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0116 AUDREYS LANE UNIT #A - Health
1.1,6-Audrey's,.Lane --_ _ - A= 028—093 ' Marstons Mills. w a Now moomm ! nommimi 0 I I no a No NMI MINI III OMNI I N I mMl1lM1mlMM INN MEMO I M EN 111111INNON Y ■ p ■ e=. 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COLn Postage $ fU Certified Fee `\rJ MA O C3 Po O Return Receipt Fee t� ��' Here p (Endorsement Required) _ O Restricted Delivery Fee Q 1 0 (Endorsement Required) r-3 O Total Postage&Fees $ r9 rU r Mr & Mrs Leland G Gaines 118 Audreys Lane Marstons Mills, MA 02648 Certified Mail Provides: o A mailing receipt lr. m A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mails or Priority Mails. e Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. n For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for. a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. s For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 COMPLETE •N COMPLETE THIS SECTIONON DELIVERY I ■ Complete items 1,2,and 3.Also complete A. Sigpature I item 4 if Restricted Delivery is desired. ❑.Agent ■ Print your name and address on the reverse X6WK-0❑Ad ressee. so that we can return the card to you. B. Rec ' by(Printed Name) C.,D to of elivery f ■ Attach this card to the back of the mailpiece, or on the front if space permits. 6 D. Is very address different from item 1? ❑Y. 1, Article Addressed to: If YES,enter delivery address below: ❑No I I ! i I I Mr & Mrs Leland G Gaines 118 Audreys Lane s. SSeru''eType Marstons Mills, N; I 1 n IV_ertified Mail CI Express Mail I ❑Registered WReturn Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Numbed , 'ij,.2 i 1�10:1'01�0 0 0 0�112 6 51 3 610 I (rransfer from servlce label) 1 1 t , PS Form 3811. February 2004 Domestic Return Receipt +0259e-02-M-1540 i i UNITED STATES POSTAL SERVICE First-Class Mai I Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • I Town of Barnstable i { Regulatory Services Department Public Health Division i 200 Main Street I Hyannis, MA 02601 f ... . .. ...»._... ._ I��►�i i11111i! �I �t � l �� S�h. A' Ye Town of Barnstable Barnstable Regulatory Services DepartmentPJHWmkaCft "'JW Public Health Division I .� '639� 1� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2851 3610 t June 10, 2014, Mr& Mrs Leland G Gaines 118 Audreys Lane Marstons Mills, MA 02648 The septic system located 116 Audreys Lane, Marstons Mills MA was last inspected on • 4/4/2014 by David B. Mason, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to overloaded or clogged SAS. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE'B ARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Q:SEPTIC\Sample Failure Ltr\116 Audreys Ln NW Jun2014.doc Parcel Detail http://issgl2/intranet/propdata/ParcelDetaii.aspx?ID=1798 MASS . r \ td R � � U Logged In As: Pa rC2I Deta I I Wednesday, June 4 2014 Parcel Lookup Parcel Info Parcel028-093 ( Developer!LOT sz� ID Lot --- - Pri��.__ Location.116 AUDREYS LANE 150 Sec�; Frontage Road LAURIES LANE Frontage Village MARSTONS MILLS I Fire IC MM District Town sewer exists at this Road�_050__ address 'Nc Index Asbuilt Septic Scan: Interactive 028093 1 Map ' Owner Info Owner IGAINES, LELAND G&LOUELLA M Owner F Streetl 1116 AUDREYS LANE Street2 City IMARSTONS MILLS State LA Zip 02648 Country Land Info Acres;0.46 Use Single Fam MDL-01 Zoning iRF —I Nghbd 0105 Topography iLevel Road LPaved _..— , Utilities I Septic,Gas,Public Water Location Construction Info Building 1 of 1 Year 1976 —� Roof Gab,el /H/H p Ext lWood Shingle Built Struct Wall Living j2118 Roof�Asph1F GIs/Cmp AC None Area Cover Type' W°K''iInt Bed , c-_ Style�CaFe Cod Wall�Dryv✓all Rooms 13 Bedrooms eAS r—_ _ Int i ____W_��_ Bath,--- Model(Residential ;Carpet 13 Full ear Floor Rooms Heat___-.n _. Total Grade Average Type lgot iir Roo.. Rooms 1/2 Stories — Heat �----` Found-. stories 1 Fuel Oil - ation(Typical Gross http://issg12/intranet/propdata/ParceIDetail.aspx?ID=1798 6/4/2014 l 14 I 1� Commonwealth of Massachusetts _ 4 Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form Not for Voluntary Assessments °M 116 Audrey Lane, MaIrstons Mills Property Address Leland and Louella GI ines Owner Owner's Name information is Marstons Mills ( MA 02648 April 4, 2014 required for every p page. City/Town i State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector:key to move your cursor-do not David B. Mason use the return Name of Inspector key. David Mason � Company Name 4 Glacier Path M' Company Address East Sandwich + MA 02537 City/Town State Zip Code 508-367-1617 i S1287 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported Below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ® Fails Needs Further Evaluation by the Local Approving Authority rr^ V April 9, 2014 Insrector's Signature Date C) c::> C The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow'of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent t I the buyer, if applicable, and the approving authority. I ****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. L �d �1 �Z I t5ins•3/13 + Title 5 Official Inspection ubsurface Sewage Disposal System•Page 1 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage)Disposal System Form -Not for Voluntary Assessments 116 Audrey Lane, Marstons Mills Property Address I Leland and Louella Gaines Owner Owner's Name ` information is Marstons Mills ! MA 02648 April 4, 2014 required for every p page. Cityrrown ' State Zip Code Date of Inspection B. Certification (cont.) f Inspection Summ i ary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. I Comments: Ii I I 13 System Conditio y Passes: Pass y � ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or reoaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box fort"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank isimetal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N, ❑ ND (Explain below): I t5ins-3/13 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 116 Audrey Lane, Marstons Mills Property Address Leland and Louella Gaines Owner Owner's Name information is April Marstons Mills MA 02648 A 4 2014 required for every p � , page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will ass inspection if with approval of Board of Health): P P ( pP ) ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a.manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 116 Audrey Lane, Marstons Mills Property Address Leland and Louella Gaines Owner Owner's Name information is Marstons Mills MA 02648 Aril 4, 2014 required for every _p page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5,rpm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 116 Audrey Lane, 'Marstons Mills. Property Address Leland and Louella Gaines Owner Owner's Name information is Marstons Mills MA 02648 April 4 required for every p �il , 2014 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.gg .A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd: For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 116 Audrey Lane, Marstons Mills Property Address Leland and Louella Gaines Owner Owner's Name information is April Marstons Mills MA 02648 A 4 2014 required for every p � , page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based.on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 116 Audrey Lane, Marstons Mills Property Address Leland and Louella Gaines Owner Owner's Name information is Marstons Mills MA 02648 April 4 required for every p �il , 2014 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage No 9 ( Y 9 (gPd))� Detail: 2103; Gallons and 2012; Gallons Note; This property is on well water so no records exist. Sump pump? ❑ Yes ® No Last date of occupancy: Current Date 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 Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 116 Audrey Lane, Marstons Mills Property Address Leland and Louella Gaines Owner Owner's Name information is Marstons Mills MA 02648 April 4, 2014 required for every p page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Board of Health; Indication of 3 past pump outs Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1100 gallons How was quantity pumped determined? Site tube on truck Reason for pumping: Needed access for camera and electronic mole 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 I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 116 Audrey Lane, Marstons Mills Property Address Leland and Louella Gaines Owner Owner's Name information is Marstons Mills MA 02648 Aril 4, 2014 required for every p page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: January 12, 1995 System is 19+ years old Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line. 10+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Observable components in working condition Septic Tank(locate on site plan): Depth below grade: 2.6 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Typical 1000 gallon tank Sludge depth: 6" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 116 Audrey Lane, Marstons Mills Property Address Leland and Louella Gaines Owner Owner's Name information is Marstons Mills MA. 02648 April 4, 2014 required for every p page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 38" Scum thickness 5" Distance from top of scum to top of outlet tee or baffle 3" Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? scour stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Observable component portion in adequate condition for the age Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I °M 116 Audrey Lane, Marstons Mills Property Address Leland and Louella Gaines Owner Owner's Name information is Marstons Mills MA 02648 April 4 required for every p �il , 2014 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 116 Audrey Lane, Marstons Mills Property Address Leland and Louella Gaines Owner Owner's Name information is Marstons Mills MA 02648 April 4, 2014 required for every p page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box if resent must be opened) locate on site plan): ( P P ) ( P ) Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution Box does not exist in this system. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: The first it was identified. The second it was excessively p p deep and could not be located, so a camera system was utilized to observe condition of the second pit. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 116 Audrey Lane, Ma�rstons Mills Property Address I Leland and Louella Gaines Owner Owner's Name information is Marstons Mills ! MA 02648 Aril 4, 2014 required for every p page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): I The second pit was failed with effluent level up to the invert inlet of the pit. No effective leaching area remained. f Cesspools (cess, ool must be pumped as part of inspection) (locate on site plan): f Number and configuration Depth—top of liqul id to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction i Indication of groundwater inflow ❑ Yes ❑ No 1 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for VoluntaryAss essments 11 6 Audrey Lane M r a stops Mills Y Property Address Leland and Louella Gaines Owner Owner's Name information is Marstons Mills MA 02648 April 4 required for every P �il , 2014 page. City/Town State Zip Code Date of Inspection D. System Inf i rmation (cont.) Comments(note icondition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i i Privylocate on jite plan): ( P ) Materials of construction: Dimensions t Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 116 Audrey Lane, Marstons Mills Property Address Leland and Louella Gaines Owner Owners Name information is Marstons Mills MA 02648 April 4 required for every p �il , 2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately �I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 116 Audrey Lane, Marstons Mills Property Address Leland and Louella Gaines Owner Owner's Name information is April Marstons Mills MA 02648 A 4 2014 required for every p � , page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 20 feet Please indicate ail methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Groundwater contour map z Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Utilized Town of Barnstable information of groundwater countour map and ground contour map Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts i W Title 5 Official Inspection Form Subsurface SewagelDisposal System Form -Not for Voluntary Assessments 116 Audrey Lane, Marstons Mills Property Address Leland and Louella Gaines Owner Owner's Name information is Marstons Mills MA 02648 April 4, 2014 required for every p page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked E Inspection Summary D(System Failure Criteria Applicable to All Systems)completed E System Information—Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN U BARNSTABLE LOCATION eR0 d 4Uae- Z-AAM, SE G ' VIi.I GE ASSESSOR'S MAP INSTALLER'S NAME& PHONE NO. &6(!1 ago SEPTIC TANK CAPACTI'Y 00 / LEACHR40 FACILITY: (type) a .ti'dp •®t&t g&W 10(size)• i, f NO.OF BEDROOMS BUILDER OR OWNER o g PERMFTDATE: 5•tq-9a COMPLIANCE RATS: fa- i'7•0 . 5cpa1-on bistuce$etween the: Maxunutn Adjusted Grotmdwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If'any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wotland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by � � 1 D .. t TOWN OF BARNSTABLE LOCATION SEWAGE# '.VILLAGE M�YS/OyIS ��.5' ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. �"D$"$/20�g7,2� JaSe,C1®� �.�/'•-D s SEPTIC TANK CAPACITY 1,06V LEACHING FACILITY.(type) 2a,5290 (size) NO.OF BEDROOMS / OWNER Z-04* 0 N/4"-gs PERMIT DATE: 23 —/ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility,)/ Feet FURNISHED BY nNoIQi5y 15 G,4h,4 : e 13 orcd► j/ /� TOWN OF BAR.NSTA.BL.E LOCATION l l to � ,-t d%re-os L" SEWAGE VILLAGE A!�IAIL5J"l d LIS ASSESSOR'S MAP& LOT i INSTAL.ER'S NAME&PRONE NO. SEPTIC TANK-CAPACM.. �D7TT� LEAcHvG FACaLTi Y: (type)�' (size) NO.OF'BEDROOms ._ ? BUILDER OR OWNER PERMITDATE: � COMPa..ANCE DATE:— Separation Distance Eetweep the; Maximum Adjusted Groundwater fable to(lie Bottom of Leaching Facility Feet Private,Water Supply Well and Leaching Paciiity (If any wells exist on site or within 2W feet of leaching facility) Feet Edge o('Wetland and Leaching Facility(if any wetlands exist within 300 feet o�ff caching iaciliry) / Be_.et l uritished by » G . l A- -Ao' No. / ` C�w' Fee e® THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpliLation for Mispo8al 6pstem Construction Permit Application for a Permit to Construct Repair(Zt-Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /16 14aDR J-0 y`•p �#�/ Owner's Name,Address,and Tel.No. rtis��'srotis ��!!S 4_,61190D (5,410rS Assessor's Map/Parcel Installer's Name,Address,and Tel.No. p$-<j20- Designer's Name,Address,and Tel.No. ✓bS�,d�i U�1114rHos %'r a Qo Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 22 j Design Flow(min.required) d gpd Design flow provided ..J?' gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 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 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. /`7 r�� Date Issued - - ---------- =- 'No. ��"! Ql� ? Fee �O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 4pfication for Disposal 6pstent construction Permit Application for a Permit to Construct ) Repair(�Opgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. //6 14aigN/I ;y L#s1G Okarier's Name,Address,and Tel.No. Assessor's Map/Parcel _ � Installer's Name,Address,and Tel.No. 0 Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures `/ Design Flow(min.required) 3 3 d gpd Design flow provided 3 T � gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil A Nature of Repairs or Alterations(Answer when applicable) /,1 5r,4a Date last inspected: I Agreement: The undersigned agrees to ensure'the construction and maintenance of the afore described on-site sewage disposal system in ' d accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign Date Application Approved by Date i /,�t 3 Application Disapproved by Date for the following reasons Permit No. ��O/L J -07? Date Issued Th_7 COMMONWEALTH OF MASSACHUSETTS - BARNSTABLE,MASSACHUSETTS - Certificate of Compliance THIS IS TO CERTIFY, //that the On-site Sewage Disposal system Constructed( e—)— Repaired(c—)-- Upgraded( ) Abandoned( )by�OS�/��1 12, —5 at /�� j /J � /�r�/- 6�l O92��s has been constructed in accordance with the provisions of Trtle 5 and the for Disposal System Construction Permit No,�J c90 dated o ., P P Y �� � Installer ,/ Designer ~xn #bedrooms 3 Approved design flo /Y. gpd The issuance of this permit shall not con ed as a guarantee that the system �functi�rra/s,designed. Date Ins vector ---------------------------------------------- ------------------------I------ - ----------- No. G�L� C Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Vsposal :0)pstem Construction Permit Permission is hereby granted to Construct(z--) Repair( 44•-' Upgrade( ) Abandon( ) System located at //1, 114ZQ %C/�,s LVhr_ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this ermit. Date Approved by JUL/0ii2014/MCN 09: 15 AM FAX No, P. 001 Town of Barnstable °f" r Regulatory Services ` .� Richard V. Scali,Interim Director i 4 Public Health Division rota Thomas McKean,Director 1 200 Main Street,Hyannis,MA 02601 Office: 50 8-862-4644 Fax: 508-790-6304 r Instaler&Designer Certification Form Date: Sewage Permit# k . o Assessor's Map'Tarcel Designer: 4- % Installer: Address: / Address: *tf On was issued a permit to install a (date) (instal er) septic stem at �� based on a design drawn b p Y � Y address) (V 1 C/ dated } } �( (dew ) DI VI(tc, pv 'lew- I 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. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10 •.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-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with,the terms of the IAA approval letters(if applicable) OF Mgs,F (ffisfiller s Signature) a, 1 I51Et�� (Designer's Signature NFIA. ! .. PLEASE RETURN TO H -STABLE_PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE IIECEMD 13`Y'THE BARNSTABLE PUBLIC HEALTH DIVISION. THA K'Y'OU. — Q:1SepticlDesigner Cm-ification.Form Rev 8-14-13.doe .0! Deck O FFIC,IL Bath Kitchen r Family 16.0' 24.0' Room Laving 16.0' Dining - - l~ Porch oo,n Room z 32'.0' W' 24.0' S r'" 1/2 Bath Converted 2-car Gargage f Family 24.0' 24.0' 1st Floor Co Dining Room Area 24.0' r �VS e TvT rs\ Alaa.�.s - i co = Cam- 1 y� Buking ft (Pa - 2) I orr / lient Gaines Leland G.&Louella M. Propn Address 116 Audrcys Ln Ci1y Marston Mills kM Barnstable State MA Zip Code 02 8-1642 L der Rockland Trust Co i I 32.0' 7•c' Bath 9•0' Ib•o' 20.0' o, 20.0' r6 Bedroom to Bedroom j �. � i�•4� rr•o' � i S 32.0' � �4•0 an _ 6a*ti 480 sft Finished Room co above Garage .o� , o Bedroom 1a•a' SKETCH CALCULATIONS At I Al :48.0 x 16.0= 768.0 A2:32.0 x 8.0= 256.0 First Floor 024.0 A3:24.0 x 24.0= 576.0 as (ems OIZAr 30,0 Orr 2m 4m. fim Srri_. lom- . Nor 6planner . 1 i e e i i e i I t 8 a i To �f Bdb-astable P# Department of Regulatory Services z Public wealth Division DateMUM v sKAM&g ems$ 200 Main Street,Hyannis MA 02601 J 1 Ad � � . {: Fee Pd: Date Scheduled �,. �,Yfa e xts:_ a a .e R F .r.m�� .- Ji ..Ime /�° raz t oil S tta ' ity A sesse�t for Sewage Disposal /� ,n-D AA ,, _/ i I Performed By: K�r`"i l�i�/1 C/t' Witnessed Dy:_ LOCATION & GENERAL DwORMATION Location Address'. 1 't ` Owner's Name Assessor's Map/Nrcel: v I - EngineePs Name+ ¢art+ NEW CONSIRU i70N REPAIR /` Telephone# � __ � Land Use Slopes(%) yX Surface Stones_� 'C k Distances from: Open Water Body ft Possible Wet-Area?�2100 ft Drinking Water Well ��t breinage Way ft. Property e Lin �I t) ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands in proxitnity to holes) V - i i i I • I i 1 Parent material(9e010gic) L ���"� Depth to Bedroek Depth to Groundwakdr. Standing Water in Hole:' i Weeping from Pit Face w " Estimated Seasonal;High Groundwater DtTE TION FOR SEASO�AL HIGH WATER TAtLE ! ' Method Used: in. Depth to SON mot[Ics: . 0 Depth abperved ding in obs-hole: j In. Orounwnter Adjustment a ik9 Depth tailweeping from side of obs.hole: i AcU,f 1etOC, _v- Adj.OrauntiwnterLe�el.,,,o p w3 1 Index Well# Reading Date Index Well level - i L PERCOLATION-TEST Date . T411t Observation 1 I Time at 91, _ .. -- Hole# i X� �, �s Time at G" Depth of Pere `. Time(9"-6'-) Start Pre-soak Time.@ ; 11.f3 End Pre-soak Rate MinJInch Site Failed' Additional Testing Needed(YIN) Site Suitability Assessment Site Passed Observation Hole Data To Be Completed on Back Original:.Public kle$lth Division — ***If percola�i6n test is to be conducted within 100' of wetland,you must first notify the Barnstable C4. servation Division at least one(1)week prior to beginning. DEEP OBSERVATION HOLE;LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA); . "(Mtinsell):' Mottling (Structure,Stones,Boulders. Consistenc %.Gravel A;4a?',90 .. A-Mo DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc 3a Gravel) DEEP OBSERVATION HOLELOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil 7 Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Sall they Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. ra I t Flood Insurance Rate Map: Above 500 year flood boundary No. •Yes Within 500 year boundary No ` Yes Within 100 year flood boundary No_ Yes Depth of Naturally Occurring Pervious Material Does at least fourfeet of naturally occurring pervious material exist.in all areas observed throughout the area proposed for the soil absorption system? e If not,what is the depth of naturally occurring pervious material? Certification I certify that on -C (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the-above analysis was performed by me consistent with the required training,expertise and experience described in 3..10 CMR 15.017: Signature I v v Date Q:\SEPTIMERCFORM.DOC Barnstable CF THE Tp� The Town of Barnstable ky-1-1td &"M„ `erg Growth Management Department All-America CRY 367 Main Street,Hyannis,MA 02601 a i r' Office: 508-862-4678 Patty Daley Fax: 508-862-4782 Interim Director 2007 MEMORANDUM TO: Tom McKean FROM: Beth Dillen DATE: 5/1/08 RE: 116 Audrey's Lane, Marstons Mills Hi Tom — Mr. Gaines, the applicant, believes he is only allowed three bedrooms at this property. He uses the first floor bedroom in the main house as an office, and would be willing to widen the opening to five feet, but is unable to do so because of the placement of the doorjamb (see attached photos). Tom Perry attended the site visit yesterday and agreed it would not be feasible. As such, the applicant is requesting the option to have a deed restriction recorded at the Registry of Deeds limiting the property to a total of three bedrooms. Please let me know if you have any questions or would like additional information. Thanks, Beth e Bk 23152 P':9_159 47832 09-12-2008 a 12= 240 Hair i-A n; - B,4RR_ T BABNWABU- yQ MA99. `fig prED,a. '08 JUL 24 P 1 :3 7 Town of Barnstable Zoning Board of Appeals Comprehensive Permit Decision and Notice Appeal 2008-043—Gaines Decision -Chapter 40B Comprehensive Permit Applicant: Leland G. and Louella M. Gaines Property Address: 116 Audrey's Lane, Martons Mills, MA 02648 12 � 3 Assessor's Map/Parcel: Map 028,Parcel 093 �� Zoning: RF Zoning District GROWTH Applicants: The applicants are Leland G. and Louella M. Gaines,who reside at 116 Audrey's Lane,Martons Mills,MA The applicants were granted title to the property by confirmatory deed recorded in the Barnstable County Registry of Deeds on September 30,2003 as recorded in Book 17728,Page 270. Relief Requested: The applicant has applied for a Comprehensive Permit under Chapter 40B of the General Laws of the Comrnonwealth of Massachusetts, and in accordance with Article II of Chapter Nine of the Code of the town of Barnstable,more commonly termed the"Accessory Affordable Apartment Program." The zoning relief necessary for this Comprehensive Permit to be issued is that of a-variance to Section 9-14 of the Code—Amnesty Program to permit an accessory apartment unit within the garage of a single- family owner-occupied residential dwelling. The issuance of this Comprehensive Permit would allow for an accessory affordable apartment unit within the attached garage of the principle residence. Locus and Background: The property at issue is a 0.46 acre lot locate?at 116 Audrey's Lane,Martons Mills,M_A. The lot was developed in 1976 with a Cape Cod style home. The effective living area of the main residence is 2,289 square feet. The accessory apartment is a one bedroom unit within the garage of the principle residence. The square footage of the rental area is approximately 480 square feet. The lot is served by private well water and on-site septic, and is located in a Groundwater Protection Overlay District. The Town of Barnstable's Public Health Division reviewed the application, and on May 5,2008, approved a total of three(3)bedrooms at the property. y r Procedural Summary: A site approval letter was issued for the property by Assistant Town Manager Tom Lynch on June 3,. 2008, in accordance with MGL Chapter 40B and 760 CMR. Notice of the site approval letter was sent to the Department of Housing and Community Development in accordance with the requirements of CMR 760. An application for a Comprehensive Permit was then filed at the Town Clerk's Office and the Office of the Zoning Board of Appeals. JA A public hearing before the Zoning Board of Appeals Hearing Officer was duly advertised in the Cape Cod Times on June 18, 2008 and the Barnstable Patriot on June 27, 2008, and notices were sent to all abutters in accordance with MGL Chapter 40B. On July 9,2008 Hearing Officer Gail Nightingale presided over the public hearing. The applicants, Leland G. and Louella M. Gaines, were present at the hearing. Cindy Dabkowski of the Growth Management Department was also present. Ms. Nightingale reviewed the file with the applicant to assure compliance with all of the program requirements. Findings of Fact on the Comprehensive Permit: At the hearing on July 9, 2008 the Hearing Officer made the following findings of fact: 1. The applicants are Leland G. and Louella M. Gaines,who reside at 116 Audrey's Lane Marstons Mills,MA 02648. They are requesting a Comprehensive Permit to convert an existing one bedroom apartment in the attached garage of the principle residence into an accessory affordable apartment. The conversion of the unit to an accessory affordable unit within the garage of a single-family owner-occupied residential dwelling qualifies for the"Accessory Affordable Apartment Program." 2. The applicant was granted title to the property by confirmatory deed recorded in the Barnstable County Registry of Deeds on September 30,2003 as recorded in Book 17728,Page 270. 3. On June 3,2008 a site approval letter was issued for the property by Assistant Town Manager Thomas Lynch, in accordance with MGL Chapter 40B and 760 CMR. Notice of the site approval letter was sent to the Department of Housing and Community Development, in accordance with the requirements of CMR 760, and no issues were communicated from the Department on this particular application. 4. The proposed accessory affordable unit is approximately 480 square feet, and is in the attached garage of the principle residence. 5. The applicant is aware that the unit must meet all applicable building codes to be occupied and that the Building Division and Fire Department will also be inspecting the unit for compliance with all applicable building and fire codes. 6. The house is served by private well water and a private on-site septic and is in an identified Groundwater Protection Overlay District. The proposal has beer,reviewed by Thomas McKean, Health Director, and he has approved a total of three (3)bedrooms at the property. 7. On April 30, 2008 the applicant signed an Accessory Affordable Apartment Program Agreement Affidavit that commits,upon the receipt of a Comprehensive Permit,to the recording of a Regulatory Agreement and Declaration of Restrictive Covenants at the Barnstable Registry of Deeds. That document will restrict the unit in perpebaity,as an affordable rental unit and requires that the dwelling be owner- occupied as his principal residence. 8. The applicant understands that the affordable unit will be rented to a person or family whose income is 80% or less of the Area Median Income(AMI)of the Barnstable Metropolitan Statistical Area(MSA) and further agrees that rent(including utilities) shall not exceed 30% of the monthly household income of a household earning 80% of the median income,adjusted by household size. In the event that utilities are separately metered, the utility allowance established by the town of Barnstable shall be deducted from rent level so calculated. 9. According to the Massachusetts Department of Housing and Community Development, as of May 7, 2008, 6.7%of the town's year round housing stock qualifies as affordable housing units. The town has 2 not reached the statutory minimum of affordable housing under MGL Chapter 40B Section 20-23 or its implementing regulations. The Town of Barnstable's Local Comprehensive Plan encourages the use of existing housing to create affordable units and the dispersal of these units throughout the town. Finding Summary: Based upon the findings, the Hearing Officer ruled that the applicant has standing to apply fora Comprehensive Permit under MGL Chapter 40B and the Town of Barnstable's Accessory Apartment Program. The proposal is also deemed consistent with local needs because it adequately promotes the objective of providing affordable housing for the town of Barnstable without jeopardizing the health and safety of the occupants provided all conditions of the Comprehensive Permit are strictly followed. Ruling and Conditions: Based upon the findings, a ruling was rude to grant the Comprehensive Permit in accordance with MGL Chapter 40B to the applicants,Leland G. and Louella M. Gaines. It is issued to allow for a one bedroom accessory affordable apartment unit in accordance with the following conditions: 1. Occupancy of the affordable unit shall not exceed two (2)people. 2.The total number of bedrooms on the property with the existing on site septic system shall not exceed three (3). 3. This unit shall not be occupied by a family member of the owner(s). 4.All parking for the accessory apartment and the main dwelling shall be on-site, and no additional lodgers shall be permitted on site for the duration of this Comprehensive Permit. 5. To meet the requirements of affordability, the cost of housing(including utilities) shall not exceed 30%of 80%of the median income for a single individual for the Barnstable MSA. In the event that utilities are separately metered, the utility allowance established by the town of Barnstable shall be deducted from rent level so calculated. 6.All leases shall have a minimum term of one year. 7. The Growth Management Department shall serve as the monitoring agent for the accessory apartment. 8. The applicant must apply for a building permit for the accessory unit,whether the unit is new or pre-existing. Before securing an occupancy permit and certificate of compliance, the Building Commissioner must determine that the unit conforms to the approved plans as submitted with the building permit application and meets state building and fire codes. The Health Division must determine that the dwelling is in compliance with applicable on-site wastewater discharge requirements. 9. The applicant may select his own tenant,provided the tenant meets the requirements of the program as cited above and provided that person's income is reviewed and approved by the Growth Management Department of the town of Barnstable as a qualified individual. The applicant will be required to work with the town to provide information necessary to document that the tenant qualifies. The unit shall be rented on an open and fair basis to an income eligible individual or family. Whenever a vacancy occurs,notice must be given to the Growth Management Department and the unit must be listed with the Town. 3 y rA 10. Every twelve months the applicant shall review the income eligibility of the individual occupying the unit. No later than a year from the date of issuance of this Comprehensive Permit,the applicant shall file with the Growth Management Department of the town of Barnstable an annual affidavit listing the rent charged and income level of the occupant of the unit. The applicant shall provide the town any additional infonration it deems necessary to verify the information provided in the affidavit. Upon any report from the town that the terms and conditions of this permit are not being upheld, the Zoning Board of Appeals or it's Hearing Officer shall have the ability to hold a hearing to show cause as to why this permit should not be revoked. 11. This Comprehensive Permit shall not be transferable to any other person or entity without the prior approval of the Hearing Officer or Zoning Board of Appeals. This decision,the Regulatory Agreement and Declaration of Restrictive Covenants and all other necessary documents shall be filed at the Barnstable County Registry of Deeds. If the ownership of the property is transferred, the Growth Management Department of the town of Barnstable shall be notified within 60 days of the name and address of the new owner. 12. This Comprehensive Permit must be exercised and the unit occupied within 12 months of its issuance or it shall expire. Ordered: Comprehensive Permit 2008-043 has been granted with conditions. A written copy of this decision shall be forwarded to the Zoning Board of Appeals as required by the Town of Barnstable Administrative Code Chapte_241, section 11. If after fourteen(14) days from that transmittal the Members of the Zoning Board of Appeals takes no action to reverse the decision,this decision shall become final and a copy shall be the filed in the office of the Town Clerk. Appeals of the final decision,if any, shall be made to the Barnstable Superior Court pursuant to MGL Chapter 40A, Section 17, within twenty(20) days after the date of the filing of this decision in the office of the Town Clerk. The applicant has the right to appeal this decision as outlined in MGL Chapter 40B, Section 22. In accordance with Chapter 241, section 11 of the Town of Barnstable Administrative Code, the hearing officer transmitted a written copy of the Comprehensive Permit decision to the Zoning Board of Appeals on July 9,2008. Fourteen(14) days have elapsed since the transmittal to the Board, and no Board Member has taken action to reverse the decision. - Ga}+1 N_ghtingale,� earing, ff cer Date Signed 1,Linda Hutchenrider, Clerk of the Town of Barnstable,Barnstable County,Massachusetts,Hereby certif; that twenty(20) days have elapsed since the Zoning Board of Appeals filed this decision.and that no , appeal of the decision has been filed in the office of the Town Clerk. Signed and sealed thisr under.the pains and penalties of perjury. Linda Hutchemider,Town Clerk 4 S F; N0, 249 Pa P, 2of2 2? 2iC8 10. 04AM `,y. .� h .T ! i ' Dflf en, Etizallbeth ` .F2 era: McKean, Thomas 44 Z " Tuesday, May 13,2008 9:47 AM �t+ To. Dillen, Elizabeth E = ` "Subject: RE: 116 Audrey's lane, M Mills rrG:I L-1ked 0 Torn- be said the owner neeeds his privacy in the very small office room. ��'i'" :f i So, please require a carefully worded deed restriction restricting the number of bedrooms. =Original Message----- Frain. Dillen, Elizabeth Saint!Tuesday, May 13, 2008 9:43 AM ='. 'I"im McKean, Thomas; Perry,Tom Subject. RE: 116 Audrey's Lane, M Mills It that's what you require,then I will direct them to do it. Betk.DUL-n Spe6at projeets coardlnator f;;Gt.oth Management Department S 7"cwa gf Barnstable 1 s 367 Ma�n5treer,Hyanrci5 MA Bax 509,862,4782 t -----Original Message--- From. McKean,Thomas Seat.-Tuesday, May 13, 2008 9:15 AM To: Perry,Tom ; Cc: Dillen, Elizabeth Subject: RE: 116 Audrey's Lane, M Mills a,, Will the door be removed permanently? ----_Original Message----- t;. From., Perry,Tom Sent:Tuesday, May 13, 2008 8,39 AM To- McKean, Thomas �c: Dillen, Elizabeth €=sly ^ Subject: FW: 116 Audrey's Lane, M Mills Tom I was at this house and there is no way to make the doorway wider on any room that 9 could be construed under Title 5 as a bedroom-They are fine with a deed restriction }(' -----Original Message----- €Fi . from: Dillen, Elizabeth yenta Monday, May 12, 2008 4:56 PM i� To: Perry,Tom Subject: 116,Audrey's Lane, M Mills s : K 3/208 i 11 3 _'{FS P, 2 3. 2 0 0 8 10; 0 4 H M"� BARNSTABL� BOARD OF HEALTH T N O, 2 4 9 P. l i } " I1hlpecto rT® of Barnstable le office Ho:u0tz Regulatory Services -9� a:3a Thom"Ve G erg]DIreCaor HA Public Health DIM'Sion Thomas M Director Jai. 200 Main a Street,i4yamis.MA 02601 SR, 508 790-6304 ANNE SQL® grr4 Information: s.R 3 . is(r��ss: ` Map Parcel .,fii; Y pr to add an fi, 2, :Rowma bedrooms exist on our opt►now? Are you planning Y k 2a. Plpnso include a copy of your floor plans for the entire propany. x4 . 3. l�iL±.o dowelling connected to public seater? FBS or N® f ];f le! dwelling is connect ead f®public sewer9 slip quest �9 below, 2,.. bz, g. ]�c���atj,on of dwelling is IDE x ®IIZ,SXDE a Zone of Contribution to public imp]Ay wells? �e Is the dwelling col�ccted to ®NSITE 'LL or toCP:(:]B:L1LW.4 ? 60 'Is P.disposal works construction permit on file? YES Or NO ` 4' ermit? 6a.'[f'1r,a& how many bedrooms were approved according to this p f' f' BeA2'tDorl's. `rxF r.F C.p� 7. Were!any building perraits obtained for constmction of additions bedrooms? YES or N0 3A,.. €l S _ j �. is lac=an engineered septic system plan on file at the Health Division? YES ®� NO 9. Has the septic system been inspected by a DEP certified inspector witbin the last tom®years? .; IT S or NO fit, J; 1:.. . . f-V, o-e�wpmm efl-Ovmmuv-movvvm----- {�av® arcmean------measaP��eemevvvv------ft. mp Vomw vov0000mm0l®09oawwvovomm --oo•i CID FOR OFFIM USE MY TO BE,510M BY AMALTH INsPEc; RtAQE-rT ONLY OW 4 W-U ibo l- Avh�� M.. 'fhb Public Health Division has no objection to °bedrooms at this property. ,g ?%a t10 �o Date: �y X�4; ��°/h�alth/wpjales/®m�essyq�p . 3ni f R'. �"SF SFP. 23, 2008 10: 05AM N0, 249 P. 3 T Barnstable 5 3 n Oi i Vim The Town ®f Barnstable Growth Management Department 3671bIain Street,Hyannis,MA 02601 y ' .' Patty Daley . Office:: 508d862�}b78 Interim Director 1. >: 508-862-4782 y , = 2007 t jrp $141 TO: Tom McKean fir;F"� �R. FR®M: Beth Dillen H DATE: 511/08 t RE 116 Audrey's Lane, Marstons Mills ` HI Torn Mr. Gaines, the applicant, believes he is only allowed three bedrooms at this property. He uses the first floor bedroom in the main house as an office, an would be willing to widen the opening to five feet, but is unable to do so because f; f!:. of the placement of the door jamb (see attached photos). Tom Perry attended the site visit yesterday and agreed it would not be feasible. f AS such, the applicant is requesting the option to have a deed restriction recorded at the Registry of®eels limiting the property to a total of three bedrooms. Please let me know if you have any questions or would like additional a. {. information. Thanks, Beth y, i' j t^�"pit �• s li. The Town of Barnstable anxtvsTwst�. A Growth Management Department �FO"AP�A 367 Main Street, 3rd Floor Hyannis, MA 02601 Tel:508-862-4678 Fax:508-862-4782 April 30,2008 John C.Klinun,Town Manager Janet Joakim,Town Council President Barnstable Town Hall 367 Main Street Hyannis,MA 02601 Re: Leland&Louella Gaines - 116 Audrey's Lane,Marstons Mills; one-bedroom accessory unit This letter is to inform you that the Accessory Affordable Apartment (Amnesty] Program has received a request for a project eligibility letter under the Community Development Block Grant (CDBG) Fund and under Article II of Chapter Nine of the Code of the Town of Barnstable and the criteria for the Local Chapter 40B Program. This office is reviewing the request. If the Town has any comments on the project, please forward them to me so that they can be addressed in the site approval letter. This letter gives you official notice of our receipt of the above application(s). We will issue a decision as to the acceptability of the sites and the consistency of this development within the guidelines of CDBG. Sincerely, 3 Elizabeth Dillen J , Special Projects Coordinator , Growth Management Department } cc: Building Division , Health Division Fp' Town of Barnstable Health Inspector Office Hours .Ft TOr'ti� Regulatory Services 8:00—9:30 Thomas F.Geiler,Director 3:30—4:30 9r Public Health Division Only 039. �0 Argo a Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT QUESTIONNAIRE 1. General Information: Address: &&Z—val Map Parcel Qq3 Name: Qf�� C ��� Phone: ��' 2. How many bedrooms exist on your property now?Y— Are you planning to add any bedrooms? ND 2a. Please include a copy of your floor plans for the entire property. 3. Is the dwelling connected to public sewer? YES or NO If the dwelling is connected to public sewer, skip questions 4-9 below. 4. Location of dwelling is INSIDE r OUTSIDE a Zone of Contribution to public (V* supply wells? 5. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER? 6. Is a disposal works construction permit on file? YES or NO 6a.If yes, how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES or NO 8. Is there an engineered septic system plan on file at the Health Division? YES or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO ------------------------------Ar"'"-------------------------------------------------------------------------------------- lv (1 , e I @D � aCx Pz 14 13X FOR OFFICE USE ONLY . � Kp,3 q &A-VJ� TO BE SIGNED BY A HEALTH INSPECTOR/AGENT ONLY Ova f=,,J js '' C�z.�� �►01- P�-� The Public Health Division has no objection to bedrooms at this property. a,s ?,cg tie Signed: Date: _ . 0 Inspector(Print): M Q;Aealth/wpftles/amnestyapp /94 ter, 7--te" taf Te- �1 1 _ L,� ► oo:) r q TOWN OF BARNSTABLE LC.CATION , SEWAGE VILLAGE� ASSESSOR'S MAP & LOT G -bl3 INSTALLER'S NAME & PHONE NO onS SEPTIC TANK CAPACITY /6900, LEACHING FACILITY:(type) �� C2�/��J (size) k /O NO. OF BEDROOMS FoldvilliTE WELL R PUBLIC WATER 'BUILDER O OWNER DATE PERMIT ISSUED: li DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes C n� ;F# Vk . a o7-0 oq3 . FRs.............................. /Z THE COMMONWEALTH OF MASSACHUSETT/ 00 BOARD OF HEALTH TOWN.OF BARNSTABLE Appliration for Mitip miallUorkri Cfa mitrurtinn rantit Application is hereby made for a Permit to Construct ( ) or Repair 0< an Individual Sewage Disposal System at: ....../l..---- .J .-----........- � `�►.s .� vas ocation.Address or Lot No. ....17.0 . .� -----.....�►.... .�c ........l_l� �o�rs-...... �}-Q.�.1...• I.. � Cs L0 O e r 5 C�T�J7V / 7 AC s . ✓L/11"" ...:�C-------------•-------�7_._.------------......... ----------------...-- ---------------------------------------------------------------�--------....------------.... Installer Address U Type of Building Size Lot__ GU..==:..Sq. feet Dwelling— No. of Bedrooms------------—7.....___ _______.-----Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures W Design Flow................ gallons per person per day. Total daily flow............. ....................gallons. WSeptic Tank—Liquid capacity/,Md---gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq.'ft. Seepage Pit No----------_--------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z ,Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................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........................ �+ •--•--•-•-•---------•--• -------•-•--...---•-----------•-•-••-------------•---•-•-•-•--••-•-------••......................................................... 0 Description of Soil........................................................................................................................................................................ x U -•-•.....•------•--•----...--•-•-----••-------•----•---•-•-----•---------------------------------•------------------------------------------------------------------------------------•-•-•-----•------- W UNature of Repairs or Alterations A sorer when applicable---—D_...._�---_.-_-_- -------'--0-i.............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance h been is ue y t board of health. A,�Signed ...... .... ... APPlication APProved BY .. 4 I LTare Application Disapproved for the following rearon - ------------------------------------------------------------------------------------- ------------- ................................ ............................ ...................----------- ............. ....... . ....... . ........ ...-- --..... ........ ------ ------- Permit No. ------7.... . ---��- -------------- Issued ..... ...... a NI Fss.............................. �i THE COMMONWEALTH OF MASSACHUSETT�S BOARD OF HEALTH ^� TOWN OF BARNSTABLE Appltration for Uhripw ttl Wurkfi Tomitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (�) an Individual Sewage Disposal System at: f/( . ----•-•-•---......•----•••----..................--__-_•i.......................................... Location Address or Lot No. i......G Gt..cr... ✓dJ , � c . Owner .5�— Addre s................................. C�vsTi¢�c -T- •--•-••---•-•-••----• ••--•------rG--------- --------------- .-- � Installer Address U Type of Building Size Lot__ ? GUU _..Sq. feet Dwelling— No. of Bedrooms._........ ...........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) QI Other fixtures_.................................... W Design Flow.............. .V ..-----••-•-----gallons per person per day. Total daily flow............. ...................gallons. WSeptic Tank—Liquid capacityZ//) ...gallons Length................ Width---------------- Diameter_------------- Depth................ � x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I----------------minutes per inch Depth of Test Pit------_............. Depth to ground water........................ f4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x . --•••--------•--------------•-••-••-•••-•••------••••••••-•••••-------•-•-•-•--••••----•••..........-•-•-••-•-•--•••••--•--•••---••--••....-••-----....•-•-- Descriptionof Soil I. - ---------------------------------------------------------------------------•-------------------•----------•---••-•--------••--- U ----------------------------------•......-•--•---• -•-•••••-•-••-•••-•••--•-•--••----••......••••••••••••-•--------•--•--••------••---•--•-•-••-------•------•••---•--•-••-•-••••---•••......---••••-- W ------------------------------------------------------------------------------ -----•-••--•--•••••----••-•------------------------------------•--•------------- ------------------------------------ U Nature of Repairs or Alterations—Answer when applicable----.�:d h._-.-.':.---..--_._160' � ......tf�:_l.�_,.�............... ....................................................I r% -y �T" S 7?j"j . G-, ; Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued/by th- board of health. Signed .............:. .......... ............ ......... . '- .-_ -. ........ e � Application Approved By ...�.....��1/�=� ... 1- --`�----- ./ -- - ... .. ,/ 1...C��)il..../...... Application Disapproved for the following rea son r,. .... ... . ` .. .... ..................................................:/..... ---................. ... ............ .. ... ........ =j._ . ......................... -------------------------------------------................-------------------------------------- . ... � / e Permit No. ... "f 1 - Issued ..........1...__...- . :................ to THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (fPXtilfi atP of Compliance THIS IS TO CERTIFY, Thatthp-yipdividual Sewage Disposal System constructed ( ) or Repaired ( �X) by — — InscJler at .................................------------------------------.eo fin-------'.-4— . `----- 5.-------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ---------------------------------------------- dated -----------------------------------------.__ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ,.�-� DATE... .".......� '`. ------------------------------ Inspector`^_.../'�s ------- -- ----—------------------------------------ ------------------- Qtc Orr ��3 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No......................... TOWN OF BARNSTABLE FEE....._A... Utotrooal or_ko (gonotrurtion Prmtt sGL.E/� C,/iJ ��.LJC �hJ Permission is hereby granted..................... -----G�-- -----------------------------. ...__......-----...._._....__...._..---........-----.. to Construct ( ) or Repair (>-:�) an Individual Sewage Disposal System at No. //(�_.__ Z�J/L#_. --!/tj - $ f Street C�' L�� as shown on the applic tion for Disposal Works Construction P ''mit No... .:7 at M.....__j�. .......� g9/y Board of Health V DATE............... : r' = ----------------------- FORM 3650a HOBBS&WARREN.INC.,PUBLISHERS LOt,EAI SEWAGE PERMIT NO. VILLAGE A0,6 0-3- e- 673 IYTA LL R'S NE & ADDRESS e BUILDER 0 0 N R DATE ERMIT ISSUED DATE COMPLIANCE ISSUED _. r it Y \` (\ ' ' C' sJ�_ I --" ���� ��� � :, ���� THE COMMONWEALTH OF MASSACHUSETTS BOARD 0 - HEA T4 Application is hereby made for a Permit to Construct (bl� or Repair an Individual Sewage Disposal System at: 0_ � t..,...L Owner Address Installer Address Type of Building Size Lot_ .....Sq. feet Dwelling—No. of edroom?---------- Expansion Attic Garbage Grinder ( ) Otherfixt res ----- --------V��------ex........Z�,gpzr—---------2_0--------------------------------------------------------------------------- Other Distribution box ( ) Dosing tank ( ) X P Ll 1-4 -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until uCertificate of Compliance has been issued by the board of health. � Applicaticri �~ � Date . Application Disapproved for the following reasons:— ....................—._--'..------_---'_`----- � ...................................................... ........ ...................................................................................-------.-----_--..'-- ~.e Permit No...................................... .................... Issued........................................................ o"m -------_------------------------------------------ '—' -- — ~ _~Mod � THE COMMONWEALTH orwAssxoHuScrrs BO� U��� �� �� TH ��" ~�� �� " "��A ----x���'��%����� ..................... � ����m��� ��= ��- ���~� ���� '��� ��� �� �-�v----�---~^ --~ -~-n--~-~ ---~-~- ~~�-~-'~~-^ nr ---`- /\unlkaduo is hereby made for u Permit to Construct (^~< or Repair ( ) an Individual 6cv,uge Disposal System at: /, Z_ | -----' -' -'-'--- ----- - ...............'----'----------'--------'- ----__-------- __-_____-.-------- .------'-.-_-- ...... Owner Address -----_.----- -------------------------------------------- ----_------_.----'----_................................................ Installer Address - Tvnc of Building Size Lot.......Z)?�,«Zi 6---Sg, feet Disposal Trench--No. -------------------- Width Iota -------------------- Total area--_--..�g. h. Pit I�u---{--- Drot6 below inlet Total area------------------sq. 6 Z Other Distribution bur ( ) Dosing tank ~~ Percolation Test Results Performed by.-----------_-_-------.---_' Date-------.-------- Icst Pit No. l................minutes per inch Depth of Test Pit.................... Depth to ground water---------------------- 1:14 Test Pit No 2................minutes per inch Depth of Test Pit.................... Depth to ec0006 water-_------ 0 Al --------._-- ---------------------------------------------------_--_--.----.-__-----_.-___----._----_.-- O Nature ofD Alterations when The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article"XI of the State Sanitary Code-The undersigned further agrees not to place the system in operation until a Certific�,te of Compliance has been issued by the board of health. Si '---''--_'''' A plication Approved 4 Date Application Disapproved �6r' the�following reasons:- .....................................................................................----_----__--_-.--.-_-_--._-.-._--._--.----' --' Date THE COMMONWEALTH OF MASSACHUSETTS _----_------- THIS IS TO CERTIFY, That the Individual Se�vage Disposal System constructed or Repaired by-...-::................i V. ....... ......................................... ----- ------ ---- ---- .......... .. .........--- - - ------- Z has been installed in accordance with the provisions r icle X1,of The State Sanitarv'Zqde'as describe�d he THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ----- THE oowwomvvsALT* OF wxssAc*ussrTe � � ������ � � [ ---^�� -'«]F' _'----� ^^°� ^ ------~ ~-----'-''------'�r-- ���. / v^�~--........ �0��^ l�~=K o�o��m«��� Norkii *�ouofitrur4mw*v ramit � to Constr/62A YRej(air.4V) an Individual S sal/S_yste ev at No....X..4A.'CA1........ Strjet - 4�it a» shown ou the application for Disposal Works Construction DATE................................................................................ �~ ronM /oss nnaasa WARREN. 'wr' pvoL/s*cns 1., j, •�.ti F..nwt.l - .y fig= 0.1 {•! r -ff .k • ` r .: i O•, 0 O / - r Y�` ICI A / { 3S it Ts a+ ♦ Yi •� I �� � �, 'ate �1 1 '3} { ;. �+®� C��'9'I�Y TfJFa7r rNE 6viL�Iiv� s"Wi �air .°�s�'GiB,1%L/ DAJ rs�/s .o6,a4M ev LOCgY'a�a ©.v 'VAr � � ��� •Sily1�¢�_ +�_ �y r� ''"` �r OA7 rAI& T Cam' ' �- IM/�./i�M. iCQr1,✓i�TE'tG�AC TEa Z'�. c";� ' ftN���-�y ��' �" '�' "` Rl } CIVIL E'AlCv V4dY6Fr ALS LEA/ SeofOVF.rV"e4S L`Ga�JT'•E GAb1►��'I►�'i�UTN, M6�S�. ��a�r�- �E�.., .�;� :�dro�eV �t�� F, , l _40.00 ` no LEGEND MARSTONS MILLS. R 67 PROPOSED CONTOUR ® PROPOSED SPOT GRADE —— 98 —— EXISTING CONTOUR wAKEBY AO + 96.52 EXISTING SPOT GRADE % � 9 r------- ; �� \ W— EXISTING WATER SERVICE 2s�q� LOCUS \� X' ice/ it -+� ! \�� `� ,, P , `,\�O. TEST PIT 116 AUDREY'S N i LANE �/ % i ♦♦ 92 I ♦ RHODDYS �` �VW5 \O { ♦ OAKS \J N ' ; �♦ N P ; < \�` '' \ LOCUS MAP m D 92.2 °,- ' S LOCUS INFORMATION ��Dc i �.••` _ i ; BIR�l.• loll,2 \N PLAN REF: 272/92 j * ---------------sir--- �:F O \ S�\ `,�`�p . TITLE REF: 17728/270 1 92 0 c A �/ PARCEL ID: MAP 28 PAR. 93 ZONING: "� E:� ---- � � i `� \� �� FLOOD ZONE: "C" 1 PORCH w � PINE Oj �.\ COMMUNITY PANEL: 250001-0015-C DATED:08/19/85 INV. J �,, '� SEPTIC SYSTEM #116 EL=90.35 ory ���;;,� _ REPAIR PLAN WELL :; TOF=93.00 `p- OHw uPo LOCATED AT: `, 116 A U D R E Y'S LANE J* LP MARSTONS MILLS, MA. PATIO DECK PATIO ; �' ��.'� PREPARED FOR 100, LELAN D G. & LOU ELLA M . SEP. TANK , OAKS � i G A I N E S , JUNE 11, 2014 LOT 63 ; p' OF DARREN M• • t i TO n�E�\, 1 WELL No 1140 LOT 62 AREA=20,001t S.F. BENCHMARK: SANITAR h LOT 70 TOP OF CONC. BLHD TOWN WATER AND FOUNDATION ELEV=93.00 MEYER & SONS INC. P.O. Box 981 GRAPHIC SCALE E. SANDWICH , MA 02537 20 0 110 20 40 80 PH. (508)360-3311 fax (774)413-9468 meyerandsonsinc@gmaii.com ( IN FEET ) 1 inch = 20 ft. SHEET 1 OF 2 J#1660 T.O.F. NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS NOTE: PLACE RISERS OVER ALL COVERS W/IN 6" OF GRADE ! FINISHED GRADE (92.0) EL: 93.0 F.G.EL: 92.0 A __ \ f F.G.EL: 92.0 F.G. EL: 92.0 MAINTAIN 2% MIN SLOPE OVER LEACHING AREA a .s TOP TANK=EL. 90.58 2" OF 3/8" DOUBLE WASHED 3 4" - 1-1 2" _j STONE OR FILTER FABRIC DOUBLE WASHED STONE 6" 4" SCH 40 PVC 10 I 14 s" A IIN 1% (MIN. ®®®® p ®®®® TEE'S ARE TO BE I NV.88.65 ) 4 SCH 40 PVC 2 EFF. DEPTH ®®®®®®®®®®® INV.89.25 V.88.45 4' 2 X 8.5' 4' GAS - EXIST. INVERT PROPOSED DB 3 BAFFLE EFFECTIVE LENGTH = 25' _ (H20) DISTRIBUTION BOX INV. 89.50 INV. ELEV.= 88.20 EXIST. 1 ,000 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON ��� OF 44ss9� BREAKOUT OUTLET TEE AS MANUFACTURED BY o DAR IREN �G�r ELEV.= 89.20 TUF-TITE, ZABEL, OR EQUAL M /Y TOP CONC. ELEV.= 89.20 i /I OV 4 INV. ELEV.= 88.20 ®®®®®®® NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING ` ®®®®®®® PIPE INVERTS PRIOR TO CONSTRUCTION 'QFGIST ®®®®®®® 2) D-BOX SHALL BE SET LEVEL AND TRUE SANITA(,\� 1 I BOTTOM EL.= 86.20 ®®®®®®® lm TO GRADE ON A MECHANICALLY COMPACTED SIX I 3.75' 1 5 FT. 1- 3.75' INCH CRUSHED STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2) SEPARATION 5.0 FT. EFFECTIVE WIDTH 12.5' 3) INSTALL INLET & OUTLET TEES AS REQUIRED SEPTIC SYSTEM PROFILE ADJUST. GRNDWATER EL: 81 .20 r SOIL ABSORPTION SYSTEM (SECTION) (500 GALLON LEACH CHAMBER) GENERAL NOTES: DESIGN CRITERIA 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL LOGS P#: 14393 BOARD OF HEALTH AND THE DESIGN ENGINEER. NUMBER OF BEDROOMS: 3 BEDROOM DESIGN 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE DATE: MAY 28, 2014 LOCAL RULES AND REGULATIONS, EXCEPT AS NOTED BELOW: SOIL EVALUATOR: DARREN MEYER, CSE 1614 DESIGN PERCOLATION RATE: <2 MIN/IN - 310 CMR 15.405 (1) (8): DAILY FLOW: 110 G.P.D. X 3 BR = DESIGN FLOW: 330 G.P.D. 1) A 5.0 FT. VARIANCE FROM 310CMR15.211 TO ALLOW LEACHING WITNESS: DON DESMARAIS, BARNSTABLE HEALTH GARBAGE GRINDER: NO (not designed for garbage grinder) TO BE 15.0 FT (MAX) FROM DWELLING VS REQ'D 20 FT. (LINER PROVIDED) 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE EXIST. 1,000 GAL. SEPTIC TANK TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE Elev. TP-1 Depth Elev. TP-2 Depth DESIGN ENGINEER. 92.20 0" _- _ _ -(330)_=__445..94_S..F.A A- -LEACHING-AREA-REQUIRED: - - -- 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING LOAMY SAND LOAMY SAND .74 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. 10YR 3/2 10YR 3/2 91.70 6" 91.70 6" 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. B LOAMY SAND B LOAMY SAND USE TWO (2) 500 GALLON PRECAST LEACH CHAMBERS W/ 4' 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 10YR 5/8 10YR 5/8 STONE ON ENDS & 3.75' STONE ON SIDES: 25' L x 12.5' W X 2'D THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 90.20 24" HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. C SANDY 90.04 C SANDY 26 BOTTOM AREA: 25' x 12.5'= 312.50 SF 7. WATER SUPPLY PROVIDED BY PRIVATE WELL. LOAM LOB SIDE AREA: (25 12.5) X 2 X 2 = 150 SF 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED 10YR 6/6 10YR 6/6 TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 88 20 48 88.28 47" TOTAL SQUARE FEET PROVIDED = 462.50 vs. 445.94 REQ'D 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE BOTTOM C2 MEDIUM C2 MEDIUM DESIGN FLOW PROVIDED: 0.74(462.50 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING PERC ® EL. 87.50 `` 10. EX CONSTRUCTION. N 5Y7 LEACHING TO BE PUMPED. CRUSHED AND FILLED PER TITLE 5. 2.5Y7/3 2. EXISTING /3 PROPOSED SEPTIC SYSTEM UPGRADE P LA N l 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 81.20 132" 81.20 132"12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY 116 1 6 AU D R EY'S LANE, M. MILLS, MA AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY PERC RATE <2 MIN/IN. ("C" HORIZON) Prepared for: Gaines 13. NO ABUTTING PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. NO GROUNDWATER OBSERVED 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. System Design and Topography Plan by: SCALE DRAWN MEYER&SONS, INC. D M M 15. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPECIFIED) " 1, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 N.T.S. to conduct soil evaluations and that the above analysis has been performed b me consistent with the PO BOX 981 16. PLACE 40 ml LINER AS SHOWN TO PREVENT INFILTRATION. Y ' P Y DATE CHECKED SHEET N0. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Eval. Exam in October, 1999. EASTSANOWICH,MA02537 508-362-2922 0 6/1 1/14 D M M. 2 of 2