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HomeMy WebLinkAbout0019 LILLIAN DRIVE - Health 19* LILLIAN DRIVE,HYANNIS A=248 - 204 j ,4 commonwealth a massachuset Title 5 Official Inspection Poem Subsurface Sewage Disposal Z-11 S;�Mem Frx-#''n..Mm for i�oWntary Asseasr:tt3ents C) o /RopertyAddress / `"" �/�f .-�./.-- t � ..�-:—��_.,_ LcA Qarter l)uvner'sName ---` Za�J�G !�1 _ ���✓ ZNo7 .—_L!ciS —CCt(N'1,2l'GN r� informations required for every q✓)t� f ,� / page. �yliown ----------�m-_- ._� © � // 16 5t Slate Zip Code Date OYInspettion Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. MPortaft outf When A. General Information Bing out forms �/ / a b ? on the computer, J� use only the tab Inspector. key to move your , cursor- et not V,ly use the return key. Name of inspector Cow Name Company Address � alyrrow s ci 0"I� D_� d"0 state �ago / / ! 0 Zip Code fD �� Telepho Number license Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5"10R16.000). The system: Passes ❑ Conditionally Passes ❑ .Fails ❑ Needs Further Evaluation by the Local Approving Authority Inspector' Signature / / Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DER The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. .a _ "'"This report only ciescribes 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. Sns•313 Title5officialInspectionFom[Subsurface Sewage Disposal system.Page 1of17 O#d VS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Di � al 9 sp " System Form Not for Voluntary Assessments 12 zil!` a� oU/1v1� Property Address Owner information is Ow pees Name Al � required for every ✓rdf S //'14 04601 page. City/Town State Zip Code Date of spection B. Certiflcaiaon (cunt.) Inspection Summary: Check A,B,C,D or E I a/wayscomplete all of Section D A) System sses: 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. y Check the box for"yes",,."no"or"not determined"(Y,.N, ND) for the following statements. If"note: determined,"please ex0ain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): n t5rs•3M 3 Title 50ffidal Irtspecticn Form Subsuface Ssw%e Disposal Symm•Page 2 of 17 Commonwealth of Massachusetts Tide 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'Zi��i G✓I ��1 ve Property Address Ow ner's Name �uQred for every A/14 page. Citylrown State Zip Code Date of In pest' n B. Certification (cant.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): i ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a mannerwhich will protect publichealth, 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 i 155ns•3M 3 Tice 5Official Inspection F orm Subsvface Savage Disposal System•P$ge 3 of 17 Commo nwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage DisposalSystem Form -Not for Voluntary Assessments Property Address owner Ow nees Name /� l �u edforevery / Cj A 0t C / / page. City/Town State Zip Code Date of Wspedon B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and sal absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water; supply well ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well'. Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other i i I 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 logged 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 i ❑ �� Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool gZ Liquid depth in cesspool is less than 6'below invert or available volume is less than%day fl ow i i t5ns•3H3 TileSOMdallrepectmFormSunsWaw Sewage DisposalSyom•P e4of17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments / g _Z //l A t, r-al vV__ Property Address ON r►er �� infortration is Cw ner's Name required for every 14C7 ci 00tf4- t Me. Oy/rown State Zip Code Date of kisbelion B. Certification (corn.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within 100 fleet 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. ❑ ny 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 fleet 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.] ❑ e 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 0 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 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. t5ms•3M 3 Title 5Official inspection Form Subsuface Sewage Disposal Sim•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Foal -Not for Voluntary Assessments Property Address 141 Ow ner ON ner's Name -/4 &P"�V7 L2 infomrat ri is l required for every q✓I41 f page. Cky/rown State Zip Code Date 6f Insoection C. Checklist Check if the following have been done. You must indicate"yes°or"no'as to each of the following: Yes ❑ mping information was provided by the owner, occupant, or Board of Health ❑ ere any of the system components pumped out in the previous two weeks? ❑ as 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 WA) 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,ened, 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 r❑ ty ( p 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 (f any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): bins 313 Tile 5Ofti d Impaction For[SuDsuiaee Sewage Dispose!Symem•Page 6of17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage DisposalSystem Form -Not for Voluntary Assessments Property Address ON ner Om pees Name information is required for every o N IJ 4 eP 6 Q �� 9 /IO page- Cityfrown State Zip Code Gate of pec' n D. System In�f, tion Description: /-W lT-1 //e +(c G y 4-- pZ Soo ` o vl ( G"4011-afIE7� Number of current residents: Does residence have a garbage grinder? ❑ Yes E r--No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes No information in this report.) Laundry system inspected? ❑ Yes E K_N_o_7 Seasonal use? ❑ Yes E 1, No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ es No Last date of occupancy: /v e Commercial/industrial Flow Conditions Type of Establishment: Design flow(based on 310 CM R 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes E I No Industrial waste holding tank present? ❑ Yes E I No Non-sanitary waste discharged to the Title 5 system? ❑ Yes No Water meter readings, if available: t5rs-3M 3 Title Wffidaf Inspection F orta Subsurface Sevrage Disposal System- 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 ZLll 40 z ,I Roparty Address u✓a H z7 Owner ON ner's Name inforfration is required for every Avl h 1 page. C&y/raw n State Zip Code Date of Inpoecta D. System Information (cont.). Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type 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)and a copy of West inspection of the VA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): O o t5ns•3M 3 Yi0e 5Offiaal hupecfion Form Subsufaw Sewge Disposal SyMm•Page Uf 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Dis posal sposal System Form -Not for Voluntary Assessments 19 Z/`//`CiL-j '01w-L Property Address ON net information is �"�ners Name / required for every a 0 !t / ',� 6 ,O page. CRyf row n State Zip Code Date of frispecron j D. System Information (cont.) j Approximate age of all components, date installed(if known)and source of information: icon -- � Were sewage5 odors detected when arriving at the site? Yes No i 1 Building Sewer(locate on site plan): Depth below grade: _ feet i Material of constructi%40 i ❑ cast iron PVC ❑ other(explain): / Distance from private water supply well or suction line: ` 0 feet Comments (on condition of joints;venting, evidence of leakage, etc.): i Septic Tank(locate on site plan): Depth below grade: / d g feet 7en cotruction: oncrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) i f If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) `l ❑/ Yes ❑ { No Dimensions: Sludge depth: p� Mrs•3M3 Tide 50Mda11nspwdonForm Subsufaw Savage Disposal Symm-Pag 9of17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form m Not far Voluntary Assessments l9 L/6/,� !,, Property Address Owner �✓G h o infonnation is Z_ ON ner's Name required for every q, A 4t page. Uty/Town State Zip Code Date 9f Inspection D. System Information (coot.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle J How were dimensions determined? i "le Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): O t N --It /!o" . 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 w`n"3M3 Title50fficial InspecfionFamc Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address VG �d Cw ner Ow nets Nameinformation is L requvedforevery A'�4 IJpe Cdylt'own State Zip Code Date of pee' D. System Information (cont) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other,(explain): Dimensions: Capacity' gallons Design Flow. gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in worldng order: C] Yes ❑ No Date of last pumping: Date Comments (condition of alarm.and float switches, etc.): "Attachcopy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Ors•313 TWe50f5aal Ins tionForm SubmOace pee Savage Disposal S)Stem•Page 11 aF 17 ' t F' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage DisposalSystem Form Not for Voluntary Assessments Property Address ow ner ow nets Name information is a !� required for every G ✓1 �// �� O D �� page. City own State Zip Code bate of tion D. System Information (cons.) Distribution Box (f 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.): o � AV Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No* Alarms in working order. ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3M 3 TiBe S Oftidal Inspection Form SubsWwa Sewage Disposal System•Page 12 of 17 X Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Properly Address ON nor ON ner's Name information is / required for every G✓14 0( / (� Ll page. Cdyrrown State Zip Code Date of lr#lx D. System information (cont.) Type: ❑ leaching pits number ❑ leaching chambers number. ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovative/altemati%e system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 0 0 Cr vt 14✓t-e Gi✓r C' so JI l�S 0 ���ti,l� c 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 Ons-3H3 T"We5Of5dd Impection For[Subsuface Sevage DispoSd SyMm-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r Property Address / — /llI ✓I - ./�i/6 Ow ner ow ner's lame G' information is required for every Cfly/Town page' State Zip Code Date of in D. System Information (cont.) 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.): Ons•3113 Tile 50ffidal InspecficnFarm Subsurface SeyMeoispossl S)SWM.Page 14 d 17 Y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Foam Not for Voluntary Assessments Property Address —Z' —al �/Y Ow ner Cw ner's Name O information is required for every page. Clyfrown State Zip Code Date 9f Inspe6tion D. System Information (cons.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where publi er supply enters the building. Check one of the boxes below. ❑ nd-sketch in the area below drawing attached separately dris-3n3 riitesotficia lmspecfionForm subsirtare savage Disposal system-Page 15d 17 Assessing As-Built Cards Page 1 of 2 Z6r YL TOWN OF BARNSTABLE ur tit/t/", t✓+G- LOCATION SW12 C &a A SEWAGE a -at nr VILLAGE u-c—s wt Z ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. 1,6_t / `bI YB' SEPTIC TANK CAPACITY LEACHING FACILITY:(type) SnC //_l' (size) + NO.OF BEDROOMS �. BUILDER R OWNER 1 00i' PERMUDATE: I----& COMPLIANCE DATE: 90_ 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 Wedand and Leaching Facility(If any wetlands exist within 300 feet of Wng facility) Feet Furnished by O h ° 1 " r ,el a 1 i httn•/hanxnw tnwnnfliarnctahlP rtc/AccPccinv/HMdi.nlnv.ngnl;?mannar=24R?-04&.q'en=1 10/24/201 fi Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address __/__9 owner t4 r� hformation is Owner's Name requiredforevery page' Cilyfrown State Z P Code Date of Insp coon D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells t'y Estimated depth to high ground water. feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Bo of Health-explain: //II ���f lrJ�� ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must d' be how you established the high ground water elevation: al�u �a�dC4� 141 f — 410 C.-1e,,Cl. V" o 7'� �GN►11�r� T_z_L'� Cj_'1:1 I Before filing this Inspection Report, please see Report Completeness Checklist on next page. t%ns-3h3 Title 6Official Inspection Fan[Suburface S"geDisposal SYMM-Page 16 d 17 Commonweafth of Massachusetts Title 5 Official . Inspection Form Subsurface Sewage Disposal System/Form-Not for Voluntary Assessments Roperty Address Om nor ON ng's Name hfornetion is requiredfor every d1 cif/f page. cayfrown State Zip� Oate qf 6�spection IL E. �RepOft COmpleterms Checklist i:J htspection Summary:A, B, C, D, or E checked S1I� Inspection Summary D(System Failure Criteria Applicable to All Systems)completed stem Wr mation—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file Cm-313 riwmacw trspedtmFerM Si rf—SewWOmp-d System,Page 17 d 17 TOWN OF BARNSTABLE �FtHETO OFFICE OF BARISTIM i BOARD OF HEALTH NAB& p op,e�039. `gym 367 MAIN STREET 'eOMPY�`' HYANNIS, MASS.02601 December 29, 1999 David Sauro 20 North Main Street South Yarmouth, MA 02664 RE: Lot#42, 19 Lillian Drive, Hyannis Dear Mr. Sauro: You are granted a variance on behalf of your client Davenport Building Company, from 310 CMR 15.214, restricting sewage flows to one bedroom for every 10,000 square feet of land within Zone II districts. You are granted permission to construct an onsite sewage disposal system at Lot 42 Lillian Drive, Hyannis, with the following conditions: (1) No more than two (2) bedrooms are authorized. Dens, study rooms, finished attics, sleeping lofts and similar-type rooms are considered "bedrooms" according to the Massachusetts Department of Environmental Protection. (2) The applicant shall submit revised house plans to the Board of Health showing elimination of the proposed dormer, elimination of the second floor windows, and showing a typical ranch style roof. (3) The applicant shall record a properly-worded deed restriction at the Barnstable County Registry of Deeds limiting the dwelling to two (2) bedrooms. The deed restriction shall be signed by the property owner. A copy of the recorded deed restriction shall be submitted to the Board of Health 2rE to obtaining a disposal works construction permit. sauro2 �j This variance is granted because it is the Board's policy to grant applicants approvals to construct two (2) bedrooms on lots of less than 18,000 square feet in size. Sincerely yours, Susan G. Rask, R.S. Chairperson Board of Health Town of Barnstable SGR/bcs sauro2 CfTHE T� DAB:---A� 1 IAANSTABLE, • < , QPEE y MASS. $ F:•,' r�^ Town of Barnstable Board of Health 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION Address: . ,�GT yy2 G/L G t Bt�► �6-;ve- Property �f'�'►15�- Assessor's Map and Parcel Number: )a/ ZOyf Size of Lot: Z7 Wetlands Within 300 Ft. Yes Subdivision Name: No Business Name: APPLICANT CONTACT PERSON Name: i i Name: -)�a.tlj'd Sac,4-r0 Address: an 00C-4h &iaei n Address: Zp t-)& '7th Phone: _�Q�- 3 9"s- as 9 3 Phone: Sp 8 - 350 U FAX: 5-6? - 3g-*- 6765 FAX: S`0 8-39/ - '71,S VARIANCE FROM REGULATION(List Res.) REASON FOR VARIANCE(May attach if more space needed) &a yd o -P /-1 en l5�h /D c!ll D w ---t—Ax 3 Yeri, a.-f R CS 0 t�- a- 0 died rov--s, AtO ►-t e— Checklist(to be completed by office staff-person receiving variance request application) Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans) Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variances only) Variance request application fee collected(no fee for lifeguard modification renewal,,grease trap variance renewals[same owner/leasee onlyi,outside dining variance renewals(same ownertle m only).and variances to repair failed sewage disposal systems[only if no expansion to the building proposed)) Variance request submitted at least 15 days prior to meeting date ' VARIANCE APPROVED Susan G. Rask, R.S., Chairman NOT APPROVED Sumner Kaufman, M.S.P.H. REASON FOR DISAPPROVAL Ralph A. Murphy, M.D. Q:/Wp/VARIREQ I I 2'-0• 14'-0' 4'-3' 7*-6' 14'-3' r — � I I LLZ L — J • I I o O 5 I PATH ao I Cho BEDROOM #1 i 6 KITCHEN/DIN. 0 W3/4%57 B' x 2B• 5GUTTLE � OI-B• O 4'-O' GO . — — — — — — — — -- z t9 t� W O iV O V-4 � LIVING RM. 14'-O' '-5 1/2 r' BEDROOM #2 BAT c 2xG WALL DIMENSIONED 1 THE 2x4 WALL LINE b 3 i9 B I v O O1 CW/STUD POCKETS:) RETAINING QFni lx?Fn I i i I IEEE LEFT SIDE ELEVATION ` SGALEs 1/4' DROP WALL 4 FOR AD 0- MAME� o STANDARD BASEihm C4' CONCRETE SLAB) i9 WINDOW PER BIRDER 7*-0' 6•.�• 6•�. 6..6. 6•�. T-0' O - -1 L N � L _J L _ J L - -J CENTERLINE OF M 2 x 10 GIRT ABOVE O TYPICAL 30' x 30' x 10- GONG. COL. PAD I I I . O I TYPICAL B' CONCRETE WALL i9 I I ON 16' x 8' GONG. FOOTING p I � BA SE MEN T PLAN SCALEm 1/4' - 1'--0' 12 12� GROSS SECTION TYPICAL ROOF CONSTRUCTION, ASPHALT ROOF SHINGLES/15# FELT PAPER. 5/5' CDX PLYWOOD 5HEATHING/2 x 10 RAFTERS AT IG' O.G./PROVIDE 'PROPERVEN' • OR EQUAL 5TYRAFOAM INSULATION TO MAINTAIN VENTING AT EAVES AND SLOPED INSULATED CEILING5/PROVIDE CONTINUOUS KNEEWALL SOFFIT VENTING r3/4* T+G PLYWOOD GLUE SAVE TRIM = Sx5 FASCIA W/ lx2. 1xB 5'-9' VENTED SOFFIT. lxB FRIEZE W/ 1 3/1 AND NAILED TO JOISTS BED MOULDING. CixB = 7 1/2') 2 x 10's at 16' ox. � ,i COURSE BETWEEN FRIEZE + lx4 WIND( HEAD • DH'S CLAP = 1'3 ADJUST FRIE FOR PROPER SIDING COURSING CADD 1 N LIVING RM. KITCHEN/DIN. PAD TO CASEMENT HEADER TO ALIGN) I� L - G 1/4' FIBERGLASS INSUL. TYP. 3/4' T+G PLYWOOD GLUE IN BASEMENT CEILING AND NAILED TO JOISTS L F 2 x 10'5 at 16' ox- 2 x 10's at 1G' c.c. 2 x G TREATED SILL. C3) 2 x 10 GIRT 8' CONCRETE WALL 3 1/2' CONC.-FILLED STEEL LALLY COLUMN 4'• GONG. SLAB ._—�i-• .. a• rnw�r rnw�r CnnTlwl/'. 00 RIGHT SIDE ELEVATION i .0-3 = .V/L 831VOG NOUVA_9�1* NV9N o (P Z � rn � : r ; rn an � oo ❑ O oo ❑ l�nimillITM %yam SEE: 1ARNSPABI.>E. ; , Town of Barnstable- Board of Health 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION Property Address: GT yew q L/L L i �, t j/ �ca.ar"'7 I j $. Assessor's Map and Parcel Number: Zy& f of 00(70� Size of Lot: . Z7 Wetlands Within 300 Ft. Yes Subdivision Name: ,td A No_ice Business Name: i APPLICANT CONTACT PERSON Name: i� Name: zl) Llt ct &L,,-O Address: On 0or-_ i r) * `1 Address: r.yet rvrl MCI h r Y1') O aZ(o ra �o y�-►^"-�O ct�fL,� . 02(o Iv 44 Phone: �`Qg-3 9fs - a� 9.3 Phone: 5O$ - 3,70 9.3 FAX: 5-big G 7i6 5 FAX: S`Q 8-S?4 - e�76 5' VARIANCE FROM REGULATION(List Res.) REASON FOR VARIANCE(May attach if more space needed) % &r,,d 6 -F Neri/`/h /D 4I(JOCA) —YAL2 ,3,3 r-e!i. f,2L r f S o S OC,;� 2 --fc cu 0 gs-e d re,, r About e— z <3 i o C/r�iQ ds Z/5 Checklist(to be completed by office staff-person receiving variance request application) Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans) Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variances only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only],outside dining variance renewals(same ownedleasee only],and variances to repair failed sewage disposal systems(only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G. Rask, R.S.,Chairman NOT APPROVED Sumner Kaufman, M.S.P.H. REASON FOR DISAPPROVAL Ralph A. Murphy, M.D. Q:/WP/VARIREQ • 2.-O. 14'-0' 4'-3' 7'-G' 14'-3' r © 1 F71 -f- - -I - C ID —tkP I ATH a-jQCho BEDROOM #1 �- i 60 KITGHEN/DIN. O -10 5 3/4 7f-3' 4'-il' .1 s O B' x 28' SCUTTLE 0 O 4'-0' CO . i� a- O iv O OV © LIVING RM. 14'-0* '-4 1 '-5 1/2 17'-2' I F BEDROOM #2 BAT cr ir I 2xG WALL DIMENSIONED �D THE 2x4 WALL LINE 0 a I o O CW/STUD POCKET53 RETAINING QFAI PPFn cr w NOliVAATl ACIIG 1-4-ij nil H CEII, LLLJI `4 G'-0' 14'—O' 6.-0. ---- - - - - I �3 I I t -+ • 14 N b � N I 08 c I I � N� I I z x z L t -J ' g 61 Z °U o� r O> T A C� F / L� J • cn ril t �, rnX t Z b I rl+ x t D 0 6) n ' 1 0� F �� z o 1 i- t A t Ft7 1 Q I Lt t lV LP I V G.—O. 7'-0' 7'-0' G'-0' 12 GROSS SECTION TYPICAL ROOF CONSTRUCTION, ASPHALT ROOF SHINGLES/15# FELT PAPER. 5/5' GDX PLYWOOD SHEATHING/2 x 10 RAFTERS AT 16' O.G./PROVIDE 'PROPERVEN' OR EQUAL STYRAFOAM INSULATION TO MAINTAIN VENTING AT EAVES AND SLOPED INSULATED CEILINGS/PROVIDE CONTINUOUS KNEEWALL SOFFIT VENTING 3/4' T+G PLYWOOD GLUE SAVE TRIM - ixB FASCIA W/ 1x2. lxB B' AND NAILED TO JOISTS 5�� VENTED SOFFIT. lxB FRIEZE W/ 1 3/1 BED MOULDING. C1xB = 7 1/2') 2 x 10's at 16' ox. �'Q COURSE BETWEEN FRIEZE + lx4 WIND( HEAD • DH'S CLAP = 1'3 ADJUST FRIE FOR PROPER SIDING COURSING (ADD 1 N LIVING RM. KITCHEN/DIN. PAD TO CASEMENT HEADER TO ALIGN) 14 1� L G 1/4' FIBERGLASS INSUL. TYP. 3/4' T+G PLYWOOD GLUE IN BASEMENT CEILING AND NAILED TO JOISTS ' 2 x 10's at 16' o.c. 2 x 10's at 16' o.c. 2 x G TREATED SILL. C33 2 x 10 GIRT B' CONCRETE WALL 3 1/2' GONG.-FILLED STEEL LALLY COLUMN 4's CONC. 5LAB--i .__ /"'• .. n• /`/BAIT P/1A1/` C/'1/�TIAI/`. L�J � 0 RIGHT SIDE ELEVATION NOUVA9�1' NV9N 00 I E I T* O— j s i I 70 �� I 1111111 WE � r 1�1 o D _- � 00 ❑ O oo ❑ z a M E: D/1AI MASILAffi E, + rptF g s6g9. `�� '�i REC L4 Town of Barnstable? IInn f Ak"ED3 Q)AIM9 Board of Health E r 4 a_,'5!48Lc 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Susan G.Rask,R.S. FAX. 508-790-6304 Sumner Kaufman,M.S.P:H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION 'P" Property Address: ,1/GT y� l q L/L G t t (/e- r fir►")5A Assessor's Map and Parcel Number: 2,y� )01 Ob'f Size of Lot: . Z7 Wetlands Within 300 Ft. Yes Subdivision Name: No_ Business Name: APPLI CONTACT PERSON Name: �rI Name: .1ct.0?d 6au-r-o Address: C;2D 0-0C—N-, lei n Address: Zp tj& , � 7,f rmaccf A') ��-�!'� -�;o yct:-rm-7oct_-Hn,/v1 t9. 02- 44 Phone: gyp$-3 T - 9--2 9.3 Phone: ISU 8 - 39?-.POL 93 FAX: -6-3 - ` g*- 6 76 5 FAX: 59 S-d?4 - t'7I-5' VARIANCE FROM REGULATION(List Res.) REASON FOR VARIANCE(May attach if more space needed) ,tea.,d e -F 14 ea 1`% -i o (g ll o w --t-h e e�i,5�►'t-c.cfi c�-,-, ,3.3 rem. arf S o o 0- Jf-W Q 93-ed rCl- s hoe- Se.c- cr>n FS Z <3 i O CtYI/Q G's Zl� Checklist(to be completed by office staff-person receiving variance request application) Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans) Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variances only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals(same ownerileasee onlyi,outside dining variance renewals(same ownerileasee only),and variances to repair failed sewage disposal systems[only if no expansion to the building proposed)) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G. Rask, R.S.,Chairman NOT APPROVED Sumner Kaufman, M.S.P.H. REASON FOR DISAPPROVAL Ralph A. Murphy, M.D. Q:/WP/VARIREQ 14'-0' 4'-3' 7'—G o 14'-3• O r - - - -{- - -} — Q o ID �ATHcl x . 0 BEDROOM ## 1CFO i 6 KITCHEN/DIN. 'l 0 —10 3/4 7f-3' 4' L 5* x 25* SCUTTLE ' o c O 4'-0' CO . L - - - - - - - Z9 O ° O © ad LIVING RM. 14'-0' '-4 1 '-5 1/2 17'-2' BEDROOM #--2 Z9 BAT 2xG WALL DIMENSIONED THE 2x4 WALL LINE i O1 CW/STUD POCKET53 RETAINING QFf']I IeFll DROP WALL O FOR M-00 le- ,� aM�V ILNIJ O V STANDARD BASEMENT C4' CONCRETE SLAB) WINDOW PER BIRDER 7.-0. O .E/ PK7. 77-"m- T r -}--- -} - --� - -o--I- - --F- -�--� - - --f-o- --�-- - T- '" L -� L -__I L_J L _ J L - -j - CENTERLINE OF C3) 2 x 10 GIRT ABOVE o TYPICAL 30" x 30' x 10• GONG. COL. PAD I I i I O I i TYPICAL 8' CONCRETE WALL I ( ON 16' x 8' CONh. FOOTING O I 40•-0' BASEMENT PLAN SCALEv 1/4' 1•-O• 12 GROSS SECTION TYPICAL ROOF CONSTRUCTION, . ASPHALT ROOF SHINGLES/15# FELT PAPER. 5/5' GDX PLYWOOD SHEATHING/2 x 10 : RAFTERS AT 16' O.G./PROVIDE 'PROPERVEN' • OR EQUAL STYRAFOAM INSULATION TO MAINTAIN VENTING AT EAVES AND SLOPED INSULATED CEILINGS/PROVIDE CONTINUOUS KNEEWALL SOFFIT VENTING 3/4' T+G PLYWOOD GLUE _ EAVE TRIM = 1x5 FASCIA W/ ix2. 1xB B' AND NAILED TO JOISTS 5-9 VENTED SOFFIT. 1x5 FRIEZE W/ 1 3/1 BED MOULDING. C1xB = 7 1/2') 2 x 10's at 16' ox. ,i COURSE BETWEEN FRIEZE + ix4 WIND( HEAD • DH'S CLAP = 10 ADJUST FRIE FOR PROPER SIDING COURSING CARD I N LI ING RM. KITCHEN/n(N. PAD TO CASEMENT HEADER TO ALIGN) I� L 6 1/4' FIBER LA55 INSUL. TYP. 3/4' T+G PLYWOOD GLUE IN BASEMENT FILING AND NAILED TO JOISTS 2 x O's at 16' D.C. 2 x 10's at 16' O.G. 2 x G TREATED SILL. C3) 2 x 10 GIRT B' CONCRETE WALL 3 1/2' GONG.-FILLED STEEL LALLY COLUMN 4'! GONG. SLAB-7i .._-��• .. a• /"/1♦IT /"/CAI/' rnnTiui•. "V C�� 0 � rn Of : r ; rn � c dD � oo ❑ O oo ❑ z N (7 r I O Z PIGHT SIDE ELEVATION rl i N � n rD- II r 0 z zb'r -..:, TOWN OF BARN§TABLE ®P g/10 00 LOCATION l�CZIA Dr SEWAGE # , - " VELLAGE +mot S ASSESSOR'S MAP & LOT d'tD INSTALLER'S NAME&PHONE N0. 1-� 'r SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS Z_ BUILDER R OWNER PERMITDATE: COMPLIANCE DATE: z Mao 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 Jeaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of aching facility) Feet Furnished by 0 toy } f f r r J No. 00-�6'5�- FEE �) Board of Health, �u r».5 fit�l l� MA. �� APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT application for a Permit to ConstructV"'Repair( ) Upgrade( Abandon( Pllr.omplete System ❑Individual Components Location ` Owner's Name Map/Parcel# 01 R Je �q r-[:e 1 a Address'Zd k), Mal �- Lot# ya Telephone# Installer's Name Qk r" LL:fo r3j Designer's Name Address 313 � AddressZS oeoilte a wii Telephone# 3155 Telephone# _ 7 Type of Building inq 1e Fit 1Wi/tom $IYi e Lot Size sq.ft. Dwelling-No.of Bedrooms d Garbage grinder ( ) Other-Type of Building No.of persons Showers (, ),Cafeteria ( ) r. Other Fixtures Design Flow (min.required) AO O gpd Calculated design flow tea`t O Design flow provided zP'c';L0 gpd Plan: Date 1I M-7f 99 Number of sheets / Revision Date 412,f Title %7 p /�f; - � r ��- Description of Soil(s) sec/, M ('our5G (m 0- fo'?y Soil Evaluator Form No. ,FX;Py Name of Soil Evaluator Card 1 A Date of Evaluation d 1--3 1.7;;Z Ole- DESCRIPTION OF REPAIRS OR ALTERATIONS The unde i ed agrees to inst the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agree o of to ce system in era' n until a Certificate of Compliance has been issued by the Board of Health. Signed - Date 7� �-,4 r TOWN OF BARNSTABLE LOCATION 4I/�� Dr SEWAGE # CV At 0 VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1 cZ�d LEACHING FACILITY: (type) K. llS (size) NO. OF BEDROOMS Z. BUILDER R OWNER PERMITDATE: 1'''r QQ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet.� 'i Private Water Supply Well and Leaching Facility 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 aching facility) Feet Furnished by O vk t 00 b - W W FEE No. ; UBoard of,Health, 6 a r-"5 to b/(f- MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT'' Application for a Permit to Construct�/<Repair Upgrade( Abandon m lete S stem ❑Individual Components ( ) p g ( () ) - o� P Y P Location 9 L i a K Owner's Names Map/Parcel# Me !I lQ ,)ress �7" C-vrftc�u Lot# 1/9 Telephone# 396 GZ F Y3 Installer's Name 4PON C c-t �­io c-f U,1 Designer's Name Address Address J j � ��C:K..rrr e-v, � ..•G�- i�.� d/y9 Diu vT� � O 5)'"� ..Sun wi< <i.� D�Sti3f Telephone# Tj _ c�" �i '�j Telephone# jP� _ 7� Type of Building 51 Iy 1e Fif 1,4y IA,e. Lot Size sq.ft. Dwelling"-No.of Bedrooms o2 /'la Garbage grinder ( ) ' Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) dtS U gpd .Calculated design flow a,9 O Design flow provided 0 gpd Plan: Date 1112`7/5 9 Number of sheets / Revision Date All" , -Title 51),e f 5P�77 c .5 v t5 Telf—i 7 /11 t i //ia ry ' Desdription of Soil(s) n'rPa/- va 1100r5e 57ar­11 w .7' Soil Evaluator Form No. R- 7 Name of Soil Evaluator Cary 6,7 Date of Evaluation a�%/9/9� Y` F DESCRIPTION OF REPAIRS OR ALTERATIONS .e \ The unde i ed agrees to inst the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and ter-•'•. further agree o t to ce l system in era' n until a Certificate of Compliance has been issued by the Board of Health. Signed Date No. �oa� FEE COMMONWEALTH NW F ( T ¶ TTS �oI Board of Health, 1SVII/nj/P./oe' MA. CERTIFICATE Of COMPLIANCE Description of Work: ❑Individual Component(s) J24complete System The under si ed her b certify th the Sj,WD' poLMaSem; nstructed Repaired ( ),Upgraded ( ),Abandoned ( ) by: / at has been installed in accord ce with the provisions of 310 CMR 15.00 (Title 5) and the aDproved design plans/as-built plans relating to application No. 00 , dated /'�9��. Approved Design Flo 7 (gpd): j Installer 0 dr / Designer: Inspector:The issuance of this permit shall not be construed as a guarantee that the system-will=:unctionnas designed. No. FEE Zy�,Z4 r( Board of Health, X� MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is herebyranted to; Construct Re air Upgrade( an individual sewage disposal s g ll// P ( ) Pg ( ) Abandon( ) stem g p Y at L / a'!" ors / �"7 as described in the application for Disposal System Construction Permit No. GO��� , dated ��S Provided: Construction shall be completed within three years of the date of this permit. All to al conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date Board of Health ` __16�foG Eu�lYq�+.SDdnd — ,�- e6/6i/i i�+.Id•..MN�..9 V :raour�oi "r}".�TIOY611�7N'11A Y..r .rs .d 13{11LS FllYW Hlffi1N OT r...d.+Aaw uMde� as wxrM -1�?3� 'Q cmai viw&Z{AYU a � � t- L ° d ° s _` ° e El 4 .... —.. ' 1 5 i- oo 6 i t; e P. tf C� +L n DEED RESTRICTION WHEREAS Cape Cod Building SuPPIY� Inc. a Massachusetts Corporation duly organized under the laws of the Commonwealth of Massachusetts, with its usual place of business located at 63 Warehouse Road, Hyannis, MA 02601, is the owner of Lots 33, 38, and 42 on a plan of land entitled "Craig Port, a residential subdivision in West Hyannis, MA, Property of Rolkin Realty Trust (Frank L. Elkin, Trustee, dated September 1961, Ed Kellog, Engineer, Osterville," which plan is duly recorded in the Barnstable County Registry of Deeds in Plan Book 165, Page 41, which lots were conveyed to us by Deed from Rolde to Cape Cod Building Supplies, Inc. recorded in the Barnstable County Registry of Deeds in Book 1397, Page 616 and Book 1434, Page 650 WHEREAS, We, as the owners of said lot have agreed with the Town of Barnstable Board of Health to a restriction as the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a variance from the 310 CMR 15.214 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and to obtaining a building permit for each lot; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting the variance from 310 CMR 15.214, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single family home on each lot is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document; NOW, THEREFORE, We do hereby place the following restriction on the above referenced parcel in accordance with the agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: 1. We may have constructed upon each lot a house containing no more than two (2) bedrooms. We agree that this shall be permanent deed restriction affecting Lots 33, 38, and 42 on Lillian Drive, West Hyannis, MA, as shown in a plan recorded in Plan Book 165, Page 41. For our title to Lots 33, 38, and 42, see deed recorded in the Barnstable County Registry of Deeds in Book 1397, Page 616 and Book 1434, Page 650 Executed as a sealed instrument this day of January, 2000. Cape Cod Building Supplies, Inc. c I i John G. Doherty, Jr. , President COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. January 4 , 2000 Then personally appeared the above named John G. Doherty, Jr. and acknowledged the foregoing instrument to be his/her free act and d, b for e; Notary Public i ael J. Princi My Commission xpires: 9/8/04 'I i I SYSTEM COMPONENTS* ELEVATIONS## A VARIANCE Is REQUESTED FOR A Two BEDROOM ZONE: RB LOCUS: i DESIGN FLOW (DEED RESTRICTION ^REQUIRED). SETBACKS. MIN. 3" TOPSOIL FRONT 1. TOP FOUNDATION.................................. 100.00 ' I ' E SIDES - 001 ROUT w 28 ORGANIC MATERIAL & REAR - 10' 2. INVERT OF PIPE AT FOUNDATION.........................95•00 BOULDERS, IN COMPLIANCE FRONTAGE - 20' WITH 310 CUR 15.255(3)), AREA - 43,560 S.F. I 3. INVERT OF PIPE AT SEPTIC TANK INLET.............. 94.79 COMPACT TO 90X: DRY ' WITHIN WELLHEAD ZONE DENSITY 4. INVERT OF PIPE AT SEPTIC TANK OUTLET........... 94.54 2" LAYER OF 1/8-1/2" aAW RD. DOUBLE WASHED STONE - FEMA FLOOD ZONE C LNIM OR 5. INVERT OF PIPE AT D-BOX INLET........................94.50 _ 7 PANEL J250001 0008 D CARLMA AVE. ' (AREAS OF MINIMAL FLOODING Of - _ 6. INVERT OF PIPE AT D-BOX OUTLET..................... 94.33 8 OUTSIDE 500 YEAR FLOOD ZONE) cam►RD. �D 7. INVERT OF PIPE AT GALLEY................................. 94.30 3'5, 5 2' 3.5' -iY SITE 8. BOTTOM OF GALLEY............................................... 92.30 3/4-1 1/2" DOUBLE 9. BOTTOM OF AGGREGATE........................................ 92.30 wasHEO STONE GENERAL NOTES: ' 9 *LOCATED ON SECTION & PROFILE - .. :• ; ' 1. THE SYSTEM COMPONENTS AND CONSTRUCTION **BENCHMARK = STAKE SET = 102.23 -�' _ i i 1 I ' i, SHALL BE IN ACCORDANCE W/1N THE STATE OF SHOULD UNSUITABLE MATERIAL BE ENCOUNTERED EDGE OF EXISTING PAVING- MASSACHUSETTS SANITARY CODE TITLE 5, AND LOCAL BELOW 94,30 1T SHALL BE REMOVED & REPLACED PR 'OSED WATER & GAS BOARD OF HEALTH REGULATIONS. SECTION A - A PROPOSED EDGE OF WITH A 5' OVERDIG PER TITLE 5 REGULATIONS TYPICAL SECTION GRAVEL ROAD ! Y 2. CONTRACTOR SHALL NOTIFY DIG-SAFE PRIOR TO NOT TO SCALE ' - CONSTRUC7ON AND BE RESPONSIBLE FOR ALL UNDERGROUND UT►LI77ES. ES77MATED HIGH GROUNDWATER CALCULATION \`' (USGS/CCC METHOD) 3. ELEVATIONS ARE BASED ON BENCHMARK AS SHOWN. INDEX WELL: AIW-230 ZONE: D NOTE: PROPOSED EDGE OF 16' GRAVEL- ROAD `r 4. PIPING -SHALL BE SCHEDULE 40 PVC: DATE OF READING: 2120197 DEPTH TO GROUNDWATER: 21.92 AND PROPOSED UTILITIES PER PLAN OF LILLIAN \ �\ . ' C i GROUNDWATER LEVEL ADJUSTMENT: 1.90 DRIVE, CENTERVILLE, MA BY CJ ENGINEERING FOR , \ �\ •IP FNO 4 5. SYSTEM COMPONENTS SHALL MEET H-10 LOADING ACTUAL GROUNDWATER LEVEL SITE. EL. 68.00 J ALL CAPE ENGINEERING. REVISED 6123197 ;_; .�. - \ UNLESS OTHERWISE SPECIFIED OR H-20 LOADING ES77MATED (MAX) HIGH GROUNDWATER LEVEL: EL. 69.90 UNDER DRIVEWAYS 6. CONTRACTOR SHALL WATER TEST D-BOX FOR jf/PER USGS MAP - PROPOSED SAS AT EL. 50.00 f ABOVE MEAN SEA LEVEL, , m LEVELNESS. i PER GROUNDWATER CONTOUR MAP 1995 - GROUNDWATER AT EL. 20.00 (MSL) / 1 •1 ��\ �� ' �' - 50.00 - 20.00 = 30.00 TO GROUNDWATER d�•` I 1 ,\ `t�A l_ -� SLED WA � �� �� a 7. ANY AL TERA 770NS OF 1NlS DESIGN SHALL BE I 1 1 L y �' 1 Y J - - APPROVED IN WRITING BY THE ENGINEER AND BOARD OF 98.00 (GRADE AT SAS) - 30:00' = 68.00 (GROUNDWATER ELEVATION) STAKE SET I l ," 1 `I` \ -____ 1 1 _-7_ ' - HEALTH. EL. = 102.23 -----L--- -----�-- ` -_ �� 8. ENGINEER SHALL BE NOTIFIED 48 HOURS IN U.P. / 1 ADVANCE FOR FINAL INSPECTION OF SEPTIC J I 1 1 �� •��9 l / I r SYSTEM INSTALLATION. SOIL TEST LOGS P-8874 P-8875 ,, 1 I /DEPTH HORIZON HORIzoN DEP774 HOR►zory , , , ;2> I - / J DESIGN CRITERIA: 1 - GRADE = EL. 93.50 `GRADE = EL.-83.00 !C r \ i i ' ► I � ! 1 J 94 0" 0• p ORGANICS & FILL pj� O�• I V 1 I 79 DESIGN FLOW: LEAVES 1 \ I I /,��• t % I l /qy'I t I / I 1 t ► / / / / 2 BEDROOMS ® 110 GPD = 220 GPD 6" 2" AM AN u 1 OpQN� ; �. 1 �� t , // / /� SEPTIC TANK = 1,500 GALLONS LOAMY SAND 0 LO Y S D A l :._ r.. r ._.. l - ; ! / o :, t, ;� �, <_ ?7)WN WALE - 7.5YR4/i f 0YR2/1 I , . 1 Op ! I -887 J / / / I „ .i / NO GARBAGE DISPOSAL J / , TELE�HONE, ELECTRIC & 12" 30" _ SLOPE TO DRAIN ! , 7 I l ! / // l J i i C-A$LE TV SIZE OF LEACH FIELD REQUIRED. AWAY FROM / 1 / l / J / / i SANDY LOAM p LOAMY SAND Bw LOT 42 I l t I / �* ! l l l / / J J / J DESIGN OF PERC RATE. 2 MIN/INCH 7.5YR3/3 IOYR4/3 FOUNDATION !/ �' , J , , 15" 60" F��G 12, 125 S.F. I ► r I I�Rq�E' REQ'D AREA = 220/0.75 = 293.3 S.F. AA = (8.5+8.5+4+4)(5.2+3.5'+3.5) = 305.0 S.F LOAMY SAND Bw 10YR3/6 '/' I I I ��• - I I I 1 / / RETAINING WALL, MAX. MED. TO COARSE C1 �F i I I q I I EFFECTIVE LENGTH_ = 25' 30" SAND W/GRAVEL CB/DH FND 1 I �j I 1 I I I I I I I I/ '�) Q HEIGHT = 5'l 1 I h 1 I / P-8875 EFFECTIVE WIDTH _ t 2.2' 1 OYR4/s S� I I I , I I I I I I I 1 ! I \ MED. TO.COARSE C1 �.?a+ I! '_ I I d i � I I SAND W/GRAVEL I I , I \ r 2.5Y7/6 �' �'� ,� I I� � I-. I ! I t. I i rl r I ► ` 1 FINE TO MED. C2 FINE TO MED. C2 I �;1 I - SAND SAND . 1 j i t 1 I { t 1 1 1 I LEGEND: 10YR7/3' 1 OYR5/8 " .1 I - _1� i I 144 132" b '1' I ; I I w 1 - 1 I 1 1 LOT BOUNDARY \ r-.. 1 I i i i i I i i L C�T 40 i WATER BOTTOM OF EXCAVATION FOR LEACHING FACILITY TO I 1 I GAS SOIL TESTS CONDUCTED ON 2113197 BE INSPECTED BY THE ENGINEER OR HEALTH AGENT , I I 1 1 I I I I I 1 1; \6Jr S.F.S F BY CAROLYN J. DOYLE, P.E. "' I 1 I I r I I I \ `\ T - TELEPHONE \ �� ELECTRIC CABLE � WITNESSED 8Y BARNSTABLE BOH AT TIME OF CONSTRUCTION. `� I 1. 1 I I I 1 I _ _ _ _ _ _ AGENT JERRY DUNNING 21 I PROPOSED CONTOURS 1 1 1 C N !N CE 1 I ! I \\ 80 - - EXISTING CONTOURS `� •�'' // TO BE REMOVED -1 I I I I \\ \` - LIMITS OF OVERDIG MAX. FINISHED GRADE OVER �8 (�£ ) I NO GROUNDWATER OBSERVED AT 132" (EL. 72.00) LEACHING FIELD = 98.05 RT �, .t G', -------'------------ LIMITS OF LEACH FIELD ` `I TWO 500-GALLON PRE-CAST CONCRETE GALLEYS, - - EXISTING TRAVELED WAY PERC RATE <2 MIN/INCH AT 42" IN P-8874 '¢1' `G'� 8'6" x 5'2" EACH, WITH 4' CR. STONE ON ENDS SLOPE TO DRAIN AND 72" IN P-8875 AND 3.5' CR. STONE ON SIDES p-8874 TEST PIT, LOCATION & NUMBER SOLID 4" PVC, S=0.021 D-BOX TO BE PLACED ON CRUSHED STONE BASE. MIN. 6" THICK 2" LAYER OF 1/8" - 1/2" DOUBLE REVISIONS: RISER TO WITHIN 6" OF GRADE, TYP. WASHED STONE ABOVE GALLEYS 0 20 40 1 SOLID 4" PVC, 5=0.021 SOLID PVC, FIRST 2' TO BE LEVEL, REST AT S=0.005 SCALE: IN- 20' �� Of �IkNOd�'MA TITLE: SITE PLAN & SEPTIC SYSTEM DESIGN �o T P Y c� LOT 42, 19 LILLIAN DR., CENTERWLLE, MA CAROLYNii� ------------- o 0 4: . J. o Az`a3�,1 E WARNER OWNER: DAVENPORT BUILDING CO: TRUST 2 No.34531 [4o•38721 20 NO. MAIN ST., SO. YARMOUTH, MA 02664 o 0 0 0 o a 4 5J 6 7 NOTES FOR SEPTIC TANM:S: 15 � � 4• At � CJ ENGINEERING D-BOX DB-5 BY SHOREY CR ON� ON ENM 1. INLET TEE SHALL EXTEND A MIN. OF 10" BELOW THE FLOW LINE. �I 449 ROUTE 130, SUITE 13 I. CONCRETE PRODUCTS OR tl �l ( 6 a� SANDWICH, MA 02563 SEPTIC TANK EQUAL, PROVIDE FLOW 8 2. OUTLET TEE SHALL BE PROVIDED PER THE TABLE BELOW. yy l3 (508) 888-4975 H-10 RATED LEVELLORS ON OUTLET 3.5' CR. STONE LIQUID DEPTH IN SEPTIC TANK DEPTH OF OUTLET TEE BELOW FLOW LINE PIPES ON SIDES 4 FEET 14 INCHES MAP: 248 PARCEL: 204 PROVIDE GAS BAFFLE 5 FEET 19 INCHES 6 FEET 24 INCHES PROPOSED SEPTIC SYSTEM - PROFILE 7 FEET 29 INCHES DATE: 11129199 SCALE: AS SHOWN NOT TO SCALE 8 FEET 34 INCHES SURVEY BY.• TERRY A. WARNER, PLS HARMCH, MA (508) 432-8309 DWG: CJ134/LILLIAI9.DWG SHEET 1 OF 1 II