Loading...
HomeMy WebLinkAbout0614 PHINNEY'S LANE - Health 614 Phinney's Lane Centerville P A = 250 064 I 14REcvctFo�o llll m � UPC 12534 No.2.... 1... 53LOR a°osr.coNS�`� HASTINGS, MN I l 1 Fax Send Report NOV 19-2010 09:23 FRI Fax Number • 15087906304 Name BARNST HEALTH Name/Number GMD Page 0 Start Time NOV-19-2010 09:21 FRI Elapsed Time 00,001, Mode STD G3 Results [No Answer) t Town of Barnstable Health inspector 1neOf rs .Regulatory Services 8:30-9:30 r 8r Thomas r.Geiler,Director 3:30—4:30 • Public Health Division gip+ Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT-SFPTIC QUESTIONNAIRE Date:November 15,2010 1. General inlitrmation: Size of Property:0.53 acres Address:614 Phinneys Lane Centerville,MA 02632 / Map 250 Parcel 064 Name:N icbacl I7,Raleigh Phone it:5087737-264✓8 2a_ How many bedrooms exist at yourproperty now?3 2b. Are you planning to adrl any bedrooms?NO If yes,how many? 0 2c. How many bedrooms total are proposed at this property(including the amnesty unit)?Previnusly permitted studio apartment 2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Show all existing rooms in the home and the proposed amnesty apartment. Provide width measurements of any open doorways. Please label each room clearly. 3. Is the dwelling connected to public sewer? NO If the dwelling is connected to public sewer,skip questions#4 through#9 below. 4. Location of dwelling is INURE or , OUI:S'IDE a Saltwater Estuary Protection Zone? 5, location of dwelling is INSIDE or OUTSIDE a 'Lone of Contribution to public supply wells? 6. Is the dwelling ccmncoted to as PUBLIC WATER YES 7- Is a disposal works construction permit on file? YES' w NO 8. If yes,how many bedrooms were approved according to this permit? Bodrooms. 9. Were any building permits nhtlined for construction of additional bedrooms? YL:S or NO mac: 10. is there an engineered septic system plan on file at the llealth Division? YF.S or NO 11. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO FOR OFFICE•USE ONLY The public Health Division has no objection to �+ bedrooms at this property. Special Conditions: Date: - 11Il A)"'o Q:UiMr)-Housing\Accessury An'onlaftic Apsnmcnt Pro&haw\ADNffNT-ORMS&LF,'1THRS\Hlank Forws amnastyappl.DOC McKean, Thomas From: McKean, Thomas Sent: Thursday, November 18, 2010 4:13 PM To: Dabkowski, Cindy Subject: RE: AAAP Program 1) Map 228 Parcel 105, 473 Pine Street Centerville MA Dennen The floor plans for 473 Pine Street shows four(4) unlabeled rooms, a "computer/den" room which is enclosed with privacy plus three bedrooms on the submitted plans. However, the septic system is only permitted for three bedrooms. The floor plans need to be revised/completed properly and the computer room will have to either be removed or redesigned so that it will not be considered as a "bedroom." 2) Map 228 Parcel 105, 473 Pine Street Centerville MA Dennen,-Too many bedrooms , only three bedrooms allowed, but the submitted floor plan shows four bedrooms. Will the applicant pull a building permit to remove the wall to remove the fourth bedroom? ----Original Message----- From: Dabkowski,Cindy Sent: Wednesday, November 17,2010 11:43 AM To: McKean,Thomas Subject: AAAP Program Good Morning Mr. McKean Will you be able to sing off on the following AAAP properties? * Map 250 Parcel 064 614 Phinney's Lane Centerville Raleigh (Revised floor plans- include five foot opening between two upper bedrooms) * Map 228 Parcel 105 473 Pine Street Centerville MA Dennen Please let me know as soon as possible I would like to speak with you regarding a couple of initial site visits. Some issues that I hope that the Health Department is able to assist with such as moisture, mold, mildew, etc. Are you available to speak with me? 1 Town of Barnstable Health Inspector F114E t Regulatory Services off ce Hours g or yery 8:30—9:30 �.� Thomas F.Geiler,Director 3:30—4:30 BARNSTABLE, i Public Health Division 9 MASS. 1639.�a Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM.APPLICANT - SEPTIC QUESTIONNAIRE Date:November 15,2010 1. General Information: Size of Property: 0.53 acres Address: 614 Phinneys Lane Centerville,MA 02632 Map 250 Parcel 064 Name:Michael D.Raleigh Phone#: 508-737-2648 2a. How many bedrooms exist at your property now?3 2b. Are you planning to add any bedrooms?NO If yes,how many? 0 2c. How many bedrooms total are proposed at this property(including the amnesty unit)?Previously permitted studio apartment 2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Show all existing rooms in the home and the proposed amnesty apartment. Provide width measurements of any open doorways. Please label each room clearly. 3. Is the dwelling connected to public sewer? NO If the dwelling is connected to public sewer,skip questions#4 through#9 below. 4. Location of dwelling is INSIDE or OUTSIDE a Saltwater Estuary Protection Zone? 5 . Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? 6. Is the dwelling connected to an PUBLIC WATER YES 2` 7. Is a disposal works construction permit on file? YES =' or NO — 8. If yes,how many bedrooms were approved according to this permit? Bedrooms. ? ® P1i 9. Were any building permits obtained for construction of additional bedrooms? YES dr NO M 10. Is there an engineered septic system plan on file at the Health Division? YES or NO 11. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO ------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY The Public Health Division has no objection to bedrooms at this property. Special Conditions: W4 tv,vS�— �e Signed: Date: 11 /Z Q:\GMD-Housing\Accessory Affordable Apartment Program\ADMIN\FORMS&LETTERS\Blank Forms amnestyappl.DOC j� 1 E I coca, age,., `e� 9 f i � f LO°d i 'N i 1 ev ¢_ p i' F i Town of Barnstable Health Inspector Regulatory Services Office Hours t� �tq � g y 8:30—9:30 Thomas F.Geiler,Director 3:30—4:30 1BM ,sTAB • i Public Health Division MAN. � 1639. ,0� ArFn�,t a Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT SEPTIC QUESTIONNAIRE Date: September 27,2010 1. General Information: Size of Property: 0.53 acres Address: 614 Phinneys Lane Centerville,MA 02632 Map 250 Parcel 064 Name:Michael D. Raleigh Phone#: 508-737-2648 2a. How many bedrooms exist at your property now?3 2b. Are you planning to add any bedrooms?NO If yes,how many? 0 2c. How many bedrooms total are proposed at this property(including the amnesty unit)?Previously permitted studio apartment 2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Show all existing rooms in the home and the proposed amnesty apartment. Provide width measurements of any open doorways. Please label each room clearly. 3. Is the dwelling connected to public sewer? NO If the dwelling is connected to public sewer,skip questions#4 through#9 below. 4..Location of dwelling is INSIDE or OUTSIDE a Saltwater Estuary Protection Zone? 5 . Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? 6. Is the dwelling connected to an PUBLIC WATER YES 7. Is a disposal works construction permit on file? YES or NO o 8. If yes,how many bedrooms were approved according to this permit? Bedrooms. —t O 9. Were any building permits obtained for construction of additional bedrooms? YES or NO 10. Is there an engineered septic system plan on file at the Health Division? YES or N 3 to 11. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or N(8 n w -----------c� r ...... .... FOR OFFICE USE ONLY CD M Ic ea o objection to --'-' bedrooms at this property. Special Conditions: Signed: Date: Q:\GMD-Housing\Accessory—TAffordable Apartment Program\ADMIMFORMS&LET�TEEERS\Blank Forms amnestyappl.DOC IVDttr 14-1. se cl 7�f ilk t '} cak i ----------------- s f Ilk S co 1pp R ks ": of NL k tT „ �a ;- •,,�.� �._ -!�, TI---� I i _ - - � i .��. - _, r � I � ,, � /' � � 44 a`�` I d.�`'� 5 � j � f � 6 E � �$^ �” ��.. # � "' r x r ,� U��.�y�� 20 �IVY ---� IL C � r-jr- lam,1 U�t ov V"-X 19 ai owKe r OVVIY C I � ,� 211A a McKean, Thomas From: McKean, Thomas Sent: Friday, November 05, 2010 3:34 PM To: Dabkowski, Cindy Subject: 614 Phinney's Lane Good Afternoon, The proposed floor plan for the above-referenced property is disapproved. The septic system is designed for three bedrooms and the property, consisting of 0.53 acres, is located wi i`— i'�'fFm a nitrogen sensitive area. The submitted floor plan shows three bedrooms plus a basement apartment. Four bedrooms are not allowed at this property. An amnesty septic questionnaire was received on October 5, 2005 which was disapproved by the Health Division for the same reasons. Sincerely, Thomas McKean Pti 1 Town of Barnstable. Health Inspector �= of r Office Hours h�P� '►-� Regulatory Services 8:30—9:30 Thomas F. Geiler,Director 1:00—2:00 snaorsrnsM ,�� Public Health Division ArFp Thomas McKean Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 , tiaFax:�5;08-790-6304 AMNESTY PROGRAM APPLICANT-SEPTIC QUESTIONNAIRE` rti� r�- r.' 1 1. General Information: Size of Pro erty: Address: Map(�7357 Parcel 1�� Name: Phone#: - 2a. How many bedrooms exist at your properly now? 2b. Are you planning to add any bedrooms? If yes,how many? (J 2c. How many bedrooms total are proposed at this property(including the amnesty unit)? 2d. Please include a copy of the.floor plans for the entire property- showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label . each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or NO ����tlte�dwe`�hngs connected to public.sewer,sl�tpyquestaons�#4 tlrough�#9 be"lnw x a. 4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells?Cr 5. Is the dwelling connected to an ONSRE WELL or to PUBLIC WATER? 6. Is a disposal works construction permit on file? YES or NO 6a. If yes,howjnany bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES or NO .8. Is there an engineered septic system plan on file at the Health Division? YES or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO -/ ------ — -- -/---------------------------=------------------------------------------- ' FOR OFFICE USE ONLY C�ICT The Public Health Division has no objection to bedrooms at this property. 70)3 Special Conditions: Signed: Date: O;AeaIth/wpfiles/amnesryapp w6s, npl- - --�L 8 to+r A.1,-� a n��-►�-Spn Srtve l�M;*A 2 3 R46" Par f Lro f 4A)m rho 6w Alhay, �W? �� ,96� �ar� � ����/ � � � � � � �� ��D L' G N'2 �, qtJ� Y' Bnl-� G'k 20795 Ps L4 a 1;347 BARNSTABLE �t r TOWN CLERK MAH4 "'¢ '06 FEB -2 A10 :19 . CFO MPy� n Town of Barnstable Zoning Board of Appeals Comprehensive Permit Decision and Notice Appeal 2006-013—Furtado Decision-Chapter 40B Comprehensive Permit Applicant: Mark Furtado Property Address: 614 Phinney's Lane, Centerville, MA Assessor's Map/Parcel: Map 250, Parcel 064 Zoning; Residential D1 Zoning District Applicant: The applicant is Mark Furtado, who resides at 614 Phinney's Lane, Centerville, MA, and was granted title to the property.by deed recorded in the Barnstable Registry of Deeds on September 8, 2003 as recorded in Book 17604,Page 096. Relief Requested: The applicant has applied for a Comprehensive Permit under Chapter 40B of the General Laws of the. Commonwealth of Massachusetts, and in accordance with Article II of Chapter Nine of the.Code of the town of Barnstable,more commonly termed the"Accessory Affordable Housing Program:" The zoning relief necessary for this Comprehensive Permit to be issued is that of a variance to Section 9- 14 of the Code—Amnesty Program to permit an accessory apartment unit to'a single-family owner- occupied residential dwelling. The issuance of this Comprehensive Permit would allow for an accessory affordable apartment unit in the lower level of the principle residence. Locus and Background: . The property at issue is a 0.53 acre lot located at 614.Phinney's Lane, Centerville. The lot was developed in 1940 with a single-family home.The effective living area of the main residence is 1,526.square feet. The accessory apartment is a studio unit located in the lower level of the principle dwelling. The square footage of the,rental area.is approximately 415 square feet. The lot is served by public water and on-site septic, and is located within a Groundwater Protection Overlay District. The town of Barnstable's Public Health Division reviewed the application, and on November 1, 2005, approved the property for a total of three (3)bedrooms with the existing on-site septic system. Procedural Summary: A site approval letter was issued for the property by Elizabeth Dillen of the Growth Management Department on December 20, 2005, in accordance with MGL Chapter 40B and 760 CMR. Notice of the site approval letter was sent to the Department of Housing and Community Development in accordance with the requirements of CMR 760. An application for a Comprehensive Permit was then filed at the Town Clerk's Office and the Office of the Zoning Board of Appeals. A public hearing before the Zoning Board of Appeals Hearing Officer was duly advertised in the Barnstable Patriot on December 23,2005 and December 30, 2005, and notices were sent to all abutters in accordance with MGL Chapter 40B. ' 114 O2 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS I Uq.. DEPARTMENT OF ENVIRONMENTAL P RECEIVED JUL 2 9 Z003 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 614 Phinney's Lane Centerville, MA 02632 Owner's Name: Lawrence&Julie VanKleef Owner's Address: Date of Inspection: July 22, 2003 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Map:250 Osterville, MA 02655-0049 Parcel: 064 Telephone Number: (508) 862-9400 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. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority U Fa s Inspector's Signature: 01W Date: July 23, 2003 The system inspector shall submih 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 } 'f Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 614 Phinney's Lane Centerville, MA Owner: Lawrence&Julie VanKleef Date of Inspection: July 22, 2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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 distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 614 Phinney's Lane Centerville, MA Owner: Lawrence&Julie VanKleef Date of Inspection: July 22, 2003 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. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal 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 v Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 614 Phinney's Lane Centerville, MA Owner: Lawrence&Julie VanKleef Date of Inspection: July 22, 2003 D. System Failure Criteria applicable to all systems: You must indicate either"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 '/z 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. ✓ 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.] No (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 System: 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 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. 4 r Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 614 Phinney's Lane Centerville, MA Owner: Lawrence&Julie VanKleef Date of Inspection: July 22, 2003 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant, or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period ? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ Were all system components,excluding the SAS, located on site? ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example, a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 614 Phinney's Lane Centerville, MA Owner: Lawrence&Julie VanKleef Date of Inspection: July 22, 2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 4 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system (yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Qpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped in July 2002-per owner Was system pumped as part of the inspection (yes or no): 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: 1991 -per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 614 Phinnev's Lane Centerville, MA Owner: Lawrence&Julie VanKleef Date of Inspection: July 22, 2003 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints, venting,evidence of leakage, etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 3" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: S" Distance from top of cum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There were no signs of leakage. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 614 Phinney's Lane Centerville, MA Owner: Lawrence&Julie VanKleef Date of Inspection: July 22, 2003 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: None (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: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 614 Phinney's Lane Centerville, MA Owner: Lawrence&Julie VanKleef Date of Inspection: July 22, 2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits, number: I - 6'x 6'(1000 gal.) 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.): The pit had 4'of water on the bottom. There were no signs of failure. The bottom to grade was 9. The cover was 12"below grade. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth -top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 614 Phinney's Lane Centerville, MA Owner: Lawrence&Julie VanKleef Date of Inspection: July 22, 2003 Map: 250 Parcel: 064 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. i� rrOnT � I � 3 a � as a3 3 3 Yy y Ysy 10 Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 614 Phinney's Lane Centerville, MA Owner: Lawrence&Julie VanKleef Date of Inspection: July 22, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25 +/- feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using the Barnstable topographic map and the Cape Cod Commission water contours map, the maps were showing approximately 25'+/-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. Il Commonwealth of Massachusetts Executive Office of Enviromnental Affairs Dept. of Environmental Protection One winter Street Boston Ma. 02108 .title Septic Grad � � D.E.P. Title V Septi c Inspector kip P.O. Box 2119 Teaticket, MA 02536 _ (508)564-6813 WILLIAM F.WELD Governor 1O 11 12 ARGEO PAUL CELLUCCI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 0 j PART A -e CERTIFICATION A ';0 (� V LCA (3(`� Property Address: 614 Phinneys Ln.Centerville 02632 ` '\ ZS Address of Owner: sz C Date of Inspection: 3125/98 (If different) c�+7 co Name of Inspector: John Graci Kimberly Mercer 1Ti C.0 I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) \ 00 Company Name,Address and Telephone Number: CA CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: x Passes This Inspection Is based on criteria donned In Title V code 310 CMR 16.303.My findings are of how the system is _ Conditionally Pa es perfortningat the time of the Inspection.My Inspection does Needs F rther aluation By the Local Approving Authority not imp Iv any warrsntyor guarantee of the longevity ofthe septic system and any of Its components useful life. Fails Inspector's Signature: Date: 3125198 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B,C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of CoThpllance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04)17197) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 614 Phinneys Ln.Centerville 02032 Owner: Kimberly Mercer Date of Inspection:3125199 _ Sew.ane backup or.breakout.or hiah.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced —The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of the following: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or pending of effluent to the surface of the ground or surface waters due to an overloaded or clogged cesspool. SAS is in hydraulic failure. (revleed 04Q7)87) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 514 Phinneys Ln.Centerville 02532 Owner: Kimberly Mercer Date of Inspection:3125199 D]SYSTEM FAILS(continued) Yes No 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 112 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No _ — the system is within 400 feet of a surface drinking water supply is within 200 feet of a tributary the system Y to a surface drinking water supply — — Y _ — the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised WNW) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 614 Phinneys Ln.Centerville 02632 Owner: Kimberly Mercer Date of Inspection:3125199 Check if the following have been done:YOU must indicate either"Yes"or"No"as to each of the following: _c_ — Pumping information was requested of the owner,occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this inspection. x As built plans have been obtained and examined. Note if they are not available with NIA. x The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. _c_ — The site was inspected for signs of breakout. x All system components,excluding the Soil Absorption System, have been located on the site. x The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue,approximation of distance is unacceptable)[15.302(3)(b)] (revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 514 Phinneys Ln.Centerville 02632 Owner: Kimberly Mercer Date of Inspection:3125199 FLOW CONDITIONS RESIDENTIAL: Design flow: sag g•p•d./bedroom for S.A.S. Number of bedrooms:-2 Number of current residents: 4 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings, if available:(last two(2)year usage(gpd). rda Sump Pump(yes or no): No Last date of occupancy: spring of1997 COMMERCIAL/INDUSTRIAL: Type of establishment: nla Design flow:o gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No . Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings, if available: n1a Last date of occupancy: nhi OTHER:(Describe) rda Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Na System pumped as part of inspection: (yes or no)No If yes,volume pumped:0 gallons Reason for pumping: nla TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records, if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components, date Installed(if known)and source information: 1991 Sewage odors detected when arriving at the site: (yes or no) No (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 614 Phinneys Ln.Centerville 02632 Owner: Kimberly Mercer Date of Inspection:3125199 SEPTIC TANK: x (locate on site plan) Depth below grade: 6" Material of construction:x concreate metal_FRP Polyethylene—other(explain) If tank is metal, list age nia . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: Le•5"N5•r•w4.10" Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle: 26" Scum thickness:2" Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: 16" How dimensions were determined: measured Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) I Septic tank and all components are structurally sound and functioning property.Recommend pumping every two years. C GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: _concrete_metal_FRP_Polyethylene_other(explain) Dimensions: nra Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:n1a Distance from bottom of scum to bottom of outlet tee or baffle: rva Date of last pumpingiil, Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Na BUILDING SEWER: (Locate on site plan) Depth below grade: v Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction line?o— Diameter: a rrermments: (conditions of joints,venting,evidence of leakage,etc.) (revised 0427)97) L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 614 Phinneys Ln.Centerville 02632 Owner: Kimberly Mercer Date of Inspection:3125199 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: Na Material of construction:_concrete_metal_FRP_Polyethylene_other(explain) Dimensions: nie Capacity: Na gallons Design flow: rya -gallons/day Alarm level:_nia Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) No DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: nia Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) Na PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_ves Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) Na (revised 04127)87) I— - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 614 Phinneys Ln.Centerville 02532 Owner: • KlmberlyMercer Date of Inspection:3125199 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan, if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: n1a Type: leaching pits, number: one 1000 gallon leach pit leaching chambers,number:We leaching galleries,number: rda leaching trenches,number,length: n1a leaching fields,number,dimensions:rya overflow cesspool,number:nla Alternate system: nla Name of Technology:_rva Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Leach ph and all components are structurally sound and functioning properly.System never had more than T of water In It. CESSPOOLS: (locate on site plan) Number and configuration: n1a Depth-top of liquid to inlet invert: rda Depth of solids layer: n1a Depth of scum layer: n1a Dimensions of cesspool: rya Materials of construction: n1a Indication of groundwater: rda inflow(cesspool must be pumped as part of inspection) n1a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) n1a PRIVY: (locate on site plan) Materials of construction: rda Dimensions: rya Depth of solids: n1a Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) We (revised 0427197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 614 Phinneys Ln.Centerville 02632 Kimberly Mercer 3125198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) V n0A A �7 AA r� � C y� 6A Pepe ! of 16 (revived 04f27197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 614 Phlnneys Ln.Centerville 02632 Kimberly Mercer 3125199 Depth of groundwater 124 Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property,observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS maps and charts ti (revised0027197) page 1t1 of 10 OE INE 1p� �. � The Town of Barnstable ► BARNSTABLE, Growth Management Department i63q. �0 pr�OjNA�p 367 Main Street Hyannis, MA 02601 Tel:508-862-4678 Fax:508-862-4782 October 5, 2005 Mr.John C.Klimm, Town Manager GaryR Brown,Town Council President Barnstable Town Hall 367 Main Street Hyannis,MA 02601 Re: Joan Koslowski- 23 King Arthur Drive, Osterville- a single-family accessory unit Lynn Marble- 63 Ebeneezer Road, Osterville- a single-family accessory unit Francenete DaSilva- 297 Hinckley Road,Hyynnis - a single-family accessory unit Mark Furtado - 614 Phinneys Lane, Centerville- a single-family accessory unit Gentlemen: This letter is to inform you that the Accessory Affordable Housing (Amnesty) Program has received requests for project eligibility letters under the Community Development Block Grant (CDBG) Fund and under Article II of Chapter Nine of the Code of the Town of Barnstable and the criteria for the Local Chapter 40B Program. This office is reviewing the requests. If the Town has any comments on the projects,please forward them to me so that they can be addressed in the site approval letter. This letter gives you official notice of our receipt of the above application(s). We will issue a decision as to the acceptability of the sites and the consistency of this development within the guidelines of CDBG. _ Sincerely, - `Y`s YLabeth Dillen Special Projects Coordinator Growth Management Department? , cc: Town Attorney's Office Building Department ✓Public Health Department TOWN OF BA/RNSTABLE SEWAGE # F-7 V,1 LAGE CtoloTtrVAL ASSESSOR'S MAP & LOTa'S0� 0 / }INSTALLER'S NAME&PHONE NO.. SEPTIC TANK CAPACITY UVb LEACHING FACILITY: (type) X�� (/GV S�� (size) NO.OF BEDROOMS 3 BUILDER OR OWNER �VIIL I/��GLT PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachinT facility) Feet Furnished by T A 4P dAT' 3 , TOWN OF BARNSTABLE LOCATION ]-! /11�a COltt SEWAGE # !� VILLAGE y. ASSESSOR'S MAP LOT INSTALLER'S NAME 6z PHONE NO. 1 �a rt I f/ SEPTIC TANK CAPACITY 1O-0-V 4,e9 G LEACHING FACILITY:(type))� f ° G (size) x pNO. OF BEDROOMS o� PRIVATE WELL O UBLIC WATER s� BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: . VARIANCE GRANTED: Yes No !144 r t No.. �.-.._.. Fi�s....1 6............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...-----...j.- .tl..................OF....���s�.t1`?'rd_b��.....--------------•----..._____-____ ApplirFation for Disposal ork Tutistrnrtiun amit Permit - 7 r Re air an Individual Application is hereby made for a Pe t to ( ) o p (�) Sewage Disposal System at, * , ................. r �'...................................................................... Location-Address or Lot No. • �//t>�. !..... �rc: .............------ -------•-------------- Owner<.— ' Address �W � .i.t e �r �eW-.� ---•----•-----•-------------•--•-------------•---------•--------........_....................._. nstaller Address Type of Building Size Lot.___.-"4.0 6 ..Sq. feet Dwelling—No. of Bedrooms.....71M.........................Expansion Attic WO) Garbage Grinder (Al) pa-, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QI Other fixtures ................................_..................... Design Flow..................................�5--_.gallons per person per day. Total daily flow.........................2Z�......gallons. WSeptic Tank—Liquid capacity_.�_gallons Length_.,S_-fo_-._. Width_'4.:n4.&._ Diameter______ ______ Depths__�_ ".. x Disposal Trench—No..................... Width.................... Total Length...................... Total leaching area....................sq. ft. Seepage Pit No.......0".4.._..__ Diameter......L ......... Depth below inlet.....A........... Total leaching area---;?�4?_7-;..sq. ft. Z Other Distribution box (X) Dosing tank ( ) q A„ �A Percolation Test Results Performed b ._*.i'-' V10A.._-A. .Q-dSCh.....................i.--. Date._.-.3�5/!�/_,a �f Test Pit No. 1......2.......minutes per inch Depth of Test Pit....At!.......... Depth to ground water_.-„__.. ........ ►-� �' Test Pit No. 2...... ..minutes per inch Depth of Test Pit----i_�_1 STEPHE _.____-_.. Depth to ground water_. __�_ ______________ UxW ""� �..srle C,�iujam Qt .2.r cPrr`TQ.�..G._xx►_s c ..�p�tS��j . _...Z,_ _1_-1.-•(a(_,1__��.GI"A�c��1f I.l.`>�s,_.�Q In:,s�x - . 11//_ . A L iL�Yt eN _...------•................••-•-•.._.._.._..-•-•-..__........•••••-•. ------. ••• ••-•-•-•-•••............................ - �C9 --•-WILSUNODescrip(ion of Soil.-T?} 1 f.......... --------•-- _._. ---- ------------------------- i 6 d` `-Y Nature of Repairs or Alterations—Answer when applicable------- _ .7 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The un rsi d further agrees not to place the system in operation until a Certificate of Compliance be issued oard of health. Signed ....... . ............ : ........... . ............................------- ------------------ --------------------- Dace Application Approved By .. . . ----.. ....� ------ Application Disapproved for the following reasons- -------------------------..."............................................................................... ------------------------ ---------------------------------------------------------------- ------........................................................ --- --- --- ---------------------------------------------------------- -------------------------------------- Permit No. 31:..:.�..7......................................... Issued ...........�..f�'....-TJ................. I�a.e........ Dace f. 1 No....���/ s s FEB.... .�....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......Tow-.)..................OF...... g `.11f:itok.tG.................................................. ApplirFation for Dispas al Works Tontratrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal System at: .........-••--••----•-••......................................•••.....----------............_..... .......---...----.....___....._-•--•-------.............._..--•---........_......-----••-_........ Location-Address or Lot No. ..-••--..G1.//r c3�_.....l t_� r •••-•-••-------•------••----•------•-•------• {4_____hhe rzr ..... ��. e_..yy... �falri��/ ............... Owner Address W Installer Address Type of Building Size Lot..... _ -.,�____d�_- ---------Sq. feet Dwelling—No. of Bedrooms.....:7 �,r-r.�..........................Expansion Attic o/O) Garbage Grinder (�) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ................................. W Design Flow.................................. ____gallons per person per day. Total daily flow.__._......_.___.-._--___zz�______gallons. WSeptic Tank—Liquid capacity.lCCO.gallons Length__` '._.. Width_��-_l Q.. Diameter------- ------ Depths.J_.C,.''_.. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......erase .... Diameter..__.. ..... Depth below inlet_................. Total leaching area... ....sq. ft. z Other Distribution box (7Q Dosing tank Al Percolation Test Results Performed by._`?��vY!..... .4-__ ________________________ Date___..' �l l �i uF hlq Test Pit No. 1______2<_......minutes per inch Depth of Test Pit....!3_.......... Depth to ground water.-"'"...____. q� v STEPHEN 44 Test Pit No. 2....."- ._minutes per inch Depth of Test Pit....iz........... Depth to ground water.... _��3�__._._.._--. 01 •--- -----------•-•---------•-••-••........................•• .........._......-- ----------------------- ------------- W1t:SON Description of Soil_...! '---�_.;_S�:. !�...;�nla.�•G�I. __S�?�oi� Z ! .jGEuy� a�cQ T!_1�l----....... N x 1A..._�.'.'&.*.p-z_9_" .Ta gsl Sib �l 4 A �,Trba �; lwPQr!. �e?�A� f!xffl1e _F.. ✓�. � .. W °..•, 11 7 -� .__.�.._._.. __. _ 1.............�__ �. xZ'` ______19�____ !i✓tc.-.1_t.vx�.._ .�Q.. _._ _S_ 2........................................................................................... ..� U Nature of Repairs or Alterations—Answer when applicable......_ &n......6?..... 2.._"trhlti�............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersig d further agrees not to place the system in operation until a Certificate of Compliance h ee issued b . rd of health. Signed .............. - /-- ^ ................................. ................Dare ApplicationApproved By ....... ............................... - - - ---.............................--------------------------...--------------------- .—./. �" �1......- Application Disapproved for the following reason ......... --- ------------------ -------------------------------------------------------- --..........................-- r .................... .............................................................................................. ..............---.---..--..-..---...--....-...-...--...... Date ..... ...-.-.................. a Permit No. V7(F-7------------------------------------ Issued Date THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH ...........................�..P..WTt,OF ........... ./!t'!�'''!��E ...................................... THIS IS TO CERTIFY, T at the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ................................ . .....................i --------------......----............--------------------------------....--------------.-......---------------------------- `` Inset ler at ......................... .... ........ .�./f/sv .. ..... i.1-6.------ has been installed in accordance wit provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. V77� .?------------------------ dated ------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........ ............. ........................... ................................................ Inspector ---- -- ........-------- --------.............................................-----------...... THE COMMONWEALTH OF MASSACHUSETTS BOARD�OF HEALTH 9/U ............... .....OF......... .. ...... ........::::_ "�� No...._..: ........... FEE... Disposal Work.5 Tonotrurtion Fautit Permissionis he eby granted----•-------.---=••---•----••---•-•-••-•----••---•------=-•-•----•--•--•••-•••---•••••••-••--•---•-•--••-....:..•-•-•.....-••••.............. to Construct .( or epa• , ( ) an Individual Sewage Disposal System at No.....................2-2f--- r Street // as shown on the application for Disposal Works Construction Permit o.. l-- __ Dated.. `^1_ ^t` ------------------ Q -------- -- . ..... / ...................•._-• Boa•d of ea DATE `' EE/ ',: t FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION 4'-11n,1� S /AA SEWAGE II � A O� VILLAGE QXRE V+t L ASSESSOR'S MAP INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY llVb LEACHING FACILITY: (type) `X�� yW S�� (size).r NO.OF BEDROOMS 3 + " _ c BUILDER OR OWNER �V�l t- Vf.V UC I U.,,P PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility _ Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) _ Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of Ieachin facility) _ Furnishedby T'i►YpeL +�� FOr� j. A�' 1 r ai 17 aS 03 3 3 W-1 qs:7 http://issgl2/intranet/propdata/prebuilt.aspx?mappar=250064&seq=1 8/16/2010 _. _ _ --,I--,-,-----"'--, - - - r , . ., .., . ; , ,. . d -. ,,. . I�:.:iI�I1�I��i1".i�.�I�I III-,1I�-I I I,I I,I I 1 I I 1�1III 1�I II�II I�i,�I I 1I II,�I��1��1I���I I,I 1�,I1,I I.I I I�-�II I I I�L 1I1�III I-II�I �I III II�I I�I I II�.1I.-1 I I I�'1II,II.1 1I.-II�I-,1�'Il I I�I I.I II l I I'I I-'�.1II I1I 1 I�II.;1 I 11":.O I�.I-.1 1.I.�I.�..II II...I�II I I.I I I I,1�I'I.�I I�-I I--C.�,�.I BI I IIII I-I I�/�II.�-.I,I--d�I,�I I'I hII I-�I I�-.I I,I,�.-'�I�I I.1I,-1�-II.�,I��-I--I II,d,II,I'-I I I)I-�II I I-,I'.�I II-I,V1II'II.I-II.I II-.-1,I#-I�1-I1-4II0*'II II II-4I�I-.N�*.'/\�.-I. I�1 1I IIk 1 1I I-q,1-1,�I--I I I�II II e\II,-I.-��\,.-'IC I I I I�.,.I,1 I,I1 1-I-I II"(�I-3�,\-�'I�\I,I:�-1I,-�.I�I 1-1.-1,�.-"-,,(%I\*��I,'I 1I\11�-I I\1A1 r.)�"A-\(I-3I I�II�,ii'�.%�I"I I I,.I),I�II I-"I-I*,'I<�1I I 1I�III�-�I II,1I,I I\1,.�1I N.II I,-�I\\I�-,I-�,I�I 1I I I I\I I 1.II I\-II I�1�,I�1,I/II I�"1,1/\II1%�IIII It 1I I II 1,i I�I I I1 0II.I I I I -OII.III\�./1-��I�I1 1\,0�."I;I 1II1./I�-I;II:I.,I.�,.-11 1 1 I b.I.,I I/-�I I%II I�."I/II II I..I e1II II I�8I I�/1�:1I 1�-.I I l�\,I e-II 11��.I\I.,1II I/,III%I-.�.---,-I%\I'��%IN I"j�1 I I,-1I�II"-"I I..-�1,-1,-I�/I-C I-�1 I..�--I I BF_R,--I.n1/—�.,d-'d.�/e,I��.\I I�II��hI-I�..�-I I-I�-,1�I'I-��..,1-I\I I_1;,1II�-I�,I.\I,I�--I--�nI,.I I'��\-I�l 1\l1.�o�\o-1 1d�&IIl I,I,I I,IlII��lI y�I II I�1II�,'I..I�I II I II I II 1 II�1I I I�I 1�.II.0I.I,II 1 II.�I.>I II�I��I I\I 111�1 I�I.1.1I1 I"-I-,��1�I�''I I-I I I I�I �I II II-�,II 1II�.II 8 III,II�,I II)8I eI-I II-.I I�I(I�1&I-.."1,I-I I8 I�)---6.I II"II-1�CI >.I,-I�I1I)I��71 ,�.I'I YI I"I�I.5I I,Ip�III.l1I I'e�,%IA�II�-2I�- .0� ,. ?h . I I I��I 1 I1I,-1� II IA II I I I I I.I��II 0II �11 I I II I"II I I I II1 1 I I,I�I�.I..I�I.I.I I�.��I I I I�I II II.!, �I��I.1 I�I k�11.III I0I.�II I I I1 1-I I IiI�.�-I�I I,�I�1�e II-�I I,II�'III�,.I"I 1IIe,II i I II.���—I II 1I'1 1�I 1�,I.II III�I"�.1 1.,.I."I�I1 I I- I II�I I�,,-1,�,-I,,I�,��-II�I�1�II,�;,;I�-:I-2I.-I>0C-II,-III"I6II I��-,.1;��I�,:II�.�1 I I,1�I"I 4,I�I 1'I�.�,I.,,I l.I�I l I I I.�I:I.�-.1�I I..I.,.�'�I�I 1 1�I1�:,,I,1 I�1,�,,I,-.II I 1.,I,�1:1 I1,-P1 I.-��II;'I'I;�I.I-�,.-1�,1 I�---,-.,-1�1-I�1 11 :'-.���1� .1.I�1.,I 1�,II,�-�-."I,,,1I"�I,I",1��I:",�,,"I-1:�7I':1��"I'I1'-�,�.''-1�O I�I,,I.�I�,.�l���I 1�-.,"%-�-1,1:�I-'�"1-I,I�,I.,1-:I�',.A,,���,"1-,,I 1I.I-��-,�"1,���.I II�-I��I I II�11 1'�,"I��7�--;II�II 1I-%,I II 1"��1��1,".Ie.'�'I,.-SI�;��,�-:-�:'.-.—1,�1�I�"II-�.,":,,�-,I.k�-.:�I�,1'�,-,,,.;,II,,:,1", ��,,,I,-II:'�,,1I,�,I-��1-.-,1 I1,-1-"'�,,1�1�-I��,,,,-',,�1-,,1.��-�",�-"�,,,.�i-,','-��,,"1I�"`,1"',-.,1�',��-"-�,-'.1-,-,'I-�,i-,r-,.-,�_�­1,I"�-,;I-',-',"e,--:'�1,I��.� ,1�,.�-:-� Cc� / G r e^C ✓1:S 1� c>C �70/7O L�C i1`i Sj1�+f1 L ,. f.♦ - 1�G� - . .1n- ; - 1 -e `. ;; v _ .. r— a i"? ,S ¢Gr rr ass r r �* � � z' .7 0 . , ".4,,: h �, n �r.. �� e s 0 r n —— ^. - �i arnstable r :, , . . e L ,,.,. J -. s r 4 84 . I A OCU� ,,.. V y r Qi CD a v . . , 0o / !" ', .,` - /y� J l d " I - r„ !' / .. '.. .» . .. � i ,.,.. , v O 0 ,, , J �. l N .. ,: .a r ,., - , .. . 1 _ ., . , , 88 - ' . 0 L cation Ma - N F Ross R. & Julia C. Ofander' P . . ,. % .� -----� , , r ..1 :. / ' f f , ; ,v , I `.. ,'i BM Elev 2 ._ I /S M,.. x.y ' 80.87 Assume Assessors Ma -250 t, on J P -I..I�IU/I 1I;.�1,I I�I I�I.��I I/� I��-/I.-!/,./'I I,I..I II��I-"I I I I 11 I�I,.II.I�I I II�I� �I I.I�I I II I O 0 �. L ,,, . er 90 �,1I/4."I �II,I,V/9 I 10 2 II/I /,.6/..I�1 ?I I�I I,-.,rI.I e—I I.'x. �I 4,j�I I,.yIA-.�r Ia,�I.e-I I 1-�I1 I-I I..III \ " -A / r " I r:. > i ro �. .., ., P T , , x 5 Car.�i rL`" - /f .,terra , o , t 1 :. :. M \ . w . .. .., n /� 7�ter Gtia / I . '8 A -, Leach Pit t , ., R,. Ho i ,; . , k. s O .. . _ .„.. I -., ... r 9 „, r S , g4 / M , r / ,. / ., , ,, ,k. - � ' , i . . �.- � �. _ .._ ._ �. r � � h :.. ...... . ,. ..,.. +r::r _v .., „, >; _ 4� - A f __ �... _ , 96 82 . .< _. , -r s. y _ � . , , i i ... .. .,...t r-. A f r 45 �x r. .4i.. t",.. ...1.. .F.' ..... _ , 7. }' .. ..h,. .. },.�.,. ., ..n....,.-y.. ....,- ,,. �.. R ....+. 7 :.:. a,x. 5�. _M / �. w..: ! ....Y .- h 1 / I -I � _ ,cg do 1 r i l F, , 1 Existi I/�/-//I/ 1I1/I-rIfl:I I II/�IF I/9 f—8d—,�I I -I /-3//-I� 1 - i r Y i 1 { J J H use > P , .. 88, i ,,,., a A0 -~\ o �, 88 �. O ") i �. 84 . , 0 / - +4 <C R, i .r A i i r f _ t C 1 / r G C� ro i _. "+ ^� i r >. :. I I III I I I�I I IWII.I 1 II�I I I I.I I-.I�-I�r��I.I I�I r I III I NII�::�I��I�)I I � .�I"90c�rc-a,a!I I I It II oI .,.�I�I I-I- II I� II�I� I�1I I .I II� I I �I I ��II I�I II NI I/� �.I F8II I�.�I II 2I. /�I I/II�I�I�I I��I 1 I�I�I I I I . 1 3 h J ti M, , 1 (^gyp � � 9 , 1 / f O „_ ,. M e k . ', e r 86 , f w 0 - F' > ., U t e C@ r :;: I . i P li J. u nes �. P 9 , .., .,:. . U i I 94 ,....a *4 i f $$ f i , f _ + , , S E a .. s ,. s -/ n o ,., d' - Shed _ ,.. . . i a 1) 7 „ , t. i 0,. . . 5 / i.., .: ,.,...,a, <f f . ..1. ...... .s...> '3 :. A .. .. i-, - - y�.a, 16 9 11 8 1 1NITlAL .ASS E elk N 9 U 4 ..k� ..'I ,. D ATE r_, R P TI �.� ,. i _ , / . 9 r ,, , ti. . r .,,, p .. -' S to 1 P l a n o f Land , . . .,, .- N ,I ,. .,, r , ., -1 9 2 � . , -, rv„,. ti.h< ... t < _. _ ,. a r � S B n tab _ rt .. , , � le Ma sac u ett� .. / 94 CB d h , for , ,, .:.. ,, ,11 „ , ,M r r. l 6 ,,. 9 � . -,�1 y W lllaa l� rce r �.. . / ,,. . 1.. .'.3 R . - w .... /jr ,n- 98 m '^... ,. r. _ ti . _ ti , �. �.�,.,. _ , N F John :S. Morin U JOB NO ���81 _ _ ,SCALE. 1 2 14s� .,r e, ,. ,��.. , k r _ :, , �. . _., . .. . EP HE N ,�✓ L I , , 0 6�� , .� . �, , ,. S 2 20 IL rox,,. , .. ,. . ,, , " '� r... J// 4 F J n , r- f y , . . - ., W 7 _-, ., „ ;,<. , r m , :, S ,, r.,- ,. .., .. n ,,,,., E W ,_ ,"I LEVY LDREDGE & AWR ASS CIATES_ NC.0 I . , r , .-.. NGINIBRS Y CAPE CNI9'ECTS .��E LANDS AR LAHNI R.S LAND SURVEYORS . , . / , a. , is , ,r; , � -1 .``• ..ti{,' '-,. ,. f p.. 8-89 .__ STRE N .s a"An ET CErITERlLLE ,MA 0263 . f,,. �.., �... - .; ,. - .�. .. , .., 5 s.z r .,:..,-..: . .,, ,,a. 5 Yf ! :. ., .., ... .. ... ... . �. a '9➢.. 'I i �, ., , , .:: ,r,, ri'v. .,_. -. 1. ,. Y. :: , .. {: ,<s v... ., ., .n,. ,.,. .. .. . . z' } .. .r °7. , ,-. t.. ,,- e .;..x ..,. ..:t, ," ...1 ......m. ... :. .. ... .'„. ,.. .. . , R a . ^`� r .. ,'. ,: i .p , ,. a. ., .. , . ,. 1 20' ON MINIMUM OR A5 INDICATED PLAN 0 N !{_S. , 1 0 MIN .. W w. 1 ALL ORKMANS IP AND MATERIALS ;S H HALL 'CONFORM. TO D.E.Q.E. A RY NSION TO 12 M soN ExTE ;TITLE 'S .......THE -T(7 OF RULES AND BELOW GRADE TOWN BACKFlLL WITH , .. N TION - G .: -rop of Fou DA RE ULATIONS OR THE' SUBSURFACE OF SEWAGE; 9 MIN. " F E AGE, ., ?r CLEAN.SAND MASONRY EXTENSION TO 12 �9, D. , ,,. . . . AN THE REQUIREMENTS 0F` THIS PLAN. , BELOW GRADE 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO 4.. . Z ,, _ WITHIN W IN 12 OF FINISHED GRADE. .... 4 SCH. 4 P PIPE h • , 3. ALL `MIN. PITCH 1/8 PER FT: N L MASONRY UNITS USED 'TO BRING COVERS TO -GRADE SHALL R H L BE MORTARED IN PLACE. 4 .p 2 .LAVE OF ER ftOW UNE _ 1/8f 4. " A Lt COMPONENTS OF THE SANITARY SYSTEM A 10 TEEY Y TEM SHALL BE CAPABLE ".. 1/2- WASHED STONE OF WITHSTANDING H 0 3 MIN. ,< Si< •_ ; 1 LOADING UNLESS THEY ARE UNDER 0R GALLON 8 5 WITHIN 1 V — _ , a WIT 0 FT OF DRIVES OR PARKING AREAS. H 20 LOADING`. , , _ 2 MIN. LEVEL _ ,W LEACH , 4—0 0 .,, PIT. , SHALL BE USED UNDER 0 84, ,t • R WITHIN 10 FT. OF DRIVES OR MIN. �' uQulD wasHEo STONE PARKING. DISTRIBUTION ► <., LEVEL 8 ,O � Box W 5. NO DETERMINATION HAS BEEN MADE AS TO .COMPLIANCE WITH DEED RESTRICTIONS OR ZONING REGULATIONS. `WN -AP r 7s o { RE I S 0 ER/ PLICANT SHALL OBTAIN SUCH DETERMINATION. , HFROM THE APPROPRIATE AUTHORITY. A oa© LOCATION MAP GALLON SEPTIC TANK i r Z 6. HORIZONTAL AND VERTICAL :CONTROL SEE LEVY, E-DREDGE r L. ASS e2 a C> . . � ESSORS MAP. .. PARCEL � '� & ,WAGNER FIELD NOTEBOOK LIOUIO DEPTH IN SEPTIC TANK DEPTH OF OUTLET TEE BELOW FLOW LINE 4 . BOTTOM OF TEST HOLE 6�• 6 4 FEET 14 INCHES PRE)B A B E ,1fnn W 4ER ',wc, 5 FEET 19 INCHES $f�-�rsF�-rrwr�o _ . .._. . _. .._.. -- -- 6 'FEET 4INCHES CURRENT ZONING INTERPRETATION: A N DESIGN CALCULATION SEWAGE DISPOSAL SYSTEM PROFILE MIN. FRONT SETBACK 30 -- FEET NUMBER OF BEDROO►S /tea ' NO TO SCALE r LE GARBAGE DI P MIN.' SIDE SETBACK ' t�_ ARB GE S OSAL`-'UNIT tlo A ,/ FEET TOTAL ES MATE LOW TI D F MIN. REAR SETBACK /a FEET JIO GAL. BR. DAY X �' DR. -� GAL. DAY 3 REQUIRED SEPTIC TANK CAPACITY �0 GAL. x ACTUAL SIZE OF SEPTIC TANK /4LiC3 GAL - LEACHING AREA REQUIREMENTS PERCOLATION SOIL TEST >� 77 SIDEWALL AREA 2� GPD. S.F. BOTTOM` AC GPD. F. _ / AREA /S. OVa�ch S" Z91/ . ; DATE OF SOIL TEST s SIDEWALL 27T 2 6 SF x 2,T GPD` SF — �I7 1 GAL DAY TEST BY s5���� c.v,lsr..z 2 BOTTOM 7T f o 2 SF x 40 GPD SF 8 GAL DAY WITNESSED BY Pe, Zee, le PERCOLATION RATE MIN./INCH 7 SF 5 4 GAL DAY BREAKOUT CALCULATION: TEST PIT �1 TEST :PIT #2 ELEV.= 4, ELEV.= g i, F, —0,00 --0.00 �� Tc�soi!�Su6soi l w Tr�o�o�/t"Su�asa;l z4 G!a 5a �. - 82,9 29 - - ___ — 79, E y/ nos // LEGEND; EXISTING SPOT ELEVATION OOXO EXISTING CONTOUR-------00--- s� 49 ~ — �9.� FINAL SPOT ELEVATION 00.0 L FINA CONTOUR TP BOTTOM of TEST '0 SOIL TEST PIT LOCATION TE HOLE BOTTOM OF TEST HOLE OR WATER ELEV. "7/, y' R W V' 9. W W W .�. o WATER ELEV.. TOWN WATER SEPTIC TANK DISTRIBUTION BOX ❑ LEACHING PIT WATER LEVEL ` ADJUSTMENT-. �1� PRIMARY O RESERVE LEACHING PIT TEST 'DATE WATER LEVEL INDEX WELL L WATER N E LEVEL RANGE ZONE 1 3 -�. �� ISSUE s3�J ` / L INITIAL S DEPTH TO; AT V E WATER LEVEL FOR IN WELL NO, DATE - DESCRIPTION BY FOR 'MON H OF: T WATER LEVEL ADJUSTMENT DEPTH TO HIGH WATER I . > ;. g _ .0 0 h;, 1/i a 11�'cr cc r g rtr{' Fw STEPHECJ ,, ALLY t� V4'ILSOf� L APPROVED: BOARD OF HEALTH No.sozLs SCALE: JOB NO. 1481 r SITE PLAN s� DATE AGENT 3 I� LEVY ELDREDGE & WAGNER ASSOCIATES INC. PERMIT I�IGMM LANDS O ARCHITRM PLANNERS LAND SU"UORS ° r 889 WEST MAIN STREET CENTERV= MA 02632 NEW ENGLAND REPROGRAPHICS 8 SUPPLY CO,