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Home My WebLink About0032 MILLRACE ROAD UNIT #A - Health F"32 Millrace Road Marstons Mills A=" .047-143 5 M E A No. 2-153LY UPC 12934 amead.com • Made In USA a i r =uw1myG=W1w SFI i sammacims 91W000�1 csn� s��narp i g/9/� = � TOWN OF/BAARNSTABLE LOCATIONJJ X l II r4_Ce !20QCL (" '—VILLAGE VILLAGE i BLS ASSE OLR'S MAP&/FgCEL NAME&PHONE/NCO. SEPTIC TANK CAPACITY VDD S LEACHING FACILITY:(type) / (size) NO.OF BEDROMS ,1 OWNER 1 l C,1 50/` PERMIT DATE: 69?vf E 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 P,YI , S_ of� 48 31 35F$" 6 26 43' k \ \ L \ \ \ k L k \ \ \ \ \ \ k \ \ k \ \ \ \ \ \ \ k \ \ f f f ! f f f ! J J / .J l f f f f f \ \ \ \ L L L L L \ \ \ \ \ \ L \ L L \ L h 1 J f f f / fv/ rvf J J .' / f / f / F / / / f • F f f J ! !vf J Water - Service Gene ��- �- � Town of Barnstable snsxxsrnai�, Board of Health FnC" 200 Main Street, Hyannis MA 02601 Office: 508-8624644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,DMD Junichi Sawayanagi November 21, 2012 Ms. Kate Mitchell, Esq. 761 Main Street P.O. Box 160 West Barnstable, MA 02668 RE Variance Decision/ Ceiling Height at 32:Mlllrace Road, Marstons Mills, MA:: Dear Ms. Mitchell, You are granted a variance on behalf of your clients, John Nugnes, Catherine Nugnes , Richard Nickerson, and Dianne Nickerson, from Section 105 CMR 410.401, of the State Sanitary Code, Chapter 2, Minimum Standards of Fitness for Human Habitation. This variance will allow you to continue to utilize the basement area at 32 Millrace Lane Marstons Mills for human habitation with the lower floor-to-ceiling height currently in existence there. The State Sanitary Code requires a minimum floor-to-ceiling height of seven feet (84 inches) in every habitable room. The Board granted this variance with the condition that the false ceiling be i removed and a minimum of 80 inches of floor-to-ceiling height shall be attained. You stated that the basement area was originally constructed to be used as a family apartment. It was never rented out. The existing floor-to-ceiling height in the basement is only 76 inches with the false ceiling in place. Once the false ceiling is removed, the floor-to-ceiling height will be 80 inches. Although the lower ceilings could be a safety issue for taller individuals, the Board is of the opinion that the lower ceilings should not be a,health issue for most individuals and it would be manifestly unjust to order you to reconstruct the dwelling to attain 84 inches, considering the projected cost to raise the entire - dwelling. Sincer ly yours, Wayne.M'ier, Q:\WPFILES\MitcheII32MillraceLaneCeilingHeight2Ol2.doc (i pF THE 1bk, DATE: 3 FEE: • BnBxsrnst4 ntnss. v� 1639• REC. BY C` Town of Barnstable �j SCHED. DATE: Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-8624644 Wayne A.Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION Property Address: 32 Millrace Road, Marstons Mills, MA - Assessor's Map and Parcel Number: 0 4 7/14 3 Size of Lot: . 51 acre �-:R p Wetlands Within 300 Ft. Yes Business Name: " No x Subdivision Name: APPLICANT'S NAME: Kate Mitchell, Esq. Phone 508-362-1P69 Did the owner of the property authorize you to represent him or her? Yes X No PROPERTY OWNER'S NAME CONTACT PERSON a John & Catherine Nugnes Ear Name: Richard &ni�anne Nickerson Name: Kate Mitchell, Esq. Address: 39 Blossom Ave. , Unit 1 Address: 761 Main Street, P.O. Box 160 Osterville, MA West Barnstable, MA Phone: 774-238-9035 Phone: 508-362-1369 VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) Dept. of Health Rest. Please see Variance Request Form 410`.A01 - ceilincr height Cnn inuatinn Sheet attached hereto. NATURE OF WORK: House Addition ❑ House Renovation ® 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 of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian 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 expense (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[same owner/lessee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\BAJ9P9B7\VARIREQ.DOC Excerpt from the Board of Health Meeting Minutes of 8/21/12: I. Variance — Housing: Kate Mitchell, Esquire, representing John and Catherine Nugnes, Richard and Dianne Nickerson, owners — 32 Millrace Road, Marstons Mills, Map/Parcel 047-143, 0.51 acre lot, basement ceiling height-80 inches. Approved With Conditions. Attorney Kate Mitchell was present and explained the living quarters in the basement was originally built as a family apartment. It was never rented out and has a ceiling height of only 76 inches with a false ceiling. With the false ceiling removed, the ceiling will reach 80 inches. She also mentioned the State Code has recently been lowered to 80 inches. The Board voted to grant a variance based upon increasing the basement ceiling height to 80 inch and with the condition that the basement living area meets the Building Codes for proper egress. f Variance Request Form Continuation Sheet The basement apartment at 32 Millrace Road, Marstons Mills, complies with the area requirements of the Zoning Ordinance of the Town of Barnstable, as can be seen from the attached floor plan. The apartment's ceiling height of 80 inches complies with the current Building Code, Section R305.1.1. requiring a basement ceiling height of not less than 6 feet 8 inches. However, Department of Health Regulation 410.401 requires a ceiling height of 7 feet. This 4-inch discrepancy is minimal and poses no foreseeable health or safety risk to any occupant of the apartment. The property at 32 Millrace Road is to be sold pursuant to a Purchase and Sale Agreement between Mr. and Mrs. Nickerson and Mr. and Mrs. Nugnes,the Buyers. The Buyers wish to use the apartment to provide living quarters for their daughter. The Applicants respectfully request that this Board grant a variance from its ceiling height requirement for this apartment. August 3, 2012 Town of Barnstable Board of Health 200 Main Street Hyannis, MA 02601 RE: Variance Request for 32 Millrace Road, Marstons Mills, MA Dear Sir or Madam: We, Richard Nickerson and Dianne Nickerson authorize Attorney Kate Mitchell to represent us before the Board of Health in the request for a Variance on our property located at 32 Millrace Road, Marstons Mills. Thank you. Sincerely, Richard Nickerson S Dianne Nickerson r - �r August 3, 2012 To: Thomas Perry and Thomas McKean RE: 32 Millrace Rd., Marstons Mills, MA (Map 047 Parcel 143) Gentlemen: This is the property I had discussed with both of you previously. It had the unpermitted finished basement and the ceiling that was 76"in height. We have today filed for a variance from the Board of Health with regard to the ceiling height. Our hearing date is 8/21/12. If the variance is granted, and the building permit is issued, we will be able to remove the suspended ceiling and install strapping and sheetrock. We will then have 80of ceiling height. We are also going to file the building permit today, and Tom McKean told me when it arrived at the Board of Health he would review it, and if satisfied, would send it along in the permitting process, subject to the satisfactory variance from the Board of Health. Our hope is that if the variance is granted, we can obtain the building permit on August 22°a, so that the owners can complete the work, and we can close this property on August 31st as planned. The present owners are Richard and Dianne Nickerson, the prospective owners are John and Catherine Nugnes. The new owners are going to use the space as an in-law apartment, and next week we will be filing the necessary forms for that use. I thank you for your help in resolving this matter. irncerely' ard d Am - i bernie(a)bkrealestate.com www.bkrealestate.com Bayberry Square l B, 1645 Route 28 Centerville, MA 02632 (800) 339-2573 (508) 778-4005 FAX: (508) 778-6611 ro r , August 3, 2012 D r� o4/tl To: Thomas Perry and Thomas McKean RE: 32 Millrace Rd., Marstons Mills,MA(Map 047 Parcel 143) Gentlemen: This is the property I had discussed with both of you previously. It had the unpermitted finished basement and the ceiling that was 76"in height. We have today filed for a variance from the Board of Health with regard to the ceiling height. Our hearing date is 8/21/12. If the variance is granted, and the building permit is issued, we will be able to remove the suspended ceiling and install strapping and sheetrock. We will then have 8011of ceiling height. We are also going to file the building permit today, and Tom McKean told me when it arrived at the Board of Health he would review it, and if satisfied, would send it along in the permitting process, subject to the satisfactory variance from the Board of Health. Our hope is that if the variance is granted, we can obtain the building permit on August 22°a, so that the owners can complete the work, and we can close this property on August 3 1"as planned. The present owners are Richard and Dianne Nickerson, the prospective owners are John and Catherine Nugnes. The new owners are going to use the space as an in-law apartment, and next week we will be filing the necessary forms for that use. I thank you for your help in resolving this matter. Si cerely' ernard g I ` t bernie@bkrealestate.com www.bkrealestate.com Bayberry Square 1 B, 1645 Route 28 Centerville, MA 02632 (800) 339-2573 (508) 778-4005 FAX: (508) 778-6611 August 3, 2012 / I To: Thomas Perry and Thomas McKean RE: 32 Millrace Rd., Marstons Mills, MA(Map 047 Parcel 143) Gentlemen: This is the property I had discussed with both of you previously. It had the unpermitted finished basement and the ceiling that was 76" in height. We have today filed for a variance from the Board of Health with regard to the ceiling height. Our hearing date is 8/21/12. If the variance is granted, and the building permit is issued, we will be able to remove the suspended ceiling and install strapping and sheetrock.-We will then have 80ilof ceiling height. We are also going to file the building permit today, and Tom McKean told me when it arrived at the Board of Health he would review it, and if satisfied, would send it along in the permitting process, subject to the satisfactory variance from the Board of Health. Our hope is that if the variance is granted, we can obtain the building permit on August 22na, so that the owners can complete the work, and we can close this property on August 3 1"as planned. The present owners are Richard and Dianne Nickerson, the prospective owners are Jahn and Catherine Nugnes. The new owners are going to use the space as an in-law apartment, and next week we will be filing the necessary forms for that use. I thank you for your help in resolving this matter. Irere'y'nard �� a • ay. , �.i .� YA. t bernie@bkrealestate.com Bayberry Square 1 B, 1645 Route 28 Centerville, MA 02632 (800) 339-2573ti, N3 ` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Millrace Road Property Address Richard & Dianne Nickerson Owner Owner's Name information is Marstons Mills MA 02648 December 8, 2011 required for State Zip Code Date of Inspection every page. Cityrrown 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: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell _ cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. _ Company Name 189 Cammett Road %0 Company Address 02648 Marstons Mills MA eesn rZ State Zip Code city/Town cry 504428-1779 S112855 - Teldphone Number License Number cC0 C_> B. Certification I certify Itiat 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 December 8, 2011 Job# 11-224 jInect—orr'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 is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Official Inspection Form,Subsurface Sewage Disposal System•Page 1 of 17 t5ins•11/10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 32 Millrace Road Property Address Richard& Dianne Nickerson Owner Owner's Name information is required for Marstons Mills MA 02648 December 8, 2011 .-- every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: Tank was not in need of pumping at time of inspection, leaching pit had 8-9"of effective leaching. 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. 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 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): t5ins-111110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts • Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 32 Millrace Road _ Property Address Richard & Dianne Nickerson Owner Owner's Name information is required for Marstons Mills MA 02648 December 8, 2011 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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•11f10 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 32 Millrace Road Property Address Richard& Dianne Nickerson Owner Owner's Name information is required for Marstons Mills MA 02648 December 8,2011 -_----------- --- every 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 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow t5ins•11/10 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 32 Millrace Road Property Address Richard& Dianne Nickerson Owner Owner's Name information is required for Marstons Mills MA 02648 December 8, 2011 every 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.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 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. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 a Commonwealth of Massachusetts ,p Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Millrace Road Property Address Richard & Dianne Nickerson Owner Owner's Name information is required for Marstons Mills MA 02648 December 8, 2011 __. every page. Cityrrown 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 15ins-11I10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Millrace Road _ Property Address Richard & Dianne Nickerson Owner Owner's Name information is required for Marstons Mills MA 02648 December 8, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information Description.- Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 172,000 gal. _ 9 ( Y 9 (gpd)).- 236 gpd. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied. 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: 15ins•11/10 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Millrace Road Property Address Richard & Dianne Nickerson Owner Owner's Name information is required for Marstons Mills MA 02648 December 8, 2011 - every 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: Tank pumped one year ago. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Millrace Road Property Address Richard& Dianne Nickerson Owner Owner's Name information is required for Marstons Mills MA 02648 December 8,2011 every 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: 1989 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1' 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.).- 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: 8.5' long x 5.2'wide- 1000 gal. Sludge depth: 3" l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts IN Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r(0 32 Millrace Road Property Address Richard& Dianne Nickerson Owner Owner's Name information is required for Marstons Mills MA 02648 December 8,2011 every page. Cityfrown 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 27 2" Scum thickness Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was found at bottom of outlet invert and baffles were intact. 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-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 I Commonwealth of Massachusetts IFTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Millrace Road -01 Property Address Richard& Dianne Nickerson Owner Owner's Name information is required for Marstons Mills MA 02648 December 8,2011 every page. Cityrrown 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-11110 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 32 Millrace Road Property Address Richard& Dianne Nickerson Owner Owner's Name information is required for Marstons Mills MA 02648 December 8, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): 1. 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.): No solids or high stains present. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Millrace Road Property Address Richard& Dianne Nickerson Owner Owner's Name information is Marstons Mills MA 02648 December 8, 2011 required for State Zip Code Date of Inspection every page. Cityrrown D. System Information (cont.) Type: ® leaching pits number: One 46 pit. ❑ 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.): Liquid level was found 12" below inlet with a stain line indicating pit had 8-9"of effective leaching . 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 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 32 Millrace Road Property Address Richard& Dianne Nickerson Owner Owner's Name information is Marstons Mills MA 02648 December 8, 2011 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Privy (locate on site plan): Materials of construction.- Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 15ins-11110 | , . Commonwealth of Massachusetts ��~�N�� x��^��^��N 8��"�^�� N°�� ` � N��~= �� °�UV �~~�~°� N. .~��~~~~��U�~. . Form Subsurface Sewage Disposal System Form ' Not for Voluntary Assessments 32 |Millrace Road -_ - ' ' r----- —'----------�—'-----'-------- »mporw»do,eos Richard &_Dianne-Nickerson _ '-- --Owner Owner's mwne''owome information is required for Ma,stonsN1iUs MA 02648 Deoember8 2011 State Zip Code Date of Inspection ------ every»aoe. ~''''~—' '�— D' System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal syotem, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100fep Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below LJ drawing attached separately ' 48 31 35 626 43 I Ell Water Service | | Millrace Road ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Millrace Road Property Address Richard& Dianne Nickerson Owner Owner's Name information is required for Marstons Mills MA 02648 December 8, 2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells 20+ Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water at el 45 and topo map shows property at el. 80. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•11110 Title 5 official Inspection Form Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 32 Millrace Road Property Address Richard & Dianne Nickerson Owner Owner's Name information is Marstons Mills MA 02648 December 8,2011 required for City/Town State Zip Code Date of Inspection every page. E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file Title 5 official Inspection Form:Subsurface sewage Disposal System-Page 17 of 17 t5ins-11/10 TOWN OF BARNS ABLE i �j / LOCATION./01�-3 �� C� �/ SEWAGE # RL mil` od17- %�.� VILLAGE. ASSESSORS MAP LOT INSTALLER'S NAME & PHONE NO. � PLO SEPTIC TANK CAPACITY /0 00 LEACHING FACILITY:(type) n )4 4ssize /�3 O G 'oNO. OF BEDROOMS `� PRIVATE WELL OC WATER BUILDER OR OWNER . S/A DATE PERMIT ISSUED: DATE COLIPLIANCE ISSUED;_ c/ VARIANCE GRANTED: Yes No CD --9/%000� No......................... FEs.............................. ' THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Applirtttion for Disposal Works Tonstrnrtion Prrmit Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal System at Location-Address •- /. / or Lot No ...wner of /�d dress ...............................- l ... . _ ........... . Z.� Installer Address d Type of Building Size Lot.Z... dam!' ......Sq. feet U I--1 Dwelling—No. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ! # ! ,f`1'__;. No. of persons.........24.............. Showers Cafeteria ( ) Pa Other fixtures ...........................•.............................. Design Flow................' ..................gallons per person per dayi Total dail I y/flow...... './7.........-......•.....galloons l WSeptic Tank—Liquid capacity,_�1CW.gallons Length-__��. .. Widths....._.. Diameter_-_-_----__-__ Depth.X.�<'... x Disposal Trench—No..................... Width....... .---------. Total Length..................:.. Total leaching area....................sq. ft. Seepage Pit No...._..j_.._....... Diameter.........2K-_-_... Depth below inlet........A.._..... Total leaching area.. -T--.sq. ft. It*Z Other Distribution box Q ) Dosing tank ( ) aPercolation Test Results Performed by , ,10. .__;:� '.;' ; P�2Z Z_____ Date...... .. :- Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water--_ fV fir, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---------------- .____--. O Description of Soil---- 1;.- `1. _.r '_I f rf �:: ......................'� • - ' = - x W UNature of Repairs or Alterations—Answer when applicable................................................................................................ ------------------------------•----------•---•-------------------------•----------.....----.....------------------•----•---- ---------------------------•-------------•------------....._..........---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI.1 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board:of health.,r , Signed• .... .. '7 Application Approved BY-••••--•................•............ ._ - _.-.--•--- Date Date Application Disapproved for the following reasons:............................................................................................................... •.............•-•-•-------•••......._...--•---••-•••••••--•...----------••----•-...•-----•...•----•••••----••--------•-•-•-•--•--------••--••••-•••-•----•••••-•--•-•......••--••••--••••••-••----•-•--- Permit No._._.9L... _. ................... Issued ............ a Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH (�er#ifirtt#e of Tomplittnre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed "(�) or Repaired by %. :1'., e6 , _/7rr Installer at.........................................1 1 L_ ••#' /� / ' ...... .. %.' i 7 l fl. 1' - has been installed in accordance with the provisions of TITlr 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__-----(I_--o__'-_V03...... dated-.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................•---•--....------.....-•-------•----....._..........--••--•..... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD O F HEALTH , r� f t�%? O F /. . . .may ' G Ll J No...... :. FEE........................ Disposal Works T�anotrnr#ion .ernti# Permission is hereby granted...........:..!"... .:. ' -.r._.......7,/J l ..............................................."A ` ' r to Construct or Repair ( ) an Individual Sewage Disposal System at No.•--•-•-•-•- ' ' ' 1 • ^ :'_. P I; I A J'' r r— r . " 1 --•-•-----------------.---- ---- ------------------------;------------------------------------------_--- R Street as shown on the application for Disposal Works Construction Permit __- Dated.......................................... e 1 .....................................................— rr Board of Health DATE--------•--- �--�...^...l-G-------g•-•7- FORM 1255 A. M. SULKIN, INC., BOSTON 71 _'!S<�9 No, FRii...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF�H�EALT ...... .....OF..........?oG.. ._ . . - ...... .. Appliration for Dispasal Workii Tonstrurtion ramit Application is hereby made for a Permit to Constryct or Repair an Individual Sewage Disposal Systeqi at: 0se -4 D. L r ......... .............. ...... Location Address No. ..... ........................ ................ dress A.4ellal-I........ .....................d.."Y .................. .............Z_)..�FOR12......7� Pq Installer Address Type of Building Size Lot.AZ_/7j_'Sq. feet U in Dwelling—No. of Bedroo s............. ............................Expansion Attic Garbage Grinder 4 W17 ,7 P4 Other—Type of Buildin _ _4. No. of persons... gp - - ........6............. Showers (Aa — Cafeteria P4 Other fixtures . ....................... .. %;-V .< . ...........................................................I............................................................. Design Flow................ gallons per person pefda W ---------------- q/r Total dail flow----------3...S-40.....................gall6ns 1:4 Septic Tank—Liquid capacity Y/ W /.#M.gallons Length....fpe_'. Width.,..r. ........ Diameter................ Depth_ Disposal Trench—No. .................... Width.......r--------- Total Length................... Total leaching area....................sq. f t. Seepage Pit No--------/----------- Diameter.........i------- Depth below inlet.........X..... Total leaching area..4t7sq. ft. ZOther Distribution box Dosing qnk Percolation Test Results Performed Date...... ... 14 Test Pit No. 1................minutesperinch Depth of Test Pit.................... Depth to ground water.. �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water?/V............... P4 ...................................................... ........ .......................... 0 Description of Soil............4045D. 441.w....... ........ W '9.:R .. W., ............................. ----------------------- ------------*----------------------------------*---------------------------"-------------------------------I--------*------I—--------------1-------*1-------------- .......................... ............................................................................................................................................................................. U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'L I HE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by thhe board, )f health. Signed.... .. . . . ................................ Application Approved By......................................./�....................................... Date ................... ........................................ Date Application Disapproved for the following reasons:....................................................................__...................................... ..................................................................................................................................................................................................... Date PermitNo..... ------------------- Issued....................................................... Date -SMOKE ALARM (,-----SMOKE CO SENSOR HW UNFINISHED/UTILITY AREA [HEAT] LIVING AREA CLOSET CLOSET CLOSET (,-----SMOKE ALARM AND CO SENSOR 0 � BEDROOM w z w 0 N BATHROOM KITCHENETTE w 01 0 U STORAGE/UTILITY CLOSET SINK BASEMENT APARTMENT = 761 SQ. FT. HOUSE = 1,360 SQ. FT. BASEMENT LAYOUT PLAN LOCATED AT 32 MI LLRACE ROAD MARSTONS MILLS, MA PREPARED FOR* RICHARD AND DIANNE NICKERSON 2 0 2 4 8 SCALE: 1/4" = 1 FT SHEET I OF I DATE:07-23-12 BATHROOM BEDROOM SHOWER SINK LIVING ROOM CLOSET SMOKE ALARM AND CO SENSOR CLOSET CLOSET MASTER BEDROOM ICAR GARAGE LAUNDRY CLOSET CLOSET O�SMOKE ALARM AND CO SENSOR KITCHEN BAR CLOSET CLOSET DINING ROOM Lu SIN BATHROOM 3 z cn CLOSET m REF. SINK ~ FIRST FLOOR LAYOUT PLAN 'HOUSE = 1,360 SQ. FT. LOCATED AT 32 MILLRACE ROAD MARSTONS MILLS MA PREPARED FOR RICHARD AND DIANNE NICKERSON 2 0 2 4 8 SCALE: 1/4" = I FT SHEET 2 OF 2 DATE:07-23-12 76-��,T 'RT GENERA4, NO 7 EO -I/A/ IAJ AQ- ARE A.�Lj M c-*-r-> 'PAT,U Y-1 Tc>F U- 1 L 7r- RUA," OF 0 0 (3 P1 71CH A 4, L IIVZ-,,5 A R/N/ To (D 13. 4LL PIPE5 7 o xAlp liv rgE s Ys r,51pf sH..4L N (D 0(5 010) ,&D .4Sr IR01Y OR SeH6,PV1,C 40 PVC. 5F AC L LALL 6FPTIC 24NA�5, ,PISTRIBU71011 (D (D (DO 0 (3) 0) (D 11,A lr5S,�441,4 A6E PE,516NeP @ 0 (D 0) (D J Q (D (Do AOR 11-Z0 1-YA1E,6'1, ZOWAING5 W,�?WAI IP @ (D (D 00 00 (DO ZINAe AWWAIG. 5, ReMOVE 4kk IUNSUITASkC 44fAr -1 CRIA 0 (D 0000) 00 AFN4.4 7�q r1le INVEIFT eLeY.4T10A1,5 0 (1) (a) 0 e 0 0 (D (Do@ __Z,, C I, 0AIVIURY 7'ic-,c ax' 7'NE APIA',oc&.50R�6 AOR A PISUNCE Or AlANP BA CKf'/k k WITP C41Y-FREE 00 �00@000 6,41W,4NR 6R,4 IlCk 1-1,4VIII16 A PERC044770N T, 7 PICAL P1ST1?1,6Zlr1o,?V 46OX OF Z Af1,AbfZ17'd5�S �,P4R INCH 0/f kC,'55 R,4 7,, U o w AT E--- P_ e_.Q c- u�JT R-r---D tl T TYPICAL 1,VCA11N6 PI 7 49 7RE?3,&f!�KeTAf5LEe0,4)?P OFH6A1,rq1VZl,57 vo, P1,9T1?18&7-10/lvl BOX A,,VPl000G4,4_. NOT 70, 6C41_,E 16415 VO7 -1EP WA�N T4�6 t5YSTEM15NE,4/? OBSEIYV,4TION P17-d Rf 1Al)4'0/F(:TCP �S�E-PTIC 7;41VK 13Y COWAZZ7_101Y AAIP PR/O/?.)rO 9.4CffQ44 IA16� TYPIC.44 1000 G,,41,, SEPTIC TANK CRCOLA PON XWTE (Z �-lk / I AM,-__R10,4N PVEC,4ST 0/'F E,�WAZ_ W 7 ZIN46,1555 OrWl NOTEPI,444 ,5Y,5r�FW N07' 7-0 t5C,41,Z.-_ COWPONENr,5 44t ge 00, _r-_,eY4;r10NS 5 Y Am s--:;, clod Lo j ,.4NSr4LZEP -IN -OROFP 71P:�OUGHOU7 9,EINc I 'll I -T1 T4, 6OAeP OFqE,4L7,q 40C0K'P,4&CZ'_ W1 Tq F -Y 01c ME S1 F w ' eOPE ANP,4NY I-00AL ,';NXE6� wl TH 4 er-7RIC P*v a, pv��z r/-/ --el?IIVG INC P-NGW6WR� ARROW EIYGIIVL- ROPS /N TOP<!� eo T rojf, 91111CII W,4 Y A P?t%Y C0NCA,'_'7,E --4 000 re,5 7- Alk -AlOrT.'ACCE55 / ,4A1A101_E,5 rO ,,�PTIC 7A AND LEACHINOP175 TO BE 3VILT t1P 70 Y 6,0,40,E. 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