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HomeMy WebLinkAbout0011 SHAMMAS LANE - Health l �11 Shammas 'Lane Marstons Mills A = 064 109 y I I A Town of Barnstable Health Inspector of ' ti ours Regulatory Services office 8:30—9:309:30 �,. Thomas F.Geiler,Director 3,:30—4:30 1 &UMSPABLE. # Public Health Division MASS Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT — SEPTIC QUESTIONNAIRE Date: October 23,2012 1. General Information: Size of Property.75 acre Address: 11 Shamrnas Lane Marstons Mills'MA 02648 t Map 064 Parcel 109 Name: Kevin R and Amy White Phone#: 2a. How many bedrooms exist at your property now?3 2b. Are you planning to add any bedrooms?NO If yes,how many? 0 2c. How many bedrooms total are proposed at this property(including the amnesty unit)? 1 2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Show all existing rooms in the home and the proposed amnesty apartment. Provide width measurements of any open doorways. Please label each room clearly. 3. Is the dwelling connected to public sewer? NO If the dwelling is connected to public sewer,skip questions#4 through#9 below. 4. Location of dwelling is INSIDE a Saltwater Estuary Protection Zone? 5 . Location of dwelling is INSIDE a Zone of Contribution to public supply wells? WP 6. Is the dwelling connected to an PUBLIC WATER? 7. Is a disposal works construction permit on file? YES or NO 8. If yes,how many bedrooms were approved according to this permit? Bedrooms. 9. Were any building permits obtained for construction of additional bedrooms? YES or' NO "v O 10. Is there an engineered septic system plan on file at the Health Division? YES ,,or NO t:a 11. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO ------------------------------------ FOR OFFICE USE ONLY t2 C' -!-d75 �. The Public Health Division has no objection to 3 bedrooms at this property. Special Conditions: Signed: Date: �ParceliDetail Page I of 3 rj v 0,7AV .s: 4tnss .� E� ..�• � - 11+39�� _ Logged In As: Parcel Detail Wednesday, October 10 2012 Parcel Lookup Parcel Info Parcel ID 064-109 I Developer LOT 18 Lot Location 11 SHAMMAS LANE I Pri Frontage . I Sec Road I Sec E Frontage Village IMARSTONS MILLS I Fire District I C-O-MM Town sewer exists at this address I No I Road Index 2103 Asbuilt Septic Scan: , 4 - 064109_1 Interactive 064109 2 Map _ W 064109_3 i r- (� Owner Info Owner JBISSETT, BRUCE &JOANNE I co-owner %WHITE, KEVIN R&AMY Streetl 11 SHAMMAS LANE I Street2 City I MARSTONS MILLS I State LAJ Zip 02648 Country land Info Acres 1.05 use Single Fa m MDL-01 I Zoning RF Nghbd 0105 Topography Above Street I Road Paved I Utilities Septic,Gas,Public Water I 'Location I j� Construction Info Building 1 of 1 Year Roof Roof Gable/Hip Ext Wood Shingle Built I Struct Wall Living(� Roof AC ,... WDK 3 P 1638 As h/F GIs/Cm Central Area I Cover�I p p Type 17 1 I Style Ranch Int D all Bed 3 Bedrooms t Wall Rooms ' SASBath Model Residential Int Carpet Floor Rooms 2 Full SAS 26 P b 13` Grade Average Plus Type Hot Air Rooms Total 8 Rooms Heater Found- GAR 2 Stories 1®Story Fuel F as ation Poured Conc. Gross 4267`Area http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=4279 10/10/2012 7NEj°"yo Town of Barnstable Health Inspector � r • BAMSPABIM : Regulatory Services Office Hours � 8:00-9:30 A 1639. Thomas F.Geiler,Director rEn ti��°` 1:00—2:00 Public Health Division Only Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT UESTION NAIRE T General Information: Address: L Map O�_Parcel I p'L Name: 9 WCZ Phone: 2t�—Z !83 2. How many bedrooms exist on your property now? 2a. Please include a copy of your floor plans. 3. Is the dwelling connected to public sewer? YES If the dwelling is connected to ublic sewer, ski or NO p p questions 4-9 below. 4. Location of dwelling ' INSIDE or OUTSIDE a Zone of Contribution uti supply wells? on to public S. Is the dwelling connected to an -'f.r ONSITE WELL or to PUB c LIC WATER? 6. Is a disposal works ' 6a.If yes,how many bedrooms or NO were approved accordpermit on file? ing g to this permit? 7. Were any buildin a Bedrooms. g p rmits obtained for construction of additional bedrooms? YES or NO 8. Is there an engineered septic system plan on file at the Health Division? YE S or NO YES or 9. Has the septic syst en inspected by a DEP certified inspector within NO hm the last two years? -------------------- ____ FOR OFFICE USE ONLY ------------------ TO BE SIGNED BY A HEALTH INSPECTOR/AGENT ONLY The Public Health Division has no objection to bedrooms at this property. .Signed: Inspector(Print): Date: vv� YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town (WHICH YOU MUST DO BY M.G.L. - it does not give you permission to operate). You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1'' FI., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. DATE: Fill in please: APPLICANT'S YOUR NAME: f!�ti� 4�x/isf BUSINESS YOUR HOME ADDRESS: _/lSAc,r�.r�uiAr _........... _7�� -S4�9Z TELEPHONE # Home Telephone Number: NAME OF NEW BUSINESS JiSfc�iv10/��L/n7L� TYPE OF BUSINESS � d ta'i IS THIS A HOME OCCUPATION? YES NOS Have you been given approval from the building division? YES . NO ADDRESS OF BUSINESS 104,- lv4, W71 MAP/PARCEL NUMBER When starting a new business"there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200' Main St:- (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature" COMMENTS: 2. BOARD OF HEALTH This individual has be forme t p rmit re ements that pertain to this type of business. Authorized Signature MUST COMPLY WITH ALL COMMENTS: HAZARDOUS MATERIALS REGULATIONS 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual ha infor of the licensing requirements that pertain to this type of business. ' .I Jl� Authorized Signature" COMMENTS: Hazard s Materials Inventory Sheet Checklist ate Physical Street Address-Check database to ensure it exists Working Phone Number Actual Amounts -( ie. gas being used to fuel machines, thinner to ;_clean brushes all count as hazardous materials-no blanks) Storage Information - location of storage, how long is storage for? / If none, note that. r/ / Disposal Information -where and who? If none, note that. Applicant Signature - understand what is listed and noted —" �Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -give.a vehicle washing policy and pl xain it tAttach the Business Certificate with your sign off and comments 'ventory form should explain what the business consists of and the procedures ping. Notes need to be left to explain what you discussed with them. i Y Date: 7 /f0 //0 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: 7_ /SSZ� k"ma®c kc BUSINESS LOCATION: LrJa,04., ,�art,&�.S,41wX &/,a INVENTORY MAILING ADDRESS: Jl fors- ,4 '� 0o2-1a— TOTAL AMOUNT: TELEPHONE NUMBER: CONTACTIPERSON: YG Ifs.- z:i_r EMERGENCY CONTACT TELEPHONE NUMBER: 77�7�a 'Z MSDS ON SITE? TYPE OF BUSINESS: ,&. / I - , / INFORMATION/RECOMMENDATIONS: Vfll l Se gg a�l 9!V,&kS Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemica►s (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout *kI3 Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor & furniture strippers Other products not listed which you feel Metal polishes ay be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS I Town of Barnstable Health Inspector oEt Toys Regulatory Services office Hours 8:30—9:30 4„ Thomas F.Geiler,Director 3:30—4:30 BMWMBLE, * Public Health Division 9 MASS. g 039. aim Thomas McKean,Director ArFO�� 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT — SEPTIC QUESTIONNAIRE Date:November 12;2012 1. General Information: Size of Property 1.05 acre Address: 11 Shammas Lane Marstons Mills MA 02648 Map/Parcel 064-109 Name: Kevin R. and Amy White Phone#: 2a. How many bedrooms exist at your property now? 3 2b. Are you planning to add any bedrooms?NO If yes,how many? 2 in main house and 1 in accessory apartment 2c. How many bedrooms total are proposed at this property(including the amnesty unit)? 3 2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Show all existing rooms in the home and the proposed amnesty apartment. Provide width measurements of any open doorways. Please label each room clearly. 3. Is the dwelling connected to public sewer? NO Septic,Gas,Public Water,.. If the dwelling is connected to public sewer,skip questions#4 through#9 below. 4. Location of dwelling is INSIDE a Saltwater Estuary Protection Zone? 5 . Location of dwelling is INSIDE a Zone of Contribution to public supply wells? WP , 3 6. Is the dwelling connected to an PUBLIC WATER?YES 14: 7. Is a disposal works construction permit on file? YES ::Mr NO --- UJ 8. If yes,how many bedrooms were approved according to this permit? Be rooms. 9. Were any building permits obtained for construction of additional bedrooms? YES Jr NO #, v� 10. Is there an engineered septic system plan on file at the Health Division? YES.- or NO 11. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO '°.r ------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY The Public Health Division has no objection to bedrooms at this property. Special Conditions: Signed: Date: \ S HALL Q _'i S� A•04 s ,,,y � I�N��SL �k113h,'` 5H0 �1 :d8 5H8+6'?�14E� SUE:YOUNG PAGE 1 Aw Got 7-77 or I r� 1 �'� it ,� �• I �� ��. I s 1 I - -_ - -�t----f T-z - +• 4'.Q"x X-Q° 4'•0"x 3'-p"• 4'4"X 3-Q" AsBuilt Page 1 of 1 TOWN OF BARNSTABLE � LOCATION Ile 5W4A-7 /Yl Q,S ZAI` SEWAGE#90/9'017 VILLAGE&w . A- - —ASSESSOR'S MAP&PARCEL'�4(/ )K INSTALLER'S NAME&PHONE NO( 1d,Q&i SEPTIC TANK CAPACITY/GZ•'U �Ql�O✓y LEACHING FACILITY-(type) 19' Ate—,;,I 2"$(size) &I?, X 5 4 NO.OF BEDROOMS OWNER PERMIT DATE:� 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 I • I I r . http://issgl2/intranet/propdata/prebuilt.aspx?mappar=064109&seq=3 11/13/2012 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not'for Voluntary Assessments 11 Shammas �avr_ Property Address Bruce Bissett Owner Owner's Name information is required for every Marstons Mills MA 02648 March 13, 2012 page. Cityrrown 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 A. General Information filling out forms on the computer, t use only the tab 1. Inspector: U U key to move your cursor-do not David D.:Coughanowr, R.S. use the return Name of Inspector, key. Eco-Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich MA 02563 Cityfrown State Zip Code 508 364-0894 1328 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. ❑ Pusses ❑ Conditionally Passes Fails ❑ Needs FurtherEvaluation by the Local Approving Authority (ba k 4��- ram' March 13, 2012 Inspectors 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 bas a design flow of 10,000 gpd or greater,,the inspector and the system owner shall submit the report to the appropriate fd-&hal office of the'bEP. The original should be sent to the system owner and copies sent to the buyer, if applicable; and the approving authority. ****This report only describesconditions=at the,time.of inspection and under the conditions of use at that time. This lnspectio'n`d'oes'not�dd4is how the system will perform in the future under the same or different conditions of use. ' !W.ut erg jib ,M0l � 2 t5ins•11/104 T41e 5'Official Inspeclion fo :Su rface'Sewage Dlsposal System•P e I of V Commonwealth of Massachusetts s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Shammas Way Property Address Bruce Bissett Owner Owner's Name information is required for every Marstons Mills MA 02648 March 13, 2012 page. Cityrrown 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: Inspector's Note==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4-5. The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. 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•11110 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 11 Shammas Way Property Address Bruce Bissett Owner Owner's Name information is required for every Marstons Mills MA 02648 March 13, 2012 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): - El 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 tSins•11110 Re 5 official Ins pection Form:Subsurface Sewage Disposal System•Pape 3 of 17 Commonwealth of Massachusetts 1 ,1112. f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 Shammas Way Property Address Bruce Bissett Owner Owner's Name information is required for every Marstons Mills MA 02648 March 13, 2012 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 ❑ ® Liquid depth in cesspool is less than 60 below invert or available volume is less than %day flow t5ins.11f10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts r=_ Titte 5 Official Inspection Form a Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments 11 Shammas Way Property Address Bruce Bissett' Owner Owner's Name information is required for every Marstons Mills MA 02648`. March 13, 2012 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: ❑ 0 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. ❑ Z Any portion of-a cesspool or privy is within a Zone 1 of a public well. ❑ 0 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 equalto 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.] ❑ 0 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 god to 1.5,000 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 ❑ ❑ thesystem is within 200Jeet,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 I I 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. t5'ms-<'11/it) Tille S Orricial Inspection Form:Subsurface,Sewage Disposal System•Page 5 of 17 ,. Commonwealth 6f Mas'sachusetts =_4; Tithe 5 Off -cial Inspection Form —` Subsurface Sewage=Disposal System Form-NotJor Voluntary Assessments r_ 11 Shammas Way Property_ Address Bruce Bissett Owner Owner's Name. information is required for every Marstons Mills MA 02648 March 13, 2012 page. CitylTown 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 0 El Pumping information wasprovided by the,owner, occupant, or Board of,Health EJ 0 Were anyof the system components.pumped out in the previous two weeks? Z ❑ Has the system received.normal flows in the previous two week period? El 0 Have large volumes of water been introduced to the system recently or as part of this inspection? E ❑ Were as built plans of the-system obtained and examined? (If they were not available note as.N/A). [9' ❑ Was the facility or dwelling inspected for signs of sewage back up? Z ❑ Was.the site.,inspected for signs of breakout?` ❑ 0 Were:all system components, excluding the SAS, located on site? El M 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 Sail 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 1.5.302(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 bed;rooms):. 330 gpd t5ins.•11110 Title 5.Ofricial Inspection Form:.Subsurface'Sewage Disposal System.•Page 60 17 Commonwealth of Massachusetts _- -_ Tale 5 Official Inspection Form = Subsurface Sewage Disposal System Form Not for Voluntary Assessments 11 Shammas Way Property Address Bruce Bissett Owner Owner's Name information is Marstons Mills MA 02648 March 13 201.2 required for every , page. Cityrrown State`. Zip Code Date of Inspection D. System Information Description: Number of current,residents 2 Does residence have a garbage,grinder? ❑ Yes 0 No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes [0 No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes [D No Watermeter readings, if available (last 2:years usage-(gpd)): 367 gpd Detail: 2010, 20'11 Sump pump? ❑ Yes ED No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions Type of Establishment:' Design flow(based on 310 CMR 15.203)` Gauons 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•11'/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of'Massachus`efts Title 5 Official inspection Form: _ Subsurface Sewage Disposal System,Form-Not for Voluntary Assessments ;h 11-ShammasWay .Property Address Bruce Bissett Owner Owner's Name information a Marston.s Mills MA 0264.8 March 13, 2012 required for every, page. City(rown; State' Zip Code Date-of Inspection D. System Information Last date of`occupancy/use:' Date: Other(describe,below): General Information Pumping Records: Source of information` owner Was system pumped as.part of the inspection? ❑ Yes Z No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑X Septic tank, distribution box,soil absorption system 0 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;IIA system by system operator u nder contract Tight tank. Attach a copy of;the DEP- approval. ❑ Other(describe): t5ins,11rio- Titlo S;Official Inspection Forth;Subsurface,Sewage Disposal System•Page 0 of 17 Commonwealth of Massachusetts Title 5- Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 11 Shammas Way Property Address Bruce Bissett. Owner Owner's Name information is Marstons Mills NIA 02648 March 13 2012 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (font:) Approximate age of all components, date installed (if known) and,source of information: Age: 24+ years. Certificate of Compliance issued 9/2/87. (permit#87427). Were sewage odors detected when arriving at the site.? ❑ Yes 0 No Building Sewer(locate on site plan): Depth below grade; 2feet Material of construction: ❑ cast iron N 40 PVC ❑ other(explain): Distance frorn private water supply well or suction line: feet Comments (on condition of joints,,venting, evidence of leakage, etc.): Sewer line appears structurally sound with no evidence of leakage or backup into dwelling. Septic.Tank (locate on site plan) Depth below grade: feet Material of construction: E9 concrete 0 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 x 5 x 6- 1000 gallon tank Sludge depth: not determined t5ins•11110 Title 5Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of17 Commonwealthiof.Massachusetts E - Tide 5f Official Inspect Form Subsurface Sewage Disposal System.Form,-,Not for Voluntary Assessments 11 Shammas Way Property Address Bruce Bissett Owner Owner's Name. information is required for every Marstons.Mills MA 02648 March 13; 2012 page: Cityrrown 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 not determined Scum thickness not determined Distance from to of scum.to top,of outlet tee or baffle not.determined P . Distance from bottom of scum to,bottom of outlet tee or baffle, not determined How were dimensions determined? Design plan Comments(on pumping recommendations, inlet'and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,;etc.):. Septic tank not uncovered as sufficient evidence for leach pit failure had already been observed. Tank should be pumped dry at time of system repair and examined for structural integrity and condition of-tees,if it is to.be reused. Grease Trap (locate on site plan.): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass 0 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 15ins•11110 Title 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 11 Shammas Way Property Address Bruce Bissett Owner Owner's Name information is required for e r e very Marstons Mills MA 02648 March 13, 2012 page. cityrrown State Zip Code Date of inspection D. System Information (cone.) 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 fl661:switches, etc.):' Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 15ins•11110 Title 5 Ofricial Inspection Form;subsurface Sewage'Disposal System-Page 11 of 17 iy Commonwealth,ofiMassacftusetts --_ -- Title 5 Official Inspection, Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - 11 Sh'ammas Way Property Address Bruce.B.issett Owner Owner's Name information is required for every Marstons Mills MA 02648 March 13 2012 page. GOrFown State Zip Code Date of Inspection, D. System Information (cont.). Distribution Box:(if present must be opened)(locate on site plan): Depth of liquid level abo4outlet invert Comments(note if box is level and distribution'to out equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box not evaluated as sufficient evidence"for leach pit'failure had alreadybeen observed. Pump Chamber(locate omsite plan), Pumps in working order: D Yes ❑ No Alarms in working order: ❑ Yes ❑ No Corimme.nts(note condition of pump chamber,condition of pumps a.nd appurtenances, etc..): Soil Absorption System (SAS) (locate on'site plan, excavation not required): If SAS not located, explain why::; t5ins•11i10 Title 5'Offcial Inspection Form:Subsurface Sewage Disposel.System•Page 12 of 17 Commonwealth Massachusetts. U Title 5 Official Inspection Form Subsurface Sewage'Disposal System Form-Not for Voluntary Assessments. 11 Shammas`Way Property Address Bruce Bissett Owner Owner's Name information is required for everyMarstons Mills MA 02648 March 13, 2012: page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: leaching pits number: 1 ❑ 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.): While.removing soil from around the leach pit cover, the overlying soils were observed to be stained black consistent with prolonged effluent contact.When the cover was removed, I noted thick scum coating the inside of the concrete riser and on the inside of the cover. At the cover interface observed a black staining consistent with prolonged effluent contact. This staining indicates that the leach pit has been full to capacity numerous times in the past. 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 l5ins 11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.•Page 13 of 17 Coin h nwealth ofMassachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments. 11 Shammas Way Property Address Bruce Bissett Owner Owner's Name information i required for every Marstons Mills MA 02648 March 13 2012 e page. Cityrrown State Zip Code Date of Inspection 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.)-. t5ins•11Ho Titles Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of17 r Commonwealth:of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments « 11 Shammas Way Property Address Bruce Bissett Owner Owner's Name information is required for every Marstons Mills MA 02648 March 13„'2012 page. Cityrrown state Zip Code Date of Inspection D. System Information (cunt.) 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: 0 hand-sketch in the area below Q drawing attached separately Z (SIT 'CR�,►r� � E i r �`lv 2- W t5ins•11/10 Titles Official Inspection Form:.Subsurface Sewage Disposal System.•.Page 15 or 17 N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Shammas Way Property Address Bruce Bissett Owner Owner's Name information is required for every Marstons Mills MA 02648 March 13, 2012 page. Cityrrown 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: 12+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed, 7/20/87 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Approved design plan on file with the Board of Health shows bottom of system to be 4 feet above the bottom of a test pit in which no groundwater was observed. Before filing this Inspection Report,please see Report Completeness Checklist on next page. .t5ins•11110 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Shammas Way Property Address. Bruce Bissett Owner Owner's Name information is required for every Marstons Mills MA 02648 March 13, 2012 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness :Checklist Z 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 15ins-11110 Title 5 Official Inspection form:Subsurface.Sewage Disposal System•Page 17 of 17 . of� Town of Barnstable r# c c Departinent of Regulatory Services Public Health Division i a ewwen+ars. t _.� Date � � Z4 2 i ewes. �, ., i619 200 Main Street,Hyannis MA 02601 Date Scheduled Time" Fee Pd. AV61 Soil Suitabirity Assessment for Srewa e Disposal Performed By: \� Witnessed By: LOCATION& GENERAL INFORMATION Location Address �St/AMP7 9 S /�• Owner's Name 6- /Y) Address f/ S-1141`I'17 4 S /V Assessor's Map/Parcel: (/ — Engineer's Nam NEW CONSTRUCTION REPAE� Telephone# Land Use Slopes(96) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pcic tests,locate wetlands in proximity to hol • � I - C>DL . Z Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Fttce Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In, Depth to soil mottles: In. Depth to weeping from side of obs.hole: In, Groundwater Adjustment fr. Index Well# Reading Date: Index Well level : Adj,factor— Adj.Clroundwater LevalIL PERCOLATION TEST ]Hate Thne__.____ Observation zi�rI Hole# Time at 9" ri Depth of Perc � Time at G' �—� Start Pre-soak Time @ Time(9"-6") End Pre-soak �- I 10 � Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back--------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,'Boulders. �--! Consistency.%'Gravel) .. 4 �S 12- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon_ Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Grave DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravell f 't DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders. Consi ten Flood Insurance Rate Map: boundary o Above 500 year flood b d N Yes Y arY ---- Within 500 year boundary No !n Yes Within 100 year flood boundary No. Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious a rial exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervi us material?�. Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Envir mental Protection and that the above analysis was performed by me consistent with . the requir ing,expertise and p rience described in 310 CMR 15.017,. Signatur Date Z7 Zo�`Z QAS.EPT1MERCFORM.DOC Yam. TOWN OF BARNSTABLE LOCATION l S 1 SEWAGE # VMLAGE GAS lw!`S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Q-1 LEACHING FACILITY: (type) (size) NO.OF BEDROOMS . OR OWNER — PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leacWg facility) Feet Furnished by ��® � ;- i 1 O `�^ .�, �� � �. TOWN OF BARNSTABLE LOCATION 11��414 ,In Q S I /. SEWAGE#90/9 LLAGEI W ASSESSOR'S MAP&PARCEL46 INSTALLER'S NAME&PHONE NO��Qa____,Q�j +Igyp �rys� 6��V txb SEPTIC TANK CAPACITY/M;0 J 4110AV LEACHING FACILITY:(type) Iff axe— 9ft$4e$size) �94 )4 NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE':qh1zo1L 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 t'0 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes fppUtation for Bisposal *pstrm Construttiou Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.fl .4/1i/12 er's Name,Address,and Tel.No. Assessor's Map/Parcel 64/ 1��t� , ` e�llS s (✓� .%1,_rk Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required V gpd Design flow provided gpd Plan Dat4 /2_ Number of sheets / Revision Date Title Size of Septic Tank Type of S.A. I� /1,0c Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the constructi d mainte nce of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environm Code an not to place the system in operation until a Certificate of Compliance has been issued by this Bo d of He /Y e Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. -"� ok9 Date Issued No. y Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN.OF-BARNSTABLE, MASSACHUSETTS4-1 Yes ftplication for Misposal 6pstem Construction Permit ` Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components n t Location Address or Lot No.// A/ 1"4 S G er's Name,Address,and Tel.No. Assessor's Map/Parcel 6y S Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. oe Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other -:- Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required �V gpd Design flow provided gpd Plan Date Z7 /t_ Number of sheets f .Revision Date Title Size of Septic Tank Type of S.A. . FC Description of Soil N' Nature of Repairs or Alterations(Answer when applicable) ij tom, d Date last inspected: Agreement: The undersigned agrees to ensure the constYndnce of the afore described on-site sewage disposal system inaccordance with the provisions of Title 5 of the Envirnot to place the system in operation until a Certificate of Compliance has been issued by this Board of He ne //\/� 4,4 Date ' Application Approved by (i' Date Application Disapproved by r Date for the following reasons ..Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CE TIFY,that the On-siteoew ge Dis sal system C nstructed( ) Repaired( Upgraded( ) Aban/dooned( )by (l/i, at // has been constructed in acco daagpe with the provisions of Title 5 and the for Disposal System Construction Permit No. -q�dated "ONInstaller �/�sJt✓fi� � C-TG L e,_1i(.,,;0V Designer / .n. 0 1-44 �46S�dv #bedrooms Approved design flow gpd The issuance of this permit shall not be`construe as a guarantee that the system wiijllu'nc ie eI'-n-ed. Date �3/ Inspector No. Z� Fee aol) •/r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Vermit Permission is hereby granted to Construct( ) Repair(Loll U grade & Abandon( ) System located at p2esmS / 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. i Provided:Construction must be completed within three years of the date of this permit. Date T�� / �/Z Approved by / Town of Barnstable �IME.� Regulatory Services ti °s Thomas F. Geiler,Director MASSBLE' ' Public Health Division en639 a+" � Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Faxil: 5 8-790-6304 Date: L IZSewage Permi Z- Assessor's Map/Parcel Installer &Designer Certification Form Designer: �1��,p �4rt2�� Installer: Address: FAt1' `A' IG IA&t � Address: Cy r 1A0rP1�W--1A1� �> On g P q 1 1_ �L 60�' was issued a permit to install a ( te) (installer) septic system atA �� 7 based on a design drawn by (address) V"� dated ( esigner) 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. Stripout (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 u- '-fions. Plan revision or Aerlified as-bjaiKby designer to follow. Stripout (if rP cted and the soils v� e found atisf ctory. OF DAVID i\T B. �-'1 nstal is fiature) MASON �16 9 No.1066 0 0; IST P 1 A � e Signa re) PLEASE RETURN TO BARNSTABLE PUBL._ OF COMPLIANCE WILL NOT BE ISSUED UN i tL isu i n i rile r OFUM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice forms\designercertification form.doc ASS SSOR'S MAP 0. _ �Z�' ARCEL to ' `L0CATIO ' '/�' SEWAGE PERMIT NO. �VILLACE N I N S T A LLER'S NAME A ADDRESS Qk f _ U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED -75 r 'f I6e 3 600 Gftc. Ptt If &.S,Aal .5 cw P- r ASSESSORS MAP NO: No.... :7 PARCEL NO. - — !4 Fes$...: , .'-'... THE COMMONWEALTH- OF MASSACHUSETTS BOARD OF HEALTH ............ T-Lviv............0F........ �l-�z vsT.�tt3c ....------ Appliratinn for Uispoiial Morks Tonstrnrtiun Prrmit Application is hereby made for a Permit to Construct (tv) or Repair ( ) an Individual Sew a Disposal System at: SyA�r-.A.. �A�v� �1AlzsTa•vs �Jil.G.S .........................................../ Location-Address or Lot No. G�s'I�z .........•-•-•••-•••--•-----•••••-••••.............. .............C' G:. -------------------••-------•-------- fN ��rryy Owner Address Install Address U Type of Building Size Lot.__!"L—----Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building No. of persons.......................... Showers YP g ---•---•----------•-•------- P -- ( ) — Cafeteria ( ) Otherfixtures --------------------------------------------------•--------------•------------------------......-•----------------------....--•---•--------••---•--•- W Design Flow.............. �......_......._..._..gallons per person per day. Total daily flow............3--:K41......................gallons. WSeptic Tank—Liquid capacity..!dbO.gallons Length.8__6'.... Width.. Diameter................ Depth_As'.__'"_. xDisposal Trench—No. ..............:..... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------/----------- Diameter.......`...... Depth below inlet....3t-'T-- Total leaching area..3aZ.�..sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by....SH' .___...Th!........................................ Date........................................ Test Pit No. 1.... -_.minutes per inch Depth of Test Pit.... .. Depth to ground water----- --•-------_-- GL, Test Pit No. 2---- .Z.._minutes per inch Depth of Test Pit----- Depth to ground water...... .............. •-----------------------------------••--• ---•••••-•••----........-------••.....-•-•••••••••-•••---•-----•-••••--------•--------•._....---•••----••---_----- O Description of Soil......._____•..>",:.¢./,.... y1° Lo,�iy� _,�� c� . 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 A IK.1^`. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in op at until a CeFByy teedance has been sued by tthg board of health. 1. �vv Signed-- ------•.... --.............•••------•-..•.... Date Application Appro .......___ ___ - Date ` Application Disapproved for the following reasons---------------------•------•---------------------------•------•---------------------------..Da.-_...........-- ------------------------------•--------•---.......----------- ------------------ gq + Date --- --•--------.__ ISSiled........................................................ t Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH !n//V-...........OF........1;g1ZA_/,5TfJ.�«- ......._.. Appliratilan for Disposal Works Tonotrnrtinn Prrntit Application is hereby made for a Permit to Construct (v) or Repair ( ) an Individual Sewage Disposal System at: SAIA��As L.,vc 401--sTo-1.s �1G1,s Lo7-rj// ................__......_...................................................................... --.........------ ................................. Location-Address or Lot No. ...---•-------G'�w�7� !1: -------•------------------•---.....---- - .. Ow Address yner ................................ Instali�r a� Address UType of Building Size Lot.. . .....Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -----------------------------------------------------------•-•••••-•-••----•---------•------•..._......••----•----------•......•--•••---------------- W Design Flow.............. ......................gallons per person per day. Total daily flow............. ......................gallons. WSeptic Tank—Liquid capacity!O`_?..gallons Length 4"6....... Width. ....... Diameter________________ Depths_`_8".-. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No----_..L__. --_-_-- Diameter.._... '��..__. Depth below inlet-•_3:5�..... Total leaching area_-3 Z,- ...sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by...s"!^/__.__....T............ ................................ Date........................................ Test Pit No. 1---4__Z....minutes per inch Depth of Test Pit--- Depth to ground water----- (Zq Test Pit No. 2._.!�L z-___minutes per inch Depth of Test Pit.... "____ Depth to ground water.___.""............... a --------•-----------------------------------------------------------------------------------------•...................................... •.................. D Description of Soil-------------- •.� ................................................ x - U .........................•••... � :..__.S -•----••.......-•----------•-•-•-••-•••---••--------••.....----------------------------••......------------••. 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 A i!:_,E -of the State Sanitary Code—The undersigned further agrees not to place the system in op atio until a C cate pliance has been ' ued by t e board of health. �. Signed...... •--- ..U ......................................... Date Application Appro Bv-•-•••..... z __.S�... ... l t. .._ ....----•-..__..... ------ •••••••..... Date Application Disapproved for the following reasons_________________________________________________________________________________________________________________ ----------------•---•------•------•-------------....---------.....----------------.....--------.....------••...••--••-•.._..•------------------•---•-•-•-•••----••-----•--...•-•-•--------••-------•---- Date PermitNo... ------------------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................... WN.....OF......... A/STi91-�G4c........................_.... C9rdifirate of Trrntplittnrr TH-S IS TO CERTIFY, That the Individual Sewage Disposal System constructed (,< or Repaired ( ) by.. s / Installer at. �1 AA ,4-.................................................................. has been installed in accordance with the provisions of T i T iZ 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...4� ............ dated-............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE .AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE......... ............................................ ....--••.................•--•----•---•---- Inspector................... THE COMMONWEALTH OF MASSACHUSETTS �f 1 BOARD OF HEALTH NO.I�. .�_._ FEE... ........... Disposal Works Twnnstrudion Uprrutit Permissionis hereby granted............................................. ----•-•----....------•---------•------------------...........----...................••--....... to ConstrV (A- ) or Repair ( ) an Individyal Sewage Disposj� System ....•••. Street as shown on the application for Disposal Works Construction Per it NQ�7.f .....•. Dated-__�__"....._ _..1 ..�..._.. --� ................ . ..... ----- -� .................................... Board of Health .... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS + UDCATION �A2NST/�l3LE (t%�?T57`v�✓S M�us� SCALE . . .!:�: -40'. . . DATE PLAN REFERENCE � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ip,AR • Q a ' d... Per ---- - -- - -- ol - PRopasc--v sync ®h.c� 7.�N P �! A 2 A,b Box �o, Lo7'�B � ,e�5G1ZVE +i N TEST" A�3 titi OF o`er ED�AAID �yG� Cl 0 U 1No. 26100 �o 1� Es 9f61$TER��� ��oM4L LASS TOP OF FOUNDATION CONCRETE COVER °• CONCRETE COVERS •'; 4"CAST IRON 12� I AX.,° OR SCHEDULE 40 4"SCHEDULE 40 PVC.(ONLY)P.V.C. PIPE PIPE - MIN. LEACH �' PITCH 1/4'�PER.FT PITCH IjPER.F PITF/4 n , o �INV�FRT �. INVERT o o `ff�g'' ZL INVER w EL.. r. . ... SEPTIC TANK �sgDIST. . �,,INVEL... .. BOX EL:. •.' . ' : ,>__GAL. INVER7 2 INVERT w ° PROFI LE OF . GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE SOIL LOG WITNESSED BY : DATE .. . . . . . . . .... TIME. . . .. . . . . . . , �, BOARD OF HEALTH TEST HOLE I TEST HOLE 2 ,�HA! '���8i . . . ENGINEER ELEV. 47 L o- - - DESIGN DATA : Tad/[�.i T p Coat,, .8 ;/,� cagy �„ c'G.�y NUMBER OF BEDROOMS EL.�3.Ga TOTAL ESTIMATED FLOW . . 33� . . . GALLONS/DAY BOTTOM LEACHING AREA i.�3,�. . SO.FT. /PITIC-AP- SAT�p e SIDE LEACHING AREA . . �'�'j`�. . . . SQ.FT/ PITf38 �6Rt9a GARBAGE DISPOSAL AREA INCREASE) TOTAL LEACHING AREA SQ.FT . �Z, PERCOLATION RATE L�3S .T�//,ts< 77�/F MIN/INCH — — LEACHING AREA PER PERCOLATION RATE .�Plf:7 SQ.FT./C,,PP 6<? .WATER ENCOUNTERED NUMBER OF LEACHING PITS .oN6' �?iT L✓!Ti3! APPROVED . . . . . . . . . . . . . BOARD OF HEALTH ' ��� ' �� a�••STp�/�'; �' " SeD�3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DATE . . . . . . . . AGENT OR INSPECTOR r ,1H Of gTgS o`er.' o� ED �Ir s � D � 7j ti LLEY H 26100 �o PS7�R�� 9fGisTE�``�J 84NrtAYA0 PETITIONER D€ c=974 P 722 07-23-2DDa(r i e oa BARNSTABLE LAND .COURT REGISTRY REGULATORY AGREEMENT AND DECLARATION OF RESTRICTIVE COVENANTS THIS REGULATORY AGREEMENT and DECLARATION OF RESTRICTTVE COVENANTS,is made this f U n day of Q ,2004,by and between Bruce and Joanne Bissett of 11 Shammas Lane, MarstoMills,MA 02648,and its successors and assigns (hereinafter the "Owner"),and the TOWN OF BARNSTABLE (the"Municipality"),a political.subdivision of the Commonwealth; WHEREAS the Owner has been granted a Comprehensive Permit under Massachusetts General Law Chapter 40B and local regulations bythe Zoning Board of Appeals to permit the creation of an accessory apartment in an owner occupied dwelling which will be rented to a Low or Moderate Income Person/Family(hereinafter "Designated Affordable Unit";and NOW THEREFORE,in mutual consideration of the agreements and covenants contained herein,and other good and valuable consideration,the receipt and sufficiency of which is hereby acknowledged,the parties agree as follows: I. PROJECT SCOPE AND DESIGN: A The terms of this Agreement and Covenant regulate the property located at 11 Shammas Lane, Marston Mills,MA,as further described in Exhibit"A" hereto annexed. B. The Project located at 11 Shammas Lane,Marston Mills,MA will consist of one accessory apartment unit which will be rented to an eligible low or moderate income individual or family(the"Designated Affordable. Unit" or the"Unit"). C. The Owner agrees to construct the Project in accordance with the terms of the comprehensive permit, Appeal No.2004-55 and any plans submitted therewith and all applicable state,federal and municipal laws and regulation (A copy of the comprehensive permit is annexed hereto as Exhibit"B"). D. The Owner agrees to occupy the principal dwelling unit located on the property as their year round residence in accordance with the terms of the comprehensive permit. H. THE OWNER'S COVENANTS AND RESPONSIBILITIES: A THE OWNER HEREBY REPRESENTS,COVENANTS AND WARRANTS AS FOLLOWS: 1 In receiving the comprehensive permit to create the Designated Affordable unit,the Owner agreed that. the Designated Affordable Unit shall be set aside in perpetuityfor the public purpose of providing safe and decent housing to person of low income (herein defined as 80% or less of the median income of Barnstable- .. Yarmouth Metropolitan Statistical Area(MSA) and that the Designated Affordable Unit shall be deemed to be impressed with a public trust. . 2. The Designated Affordable Unit shall be rented in perpetuity to a household with a maximum income of 80% of Area Median Income or less of the Area Median Income(AMI) of Barnstable-Yarmouth Metropolitan Statistical Area(MSA) and that.rent(including utilities) shall not exceed the rents established bythe Department of Housing and Urban Development (HUD) for a household whose income is 80% of the median income of Barnstable-Yarmouth Metropolitan Statistical Area. In the event that utilities are separately metered, the utility allowance established bythe Barnstable Housing Authority shall be deducted from HUD's rent level. 3. The Designated Affordable Unit will be retained as permanent,year round rental dwelling units with at least one-year leases. 4. The Owner has the full legal right,power and authority to execute and deliver this Agreement. 5. The execution and performance of this Agreement by the Owner will not violate or,as applicable,has not violated any provision of law,rule or regulation,or any order of any court or other agency or governmental body,and will not violate or,as applicable,has not violated any provision of any indenture,agreement,mortgage, mortgage note,or other instrument to which the Owner is a parry or by which it or the Owner is bound,will not result in the creation or imposition of any prohibited encumbrance of any nature. 6. . The Owner,at the time of execution and delivery of this Agreement,has good,clear marketable title to the premises. 7. There is no action,suit or proceeding at law or in equity or by or before any governmental instrumentality or other agency now pending,or,to the knowledge of the Owner,threatened against or affecting it,or any of its properties or rights,which,if adversely determined,would materially impair its right to carry on business substantially as now conducted(and as now contemplated by this Agreement) or would materially ' adversely affect its financial condition. B. COMPLIANCE The Owner hereby agrees that any and all requirements of the laws of the Commonwealth of Massachusetts to be satisfied in order for the provisions of this Agreement to constitute restrictions and covenants running with the land shall be deemed to be satisfied in full and that any requirements of privileges of estate are also deemed to be satisfied in full. C. LIMITATION ON PROFITS 1. The Owner agrees to limit his/her profit by renting the Designated Affordable Unit in perpetuity to a household with a maximum income of 80% or less of the Area Median Income (AMI) of Barnstable-Yarmouth Metropolitan Statistical Area(MSA) and that rent(including utilities) shall not exceed the rents established by the Department of Housing and Urban Development(HUD) for a household whose income is 80%of the median income of Barnstable-Yarmouth Metropolitan Statistical Area. In the event that utilities are separately metered, the utility allowance established by the Barnstable Housing Authorityshall be deducted fromHUD's rent level 2. The Owner shall annually deliver to the Municipality and to the Monitoring Agent,as designated by the Town Manager,proof that the Designated Affordable Unit is rented,the tenant's income verification,a copy of the lease agreement and the rent charged for the unit or units. Such information shall also be forwarded to the Monitoring Agent within 30 days of the occupation of the dwelling unit or units by a new tenant. The Owner shall notify the Monitoring Agent,as designated by the Town Manager,within thirty(30) days of the date that a tenant has vacated the Designated Affordable Unit. IV. MUNICIPALITY COVENANTS AND RESPONSIBILITIES 1. The MUNICIPALITY,through the monitoring agent designated by the Town Manager agrees to perform the duties of verifying that the Designated Affordable Unit is being rented in perpetuity to a household with a maxim„rr,income of 80% or less of the Area Median Income (AW of Barnstable-Yarmouth Metropolitan Statistical Area(MSA) and that rent(including utilities) shall not exceed the rents established bythe Department of Housing and Urban Development(HUD) for a household whose income is 80%of the median income of Barnstable-Yarmouth Metropolitan Statistical Area.In the event that utilities are separately metered, the utility allowance established by the Barnstable Housing Authority shall be deducted from HUD's rent level. V. RECORDING OF AGREEMENT: Upon execution,the OWNER shall immediately cause this Agreement and any amendments hereto to be recorded with the Registry of Deeds for Barnstable County or,if the Project consists in whole or in part of 2 registered land,file this Agreement and any amendments hereto with the Registry District of the Barnstable Land Court(collectively hereinafter the"Registry of Deeds"),and the Owner shall pay all fees and charges incurred in connection therewith. Upon recording or filling,as applicable,the Owner shall immediately transmit to the Municipality evidence of such recording or filing including the date and instrument,book and page or registration number of the Agreement. VI GOVERNING OF AGREEMENT: This Agreement shall be governed bythe laws of the Commonwealth.of Massachusetts. Any amendments to this Agreement must be in writing and executed by all of the parties hereto.. The invalidity of any clause,part or provision of this Agreement shall not affect the validity of the remaining portions hereof. VHL NOTICE: Al notices to be given pursuant to this Agreement shall be in writing and shall be deemed given when delivered byhand or when.mailed by certified or registered mail,postage prepaid,return receipt requested,to the parties hereto at the addresses set forth below,or to such other place as a parry may from time to time designate by written notice. IM HOLD HARMLESS: The Owner hereby agrees to indemnify and hold harmless Municipality and/or its delegate from any and all actions or inactions bythe Owner,its agents,servants or employees which result in claims made against Municipality and/or its delegate,including but not limited to awards,judgments,out-of-pocket.expenses and attorneys fees necessitated by such actions. X. ENTIRE UNDERSTANDING: A This Agreement shall constitute the entire understanding between the parties and any amendments or changes hereto must be in writing,executed bythe parties,and appended to this document. B. This Agreement and all of the covenants,agreements and restrictions contained herein shall be deemed to be for the public purpose of providing safe affordable housing and shall be deemed to be,and by these presents are,granted by the Owner to run in perpetuity in favor of and be held bythe Municipality as any other permanent restriction held by a governmental body as that term is used in MGL Chi. 184,Section 26 which shall run with the land described in Exhibit"A"hereto annexed and shall be binding upon the Owner and all successors in title. This Agreement is made for the benefit of the Municipality and the Municipality shall be deemed to be the holder of the restriction created by this Agreement. The Municipality has determined that the acquiring of such a restriction is in the public interest. The Municipality shall not be subject to the defense of lack of privity of estate. The covenants and restrictions contained in this Agreement shall be deemed to affect the title to the property described in Exhibit M. TERM OF AGREEMENT: The term of this Agreement shall be perpetual,provided,however,that the Owner of a Designated Affordable Unit or Units may voluntarily cancel the granted Comprehensive Permit and the terms and restrictions imposed herein. Such cancellation shall onlytake effect after: 1) expiration of the lease terms entered into between the Owner and Tenant occupying said unit and 2) notification bythe Owner of said dwelling to the Zoning Board of Appeals of his/her desire to cancel the Comprehensive permit upon a date certain and the recording of said notice at the Barnstable County Registry of Deeds or Barnstable County Registry of the Land Court as the case maybe,thus rendering said Comprehensive Permit void. Upon the cancellation of the comprehensive permit,the property which is the subject matter of this restrictive covenant 3 I shall revert to the use permitted under zoning and the restrictive covenant shall be rendered void. X 1. SUCCESSORS AND ASSIGNS: A. The Parties to this Agreement intend,declare,and covenant.on behalf of themselves and anysuccessors and assigns their rights and duties as defined in this Regulatory Agreement and the attached comprehensive permit. B. The Owner intends,declares,and covenants on behalf of itself and its successors and assigns (i)that this Agreement and the:covenants,agreements and restrictions contained herein shall be and are covenants running with the land, encumbering the Project for the term of this Agreement,and are binding upon the Owner's successors in title, (u) are not merely personal covenants of the Owner,and(iii) shall bind the Owner,its successors and assigns and inure to the benefit of the Municipality and its successors and assigns for the tenn of the Agreement. XIII. DEFAULT: If any default,violation or breach by the Owner of this Agreement is not cured to the satisfaction of the Monitoring Agent within thirty(30) days after notice to the Owner thereof,then the Monitoring Agent may send notification to the Municipality that the Owner is in violation of the terms and conditions hereof. The Municipality may exercise any remedy available to it. The Owner will pay all costs and expenses.,including legal fees,incurred.bythe Monitoring.Agent in enforcing this Agreement and the Owner hereby agrees that the Municipality and the Monitoring Agent will have a lien on the Project to secure payment of such costs and expenses. The Monitoring Agent may perfect such alien on the Project by recording a certificate setting forth the amount of the costs and expense due and owing in the Registry of Deeds or the Registry of the District Land Court for Barnstable County. A purchaser of the Project or any portion thereof will be liable for the payment of any unpaid costs and expenses that were the subject of a perfected lien prior to the purchaser's acquisition of the Project or portion thereof. )UV. MORTGAGEE CONSENT: The Owner represents and warrants that it has obtained the consent of all existing mortgagees of the Project to the execution and recording of this Agreement and to the terms and conditions hereof and that all such mortgagees have executed consent to this Agreement. IN WITNESS WHEREOF,we hereunto set our hands and seals this (q day of ,20CL4- ONVNEA OWNER BY: Y. s tore signiv Printed: Bruce Bissett Printed: Toanne Bissett TOWN OyrBARNSTABLE Y BY: Signature Printed`.;:John C Klimm.Town Manager 4 COMMONWEALTH OF MASSACHUSETTS County of Barnstable,ss: (h4,Lq l.J ,2004 On this LR day of L%A� 20. before me,the undersigned notary public,personally appeared the Owner(s) ,proved to me through satisfactory evidence of identification,which were A4 f�- D(+2-�4-"Z2 ,to be the person(s) whose name(s)is signed on the preceding or attached document and acknowl ed to be that he/she signed it . voluntarily for the stated purposes. Paulette T eresa-McAuliffe v F Commonwealth of Massachusetts My Cnmmissinn Expires 7/04/2008 Notary PublicyutSF :. Printed: ��44� a'• # ' My Commission Expires: ' �f 2,.,'g ` '• fit' •'� COMMONWEALTH OF MASSACHUSETTS ` ©� -- Q �, ry County of Barnstable,ss: 2004 V On this. day of Q-LLLj _ 20otbefore me,the undersigned notary public,personally appeared the Owner(s) ,proved to me through satisfactory evidence of identification,which were M Ac' o4-Z- Sf-6W3o ,to be the person(s)whose name(s)'is signed on the preceding or attached document and acknowledged to be that he/she signed it voluntarily for the stated purposes. ____ Paulette Theresa-McAuliffe Commonwealth of Massachusetts Notary Public My Commission Expires 7/04/2008 Printed: My Commission Expires: o'f �;FFF COMMONWEALTH OF MASSACHUSETTS = F t.� % s, County of Barnstable, s � ^ ....... ' �. '• `ram ``� 2004.0. e,,��'�i,�,��Ot(M31�`�`t�`�`• litia►loo"0 , \ �1� On this Z-0' day of /(jkCt4 2001bef ore me,the undersigned notary public,personally appeared o r, &. 41-i m m Town Manager for the ToVM of Barnstable,proved to me through satisfactory evidence of identification,which were L ,to be the person whose name is signed on the preceding or attached document and acknowledied to be that he/she signed it voluntarily for thated purposes. ' a , Notary Public "• ,�`� " Printed: My Commissi ,rn SHIRLEE MAY OAKLE '• µ ' NOTARY PUBLIC COMLOINEAi.THOFWISSACHUSETTS, u. Rr '.D,?�. My Comm.Expires 3128I2004. �,' ;, .....••, i Book 946 Page 17 Doc. No. 469,080 j Ctf. No. 115577 J TRANSFER CERTIFICATE OF TITLE EXHIBIT From Transfer Certificate No. 109317 Originally Registered December 22, 1986, in Registration Book 893 Page 117 for the Registry District of Barnstable County. THIS IS TO CERTIFY that Bruce Bissett and Joanne Bissett, husband and wife, both of 222 Bloomingdale Road, Quaker Hill, Connecticut 06375, are s the owner(s) in fee simple y as tenants by the entirety A of that land situated in Barnstable in the Count of Barnstab le ble and Commonwealth of Massachusetts, bounded and described as follows: LOT 18 PLAN 38973-F Said land is subject to the agreement as set forth in Document No. 393,343. Said land is subject to the restrictions as set forth in Document No. 469,080. 7 a And it is further certified that said land is under the operation and provi- sions of Chapter 185 of the General Laws, and that the title of said Bruce Bissett and Joanne Bissett to said land is registered under said Chapter, subject, however, to any of the encum- brances mentioned in Section forty-six of said Chapter, which may be subsisting. i WITNESS, MARILYN M. SULLIVAN, Chief Justice of the Land Court, at Barnstable, in said County of Barnstable, j the thirtieth day of September in the year nineteen hundred M and eighty-eight, at 1 o'clock and. 17 minutes. 1 Attest, with the Seal of said Court, ri j JOHN F. MEADE, Assistant Recorder. 1 Land Court .Case No. 38973 I - A, "�f., a .•i...i• +, :'tom avna�. MEMORANDA OF ENCUMBRANCES ON Tnr- L.Anv uaa%ontow mom ■nw ......... ._--•_ - - DATE OF INSTRUMENT r SIGNATURE OF DISCHARGE DO.CUDIENT. KIND RUNNING IN FAVOR OF TERMS DATE AND TIME ASSISTANT RECORDER 'NUMBER OF REGISTRATION 569,634 PR 18 38973-F FS 436,830 05-30-1989 1 12-08-1992 12:41 569,634 PR 18 38973-F FS 436.831 05-30-1989 2 12-08-1992 12:41 569,634 PR 18 38973-F FS 436,832 05-30-1989 ; 3 12-08-1992 12:41 569,634 PR/M 18 38973-F 436,829 05-30-1989 �\JL 4 12-08-1992 12:41 626,726 M. 0RTGAGE FUNDING 18 38973-F 10-20-19 44 1 ORPORATION $24,000.00 10-24-1994 11:15 \�L `O 1► .�.x. 626,727 AS GE CAPITAL MORTGAGE 626,726 001 10-20-1994 ` 1 SERVICES INC 10-24-1994 11:15��� BARNSTABI E COUNTY REGISTRY F DEEDS A TTRUE CO Y,ATTEBT Jo EE 1 O '7 e S,A NAM C.. 9. ► > Town of Barnstable Zoning Board of Appeals Cn Comprehensive Permit Decision and Notice EX HI Appeal 2004-55- Bissett CD Applicants: Bnice and Joanne Bissett Property Address: 11 Shammas Lane,Marstons Mills,MA Assessor's Map/Parcel Map 064 Parcel 109 _�•.. Zoning: Residential F Zoning District C Groundwater Overlay: VP WeMLead Protection OverlayDistrict Applicant: The applicants are Bruce and Joanne Bissett,who reside at 11 Shammas Lane,Marston Mills;NM Relief Requested: The applicants have applied for a Comprehensive Permit under the General Law of the Commonwealth of Massachusetts,Chapter 40B-§20-23 and in accordance with the General Ordinance of the Town of Barnstable Chapter III,Article LXV,"Pre-existing and Unpermitted Dwelling Units and for New Dwelling Units in Existing Structures," more commonlytermed the "Accessory Affordable Housing Program" Theywant to create an accessory apartment unit to a single-family dwelling in accordance with all the conditions of this permit. The issuance of this Comprehensive Permit would allow for an owner-occupied single-family residence with an accessory affordable apartment within the single-family dwelling. Locus and Background: The propertyis a 1.05 acre lot that is developed with a 3-bedroom,2,bathroom,4,267 square feet,Ranch Style family dwelling with a pre-existing detached garage that sits approximately 100 feet to the left and in front of the single-family house. The applicants have owned the propertyfor sixteen years. The applicants heard about the Accessory Affordable Housing Program through local media and has decided to create an accessory affordable apartment. The proposed accessoryunit is to be created within the existing foot print,above the detached garage. It will be a one- bedroom unit at approximately 500 square feet. The locus is in a Residential F,in WP-Wellhead Protection Overlay District. The applicants attempted to get a Comprehensive Permit approval on the property,but were denied by the Hearing Officer at a hearing on August 20,2003. The Hearing Officer's decision to deny the appeal(which was ratified by the entire Zoning Board of Appeals) was for the following reasons: The Hearing Officer cited a letter addressed to the applicants from the Building Commissioner, Tom Perry dated June 2, 2003 including the following concerns: a. In spite of obtainiT building pernrdts, the applicaaw did not fallawplans a=njing to the appliranon prz n pting a "Stop Work Order"issuanx by the Gw mssioner onMarol 26,2003; b. The applicants did not f&gwprngramprom icres as per the 7hnshdd Criteria of the A nmesty Ondanarxr, Saxton 3:0: A sty Pgram paragraph 3.1: "Threshold Criteria:" "Real propeny mr=ining a dwelling unit or duelling units for vJx&them does not exist a urliddy issued wharnr,special penwi or bl4d,d�,g pern i4 doff not goal fy as a lazfi4 wawgornting use orstn4zaey for aT or all the units,and ubich curs in existence on a lot g1 nxnrd uidin the Town as of Jarmry 1, 2000;"or "RealParerry aka dzrelling uraZ or dudIvgwW that u as in existence as of j=rary 1, 2000 and ubuh has been dial by the BtdldingDepartment as bwg in ucLgm qf the zamzg or iv w=" A arndzT to the amrmswmr, "this st uaw vas not in existew as of that date sirxs no perrrauing vm issued Septwi-er 12, 2000. Amity daps haze pnrusions for an a ordabie hozeeter,a Conpniimize Pmrzi nwt be dtabL-d first; famed by a building pe=to allow the crnawaim" "Thrs zuas not done"u&)ini this application For these reasons the Building Commissioner initially found.that this was not a good case for the Amnesty program The Commissioner ordered that"the building be reverted back to what was originally permitted." The applicants have complied with that order,have rectified the concerns of the Building Commissioner,and are now readyto properlymove forward in obtaining a Comprehensive Permit in order to participate in the Accessory Affordable Housing Program. Procedural Summary: This application for a Comprehensive Permit was filed at the Town Clerk's Office and the Office of the Zoning Board of Appeals. A public hearing before the Zoning Board of Appeals Hearing Officer was duly advertised and notice was sent to all abutters in accordance with MGL Chapter 40A. The hearing was opened on June 9,2004,at which time'the Hearing Officer,Gail Nightingale,granted the Comprehensive Permit. Also present was Paulette Theresa McAuliffe,Accessory Affordable Housing Program Coordinator. Findings as to Standing and The Comprehensive Permit: At the June 9,2004 hearing,the Hearing Officer made the following findings of fact: 1. The applicants are Bruce and Joanne Bissett with an address of 11 Shammas Lane,Marston Mills, Mr.and Mrs.Bissett have owned the property since September 13, 1988 as documented and recorded at the Registry.of Deeds in Book 946,page 17. They are requesting a Comprehensive Permit to create an affordable rental apartment to be accessoryto the single-family owner-occupied residential dwelling. The applicants have submitted a copy of a certified deed recorded at the Barnstable Registry of Deeds documenting their ownership of the property. In addition,theyhave submitted a certified plot plan dated May 14,2003. 2. The applicants were issued a Project Eligibility(site approval) letter dated March30,2004 from Kevin Shea,Director,Office of Community&Economic Development, qualifying the application for the Accessory Affordable Housing Program. The source of the subsidyis the federal Community Development Block Grant(CDBG)program, 3. The proposed rental unit will be approxumtely 500 square feet,and will have one bedroom It will be located above the pre-existing detached garage which sits about 100 feet in front of the main house. 4. According to the Assessor's record,there is a total of 3 bedrooms on the property in the main house. The site is in the WP-Wellhead Protection Overlay District. The Public Health Division has verified that the proposed property meets the conditions of the State's Title V Environmental Code. Also,Public Health has approved an additional one-bedroom unit to be created at the property on-the condition that the applicants make a five foot cased opening(no doors) to eliminate the privacy of a"bedroom"in the main house in the room that they use for a home office. This approval is as per the."Housing Amnesty/Public Health"Form dated February 3,2003. 5. The town of Barnstable completed an inspection of the property on September 20,2002. It was noted that the unit was under construction. The applicants are aware that a final inspection by the Building Division will be required and that the Building Division also has to perform all necessary inspections to assure that the unit meets applicable minimum state and local code requirements before they are issued an Amnesty Certificate of Participation. 2 I i 6. On January28,20.04 the applicants signed an Accessory Affordable Housing (Amnesty) Program Affidavit agreeing.to complywith the program's requirements;including owner occupancy of the principal dwelling unit and further agreeing to comply with the provisions set forth in Article LXV (65) of the Town Ordinances that include their signing and recording of the Regulatory Agreement&Declaration of Restrictive Covenants. The subsidizing agency has determined that the signing and recording of the regulatory agreement qualifies the applicant as a"•limited dividend organization" as that term is used under IVLG.L.c.40B %20-23. 7. Under Chapter 3,Article LXV(65) of the Town Ordinances,the affordable unit must be rented at an affordable rent to a person or family whose income is 80% or less of the Area Median Income (AMI) of Barnstable-Yarmouth Metropolitan Statistical Area (MSA). 8. According to the Massachusetts Department of Housing and Community Development,as of September 4, 2003,5.11% of the town's year-round housing stock qualified as affordable housing units. The town has not reached the statutory.minimum under M.GJ-.c.40B §§20-23 or its.implementing regulations. Under the Town of Barnstable's Local Comprehensive Plan,the use of existing housing to create affordable units and the dispersal of these units throughout the town is encouraged. 9. Based upon the findings,the project is 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,the applicants,Bruce and Joanne Bissett,are granted.a Comprehensive Permit to permit the conversion of an accessory apartment of 500 square feet within a single-family owner-occupied residential dwelling, . subject to the following conditions: . 1. The property owners shall occupy the principal dwelling as their year-round residence. 2. Occupancy of the affordable unit shall not exceed two people. 3. This:unit shall not be occupied by a family member of the property owners. 4. To meet the requirements of affordability,the applicants must rent the unit to a person or familywhose income is 80% or less of the Area Median Income (AW of Barnstable-Yarmouth Metropolitan Statistical Area(VISA),adjusted by household size. The monthly rent payable by household inclusive of utilities shall not exceed 30% of the monthlyhousehold 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 bythe town of Barnstable shall be deducted from rent level so calculated 5. All leases shall have a minimum term of one year. 6. The property owners must obtain a building permit for the accessory affordable unit whether the unit is new or pre-existing. Before the issuance of an occupancy permit and Certificate of Compliance for the unit,the Building Commissioner must determine that the unit conforms with the approved plans as submitted to the file(as initialed by the ZBA Hearing Officer and submitted with the budding permit application) and meets state building,fire and sanitary codes. The unit must also complywith applicable state on-site wastewater discharge requirements. 6a. Because the propertyis in the Wellhead Protection OverlayDistriet and is in a neighborhood restricted to no more than three (3) bedrooms,the unit shall be open for inspections bythe Department of Public Health to insure that no more than three bedrooms exist on the entire property. 3 7. The applicants may select their own tenant(s)provided the tenant(s) meet all requirements of the program and provided that person(s) income is reviewed and approved by the Office of Community&Economic Development of the town of Barnstable as a qualified individual. The applicants will be required to work with the town to provide information necessary to document that the tenant(s) qualify. To insure that the unit pis rented in an open and fair basis to an income eligible individual or family,the unit must be listed with the town whenever a vacancy occurs. Also,the applicants must notifythe Office of Community& Economic Development of a vacancy whenever it occurs. twelve months the applicants sh all review the income eligibility of those individuals occupying the unit. $. Everytwe PP is shall file with the eve Permit the applicants ce of this Comprehensive PP , No later than a year from the date of issuance mP an��affidavit listing the rent Office of Community&Economic Development of the town of Barnstable charged and income level of the occupants) of the unit. The applicants shall provide the town any additional information it deems necessaryto 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. 9. The Accessory Affordable Unit shall be affordable in perpetuity(as affordable is defined herein),unless this Comprehensive Permit is rendered void. 10. This Comprehensive Permit shall not be transferable to any other person or entitywithout the prior approval Appeals.of the Hearing Officer or Zoning B o d oarf This decision,the Regulatory Agreement and Declaration of Restrictive Covenants and all other necessary documents shall be filed at the Barnstable CountyRegistry of Deeds. If the ownership of the property is transferred,the town of.Barnstable shall be notified within 60 days the name and address of the new owner. 11. Allparking for the dwelling and accessoryunit shall be accommodated on site,and no lodging shall be permitted on site for the duration of this Comprehensive Pe rmit. 12, 'Phis Comprehensive Permit must be exercised and the unit occupied within 12 months of its issuance or it shall expire. Transmission of the Decision of the Hearing Officer to the Barnstable Zoninoar of Appeals, ministrative Code,the In accordance with Part II,Section 4.02 and Part III,Section 3.72 of the Town of Barnstable Board of Appeals on June 9,2004 a hearing officer transmitted her written decision to the Zoning nd fourteen days having elapsed since said transmittal with the Zoning Board Appeals taking no action to reverse the decision,this d o decision becomes the decision for this Comprehensive Permit application. Ordered: Comprehensive Permit 2004-55 has been granted with conditions. Appeals of this 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 Chater 40B,Section 22. tGadight'mgale, acing cer �.��• a�e Signed ` Nf `'ten Maisachusetts,herebycertifythat Clerk of the Town ofBb4B � tS'�che er, decision and that no appeal of the twenty(20) days have elapsed since the Zonirigr�� eals�'Fi�e . decision has been filed in the ice o e Tovri� ! Signed and sealed this�_ y * er.th* P and pen ties of per)url' -%gi Clerk j�� ;_ BARNSTABLE COUNTY REGISTRY OF DEEDS 4 1 ���dta +�'�� A TRUE COPY,ATTEST EARNSTABLE REGISTRY OF OEFDi JOHN F.MEADE,REGISTER RESTRICTIVE COVENANT BRUCE BISSETT and JOANNE BISSETT, both of 11 Shammus Lane, Barnstable (Marstons Mills) , Barnstable County, Massachusetts (the "Bissetts") are the owners of LOT 18 as shown on Land Court Plan No. 38973F, which said LOT 18 is improved with a single family residence and garage and has an address of 11 Shammus Lane, Barnstable (Marstons Mills) , Massachusetts (the "Property") ; The Bissetts have agreed with the TOWN OF BARNSTABLE BOARD OF HEALTH to the recording of a restriction as to the number of bedrooms which can be included and used on the Property as a precondition to obtaining a Comprehensive Permit under the provisions of M.G.L. Chapter 40B and of the General Ordinance of the Town of Barnstable Chapter III, Article LXV, more commonly known as the Accessory Affordable Housing Program, to permit the installation and use of a residential apartment (the "Apartment") on the second floor of the said garage now on the Property. The BISSETTS hereby declare that the Property shown as LOT 18 on Land Court Plan No. 38973F and described in Certificate of Title No. 115577 is hereby subject to the following restriction which shall run with the land and be binding upon all successors in title: No more than three bedrooms may be constructed and used at any one time on said LOT 18 . For example, in the event that a one bedroom apartment is located in the detached garage now on the premises, the single family residence thereon shall be limited to two bedrooms and in the event that the said apartment is abandoned or never used, the single family residence thereon may include three bedrooms . The above restriction shall be enforceable and modifiable only by the Town of Barnstable Board of Health. For our title see Certificate of Title No. 115577 . Executed as a sealed instrument this C:215 day of 1C/ 2004 . BRUCE BISSETT �S JOANRE BISSETT s THE COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. - a�5 2004 Then personally appeared the above named Bruce Bissett and Joanne Bissett and acknowledged the foregoing instrument to be their free act and deed before me, o ary Public My Comm. Exp: JOYCE E. MARGRAF Notary Public Commonwealth of Massachusetts My Commission Expires July 16,2004 2 � 3 � o Z ZT 451-738 � t QdA 1]CGl� a5� L5 'j 1 — _ /¢7 63 ��9 CG Ldlw CERTIFIED PLOT PLAN LOCATION SCALE . .. ..... .... DATE PLAN REFERENCE S//d w' to/ 0 AlJAELi-Ey No. �6iQG �aa GISiE1� I CERTIFY THAT THE . /�'o�/Y&x!T �L Q SHOWN ON THIS PLAN IS LOCATED ON THE GROUNDt AS SHOWN HEREON, WHEN CONSTRUCTED. DATE H / ZU? � G /✓' '�'a REGISTERED LAND SURVEYO� ;ter Amnesty Program /�- Helping to Make Affordable Housing Possible i arnsta e i ,.Certificate of Cornliancep ¢_ a r-- = This certificate indicates acceptable minimum habitable requirements per Massachusetts State Building Code and Town of Barnstable zoning ordinances in accordance with the Amnesty Program. A " ma's a r: � u 4 ; . _ Location -l�"l,_Shammas'Lane, Marstons Mills, MA �--" Unit Capacity One Bedroom, not to exceed two people ( Inspector m� r. M No 11/23/2004 INE Town of Barnstable snxxsrnat.E, , r� MASS. $ Office of Community&Economic Development iOlE039.�p 230 South Street,Hyannis,Massachusetts 02601 (508)862-4683 or(508)862-4695 Fax(508)862-4725 ACCESSORYAFFORDABLE HOUSING(AMNESTY)PROGRAM Dear Applicant,this checklist is designed to help you streamline your Comprehensive Permit process. The Program Coordinator will also assist you in achieving all necessary steps to acquire the Chapter 40B accessory affordable housing unit beginning with your initial inquiry all the way through completing the final program procedures. The following elements are essential in order to meet the requirements of the Amnesty Program AMNESTY COMPREHENSIVE PERMIT CHECKLIST 1. Public Health Department— Attachments: a. Entire Property lay-out b. Amnesty Questionnaire (Provide Public Health/Amnesty Form showing your septic system complies with the total number of bedrooms requested for program participation at your property) b) Single-Family— include parLt house &unit c) Multi-Units — include permitted 8L unpermitted units 2. Site Approval Application— Processing Fee = $175.00 Attachments: Recorded Quitclaim Deed b. Certified-Property Plot Plan c. Unit Lay,Out 3. Comprehensive Permit Application - Application Fee = $100.00 Attachments: Same as attachments above WHAT THE AMNESTY STAFF PROVIDES 1. We provide Briefings &Support through every stage of the five-month process of acquiring your Comprehensive Permit in the Accessory Affordable Housing Program. 2. We provide free site visit(s) with a licensed Housing Inspector to look at your property and give you a heads up on any needed upgrades before you commit to the program. 3. We provide free research in Town records to help build your case. 4. We assisf you by assembling the application packet for your ZBA hearing. 5. We prepare and present Comprehensive Permit documents for your hearing. 6. We prepare and record your deed restriction for you at Barnstable Registry of Deeds. Should you have any questions,do not hesitate to call the Program Coordinator at (508) 862-4683. CHCKLST.DOC 7 Mcauliffe, Paulette From: r-McKea_n,Thomas_ .. . Sent: Friday, January 23;2004 2:38 PM To: Mcauliffe, Paulette Subject: RE: 11 Shammas (Hi Paulette-1 t a signed.a completed.form approving three bedrooms.--At this point,_ am.awaiting a copy of a three bedroom.deed� rrestriction for this property. ,t _ -----Original Message----- From: Mcauliffe, Paulette Sent: Wednesday, January 21, 2004 4:01 PM To: McKean,Thomas Subject: 11 Shammas Dear Tom, According to Tom Perry, property owner, Bruce Bissett of 11 Shammas Lane in Marstons Mills has satisfied whatever housing criteria needed to re-apply for Amnesty. As you know, your approval is also needed for a total of three(3) bedrooms at the property. In addition, we need you to verify that he's satisfied all health requirements necessary to move forward. Please send the attached form with your signature through inter-office mail at your earliest convenience. Also,feel free to add any additional memo you would like noted for the file. Thanks much. PT << File: PUBHLTH.DOC >> 0 0 1 r r 114 Town of Barnstable Health Inspector F THE tp� Office Hours o Regulatory Services 8:00—9:30 �. Thomas F.Geiler,Director 1:00—2:00 snxxsrns Only MASS.i639. Public Health Division �0 ArEo ,�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: Shckmm+, Lome, Map 0(o4 Parcel 1 Uq Name: &ace- i 16gnf) R% SS't4 Phone: S4 E " 4-) G - J 2. How many bedrooms exist on your property now? J 2a. Please include a copy of your floor plans for the entire property. 3. Is the dwelling connected to public sewer? YES or ONO If the dwelling is connected to public sewer, skip questions 4-9 below. 4. Location of dwelling is ONSIDE or OUTSIDE a Zone of Contribution to public supply wells? S. Is the dwelling connected to an ONSITE WELL or to PU=WATER? 6. Is a disposal works construction permit on file?(,YE or NO 6a.If ye-s, how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES or QDNO 8. Is there an engineered septic system plan on file at the Health Division? , YE/ or NO 9. Has the septic syste .,been inspected by a DEP certified inspector within the last two years? YES or-------------------------------------------------------------------------------------------------------------------- INO� FOR OFFICE USE ONLY TO BE SIGNED BY A HEALTH INSPECTOR/AGENT ONLY The Public Health Division has no objection to bedrooms at this property. Signed: Date: Inspector(Print): i Q:PT/AMNESTY/PUBLCHLTH.doc i P. 26,/2000 0,6:48 508362046 S!UE:YOUNG FA GE E1 � U �' `�J � wN 0 EWA wow i • �I li 1 l N7-4 N-0 x r N !=a� 4`.ONx T-0" 4'-Off x Y-O" 4,.ON x Tl ON F �ILJ I . � g - � ILA 46 t 4-1 o s W26/2000 06:48 508:3620463 GrJE:YOUNG PAGE 01 o-� a 24 I } f _ ,•� _ I ...........Jj 2,-, 2,-;,,% T r I � 1 • r M • M t `. 21 � I .. .... ...... . 9 Mgr!_._ -. :.r I i 1 } I R I ..5._ ...k... 4'-Oux 31-00 41-0"x 3'-(s" 41-0"x 3.O' s - - - - - - - If NJ n/ Q l � oD q 3 c r P LA-ON AC 00, e SC�.'�h/1'JnC ut 4G+ �L7O?b�rINGS J'JL. fUL4lU rfiVC vfj AA fvl a � ee t � I I 4`.O"x 3'-0" 4'-0"x X-O" 4.0"x 3'-0" s woo AL op _. . i c ... n� ® 0 SL SUE:YGUNG r PAGE 0-1 . Irk °U"V w d-6w Oman ®. � • 00 .. lt - to bd ON. GAR DR b'-F7'x'T'-m" ON. GAR DR Ix4 •TRrm i .ONT ... "/r4rION CONC. STOOP 2 xe RAFTERS • I(o" O,G. h • •�'�Ixb F A8C I A E3D, I A!\11 �- Zxi, CEILIW-3 J015TS • Irv!' O�; ?xb R4FTE:RB • Wo" b,G.- 00 \. ® J018T8 • 12" O.G. oil ■ 4" CONIC. SLAS CROSS S�CT I O, N � — A t • j r r l � ' S r\f 142167' r �� �-- DN Upj::Ieg LEVEL LET now TO SWITCH BELOW N • 3'-1" 1 1 .. I- -- -- - D-H - _ _ ry ' 7 K/ Ufi= FER LEVEE.. ;=L.00}� �'L�4� 8CALE '44"a I'-m", • FIN. CAD. t 41-011x4'-011 'a' CONC. STOOP ASSESSORS MAP : NOTES: _.___ TEST HOLE L 0 G S PARCEL : FLOOD ZONE: �C�T ,� L,/� SOIL EVALUATOR : A)Jr2 -b, M1�� ,167 1) The installation shall comply with Title V and Town of3>R4 G�,�3oard of _._ - - -- _ W I TNESS �, � -2��J, �-2 Health Regulations. REFERENCE: C�- 7�cj�� DATE: IID-°' rL �— 2) The installer shall verify the location of utilities, sewer inverts and septic _ --M-----�- c� PERCOLATION RATE: .Z hti�, I components prior to installation and setting base elevations. /05/10 7 // 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first two feet out of the d-box to the leaching shall be level. Cam' TH- I TH-2 4) This plan is not to be utilized for property line determination nor any other `1 k� 1 �1�� purpose other than the proposed system installation. 5) All septic components must meet Title V specifications. I'Db 6) Parking shall not be constructed over H10 septic components. !� �! 1 7) The property is bounded by property corners and property lines. LOCATION MAP `2 1 -!�J 8) The property owner shall review design considerations to approve of total Ln 07�b ?.I /� )�Z,� design flow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed Z � � VD approval of the design flow by the owner. CI 9) The existing leaching or cesspools shall be pumped and filled with material 1 / l,b 14 per Title V abandonment procedures. Those within the proposed SAS shall r ��� �� + 1�y�1� be removed along with contaminated soil and replaced with clean sand per V � 110 Title V specs. n &12N , kXr(;,(� 10)System components to be 10 feet from waterline. Sewer lines crossing the water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if applicable. The proposed SAS is being installed below the water service SEPTIC SYSTEM ' DESIGN ( line. The line is to be sleeved as aforementioned and maintained in place. f 11) If a garbage grinder exists it is to be removed and is the responsibility of the owner to ensure such. FLOW ESTIMATE ! 12 The installer is to take caution in excavation around the as line if such t )exists. g 3 BEDROOMS AT //0 GAL/DAY/BEDROOM -✓ GAL/DAY � � 1 13)The installer shalL verify the location, quantity and elevation of the sewer / xZ o' i - ICJ / /� � _ � jpi?.,�j � ✓�m5 _�__. ____ ; lines exiting the dwellingirior to the installation. — "' SEPTIC TANK 14)This plan is representative only that a system can fit on a property meeting Title V requirements. GAL/DAY x 2 DAYS - �6DGAL IN, USE / UGALLON SEPTIC TANK /EX/:::�;V�.! I 1 SOIL .ABSORPT ON SYSTEM It DWID CF L, Lo)��-V!-p U.ViT x 5" —E- X 1, /!� — ,C r�o.tosr A \ zoo - SEPTIC SYSTEM ' SECTION oCc � ► Li �� , _ - -- _ i000 GAL l021�1 ��. Z� .� - 03 ill SEPTIC TA K Piz SITE AND SEWAGE PLAN PREPARED FOR : C► 9,C) .J q1,, COT, Ml , , SCALE: DAV I D B . MASON R�7 DATE: bl . DBC ENV I RONMEN�AL DES I G14S W EAST SANDWICH . MA W DATE HEALTH AGENT ( 508 ) 833 2 1 77 ZI Tog 0 ter. k1 L l f