceri`tervi� e t Dear Mx'. Varacka z i `y Thank ryou .fbr meets zg ►3,'th tl t Board of,^H&ilth on 'March I r I983, ' concerning J-the~Dari en Terrace Guest,Hmase at, 539`-rMii .n,:Stieetl .. ,f's 'S'�.; 'fit /a J J br .�' fi+ ,CJ° '�' d, ' � i '�.r , *:. .. •R t . 1,�w,±� f � 1" r F �r:.nt r •'. a.•- � A i+:'w r� { ..5 t..� t � ,.. tL.r ,.You' are granted' a uari:a3nce, from vItegul:ati'on I4; 'of the` Boar t,of•;� �'. ` "Health A iu mum.'Sana.tation 8•tandards for,-Fo*d, S&iVice,-Establishi� ' m$nts, that Jrequires.,a�mini UM 'cif a 'I{?©d �01-lon 'outside 'grease:. r iv a gintercepto r• Th s Val 3 a lce S g antedx'x?elt3LiSe* y0Lt toted ItlealsR, - Tp � � ts'tsb',#lh'irce•e`'_t� nre?s-wuld u ' ay ld t be,open to�the; general and you �, u pu + + s,K* f Yr` }, '�;'} rt #Y i " *..ti r`Zk °�+.tC {; ,,7. r't t s'y'••",,Sri.A - ti, ; r �. ` a *•' r .a *tom 'ri,Y : c �r prior to`.hoard of�+Hea.l:th' apprdva2 `of any�•1"icense For pt�rrn%t, the .' `sewage `system;must b racied , b meet_ al '.,p the:require meats of k kd CMR i l"'S` tS�? thdlp to En m {: .' * .�' 'v ronmenta� Code; `'Mini ura; '� r ��fi -:'• ;r v� = Itequiremen'ts for thep;8ubsurface nispasa1 :af 5an Ltary S wage and Town.Qf',Barnstable `Head th• Reguiata.oris.` °�ln' ;add ,t on ,il :o£,',the •require ;�IA6 of rri©5'CM�, 595 Q�3t�,�'Mi�i�muni Sanitation Standards- � . 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