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HomeMy WebLinkAbout0074 MURRAY WAY - Health 74-76~Murray Way Hyannis T s A = 307 005 TI ;i Poi? C z-, 2 S'C-- Commonwealth of Massachusetts Title 5 Official Inspection Form F1, Subsurface'Sewage Disposal System Form - Not for Voluntary Assessments rUl '- 7476 Murray Way Property Address Sara Rose t Owner Owner's Name information is required for every Hyannis MA 02601 7-2-19 page. City/Town „ °,State, Zip Code Date of Inspection s F 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. 1o1ututmilt 111/// F Important:When `A. Inspector Information `°�• s9 °' fillip out forms �0�; :cti on the computer, ./ 7 _sue r JAMES R,' .a use only the tab James D.Sears key to move your. Name of Inspector SA RS ;r; cursor-do not Jim The Inspector Man �'•.o o, �� ` use the return Company Name , �`� ;c'' ♦♦�`� key. P.O.Box 784 iyF S I N SP�G�♦♦♦♦ - : u�f IrrnsrlU��� rab Company Address, West Yarmouth a. MA 02673 k City/Town State Zip Code +ten 508-364-4398 S1623 - Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5`' (310 CMR 15.000); I have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was'perform ed.based on my training and experience in the proper function and maintenance of on-site sewage disposal systems:After conducting this inspection I have determined that the system: 1. ® "Passes 2. ❑ Conditionally Passes 3. F Needs Further Evaluation"by the Local Approving Authority 4. ❑ :Fails r 7-2-19 01Apector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30'days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 , Commonwealth of Massachusetts Title 5 Official Inspection Form ! Subsurface Sewage Disposal System Form -'Not for Voluntary Assessments 74-76 Murray way `J Property Address Sara Rose Owner Owner's Name information is required for every Hyannis MA. 02601 7-2-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system isa 1500 Gal. Tank D Box and three chambers. System Conditional) 2) Sy y Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon-completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal.and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass existing tank is replaced with a complyingse tic tank as approved by the Board of inspection.if the e g p P PP 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts ,4.p Title 5 Official Inspection Form J. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74-76 Murray Way Property Address Sara Rose Owner Owner's Name information is required for every Hyannis MA 02601 7-2-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (Copt.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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):` 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts PR Title 5 Official 'Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74=76 Murray Way Property Address Sara Rose Owner Owner's Name information is required for every Hyannis MA 02601 7-2-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within , 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from•a private water supply well**. , Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal. coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No El ® 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 t5insp.doc•rev.V2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74-76 Murray Way Property Address Sara Rose Owner Owner's Name information is required for every Hyannis MA 02601 7-2-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspoolEl ' ® Liquid depth in oitgggomO is less than 6" below invert or available volume is less. than '/2 day flow 4 eAJAI6' ❑ ® 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 water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. - ❑ ® Any,portion of a cesspool'or privy is less than 100 feet but greater than 50 feet from a private`water supply well with no acceptable water quality analysis. [This system passes if the•well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- . 10,000 gpd. ❑ ® 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. large s stem the system must serve a facility 5) Large Systems: To be considered ay y y 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form FIB Subsurface Sewage Disposal System Form -Not for Voluntary Assessments e 74-76 Murray Way Property Address Sara Rose Owner Owner's Name information is Hyannis MA 02601 7-2-19 required for every y — page. City/Town i State Zip Code Date of Inspection C. Inspection Summary (cent.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no" for each of the following for all inspections: Yes No ❑ M 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? ® El available 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: ® ❑ - Existing information. For example, a plan at the Board of Health. El ® Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form `la Subsurface Sewage Disposal System.Form -Not for Voluntary Assessments 74-76 Murray Way Property Address Sara Rose Owner Owner's Name information is Hyannis MA 02601 7-2-19 required for every a page. City/Town State Zip Code Date of Inspection D. System Information' 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: 1500 Gal. Tank D Box and three chamber's. Number of current residents: NA Does residence have a garbage grinder.?' , ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ®' No information in this report.) Laundry system inspected? ❑ Yes ® No_ Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2017-63,900Ga1s g ( y g (gpd))' 2018-70,300Ga1 s Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form j Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74-76 Murray Way Property Address Sara Rose Owner Owner's Name information is required for every Hyannis MA 02604 7-2-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: NA 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: t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts y Title 5 Official Inspection � Form ia . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74-76 Murray Way Property Address Sara Rose Owner Owner's Name information is required for every Hyannis MA 02601 7-2-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) , 4. 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)and a copy of latest inspection of the VA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other.(describe): Approximate age of all components, date installed (if known)and source of information: D Box and Leaching 2005 permit #2005- 011. Were sewage odors detected when arriving at the site? ❑ Yes Z No 5. Building Sewer(locate on site plan): 1811 Depth below grade: feet Material of construction: El cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH -40. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 c Commonwealth of Massachusetts 1 Title 5 Official' lnspection Form I, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .74-76 Murray Way Property Address Sara Rose Owner Owner's Name information is required for every Hyannis MA 02601 7-2-19 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): 8" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Precast H-10 Sludge depth: Distance from top of sludge to bottom.of outlet tee or baffle 29" ' 'Scum thickness 0" 8" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 18" t How were dimensions determined? Asbuilt-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank and covers at 8" below grade. Two inlet tee's w/outlet tee. No sign of leakage or over loading. I F t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form F Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 0 74-76 Murray Way V Property Address Sara Rose Owner Owner's Name information is required for every Hyannis MA 02601 7-2-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: - feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness t . Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related-to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 1.8 Commonwealth of Massachusetts Title 5 Official Inspection Form M1�"s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 0 74-76 Murray Way Property Address Sara Rose Owner Owner's Name information is y required for every Hyannis MA 02601 7-2-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) . 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level' Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy,of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 30"x30%2" below grade w/3 lines out. Box is clean and solid w/no sign of over loading or solid carry over. t5insp.cloc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74-76 Murray Way u� Property Address Sara Rose Owner Owner's Name information is required for every Hyannis MA 02601 7-2-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumpssin 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. 11. Soil Absorption System (SAS) (locate on,site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ 'leaching fields number, dimensions: ❑,' overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev..7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L 74-76 Murray Way u Property Address Sara Rose Owner Owner's Name information is Hyannis MA 02601 7-2-19 I required for every _ f page. City/Town State Zip Code Date of Inspection D. System Information (cont:) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is Three 500 Gal. dry well chambers. Chamber's at 1' below grade. Chamber's are clean i and dry.Wall's are like new. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of.scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 1E Commonwealth of Massachusetts., I@ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74-76 Murray Way Property Address Sara Rose Owner Owner's Name information is Hyannis MA 02601 7-2-19 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) i 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form J10 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74-76 Murray Way Property Address Sara Rose Owner Owner's Name information is required for every Hyannis MA 02601 7-2-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area'below ❑ drawing attached separately 9 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 118 r TOWN OF BARNSTABLE LOCATION -74 k;iZ,2.A�, Ul fir( SEWAGE VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 1 .\Q yki-5yn �5 Vi k-I5-Z I SEPTIC TANK CAPACITY ►5'�c9 ' 1.1115 LEACHING FACILITY: (type) Q A� l•.1.,(site) NO.OF BEDROOMS_ `— BUILDER OR OWNER e PERMITDATE: :�` J°� 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 leaching f cility) Feet Furnished by s to Ll a o Commonwealth of Massachusetts ,1 Title 5 Official Inspection Form -1; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74-76 Murray Way u� Property Address Sara Rose Owner Owner's Name information is required for every Hyannis MA 02601 7-2-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12 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: 11-21-03 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: T.H.on Design plan 11-21-03 12' no G.W.. Bottom of chamber's at T-6" below grade. Bottom of chamber's at 8'-6" above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74-76 Murray Way Property Address Sara Rose Owner Owner's Name information is required for every Hyannis _.MA 02601 7-2-19 page: City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included ,go }� 7', Na G w. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Town of Barnstable Regulatory Services ' �F 1HE 1p� �P� o 'Thomas F. Geiler, Director Public Health Division BARN$TABLE, 9 MASS. $ 'Thomas McKean, Director 1639. �m 200 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 4, 2008 Aaron Rose 229 Saddler Lane West Barnstable, MA 02668 As of October 1, 2006 a new rental registration ordinance was put into affect requiring, all property owners of rental units to register their rental units with the Town of Barnstable Health Division. According to, our records, you own the rental property at 74 Murray Way, Hyannis Enclosed is an application. Please use a separate application for each rental unit you own. Should you need more applications, they are available online at .town.barn stable.ma.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information on the Health Division page. You may print out as many as you need,and return them to the Health Division with the appropriate 2008 fees included. Failure to comply with this ordinance will result in the issuance of anon-criminal ticket citation in the amount of$100. Each day of non-compliance is considered a separate offense. Should you have any,questions, please feel free to call 508-862-4644. Thank you in advance for your coopera 'o Timothy B.. O'Connell Health Inspector Health Division Direct #508-862-4646 lu_s�dv� uvl�nda� I5 74 VlAuar� Wa� {-�au��ni5 �n/� cwvoh or Sava FORM 30 C&W HOBBS 8 WARREN rnn THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN _ b DEPARTMENT Zoe w • „ �� �`l A w111 i� M14 ADDREtt 0 8ry 2- N 4 SyO� TELEPHONt Address7y V%y -, k--A OccupantVACAN"C Floor .— Apartmen No. — No.of Occupants__ No. of Habitable Rooms_No.Sleeping Rooms-2— No. dwelling or rooming units `L No.Stories 2 2 2 Name and address of owner-_AOL.0)! Av C,* CrCl►{+► 'Q.45 IL p• le, (� k/V C$'t 4."S-(JI►$4.f- Remarks Reg. Vio. YARD Out Bld s.: Fences: / Garbage and Rubbish i/ Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls.- Foundation: Chimney: BASEMENT Gen.Sanitation: 11 Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Su ply Line: Nj ❑ MS ❑ ST ❑ Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusin ,Grnd.: AMP: Gen. Cond. Distrib. Box: Gen, Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safetie : Kitchen Facilities Sink 40 Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Q d T E Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES PERJURY." INSPECTOR TITLE Lr ►�S�s�-,,g_ DATE TIME ^ , A.M. THE NEXT SCHEDULED REINSPECTION /v P.M. r 410.750: Conditions Deemed to Endanger or limpair Health or Safety The following conditions,:when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are'deemed to always have the potential to e-idanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to :al within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall w&in this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such Violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold,to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410 201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 1OE CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 41 J.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation,or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or,safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410:150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect in-estations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. ON e�v Town of Barnstable ` Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Susan G.Rask,F-S. Sumner Kaufman,MSPH Wayne Miller,M.D. Mr. Martin Moran, P.E. August 11, 2004 P.O. Box 183 South Harwich, MA 02661 RE: 74 Murray Way, Hyannis, MA A= 307-005 Dear Mr. Moran, You are granted conditional variances on behalf of your client, Garrett Regan, to install a new soil absorption system at 74 Murray Way, Hyannis, Massachusetts. The variances granted are as follows: The variances granted are as follows: 310 CMR 15.211: The soil absorption system will be located five (5) feet away from the property line, in lieu of the minimum setback of ten feet required. 310 CMR 15.211: The soil absorption system will be located seven (7) feet away from the foundation wall, in lieu of the minimum setback of twenty feet required. These variances are granted with the following conditions: (1) No more than four (4) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to four (4) bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. Q:Moran2004 C (3) The applicant shall file a request for determination of applicability (R.D.A.) with the Conservation Commission for any septic work proposed to be conducted within 100 feet of the top of the coastal bank. (4) The septic system shall be installed in substantial compliance with the May 14, 2004. (4) The professional engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the engineered plans dated May 14, 2004. These variances are granted because the physical constraints at the site severely restrict the location of the soil absorption system due to its close proximity of a coastal bank and a bordering vegetated wetland. ISinrely yours ayne hfiller, M.D. f Q:Moran2004 i THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS QCertificate of Comptiance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired Upgraded(' ) Abandoned( )by "v at —" �han constructe in ccordance with the provisions of itle and the for Disposal System nstruction ermit No. dated____ Installer � Designer The issuance of this p�rmiit shale construed as a guarantee thatje sysction asdesigned. DateL� Inspec TOWN OF BARNSTABLE LCVATION '74 o M Alkm \4),.•1 SEWAGE #� c9/J VTLLAGE��Turn n:S ASSESSOR'S MAP & LOT J�0 INLffALLER'S NAME&PHONE NO. 1 1V• P c ca.5vn 5 6e6 a g) ;} SEPTIC TANK CAPACITY 16W J "I LEACHING FACIL=' : (type) -tl r6C) 64 JI1(size) NO. OF BEDROOMS Lf BUILDER OR OWNER P. ,T vv�\,4 fLa a i E.vJ PERMITDATE: s 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 leaching f cility) Feet Furnished by ) -'� •9 y � 0 u} s C N V'1 f Sj J i No. � . Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 'Yes' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIpprication for Mto pool Owem ctConotructiott Permit Application for a Permit to Construct )Repair( )Upgrade( )Abandon( ) ED Complete System ❑Individual Components �J Location Address or Lot�i4 Owner's Name,Address and Tel.No. -76 Assessor's Map/Parce� G 0 Installer's Name,Address,and el.Now, Designer's Name,Address and Tel.No. e°� �C• /�20�A�,r � /l eP•2�nC�i�..rc . /&off, / ,l 3,2-� ��".�.� 4/?Z Z.7F Type of Building: Dwelling No.of Bedrooms Lot Size 11970 sq.ft. Garbage Grinder( ) Other Type of Building.Itz.Ie r - No. of Persons Showers( ) Cafeteria( ) Other Fixtures , `L/ Design Flow 7 ZI gallons per day. Calculated daily flow gallons. Plan Date 'S i�! Number of s eets / _Revision Date 14i-714 S/ Title Ti4 �� ©S4� .s �.�v►� Size of Septic Tank Type of S.A.S. Description of Soil 47751-Ght e,__f L 4 o 5 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 f the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by i oard of a h / ' M Signed `i'- A✓ � M 7116• Date S Application Approved by o Date Application Disapproved for/ a following reaso Permit No. Date Issued 1VC No. � Fee_ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: VYe PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACVQPtTTS Z ZippYication for Migooal *p5tem Conotruction Permit Application for a Permit to Construct§Z Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. G, Owner's Name,Address andd Tel.No. 171-1-76 /I7Yi2R$�Gt/�y/ �44 Os,/ Assessor'sMap/Parcel G !S Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �aacv� n'1 4�?z-2-,F7F Type of Building: Dwelling No.of Bedrooms Lot.Size 71770 sq.ft. Garbage Grinder( ) Other Type of Building.-5, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 7 7 Z) gallons per day. Calculated daily flow gallons. Planr.Date / o Y Number of s eets Revision Date 710 S/ Titlei�/�1'S o S4 S fie, Size of Septic Tank /_Sa0 -n Type of S.A.S. Description of Soil SPA 477'4CheW _!�;j! 4 o S n Nature of Repairs or Alterations(Answer when applicable) ICP� L Date last inspected: Agreement: f The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with.the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued�tli* oard of ea th J Signed _ 1 ! - ,CdKS�t Date �/ h S Application Approved by r U f 9 /, l Date Application Disapproved for the following reasons v Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS " (Certificate of (Compliance THIS IS"TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( a)Upgraded( ) Abandoned( )Dy /1 1 C /�h ✓�_P„r, :-� at L/- —) a en constr_ hucted in accordance with the provisions o itle 5 and the for Disposal System nstructio ermit N dated JM x, Installer Designer The issuance of this permit shall notbe construed as a guarantee that the system il t notion as designed. Date !Y I q--O. F e-11 Inspector No Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Miopooal *p!5tem (Conotruction Permit Permission is hereby grant d to Construct( )Repair( )Upgrade( )Ab ndon System located at �Y , I and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructi n mu t be completed within three years of the date of is pe ��/Y/ Date:_ Approved by (i ` V w. • Town of Barnstable Regulatory Services . Thomas F. Geiler,Director • BA"SrARLE, • WASS• Public Health Division rEo .r° Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form - Date: D Designer: . gkA/ ng ` it eRrn Installer:, Address: q ( u �-- Address: l I On l r W, was issued a permit to install a ( ate) (installer) septic system at -�y -- 7& n4k�s\-( �t%--q based on a design drawn by (address), © 4,,A ~11 dated OZ DJ ( esi er) 'PI certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 14' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State& Local Regulations. Plan revision or certified as-b * t by designer t636116w. FP0 1 OF MASSq s "``' MARTIN E. cy p MORAN :- ' CIVIL (Install 'S ature) ov No.23417 AL y Y ' . (Designer's Signature) (Affix Designer's Stamp Here) PLEASE'RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE AS- OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOT THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PITULIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Desiper Certification Form i t k - ' TOWN OF BARNSTABLE LOCATION ��') � +rVl vti(L�� �Al 1�9 SEWAGE # VILLAGE «%AA='S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 1 SEPTIC TANK CAPACITY i��uc� •7 t� j — LEACHING FACILITY: (type) `3 cg ai �.�-s(size) '-3 � 1 `� NO. OF BEDROOMS L « BULL-DER OR OWNER � ' �r PERMITDATE: f� 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 leaching f cility) Feet Furnished by ail �, �2 9 t Law Offices of KEVIN F. O'DONNELL Professional Corporation P.O. Box 659 Cohasset, Massachusetts 02025 Quincy Office: Telephone 617-773-2880 165 Washington.Street Fax 781-383-0108 Barnstable Board of Health September 16,2004 Main Street Hyannis, MA BY HAND /9- �v � G Re: 74-76 Murray Way Hyannis, MA Dear Sir or Madam: Enclosed please find the recorded Deed Restriction concerning 74-76 Murray Way. Thank you for your attention to this matter. Very truly yours, Kevin F. O'Donnell KFOD/do Enclosure Bk 19038 Ps 2- 8 7 73 DEED RESTRICTION I, Garrett Reagan, Executor of the Estate of James T. Reagan, owner of property commonly known and numbered as 74-76 Murray Way, Hyannis, Massachusetts, in Barnstable (Hyannis), Barnstable County, Massachusetts, bounded and described as follows: Being shown as Lot #2 on a plan entitled "Subdivision Plan, Land in Hyannis, Mass. belonging to Merton L. Young, et ux, Scale 1 inch+40 ft. June 1, 1960, Nelson Bearse & Richard Law, Registered Land Surveyors, Centerville, Mass." recorded with Barnstable Registry of Deeds in Plan Book 156, Page 81, further bounded and described as follows: BEGINNING at the Northwest corner of the herein-described premises; THENCE running S. 76% 20' 10" East.for a dista nce of one hundred and 00/1000 (100.00) feet to a point; THENCE running by Lot 3, on said plan, S 12°, 42' 20" West for a distance of ninety six and 94/100 (96.94) feet to a point of the Northerly side of Murray Way, a thirty foot private way; THENCE running by Murray Way, N. 77' 12' 50" West for a distance of one hundred and 00/100 (100.00) feet and to a point; THENCE running by Lot 1, on said plan, N. 12' 42' 50"East for a distance of ninety eight and 47/100 (98.47) feet to the point of beginning. Containing 9,770 square feet, more or less. Together with rights in common with all others lawfully entitled thereto, over the ways and streets as shown on said plan in Plan Book 156, Page 81. NOW, THEREFORE, Garrett Reagan, Executor of the Estate of James T. Reagan, does hereby place the following restrictions on the above-referenced land in accordance with his agreement with the Town of Barnstable, Board of Health,which restriction shall run with the land and be binding upon all successors in title: 1. 74-76 Murray Way, Hyannis, Massachusetts, in Barnstable (Hyannis), Barnstable County, Massachusetts, may have construction upon the lot a house containing no more than four (4) bedrooms. Garrett Reagan, Executor of the Estate of James T. Reagan agrees that this shall be permanent deed restriction affecting 74- 76 Murray Way located in Hyannis, MA and being shown on the plan recorded in Plan Book 156, Paged 81. For title, see Book 1530, Page 108, Parcel 1. Executed as a sealed instrument day of September, 2004. Garrett Reagan, Exec or �G1jet�ommontueaitl�ut�ta��arint�ett� � � Barnstable, ss. September ,2004 Then personally appeared the above named Garrett Reagan, Executor, known to me to be the person who executed the foregoing instrument and acknowledged the same to be his free act and deed, before me. Notary Public n,v My commission expires At?/�v 2010. S: , KEVIN F.0 DONNELL Notary Puhlic Commonwealth of Massachusetts My Commission Expires November 26,2010 Tot'%d OF �ARjqcr �p SHE 1p� �l E Ju 'FEE MASS. 1639. A,m� _ REC. BY Town of Barnsta _" 'eS N SC RED.D DATE: 'Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Wayne A.Miller,M.D. VARIANCE REQUEST FORM LOCATION Property Address: f Assessor's Map and Parcel Number: ? ' D d�� Size of Lot: , 77,0 5.F Wetlands Within 300 Ft. Yes °� Business Name: No Subdivision Name:, APPLICANT'S NAME: FS'�a le- ® V16P7 5 gahone Did the owner of the property authorize you to represent him or hers Yes V1_ No PROPERTY OWNER'S NAME CONTACT PERSON s a a� orne-a Kea?cry �9orza� ,Era /.,Ieef-/Aq Name: Co �a'e ri—e-W Re-a-awn Name:t[�f��'�/fit A or44A 4 t Address: 91p ettjzs wqsz, S ` ct e44 Address: AhboxotE.30 -Te: lar-WtCUP)q _.6Z466� 0 2-Ofo(a Phone: / -71t- Sz{S' 46056, Phone: 508-4&Z roZT.?8' VARIANCE FROM REGULATION(List Reg.) REASON FOR VrAR1?ANCE(May attach if more sppace needed) d 3IOCMIQ/5o211 l5.4.v�Csr~) m5' s�evo 'has . Sir/ Ab Drs nce l4�PZK PYO 1.P� Sly (l..(y e . ' d-' x.�'" S `> !o' yir+ed—✓``''atyr able . 6e c9r id f J d`�etfiterl;we. � etit ev-eM L V sk, r_e bel,cueeyt SAS' `All >fB lione. enyiro Cnfal uananeesr are- realae&'fed,, NATURE OF WORK: House Addition ❑00000 House Renovation 0' Repair of Failed Septic System Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. Four(4)copies o�the completed variance request form _ Four(4)copies of4ngineered plan submitted(e.g.septic system plans) _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expens (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) _ Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance renewals [sam owner/leasee only], outside dining variance renewals [same owner/leasee only], and variances to repair failed sewage disposal systerr. [only if no expansion to the building proposed]) _ Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne A.Miller,M.D.Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Susan G.Rask,R.S. Q:\HEALTH\Application Forms\VARIREQ.DOC Ca4.) L 1344h . . Bedroow�. � 6edv�, - 8e�roow� - �roo�► r 2 n d poor- sea Kitche►y k e�+en tivin� k7f" i vine �M 0 jr . a �"E, Town of Barnstable Regulatory Services M • NAM �, Thomas F. Geiler,Director s639. � Conservation Division Robert W. Gatewood,Administrator 200 Main Street, Hyannis,MA 02601 E-mail:consmation@Lown.bamstable.m a.us Office: 508-8624093 Fax: 508-778-2412 July 20, 2004 Garrett Regan 26 Kings Way Scituate, MA 02066 RE: James T. Regan -Enforcement Order dated Jan. 21, 2000 76 Murray Way, Hyannis Dear Mr. Regan, As requested, this letter to inform you that the Enforcement Order issued to James Regan on January 21, 2000 for 76 Murray Way, was complied with. If you have any other questions,please feel free to contact our office. Sincerely, Dar arle Conservation Agent C., y Cc: Board of Health i SAMPLE To be used as a Guideline NOTICE: The Town of Barnstable .reG_ornmends-thatAhe.WIicant seek legal advice to prepare a properly worded deed I restriction document. DEED RESTRICTION WHEREAS, of (owner's name) MA (address) is the owner of located (address) at MA (hereinafter referred to as and being shown on a plan entitled "Subdivision of Land in MA, Property of , et al, duly recorded in Barnstable County Registry of Deeds in Plan Book , Page ; Or on Land Court Plan Number WHEREAS, as the owner of said lot has (owner's name) agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorize I g the issuance of a building permit for the construction of a single family home on this property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, deedr CNOW, THEREFORE, does hereby place the (owner's name) wing restriction on his above-referenced land in accordance with his eeme.at with.the Tow-n.af.Bamstabje-Boa d sf He-a-Eth which-res#r-iction shawith the land and be binding upon all.successors in title: may have constructed (address) upon the lot a house containing no more than ( ) bedrooms. (owner's name) agrees that this shall be permanent deed restriction affecting located on MA, and being shown on the plan recorded in Plan Book , Paged ! Or on Land Court Plan For title of see the following deed: Book , Page Or Land Court Certificate of Title Number Executed as a sealed instrument day of Owner's signature Owner's signature Owners signature COMMONWEALTH OF MASSACHUSETTS i , ss 20— Then personally appeared the above-named known to me to be the person who executed the foregoing p g g instrument and ; acknowledged s the same to be free act and deed, before me, Notary Public 1 My commission expires: deedr Sep 13 04 01 : 03p Kevin F. O 'Donnell 781 -383-0108 p. l s. 'B �tiC� li>: Y1-.:5aEEi;�cvEt 1 t .t t 61 :-3-2680 Fax FACSIMILETRIANSMITTAL Septer b=er 11 2004 QY ,n 0,Dcn v- ` troa.rd, o.EHealth; Bamstahie 1la.x 508-790-6304. 11,e , 3 Re t' s - r7¢ 7 M Way, t A cJCC,LA 1.\t..5�.1:1i:�iC�T, iC)1 i�i-/� .�Murray ��r ti�y'� Y.�:�%ai11iIS, '�`�i,el Estate of James T. Reagan C:ONMIN,IEN I S: AttaciZed Tease find a proposed Deed. Restriction as :requested.by the 'I own of Barnstable, -Board of health_ Please let us know if this Deed Restriction is acceptable. . Thank you for your attention to this matter. TO7:AL NUIIVI€ER OF PAGES LNICLUDING COVER SHEE"i": 3 � �� y i �oEti Town of Barnstable o� _ , ,,, AB . ; Regulatory Services 9q, Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 DATE: 0 yP NUMBER OF PAGES TO FOLLOW: O TO: _ FROM:--�—� QV�n (D l 01��5 �� 0Z - PHONE:. PHONE: (508)862-4644 FAX PHONE• FAX PHONE: (508)790-6304 NOTES/COMMENTS: a cc o► � . i Q:1$EALTHTax Fosm.doc ;'1 r "r(. iessiC.bi'nal 'C"orporation P. 0. Box 6-1;9 Coliasset, Massachuse.ts 02025 'in(ti I.IFFice. `1eiePltone 781-383-01.93 165 'Washington Street 61.7-773-2880 Fax 781-383-Oi.bs FACSIMILETRANSMITrAL cry e� �,, 01 DA"I'E: September 1.4, 2004 ::X 01 Board of Health, Barnstable Fax: 508-790-6 304 lZ: Deed Restriction. for 74-76 Murray Way, Hyannis, MA. Estate of James T. Reagan. COMMENTS: Attached please find a proposed Deed Restriction as requested by the Torun of Barnstable, Board of Health. Please let us know if this Deed Restriction is acceptable. z Thank you for your attention to this matter. TOTAL NUMBER OF PAGES EVTCLUDIRiG COVER SHEET: 3 Ok 1 a SO�°�6-� T -d 801:0-CBE- TBL TTaUUOa' O •_j UTAOA dB0 =S0 t'0 -T das DEED RESTRICTION 1, Garrett Reagan, Executor of the Estate of James T. Reagan, owner of property commonly known and numbered as 74-76 Murray Way, Hyannis, Massachusetts, in Barnstable (Hyannis), Barnstable County, Massachusetts, bounded and described. as follows: Being shown as Lot # 2 on a plan entitled "Subdivision Plan, Land in Hyannis, Mass. belonging to Merton L. Young, et ux, Scale 1 inch+40 ft. June 1 1.960, Nelson Bearse & Richard Laiv, Registered Land Surveyors, Centerville, Xlass." recorded with Barnstable Registry of Deeds in Plan Book 156, Page 81, further bounded and described as follows: B 'GINNING at the Northi.vest corner of the herein-described premises; THENCE running S. 76°, 20' 10" East for a distance of one hundred and 00/1000 (1.00.00) feet to a point; , THENCE running by Lot 3, on said plan, S 12% 42' 20" West for a distance of ninety six and 94/100 (96.94) feet to a point of the Northerly side of Murray Way, a thirty foot private way; 'THENCE running by Murray Way, N. 77° IT 50" West for a distance of one hundred and. 00/100 (100.00) feet and to a point; THENCE runrung by Lot 1, on said plan, N. 12° 42' 50" Bast for a distance of ninety eight and 47/100 (99.47) feet to the point of beginning. Containing 9,770 square feet, more or less. Together -with rights in common with all others lawfully entitled thereto, over the ways and streets as shown on said plan in Plan Book 1.56, Page 81. NOW, THEREFORE, Garrett Reagan, Executor of the Estate of Jalnes :l. Reagan, does hereby place the following restrictions on the above-referenced land in accordance with his agreement with the Town of Barnstable, Board of I Iealth,-which restriction shall run with the land and be binding upon all successors in title: 1.. 74-76 Murray Way, Hyannis, Massachusetts, in Barnstable (Hyannis), Barnstable. County, Massachusetts, may have construction upon the lot a house containing no more than four (4) bedrooms. Garrett Reagan, Executor of the Estate of James T. Reagan agrees that this shall be permanent deed restriction affecting 74- 76 Murray Way located in Hyannis, MA and being shorn on the plan recorded in Plan Book 156, Paged 81. For title, see Book 1530, Page 108, Parcel 1. Z 'd 8010-686- TBL IIODUDa, o •A uineN d80 :S0 i3O tT des _ I -4 Executed as a sealed instrument day of September, 2004. Garrett Reagan, Executor �r,e��nrHt�flrct�e��ttlj of�Tasstzrl�Ya..Setts Barnstable, ss. September ,2004 'Then. personally appeared the above named Garrett Reagan, Executor, kn.oi,\,n to nie to be the person who executed the foregoing instrument and. acknowledged the same to be his free act and deed, before me. Notary Public %4y commission expires 20_ E -d 8010-E8E- IBL ilauuoQ, O •j uinaA dB0 :SO tr0 �I des Search for Ma /Farce 307005 P s Townaf Barns,, ble For Parcel Number 307005 71 �;-/ ` 12entaC Property(YIN) �. d5 B�mess Name Zone of Contr�butio�m(Y(N) Phone 000 0000000 t=ut Storage TankPermitCarilOn File €F �� � Perc Test �% ,Well permit 1Con tuct�o�n - File/Permit l 94 344 � r Issua�n�e Date ,C.ompletion,Dat'e Size of5epttc Typelaize of SAS to \ "."REPAIR T5 failed septic 9/30/03 _ mappar 307005 Owners REAGAN JAMES T proploc 74 MURRAY WAY a sinat 'Aite�rnative Technology Septic Sys ems Single o Clustered .i/A Type � I/A Service Type �, _ � , Ladd � E v � � 3delete records? f Jurie 24, 2004 To whom it may concerns Martin E . Moran of Morari Engineering is authcrized to represent the Estate of James T. Meagan in the variance request for 74-76 Murray Way 'with the Barnstable Board of Health. Sincerely, Garrett Reagan,�Xecutor Estate of James T. Reagan 26 Kings Way a Scituate, MA 02066 781-545-4058 rZO/ZO 39vd AS SS3NIsnE NOSddOHi T88V-9b9-T8L ZO :9T bOOZ.Ivz/90- Ommonweaith of Massachusetts.. Barnstable " , The Trial Court D Probate and Family Court Department Docket No. 03P1828EP-1 Probate of. Will Vi tfflithout Sureties Name of Decedent James T. Reagan Domicile at Death 76 Murray Way tre Barnstable (set and noJ Barnstable 02601 (ter or town) (county) (zip) Date of Death March I7, 2003 Name and address of Petitioner(s) "Garrett Reagan 26 Kings Way, Scituate, MA 02066 Status Executor Heirs at law or next of kin ot.deceased including surviving spouse: M. Name e Residence Relationship (minors and Incompetents must be so designated) US That said deceased left a will— —herewith th r ' or �"��`�"'���`�� presented, wherein your petitioner(g) is/Me named . execut and wherein the testator had requested that your petitioner(&I be exem t from iv'in his/hr bond(. p g g surety on m z The petitioner' hereby -(� certif;e� that a copy of this document, along with a copy of the decedent's = death certificate has been sent by certified mail'to the Division.of Medical Assistance, P.O. Box 15205, �. w Worcester,Massachusetts 01615-9906.,, Wherefore your petitioner(m) pray(s)sthat said will— )_may be proved and allowed, and that he/ be appointed execut_ thereof, /without surety on him bond(,and certif contained are true to the j ps under the penalties of perjury that the statements herein best of hi a� sir knowledge and belief. Date Signature(s) Garrett Reagan The undersigned hereby assont to the fore oin,r g g petition and to the allowance of the will without testimony, DECREE All persons interested having.been notified in accordance with the law or having assented and no objections *} being made thereto, it.is decreed that said instrument(s) be approved and allowed as the last will a of said deceased,andlhat said petitioner(s): G nd testament arrett Reagan : Of Scituate in the County. of. FPI oath ` and , Of execut or ., be appoint p ed thereof, first giving bond with you Sur ies for the ue performance of said trust a Zab CJ-P 2(11/0 1 Ju StIC e of the Proba te and Family ourt ON REVERSE SIDE) The�Commonbjealth of 1%55adp5ett5 00019 S „_ ,USE By STANDARD CERTIFICATE OF DEATH `a�37, CIANS AND REGISTRY OF VITAL RECORDS AND STATISTICS REGISTERED NUMBER STATE USE ONLY -EXAMINERS DECEDENT-NAME FIRST MIDDLE LAST SEX DATE OF DEATH(Ma.,Day,Yr) ' "T M 3 March 17 2003 / ��. PLACE OF DEATH(Cify/iown): COUNTY OF DEATH HOSPITAL OR OTHER INSTITUTION-Name(If not in either,give street and number) J[ Barnstable 4b Barnstable 76 Murray Way PLACE OF DEATH(Check only one): qc HOSPITAL OTHER 7 --- - ' RACE(e.g.White,black,American Indian,etc.) DECEDENTS EDUCATION(Highest Grade Completed) (It yes.Specily Puerto Rican,Dominican.Cuban,arc.) - (Specify) Efemenla Sec 0.12) Coll e ,�,5+) ' + + �NO❑YES 8a SoeriN: 6b White y 4 - AGE-Last Birthday UNDER t YEAq UNDER,OAY Cambridcrei, Massachusetts MARRIED.NEVER MARRIED LAST SPOUSE(It wife,give maiden name) USUAL OCCUPATION KIND OF BUSINESS OR INDUSTRY WIDOWED OR DIVORCED (Prior.If Retired) 4 .7ever Married. ,3 --- 114.Resident Maria Manager ,qb Hos ice House RESIDEN76 Murray(rOVT 7a000NTY,STAT Barnstable, Barnstable, MA� ZIP CODE D 26 01 15a V 1'lVv D O FATHER-FULL NAME STATE C. BIRTH(II hat in US, MOTHER-NAME (GIVEN) (MAIDEN) STATE OF BIRTH(/t not in the US, name country) name country) -- t6 Fdmind F. Reagan 17 MA f6 Katherine Brennan PA o 9 INFORMANTS NAME MAILING ADDRESS•NO.&ST.,CITY/TOWN,STATE,ZIP CODE RELATIONSHIP Garrett T. Reagan 21 26 King's Way, Scituate, MA 02066 122 Brother 23 METHOD OF IMMEDIATE DISPOSITION FUNERAL SERVICE LICENSEE OR OTHER DESIGNEE BURIAL ❑CREMATION LICENSE If ENTOMBMENT ❑REMOVAL FROM STATE T awrence J. Bennett DONATION OTH.SPEC. 2q _ 5586 '• + PLACE OF DISPOSITION(Name of Cemetery,Cremato or otheq 25 ry LOCATION(City?own,State) 26a St. Francis Xavier Cemetery 26b Barnstable, MA - GATE OF DISPOSITION NAME AND ADDRESS OF FACILITY OR OTHER DESIGNEE Loa -- p � 21 2003 2EIwb John-Lawrence Funeral Home Marstons Mills, MA 02648 29 PART I-Enter the diseases,injuries.or complications that caused the death.Do not use only the move of dying,such as cardiac,or respiratory arrest,shock or heart failure Approximate Intervaltw List only one cause an each line(a through it)PRINT pR TYPE LEGIB Beeen Onset and DeathIMMEDIATE CAUSE(Final /}— disease or condiAon resulting a. �f/'! r...� in death) DUE TO(OR AS A CONSEQUENCE OF) ` r Sequentially list conditions,it b. any,leading to immediate DUE TO IOR AS A CONSEQUENCE OF) - - cause.Enter UNDERLYING - CAUSE(disease of injury that C. -hated events resulting m DUE TO(OR AS A CONSEQUENCE OF) ' death)LAST PART I,-Other signiticant conditions contributing to death but not resulting in underlying cause given in Part I. WAS AUTOPSY WERE AUTOPSY FINDINGS PERFORMED? AVAILABLE PRIOR TO (Yes or No) COMPLETION OF CAUSE - ! T� OF DEATH?(Yes or No) 70 .v�� ( �/�/1\ _. ` /Q _- � 31 L'TO 32 MEO.EXAM. 3a MANNER OF DEATH S W DATE OF INJURY TIME OF INIJURY INJURY AT WORK NOTIFIED? NATURAL ❑HOMICIDE (—]COULD NOT BE DETERMINED (Ma.,Day.Yr.) (Yes or No) Ye$ (Yes or No) 33 ❑ACCIDENT❑SUICIDE ❑PENDING INVESTIGATION, 135a 35b M 35c - of Death DESCRIBE HOW INJURY OCCURRED PLACE OF INJURY(At home, LOCATION(No.&St.,CiVrown,State) File: farm,street,factory,attic.bldg.. ❑ - ere.,)Specify 35tl 351 a 36a To the best of my knowletl .death occurred at the tlme,data,and place and due to the 37a On the basis of examination andlor investigation in aau5e(5)state i9 my opinion death occurred m the time, /l/�C/l n'w date,and p H I lace and due to the taus s staled. .6 (Signature ,M a 3 (Signature 'a= and rille) Z an Title) - _ o a DATE SIGNED(Ma.,Day.Yr.) HOUR OF DEATH E m DATE SIGNED(Mo..Day,Yr.) HOUR OF DEATH EVZ u>O 36b March 20, 2003 36C 3.21 = P M <z 37b 37c M - c g NAME OF AT7ENOING PHYSICIAN IF NOT CERTIFIER a U t¢ .0 PRONOUNCED DEAD(Mo.,Oay.Yr.) PRONOUN9ED DEAD(Hr) U 36tl , 37tl L37eICENSE M NAME AND /AO'ORESS OF CERTIFYING PHYSICIAN OR MEDICAL EXAMINER(Type or Print) / �a�¢�s/�j' /yJ a�Gl v! UCEINSE NO.OF CERTIFIER - 36 W ih • 1 — d !A e `l /�' V, C C C1 — `�f 39 ` 7 3 v`( Was THERE A T1,FvES.DATE IF YES.TIME a0tl NAME O PRONTITLE T PRONOUNCEMENT FORONOUNCED - .PRONOUNCEDJ LY ,YesnrA'o) No b ._. ant M - ❑R.N. ❑P.A. DATE B ".6W .6 Is21 D 0 - - RECEIVED IN THE CITY:TOWN OF BAR t DATE OF RECORD Zw lq C6D 11 LL CLERK" /q//�� -A/t/ HE. r•vWV v q.T i,the undersigned,hereby certiR that I am the To- n Clerk of the ToNNn of Barnstable:that as such. I have custod-, of the records of births,marriages and', deaths,required by lax to be kept in mv ofnce.and I do herebc certifi that the above is a true coPy from said records. WITNESS: M} hand and the SEAL OF THE TOWN OF BARNSTABLE A TRUE COPY ATTEST: at Barnstable-Massachusetts - 2 Linda E. Hutchcnrider.To\Nn Clerk. Barnstable (If this attestation is not in red.this document has been illegally copied:-do not accept it) }5: 7-6 i --- 74, l�l u YtY-Aa a :5&7 D©5 t e kb m /uQ� e7 9¢4 bo mere ww 1 M Af- 0 1701 i6 4- 1VI u rt-u a �� ' a 397 V�::, Co ------ 1OA- 1 7 P3®z n 15 �07�© c Ebro 6c F_a --- 3; ' 7�2 /VIQU�GGG�� � aVld �b Ot,6LC tf ®� x �20 oaCA I t� fir► , f. y_ s f COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED UT FAILED INSPECTION OCT 2 2 2�03 TOWN O L HRNSTABLE TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 74-76 Murray Way Assessors Map:307 Parcel:005 Hyannis,MA Owner's Name: Estate of James Reagan Owner's Address: C/O Garrett Reagan ioAP �,.__....,...*••.-* 26 King's Way,Scituate,MA 02066- PARCEL 0 t 5 Date of Inspection: September 30,2003 LOT - - - Name of Inspector:(please print) Richard Judd,R.S. Company Name: Moran Engineering Mailing Address: 941 Main Street South Harwich,MA 02661 .Telephone Number: 508432-2878 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address an tion reported below is true,accurate and complete as of the time of the inspection.The inspecoo d on my training and experience in the proper fimetion and maintenance of on site sewage DEP approved system inspector pursuant to Section 15340 of Title 5(310 CMR 1 )'JUDD JsR N No.1125 Passes o Conditionally Passes +sTES Needs Further Evaluation by the Local Ap s X Fails 1' Inspector's Signature: Aw Date: September 30,2003 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 now 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:FAILS The observed liquid level was three inches above the too of the Soil Absorption Svstem's inlet line. The liquid level was observed over the top of the SAS leaching comtwnent. OTHER: 1500 gallon septic tank:bulkhead to tank measured at 1'-8"(ten feet required).The observed septic tank has two inlet lines:the line at the headwall requires an inlet tee and the inlet line along the sid_ewall enters at the at:cessRort at the exit line Two lines exit the septic tank One enters the failed SAS(approved per town AR lication)and the second line was traced but the SAS was not recovered(NO information per town). ****This report only describes conditions a;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. Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 74-76 Murray Way Hyannis,MA Owner: Estate of James Reagan Date of Inspection: September 30,2003 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: i� i 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): i broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 74-76 Murray Way Hyannis,MA Owner: Estate of James Reagan Date of Inspection: September 30,2003 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 whichtwill protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or piivy 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 su-rface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone l 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: Page 4 of 11 t OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 74-76 Murray Way Hyannis,MA Owner: Estate of James Reagan Date of Inspection: September 30,2003 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: , Yes No X_ _ Backup of sewage'into facility or system component due to overloaded or clogged SAS or cesspool X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than'/2 day flow X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _ _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ _X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] YES (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no y _ 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. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 74-76 Murray Way Hyannis,MA Owner: Estate of James Reagan Date of Inspection: September 30,2003 Check if the following have been done You must indicate"yes"or"no"as to each of the following: Yes No 7t_ _ Pumping informa}ion was provided by the owner,occupant,or Board of Health X_ Were any of the system components pumped out in the previous two weeks? i Has the system)received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X Was the facility or dwelling inspected for signs of sewage back up? X Was the site inspected for signs of break out? X Were all system components,Including 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? _X Was the facility owner(and occupants if different from owner)provided with information on the proper _ maintena_nce 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)] 1 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT INSPECTION FORM S SUBSURFACE SEWAGE DISPOSAL SYSTEM SYSTEM INFORMATION Property Address: 74-76 Murray Way Hyannis,MA Owner: Estate of James Reagan Date of Inspection: SeptemberFLOW CONDITIONS RESIDENTIAL Number of bedrooms(application): 4 Number of bedrooms(actual): 4_ -- DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):440 Number of current residents:--A— Does Does residence have a garbage grinder(yes or no) NO [if yes separate inspection required] Is laundry on a separate sewage system(yes or no): Laundry system inspected(yes or no):_ Seasonal use:(yes or no):NO d 02 484 GPD/AVG 03=342 GPD/AVG. Water meter readings,if available(last 2 years usage(gp )): Sump pump(yes or no):Nd Last date of occupancy:CURRENT COMMERCIAL/INDUSTRIAL Type of establishment: gpd Design flow(based on 310 CMR 15.203):___________ Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):___ es or no Non-sanitary waste discharged to the Title 5 system(y ) Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:Per town of Barnstable:6/28/02 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 X 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) roval Tight tank —Attach a copy of the DEP app _Other(describe): Approximate age of all components,date installed(if known)and source of information: 1 ce issue d 8/3/ 4 Per Town of Barnstable Health De artment. Certificate of Com Tian . Certif Were sewage odors detected when arriving at the site(yes or no):NO Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM PART C SYSTEM INFORMATION(continued) Property Address: 74-76 Murray Way" Hyannis,MA Owner: Estate of James Reagan Date of Inspection: September 30,.2003 BUILDING SEWER(locate on site plan) Depth below grade:31 &56"below top of foundation. Materials of construction: X .. cast iron 40 PVC_other(explain): Distance from private water supply well or suction line:>10' from town water suppiy line. Comments(on condition of joints,venting,evidence of leakage,etc.): N i/�an!P of leakage observed within the cellar at the time of the inspection. SEPTIC TANK: X (locate on site plan) Depth below grade:Inlet Cover:6 Outlet Cover:5" Material of construction: X ' 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: 10' 6"L by 5' 8"W by 4 05' flow line= 1500 gallon(H-10). Sludge depth:<_1" Distance from top of sludge to bottom of outlet tee: 34" Scum thickness: 11" Distance from top of scum to top of outlet tee:55" Distance from bottom of scum to bottom of outlet tee:8 How were dimensions determined: Ground probe calibrated measuring stick and measuring tap Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): The tank contains two exit lines(see page one) The liquid level was observed at the approved exit line's pipe invert. The tank contains one inlet line which re uires an inlet tee. The second inlet line enters the side of the tank across from the exit line. Re nest health department determine if the tank is in substantial com liance. Recommend tank be pumped for maintenance purposes if septic tank is in substantial compliance). GREASE TRAP:_.(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.): Page 8of11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 74-76 Murray Way Hyannis,MA Owner: Estate of James Reagan Date of Inspection: September 30,2003 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): p Dimensions: Capacity: gallons Design Flow: gallons ay 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: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0" q solids carryover,any evidence of Comments(note if box is level and distribution to outlets equal,any evidence of leakage into or out of box,etc.): The cover to the box H-10/DB-3 was located 10"below de. The box contained one inlet line and one out line. The box contained a moderate amount of cgnover. Sidewall staining indicators were observed 1.5"above the exit line vine invert. PUMP CHAMBER: (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.): n Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 74-76 Murray Way Hyannis,MA Owner: Estate of James Reagan Date of Inspection: September 30,2003 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:leaching chambers,numb_er: X leaching galleries,number:(4)4'by 4'with 2 0'of stone all around, 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 SAS cover was located and opened The interior of the SAS contained 4'-10"of standing,liquid. The liquid level was above the top of the inlet line and over the top of the SAS component The Soil Absorption System was observed to be under hydraulic failure. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition.of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction:. Dimensions: :Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 1 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM i PART C SYSTEM INFORMATION(continued) Property Address: 74-76 Murray Way Hyannis,MA Owner: Estate of James Reagan Date of Inspection: September 30,2003 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 G 4-1-1L I Ell i S, A NK I ? , ' z ' ' 1 5,3 n > PT�-- 2 . MORKAY WAY 3 a f Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C i SYSTEM INFORMATION(continued) Property Address: 74-76 Murray Way Hyannis,MA j Owner: Estate of James Reagan Date of Inspection: September 30,2003 SITE EXAM Slope 30/6-45% Surface water >50' Check collar DRY Shallow wells Estimated depth to ground water '+-feet below floor of SAS Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,dafe of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) X Accessed USGS database-explain:Barnstable ground water contour map(6/92)EL.05.0 You must describe how you established the high ground water elevation: Please see sketch below. 17,F_ L I CM- S. _o DID 6,XK OF SAS PER CAI z. 6'W LONTOUF. MAP Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ISSESSMEN FORM TS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECT PART C SYSTEM INFORMATION(continued) Property Address: 74-76 Murray Way Hyannis,MA Owner: Estate of James Reagan Date of Inspection: September 30,2003 SKETCH OF SEWAGE DISPOSAL SYSTEM reference landmarks pr ovide a sketch of the sewage disposal system including tie ithin 100 feet.Locate where pus toile waterpply enterst or the building. benchmarks.Locate all wells w 4 I 2 24,55. W �XIST►t�l�� I Page 11 of 11 OFFICIAL INS PECTION FORM—NOT FOR VOLUNTARY ASSESO�S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION PAR SYSTEM INFORMATION(continued) Property Address: 74-76 Murray Way Hyannis,MA Owner: Estate of James Reagan Date of Inspection: September 30,2003 SITE EXAM Slope 30/o--15% Surface water >50 Check cellar DRY Shallow wells Estimated depth to ground water '+-feet below floor of SAS Please indicate(check)all methods used to determine the high ground water elevation: i` 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: Checked with local excavators,installers-(attach documentation) X Accessed USGS database-explain:Barnstable around water contour man(6/921 EL.05.0 You must describe how you established the high ground water elevation: Please see sketch below. 1 10° 'Lrlwmm OF SAS PER c 4°fz E-W, 60ti1TouR N6AP b ---- -- - - TOWN OF BARNSTABLE LOCATIQ,N A/f A4e/I ! Q!J SEWAGE # 7'-3 j. VILLAGE M p j ASSESSOR'S MAP & LOT&-7- [;� INSTALLER'S NAME4'PHONE NO.&rk��j)q/ Con SEPTIC TANK CAPACITYQQZ I LEACHING FACILITYs(type) (sue) <?' NO. OF BEDROOMS PRIVATE WELL OR (UIBLIC WATER BUILDER OWNER. DATE PERMIT ISSUED: A DATE COMPLIANCE ISSUED: I VARIANCE GRANTED: Yes No i r tz tQ/•lJ �S 33' f7 3 ti I � TOWN OF BARNSTABLE CC±CATION�j��-A, AIIUI -04Z Wd-V SEWAGEvl VILLAGE ASSESSOR'S MAP & LI T ,90 INSTALLER'S NAMEA PHONE-NO.& k&� --; SEPTIC TANK CAPACITY I LEACHING FACILITY:(type) �� (size)I �' NO. OF BEDROOMS 4 PRIVATE WELL OR UBLIC WATER BUILDER �OWNER�'W DATE PERMIT ISSUED: r� � 9 DATE COMPLIANCE ISSUED: I. VARIANCE•-GRANTED: Yes C__No I i -�.. w � � �� � �' �� � Cy � '''1 (:� t .•-_. . :� .. � � J No... F f... APPROVEDTHE COMMONWEALTH OF MASSACHUSETTS ar able tion BOARD OF HEALTH TOWN OF BARNSTABLE s'D Applid an for Di-nVuual urk.6 C�unutrnr#inn ramit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: Li E v Loc tion-t\ dress ^_ or Lot No. —7&*r Installer Address Type of Building Size Lot............................Sq. feet ,., Dwelling— No. of Bedrooms............690--------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons----------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------- - - W Design Flow........... -----------------gallons per person per day. Total daily flow.............. IK4 .................gallons. 1:4 Septic Tank—Liquid capacity/4�6_-_-gallons Length---------------- Width---------------- Diameter---------------- Depth................ W x Disposal Trench— No. -------/......... Width_____ _ _______ Total Length______.............. Total leaching area....................sq. ft. Seepage Pit No.___--._.-.-_-----_ Diameter.................... Depth below inlet----IK......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ 0-, Test Pit No. 1----------------minutes per inch Depth of Test Pit_................. Depth to ground water........................ (%, Test Pit No. 2................minutes per inch Depth of Test Pit--._---._.________-- Depth to ground water-.--___...__-__--._-_--. 1:4 -•--•-•----------------•--...._._....---------.........--•-----••-•-•--•-............--•••--•-.--•-•......................................................... 0 Description of Soil........................................................................................................................................................................ x -------------------------------------------------------------------------------------------------- -------------------------------- --- ---- ------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable.. ...................r'.----- -.__/ a ......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disp sal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned ffirther agrees not to place the system in operation until a Certificate of Compliance sWniby t oard of health. Signed ----------- - ---- -- - A lication A roved B .................................. PP PP Y ..... -.. - ' --�- - -- - --... Application Disapproved for the following reasons- ------------------- ----------------------------------------------------------------------------- ------------------------------- ................. .................. ...-....----.._--........ ---------------_----------------.-.............-- e........-....--- Permit No. --......-.. -.------... Issued «' " .-3O.7-- G4 THE COMMONWEALTH OF MASSACHUSETTS r / BOARD OF HEALTH y 7 V TOWN OF BARNSTABLE Appliration for Uhnp t ial Works Toustrnrtinn meat Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: ..... ��'--------��-(J/l�'.` .`�y..... may '"1 1 - - l/M Location-Address 7 '�'l v,2U= or Lot No w,J —......................-......----- . -..........----------•---------- ......------. . y------......'° ...........}��y�r� owner Address w t �1/�`G t�U j 7 "t,N•s�J G r/l Gam; `� GU ;'�1, /�!J / t L S ,4 ------------------------------------ ----- ------- ------------------------------------------------------- ---------------------------------- �`-; Installer -----_-� � Address UType of Building C Size Lot............................Sq. feet �. Dwelling—No. of Bedrooms------------'/-------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ---------------------------------------------------------------•----------------------- .._......---------•---------------•-----•--•----------------- W Design Flow............. _________________gallons per person per day. Total daily flow---------------:�-V,59.................gallons. WSeptic Tank—Liquid capacity/a0_-gal Ions Length________________ Width__--..-_--____-- Diameter---------------- Depth................ x Disposal Trench—No. -------/......_:. Width........._....... Total Length----- Total leaching area....................sq. ft..:..._., Seepage Pit No..................... Diameter.................... Depth below inlet....GI............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date...------.............................. 14 Test Pit No. I________________minutes per inch Depth of Test Pit-------------------- Depth to ground water-_-------------------- 44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ •--•-------•----••--•--•--•-••--•-------------•-------•------•----------•------------.---•-----••---------- .---------------------------- --------------------- 0 Description of Soil--------------------------------------------------------------------------------------------•---------------••-•-•---•---------------•-•-------------•---•..........--- x U ------------------•------•----------------...-•-----------------------------•-•--. -------------•--------------------------•---------------•--------....-----•-•-•-•-----......------------•--•-•--•---. W x ------------ ----------------------------------------------- -------------------------•---•---•----------------------------------------•--------------------------------------••• -_..... U Nature of Repairs or Alterations—Answer when applicable...- `-4-0-------------,ri_-_..... ......��-4.`. - J. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system ,n operation on until a Certificate o Compliance 'h/1a"s�.byen iijsue by`tthe-*board of health. Signed -----------Cl.;............. ........ ........�.....................S . .....� , Application Approved BY --- .:f 'T--.: ` = f �' 1... -...�� !�/.1/11�.. _:................... �i / L..L.:.. ... ,. . / � U � `. `F`..j' ter � . Application Disapproved for the following reasons: .................... ......... ................................. . . ............. .................. --------------------------------------------------------"------------r Lk----- � /Dace Permit No. .. ......................... Issued 12. ........ 1--------------- C Dare � f { THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE GPrtifirate of Tomyli2 nve THIS IS TO CERTIFY, That the_I.ndividual Sewa e Disposal System constructed ( ) or Repaired ( ) by ............ -/-,- ---eU i>�------------------�-`-- ---'L'�7—.. Insmller has been installed in accordance with the provisions of TITLE 5 6, The State Environmental Code as described in the application for Disposal Works Construction Permit No. �-- _....-----..-_._------------------_-.... PP p � �. ;: -� dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE - ................. 2------------- r - I - - .. Inspector ............� - THE COMMONWEALTH OF MASSACHUSETTS 30-7— C�USJ BOARD OF HEALTH No.� TOWN OF BARNSTABLE FEE... No...... '.................. ... ......... r Rspoiial nrk� aan� r r#uan rrmi� Permission is hereby granted.............. . � � !_...5'c .. -1_....___. -_�%! -5_� to Construct ( ) or Repair an Individual Sewage Disposal System atNo.......................................... (e2.. . . ....................... Street as shown on the application for Disposal Works Construction. Permit NV---!---- �..� Dated--------------____ - 'Board of Health DATE - t z;`.. f FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS S REVISIONS: S� OLD '(� AL FLAG 1' t /° I �P\r1 �' NO. DATE DESC. • T. 6/6/00 CONSERVATION EDITS ,�, � r i ,' AREA TO BE PLANTED o WITH HIGHBUSH BLUEBERRY ' D N 1, N OQ AL '` �� � 8' -• 10' ON CENTER CHARLES�SFIARKEY � o , � -- RD JL l ASSESSORS MAP 307 $IrABR 0 1 t PARCEL 16 I '� c1: O ,.LIMIT OF CLEARING N � LOCUS � o 'LIJ , EXISTING WIRE FENCE TO BE m WAY OAK cw REMOVED' AND REINSTALLED N MURRAY — ALONG PROPERTY LINE WILLIAM & HELEN PRECOURT .nCAL R l ALt rt ASSESSORS MAP 307 N a*U BEET V t PARCEL 15 X GOSN0 JIL 1 ` I $ LOCUS MAP JdL > y A t r" I I I NOT TO SCALE J N/F ` A � � : � i .I � , � � S76�20•1 0 ,lE L ALBERT & SILM MUSHINSKY ' l ` ASSESSORS MAP 307 i� AREA TO BE '� r ` x j / I� N o PARCEL 244 PLANTED WITHv�i i WETLAND r' f _ > l d N/F SEEDMIX I �l D f �! i ���, A ` ALBERT & SILVI MUSHINSKY f ff t . CHqIN UIV>r FENCE .' z tea ASSESSORS MAP 307 z PARCEL 231 �.• 1 I ` ,_ .r �ur AREA TO BE PLANTED WITHtOSA rugosc .- v 5' M CENTER ,�, !'�'� � � � ���� ,• � � LOT 2 r� � ' -' �' •r _ ..-- -__ .,. ._ _._ _ . \.,� ^' ..- PROFESSIONAL LAND SURVEYOR DATE O ' k {{ ' .1�C r ✓ "r ,, , e,y(/( ..f -/J/�• •' ! .g, #''' .' +✓ I I 0± S. F. ; LXISII14G GRAVEL DRIVE ,, Rl - r - -- -�t -- .! _ PLAN OF O� r /f I� !, � tia` TO BE�LOAMED AND r. DECK SHED j s ' > f 7 5, ""Y•r'r'..t..`' Y .7C. DED. . ,,✓ r''/ ` t LAND •9 1, f , _''� �3" .f -...w < > f � -'' cV �j 3g .� � �: . - BALK , PREPARED I N HEAD r h,,a 7 k•. . /y uy RESPONSE TO c 4 k �I 1 1\ j ` xk, i Uy " Y },•E r r t ,,; / ? � c.a' +...,r, �� 7 6 AN ENFORCEMENT , Y ORDER r k.t; I Ko , - ti. a +' •i. t� r - IL REA.TM BE PLANTED a veVAIN ROSA rUgoaa #74 / '` '� LOCATED AT Aj�. - +"i' ro•c.:�P.i 'it "' �r�� t y ,%^``;.y.i/ w"i.nw' w.y A(►r✓' f .` r . 76 MURRAY WAY .Y „ ' l t - ! 1 N �v', , q A r ^ Yt. z ..•... •'�l.a... "$wi j —rt +.`_. .. ...r •. _ d..... _.. — _.� .. - ..z'"+w+.A••,-:;e re-. _" r. - 2 4 S' hf •., rw 's CS N 772'50►`''"'�•• �" �' �{ r I 1 1' ` 1'� I ,, f T�-i: v ° GMET �o w I l I I '' J — MASSA H USETTS 01 , CS (BARNSTABLE COUNTY) / �o� C. AL AL E . , Y ,ks. :;, I x, : � � . r ;�• � ��. N EXISTING /pr y n fE XiS Q TiNG RE FEND TO ELIzATH DILSIZIAN * . .;:K• +, /J y j , , ; , J - ` r ,. �`�,, ASSESSORS MAP 307 CONDITIONS O REt�iSThLi.Ep. r 1 / 1 r t f'' i'' . . PARCEL 245 =Y ': ALONG PROPERTY/LINE pp, I t t oo s>> `� r I / , t I / t ;�� -- '�►, -- - ;�' . ' . . :' . .: ; MAY 16. 2000 �?50 E ASH CAN { �Ik. f I 1 / I f 1 f t �' f/ i/' .' ® ENCLOSURE 05 AIc. {{ ) G / if r J / �✓ C ' PREPARED FOR: AL 2.5 p ,/ HYD --_ 8v JAMES T. REGAN BENCHMAR ` , , . _.., i. . / 76 MURRAY WAY CONCRETE BOUND EL / #41 x, ,/ ' 1 �' I 1 , , r '��. 1 1 . HYANNIS, MA C_ '�` 7.1 N.G.V.D /. /' j / j / , , f . • UPL 02601 /° // ,t j , , ,m / i rF, ti /uA r m AREA TO PLAN i f ^1 1 ,• ���' . • . 1 '. `' ', : : : : . . ' - • - . : : : :. : : : : : : : I . /. WA rnWITH Hlq� BUSH BL EBERRY �' , / � f i � f ; • - : Y .L C�' — 07 ON CEN /r.rrr �..�------------- Cl) •• „ m AkL OAL l AL Jib / � ,�. h 657 Main Street, Unit 6 '�` 2 �/, �r ` � / /'f,� /` ,OPT ,'/' P '/ RECOR_D LOCUS INFORMATION Q West Yarmouth, Massachusetts 1 �,PG / ' 02673 L.n ' ,/ �' . ' fle-109P `' , 508 778 8919 f i O c. / CURRENT OWNER: JAMES.T. REGAN c �' 1',LQ� /, ' ,� Q © 2000 The BSC Group, Inc. TITLE REFERENCE: DEED BOOK 1530, PAGE 108 v p Q SCALE: 10 10' &/' PLAN REFERENCE: PLAN BOOK 156, PAGE 81 a 0 1.25 2.5 5 ME, s ASSESSORS MAP: 307 , 0 5 10 20 PARCEL- 5 X % ' - •• RESIDENTIAL ZONE: RB • '� PROJ. MGR.: CRAIG FIELD "' i SETBACKS FRONT 20' FIELD: P. H. / A. D. NA U7/CA t W , } SIDE 10 CALL/DESIGN: KIERAN HEAIY m / . ROAD , REAR, 10 O p m DRAWN: KIERAN HEALY C ; ,t., MINIMUM LOT SIZE: 43,560S.F. ' o I* I 2WQ CHECK: CRAIG FIELD C3 O � � � GROUNDWATER OVERLAY DISTRICT: AP (NOT A ZONE II) FILE: 8174-EXC.DWG co BARNSTABLE CONSERVATION DWG. NO: 5214-01 SHEET 1 OF 1 • JOB. NO: 4-8174.00 a /0 t 0YSTEM DESIGN Design F I ow : - 4 _bedrooms tad a I /day a I i Septic Tank : I . x 200/ 880 ga I . "' ' Ii ✓'" ���.1�3_ RETAU►J FXIrT.I 500 Gal Tank ELEV ./�/ Set level first 2' Leaching Fac i I i t y . Bottom : 33.5�X IZ.8 je c) 74 c sF = J1 Sides . ! � � __ m r ✓ �a' --�_— __�_ —_ — G —f 4�a15i than suPo t SEEELEI/ ,'3 TOTAL =�54- Go I \ 4 Aar d NOTE: Garbage disposal is not permitted with this design. Use%� Use 6" crushed stone fLC�//f% SEA' !^� � TROC�Ionj Dnder S"F t i c Tank and DE,Aim j LOCATION MAP fl66essors Map 307 Forcel 5 1500 GAL . D - BOX LEACHING FACILITY area - 91 770 S . F. SEPTIC TANK ,'�X�sTl�Gt SYSTEM PROF I LE of to soala , - -- - -- - - -- - - -- - _ — _ _ ---- TEST HOLE # 1 5 --, E L n SEPTIC TANK I `1 O O ) " _. __ -- - ' I -- - FILL OUTLET �— -.__-- i ' I �_ _-�-- - i-- -- ` - - - — c�- Bw LOAMY COARSE q I I �� t g 82 SANDco -4- ELBOW Q`�o��a000�o � 4S� _ 500 GAL . CHAMBERCOiVSr/ �J TION DE TA � ;,A FAFFL E ^FTA 1 Cb MEDIUM TO COARSE SANE' 144 __ _. _ VARIANCES NOTES NO WATER �►� -WR /�.2// `/5 405 EX I ST I NG S.A. j. I T . BE PUMPED AND BACKFILLED WITH CLEAN FILL OR REMOVED . DATE : 11 /2i /03 J sin, -e �elweeI7 0,-pper7y L/rF a/70/ 2 ) EXISTING SEPTIC TANK (S TO BE MWA)E©• PERFORMED BY : RI -HARD JUDO: , � . . ��t-eQC.ired - s'4va�/qb/Q , I TNESS : SAM WH I TE B . 0 . H . ' )fvSUITABLE SOILS ARE TO BE REMOVED FOR ' �7'al7CP 6etkLeAl S.A,S and D%dyy.fn�ao�uri��: DESIGN RATE : < 2 min . / i n . 20` /re�uir�d >z' 4v4i/rrb/e. 5 ' AROUND LEACHING AREA AND REPLACED WITH APPROVED FILL MATERIAL . T/of Distance befweerr .,R,S �.nd fop a f 4 . ) DESIGN ENGINEER TO CERTIFY SOILS REMOVAL COs fo/ ,B4/�k '; /DOre u I / BEFORE SYSTEM I NSTALLAT I ON . � �i�a j -65 avai obi ) DESIGN ENGINEER TO CERTIFY SYSTEM INSTALLATION PRIOR TO BACKF I LL I NG . 6 . ) DI-STRIBUTION BOX IS TO BE WATER TESTED AT SET \\� �``yb�1 ` I THE TIME OF THE BOARD OF HEALTH I NSPECT I O'N . PERCOLATION TEST # 1 A o� % . ) ALL AREAS DISTURBED BY CONSTRUCTION ARE TO BE GRADED, LOAM COVERED . ' 4 GALLONS OF J"JATFR IN 5 r'1 I NOTES AND 7" AND SEEDED . SEWAGE SECONDS AT A DEPTH OF 102 INCHES . 8 . ) , THIS PLAN IS FOR INSTALLATION OF DISPOSAL SYSTEMS ONLY AND IS NOT TO BE USED F')R E'`TAPL I SH I NG PR )PFPTY LINES . SHED �) f JL YFT/-1 i5 To 8E (NSTPLLFD _ YL F/�F c/wE9 8ETWt=-F s.�1.s. +PJG veJl�lG7R�io .?, i7AKED PAYBALFS To Far rE12 FLfP�J• EDGE OF < /I WETLAND �/l / i a� ���p P P 101 61-7 � STK % / � /`_ T/ E T Gy � '1�i ' e�, i / r -' C.BASIN / ' Rerlirec'� koarse�74 � ¢ M:R r A N E N G 1� E E R 0 N t� I N C e /. Z: o i i I C. A S PJ o• c. fd C O/?YI 1 S T K /2 I ? �p ' o u 1 zo-y SET �� ' j �� Sew �; 941 MAIN STREET , SO . HARW I CH , MA 02661 ' , �� 432-2878 0 0 00 ---- CB/DH 2/ S .ND �/5 BAzj I N G.G. SITE PLAN & SEWAGE DISPOSAL SYSTEM IN HY4NV115 C. - ��:.. dHYDRANT FOR R R5 �u }' ES TA TE OF JAMES REAGAN PK F:T 74 - 76 MURRAY WAY HYANNI .S , MA PROJECT : 03 - 276 SCALE : i ' - 3O ' DA TE : 5/ 14/04 Re Ui 5 e d ; 615/0q- Add )U o fe 9, rzI/ 710,q- Aar � rtn���ltx�r��yr SAS,- N,�� +0u